7_Missing aspects of care 2: Complaints and resolution

SIMULATION SCENARIO No. 7

You have just arrived on your placement area for the shift in this hospital/care home/residence. Your mentor/supervisor says you have been allocated four (4) patients to care for. You greet each of these patients and look at their diagnosis and care goals and determine what they need in terms of physical care needs including mobilizing, washing and nutrition for this shift. The patients are:

Mrs Rebekah Isaac a 79 year old Jewish lady (widowed).
Miss Doreen Frame, a 72 year old lady who is quite unwell with a terminal disease and may be transferred to the adjacent hospice soon if her care needs increase.
Mrs Sofia Christodoulou an 80 year old Greek Cypriot lady.
Mr Abdul Raheem, a 75 year old Muslim man.

This scene concerns Miss Doreen Frame.

Remind the student of the goals.

Emotion phase
• Ask about their feelings during the exercise: first the patient, then the caregiver and then the nurse.

Fact phase
• What happened – describe what happened step by step (student).
• What went well?
• What did not go well?
• What assumptions were made?

Analysis phase
• What issues arose and why was there distess?
• What ought to have been done (ideas are generated by students, the tutor leads to the conclusions)?
• Encourage Student questions – is anything unclear or not mentioned from the scenario?
• What do you take away from this exercise (each student says 1 item)?
• Why did this situation turn out like this? What ought to have been done? What aspect of care were missing? (Discussion: values, respect, professional behaviour)
• What professional issues are there from this care example (person centred care, empathy, poor recording of social circumstances and next of kin, poor communication)
• Is this situation something that could happen in your country? How would the scene be in your context?
• What type of knowledge would you reflect about in this situation (from a clinical, organizational, in terms of communication, values and attitude perspective?
• Who (other professional staff) would you include into this situation?
• What differences and similarities would you point out?

I am able to recognize signs and symptoms of deterioration in dying patients.

I am able to use open questions to determine the patient/clients need and actions to resolve this.

I am able to define and explain cultural issues related to death, dying and bereavement and necessary interventions or preparations which can be supported.

I am able to analyse and draw on professional accountability and effective accurate documentation especially consequences of inaccuracy.

TOPIC

Missing aspects of care – assumptions of relationships

PREBRIEFING

Scenario topic
Miss Doreen Frame, a 72 year old lady who is quite unwell with a terminal disease and may be transferred to the adjacent hospice soon if her care needs increase. The doctor arrives and tells you he wishes to speak to her as her cancer is worsening and her laboratory tests and physical abilities are worsening. She has very little time left and they need to discuss the next stages and her and her family’s wishes.

Procedure that will be practiced in the scenario:
Get acquainted with the simulation environment (where the scenario takes place, which trainers, phantom will be used, how to use the equipment):
• Room,
• Patient in chair – evident distress

Scenario execution time: 10 mins.

REFERENCES, MATERIALS FOR CLASSES

Video of scenario
Trigger questions
Reflective space

The scenario was prepared based on the content contained in the literature:

Duty of Candor: https://www.nmc.org.uk/globalassets/sitedocuments/nmc-publications/openness-and-honesty-professional-duty-of-candour.pdf
UK Nursing and Midwifery Professional code of practice: https://www.nmc.org.uk/standards/code/
Medicines and Muslim observance: https://pharmaceutical-journal.com/article/opinion/medicines-advice-for-patients-observing-a-halal-diet
Röndahl G, Innala S, Carlsson M. Heterosexual assumptions in verbal and non-verbal communication in nursing. J Adv Nurs. 2006 Nov;56(4):373-81. doi: 10.1111/j.1365-2648.2006.04018.x. PMID: 17042817. https://pubmed.ncbi.nlm.nih.gov/17042817/
H (2011) Older people in care homes: sex, sexuality and intimate relationships. RCN Guidance document. https://www.equalityhumanrights.com/sites/default/files/004136.pdf
AgeUK – Bereavement support – financial practical arrangements: https://www.ageuk.org.uk/information-advice/money-legal/benefits-entitlements/bereavement-benefits/
P (2012) Death in the Modern Greek Culture https://research.gold.ac.uk/id/eprint/11349/1/STA_Pentaris_2012.pdf
Anon (2015) Jewish Practices and Rituals for Death and Mourning: A Guide https://tikkunvor.org/wp-content/uploads/sites/112/2019/04/Jewish-Practices-for-Death-and-Mourning.pdf

PREREQUISITES

Supporting clients/patients when they have distressed planning and determining needs for last stages of life.
Palliative options and emotional care.
Stages of grief and practical actions around stages and phases of death.
The student will be able to show knowledge by:
• Describing Holistic approaches to care planning
• Asking open questions for assessment
• Explaining and justifying patient partnership in care
The student will show skills of:
• Assessing patients physical abilities (ADLs)
• Assessment and anticipatory care eg falls, diet and nutrition etc.
• Goal setting with older patients

INTRODUCTION

The scenario is a simulation of a situation which may be set in a hospital, day centre or care home environment. The premise is a nursing student taking over shift and evaluating the patients in her care and planning the patient care based on prioritizing needs. The student has an allocation of 4 patients with physical care needs including mobilizing, washing and nutrition. The patients are:

• Mrs Rebekah Isaac a 79 year old Jewish lady (widowed).
• Miss Doreen Frame, a 72 year old lady.
• Mrs Sofia Christodoulou an 80 year old Greek Cypriot lady.
• Mr Abdul Raheem, a 75 year old Muslim man

CURRENT CLINICAL CONDITION

Miss Doreen Frame, a 72 year old lady who is quite unwell with a terminal disease and may be transferred to the adjacent hospice soon if her care needs increase.

INTERVIEW

Description of what the student should learn from the patient:

– You assess Miss Frame and her pain is increasing and her breathing is more laboured.
– You plan to negotiate with her the next stage of her terminal illness
– She is distressed holding hands with a female visitor

SIMULATION SCENARIO No. 7

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