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.
- Mrs Sofia Christodoulou an 80 year old Greek Cypriot lady.
- Mr Abdul Raheem, a 75 year old Muslim man.
This first scene concerns Mrs Rebekah Issac.
Remind the student of the goals.
• Ask about their feelings during the exercise: first the patient then the nurse.
• What happened – describe what happened step by step (student).
• What important information was made obvious?
• What did not go well?
• What types of questions were asked to reveal this information?
• What issues arose and why was there distress?
• 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: assumptions, lack of assessment, consideration of social circumstances and support)
• 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, cultural , faith based practices, 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 deterioration in elderly patients and report accordingly.
I am able to describe stress and agitation especially in elderly people and impact of confusion and distress.
I am able to define and explain ethical and cultural issues related to illness and death.
I am able to outline compassion and sensitivity for caring for older patients acknowledging limits to knowledge and how to address this.
I am able to justify professional accountability in the event of omission and questionable care.
Missing aspects of care – confusion and assumptions and insensitivity
Mrs Rebeckah Issaac is anxious and sits stiffly in her chair – she looks sad and is refusing to meet or talk to any other patients. She states she wants her ‘Ben’ to come and see her.
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):
• 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
- Supporting clients/patients when they have been bereaved or are distressed.
- Stages of grief and practical actions around funeral and living without the loved one.
- 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
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
Mrs Rebekah Isaac is anxious and lies in bed – she is restless and confused asking continuously for her husband, ‘Ben’. Her breathing is erratic.
Earlier you had an episode with Mrs Rebekah Isaac and details of her next of kin. This has been corrected and her daughter lives abroad will come to the UK in a week or so. Rebekah is confused and calling for her ‘Ben’ continuously. You explain to her that Ben cannot come as he is ‘passed away’ that is died. Mrs Isaac suddenly appears extremely sleepy and falls on her side in her chair and not responding to your voice. You check her vital signs – she cannot speak clearly (slurring) and her left arm and side of her face is paralyzed. Just then her daughter, Ruth appears.
How will you address this with Ruth? How do you address older people and serious deterioration?
You and doctor explain to Ruth that her mother has had a stroke. She is very poorly and might even not live through the night. Ruth says she does not want her mother told what has happened but pretend everything is as before.