Male teenager ‘Paul’ (13 years) (Paul Scanlon Dob: 30/05/05) an inpatient on children’s ward. He requires intimate care provision as both arms fractured and in casts. The patient does not want to be assisted by a female nurse. A male nurse is unavailable on this shift.
General Information
| Course | BSc Nursing (Adult Field) |
| Year | 2nd Year |
| Title of Simulation | Simulation 1 |
| Main Focus | Fundamental care provision |
| Time | 15 minutes + 15 minutes debriefing |
| Other |
Learning Outcomes For Course
| General patient assessment using the A-E (Airway, breathing, circulation, disability, environment) approach. |
| Promotion of patient safety. |
| Demonstrates practice emanating ethical principles such as advocacy. |
| Shows sound clinical judgement and performs appropriate clinical interventions. |
| Demonstrates safe technical skills and prevents and controls the spread of infection. |
| Displays effective communication to team members using escalation tools and appropriate documentation. |
| Displays patient centered communication. |
| Demonstrates understanding of individualized culturally competent care. |
Essential Pre-Learning
| Refer to key lecture notes pertaining to ethics and key ethical principles |
| Revise materials on ethical, legal and professional principles underpinning healthcare delivery |
| Revise key protocols; The Code; NICE guidelines; person centered care principles |
| Revisit simulation presentation and relevant Lt material |
| 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
Simulation education enables the inclusion of human factors and the consequence that these might have within the sphere of healthcare. Hence simulation education is one of the most effective ways of enabling students across disciplines to learn about and be aware of human factors and how these might impact on patient safety. As health care professionals seldom work in isolation interprofessional simulation education is recognized to be the most valuable (Dekker 2011).
| Specific Objectives for Simulation | Evaluation Criteria (E=Error) (CE=Critical Error) | |
| Patient Assessment | Systematic patient assessment (ABCDE approach) Measurement and recording of vital signs (PAWs) Pain assessment - including pain scale Nursing diagnosis/establishes healthcare need | No attempt to meet patients’ expectations (CE) Disregards patient’s preference (CE) Inability to problem solve (E) Fails to seek guidance (E) Failure to convey patient preference to team members (E) Failure to consider all aspects of patient safety (E) or (CE) |
| Situation Awareness | Perception and comprehension of nursing diagnosis/patient problem (vitals, pain, embarrassment/distress) Understands request for gender specific nurse Understands need to escalate patient preference to team members Human factors relating to patient safety | Failure to identify need for care provision (E) Practice apparently lacking underpinning ethical principles (E) Failure to convey patient preference to team members (E) Non-compliant with policies and procedures (E) Failure to consider all aspects of patient safety (E) or (CE) |
| Clinical Decision making | Assesses patient as physiologically uncompromised Listens to patient concerns/preferences Understands request for gender specific nurse Problem solves attempting to meet patient expectations Seeks guidance Understands need to escalate patient preference to team members Human factors relating to patient safety | No attempt to meet patients’ expectations (CE) Disregards patient’s preference (CE) Inability to problem solve (E) Fails to seek guidance (E) Failure to convey patient preference to team members (E) Failure to consider all aspects of patient safety (E) or (CE) |
| Technical skills | Correct hand hygiene and infection control measures throughout Technical skills- patient monitor, vital signs. | Insufficient infection control measures (CE) Unfamiliarity with technical skills (E) |
| Communication and Team work | Establishes nurse/patient relationship using active listening and appropriate body language. Uses patient friendly language Recognises and respects preference of patient in relation to healthcare providers gender Uses ISBAR to escalate care requirements Documents interventions and preferences Displays team focused communication | Failure to use ISBAR (E) Failure to communicate appropriately with patient (E) Failure to communicate appropriately with colleagues/team (E) Insensitive to cultural needs (E) |
| Other |
