Simulation Design Template:
Butch Sampson-Simulation #2
Date:
Discipline: Nursing
Expected Simulation Run Time:
approx. 20 minutes
Location: Hospital
File Name: Bradley Leonard “Butch” Sampson
Student Level:
Guided Reflection Time: twice the amount of
simulation run time
Location for Reflection:
Admission Date: Yesterday |
Today’s Date:
Brief Description of Client
Name: Bradley Leonard “Butch” Sampson
Gender: M Age: 62
Race:
Weight: 80 kg Height: 70 in
Religion: No preference
Major Support: None Support Phone: None
Allergies: No known allergies
Immunizations: Tdap (given on admission), Influenza (given on admission),
Pneumoccocal (given on admission)
Attending Physician/Team: Samantha Bell, MD
Past Medical History: 62-year-old homeless veteran with documented exposure to Agent Orange during
military service in Vietnam (1968-1969). Records from prior VA Hospital confirm diagnosis of Type 2 Diabetes
with surgical removal of two toes on right foot last year. Reports he seeks intermittent care in whatever
Emergency Department is nearest his location.
History of Present Illness: Presented at the Healthcare for Homeless Veterans office two days ago with
purulent drainage, edema, erythema, and ulceration of the great toe on the right foot. Blood Glucose 190 in the
office with HgA1C of 8.9. Reports he received a prescription for oral diabetic medication last year at a prior VA,
but only took it a few weeks before it was stolen.
Social History: Reports he has been episodically homeless for several years. Served in the US Navy from
1968 to 1971. (History is significant for service time in Vietnam on Riverine Patrol Boat.) Reports he worked
several years after honorable discharge from the Navy as a deck hand on various fishing operations, but lost
his home and work opportunities as a result of Hurricane Katrina. Reports he has been married and divorced
twice with no children. Parents and one brother are deceased. Was placed in transitional housing at a prior VA
following his surgical amputation last year, but was evicted due to multiple “rule” violations involving
possession of alcohol and smoking in his room. Reports he relocated here with his friend Joe to avoid
harassment by individuals who were preying on “older” homeless men in the area.
Butch Sampson – Simulation # 2
© National League for Nursing, 2013
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Primary Medical Diagnosis: Cellulitis right great toe, Diabetes Mellitus Type 2
Surgeries/Procedures & Dates: Surgical debridement of right great toe yesterday
Nursing Diagnoses: Knowledge deficit related to self-care of affected foot, medications; alteration in health
maintenance related to Diabetes Mellitus; impaired physical mobility related to surgical intervention to foot
Psychomotor Skills Required Prior to Simulation

Cognitive Activities Required Prior to Simulation
[i.e. independent reading (R), video review (V), computer simulations (CS), lecture (L)]

Review sample VA description of Transitional Housing. http://www.portland.va.gov/CRS/THousing.asp

Review care of patients with Type 2 Diabetes in textbook, including diet and medications.

Brehove, T., Joslyn, M., Morrison, S., Strehlow, A. J., & Wismer, B. (2007). Adapting your practice:
Treatment and recommendations for homeless patients with diabetes mellitus. Nashville: Health Care
for the Homeless Clinicians Network. http://www.nhchc.org/wpcontent/uploads/2011/09/DiabetesMellitus.pdf

Department of Veterans Affairs. (2012). Veteran diseases associated with Agent Orange.
http://www.publichealth.va.gov/exposures/agentorange/diseases.asp

