Simulation Design Template:
Henry Williams-Simulation #2
Date:
Discipline: Nursing
Expected Simulation Run Time: 20
minutes
Location: Hospital
Admission Date:
File Name: Henry Williams
Student Level:
Guided Reflection Time: 20 minutes
Location for Reflection: Lab/Classroom
|
Today’s Date:
Brief Description of Client
Name: Henry Williams
Gender: M Age: 69
Race: Black Weight: 88 kg Height: 72 in
Religion: Baptist
Major Support: Ertha (wife)
Support Phone: 320-222-2345
Betty (daughter-in-law)
320-222-1111
Allergies: Penicillin
Immunizations: Up to date
Attending Physician/Team: Dr. Nelson
Past Medical History: Chronic obstructive pulmonary disease (COPD), cardiovascular disease (CVD),
asthma, hearing loss (wears hearing aids)
History of Present Illness:
Henry Williams has been in the hospital for 5 days for an acute exacerbation of COPD and will be discharged
today to the local rehabilitation center. His wife, Ertha, will not be able to be at home and will have to move in
with their daughter-in-law until the home situation is resolved.
Social History: Retired
Primary Medical Diagnosis: COPD, cardiovascular disease
Surgeries/Procedures & Dates: Appendectomy at age 15.
Nursing Diagnoses: Alteration in respiratory status secondary to exacerbation of COPD, anxiety, potential for
depression
Henry Williams Simulation 2
© National League for Nursing, 2015
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Psychomotor Skills Required Prior to Simulation


Focused assessment including vital signs for discharge
Review of medication with the client and nurse in rehabilitation center.
Cognitive Activities Required Prior to Simulation
[i.e. independent reading (R), video review (V), computer simulations (CS), lecture (L)]






SBAR or other standardized communication tool. (R)
Review ACES Framework. Should have 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 Modified Caregivers Strain Index and the Geriatric
Depression Scale. (R)
Reading in textbook as assigned (R).
Medication Reconciliation Form
Reading in textbook as assigned. (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. Demonstrate a focused assessment needed prior to discharge from acute care setting to the
rehabilitation setting.
2. Demonstrate effective communication skills with the patient and family through the review of
medication and discharge plans.
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© National League for Nursing, 2015
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3. Demonstrate effective teaching skills with the patient and family.
4. Prepare a medication reconciliation form for the rehabilitation center.
5. Use the SBAR or another standardized tool to communicate with other health care professionals
regarding Henry’s transfer to the rehabilitation facility.
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.
Hartford Institute for Geriatric Nursing: Assisted Living/Nursing Home/Long-term Care:
http://consultgerirn.org/resources/assisted_living_nursing_home_long_term_care/
This site lists resources that learners should become familiar with regarding assisted living and long term
care facilities.
The Modified Caregivers Strain Index:
Tool : http://consultgerirn.org/uploads/File/trythis/try_this_14.pdf
Video: http://consultgerirn.org/resources/media/?vid_id=4902696#player_container
The Geriatric Depression Scale:
Tool: http://consultgerirn.org/uploads/File/trythis/try_this_4.pdf
Video: http://consultgerirn.org/resources/media/?vid_id=4200933#player_container
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
Medications and Fluids:
IV Fluids:
Oral Meds: see chart
IVPB:
IV Push:
IM or SC:
Henry Williams Simulation 2
© National League for Nursing, 2015
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Behavioral Health
Home Health
Pre-Hospital
Other:
Simulator Manikin/s Needed:
Vital Sim, SimMan® or standardized patient
Props: Glasses, hat, hearing aids
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 Henry Williams
Other: oximeter
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) nasal cannula
Crash cart with airway devices and
emergency medications
Defibrillator/Pacer
Suction
Other:
Diagnostics Available:
Labs
X-rays (Images)
12-Lead EKG
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: Discharge record and medication
record for discharge
Recommended Mode for Simulation:
(i.e. manual, programmed, etc.) either
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:
Henry Williams Simulation 2
© National League for Nursing, 2015
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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:
Prepare students to take on roles of RN’s for the
hospital (nurse number one) and the
rehabilitation facility (nurse number two). Nurse
number two will take the handoff report from the
hospital RN in a detailed phone conference using
the SBAR. May have a third nurse doing the
medication reconciliation. One student should
play the role of patient’s wife and one student
should play the daughter-in-law. One student
should play social worker who notices Henry
seems sad. The social worker will discuss the
current situation with the family and assist them
in dealing with the changes in care and life
transition. The student should be aware of the
perspective of the family members during this
transition.
Report Students Will Receive Before Simulation
Time: It is now 2:00 in the afternoon the 5th hospital day. Report is given from the day-shift RN.
Henry Williams will be discharged today to the local rehabilitation center. He has been weak and has
progressed slowly with his pulmonary rehabilitation. He still gets short of breath with his ADL’s. He is worried
about his wife and her memory lapses. His vital signs are stable and he is using his oxygen at night and as
needed for shortness of breath with activity. He will need to have teaching done, and the medication
reconciliation documentation done. We faxed some of the transfer forms to the rehabilitation center. They will
need to be called with a report on Henry and his plan of care. Henry plans to go to there for a week or so of
therapy and then go into assisted living with his wife. He has been quiet today. He took a nap this morning
after therapy and seems concerned about going to the rehabilitation center but hasn’t said too much yet. Betty
and Ertha will come later to drive Henry to the rehabilitation center. They should be included in the discharge
discussions, especially with the social worker. Social Service is aware of the transfer and they are available for
any assistance needed with the discharge. Be sure that the doctor has written his orders for the discharge and
the medications. We must have them this morning so we can fax them over to the rehabilitation center. Be sure
to get an order for the oxygen and for rehabilitation.
Henry Williams Simulation 2
© National League for Nursing, 2015
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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
Henry is in the chair, dressed and
waiting for discharge. He appears
withdrawn and sad.
"I am afraid of going to that
rehabilitation center. I hear people
never go home…. Well, it’s time to
leave the hospital today and I am
worried about everything! The nurses
keep talking to me about the
rehabilitation center like it will be a
great place for me but I won’t have
Ertha and I won’t be home so what is
so good about this? I know it’s
temporary and I need the rehab but
still, it seems so permanent and I won’t
probably see our home again. Betty is
arranging for us to go to an assisted
living apartment when there is an
opening. Poor Betty, she doesn’t even
live here.
Expected
Interventions
May Use the Following Cues