Patient handover information
Case Study Set-up Information
| Simulation 2 Frame 1 | ||
| Facilitator: Alter patient parameters in response to student actions (counting down from 20 minutes – 13 minutes) | Patient | |
| RR (Respiratory Rate) | Respirations [15] (usual range 15-22) | No observations until monitoring attached-simulate real time |
| Resp other | Patient in gown. I need to get dressed my mates are coming and I am in a dress! I don’t want you washing my bits; no way! I want a male nurse to help me. Yesterday Joe helped me. I want Joe! You are not seeing my bits! Go away! I am not washing. Becomes emotional showing vulnerability. | |
| Chest Sounds | Chest clear-equal air entry no added sounds | |
| SpO2 (Oxygen Saturations) | Oxygen saturation levels [99%] (95%-100% normal range). | |
| Oxygen therapy | On room air | |
| BP (Blood pressure) | Blood pressure [112/63] (90-140 systolic normal range) 1 point on PAWs | |
| HR (Heart Rate) | Pulse [88] (66-100 normal range) | |
| AVPU (Alert, Verbal, Pain , Unresponsive) | Alert Glasgow coma scale (GCS) [15/15] (15/15 normal; 4/4 for eye opening, 5/5 for verbal response, 6/6 for motor response). Pupils are equal and reacting to light (PEARL), 3mm in size (PEARL and 3-5mm is normal) | |
| Temperature | Temperature [36.2] (35-38.9 normal range). | Clothes smell of body odor |
| EWS (Early Warning System) | 8 years+ chart/scoring 1 | |
| Cardiac Monitor | Not attached-if attached normal sinus rhythm | |
| Capillary refill | < 2secs [normal] | |
| Skin | Warm to touch | |
| Cap blood sugar(Capillary blood sugar) | Glucose is 5.8mmols/L] (4-9 mmols/L is the normal range) if checked | |
| Urinary Output | >1ml/kg/hr | |
| IV cannula (Intravenous cannula) | ||
| IV hydration | ||
| Pain | 2/10 | Pain in both wrist but I am OK with that I recently had some paracetamol thanks |
| PCA (Patient Controlled Analgesia) | ||
| Bowel Sounds | Normal | |
| Abdomen | No distension-if asked | |
| NG (Naso-Gastric Tube) | ||
| Wound | ||
| Drain | ||
| Other | Patient has had all prescribed medications for time being. | |
| Other | Encouragement to treat manikin as patient/person | |
| Other | 8 years+ chart/scoring 1 | |
| LIFESAVER | Enter any instruction that will help facilitators or role player/standardized patient to move on if not progressing |
| Simulation 2 Frame 2 | ||
| Facilitator: Alter patient parameters in response to student actions (counting down from 10 minutes – 0 minutes) | Patient | |
| RR (Respiratory Rate) | Respiratory rate increases [21] | |
| Resp other | Angers if not listened to. Feels vulnerable and embarrassed. If nurse makes no attempt to meet expectations feels bullied. Become loud and starts saying-I hate it here! It is crap! How long am I gonna have to put up with this crap? | |
| Chest Sounds | Chest clear | |
| SpO2 (Oxygen Saturations) | Oxygen saturations [99%] if he is still only breathing room air | |
| Oxygen therapy | ||
| BP (Blood pressure) | Blood pressure is remains normal [122/66] | |
| HR (Heart Rate) | Pulse increases [92] | |
| AVPU (Alert, Verbal, Pain , Unresponsive) | Alert [GCS 15/15] [AVPU] Pupils [PEARL and 3mm]. | |
| Temperature | Temperature normal [36.2] | Clothes smell of body odor |
| EWS (Early Warning System) | 8 years+ chart/scoring 1 | |
| Cardiac Monitor | ||
| Capillary refill | ||
| Skin | Warm pink well perfused | |
| Cap blood sugar(Capillary blood sugar) | ||
| Urinary Output | >1ml/kg/hr | |
| IV cannula (Intravenous cannula) | ||
| IV hydration | ||
| Pain | ||
| PCA (Patient Controlled Analgesia) | ||
| Bowel Sounds | ||
| Abdomen | ||
| NG (Naso-Gastric Tube) | ||
| Wound | ||
| Drain | ||
| Other |  | Care Quality Commission-New fundamental standards [online]. Available from: https://www.qcs.co.uk/useful-guides/cqc-new-fundamental-standards-part-3the-standards/ {accessed 20/05/19} |
| Other |  | Care Quality Commission-New fundamental standards [online]. Available from: https://www.qcs.co.uk/useful-guides/cqc-new-fundamental-standards-part-3the-standards/{accessed 20/05/19} |
| Other | Nursing and Midwifery Council (2018) The code | Nursing and Midwifery Council (2018) The code: Professional standards of practice and behavior for nurses, midwives and nursing associates [online]. Available from: https://www.nmc.org.uk/standards/code/ {accessed 20th May 2019} |
| LIFESAVER | Enter any instruction that will help facilitators or role player/standardized patient to move on if not progressing | Use of plant/senior nurse alternative student |
