92443 Optimising Care in Chronic Conditions
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Credit points: 6 cp
Subject level:
Undergraduate
Result type: Grade and marksRequisite(s): (((92437 Nursing Care of the Older Person OR 92315 Nursing Care of the Older Person OR 92464 Nursing Care of the Older Person OR 93209 Nursing Care of the Older Person) AND (90 credit points of completed study in spk(s): C10122 Bachelor of Nursing OR 90 credit points of completed study in spk(s): C10123 Bachelor of Nursing Bachelor of International Studies OR 90 credit points of completed study in spk(s): C10351 Bachelor of Nursing Bachelor of Creative Intelligence and Innovation)) OR 90 credit points of completed study in spk(s): STM90553 144cp Enrolled Nurse BN )
Description
This subject contributes to students' understanding of and practice within chronic and complex nursing care. Considering the patient's illness experience, students are encouraged to incorporate the range of therapeutic interventions, the impact of clinical guidelines and policies, varied models of care across acute and primary health care settings, and professional teammate contribution to the delivery of chronic and complex care. This analysis extends across the trajectory of care and the various contexts of care delivery. Case scenarios congruent with clinical placement experiences and coronial evidence are utilised. With a clear focus on care delivery, communication, person-centred care, working in partnership and demonstrating Indigenous cultural respect, this subject challenges students to think innovatively to enable optimal health outcomes for people facing the challenges of chronic and complex illness.
Subject learning objectives (SLOs)
| A. | Critically reflect upon different models of care for people with chronic and complex healthcare needs across varied acute and primary healthcare settings (RN Standards for Practice 1.1, 3.1, 3.2, 4.1, 4.4 & 5.1). |
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| B. | Simulate effective conversations with people who have chronic illness in the contexts of goal setting, supported self-management and advance care planning (RN Standards for Practice 2.1, 2.2, 2.3, 2.4, 4.3, 5.2, 5.3 & 6.2). |
| C. | Prioritise the palliative approach to care for people with advanced life-limiting illness, and their family (RN Standards for Practice 1.1, 1.4, 1.5, 5.5, 6.1, 6.5, & 7.1, 7.2, 7.3). |
| D. | Critically reflect upon the impacts of colonisation on the health and wellbeing of Indigenous Australian and on how nurses can make a meaningful difference to improving current health disparities (RN Standards for Practice 1.2, 1.3, 2.2, 2.5, 3.2, 3.3, 6.1). |
| E. | Explain the roles of the nurse and broader health care team / system in enabling optimal care for people with chronic and complex conditions (RN Standards for Practice 2.5, 2.6, 2.7, 2.8, 3.4, 3.5, 3.6, 3.7, 5.2, 5.3, 6.3, 6.4, 6.6 & 7.3). |
Course intended learning outcomes (CILOs)
This subject also contributes specifically to the following graduate attributes:
- Embody a professional disposition committed to excellence, equity and sustainability (1.0)
- Engage in person-centred care that is appropriately sensitive to the needs of individuals, families and communities (2.0)
- Practise person-centred, holistic care in which all aspects of the patient's wellbeing are considered (2.1)
- Communicate and collaborate effectively and respectfully with diverse groups (3.0)
- Inquire critically to assess a body of evidence to inform practice (4.0)
- Evaluate and apply effective and creative solutions to the improvement of nursing practice and patient care (4.2)
- Competently apply knowledge and skills to ensure safe and effective nursing practice (5.0)
- Demonstrate professional cultural competency which contributes to the health and wellbeing of Indigenous Australians, inclusive of physical, social, emotional and spiritual wellness (6.0)
Teaching and learning strategies
In this subject, you will participate in a range of teaching and learning strategies that are designed to encourage you to care for people with chronic and complex care needs, and their families.
Tutorials and online learning materials
This subject benefits from both real time delivery of content within tutorials and access to online resources including podcasts, videos and learning modules. These resources enable students to quickly clarify complex descriptions and terminology, and engage with sensitive or confronting topics. Online materials include scenario-based learning unfolding at the student's pace with instant feedback provided to develop students' clinical judgement.
