NSG-300 Foundations of Nursing / NSG-300C Clinical

Assignment 1: Level 1 Nursing Care Plan and Priority Diagnosis

1. Assessment Overview

Unit/Program: Pre-Licensure BSN
Course: NSG-300 Foundations of Nursing (co-requisite NSG-300C Clinical)
Assessment Type: Individual written care plan and discussion post
Placement: Week 4–5, Topic: Clinical Judgment in Nursing Practice
Length: 3–4 page written care plan (approximately 1,000–1,200 words) plus one 200-word initial discussion post and three 100–150 word peer responses
Weighting: 15–20% of course grade (theory component; clinical passes/fails linked to this task)

This assignment develops beginning-level clinical judgment by requiring you to use the full nursing process to design a holistic, client-centered plan of care for one adult patient, then justify your priority diagnosis and interventions in a structured discussion.

2. Case Scenario (Simulated Client)

You are working on a medical-surgical unit in your NSG-300C clinical placement. Your assigned client is an 84-year-old postoperative patient who underwent a left total hip arthroplasty 24 hours ago.

• She ambulates with assistance to the bedside commode but has poor balance and guarded movements.

• Vital signs: T 37.4°C, HR 94, RR 20, BP 138/78, SpO₂ 95% on room air.

• Pain: Rates hip pain 7/10 on movement; surgical dressing is dry and intact.

• Reports poor sleep overnight, worries about falling and breaking something again.

• Lives alone, uses a walker at baseline, daughter visits twice weekly.

Using information from your lab, clinical experiences, and the NSG-300 course resources, you will generate a Level 1 nursing care plan focused on safety, pain management, and promotion of mobility and sleep.

3. Task Description

3.1 Written Care Plan (3–4 pages)

Prepare a structured Level 1 nursing care plan for the client described above, using the nursing process and the course template guidance.

i. Assessment

• Summarize pertinent subjective and objective data (no full head-to-toe chart, only focused data relevant to the problem list).

• Organize findings under physiological, psychosocial, and safety needs.

ii. Nursing Diagnoses (NANDA-I format)

• Formulate two nursing diagnoses; identify one priority diagnosis based on Maslow’s hierarchy and risk severity (for example, Risk for Falls, Acute Pain, or Disturbed Sleep Pattern).

• Write each diagnosis statement in the correct PES format (Problem, Etiology, Signs/Symptoms where applicable).

iii. Goals and Expected Outcomes

• For the priority diagnosis, create two SMART goals (specific, measurable, achievable, relevant, time-bound) that reflect realistic changes in status or behavior within 24–48 hours.

iv. Nursing Interventions and Rationales

• Identify a minimum of four evidence-based nursing interventions for the priority diagnosis.

• Classify each as independent, dependent, or collaborative, and provide a brief scientific rationale linked to current evidence (1–2 sentences each).

v. Evaluation

• Describe specific evaluation criteria you will use to determine if each SMART goal was met, partially met, or not met.

Your care plan should show beginning competence in prioritizing safety, using assessment data to support your diagnoses, and aligning interventions with best practice guidelines.

3.2 Discussion Board Post and Responses

After completing the written care plan, you will translate your clinical reasoning into a concise discussion post.

i. Initial Post (minimum 200 words)

• State one priority nursing diagnosis for the client, written in correct format.

• Provide a clear rationale explaining why this diagnosis takes priority over other actual or potential problems, drawing on assessment data and Maslow’s hierarchy or risk considerations.

ii. Peer Responses (three posts, 100–150 words each)

• Respond to three classmates who selected a different priority diagnosis.

• For each, identify one appropriate nursing intervention for their diagnosis and include a brief rationale that references course concepts or evidence.

Follow the course discussion rubric for expectations regarding critical thinking, connection to evidence, netiquette, and timeliness.

4. Assignment Requirements and Formatting

• Length: 3–4 typed pages for the written care plan, excluding title page and references; double-spaced; 12-point Times New Roman or similar font.

• Structure: Use clear section headings aligned with the nursing process (Assessment, Nursing Diagnoses, Goals/Outcomes, Interventions/Rationales, Evaluation).

• Referencing: Include at least two current peer-reviewed sources (published 2018–2026) plus your fundamentals text or institutional protocols.

• Citation Style: Follow the program’s standard (APA or Harvard) consistently across in-text citations and reference list.

• Academic Integrity: All work must be your own. Paraphrase rather than copy, and cite all sources of evidence supporting your interventions and rationales.

Additional academic expectation (new paragraph added):
Developing strong clinical reasoning at Level 1 also requires students to demonstrate explicit linkage between assessment cues, diagnostic decisions, and selected interventions. Educators consistently emphasize that novice nurses who articulate their reasoning processes more clearly show stronger progression toward safe clinical judgment and improved patient outcomes (Potter et al., 2021).