Role member providing cue:
Social Worker




Appropriate
identification of
self and patient
Vital signs
Nurse number
one should be
asking Henry
questions about
discharge today.
Nurse number
two should be
assigned to the
medication
reconciliation.
Henry can
answer questions
about his
medications
without difficulty.
He has been
Cue: “Have you seen Henry? He
looks a little sad today.”
Social worker can address the
discharge to the rehabilitation
center and the plan for
strengthening. Student should
prepare for this role by reviewing
care that is available at local
rehabilitation centers and if this
covered by insurance.
Henry Williams Simulation 2
© National League for Nursing, 2015
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She has to take time off of work and
now care for Ertha while I’m in this
place. It won’t be easy, Ertha gets
confused when she is away from our
apartment and her routine changes.
When I get anxious I get more short of
breath so I know I shouldn’t be doing
all this worrying. I know we can do it
once we get to the apartment but the
next couple of weeks will be the
hardest with all this rehab and
wondering how Ertha is doing. What a
change in our lives. We should be
enjoying retirement and our grandson
and here we are getting old before our
time.”
5-10 min
When Ertha and Betty come into the
room, his anxiety increases.
taking them
independently at
home for years.

Nurse number
one will do a
basic
assessment and
discharge
teaching.
 The social
worker will
review the
discharge plan
and insurance
coverage for
oxygen,
pulmonary
rehabilitation and
strength training.
 Nurse number
one should also
notice Henry’s
anxiety and how
it has affected
his breathing.
 Oxygen
saturation should
be checked.
Oxygen is
ordered as
needed and can
be applied now if
the saturation is
low.
Henry Williams Simulation 2
Role member providing cue:
Betty
Cue: Can we get his
medications straightened out? I
don’t want any problems after
we leave. Henry, sit up, are you
breathing ok?”
Betty is a nurse so she will be
asking questions to the social
worker about the discharge and
“who will pay for all this?”
“Ertha will stay with me for now
but I do work full time and Ty is
in school, so I am taking time off
and asking friends to help.”
Ertha will be asking questions
and her behavior will be a
distraction.
© National League for Nursing, 2015
7
15-20
min
Henry is calmer now that his questions
have been answered and breathing is
easier.

This is a
telephone
conversation
between nurse
number one (the
hospital nurse)
and nurse
number two (the
rehabilitation
center nurse).
The rehabilitation
nurse receiving
report should ask
appropriate
questions
regarding the
patient’s stay at
the rehabilitation
center. These
should include
questions about
energy level,
safety,
medications and
oxygen use.
Allow time for the
entire discharge
process. Nurse
number one (the
hospital nurse)
must give a
complete hand
off report to nurse
number two (the
rehabilitation
center nurse)
using SBAR
correctly.
Role member providing cue:
Nurse number two (the
rehabilitation nurse)
Cue: “Hi, this is Nurse Number
Two calling from the
Rehabilitation Center. I would
like to get report on Mr. Williams
please.”
Scenario ends with Betty taking
Henry in the wheelchair out to
the car with the forms for the
rehabilitation facility.
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?
Henry Williams Simulation 2
© National League for Nursing, 2015
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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. What were the key assessments and interventions?
11. How were you able to use the ACES Framework to address the transitions with both Henry and
Ertha? (Assess Function and Expectations, Coordinate and Manage Care, Use Evolving
Knowledge, Make Situational Decisions)
12. How were physical and mental health aspects interrelated in this case?
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. Prior to simulation, students can be given an assignment to identify resources for Henry in the
rehabilitation center. These could provide Henry with a written list of such things as chaplain
services, social services, occupational therapy, etc.
2. Assign roles to students in advance of the simulation and have them research their roles of RN in a
rehabilitation center, social worker.
3. Prior to simulation, have students compare nursing home and rehabilitation facilities for level of care
provided.
4. Read about dementia and the progressive nature of the disease. The student should also research
caregiver strain with this diagnosis as well.
5. Discuss life transitions and how this relates to the ACES framework with learners and/or discuss the
complexity of Henry’s case as it relates to the framework. Include Ertha’s needs in the discussion.
Henry Williams Simulation 2
© National League for Nursing, 2015
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