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 scene also concerns Mr Abdul Raheem.
Remind the student of the goals.
• Ask about their feelings during the exercise: first the patient then the nurse.
• What happened – describe what happened step by step (student).
• What was most important in this scenario (factual)?
• What did not go well?
• What issues arose and why was there distress?
• 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: assumptions, lack of assessment, consideration of social circumstances and support)
• What professional issues are there from this care example (person centred care, empathy, poor recording of social circumstances and next of kin, poor communication)
• 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, values and attitude perspective?
• Who (other professional staff) would you include into this situation?
• What differences and similarities would you point out?
I am able to recognize the impact of chronic health conditions and limited mobility on daily living activities focus on managing disease and improving health promotion in partnership with the patient.
I am able to explore psychological and emotional consequences to limited physical activity and frame within a cultural sphere.
I am able to identify and draw on potential sources of support for managing practically especially post bereavement.
I am able to discuss professional accountability and effective accurate documentation especially consequences of inaccuracy.
Missing aspects of care – disrespect
Mr Abdul Raheem is a 75 year old Muslim man who is recovering from previous heart problems (angina) and is having a period of respite care.
Procedure that will be practiced in the scenario:
Discussing his lifestyle (food etc) and understanding of a healthy diet for someone with heart problems.
Understanding of medications and frequency of dosing and side effects – does he need any guidance?
Get acquainted with the simulation environment (where the scenario takes place, which trainers, phantom will be used, how to use the equipment):
• 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
- Supporting clients/patients when they have long term degenerative conditions and limitations in daily activities of living. Addressing their personal circumstances and support structures.
- Older people living independently and adjusting to changed roles and ways of managing.
- Cultural frames of illness and family roles and caring appropriately within these.
- Locating and asking for support services and sources for older people adapting to new situations practically and emotionally.
- 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
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
Mr Abdul Raheem is a 75 year old Muslim man who is recovering from previous heart problems (angina) and is having a period of respite care. He is due to go home in a few days.
Description of what the student should learn from the patient:
– Determine how he expresses his understanding of his condition and the impact on his lifestyle
– Assess his level of independence such as managing medications, daily living tasks, diet and mobilization?
– Assess support needs and services for returning home