5. Marking Criteria / Scoring Rubric (Summarized)

Maximum: 100 marks. Performance descriptors align with common first-year BSN fundamentals rubrics used for care plan and discussion assessments.

5.1 Written Care Plan (70 marks)

i. Use of Nursing Process and Clinical Judgment (20 marks)

• High Distinction (18–20): Assessment data are accurate, relevant, and organized logically; priority problems clearly emerge from data; reasoning is explicit and defensible.

• Pass (10–13): Assessment mostly accurate but limited depth; some connection to priority problems; reasoning partially developed.

• Fail (0–9): Data incomplete or unclear; priority issues not supported by findings; reasoning largely absent.

ii. Nursing Diagnoses Accuracy and Priority Setting (15 marks)

• High Distinction (14–15): Diagnoses correctly structured, supported by data, and prioritized using pathophysiology and safety considerations.

• Pass (8–11): Minor errors in wording or linkage to data; priority partly justified.

• Fail (0–7): Incorrect formats, missing data links, or inappropriate priorities.

iii. SMART Goals and Outcomes (10 marks)

• High Distinction (9–10): Goals clearly measurable and time-bound, directly aligned to the priority diagnosis.

• Pass (5–7): Goals somewhat specific but vague in measurement or timeframe.

• Fail (0–4): Goals broad, unmeasurable, or mismatched to diagnosis.

iv. Evidence-Based Interventions and Rationales (15 marks)

• High Distinction (14–15): Interventions are specific, realistic, and clearly categorize independent/dependent/collaborative actions; rationales concisely integrate current evidence.

• Pass (8–11): Interventions generally appropriate but rationales descriptive rather than analytical, or weakly linked to evidence.

• Fail (0–7): Interventions unsafe, non-specific, or lack rationales.

v. Evaluation Criteria and Reflection (10 marks)

• High Distinction (9–10): Evaluation strategies are precise and feasible; student briefly reflects on potential need to revise plan if goals not met.

• Pass (5–7): Evaluation statements present but somewhat vague or incomplete.

• Fail (0–4): Evaluation absent or not aligned with goals.

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5.2 Discussion Board (30 marks)

i. Initial Post: Priority Diagnosis and Rationale (15 marks)

• High Distinction (14–15): States a clear priority diagnosis and defends it using assessment data, safety, and theory; integrates at least one scholarly source or course resource.

• Pass (8–11): Diagnosis appropriate but rationale superficial or primarily descriptive.

• Fail (0–7): Diagnosis off target or rationale missing.

ii. Peer Responses: Interventions and Reasoning (10 marks)

• High Distinction (9–10): Three substantive responses, each proposing a relevant intervention and rationale that extends the original post.

• Pass (5–7): Responses polite but mainly agreeable; limited addition of new insight.

• Fail (0–4): Fewer than three responses or minimal engagement.

iii. Writing Quality and Professional Communication (5 marks)

• High Distinction (5): Clear, concise writing that follows netiquette and professional tone; minimal errors.

• Pass (3–4): Meaning clear but with some mechanical issues.

• Fail (0–2): Frequent errors or unprofessional tone.

6.

One appropriate priority nursing diagnosis for this client is Risk for Falls related to impaired balance and postoperative pain as evidenced by unsteady gait and fear of falling. Focused assessment on mobility, pain, cognition, and home environment allows the nurse to identify the specific factors that heighten fall risk in the early postoperative period. A short-term goal might state that within 24 hours the client will ambulate to the bedside commode with one-person assist and no loss of balance. Evidence supports the use of multifactorial interventions that combine environmental modification, close supervision during ambulation, and timely analgesia to reduce falls in hospitalized older adults (Dykes et al., 2018).

7. Learning Resources / References

1. Dykes, P.C. et al. (2018) Evaluation of a patient-centered fall-prevention tool kit to reduce falls and injuries: A nonrandomized controlled trial. JAMA Internal Medicine, 178(9), pp. 1150–1157.

2. NANDA International (2021) NANDA International nursing diagnoses: Definitions and classification 2021–2023. 12th edn. New York: Thieme.

3. Potter, P.A., Perry, A.G., Stockert, P.A. and Hall, A.M. (2021) Fundamentals of nursing. 10th edn. St. Louis: Elsevier.

4. Jeffs, L. et al. (2019) Implementing an evidence-based model of care to reduce falls on medical-surgical units. Worldviews on Evidence-Based Nursing, 16(5), pp. 356–363.

5. Resnick, B. and Boltz, M. (2019) Functional performance and exercise in older adults in acute care. Clinics in Geriatric Medicine, 35(1), pp. 93–107.

6. World Health Organization (2021) Global patient safety action plan 2021–2030: Towards eliminating avoidable harm in health care. Geneva: WHO.