Case studies
Cases studies are used to help students explore health related scenarios that are commonly encountered by those with chronic and/or complex health conditions. Cases depict patients and their families in clinical, community and aged care situations. Students use these cases to learn concepts, interpret information, form clinical judgements and develop creative solutions for complex problems. A specific focus on supported self-management, goal setting, advance care planning and achieving optimal quality of life alongside chronic and/or progressive illness is provided. Critical thinking is developed through analysis, interpretation of and reflection on these complex issues or situations.
Group activity
A group activity specifically focusing on therapeutic communication is provided. This group activity focuses on the development of therapeutic communication skills when interacing with people who have chronic and/or complex health care needs. In small groups, guided by teaching staff, students will take on the role of nurse or patient and, with guidance, practice therapeutic engagement and communication skills, such as active listening and empathic responding. Teaching staff will provide immediate and supportive feedback to the students. Case studies developed within this simulation engage with sensitive and confronting situations and students are encouraged to consider and practice ways of interacting within these scenarios.
Structured decision making activities
Working in small teams students engage in real-time, shared decision-making activities. This assists students to engage with policies and utilise knowledge to formulate responses to patient and family situations, under time pressure, as would be expected within a clinical practice setting. Together, students learn to quickly achieve consensus for decisions. Feedback for decision outcomes is also provided in real-time allowing students to assess and reflect on their decision making choices and indeed the impact of these on patients and families.
Content (topics)
Content will include: Examination of key risk factors contributing to chronic illnesses (Eg. Obesity, mental health diseases, low socioeconomic status amongst others); Overview of the models of care to support best evidence based care for people with chronic and complex health care needs (physical and psychological), and their families across varied acute and primary healthcare settings; Communication strategies when working with people who have chronic illness in the contexts of goal setting, managing adaptations to loss and disability, supported self-management and advance care planning; Analysis of the roles of nurses and other multi-professional team members in the care of people with chronic and complex healthcare needs; Overview of the principles of partnership working to enable optimal care for patients with chronic health care needs, and their families; Overview of the key role of collaborative practice when working with people who have chronic and complex healthcare needs; Overview of symptom assessment and management (Eg. Pain and other symptoms) with a particular focus on point of care resources to assist care delivery; Overview of the practice and philosophy of palliative care and in particular, the palliative care approach; Reflection on the effects of colonisation and racism on the health and wellbeing of Indigenous Australians and how nurses can affect change in these health disparities.
Assessment
Assessment task 1: Self-care for chronic conditions
| Intent: | The aim of this assessment to further develop your understanding on how to support optimal care to a person with a chronic illness using patient centred care. In Australia, people with chronic conditions may have multimorbidities with varying levels of complexity; require increased, ongoing access to a range of services and self-management support; and are likely to be on multiple pharmacotherapies. Without effective support these people often experience poor health and reduced quality of life. |
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| Objective(s): | This assessment task addresses subject learning objective(s): A, D and E This assessment task contributes to the development of graduate attribute(s): 1.0, 2.1, 4.2 and 6.0 |
| Type: | Case study |
| Groupwork: | Individual |
| Weight: | 40% |
| Length: | 1500 words |
Assessment task 2: Partnership- centered care (Group presentation)
| Intent: | This task assists students to develop practical communication techniques to support care delivery to people who have a chronic illness. Students will demonstrate an ability to formulate culturally appropriate communications that engage clients in goal setting, supported self-management and advanced care planning. |
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| Objective(s): | This assessment task addresses subject learning objective(s): B This assessment task contributes to the development of graduate attribute(s): 3.0 |
| Type: | Presentation |
| Groupwork: | Group, group assessed |
| Weight: | 30% |
| Length: | 10 minutes in class |
Assessment task 3: Quiz/test
| Intent: | The aim of this assessment is to consolidate student knowledge and understanding about the management of chronic and complex illness and person-centred care by applying this knowledge and understanding in a revision test. |
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| Objective(s): | This assessment task addresses subject learning objective(s): A, C and E This assessment task contributes to the development of graduate attribute(s): 1.0, 2.0, 4.0 and 5.0 |
| Type: | Quiz/test |
| Groupwork: | Individual |
| Weight: | 30% |
| Length: | Sixty (60) Multiple Choice Questions in 80 minutes. |
Recommended texts
LeMone, P., Bauldoff, G., Gubrud-Howe, P., Carno, M., Levett-Jones, T., Dwyer, T., Moxham, L., Reid-Searl, K., Berry, K., Carville, K., Hales, M., Knox, N. & Stanley, D. (2019). LeMone and Burke's Medical-Surgical Nursing Critical Thinking for Person-Centred Care. (4th edn). Pearson, Sydney Australia.
