Adam Kowal, aged 88 (with a history of cardiovascular disease, treated) has been feeling weak for several days. Earlier home intervention did not succeed in improving the older person condition. He has been taken to a nursing home and is lying in bed because the family could not cope with daily care. The patient is weakened, has not eaten for several days, drinks small amounts of fluid.
Contact with the patient – preserved, patient is sometimes not logical, answers questions shortly, needs time to answer, speaks with difficulty, patient’s mood – decreased.
Starting with the leader, the participants describe in detail what happened one by one. Each student should say what they were responsible for and what they did.
This is an exploration of the reasons for the actions taken and their evaluation. In this phase the participants analyse the feelings they have experienced; this is the emotional and empathic content of the discussion. Each student chooses one or two things they did well. We do not comment on students’ opinions. The analysis phase allows to discover the reasons for successes or failures in the scenario, to understand the reasons for action.
- What was most challenging for you when you made the measurements?
- For what purpose did you make the vital signs measurements
- How did you feel when you made contact with the patient?
- What actions did you take towards the patient and why?
- Which decisions were good and why?
- What did you do first and what did you do next?
- What was your biggest success while doing the task?
- What did you find most challenging during the task?
- What actions did the leader take and why?
In the analysis phase it is also good to ask the following questions:
- How well did you as a team perform the task?
- What was the result of your action?
- What caused your frustration?
- What would you have done differently?
- How would you have done it?
It allows the students to try to compare with real events, to assess the needs, possibilities and how to use the experience gained in everyday practice.
- Please tell us what you would use from the experience gained today in a real-life situation with such a patient?
- What did you learn from the simulation?
- What do you think is important in caring for a dehydrated patient?
- What do we need to pay attention to when performing these actions?
- What is the most important thing you learned during the simulation?
- Please have everyone say what they learned during the scenario. Where can we apply the skills learned?
- What do you think should be done if the patient has culture related requarements or limitations (religious, regional, etc)?
I know what the patient’s personal history should contain.
I can give information to the patient’s family/guardian.
I am prepared to act in the best interest of the patient, to respect the dignity and autonomy of persons entrusted with care, to show understanding for the world-view and cultural differences and to show empathy in relation to the patient and his/her family.
I am ready to respect patients’ rights.
I am ready to independently and diligently perform the profession in accordance with ethical principles, including respecting values and moral obligations in patient care
I am ready to take responsibility for the professional actions performed.
I am ready to foresee and take into account factors influencing his/her own and the patient’s reactions.
Arranging patient-centred environment for older person nursing home care
In today’s class we will learn how to organise a patient’s environment in a nursing facility.
We are aware that changing the environment for an elderly patient who is ill is very difficult. Knowing what can be done for the patient can contribute to the patient’s well-being. The nurse has the opportunity to directly influence the organisation of the patient’s place. To be effective, it is essential to acquire knowledge, skills and social competences. In this scenario you will consolidate your knowledge and acquire the skills needed to create the right place for a patient with a serious condition. In today’s medical simulation class you will learn how to recognise a patient’s needs and how to provide for them. Skills required:
- interview the patient’s habits (eating, sleeping, how they have been spending their time recently),
- provide information about what personal belongings the patient may have with him,
- provide information about visits,
- provide information about the daily schedule of the facility, the rules for patient care.
- Do you remember how important it is to know about the patient’s preferences? What do you think can be done to prepare the surroundings for the patient? Can you recall what might be important for the patient?
- Do you have any ideas about what else you could ask the patient?
Imagine that you are working as a nurse in a nursing facility to which a new patient has been admitted.
There will be one person in the scenario who is responsible for collecting the interview. Do you understand all the information and know what you are responsible for?
REFERENCES, MATERIALS FOR CLASSES
- Patricia W. Stone; Ronda Hughes; Maureen Dailey. Chapter 21Creating a Safe and High-Quality Health Care Environment. Patient Safety and Quality: An Evidence-Based Handbook for Nurses.
The student has knowledge of:
- Risk factors and health threats in patients of different ages
- Etiopathogenesis, clinical symptoms, course, treatment, prognosis and principles of care
nursing care for patients in selected diseases
- Principles of diagnosing and planning patient care in nursing
- Nursing standards and procedures used in the care of patients of different age and health condition
The student has the skills:
- Gather information, formulate a nursing diagnosis, and set goals and care plans
- Implement nursing interventions and evaluate nursing care
- Prevent complications occurring in the course of diseases
- Conduct a therapeutic conversation
Adam Kowal, aged 88, has been feeling weak for several days. He has been taken into a nursing home and is lying in bed.
CURRENT CLINICAL CONDITION
Patient lying in bed, weakened. Skin dry. He reports drowsiness and headache and lowered mood. He has suffered from hypertension for 20 years – treated for this and takes medication in pills.
Time of onset of first symptoms – a few days before
- The patient has dry skin, the skin is not very elastic
- Tongue and mucous membranes are dry, little saliva, which causes problems with speaking
- Small amount of urine, dark urine with a strong smell
- Stools every other day with difficulty, hard,
- He has had headaches and weakness for several days and spends more time in bed.
- In the history, the patient states that he drinks, after a more detailed description it turns out that it is about three cups of tea a day. Mineral water is on the bedside table, unopened. He does not like to drink mineral water.
- Treatment used – Hydrochlorothiazide 1 x 1 tab, Indapamide 1 x 1 tab, Perazine p. o. 25 mg 2 x day, Spironolactone 1 x 1 tab, Hydroxyzine 10 mg at night.
- Allergies – none.