Essay – Nursing MSc level 7 markings

Case Study:

Learning outcomes (to be demonstrated by the essay)
1. Illustrate systematic understanding of nursing knowledge and skills required to effectively assess and prioritise individual care needs.
2. Critically analyse and evaluate clinical reasoning and decision making to inform evidence-based practice
This assessment is 70% weighting for the final module mark
You are required to write a 2000 -word essay that provides reflection and deconstruction of the clinical reasoning and care prioritisation process undertaken via an individual case study.
Your reflection and deconstruction of the clinical reasoning and care prioritisation process will be based on the case study provided below. Use module resources provided and extra reading from Library plus, CINAHL, Medline etc to prepare this work.
The context is an admission interview to an acute medical inpatient assessment ward.
William is a 45-year-old White British, widowed man with a Past Medical History of Alcohol misuse; he lives at home on his own. Eleven years ago, his entire family of wife and 2 children were killed in a Road Traffic Incident. He has been managed for alcohol dependence by his GP for 6 years, and has previously been diagnosed with liver cirrhosis. He is a highly paid senior barrister and works in a busy, stressful Practice. His employers are not aware he has alcohol dependency. He has a supportive family of parents and a sister who live a distance away, and who are unaware of how ill he is.
William has been distressed for several days as the anniversary of family’s deaths is this week, which usually causes a regression in alcohol intake. He contacted his GP with a 4 -day history of fever, vomiting and right upper quadrant abdominal pain. His GP has referred urgently to hospital via emergency ambulance, and he is admitted to the Medical Assessment Unit where he is receiving intravenous fluids, antibiotics, analgesia and anti-emetics, and monitoring. The plan is for urgent Abdominal Ultra sound, CT- Scans, Liver function Tests and Amylase, referral to Gastroenterology for assessment and further treatment as necessary. He is suspected to have Pancreatitis.
Initial assessment interview on admission
• One week ago, starting drinking heavily due to the impending anniversary of family’ deaths; drinking up to 1 litres of whisky in 2 days
• Has ongoing right upper quadrant abdominal pain
• Is emotionally distressed and frightened
• Has IV access, with Normal Saline in situ
• EWS has increased to 5 from 3 during transfer from Imaging department

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Priorities identified-
• Anxious and frightened
• Vomiting, hypotensive and becoming less responsive
• Acute and continuous abdominal pain

In reflecting on and deconstruction of the decision- making process that may have led to the priorities identified, you may argue that other issues should have been prioritised. These reflections can form part of your arguments and the development of the critical evaluation of this process. You can question, with reference to theory and evidence, why the particular priorities identified could/should be different, and how and why such priorities might have been decided on.
Illustrative examples (anonymous) can be used from your own practice experience as a student nurse. The work should adhere to usual legal, ethical and professional principles and no person or organisation should be identified.
The essay will be assessed using level 7 criteria.


A. General requirements

The assignment addresses the following module outcomes.

1. Illustrate systematic understanding of nursing knowledge and skills required to effectively assess and prioritise individual care needs.
2. Critically analyse and evaluate clinical reasoning and decision making to inform evidence-based practice

Weighting:  70 % of the final module mark

The assignment title is: Reflection and deconstruction of the clinical reasoning and care prioritisation undertaken of an individual case study

The context is an admission interview to an acute medical inpatient assessment ward. You have been given brief information of the patient’s case and interventions so far, with an assessment of priorities for care.

Word Count: 2000 words

In order to complete the assignment you must achieve the following

• With reference to the wider literature, theories and models of nursing, establish the holistic impact the case outline presented can have on the person.

• Reflect on, deconstruct and critically debate the decision -making process that may have led to the clinical priorities identified. You may argue other priorities should be paramount; you need to say why and back it up with the evidence -base.
• Illustrative examples (Anonymous) may be used from your own practice as a student nurse to illustrate your argument.

• The work should adhere to the usual ethical, legal and professional principles. No individual or organisation should be identifiable from your writing.

• With reference to the wider literature which can include access to primary research papers, other strategy documents, NICE guidelines etc, critically analyse the rationale for the recommended priorities of care.

• The essay will be assessed using Level 7 Essay criteria

B) Possible essay plan

Introduction (200 words)

General overview of what you are going to do in the essay.

Briefly outline the different sections.

Outline of the condition and holistic impact on the person (300 words).

General background and introduction of case study.

What is the underlying pathology of the condition?

What physiological changes have led to the immediate presentation of the patient to hospital?

Deconstruction of Clinical reasoning and prioritisation of care (1300 Words)

State whether you agree with the priorities that have been set out.

What would you suggest doing differently, if anything, and why? Debate how the underpinning evidence -base /concepts/ theories / models support your clinical reasoning?

Using wider reading, critically analyse the clinical decision-making that would lead you to prioritise the problems in the way that you have.

This can include consideration of the holistic impact of the problems on the patient.

It could include issues of ethical / legal/ professional items and / or analysis of underpinning theory, concepts and models in support of what you are proposing for prioritisation of problems.

Are there any weaknesses / conceptual gaps in the evidence base that impact clinical decision-making?

Conclusion (200 words)

What have you learnt?

What are the implications for your practice of your debate?

Where do you need to improve your knowledge?


Use the Harvard referencing system. References do not contribute to the word count.

C) Quality issues

Structure and Presentation
It should be grammatically correct with clear use of appropriate paragraphing. The use of sub titles to help structure the essay is permitted. Your essay must be word processed using an appropriate size and type of font.
The essay must be appropriately referenced following the Harvard referencing system. References are not counted in the word count.
Marking Criteria
The essay will be marked according to the published university level 7 criteria. The module team would encourage attempts at analysis and debate in the essay. This includes attempts at the critical appraisal of primary research articles.
Please ensure that patient and organisational confidentiality is maintained in the essay.

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