Simulation Design Template:
Julia Morales-Simulation #1
Date:
Discipline: Nursing
Expected Simulation Run Time: 20
minutes
Location: Simulation lab room
Admission Date:
File Name: Julia Morales
Student Level:
Guided Reflection Time: 20 minutes
Location for Reflection: Debriefing
|
Today’s Date:
Brief Description of Client
Name: Julia Morales
Gender: F Age: 65
Race: Caucasian Weight: 56 kg Height: 64 in
Religion: Unitarian
Major Support: Lucy Grey Support Phone: 555-1210
Allergies: no known allergies
Immunizations: Influenza and H1N1, last fall
Attending Physician/Team: Dr. Ann Davis
Past Medical History: Adenocarcinoma of the lung, diagnosed 4 years ago, treated with radiation and
chemotherapy. Hysterectomy at age 44.
History of Present Illness:
Julia was seen in her oncologist's office yesterday. Julia, Lucy, Dr. Davis and the nurse practitioner (Laura
Johnson) discussed at length Julia's decision to stop chemotherapy, which at this point would have no
documented benefit for Julia. Laura, the nurse practitioner, recommended a home health agency referral to
assess and support family's needs in their home.
Social History: Retired from work in local nursery/garden center. Lives with partner Lucy. Son Neil, age 42,
lives 20 miles away. Private insurance.
Primary Medical Diagnosis: Adenocarcinoma of the lung, Stage 4.
Surgeries/Procedures & Dates: Hysterectomy at age 44
Nursing Diagnoses: Chronic pain, readiness for enhanced decision making
Psychomotor Skills Required Prior to Simulation

General head-to-toe assessment
Julia Morales Simulation 1
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Cognitive Activities Required Prior to Simulation
[i.e. independent reading (R), video review (V), computer simulations (CS), lecture (L)]



