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.
Emotion phase
• Ask about their feelings during the exercise: first the patient, then the caregiver and then the nurse.
Fact phase
• What happened – describe what happened step by step (student).
• What went well?
• What did not go well?
Analysis phase
• What actions were there and why were the decisions made?
• 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: values, respect, professional behaviour, preconceived ideas)
• What professional issues are there form this care example (ethics, person centred care, empathy, documentation, legal duties)
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, organizational, in terms of communication and attitude perspective?
• Who (other professional staff) would you include into this situation?
• Are there any specific resources in your current context that could act as an enabler or as a barrier?
• Could you think of similar situations currently happening in your country and health system? What differences and similarities would you point out?
TOPIC
Missing aspects of care – assumptions
PREBRIEFING
Scenario topic
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 refuses to eat or do any hygiene cares (she is self caring). She states she wants her ‘Ben’ to come and see her. This is Rebekah’s third visit to this institution over the last 2 years so it is not too unfamiliar.
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):
• Room,
• 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
PREREQUISITES
- Supporting clients/patients when they are distressed.
- Stages of confusion, upset and distress.
- Communication – how to as questions and use verbal and non verbal cues.
- 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
INTRODUCTION
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’.
INTERVIEW
Description of what the student should learn from the patient:
– The nature of her anxiety.
– How long she has been married and any other relatives she may have?
– What support systems she has?
– How to contact her husband
