You are a newly qualified nurse working in the coronary care unit and leading the ward rounds. The consultant asks you to handover Esther.  Esther is making a slow recovery from a major myocardial infarction which was triggered by several factors; mainly from the high stress of her work; lifestyle and smoking. Esther is, at times critical of unit and says the noise of the machines make it difficult for her to rest.  She is curt with the nursing staff and her husband has stated on several occasions that he is unhappy with her care and slow recovery. 

You find that in the patient’s notes the vital signs are incomplete and the early warning scoring system is not documented.  You have noticed this on a few occasions.  Subsequently you took part in the audit and a service user improvement project.  There have been some concerns raised over the performance of two members of staff; a Health Care Assistant; Roger and a Staff Nurse; Sue. The consultant on the ward round is critical of the standards and dismissive in his demeanour at the bedside.

The themes from the patient feedback system and the improvement project are as follows;

Audit outputs: to meet documentation standards; patient handover and ward rounds to meet the Heath Care Trust communication standards


Service user comments: “listen to us; lack of basic care and hygiene needs, lack of eye contact from all health care staff,  talk to us, we keep getting asked the same questions, the nurses seem busy so I don’t want to trouble them”.


You should complete part 1: A seen exam (3 hours) utilising a scenario based approach to facilitate critical decision making and evaluation and to consider professional values needed to critically appraise evaluative and quality processes in adult health care. 

The scenario this is based on is: SCENARIO.3..docx.

The Learning Outcomes assessed for this are 1, 3, 4 & 5:

1.Critically appraise evaluative and quality processes across diverse adult healthcare settings;

3.Critically explore the knowledge, value and skills needed to manage the adult healthcare environment;

4.Examine the need to enable and empower the vulnerable adult to participate in decision making and evaluative quality processing;

5.Critically analyse the qualities required for high performance teams in adult nursing and interdisciplinary working;

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