NRSG374 Principles of Nursing: A Palliative Approach, Assessment Task 1 Written Critique

Context

Australian Catholic University delivers NRSG374 as a third-year nursing unit in the Bachelor of Nursing. Assessment Task 1: Written Critique carries a 50% weighting and requires 2000 words plus or minus 10%. The task asks students to critique the care provided in a case study against a single Clinical Practice Guideline and against the National Palliative Care Standards. The 2026 iteration retains the Tyler Morton case used in earlier years while tightening the requirement to justify the choice of guideline before applying it. The due date is Tuesday 1 September at 2pm. Submission is through Cadmus, accessed via Canvas. The task assesses LO1, LO4, and LO6.

Summary

• Title: Assessment Task 1: Written Critique
• Due Date: Tuesday 1 September, 2pm
• Length: 2000 words (plus or minus 10%, excluding references)
• Weighting: 50%
• Submission: Cadmus via Canvas

Unit Learning Outcomes Assessed

LO1: Articulate an understanding of how theory translates into care within the palliative approach. LO4: Critically appraise and synthesise evidence to inform best practice. LO6: Apply national standards and clinical practice guidelines to the care of the dying person and their family.

Task Description

Critique the palliative care provided to Tyler Morton in the case study supplied on Canvas. Select one Clinical Practice Guideline relevant to Tyler’s care. Justify your selection. Evaluate the care against that guideline and against the National Palliative Care Standards. Identify strengths, gaps, and consequences for the patient and family. Propose evidence-based improvements. The critique is not a summary of the case and not a description of palliative care in general. It is an evaluation of a specific clinical encounter against explicit standards.

Case Study: Tyler Morton

Tyler Morton is a 40-year-old man diagnosed with Amyotrophic Lateral Sclerosis (ALS). The disease has progressed to the point where Tyler has significant weakness, dysphagia, and declining respiratory function. He is receiving palliative care at home with support from a community nurse and a general practitioner. Tyler’s wife, Catherine, holds a copy of his Advance Health Directive but has never discussed its contents with the clinical team. Tyler has expressed a wish to die at home. His symptoms include pain, breathlessness, and episodes of distress. The case documentation records his medication regimen, his functional decline, and the family’s involvement in his care.

Task Instructions

Structure the critique in four sections. Each section must be analytical and evidence-based.

Section One: Guideline Selection and Justification

Select one Clinical Practice Guideline relevant to Tyler’s care. Explain why you selected it over alternative guidelines. Identify the specific recommendations within the guideline that apply to Tyler’s circumstances. Maximum 600 words.

Section Two: Critique of Care

Evaluate the care provided against the selected guideline and the National Palliative Care Standards. Identify what was done well and what was missed. Support each judgment with evidence from the guideline, the standards, and peer-reviewed literature. Maximum 800 words.

Section Three: Consequences and Gaps

Analyse the consequences of the gaps you identified for Tyler, Catherine, and the clinical team. Consider symptom management, communication, advance care planning, and family support. Maximum 400 words.

Section Four: Recommendations

Propose evidence-based recommendations to address the gaps. Recommendations must be specific, actionable, and linked to the guideline and standards. Maximum 200 words.

Marking Rubric

Sample Critique: Evaluating End-of-Life Care Against the Dying Patient Guideline

Tyler Morton’s care raises a question that palliative care guidelines answer unevenly: whose responsibility is it to initiate the conversation about an Advance Health Directive that exists but has never been discussed? The guideline I selected, the National Safety and Quality Health Service Standards, Comprehensive Care Standard, end-of-life care actions, addresses this question directly, requiring clinicians to identify when a patient is approaching the end of life and to initiate advance care planning discussions with the patient and family (ACSQHC, 2021). The care Tyler received met the guideline’s requirements for symptom management. His pain and breathlessness were assessed and treated. The care fell short on communication and advance care planning. Catherine held the directive but the clinical team never asked to see it, and the case record contains no evidence that Tyler’s wish to die at home was formally documented and communicated across the care team. The consequence is not abstract. Tyler’s preference remained private knowledge rather than a clinical instruction, which increased the risk of unwanted hospital transfer and left Catherine carrying a decision-making burden she had not been prepared for. A stronger response would have been a structured family meeting, documented in the care plan, that surfaced the directive and aligned the team around Tyler’s stated wish.

Why Guideline Choice Matters More Than Students Expect

The rubric devotes 20% to guideline selection for a reason. Students often choose a guideline because it is familiar or because it appears first in a search, then spend the essay applying it without asking whether it fits. A guideline designed for acute hospital dying may not address the specific challenges of home-based palliative care for a patient with a progressive neurological disease. Research on the implementation of end-of-life care pathways in community settings shows that guideline applicability varies with care context, and that uncritical application can generate recommendations that families cannot enact (Johnson et al., 2023). The stronger move is to compare two candidate guidelines briefly, explain what each covers and what each omits, and then justify the selection in relation to Tyler’s circumstances. That comparison demonstrates the critical appraisal the rubric rewards and protects against the charge that the guideline was chosen arbitrarily.

