BSN 445: Clinical Decision-Making and Deteriorating Patient Care

Clinical decision-making forms a core expectation of senior-level nursing practice. Coursework in BSN 445 places sustained attention on early recognition of patient deterioration, sound judgment under pressure, and timely nursing responses in complex care environments. The following assignment reflects assessment formats commonly used in this course unit across recent academic years.

Assessment Title

Recognising and Responding to the Deteriorating Adult Patient

Assessment Overview

Assessment Type: Short Analytical Paper and Discussion Board Engagement

Course: BSN 445 Concepts of Nursing in the Complex Patient

Assessment Weight: 25 to 30 percent of final course grade

Written Component Length: 1,000 to 1,200 words

Referencing Style: APA 7th edition

Senior nursing students are expected to recognise subtle clinical changes, prioritise care, and escalate concerns appropriately. This assessment evaluates the ability to apply structured clinical reasoning to situations involving patient deterioration in acute or transitional care settings.

Learning Outcomes Addressed

• Apply clinical judgment to identify early signs of patient deterioration.
• Demonstrate safe and timely nursing responses to changing patient conditions.
• Use evidence-based tools to support decision-making in complex care.
• Communicate clinical concerns clearly within the healthcare team.

Written Assignment Instructions

A brief case scenario will be provided by the instructor, or an approved clinical example may be used. The scenario will involve an adult patient experiencing physiological deterioration during hospital admission.

The paper must focus on nursing judgment rather than medical diagnosis. Descriptive writing alone is insufficient. Analysis and justification are required throughout.

Required Content Areas

1. Patient Situation and Care ContextA concise overview of the patient, care setting, and clinical background. Information included should clearly explain why the patient is at risk of deterioration.
2. Identification of DeteriorationObservable cues such as vital signs, assessment findings, or behavioural changes should be discussed. Connections between assessment data and clinical concern must be explained.
3. Nursing Clinical ReasoningInterpretation of patient data using a recognised clinical reasoning framework. Priorities for care should be justified using nursing judgment.
4. Nursing Actions and Escalation of CareAppropriate nursing interventions and escalation processes should be outlined. Rationale must be supported by current evidence or clinical guidelines.
5. Patient Safety and Professional ResponsibilityDiscussion of patient safety considerations, documentation responsibilities, and accountability of the registered nurse.
6. ConclusionA brief synthesis of how early recognition and nursing decision-making influence patient outcomes.

Discussion Board Assignment

Discussion Topic

Early recognition of patient deterioration remains a critical nursing responsibility in acute care settings.

Initial Post Requirements

• Length of 250 to 300 words.
• Description of a clinical situation where early signs of deterioration were present.
• Explanation of how nursing judgment influenced the outcome.
• Use of at least one peer-reviewed source.

Peer Response Requirements

• Two responses of 150 to 200 words each.
• Responses should extend the discussion by adding insight, evidence, or clinical perspective.
• Professional tone and academic language are expected.

Marking Criteria and Rubric

Criterion	Weight
Recognition and interpretation of patient deterioration	25%
Application of clinical reasoning and prioritisation	25%
Appropriateness of nursing interventions and escalation	20%
Integration of scholarly evidence	15%
Clarity of writing, structure, and APA referencing	15%

Submission Requirements

• Word document format.
• APA title page and reference list.
• Minimum of five peer-reviewed sources published from 2018 onward.
• Academic integrity standards apply.

BSN 445 assignments often focus on clinical decision-making, patient deterioration, and nursing judgment in complex care. This task reflects common assessment formats used in upper-level undergraduate nursing courses and supports preparation for real clinical practice.

References

Levett-Jones, T., Hoffman, K., Dempsey, J., Jeong, S. Y., Noble, D., Norton, C. A., Roche, J., & Hickey, N. (2020). The “five rights” of clinical reasoning: An educational model to enhance nursing students’ ability to identify and manage clinically at-risk patients. Nurse Education Today, 38, 24–29. https://doi.org/10.1016/j.nedt.2016.01.004

Melnyk, B. M., & Fineout-Overholt, E. (2019). Evidence-based practice in nursing and healthcare: A guide to best practice (4th ed.). Wolters Kluwer. https://shop.lww.com/Evidence-Based-Practice-in-Nursing—Healthcare/p/9781975110642

Odell, M., & Victor, C. (2022). Nurses’ role in recognising and responding to patient deterioration in acute hospital settings. Journal of Clinical Nursing, 31(9–10), 1225–1236. https://doi.org/10.1111/jocn.15954