NRSG374 Written Critique Example Assessment Paper
NRSG374 – Written Critique Example Assignment
NRSG374 – Principles of Nursing: A Palliative Approach Course
Australian Catholic University
NRSG374 – Written Critique Example Assessment Brief
Assignment Instructions Overview
This assessment requires students to complete a written critique based on a provided case study involving a patient receiving end-of-life care. The aim is to evaluate the care delivered in the case study against one chosen Clinical Practice Guideline (CPG). The critique must integrate relevant National Palliative Care Standards (NPCS) and at least one of either the NSQHS Standards or the NMBA Registered Nurse Standards for Practice.
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Students must identify both strengths and limitations in the care provided, supported by scholarly evidence, and demonstrate an understanding of palliative care principles. The word count is 1,800 words, with a 10% leeway. In-text citations count towards the word count; the reference list does not.
Understanding Assignment Objectives
This task develops critical thinking, professional judgment, and evidence-based writing skills. It is designed to foster a deeper understanding of how Clinical Practice Guidelines shape end-of-life care and to strengthen students’ ability to assess clinical practice through the lens of national standards.
The assignment focuses on evaluating how care decisions align with best practice recommendations, ethical principles, and legal obligations in nursing. It also encourages reflection on palliative care delivery and its relevance to holistic, person-centered nursing.
The Student’s Role
As a nursing student, you will act as a critical evaluator and informed practitioner. Your role is to:
- Review the provided case study with a professional and analytical lens.
- Choose one CPG (such as the “Care of the Dying” CPG).
- Apply your understanding of palliative care, clinical reasoning, and national standards to critique the care received by the patient.
- Support your critique with contemporary, evidence-based literature.
- Demonstrate awareness of how professional standards and guidelines guide and improve nursing practice.
You are not required to offer a personal opinion but must adopt a scholarly, third-person voice and maintain objectivity throughout your critique.
Competencies Measured
This assessment evaluates several core nursing competencies, including:
- Clinical Reasoning and Decision-Making: Ability to evaluate clinical actions in alignment with evidence-based guidelines and nursing standards.
- Professional Accountability: Understanding the nurse’s responsibility in upholding care standards, advocating for patients, and adhering to ethical practice.
- Evidence-Based Practice: Skill in identifying, integrating, and referencing contemporary research to support clinical evaluation.
- Communication and Academic Writing: Capacity to present ideas in a well-organized, coherent, and scholarly format, adhering to academic integrity principles.
- Knowledge of National Frameworks: Application of the National Palliative Care Standards, and either the NSQHS Standards or the NMBA Registered Nurse Standards for Practice in evaluating nursing care quality.
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NRSG374 Written Critique Example Assessment Paper
Introduction
End-of-life care is a fundamental component of palliative nursing, where the primary aim is to ensure dignity, comfort, and holistic support for patients and their families during the final stages of life. The provided case study of Tylor Morton, a 40-year-old man with Motor Neurone Disease (MND), presents a complex situation involving ethical dilemmas, family conflict, and clinical decision-making. This paper critiques Tylor’s end-of-life care using the “Care of the Dying” Clinical Practice Guideline (CPG). The analysis is grounded in the National Palliative Care Standards (NPCS) and the Registered Nurse Standards for Practice outlined by the Nursing and Midwifery Board of Australia (NMBA). The critique identifies both strengths and limitations in Tylor’s care, guided by current evidence and standards.
Understanding Motor Neurone Disease (MND) and Its Trajectory
MND is a progressive, terminal neurological condition characterized by the degeneration of motor neurons, leading to muscle weakness, respiratory failure, dysphagia, and loss of independence (Goutman et al., 2022). The illness trajectory is marked by a gradual but relentless decline in function. In Tylor’s case, the disease had advanced significantly, with symptoms such as dyspnea, dysphagia, and progressive immobility. This progression necessitated comprehensive palliative care planning to address his physical, emotional, social, and spiritual needs.
According to Brizzi et al. (2019), timely integration of palliative care in MND improves patient and caregiver outcomes. In Tylor’s scenario, the delayed recognition of his needs, family tension, and conflicting care decisions indicate a gap in proactive palliative care implementation. The importance of early palliative care referrals in MND cannot be overstated, as these interventions enable patients and families to prepare, plan, and access appropriate support.
