The summative assessment in this module directly aligns with module learning outcomes LO1, LO2, LO3, LO4.

This assessment is a 3300-word written essay that will critically discuss a complex case scenario.

Module Learning Outcomes

The module learning outcomes identify the knowledge and understanding you should be demonstrating in your assignment.  They are as follows:

LO1. Determine the physical, social, and emotional impact multiple co morbidities/complex adult health care needs have on the individual

LO2. Examine the evidence base that supports anticipatory care planning in adult with complex health care needs to optimise care

LO3. Debate the legal, ethical and professional issues that might arise in the care of adults with complex health needs

LO4. Critically reflect on the importance of co-ordination of care and interagency working within complex health care delivery to maintain patient safety

Assessment Guidance

For your 3300-word summative essay:

  1. Choose one of the complex case scenarios encountered during the module
  2. From this scenario, select one aspect of palliative/end of life care
  3. Provide a critical analysis of this one aspect of palliative/end of life care

This critical analysis should –

  • Provide a brief outline of the selected complex case scenario, identify the aspect of care and provide a rationale for the selection of this aspect of care
  • Provide a detailed and comprehensive discussion and analysis of the legal, professional and ethical issues that arise within the selected aspect of care.
  • critically discuss the value of inter-professional team working and its contribution to safe and effective patient care within the chosen aspect of care
  • Demonstrate the clinical reasoning and decision-making skills required to deliver effective and safe patient care
  • Make recommendations for practice by suggesting how effective and safe nursing care could be better optimised

Use of literature

Support your discussion with relevant evidence from research articles, guidelines, third sector involvement, all referenced appropriately in text and in a final Reference List

Case Scenario


Frank’s story is divided into sections denoting different episodes of care/intervention and it is best to work through these sequentially. 

During the preparation for assessment sessions, we will draw together key aspects of the final episode of Frank’s care that you might wish to consider to use as your aspect of care for your assignment

Frank’s Story

Mr Frank MacLeod, aged 85  lives at home with the support of carers who visit 4 times per day to help him with his daily activities such as washing and dressing and preparing meals.  At 8 o’clock this morning, his carer arrived to find him in a very distressed state struggling to breathe and they called for an ambulance to take him to hospital.

Frank is on a host of repeat medications:

  • Enalapril 10mg tablets, one tablet once daily
  • Amlodopine 10 mg tablets, one tablet once daily
  • Metformin 500mg tablets, one tablet three times daily
  • Atorvastatin 20mg tablets, one tablet once daily
  • Umeclidinium (55 micrograms) dry powder inhaler, one inhalation once daily
  • Salbutamol (100micrograms) inhaler, one –two puffs four time daily as required
  • Omeprazole 20mg capsules, one capsule once daily
  • Aspirin 75mg tablets, one tablet once daily
  • Co-codamol 8mg/500mg tablets, one to two tablets as needed up to four times a day for pain
  • Tramadol 50 mg one to two tablets as needed up to four times a day for pain
  • Triptorelin injection (as acetate) 11·25mg, one injection every 3 months
  • Fybogel sachets, one sachet once daily as required for constipation
  • Diprobase cream (500mg), use liberally as needed to moisturise skin

His past medical history includes: hypertension, chronic obstructive pulmonary disease (MRC is now stage 5), type 2 diabetes, hyperlipidaemia, localised prostate cancer (on hormone therapy), hiatus hernia, osteoarthritis of his right knee and hearing impairment.

He has been admitted to hospital three times in the last year with a lower respiratory tract chest infection and an acute exacerbation of his COPD. The length of his last three admissions was 4 days, 6 days and 10 days respectively. He was admitted 4 months ago following a fall where he sustained a fractured right humerus. Following this last admission he has been at home with increasing home care support and on discussion with his GP it is established that Frank’s COPD has progressed over the past 4 months and is now severely limiting his independence.

Frank receives a number of repeat medications.

Frank: On Admission to Hospital

When you admit Frank to the ward area you discuss how he is managing at home and he outlines how difficult he has been finding it to do even the simplest tasks and he is more and more reliant on his carers.

On admission, Frank’s respiratory status is a cause for concern: his respiratory rate is 30, his oxygen saturations are 82% on room air, he is using his accessory muscles and adopting the tripod position and it is clear that he has increased work of breathing. To further assess his respiration/ventilation status an arterial blood gas is taken. Based on Frank’s clinical presentation and blood gas results it is decided to commence Frank on non invasive ventilation (bi phasic positive pressure ventilation BiPAP).

Frank: Further Deterioration

Unfortunately, despite NIV and treatment of any exacerbating factors, Frank’s respiratory status continues to deteriorate and the healthcare team arrange to meet with Frank and his family (as Frank has asked that they be present) to discuss options that are available.

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