Levett-Jones, T. (2023). Clinical Reasoning Learning to think like a nurse. (3rd edn). Pearson, Melbourne.
Levett-Jones, T. (2020). Critical conversations for patient safety. (2nd edn). Pearson, Melbourne.
Tizani, A. (2013). Harvard’s nursing guide to drugs. (9th edn). Elsevier, Sydney.
References
Austin Health (2020). Advance Care Planning Australia. Retrieved from https://www.advancecareplanning.org.au/
Australian Institute of Health and Welfare (2021). Chronic disease. Retrieved from https://www.aihw.gov.au/reports-data/health-conditions-disability-deaths/chronic-disease/overview
Australian Institute of Health and Welfare (2019). Australian Burden of Disease Study: impact and causes of illness and death in Australia 2015. Australian Burden of Disease series no. 19. Cat. no. BOD 22. Canberra: AIHW.
Australian Commission on Safety and Quality in Healthcare (ACSQHC) (2017). National Safety and Quality Health Service Standards 2nd edn, ACSQHC, Sydney.
Austin Health (2020). Advance Care Planning Australia. Retrieved from https://www.advancecareplanning.org.au/
Australian Government. (2019). National Palliative Care Strategy 2018. Reterieved from https://www.health.gov.au/resources/publications/the-national-palliative-care-strategy-2018
Australian Health Ministers’ Advisory Council. (2017). National Strategic Framework for Chronic Conditions. Australian Government. Canberra. Retrieved from Australian Health Ministers’ Advisory Council
Bloomer, M., Botti, M., Runacres, F., Poon, P., Barnfield, J., Hutchinson, A., & Bloomer, M. (2018). Communicating end-of-life care goals and decision-making among a multidisciplinary geriatric inpatient rehabilitation team: A qualitative descriptive study. Palliative Medicine, 32(10), 1615–1623. Retrieved from https://doi.org/10.1177/0269216318790353
Brighton, L.J., Bristowe, K. (2016). Communication in palliative care: talking about the end of life, before the end of life. Postgraduate Medical Journal 92:466-470. Retrieved from https://pmj.bmj.com/content/92/1090/466
Brownie, S., Scott, R., & Rossiter, R. (2016). Therapeutic communication and relationships in chronic and complex care. Nursing Standard, 31(6), 54–63. Retrieved from https://doi.org/10.7748/ns.2016.e9847
Garling, P. (2008). Final report of the Special Commission of Inquiry into Acute Care Services in New South WalesPublic Hospitals, NSW Government, Sydney.
Health Workforce Australia. (2014). Developing Aboriginal and Tores Strait Islander cultural capabilities in health graduates: A review of the literature. Retrieved from https://www.voced.edu.au/content/ngv%3A66993
Hunter, S. (2015). Miller’s Nursing for Wellness in Older Adults, 7th edn, Lippincott, Sydney
NSW Health. (2019). Integrated care for patients with chronic conditions. Retrieved from https://www.health.nsw.gov.au/integratedcare/Pages/chronic-conditions.aspx
Nursing and Midwifery Board of Australia (2016). Registered nurses standards for practice, Melbourne, Victoria
Palliative Care Curriculum for Undergraduates. (PCC4U). Project Team, with funding from the Australian Government Department of Health. (2019). Palliative Care Curriculum for Undergraduates (PCC4U), www.pcc4u.org
Therapeutic Guidelines. (2017). Palliative Care, Version 4, McPherson Group, Melbourne.
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