Common Misconception About Critique

Students frequently treat critique as fault-finding. The rubric asks for strengths as well as gaps, and the high-distinction descriptor requires a balanced evaluation. A critique that lists every failure of the clinical team without acknowledging what was done well is not a critique; it is an indictment. The care Tyler received included appropriate symptom assessment and medication management. Those elements matter because they establish that the clinical team was engaged, not negligent. The critique becomes more credible when it acknowledges that engagement and then asks why it did not extend to advance care planning. The same logic applies to the consequences section. Students sometimes write that the patient “suffered” without explaining what suffering means in this context or how it connects to the gap. A stronger analysis distinguishes between physical suffering, which the team addressed, and existential or relational suffering, which the communication gap left unaddressed. That distinction shows the examiner that the student understands the difference between symptom control and holistic palliative care.

Conclusion

This critique rewards students who anchor every judgment in a named guideline and a named standard. The four sections build an argument: the guideline establishes the benchmark, the critique measures the care against it, the consequences section explains why the gap matters, and the recommendations propose a remedy. Students who write general descriptions of palliative care principles will meet the lower bands. Students who select a guideline with justification, evaluate the case against specific recommendations, and propose recommendations that a clinical team could actually implement will meet the higher bands. The Tyler Morton case contains enough detail to support a rich critique. The task is to use that detail rather than to summarise it.

References

Australian Commission on Safety and Quality in Health Care. (2021). National Safety and Quality Health Service Standards (2nd ed.). ACSQHC. https://www.safetyandquality.gov.au/standards/nsqhs-standards

Johnson, C., Parker, D., & Chen, L. (2023). Implementing end-of-life care pathways in community settings: Barriers, enablers, and adaptations. Palliative Medicine, 37(4), 512–528. https://doi.org/10.1177/02692163231154762

Nursing and Midwifery Board of Australia. (2016). Registered nurse standards for practice. NMBA. https://www.nursingmidwiferyboard.gov.au/codes-guidelines-statements/professional-standards/registered-nurse-standards-for-practice.aspx

Palliative Care Australia. (2023). National Palliative Care Standards (5th ed.). PCA. https://palliativecare.org.au/standards

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Critiquing Palliative Care for Tyler Morton: Advance Care Planning and Breathlessness in ALS

Tyler Morton’s care demonstrates competent symptom management but reveals a serious gap in advance care planning, communication, and coordinated home-based palliative care. The most appropriate Clinical Practice Guideline for this critique is the National Institute for Health and Care Excellence guideline, Motor neurone disease: assessment and management (NG42), because it directly addresses respiratory decline, breathlessness, end-of-life planning, and family involvement in motor neurone disease. Tyler’s progressive weakness, dysphagia, worsening respiratory function, pain, distress, and preference to die at home place him squarely within the guideline’s scope. The central argument is that Tyler received responsive symptom care, but the clinical team did not adequately identify, document, or act on his existing Advance Health Directive and home-death preference; consequently, the care risked avoidable distress, unwanted hospital transfer, and unnecessary decision-making burden for Catherine.

Guideline selection and justification

NICE guideline NG42 is the most suitable benchmark because it provides disease-specific recommendations for people with motor neurone disease, including amyotrophic lateral sclerosis. It covers the organisation of care, respiratory assessment and support, symptom management, advance care planning, and preparation for end of life (National Institute for Health and Care Excellence [NICE], 2019). Tyler’s clinical picture matches these priorities. He has significant functional decline, dysphagia, declining respiratory function, breathlessness, pain, and recurrent distress. A general end-of-life guideline may address dying well, but it does not provide the same level of disease-specific guidance on non-invasive ventilation, respiratory deterioration, dysphagia, and anticipatory planning in ALS.

The guideline recommends early palliative-care involvement, regular respiratory assessment, and discussion of respiratory support when dyspnoea or signs of hypoventilation emerge (NICE, 2019). It also directs clinicians to discuss end-of-life preferences and assist patients to document advance care plans before communication or cognition deteriorates (NICE, 2019). Tyler’s case makes these recommendations especially relevant. He has already expressed a wish to die at home, while Catherine holds an Advance Health Directive that has not been discussed with the clinical team. The guideline therefore offers a precise standard against which the care can be measured.

MND Australia’s guidance reinforces the same priorities. It recommends early palliative-care input, repeated discussion of life-sustaining treatment preferences, assistance with advance directives, and early referral to home-based or hospice services before the terminal phase (MND Australia, n.d.). Tyler’s care appears to have involved a community nurse and general practitioner, which suggests some palliative support. However, the absence of documented communication about the Advance Health Directive indicates that the team did not fully operationalise the planning component of the guideline.

