Carel Mountain
cmountain@shastacollege.edu
GIFTS workshop
March 23, 2011
Rationale: To connect classroom content with worksite learning through the use of an
ongoing case study format.
Description:
Case studies have long been the basis of providing clinical (or worksite) application of
in class learning. Students participate, often reluctantly, in case study presentations.
This is the idea behind Sean Palmer, fourth semester nursing student, and ongoing
case study persona. Sean Palmer is introduced in the first week of the class during the
clinical application of Redirecting Angry Patients Successfully. Each subsequent case
study builds on the next with Sean (or his family and close friends) having experiences
that take the class material and apply it to real life situations. Sean’s first experience
has him as the patient and the students are the nurses at Way Big Psychiatric Hospital.
By the final scenario, Sean is back in school and a friend from prerequisites who is in
the Dental Hygiene program has some serious mental issues. Throughout the
scenarios the student is asked to make decisions about the care they are providing
Sean or about how he should handle the situation (when he is the student nurse). By
the end of the semester the students feel like they know Sean (not only through
description but his picture is up on a Power Point slide in the classroom during the
exercise). Many of them can relate to Sean’s experiences. These case studies provide
the opportunity to discuss how to handle different situations, the decision making
involved, and possibly provide additional tools that they can use in the clinical area.
This activity takes about 15 to 20 minutes and is used at the wrap up of the class
period. The basis is taking what is learned in the classroom and applying it to real life
or work situations.
Processing:
The instructor should have the students work in groups of two to three to answer the
questions at the end. Once the students have sufficiently worked on the questions
(about 5 minutes) the students are instructed to read the story out loud with popcorn
reading. When the first set of questions is reached the teachers should direct the
discussion so that students can share their answers and discuss the thinking and
reasoning that led to those answers. There may not be a consensus within the group
but this may assist them in clarifying their own thinking or way of interacting . Continue
with this process until the activity is completed.
Shasta College
REGN 33
Mental Health Scenario II
It’s Friday night shift and you have been floated from the In-Patient Psychiatric Unit to
the Crisis Intervention/ Psych ER at Way-Big General Hospital. The emergency
department seems very busy and you remember that it is a full moon. Just after
midnight a patient is brought in by his family and you recognize him from being on your
unit previously. The patient is Sean Palmer, a 28 year old male fourth semester nursing
student. Sean had his first break when he was assigned to go the Shock Trauma ICU
at Mercy for his first rotation.
He is now at the psych emergency room after witnessing a shooting during his clinical
rotation. While taking care of a patient on the STICU a family member came in wielding
a gun and threatening to kill all of the nurses. In the process of subduing the family
member the gun went off and the patient was killed. Sean was the student nurse
assigned to the patient.
Initially following the incident Sean seemed to be fine. He attended class on
Wednesday and Thursday but failed both of his online exams. By Friday he was
speaking with garbled speech and was frightened of going out of his home. When
asked by his fellow students if he was alright he responded “I am just jittery. I will be
fine once I am back in clinical.”
In what order would the following need to occur?
__________ Validate that he has had a traumatic experience
__________ Recognize that he is in crisis mode
___________ Talk to Sean about how he has coped in the past
___________ Be aware of your own feelings that may be generated
A few weeks later Sean returns to the STICU where he immediately begins to perspire
profusely. He is having difficulty concentrating on his patient and is unable to do even
the simplest skills. He returns to the Psych ER. Rank the order of the following
interventions for Sean:
__________ take him to see
his crisis counselor
____________ understand that his
usual coping mechanisms are failing
__________ have him take a PRN
_____________ Try to establish
rapport
Shasta College
REGN 33
Mental Health Scenario V
Sean Palmer, a nursing student in REGN 33/34, is attending his first clinical day at
Crestwood Treatment Center. Sean has grown up in the Shasta Area and attended
Shasta Union High School where he was active in swimming and music activities. Sean
is looking forward to his rotation at Crestwood after a somewhat stressful clinical
rotation at MMC. He arrives and is assigned a patient and then attends morning
meeting. After the meeting Sean is hanging out in the day room when realizes that he
sees someone he recognizes from high school. Matthew Phillips, a schizophrenic who
has been on at Crestwood for the past three weeks, was a member of the swim team
with Sean. They were in the same graduating class and had been casual friends.
Matthew is standing with the other patients waiting for the smoke break to begin. He
has grown a mustache but Sean is positive that this is the same person who was on the
swim team with him.
Sean would like to talk to Matthew but doesn’t really know how to handle the situation.
Which would be most appropriate at this point?
_____ Speak with the Team Leader
_____ Go over and talk with Matthew
_____
_____ Look in Matthew’s chart to
see what brought him here
Call the instructor
Later in the day, Sean attends the same group with his patient. This happens to be the
same group that Matthew is in. During the group Matthew appears to be whispering to
himself and casting furtive glances over his shoulder. Matthew always wears his red
hood no matter what he is doing or where he is going. The staff had discussed this at
morning meeting and stated that Matthew has delusions that the aliens are sending
messages to him continually. Matthew believes that as long as he is wearing his red
hood those messages can’t get through. The messages from the Aliens are often
negative in nature and have instructed Matthew to become very destructive in the past.
Matthew sees Sean during the group sessions and gives him a nod of recognition.
After group Matthew comes up to Sean and says “Hey, don’t I know you?” How should
Sean respond?
When Sean comes back for his second day at Crestwood, Matthew seeks him out to
talk. He says the matter is urgent and confidential. Matthew confides to Sean that he is
receiving messages from the Chief Alien in charge telling him to cut himself. Sean
knows that Matthew has made a previous suicide attempt based on other alien
messages. Matthew tells Sean “My hood just isn’t working. What should I do?”
Decide on a plan of action for Sean and be prepared to defend your answer.