Standardized Patient Simulation
NS 228 - Mental Health Nursing
Nancy Jones – Depression Case (Student’s Copy)
Student Learning Objectives:
1. Demonstrate therapeutic communication techniques to facilitate the nursepatient relationship with clients suffering from depression (SLO #1, SLO # 6).
2. Identify environmental safety concerns when working with clients who are
experiencing depression and suicidal ideations (SLO #4).
3. Perform a mental status examination (SLO #1).
4. Identify symptoms associated with depression (SLO #1, SLO #3).
5. Demonstrate effective use of the SADPERSONs tool to identify people at
risk for suicide (SLO # 4).
6. Create a nursing care plan based on this scenario in congruence with the
patient’s healthcare needs, preferences, cultural and spiritual values, beliefs,
and practices (SLO #6).
7. Document a professional nursing note based on your assessment findings
(SLO #5).
8. Use SBAR tool for communication hand-off (SLO #2).
Students’ Pre Simulation Assignment
1. How would a patient with major depressive disorder (MDD) present?
2. Identify at least 3 factors that are thought to influence an individual’s
susceptibility to depression.
3. What are the priority nursing interventions when caring for a patient with
depression?
4. What questions should a nurse ask to assess a patient’s risk for suicide?
5. What additional steps may be taken if medications do not work?
Note. Please complete the pre simulation assignment questions before coming to your
scheduled simulation class.
Topics and Skills to Review:
Depression, SADPERSONS tool, mental status examination
Created by Rondine Douglas-Stanley, MSN, RN, CNE, MH-BC and Eda Ozkara San, RN, MBA, PhDc
1
Standardized Patient Simulation
NS 228 - Mental Health Nursing
Nancy Jones – Depression Case (Student’s Copy)
Report to Students
Time: 7:00 a.m.
You are assigned to care for Nancy during your shift. The night nurse reports that
Nancy has been in bed all shift and is only visible on the unit when its meal time
and time to get medication. Nancy has poor appetite. Breakfast she ate 20%, Lunch
0% and dinner 45%. She has been compliant with medications, which include
Multivitamin, Thiamine, Folic Acid, and Prozac. VS are as follows: BP 100/60, P
70, Temp 98.6, and RR 12. Pt denied pain during the night shift. Remained
withdrawn with flat affect. Pt is having passive suicidal ideation, but denies a plan.
Remain on q15min checks for safety.
Additional Information, Medical History
Patient data:
Female – Age 50 years. Weight – 100 pounds
Height 62 inches
DOB:
2/03/65
MR#:
12345
Medical history:
Type II Diabetes and Alcoholism.
Smoking history: No
Illicit drug use history: No
Alcohol use history: Yes
Created by Rondine Douglas-Stanley, MSN, RN, CNE, MH-BC and Eda Ozkara San, RN, MBA, PhDc
2
Standardized Patient Simulation
NS 228 - Mental Health Nursing
Nancy Jones – Depression Case (Student’s Copy)
Physician Orders
Admitting Diagnosis: Depression
Patient Name: Nancy
DOB: 2/03/1965
Age: 50
Height: 5’2
Weight:100lbs
MR# 12345
Gender: Female
Allergies & Sensitivities: No Known Allergies
Date
Time
PHYSICIAN ORDER AND SIGNATURE
Diet: Diabetic Diet
Activity: Out of Bed as Tolerated
Blood glucose monitoring BID
Vital signs every shift
Record I &O
Frequent checks – q15min
*Medications:
Prozac 30mg PO daily
Thiamine 100mg PO daily
Folic Acid 1 tab PO daily
Multivitamin 1 tab PO daily
Metformin 500 mg tab PO daily
PHYSICIAN/PROVIDER
SIGNATURE
Mary Jones, MD
Created by Rondine Douglas-Stanley, MSN, RN, CNE, MH-BC and Eda Ozkara San, RN, MBA, PhDc
3
Standardized Patient Simulation
NS 228 - Mental Health Nursing
Nancy Jones – Depression Case (Student’s Copy)
Examples of Therapeutic Communication in Therapeutic
1. Properly introduce self and spends a few brief minutes seeing how the patient is
doing.