Swift, C. S., & Boucher, J. L. (2005). Nutrition care for hospitalized individuals with diabetes. Diabetes
Spectrum, 18(1), 34-88. doi: 10.2337/diaspect.18.1.34
http://spectrum.diabetesjournals.org/content/18/1/34.full.pdf+html
Simulation Learning Objectives
General Objectives
1.
2.
3.
4.
5.
6.
7.
8.
9.
Practice standard precautions throughout the exam.
Employ effective strategies to reduce risk of harm to the client.
Assume the role of team leader or member.
Perform a focused physical assessment noting abnormal findings.
Recognize changes in patient symptoms and/or signs of patient compromise.
Perform priority nursing actions based on clinical data.
Reassess/monitor patient status following nursing interventions.
Perform within scope of practice.
Demonstrate knowledge of legal and ethical obligations.
Butch Sampson – Simulation # 2
© National League for Nursing, 2013
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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.
Employ therapeutic communication.
Assess knowledge of self-care for Type 2 Diabetes including diet, medications, and care of foot.
Complete medication reconciliation.
Provide discharge teaching.
References, Evidence-Based Practice Guidelines, Protocols, or
Algorithms Used for This Scenario:
American Diabetes Association. (2012). Standards of medical care in diabetes-2012. Diabetes Care
35(Supp 1), s11-s63. doi: 10.2337.dc12-s011.
Beaulieu, A., & Fessele, K. (2003). Agent Orange: Management of patients exposed in Vietnam.
Clinical Journal of Oncology Nursing, 7(3). doi: 10.1188/03.CJON.320-323.
Brehove, T., Joslyn, M., Morrison, S., Strehlow, A. J., & Wismer, B. (2007). Adapting your practice:
Treatment and recommendations for homeless patients with diabetes mellitus. Nashville: Health
Care for the Homeless Clinicians Network. http://www.nhchc.org/wpcontent/uploads/2011/09/DiabetesMellitus.pdf
Department of Veterans Affairs. (2012). Veteran diseases associated with Agent Orange.
http://www.publichealth.va.gov/exposures/agentorange/diseases.asp
Fargo, J., Metraux, S., Byrne, T., Muley, E., Montgomery, A. E., Jones, H., & Culhane, D. (2012).
Prevalence and risk of homelessness among US Veterans. Prevent Chronic Disease, 9, 110-112.
doi: http://dx.doi.org/10.5888/pcd9.110112
Infectious Diseases Society of America. (2012). 2012 Infectious Diseases Society of America clinical
practice guideline for the diagnosis and treatment of diabetic foot infections. Clinical Infectious
Diseases 54. E132-e173. doi: 10.1093/cid/cis346
Nooe, R. M., & Patterson, D. A. (2010). The ecology of homelessness. Journal of Human Behavior in
the Social Environment, 20 (2), 105-152. http://dx.doi.org/10.1080/10911350903269757
Butch Sampson – Simulation # 2
© National League for Nursing, 2013
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O’Toole, T. P., Conde-Martel, A., Givvon, J. L., Hanusa, B. H., & Fine, M. J. (2003). Health care of
homeless veterans. Why are some individuals falling through the safety net? Journal of General
Internal Medicine, 18, 929-933.
Swift, C. S., & Boucher, J. L. (2005). Nutrition care for hospitalized individuals with diabetes. Diabetes
Spectrum, 18(1), 34-88. doi: 10.2337/diaspect.18.1.34
http://spectrum.diabetesjournals.org/content/18/1/34.full.pdf+html
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:
Standardized patient or moderate fidelity or
high fidelity manikin.
Props: Dressing covering right great toe.
Wheelchair, cane and bag with belongings in
room.
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
Monitor attached
ID band
Other:
Documentation Forms:
Physician Orders
Admit Orders
Flow sheet
Medication Administration Record
Kardex
Graphic Record
Shift Assessment
Triage Forms
Code Record
Anesthesia / PACU Record
Standing (Protocol) Orders
Transfer Orders
Other: see chart materials
Recommended Mode for Simulation:
(i.e. manual, programmed, etc.)
Mode will not change for this scenario. Simulator
may be set manually or programmed or this
Butch Sampson – Simulation # 2
© National League for Nursing, 2013
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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: dressing change supplies;
compression stockings
simulation may be conducted with a standardized
patient.
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
Pharmacy
Lab
Imaging
Social Services
Clergy
Unlicensed Assistive Personnel
Code Team
Other:
Important Information Related to Roles:
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:
Butch Sampson – Simulation # 2
© National League for Nursing, 2013
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Report Students Will Receive Before Simulation
Time: 1100
Situation: Bradley Leonard Sampson is a 62-year-old patient of Dr. Bell. He prefers to be called “Butch.” He
was admitted 3 days ago for cellulitis of right great toe. He had a debridement of his right great toe and he was
treated with IV antibiotics.
Background: Butch has Diabetes Mellitus Type 2, but because of his chronic and episodic homelessness, he
has had difficulty managing this condition. He is a Navy veteran with known Agent Orange exposure from the
Vietnam War. He says after he was discharged he worked as a deck hand for several years with various
fishing operations, but lost his home and job in Hurricane Katrina. He has no known relatives. He says his
parents and brother are deceased and although he was married and divorced twice he has no known children.
He is being discharged today to transitional housing as part of a VA program and has been assigned a case
manager. Dr. Bell has also ordered home health and PT visits for follow-up care for his diabetic foot ulcer. He
is a smoker - 1 pack a day x40 years and consumes alcohol regularly. These lifestyle issues have created a
problem for him in the past in previous transitional housing. His fasting blood sugar today was 130. It has
improved from 190 on admission with control of the infection, balanced diet and use of Metformin.
Assessment: He is willing to give the transitional housing unit a try and will also consider permanent housing
if it becomes available through the VA program. He’s just getting ready for discharge. His social worker, Bill,
will take him to his new place. I just took his discharge vital signs and they are stable. I also re-dressed his toe
this morning and the surgical wound was pink and moist with scant serous drainage.
Recommendation: Go over the discharge instructions that are on his chart and see if he understands all of
them. Please complete the medication reconciliation form too. Make sure he gets the surgical shoe before he
leaves.
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
Resting in wheelchair dressed in
street clothes with right foot
elevated on a pillow. Dressing dry
and intact with no visible drainage.

