Carmen has experienced a panic attack followed by aggressiveness as she did not understand the reason of being disturbed with a blood test technique by the nurse at her local health center. As the nurse expressed she did not have time to manage the situation with Carmen, she referred the patient to the nearest emergency room in order to manage agitation and aggressiveness of Carmen towards her. Carmen is taken to the nearest Emergency Room by her husband. Once Carmen has arrived and received the triage (after having waited to be attended for at least 1 hour in a waiting room full of people that she does not recognize); and the physician has decided to administer medication to control the agitation; the team is deciding to hospitalize her or not. Her husband is additionally creating a conflict as he believes the healthcare team wants to separate her from him and a male nurse and a male physician want to explore her wife and are touching her. Carmen cannot read because she never learnt to read. Her husband is her only support. She is also commenting things that happened while she was an infant though she is not able to remember what she did a couple of hours ago and not even the date.
Remind the goals.
Emotion phase:
• Ask about the feelings during the exercise: first the patient, then the caregiver and then the nurse.
Fact phase
• What happened – describe what happened step by step?
• What went well?
• Feedback from observers on verbal and non-verbal interaction and critical activities.
Analysis phase
• Why specific decisions were made?
• How it should / could be done (ideas are generated by students, the tutor leads to the 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)?
• What should happen (select 3-4 items here that should always be discussed with students regardless of whether they happened or not)?
• Point out step by step what the students’ behavior should look like – exemplary.
• Motivate students to think reflectively while deceiving strengths and correct paths.
Cultural competencies/Social and Cultural aspects to reflect about:
At this point please reflect and discuss on the cultural similarities and differences with your context according to the items exposed at the general introduction of this document keeping in mind what “culture” and “cultural aspects” are.
• What sort of improvements would you make (in terms of: organization, communication, etc…) to overcome the situation lived by the older person by taking the caregiver into account?
• What documents/information would be necessary either to create or to identify in this situation?
• Who (other professional staff) would you include into this situation?
• What type of knowledge would you reflect about in this situation (from a clinical, organizational, in terms of communication and attitude perspective?)
• Have you missed any professional intervention that you may apply in your own context?
• Could you reflect about how this situation described happens in your own country and health system? What are the main ethnic groups living in your country? How this situation would have been in those cases with different groups from different cultural backgrounds? What information about their cultural characteristics do you have? Is this information based on scientific or qualitative evidences? How many cultural and social aspects can you identify in this scenario?
•How do you think this situation occurs in other cultures/countries and in yours? Any scientific evidence or literature reference that could support your decisions?
TOPIC
Interprofessional collaboration towards fostering older person safety and functioning
PREBRIEFING
In this session we will see how Carmen is transferred from an outpatient service such as the blood sample nursing consultation to the emergency room due to agitation, confusion and cognitive impairment.
We are aware that the probability of living with any kind of dementia increases from 65 years old and that some social and cultural aspects may represent a risk factor for such population (such as: low income situation, belonging to some cultural groups with poor access to the health system) It is of high importance to be aware that patients with multi pathologies might be accessing to healthcare facilities for some specific reasons although they can experience any of the signs and symptoms related to any of the other pathologies they are currently living, It is something that usually occurs with people that live with dementia. Knowledge of its causes and consequences can help to improve disease management. The nurse has the opportunity to directly influence the patient’s actions and also the rest of the team by putting the patient in the centre of the lived experience. For this to be effective, the acquisition of knowledge, skills and social competencies is essential. However, people with dementia do not benefit from being hospitalised and not even from being submitted to the current hospital clinical pathways designed for oriented patients. Despite of improving their current situation, they get worse as it is an unknown setting with non-trained healthcare and non-healthcare professionals in specific dementia training. During this scenario, the student should take the decision of hospitalising or not hospitalising a patient with no other clinical condition further than disorientation and agitation. By completing this scenario, you will consolidate your knowledge and acquire the skills needed to care for people with dementia. In today’s simulation class, you will learn how to recognise symptoms and carry out appropriate tests and measurements on a dementia patient.
REFERENCES, MATERIALS FOR CLASSES
- Holmerova, I., Waugh, A., MacRae, R., Veprkova, R., Sandvide, A., Hanson, E., … & Tolson, D. (2016). Dementia palliare best practice statement.
