Adam Kowal is 88 years old and he’s currently staying in a health care center. Despite the efforts, the patient’s condition is getting worse. He doesn’t eat or drink. At admission the patient declares to be catholic.
Description phase
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.
Analysis phase
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?
Application phase
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?
Cultural aspect:
- What do you think should be done if the patient has culture related requarements or limitations (religious, regional, etc)?
TOPIC
Assessing the signs of forthcoming death and implementing patient-centred, culturally appropriate end-of-life care
PREBRIEFING
In today’s class we are going to learn how to take care of a patient who is dying.
We are aware that the moment when the patient is dying, is always painful, especially for his family. Knowledge regarding this topic is important in order to take proper actions at the appropriate time. The nurse has the ability to support the patient’s family in this difficult process. In order to be effective, it is necessary to acquire knowledge, skills and social competences. By implementing this scenario, you will consolidate your knowledge and acquire the skills that are necessary to take care of a patient who is dying. During today’s medical simulation you are going to learn how to recognise the symptoms of death as well as conduct appropriate tests and take the measurements of a person who is dying. Skills required:
- a skill to measure basic vital functions in accordance with the applicable procedure (RR blood pressure, heart rate, saturation) using medical equipment and breathing, and how to interpret the results
- a skill to interpret and document the results of measurements, as well as provide information about the patient’s health in the therapeutic team.
- Do you remember the symptoms of death? What, in your opinion, should we do when it is stated that the patient is dying? Do you remember how to support the patient’s family?
Imagine that you are working as nurses and there is a dying patient at the health care center.
Four people will take part in this scenario. One person will act as the first nurse who will lead the team and will be in charge of the assessment of the patient’s condition. The second one will be a nurse responsible for preparing the patient. The third and fourth one will be the members of the patient’s family. Do you understand all the information and know what you are responsible for?
REFERENCES, MATERIALS FOR CLASSES
- https://www.zwrotnikraka.pl/jak-towarzyszyc-umierajacemu-na-raka/
- Karen A Kehl. How hospice staff members prepare family caregivers for the patient’s final days of life: An exploratory study. Palliat Med. 2015 Feb; 29(2): 128–137.
- https://www.mypcnow.org/fast-fact/teaching-the-family-what-to-expect-when-the-patient-is-dying/
- https://oxfordmedicine.com/view/10.1093/med/9780190066529.001.0001/med-9780190066529-chapter-9?print=pdf
PREREQUISITES
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
- Geriatric
- 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
INTRODUCTION
Adam Kowal is 88 years old and he’s currently staying in a health care center. Despite the efforts, the patient’s condition is getting worse. He doesn’t eat or drink.
CURRENT CLINICAL CONDITION
The patient’s condition is very severe. His pulse is weak, barely palpable, blood pressure is very low and his breath is under 10/min.
INTERVIEW
The patient’s condition is severe. His family has arrived to be with the patient.
Current treatment – none (since two days).