2. Is more sensitive to the patient’s depressed mood
3. Says “I know this is a difficult time for you” (open ended questions and active
listening)
4. Sets some treatment objectives – “We want to see you up and around just as fast
as we can”
5. Uses humor – “Won’t be long until you will be taking those dance lessons
again?”
6. Focusing – as patient talks about fear of being able to care for self after
discharge.
7. Therapeutic Use of Touch – Nurse touched patient’s shoulder.
Communication Techniques
Therapeutic
Non-therapeutic
Active Listening
Open ended Questions
Clarifying
Therapeutic Touch
Use of Silence
Humor
Focusing
Confrontation
Summarizing
Giving Reassurance
Rejecting
Approving
Disapproving
Giving Advice
Defensiveness
Asking Why
Disregarding feelings
Making Judgments
Created by Rondine Douglas-Stanley, MSN, RN, CNE, MH-BC and Eda Ozkara San, RN, MBA, PhDc
4
Standardized Patient Simulation
NS 228 - Mental Health Nursing
Nancy Jones – Depression Case (Student’s Copy)
Student Observation Sheet
States
Date: ____________________
Positive Findings
Areas for improvement
1
2
3
Learning Outcomes:
Met
Unmet
1. Demonstrate therapeutic communication techniques to facilitate the nurse-patient relationship with
clients suffering from depression (SLO #1, SLO # 6).
2. Identify environmental safety concerns when working with clients who are experiencing depression
and suicidal ideations (SLO #4).
3. Perform a mental status examination and identify symptoms associated with depression (SLO #1,
SLO #3).
4. Identify symptoms associated with depression (SLO #1, SLO #3).
5. Demonstrate effective use of the SADPERSONs tool to identify people at risk for suicide (SLO # 4).
6. Create a nursing care plan based on this scenario in congruence with the patient’s healthcare needs,
preferences, cultural and spiritual values, beliefs, and practices (SLO #6).
7. Document a professional nursing note based on your assessment findings (SLO #5).
8. Use SBAR tool for communication hand-off (SLO #2).
Created by Rondine Douglas-Stanley, MSN, RN, CNE, MH-BC and Eda Ozkara San, RN, MBA, PhDc
5
Standardized Patient Simulation
NS 228 - Mental Health Nursing
Nancy Jones – Depression Case (Student’s Copy)
Reflection
Question 1: Have you had a previous experience of communicating with a
hospitalized patient diagnosed with major depressive disorder?
Question 2: How did this simulation scenario help you to improve your
communication skills?
Question 3: Please state at least 3 take away messages from the simulation
experience.
Created by Rondine Douglas-Stanley, MSN, RN, CNE, MH-BC and Eda Ozkara San, RN, MBA, PhDc
6
Standardized Patient Simulation
NS 228 - Mental Health Nursing
Nancy Jones – Depression Case (Student’s Copy)
SAD PERSONS Scale
S – Sex: 1 if male; 0 if female; (more females attempt, more males succeed)
A – Age: 1 if < 20 or > 44
D – Depression: 1 if depression is present
P – Previous attempt: 1 if present
E –Ethanol abuse: 1 if present
R – Rational thinking loss: 1 if present
S – Social Supports Lacking: 1 if present
O – Organized Plan: 1 if plan is made and lethal
N – No Spouse: 1 if divorced, widowed, separated, or single
S – Sickness: 1 if chronic, debilitating, and severe
Guidelines for action with the SAD PERSONS scale
Total points
Proposed clinical action
0 to 2
Send home with follow-up
3 to 4
Close follow-up; consider hospitalization
5 to 6
Strongly consider hospitalization, depending on confidence in the follow-up
arrangement
7 to 10
Hospitalize or commit
Created by Rondine Douglas-Stanley, MSN, RN, CNE, MH-BC and Eda Ozkara San, RN, MBA, PhDc
7
Standardized Patient Simulation
NS 228 - Mental Health Nursing
Nancy Jones – Depression Case (Student’s Copy)
Created by Rondine Douglas-Stanley, MSN, RN, CNE, MH-BC and Eda Ozkara San, RN, MBA, PhDc
8