- Lillo-Crespo, M., & Riquelme, J. (2018). From home care to care home: a phenomenological case study approach to examining the transition of older people to long-term care in Spain. Journal of research in nursing : JRN, 23(2-3), 161–177.
- Riquelme-Galindo, J., & Lillo-Crespo, M. (2021). Designing Dementia Care Pathways to Transform Non Dementia-Friendly Hospitals: Scoping Review. International Journal of Environmental Research and Public Health, 18(17), 9296.
- Tolson, D., Fleming, A., Hanson, E., de Abreu, W., Crespo, M. L., Macrae, R., … & Routasalo, P. (2016). Achieving prudent dementia care (Palliare): an international policy and practice imperative. International Journal of Integrated Care, 16(4).
- Chau, J. P. C., Lo, S. H. S., Lee, V. W. Y., Yiu, W. M., Chiang, H. C. Y., Thompson, D. R., & Lau, A. Y. L. (2020). Fostering gerontology students’ competence in Interprofessional collaborative practice. BMC Medical Education, 20(1), 1-8.
- Moncatar, T., Nakamura, K., Siongco, K., Seino, K., Carlson, R., Canila, C. C., Javier, R. S., & Lorenzo, F. (2021). Interprofessional collaboration and barriers among health and social workers caring for older adults: a Philippine case study. Human resources for health, 19(1), 52.
- Lillo-Crespo, M., Riquelme, J., Macrae, R., De Abreu, W., Hanson, E., Holmerova, I., … & Tolson, D. (2018). Experiences of advanced dementia care in seven European countries: implications for educating the workforce. Global Health Action, 11(1), 1478686.
- Bellelli, G., Morandi, A., Davis, D. H., Mazzola, P., Turco, R., Gentile, S., … & MacLullich, A. M. (2014). Validation of the 4AT, a new instrument for rapid delirium screening: a study in 234 hospitalised older people. Age and ageing, 43(4), 496-502.
PREREQUISITES
The student has the knowledge and ability:
- To know and to understand the experience of suffering from a chronic process (or disease) and living with dependency.
- To base the interventions of Health Sciences professionals on scientific evidence and available means.
- To lead, manage and work within a team.
- To establish evaluation mechanisms, considering scientific, technical and quality aspects.
- To apply the necessary methods and procedures in your field to identify health problems.
The student has the skills:
- To carry out nursing care techniques and procedures, establishing a therapeutic relationship with patients and their families.
- To select care interventions aimed at treating or preventing health problems and their adaptation to daily life through proximity resources and support for the elderly.
- To provide care, guaranteeing the right to dignity, privacy, intimacy, confidentiality and decision-making capacity of the patient and family.
- To individualize care considering age, gender, cultural differences, ethnic group, beliefs and values.
- To know palliative care and pain control to provide care that allleviates the situation of advanced and terminally ill patients.
INTRODUCTION
A Spanish lady called Carmen (75 years old) is taken to the Emergency Room after an episode of disorientation and aggression to healthcare staff during a blood sample test at the Health Center. She needs to be explored and assessed by a group of professionals at the emergency room. After going through different tests and interventions staying at the Observation Room, the team is deciding either to hospitalize her or not. During this scenario, the situation gets worse and the old lady gets even more disoriented and is separated from her husband. Her husband does not understand the situation and starts arguing with the staff. He is a Spanish gipsy man (from the Roma culture) and does not want her wife to be explored by a man without his presence. He says they have been together for all their lives and he is the one in the couple who is making decisions. Even though he has observed Carmen’s changes in daily life he has been reluctant to take her to healthcare facilities and services. As part of Spanish gipsy culture they are evangelists and they traditionally are much more eager to first visit alternative medicine services such as: curanderos.
CURRENT CLINICAL CONDITION
The clinical situation of Carmen is the same as in the previous Scenario 26 though in this case the context is different (she has been transferred to the nearest emergency room) and the social and cultural situation is also different as Carmen now is married with a gipsy man and has a low income situation and her relative has a poor understanding of the situation.
INTERVIEW
The student should analyze the patient situation, caregiver situation and talk to the physician in order to make decisions based on the current clinical situation and the potential benefits of adapting the current pharmaceutical and non-pharmaceutical therapies available in the healthcare setting (the emergency room).
