Download Simulation 3 Template

Simulation Design Template:
Lucy Grey-Simulation #3
Date:
Discipline: Nursing
Expected Simulation Run Time: 20
minutes
Location: Simulation lab
Admission Date:
File Name: Lucy Grey
Student Level:
Guided Reflection Time: 20 minutes
Location for Reflection: Debriefing room
|
Today’s Date:
Brief Description of Client
Name: Lucy Grey
Gender: F Age: 74
Race: Caucasian Weight: 50 kg Height: 64 in
Religion: Unitarian
Major Support: Lucy Grey Support Phone: 555-1210
Allergies: no known allergies
Immunizations: Influenza vaccine, yearly
Attending Physician/Team: Dr. Barbara Green
Past Medical History: osteoarthritis; right knee replacement at age 65
History of Present Illness:
History of falls, once a month since the death of her partner. Had comprehensive neurological work-up with no
physiological abnormalities noted.
Social History: Single, lives alone, partner Julia Morales died 3 months ago. Retired teacher.
Primary Medical Diagnosis: Fall at home
Surgeries/Procedures & Dates: Right total knee replacement at age 65
Nursing Diagnoses: Anxiety, grieving, risk for falls, risk for injury, ineffective coping, risk for loneliness
Psychomotor Skills Required Prior to Simulation

General assessment skills
Lucy Grey Simulation 3
© National League for Nursing, 2015
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Cognitive Activities Required Prior to Simulation
[i.e. independent reading (R), video review (V), computer simulations (CS), lecture (L)]
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
SBAR or other standardized tool to communication tool. (R)
Basic knowledge of geriatric syndromes and the atypical presentation of older adults. (L, R)
Tools in the Try This: ® and How to Try This Series, available at http://consultgerirn.org/resources.
Specific tools recommended for this scenario are the SPICES, and Hendrich II Fall Risk Model and the
Geriatric Depression Scale.(R)
The Generalized Anxiety Disorder 7 (GAD-7). (R)
Readings related to grieving and to the care of the older adult. (R)
Simulation Learning Objectives
General Objectives
1. Practice standard precautions throughout the exam.
2. Employ effective strategies to reduce risk of harm to the client.
3. Assume the role of team leader or member.
4. Perform a focused physical assessment noting abnormal findings.
5. Recognize changes in patient symptoms and/or signs of patient compromise.
6. Perform priority nursing actions based on clinical data.
7. Reassess/monitor patient status following nursing interventions.
8. Perform within scope of practice.
9. Demonstrate knowledge of legal and ethical obligations.
10. Communicate with client in a manner that illustrates caring for his/her overall well-being.
11. Communicate appropriately with physician and/or other healthcare team members in a timely,
organized, patient-specific manner.
Simulation Scenario Objectives
1.
2.
3.
4.
5.
Perform physical and other assessments as necessary of an older adult.
Identify client’s concerns of loneliness and grieving.
Assess and inform physician of normal exam except for abrasion on right forearm.
Use therapeutic communication techniques and help client identify her concerns.
Assist client and family member to identify plan for frequent visits and “checking in” with client to
decrease her anxiety and fears.
6. Use the SBAR or another standardized tool to communicate with other health care professionals.
Lucy Grey Simulation 3
© National League for Nursing, 2015
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References, Evidence-Based Practice Guidelines, Protocols, or
Algorithms Used for This Scenario:
These and other tools in the Try This: ® and How to Try This Series are available on the ConsultGeriRN.org
(http://consultgerirn.org/resources), the website of the Hartford Institute for Geriatric Nursing, at New York
University’s College of Nursing. The tool, an article about using the tool, and a video illustrating the use of the
tool are all available for your use.
SPICES- An Overall Assessment Tool:
Tool: http://consultgerirn.org/uploads/File/trythis/try_this_1.pdf
Video: http://consultgerirn.org/resources/media/?vid_id=4200873#player_container
The Geriatric Depression Scale:
Tool: http://consultgerirn.org/uploads/File/trythis/try_this_4.pdf
Video: http://consultgerirn.org/resources/media/?vid_id=4200933#player_container
The Fall Risk Assessment:
Tool: http://consultgerirn.org/uploads/File/trythis/try_this_8.pdf
Video: http://consultgerirn.org/resources/media/?vid_id=4200978#player_container
Readings related to grieving after loss of a family member: Example:
Article: Bent & Magilvy. (2006). When a partner dies: Lesbian widows. Issues in Mental Health Nursing, 27,
447-459.
