Jack, 83 years old, lives with his wife Martha in a detached house. The couple have no children and no other family are living nearby. Jack recently visited the health-care centre due to several recent falls. No somatic cause for the falling was found at that time. Jack was advised to continue to exercise and eat and drink sufficient fluids. Jack has a history of hypertension and gout.
Jack’s functional ability has slowly deteriorated due to age and his gout. He now requires daily help with everyday activities at home like washing and dressing himself. Jack has good cognition, can administer his own medication and feels safe at home. The main concern relates to his physical functional ability. He requires extra support and assistance with daily living activities. Jack still has a good appetite and enjoys his food, however Martha finds it challenging to provide the type of meals that are recommended for patients with gout, a condition that Jack was diagnosed with a number of years ago.
Within the last month, Jack has already fallen twice. He was not hurt but could not get up on his own. After his last fall, his wife, Martha hurt her back helping him up.
In summary Jack requires immediate support from the home care service to assist with washing and dressing and an assessment of other requirements, with a specific focus on mobility aids, mobility safety and dietary requirements.
General Information
| Course | Paramedics |
| Year | 3rd Year |
| Title of Simulation | Evaluation of the functional ability of an elderly patient in emergency care |
| Main Focus | Evaluation of the functional ability of an elderly patient and evaluating further care needs. |
| Time | Mid-day |
| Other |
Learning Outcomes For Course
| On completion of this programme the learner |
| - Can evaluate the needs of an elderly patient with a particular focus on the activities of daily living. |
| - Can assess the potential support structures that are required to ensure a person’s safety at home. |
| - Is conversant with legislative requirements with respect to reporting patient needs to home care services. |
| - Demonstrates knowledge of the correct reporting procedures and the appropriate services to contact. |
| - Demonstrates a capacity to work in collaboration with the ambulance unit personnel. |
| - Understands the meaning of interprofessional collaboration in determination of an elderly patient’s need for services. |
Essential Pre-Learning
| The law of supporting functional ability of elderly citizens and of the social and health services of elderly citizens §3, §15, §25 (Laki ikääntyneen väestön toimintakyvyn tukemisesta sekä iäkkäiden sosiaali- ja terveyspalveluista) www.finlex.fi/fi/laki/ajantasa/2010/20101326#L4P39 |
| The law of social services §35-38 (Sosiaalihuoltolaki) https://www.finlex.fi/fi/laki/ajantasa/2014/20141301 |
| The summarised pre-learning material (delivered to learners in advance as an email attachment) |
| Cultural competency framework: https://www.ceh.org.au/framework-cultural-competence/ |
Summary of Simulation
Debrief:
Please utilize the debrief Model appropriate to your facility and use the expectations and evaluation criteria to guide the debriefing process. .
The post-simulation debrief is an essential part of simulation based education. The aim is to facilitate the reflective process, which assists learners to make connections and integrate new experiences
| Specific Objectives for Simulation | Evaluation Criteria (E=Error) (CE=Critical Error) | |
| Patient Assessment | - Primary assessment - Trauma assessment • ABCDE to include all vital signs, oxygen saturation, blood glucose and GCS. - Secondary assessment • Assessment of homecare needs including activities of daily living, mobility and dietary requirements | Is the assessment completed accurately using the ABCDE model? Is consideration given to the possibility of trauma prior to moving the patient? Do the team adequately assess activities of daily living? What functional assessments are completed? |
| Situation Awareness | not applicable | not applicable |
| Clinical Decision making | - Primary assessment: no need for treatment - Secondary assessment: no need for treatment or for a visit to the ’ER’ - Evaluation of functional ability: imminent need for home care services, mobility assistance and support for specific dietary requirements. | Is the patient transported to ER? Is the need for services recognised? Was the patient’s functional ability evaluated with consideration given to his diverse requirements? Did the team give due consideration to Martha’s resources and her concerns? |
| Technical skills | - Reporting the homecare needs to the appropriate home care services | Did the outcome include a report to the home care services or a plan to ensure the patient’s safety at home? |
| Communication and Team work | - Effective communication between team members - Effective communication with external resources - Patient and family-focussed communication throughout the scenario | Was there evidence of patient and family-focussed communication? Did the team display empathy and sensitivity when discussing the potential need for home care services with Jack and Martha? Was there evidence of effective team communication i.e. between the paramedics themselves and the services they reported to? Did the team perform a midway debrief? |
Patient handover information
Case Study Set-up Information
| Simulation 2 Frame 1 | ||
| Primary assessment: ABCDE | Patient | |
| RR (Respiratory Rate) | ~20 | |
| Resp other | Normal rate and depth, no evidence of respiratory distress, no cyanosis | |
| Chest Sounds | ||
| SpO2 (Oxygen Saturations) | ||
| Oxygen therapy | ||
| BP (Blood pressure) | radial pulse | |
| HR (Heart Rate) | ~80 | |
| AVPU (Alert, Verbal, Pain , Unresponsive) | ||
| Temperature | ||
| EWS (Early Warning System) | ||
| Cardiac Monitor | ||
| Capillary refill | ||
| Skin | ||
| Cap blood sugar(Capillary blood sugar) | ||
| Urinary Output | ||
| IV cannula (Intravenous cannula) | ||
| IV hydration | ||
| Pain | + | |
| PCA (Patient Controlled Analgesia) | ||
| Bowel Sounds | ||
| Abdomen | ||
| NG (Naso-Gastric Tube) | ||
| Wound | - | |
| Drain | ||
| GCS | 15 | |
| Trauma assessment | - |
| Simulation 2 Frame 2 | ||
| Secondary assessment | Patient | |
| RR (Respiratory Rate) | 20 | |
| Resp other | 0/0 | |
| Chest Sounds | ||
| SpO2 (Oxygen Saturations) | 97 | |
| Oxygen therapy | ||
| BP (Blood pressure) | 130/90 | |
| HR (Heart Rate) | 80 | |
| AVPU (Alert, Verbal, Pain , Unresponsive) | ||
| Temperature | 36,7 | |
| EWS (Early Warning System) | ||
| Cardiac Monitor | Sinus-rhythm, normal ECG | |
| Capillary refill | 1 second | |
| Skin | Normal | |
| Cap blood sugar(Capillary blood sugar) | 5,8 | |
| Urinary Output | Normal | |
| IV cannula (Intravenous cannula) | ||
| IV hydration | ||
| Pain | 1 (joints, chronic) | |
| PCA (Patient Controlled Analgesia) | ||
| Bowel Sounds | + | |
| Abdomen | Normal | |
| NG (Naso-Gastric Tube) | ||
| Wound | ||
| Drain |