Basic knowledge of geriatric syndromes and the atypical presentation of older adults. (L, R)
Tools in the Try This: ® and How to Try This Series, available at http://consultgerirn.org/resources.
Specific tools recommended for this scenario are the SPICES, the KATZ Index in Activities of Daily
Living and Informal Caregivers of Older Adults at Home: Let’s PREPARE! (R)
Readings related to adenocarcinoma of the lung, hospice, and palliative care. (R)
Simulation Learning Objectives
General Objectives
1. Practice standard precautions throughout the exam.
2. Employ effective strategies to reduce risk of harm to the client.
3. Assume the role of team leader or member.
4. Perform a focused physical assessment noting abnormal findings.
5. Recognize changes in patient symptoms and/or signs of patient compromise.
6. Perform priority nursing actions based on clinical data.
7. Reassess/monitor patient status following nursing interventions.
8. Perform within scope of practice.
9. Demonstrate knowledge of legal and ethical obligations.
10. Communicate with client in a manner that illustrates caring for his/her overall well-being.
11. Communicate appropriately with physician and/or other healthcare team members in a timely,
organized, patient-specific manner.
Simulation Scenario Objectives
1.
2.
3.
4.
5.
Provide care for terminally ill older adult and her family in the home setting.
Perform physical and functional assessments of older adult.
Identify purpose of hospice care and services provided.
Explain advance directives and durable power of attorney.
Relate the importance of providing individualized care unique to each individual and family.
References, Evidence-Based Practice Guidelines, Protocols, or
Algorithms Used for This Scenario:
These and other tools in the Try This: ® and How to Try This Series are available on the ConsultGeriRN.org
(http://consultgerirn.org/resources), the website of the Hartford Institute for Geriatric Nursing, at New York
University’s College of Nursing. The tool, an article about using the tool, and a video illustrating the use of the
tool are all available for your use.
SPICES- An Overall Assessment Tool:
Tool: http://consultgerirn.org/uploads/File/trythis/try_this_1.pdf
Video: http://consultgerirn.org/resources/media/?vid_id=4200873#player_container
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Katz Index of Independence in Activities of Daily Living:
Tool: http://consultgerirn.org/uploads/File/trythis/try_this_2.pdf
Article: http://www.nursingcenter.com/library/JournalArticle.asp?Article_ID=781870
Video: http://consultgerirn.org/resources/media/?vid_id=4610636#player_container
Informal Caregiver of Older Adults at Home: Let’s PREPARE!
Tool: http://consultgerirn.org/uploads/File/trythis/try_this_sp2.pdf
American Cancer Society – What is Hospice Care?
http://www.cancer.org/acs/groups/cid/documents/webcontent/002868-pdf.pdf
Review Advanced Directive resource. Each state has their own laws and the correct form is available
on the following website:
http://caringinfo.org/i4a/pages/index.cfm?pageid=3289
Review the Essential Nursing Actions in the ACES Framework at: http://www.nln.org/professionaldevelopment-programs/teaching-resources/aging/ace-s/nln-aces-framework
Fidelity (choose all that apply to this simulation)
Setting/Environment:
ER
Med-Surg
Peds
ICU
OR / PACU
Women’s Center
Behavioral Health
Home Health
Pre-Hospital
Other:
Medications and Fluids:
IV Fluids:
Oral Meds: see chart
IVPB:
IV Push:
IM or SC:
Diagnostics Available:
Labs
X-rays (Images)
12-Lead EKG
Other:
Simulator Manikin/s Needed:
Documentation Forms:
Simulator or standardized patient for Julia
Morales. Actor or standardized patient for
Physician Orders
family member - Lucy Grey, age 73 and 42Admit Orders
year old son Neil. If utilizing students as actors,
Flow sheet
need to prepare them first, supply script and
Medication Administration Record
objectives, and explain roles and expectations
Kardex
so that student can represent the family
Graphic Record
member's perspective.
Shift Assessment
Triage Forms
Props: Home set-up - couch, chairs, and table,
Code Record
oral meds
Anesthesia / PACU Record
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Equipment Attached to Manikin:
IV tubing with primary line
fluids running at mL/hr
Secondary IV line running at mL/hr
IV pump
Foley catheter mL output
PCA pump running
IVPB with running at mL/hr
02 Home oxygen tank and nasal cannula
available
Monitor attached
ID band
Other:
Equipment Available in Room:
Bedpan/Urinal
Foley kit
Straight Catheter Kit
Incentive Spirometer
Fluids
IV start kit
IV tubing
IVPB Tubing
IV Pump
Feeding Pump
Pressure Bag
02 delivery device (type)
Crash cart with airway devices and
emergency medications
Defibrillator/Pacer
Suction
Other:
Roles/Guidelines for Roles:
Primary Nurse
Secondary Nurse
Clinical Instructor
Family Member #1
Family Member #2
Observer/s
Recorder
Physician/Advanced Practice Nurse
Respiratory Therapy
Anesthesia
Standing (Protocol) Orders
Transfer Orders
Other:
Recommended Mode for Simulation:
(i.e. manual, programmed, etc.)
Any type of human patient simulator or
standardized patient. Fidelity is increased if an
actor or standardized patient is used for Julia in
this simulation.
Student Information Needed Prior to
Scenario:
Has been oriented to simulator
Understands guidelines /expectations for
scenario
Has accomplished all pre-simulation
requirements
All participants understand their assigned
roles
Has been given time frame expectations
Other:
Important Information Related to Roles:
Family member is Julia's 73-year-old partner
Lucy Grey who is providing her care. Lucy is
healthy but has decreased strength and mobility
related to arthritis and past knee surgery.
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Pharmacy
Lab
Imaging
Social Services
Clergy
Unlicensed Assistive Personnel
Code Team
Other:
Report Students Will Receive Before Simulation
Time: 2:00 PM
Julia is a 65 year old woman who has Stage 4 lung cancer and wishes to forego further treatment. You are
doing a home visit with orders from the oncology nurse practitioner to assess client needs for comfort, safety,
and other support. They have questions about hospice care and what that means, especially related to being
treated for pain.
Significant Lab Values:
refer to chart
Physician Orders:
refer to chart
Home Medications:
refer to chart
Scenario Progression Outline
Timing
(approx.)
0-5 min
Manikin Actions
Expected
Interventions
May Use the
Following Cues
Julia (lying on couch with
blanket) and Lucy welcome
nurses into home. [May also
have Julia's son Neil present.]


