Rita is an 86 year old lady that was found by her cousin, on the floor in her house after she sustained a fall. She has been admitted to hospital and after the necessary tests she is diagnosed with a compound hip fracture. The doctor explains to Rita and her cousin that she will need an urgent hip replacement operation and she needs to give her consent for the operation. Rita is in pain and confused about whether she will sign for the operation. Some pain medication is given to Rita and she is feeling a little better. She has decided to wait for her 4 children to come before she decides on the way forward. The doctor leaves and the student nurse remain with the patient. Rita’s children arrive together with their wives and children. They bombard the student nurse with questions regarding their mother’s situation. They ask to see the doctor and after calling the doctor the nurse informs the relatives that the doctor cannot come now as he is busy.
Rita’s children would like a second opinion as they are worried about their mother undergoing an operation. She is a type one diabetic and suffered a heart attack 4 years before. Rita’s family start to become irritable and start shouting that they need to speak to the doctor.
• Remind the goals (student doing the exercise.
• Ask about the feeling during the exercise.
• What happened – describe what happened step by step (student)?
• What went well?
• Why specific decisions were made?
• How it should be done (ideas are generated by students, the tutor leads to the right conclusions)?
• What to do to make it better?
• Students’ questions.
• What do you remember from the exercise (each student says 1 item – preferably everyone should say something different?
• Point out step by step what the students’ behavior should look like – exemplary.
• Motivate students to think reflectively while deceiving strengths and correct paths.
I can demonstrate knowledge regarding the importance of obtaining informed consent from patient.
I can demonstrate knowledge regarding information giving to patient and relatives.
I can recognise a potentially volatile situation (risks of escalation).
I can provide appriopriate and timely interventions (de-escalation techniques).
I can demonstrate effective communication with the patient, relatives and health care team.
I can integrate resourceful teamwork in providing patient centred care.
I can understand the importance of the importance of families and extended families in decision making in the person’s culture.
The importance of informed consent and dealing with potentially volotile situations
REFERENCES, MATERIALS FOR CLASSES
The scenario was prepared based on the content contained in the literature:
- Cocanour, C.S. (2017). Informed consent-It’s more than a signature on a piece of paper. American journal of surgery, [online] 214(6), pp.993–997. Available at: https://www.ncbi.nlm.nih.gov/pubmed/28974311 [Accessed 1 Dec. 2020].
- Spielfogel, J.E. and McMillen, J.C. (2016). Current use of de-escalation strategies: Similarities and differences in de-escalation across professions. Social Work in Mental Health, 15(3), pp.232–248.
- The student has knowledge regarding the importance of obtaining informed consent and the local legal and ethical implications.
- The student will be aware of local de-escalation guidelines and the importance of applying these guidelines in volatile situations.
Rita is an 86 year old lady that has been admitted to hospital after a fall at home. After the necessary tests she is diagnosed with a compound hip fracture. The doctor tells Rita that she will need an urgent hip replacement operation and she needs to give her consent for the operation. Rita is in pain and confused about whether she will sign for the operation. She will wait for her 4 children to come before she decides on the way forward.
CURRENT CLINICAL CONDITION
Patient is in pain and anxious about the way forward.
The student should:
– engage in de-escalating verbal communication with the family and the patient,
– demonstrate control over own emotions and behavior.