Explore resources in the community available to older adults with identified needs.
A Brief Measure for Assessing Generalized Anxiety Disorder:
Spitzer, R.L., Kroenke, K., Williams, J.B., Lowe, B. (2006) A brief measure for assessing generalized
anxiey disorder: The GAD-7. Archives of Internal Medicine, 166, !092-1097. Retrieved from:
http://archinte.ama-assn.org/cgi/content/full/166/10/1092/IOI60000F1.
Review the Essential Nursing Actions in the ACES Framework at: http://www.nln.org/professionaldevelopment-programs/teaching-resources/aging/ace-s/nln-aces-framework
Fidelity (choose all that apply to this simulation)
Setting/Environment:
ER
Med-Surg
Peds
ICU
OR / PACU
Women’s Center
Behavioral Health
Medications and Fluids:
IV Fluids:
Oral Meds:
IVPB:
IV Push:
IM or SC:
Diagnostics Available:
Lucy Grey Simulation 3
© National League for Nursing, 2015
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Home Health
Pre-Hospital
Other:
Labs
X-rays (Images)
12-Lead EKG
Other:
Simulator Manikin/s Needed: manikin or
standardized patient
Documentation Forms:
Physician Orders
Props: Patient needs scrape on right arm with
Admit Orders
bleeding.
Flow sheet
Medication Administration Record
Equipment Attached to Manikin:
Kardex
IV tubing with primary line
Graphic Record
fluids running at mL/hr
Shift Assessment
Secondary IV line running at mL/hr
Triage Forms
IV pump
Code Record
Foley catheter mL output
Anesthesia / PACU Record
PCA pump running
Standing (Protocol) Orders
IVPB with running at mL/hr
Transfer Orders
02
Other:
Monitor attached
ID band
Recommended Mode for Simulation:
Other: IV to saline lock
(i.e. manual, programmed, etc.)
Equipment Available in Room:
Bedpan/Urinal
Foley kit
Straight Catheter Kit
Incentive Spirometer
Fluids
IV start kit
IV tubing
IVPB Tubing
IV Pump
Feeding Pump
Pressure Bag
02 delivery device (type)
Crash cart with airway devices and
emergency medications
Defibrillator/Pacer
Suction
Other:
Any type of human patient simulator. Fidelity in
communication is improved if actor or
standardized patient is used for Lucy in this
scenario. Can use monitor display to provide vital
signs.
Student Information Needed Prior to
Scenario:
Has been oriented to simulator
Understands guidelines /expectations for
scenario
Has accomplished all pre-simulation
requirements
All participants understand their assigned
roles
Has been given time frame expectations
Other:
Lucy Grey Simulation 3
© National League for Nursing, 2015
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Roles/Guidelines for Roles:
Primary Nurse
Secondary Nurse
Clinical Instructor
Family Member #1
Family Member #2
Observer/s
Recorder
Physician/Advanced Practice Nurse
Respiratory Therapy
Anesthesia
Pharmacy
Lab
Imaging
Social Services
Clergy
Unlicensed Assistive Personnel
Code Team
Other: neighbor Adele
Important Information Related to Roles:
Report Students Will Receive Before Simulation
Time: 12:30 PM
(From paramedics who brought Lucy to the ED.) “Patient called 911 after having a dizzy spell and near fall in
her home. When we arrived she was sitting on her couch in her living room. Her blood pressure is 160/88,
heart rate is 102, respirations are 20, and her oxygen saturation is in the 90s. She is on 2 liters of oxygen per
nasal cannula. She was alert and coherent and apologetic for calling us. Denies taking any medications today,
states she had tea and oatmeal for breakfast. No complaints of pain, she has good mobility, a little slow due to
‘stiff knees.’ There is a scrape on her arm; we just taped a gauze pad on it. We have a saline lock in her right
forearm.”
Significant Lab Values:
refer to chart
Physician Orders:
refer to chart
Home Medications:
refer to chart
Scenario Progression Outline
Lucy Grey Simulation 3
© National League for Nursing, 2015
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Timing
(approx.)