Introduce self
Explain purpose of
visit
Take vital signs
Begin general and
pain assessments.
Pain level is 2/10;
took pain
medication one
hour ago.
Role member
providing cue:
Cue:
Continue
assessment using
SPICES tool.
Listen to Lucy and
Julia’s concerns
Role member
providing cue: Lucy
Cue: Voice/actors
for Julia and Lucy
can reply "NO" to
“Laura, my nurse practitioner,
said you'd check how I was
feeling and help us figure out
how I can stay home and be
comfortable.”
5-10 min
Lucy: “I am able to help her
now, but if she needs more help
walking, I am not strong enough
to do it.”
Julia: “I am ok. Just weak. I
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need help getting to the
bathroom. I lay here on the
couch or in bed.”
10-15 min
15-20 min
Julia: "I'm okay but we know I
will just get weaker with time. I
am pretty tough right now, only
need help if I'm walking a long
way.”
Julia also answers some of the
questions for assessment, tires
easily.
Lucy: "If she goes on hospice
care, will you stop everything?
Can she get pain treatment?"

Lucy: "Who should I call if I
have questions? How will I get
a walker?"


and responds to
their priorities
each area of
SPICES tool at this
point in time.
Continue
assessment using
Katz Index of
Independence in
Activities of Daily
Living
Nurses should
give basic
explanation of
hospice care.
Role member
providing cue: Lucy
Cue: Responses
are: help needed
with transferring to
toilet, and moving
from room to room.
Total points = 5/6.
Slightly dependent.
Lucy: Could we get
one of those things
to help her walk?
And a portable potty
or something, if she
can't get to
bathroom?
Neil: Mom, how about trying
another round a chemo? Don’t
you want to try?


Continue
assessment using
Informal
Caregivers of
Older Adults at
Home: Let's
PREPARE
Offer help with
resources/organiz
ation of meds and
referrals
Acknowledge
Neil’s concerns
and facilitate
further dialogue
about Julia’s
wishes. Introduce
topic of advance
directives and
durable power of
attorney.
Role member
providing cue: Lucy
Cue: “I am not sure
when to call the
nurse practitioner.”
Debriefing/Guided Reflection Questions for This Simulation
(Remember to identify important concepts or curricular threads that are specific to your program)
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1.
How did you feel throughout the simulation experience?
2.
Describe the objectives you were able to achieve.
3.
Which ones were you unable to achieve (if any)?
4.
Did you have the knowledge and skills to meet objectives?
5.
Were you satisfied with your ability to work through the simulation?
6.
To Observer: Could the nurses have handled any aspects of the simulation differently?
7.
If you were able to do this again, how could you have handled the situation differently?
8.
What did the group do well?
9.
What did the team feel was the primary nursing diagnosis?
10. How were physical and mental health aspects interrelated in this case?
11. What were the key assessments and interventions?
12. How were you able to use the ACES Framework with Julia’s situation? (Assess Function and
Expectations, Coordinate and Manage Care, Use Evolving Knowledge, Make Situational Decisions)
13. Is there anything else you would like to discuss?
Complexity – Simple to Complex
Suggestions for Changing the Complexity of This Scenario to Adapt to Different Levels of Learners
1. Julia could be more gravely ill and students would need to assess and plan appropriate interventions.
For example, she could have decreased mobility raising concerns about pressure ulcers.
2. Students could get into detail about advance directives and durable power of attorney.
3. Have students perform a home visit with the focus on preparing Julia and her family for the dying
experience.
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