Debriefing Tool: Bertha Rove
1. What is the first thing that comes to mind about the clinical experience you just had?
First thing that comes to mind is that its very difficult to gather history on a patient who can not
communicate
2. What went well and why?
My assessment went better this time and I did well with the history section since the patient
could not communicate.
3. What are one or two things you would do differently and why?
This clinical experience proved to be very frustrating since abilities on human are already
limited, now there was a sim that could not speak. Makes it a hard learning opportunity when
communication is also lacking. If this was a real pt it would be a different circumstance.
4. Have you cared for a patient before (clinical or sim) that presented similarly to this
patient? If so, what was similar and why? (pathophysiology, signs and symptoms, etc)
n/a
In this section, you will describe your findings within the simulation from the medical
record, physical assessment, and plan of care for the patient.
1. Recognize Cues: able to recognize normal vs. abnormal
a. Environmental cues
Pt has a history of smoking and alcoholism.
b. Patient and Medical Record cues (Signs/Symptoms, VS, lab and diagnostic study
data, MAR)
Bilateral crackles in lungs, hypertensive with medication, Rass -1 varies, no skin concerns all in
tact
c. Time pressure cues
Watch propofol
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2. Analyze Cues: Requires knowledge of signs and symptoms, pathophysiology of
Diagnosis. What did the s/s, cues mean to you as the nurse caring for this patient? What
was your analysis?)
Due to the patient having a history with smoking predisposes her to contract pneumonia
3. Prioritize hypothesis: Did you generate any hypotheses of the problem that you
identified. Were you able to prioritize your problems, if so, what were they? What did you
identify as acute or chronic?
Pneumonia is an acute problem while pt hypertension is chronic
4. Generate Solutions: Requires knowledge of conditions and treatments for conditions;
did you need more information/further assessment? Were your solutions supported by
your observations?
n/a
5. Take Actions: What nursing interventions did you identify; and how did you prioritize
them?
Evaluating pt every 5-15 mins depending on the titration of the propofol
6. Evaluate Outcomes: Patient observation cues; follow-up on labs, VS, assessment, etc;
determine improvement, worsening, or remaining the same of condition
Pt is improving since beginning of the shift
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Did you need additional:
1. Knowledge and information? If so, what?
Get a complete background history if the pt had the ability to speak
2. Skills? If so, what?
Vent care
Other questions:
1. Consider the other care this patient requires; NG tube, central line, mechanical
ventilation. Give some priority nursing care and/or interventions for each
a. nasogastric tube, e.g. how do you assess proper placement, how do you
administer medications
As X-ray is the best way to verify placement of NG tube. Caregiver connects syringe filled with
medication into NG tube and flushes after.
b. central line, infection prevention
Central line placement is verified by an ultrasound. In order to prevent infection, hand
hygiene is use, chlorhexidine for skin prep, and only using sterile devices
c. mechanical ventilation, what does “bucking the ventilator mean” ?
To monitor a pt with mechanical ventilation the nurse must check pulse ox and
capnography. “ bucking the ventilator” occurs when a pts vent depends are not matched by
assistance from the mechanical ventilator
in conference, a review of all of the medications/purpose and use
a review of all of the labs/diagnostic; purpose and interpretation
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