Application and Critique of the Care of the Dying CPG
The “Care of the Dying” CPG provides a structured approach to managing the final days of a patient’s life. It emphasizes symptom control, psychosocial support, communication, and dignity. In Tylor’s case, application of this CPG appears inconsistent and fragmented.
Symptom Management
Tylor experienced significant discomfort, including breathlessness, anxiety, and gastrointestinal infections. The CPG recommends thorough and continuous assessment using validated tools like the Symptom Assessment Scale (SAS) and the Australia-modified Karnofsky Performance Scale (Barbetta et al., 2019). Although assessments were documented, actions based on findings were insufficient. Tylor’s reported distress and discomfort did not result in adequate symptom control or timely intervention, which undermines the principle of comfort-focused care in the final days.
Psychosocial and Family Support
End-of-life care must include support for family members and address unresolved conflicts. The CPG outlines that family meetings, open communication, and grief support are essential (Palliative Care Australia, 2018). However, the tension between Tylor’s wife Catherine and his extended family was not adequately addressed. The failure to facilitate dialogue among family members contributed to emotional strain and ultimately compromised Tylor’s dying experience.
Decision-Making and Advance Care Planning
The absence of clear, documented advance care directives and limited involvement of Tylor in decision-making are critical flaws. The CPG stresses the importance of honoring patient preferences and advance directives. Catherine’s hesitation and the lack of inclusion of Tylor’s mother and brother in care planning reveal a fragmented approach. The registered nurse’s role should have included advocating for Tylor’s values and promoting collaborative care planning as outlined in NMBA Standard 2 (NMBA, 2016).
Place of Death and Environment
According to the CPG, patients should have the opportunity to die in their preferred setting, surrounded by loved ones. Tylor’s case reveals ambiguity about his preferred place of death. The conflict about whether to remain at home or be transferred to hospital with a PICC line for intravenous therapy reflects poor planning. The decision to keep him at home was appropriate but lacked clear communication and support from health professionals, as per NPCS Standard 4 (Palliative Care Australia, 2018).
Integration of the National Palliative Care Standards
The National Palliative Care Standards guide consistent and quality palliative care delivery. In Tylor’s care, several standards were only partially met.
Standard 2: Developing the Care Plan
Care planning for Tylor was reactive rather than anticipatory. The care plan did not adequately address his deteriorating condition, psychosocial needs, or family dynamics. NPCS Standard 2 emphasizes holistic, personalized care planning in collaboration with the patient and family. The lack of structured family conferences or care coordination meetings shows a missed opportunity to align care with best practice.
Standard 3: Care for the Carers
Tylor’s primary carer, Catherine, experienced considerable stress and uncertainty. The standard mandates support for caregivers to enhance their capacity and well-being. There was limited evidence of formal support mechanisms, education, or respite services offered to Catherine. Failure to support carers not only affects their well-being but also impacts patient outcomes.
Standard 6: Grief Support
Grief support for family members is a core component of quality palliative care. Tylor’s mother and brother were not adequately prepared for his death. The exclusion of extended family members and lack of bereavement preparation conflict with Standard 6. Post-death support, including emotional, cultural, and spiritual care, should have been anticipated and provided.
Alignment with NMBA Registered Nurse Standards for Practice
The NMBA Registered Nurse Standards for Practice outline competencies required for delivering safe and ethical care. Several standards were not adequately upheld in this case.
Standard 1: Thinks Critically and Analyses Nursing Practice
Registered nurses must apply evidence-informed reasoning in care decisions. The clinical team failed to critically appraise and implement the CPG recommendations effectively. This includes failure to anticipate the trajectory of Tylor’s condition and the need for stronger family engagement.
Standard 2: Engages in Therapeutic and Professional Relationships
Effective communication and therapeutic relationships with patients and families are essential. In this case, the absence of inclusive communication with Tylor’s family, especially his mother and brother, undermined trust and compromised person-centered care.