0-5 min
Manikin Actions
Expected
Interventions
May Use the
Following Cues
Lucy: “I'm sorry to be a bother.
I'm probably fine. I scraped my
arm on the coffee table I think.”
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Introduce self
Identify patient
Take vital signs
Should do
orthostatic blood
pressures.
Begin
assessments,
both the general
assessment and
use tools
students deem
appropriate.
Role member
providing cue:
Cue:
Nurses should
ask about details
of medications,
when, dose, how
often, effects of
medications on
sleep and
general cognition
 Continue
assessment
 Use therapeutic
communication,
listening to
patient's
concerns.
Encourage Lucy
to verbalize her
fears.
Role member
providing cue:
Cue:

Role member
providing cue: Nora
Cue: What else do
you think we could
do to help Aunt Lucy
not be so scared?”
Can we get Meals
on Wheels, or what
else is out there for
her?
“You know my neighbor died in
his home a few weeks ago. He
lived alone. They found him on
the floor. Probably his heart.”
5-10 min
“I don’t like being alone. I’m
afraid sometimes.”
“Sometimes I can't sleep and I
have to take a pill. Ambien… or
Benadryl.”
10-20
min
Niece Nora and/or neighbor
Adele arrive.
“Aunt Lucy, what happened!? I
was so worried!”
Lucy: “Oh, I’m sorry to worry
you. I just got a little dizzy. I
suspect I’ll be fine. Don't anyone
tell me I need to move out of my
house.”
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Note patient’s
concerns and
explore fears.
Involve
friend/family in
forming plan for
patient.
Help discover
ways to alleviate
fears using
Lucy Grey Simulation 3
© National League for Nursing, 2015
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Emergency room physician
enters room and Lucy states:
“Oh, doctor, I’m here again, so
sorry. I think I’m probably OK
now; they are taking care of me.”
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
resources
available.
Nurses need to
give report
Should follow
SBAR or other
tool. Need to
include vital
signs and
address other
concerns as well,
including
cognitive state,
and patient's
fears.
Role member
providing cue:
Physician
Cue: Order labs
CBC and
electrolytes, order
social service
consult for help with
resources including
a bereavement
support group.
Debriefing/Guided Reflection Questions for This Simulation
(Remember to identify important concepts or curricular threads that are specific to your program)
1.
How did you feel throughout the simulation experience?
2.
Describe the objectives you were able to achieve. What were Lucy’s objectives? Why do you think she
is really calling 911?
3.
Were you satisfied with your ability to work through the simulation?
4.
To Observer: Could the nurses have handled any aspects of the simulation differently?
5.
If you were able to do this again, how could you have handled the situation differently?
6.
What did the group do well?
7.
What did the team believe was the primary nursing diagnosis? Is this the same as Lucy’s primary
concern?
8.
What were the key assessments and interventions?
9.
How were you able to use the ACES Framework with Julia’s situation? (Assess Function and
Expectations, Coordinate and Manage Care, Use Evolving Knowledge, Make Situational Decisions)
10. How were physical and mental health aspects interrelated in this case?
11. Is there anything else you would like to discuss?
Complexity – Simple to Complex
Lucy Grey Simulation 3
© National League for Nursing, 2015
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Suggestions for Changing the Complexity of This Scenario to Adapt to Different Levels of Learners
1. The simulation could be modified with the addition of abnormal assessments showing an increase in
confusion, possibly Alzheimer’s disease.
2. Learners could have an in-depth discussion of normal grieving versus dysfunctional grieving patterns.
3. Learners could be expected to find appropriate services for Lucy during the simulation. These could be
available in a resource book in the simulation lab.
4. Students could use the Texas Revised Inventory of Grief
(http://www.apa.org/pi/about/publications/caregivers/practice-settings/assessment/tools/texasgrief.aspx) a tool that can provide additional information to help differentiate the origin of Lucy’s
difficulties adjusting to life without her partner.
5. Lucy could have a panic attack and students could use the Impact of Event Scale - Revised (IES-R),
(http://consultgerirn.org/uploads/File/trythis/try_this_19.pdf) to assess her current stress level.
Lucy Grey Simulation 3
© National League for Nursing, 2015
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