An alternative guideline, the Australian Commission on Safety and Quality in Health Care’s National Consensus Statement: Essential elements for safe and high-quality end-of-life care, could also apply. It establishes broad expectations for person-centred, coordinated end-of-life care and defines advance care planning as a process that makes a person’s values and preferences known for future decision-making (Australian Commission on Safety and Quality in Health Care [ACSQHC], 2023). It is useful for evaluating Tyler’s care, but it is less disease-specific than NICE NG42. It does not provide the detailed ALS-focused recommendations on respiratory decline, non-invasive ventilation, dysphagia, and anticipatory symptom management that Tyler’s presentation demands.

The NICE guideline is therefore selected because it offers both clinical specificity and end-of-life guidance. It enables the critique to assess not only whether Tyler’s symptoms were managed, but also whether the team anticipated the predictable trajectory of ALS. The choice matters because ALS progresses in a way that makes early planning clinically urgent. Delaying conversations until respiratory failure or acute distress occurs may remove Tyler’s opportunity to participate meaningfully in decisions about his care.

Critique of care

The care provided to Tyler shows several strengths, particularly in symptom recognition and pharmacological management. The case records pain, breathlessness, and episodes of distress, and the team appears to have assessed and treated these symptoms. This responsiveness aligns with the National Palliative Care Standards, which require services to assess and respond to the physical, psychological, social, and spiritual needs of the person and family (Palliative Care Australia [PCA], 2018). Tyler’s pain and breathlessness were not ignored. The presence of a medication regimen, community nursing input, and general-practitioner involvement indicates that the clinical team recognised his deteriorating condition and remained engaged.

Breathlessness deserves particular attention because it is both a physical symptom and a source of fear. CareSearch identifies opioids, particularly morphine, as first-line pharmacological treatment for refractory dyspnoea in palliative care, while non-pharmacological measures such as repositioning and airflow from a fan may provide additional relief (CareSearch, 2026). MND Australia similarly recommends opioids for symptomatic dyspnoea and intractable pain, with benzodiazepines considered when anxiety contributes to respiratory distress (MND Australia, n.d.). If Tyler received appropriate assessment, titrated medication, and non-pharmacological support, the team met an important element of palliative care.

The major weakness lies in advance care planning. Catherine holds Tyler’s Advance Health Directive, but the case provides no evidence that the clinical team reviewed it, discussed it with Tyler, or incorporated its contents into the care plan. NICE expects clinicians to identify and document a person’s preferences for future care, including preferences about respiratory support and place of death (NICE, 2019). Tyler’s stated wish to die at home is clinically significant, but it appears to remain informal rather than translated into a documented, shared plan. This creates a gap between what Tyler wants and what the care team can reliably deliver.

The National Palliative Care Standards reinforce this concern. They emphasise that care should be coordinated, responsive to the person’s goals, and inclusive of family and carers (PCA, 2018). Tyler’s home-death preference and Catherine’s possession of the directive should have prompted a structured conversation involving Tyler, Catherine, the general practitioner, and the community nurse. The team may have assumed that Catherine’s possession of the document meant its contents were known. That assumption is unsafe. An Advance Health Directive has clinical value only when its instructions are understood, verified, documented, and accessible to those making decisions.

Communication with Catherine also appears incomplete. The case does not show evidence that she received clear information about Tyler’s likely trajectory, the meaning of respiratory decline, available treatments, or the practical steps required to support a home death. The National Consensus Statement states that end-of-life care should involve the person, loved ones, and carers in decisions and should be coordinated across services (ACSQHC, 2023). Catherine is not merely a bystander in Tyler’s care. She is likely providing daily support, observing deterioration, and potentially needing to make urgent decisions if his condition worsens.

A further gap concerns the coordination of care. Tyler receives support from a community nurse and a general practitioner, but the case does not establish a clear shared care plan, documented escalation pathway, or agreed response to acute breathlessness. In ALS, respiratory deterioration can occur quickly, and unplanned emergency intervention may conflict with a person’s preferences (MND Australia, n.d.). Without a documented plan, a night-time crisis could lead to an ambulance call, hospital transfer, or invasive interventions that Tyler may not want. The absence of such planning does not necessarily mean the team acted negligently. It does mean the care was incomplete when measured against the expectations of the selected guideline and national standards.

Consequences and gaps

The consequences of these gaps affect Tyler, Catherine, and the clinical team in connected ways. For Tyler, the most immediate risk is that his preference to die at home may not be honoured. If he develops acute respiratory distress and no clinician has documented his wishes, emergency services may transfer him to hospital. Such a transfer may increase physical discomfort, disrupt familiar surroundings, and expose him to interventions he did not choose. His pain and breathlessness may be treated, but his autonomy and sense of control may be undermined.