Role member
providing cue:
Butch
Cue: If students


Greet patient,
check ID.
Introduce self.
Wash hands.
Butch Sampson – Simulation # 2
© National League for Nursing, 2013
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Has cane and belongings in bag.
BP 120/80, Pulse 72, Resp. 16,
Temp 98.6 F
“You can just call me Butch.
I’m ready to get out of here! My
case manager said he’d give me a
ride to the new place.”


Establish
therapeutic
communication
(interest and
concern).
Explain reason for
assessments.
forget to introduce
themselves, Butch
can say, “Who are
you and what do
you want with me?”
Ask Butch to
describe how he
will take his
medications. May
offer other written
materials about
medications.
Complete
medication
reconciliation
form.
Role member
providing cue:
Cue:
Assess
understanding of
diet by asking
Butch what he
knows about food
choices.
Can provide
additional
resources about
diet.
Role member
providing cue:
Cue:
Discuss reasons
for elevation of leg
and limitations on
activity. Discuss
home visits and
follow up at
Role member
providing cue:
Cue:
Answers questions appropriately.
If students ask personal questions
about why he is homeless or
specifics about his military combat
patient will say, “That’s none of
your business.”
5-10 min
“I take that antibiotic horse pill
three times a day, right? Eat
something with it, too.”
“I’m supposed to take that
diabetes pill—Metformin—twice a
day before breakfast and before
supper.”
10-15 min
15-20 min


“The dietician said I should try to
have a half a plate with
vegetables and fruit. A quarter of
a plate with some kind of meat
and a quarter of a plate with
something like potatoes, rice, or
noodles. She also gave me this
sheet for keeping track.”

“I know I need to take better care
of myself, but being cooped up
inside all day just doesn’t seem
like any way to live.”

“OK, I’m ready to get out of here.
Need to stop downstairs and have
a smoke. They say at least I can

Butch Sampson – Simulation # 2
© National League for Nursing, 2013
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smoke at this new place outside
on the porch.”
Healthcare for
Homeless
Veterans (HCVC)
clinic.
Debriefing/Guided Reflection Questions for This Simulation
(Remember to identify important concepts or curricular threads that are specific to your program)
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.
Have you ever served in the military, or do you know someone who has? If so, how did your personal
experience with these individuals influence your participation in the scenario?
8.
If you were able to do this again, how could you have handled the situation differently?
9.
What did the group do well?
10. What did the team feel was the primary nursing diagnosis?
11. How were physical and mental health aspects interrelated in this case?
12. What were the key assessments and interventions?
13. Is there anything else you would like to discuss?
Specific Debriefing Questions for this Scenario:
1. Do you have any concerns about Butch’s ability to manage his own care?
2. What are Butch’s strengths?
3. What other members of the health care team could help to manage Butch’s care?
Butch Sampson – Simulation # 2
© National League for Nursing, 2013
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