Standard 6: Provides Safe, Appropriate, and Responsive Quality Nursing Practice
This standard highlights the importance of safe and timely responses to changes in a patient’s condition. Tylor’s rapid decline required more responsive and coordinated care. The failure to manage his respiratory symptoms and gastrointestinal infections effectively represents a breach of this standard.
Addressing the Gaps and Improving Care
To improve outcomes in similar scenarios, the following actions are recommended:
Strengthen Interdisciplinary Communication: Regular team meetings, family conferences, and documented advance care planning should be standard practice.
Enhance Carer Support: Carers should receive education, respite, and psychological support to manage the demands of caregiving.
Promote Cultural and Family Inclusion: Cultural values and family dynamics must be acknowledged. Involving all stakeholders in care planning fosters harmony and better outcomes.
Focus on Symptom Management: Use of validated tools and timely interventions can alleviate suffering and enhance comfort.
Training and Education: Nurses and healthcare workers require regular training in palliative care principles, communication, and ethical decision-making.
Conclusion
Tylor Morton’s case highlights the critical importance of structured, compassionate, and inclusive end-of-life care. While elements of the “Care of the Dying” CPG were followed, significant gaps were evident in symptom management, family involvement, carer support, and adherence to professional standards. Integrating the National Palliative Care Standards and NMBA Standards for Practice ensures a holistic, ethical, and patient-centered approach. Registered nurses must advocate for comprehensive care that honors patient wishes, supports families, and upholds professional accountability. Moving forward, palliative care in MND cases must be anticipatory, inclusive, and coordinated to ensure a dignified and peaceful dying process.
References
Barbetta, C., et al. (2019). Australia-modified Karnofsky Performance Scale and physical activity in COPD and lung cancer: an exploratory pooled data analysis. BMJ Supportive & Palliative Care. https://spcare.bmj.com/content/early/2019/07/11/bmjspcare-2019-001869.abstract
Brizzi, K., et al. (2019). Integration of a palliative care specialist in an amyotrophic lateral sclerosis clinic: observations from one center. Muscle & Nerve, 60(2), 137–140. https://onlinelibrary.wiley.com/doi/abs/10.1002/mus.26607
Goutman, S. A., et al. (2022). Recent advances in the diagnosis and prognosis of amyotrophic lateral sclerosis. The Lancet Neurology. https://www.sciencedirect.com/science/article/pii/S1474442221004658
Nursing Midwifery Board of Australia. (2016). Registered Nurse Standards For Practice. https://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Professional-standards.aspx
Palliative Care Australia. (2018). National Palliative Care Standards (5th Ed.). https://palliativecare.org.au/standards
Riley, K., & Hupcey, J. (2022). Person-Centered Care Considerations for End-of-Life Care to Persons With Severe and Persistent Mental Illness. Journal of Gerontological Nursing, 48(3), 11–16. https://journals.healio.com/doi/abs/10.3928/00989134-20220210-04
Detailed Assessment Instructions for the NRSG374 Written Critique Example Assessment Paper
Assignment Detail:
Students are to provide an 1800 word critique of the provided case study using only ONE CPG.
To complete this task you will need to discuss and critique relevant elements of the CPG and case study whilst upholding the National Palliative Care Standards at least one of:
– NSQHS
– NMBA standards and/or
Assessment criteria: The assessment will be marked using the criteria-based rubric.Please note that in-text citations are included in the word count whilst the reference list is not included in the word count. Words that are more than 10% over the word count will not be considered
Now that you have read the case study and selected ONE of the CPG provided you are required to:
– Review and critique the care given to the patient against the CPG you have selected and provide evidence to support your critique through additional research that you will undertake
– Highlight the importance of the National Palliative Care Standards and at least one of the NSQHSS and/or the NMBA Standards and how they influence our practice
– Demonstrate knowledge on the illness trajectory of Motor Neurone Disease (MND) in line with Palliative Care Principles
– Provide links between the case study and your chosen CPG to identify highlights or limitations in care
– Ensure that your sources are all contemporary (within the last five years) and from evidence based sources)
– Read all instructions and the rubric very carefully
Case study – Care of the dying patient CPG
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