Tyler may also experience psychological distress. Breathlessness is frightening, particularly when a person knows that respiratory function is declining. If he believes that his home-death preference has not been heard, he may fear abandonment, loss of control, or unwanted treatment. The clinical team may have managed his physical symptoms, but it may not have addressed the existential and relational dimensions of his suffering. Palliative care is intended to minimise distress for both the dying person and those close to them (ACSQHC, 2023). A failure to discuss the Advance Health Directive therefore has consequences beyond paperwork.

For Catherine, the gap creates a heavy and avoidable burden. She holds a legal document but may not know whether its contents reflect Tyler’s current wishes. She may also be uncertain about what to do during a crisis, whom to contact, or whether hospital transfer would align with Tyler’s preferences. The National Palliative Care Standards recognise family members and carers as partners in care, not simply recipients of information (PCA, 2018). Catherine needs clear, timely communication and practical guidance to fulfil that role without carrying the entire decision-making load alone.

The clinical team also faces consequences. Incomplete documentation of Tyler’s preferences creates uncertainty for nurses, general practitioners, and after-hours services. Different clinicians may make different assumptions about resuscitation, hospital transfer, non-invasive ventilation, or symptom management. This inconsistency can fragment care and expose the team to ethical and legal uncertainty. A documented advance care plan would not remove clinical judgement, but it would provide a clear reference point for decisions made during deterioration.

The gaps are interconnected. Poor communication leads to incomplete documentation; incomplete documentation increases the likelihood of inconsistent decision-making; inconsistent decision-making increases Tyler’s risk of unwanted transfer and Catherine’s distress. The problem is therefore not a single missed conversation. It is a failure to convert Tyler’s known preferences into a coordinated, actionable plan.

Recommendations

The clinical team should arrange a structured advance care planning meeting within the next routine home visit. The meeting should include Tyler, Catherine, the general practitioner, and the community nurse. Its purpose would be to review the Advance Health Directive, confirm that it reflects Tyler’s current wishes, document his preference for home-based care, and clarify his views on hospital transfer, non-invasive ventilation, resuscitation, and symptom-focused treatment.

The team should then record the outcomes in a shared care plan accessible to all involved clinicians. This plan should identify Tyler’s preferred place of care, Catherine’s role, after-hours contacts, escalation procedures, and medication instructions for anticipated breathlessness or distress. MND Australia recommends early referral to home-based or hospice services and repeated review of life-sustaining treatment preferences, particularly as respiratory function declines (MND Australia, n.d.). A documented plan would make Tyler’s wishes visible across settings and reduce the likelihood of crisis-driven decisions.

Symptom management should also be reviewed proactively. The team should assess breathlessness using a validated measure, review the effectiveness and side effects of current medication, and consider low-dose opioids where clinically appropriate. CareSearch identifies opioids as first-line pharmacological treatment for dyspnoea in advanced disease, with non-pharmacological strategies such as repositioning and airflow used alongside medication (CareSearch, 2026). Any plan should balance relief of breathlessness with Tyler’s preferences concerning alertness, sedation, and family involvement.

Finally, the team should provide Catherine with written, plain-language information about what to expect as ALS progresses, how to recognise worsening respiratory distress, and whom to contact out of hours. This recommendation aligns with the National Palliative Care Standards’ emphasis on family support and coordinated care (PCA, 2018). It also aligns with the National Consensus Statement’s expectation that end-of-life care should be planned and delivered in partnership with the person and their loved ones (ACSQHC, 2023). These actions would convert Tyler’s preference for a home death from a private wish into a clinically supported plan.

References

Australian Commission on Safety and Quality in Health Care. (2023). National Consensus Statement: Essential elements for safe and high-quality end-of-life care. ACSQHC. https://www.safetyandquality.gov.au/sites/default/files/resources/attachments/national_consensus_statement_-essential_elements_for_safe_and_high-quality_end-of-life_care.docx

CareSearch. (2026, September 28). Dyspnoea: Clinical evidence summaries. https://www.caresearch.com.au/Evidence/Clinical-Evidence-Summaries/Dyspnoea/

MND Australia. (n.d.). End of life in MND. https://www.mndaustralia.org.au/info/for-health-professionals/end-of-life-in-mnd/

National Institute for Health and Care Excellence. (2019). Motor neurone disease: Assessment and management (NICE guideline NG42). https://www.nice.org.uk/guidance/ng42

Palliative Care Australia. (2018). National Palliative Care Standards (5th ed.). https://palliativecare.org.au/wp-content/uploads/dlm_uploads/2018/11/PalliativeCare-National-Standards-2018_Nov-web.pdf