SIMULATION DESIGN & PLANNING TEMPLATE
Scenario Name Mental Health Issues Junior Level
Measurable Objectives (minimum 2, maximum 10)
1. Differentiate between physical disease symptoms and mental health issues in relation
to Parkinson's disease.
2. Accurately administer a neurological assessment and a Mini Mental State Exam.
3. Develop a nursing problem list with options to be considered to address each
problem and possible approaches to teach the patient and family.
Instructor’s Name Mary Proudfoot Edmonds Community College, Janine Buis
Northwest Hospital and Medical Center
Date Submitted Spring 2013
Will There Be Any Pre-Simulation Lecture? Review prior to simulation: Structure and
function of the nervous system, Neurological Assessment, Mini Mental Status Exam
Expected Scenario Time 15 minutes Expected Debrief Time
30 minutes
Report and Information Provided To Participants Prior To Simulation
Mrs. Turner is a 63-year-old Caucasian woman who was brought in to the clinic by her daughter and
her son-in- law. Her daughter and son-in-law think that Mrs. Turner is depressed following the death
of her husband a year ago. She has not been responding much to them and hardly smiles anymore.
Her movements have become slowed. They also think that she is anxious because her hands shake
when she is sitting in her chair.
Mrs. Turner grew up in New England with a sister and a brother. When she was young she worked in
her father’s filling station pumping gas. Her father died at age 76 from a heart attack. Her mother died
at age 79 from pneumonia. Her older brother has been diagnosed with Alzheimer’s disease. Her
husband died one year ago from lymphoma.
Mrs. Turner’s health has been generally good and she worked until she was 60 years of age as a nurse.
She cared for her husband during the final stages of his illness. Since her retirement Mrs. Turner has
continued with her hobby of gardening. She is now finding it harder to bend and move to accomplish
the gardening chores. This has been going on for about 2 years
Patient Information
HEET V Grant Simulation Scenario Template 2013. Excerpts adapted and used by permission
from National League for Nursing's & Laerdal Medical Corporation's Simulation Design Template
(2008), and Northwest Medical Center's Scenario Planning Worksheet (last accessed March 2013).
1
SIMULATION DESIGN & PLANNING TEMPLATE
Patient Name:Mrs. Turner Gender: Female
Weight: 142 lbs
Age: 63
Birth date:, June 9
Height: 5’4”
ID band MR #00001234 Acct. # 1198765432
Hx. Present Illness: Mrs. Turner is a 63-year-old Caucasian woman who was brought
in to the clinic by her daughter and her son-in- law. Her daughter and son-in-law think
that Mrs. Turner is depressed following the death of her husband a year ago. She has
not been responding to them and hardly smiles anymore. Her movements have become
slowed. They also think that she is anxious because her hands shake when she is sitting
in her chair.
Social History: married for 39 years and has four children and two grandchildren
Support System: daughter and son-in-law
Allergies:
NKA
Past medical history: Spontaneous miscarriage between 2nd and 3rd child,
hysterectomy age 59
Physical description of how you want the manikin to present at start of scenario?
Moulage: Standardized patient, pale face, street clothes and gray wig, well
groomed.
Assignment Of Roles (Please indicate below roles to be assigned):
Primary Nurse
Secondary Nurse
Family Member son-in-law
CNA/MA
Advanced Practice Nurse Clinical Instructor
Family Member daughter
Observer(s) x1
Patient
Important Information Related To Roles:
Please provide entire script and sequence to patient, daughter and son-in-law
Family, please improvise as you are concerned about mom’s deterioration and
depression runs in the family.
Recommend 2 nurses assess patient together and ask CNA to take Vital signs.
HEET V Grant Simulation Scenario Template 2013. Excerpts adapted and used by permission
from National League for Nursing's & Laerdal Medical Corporation's Simulation Design Template
(2008), and Northwest Medical Center's Scenario Planning Worksheet (last accessed March 2013).
2
SIMULATION DESIGN & PLANNING TEMPLATE
Setting/Environment
Other Outpatient Clinic
Medications and Fluids:
Other Takes multivitamins
Equipment available in room:
Other: reflex hammer, tongue blade, cotton balls,
cinnamon stix, penlight stethescope, blood pressure cuff,
thermometer, scale, Brochures on Parkinson's disease, Risk
Falls, Depression
Documentation Forms:
Other Fall risk assessment tool, Intake form,
Mini mental state exam
Significant Lab Values CBC and Chemistry panel normal
Recommended Mode for Simulation
Manikin to be used Standardized Patient
Patient
Daughter
Son In law
ARNP
Scenario Progression Outline
#1
Initial Amount
Time in Initial
Stage- 10 mins
Baseline Vital Signs
T PR 98.4-84-20
BP 108/70
SPO298%
Cardiac Rhythm
NSR
Breath Sounds
Clear
Heart Sounds
Normal
Abdominal Sounds
Hypoactive
Other Symptoms:
PT. Move slowly,
decreased arm swing,
tremor of right hand,
when resting. Look
over to daughter for
reassurance and seek
clarification about
discussion.
Verbalization
(Pt/Manikin
Cues)
PT Have flat affect in
speech and
appearance.I have
trouble getting up
from the chair
without help. My
voice has changed, I
can't sleep like I
used to and I am
constipated.
I sometimes feel I
can’t swallow; my
whole body is stiff
and weak.
Expected
Interventions
Confederate
Actions/Additional Role Player
Cues
Nurse: Vital signs
Neurological
assessment
Data on motor and
non motor
symptoms
Beck’s depression
inventory
Daughter Speak a few minutes
into assessment intake: Asking
about medication to help her
mother regain her energy and
enthusiasm. She is concerned
about depression and mother not
wanting to socialize with friends
or neighbors.
HEET V Grant Simulation Scenario Template 2013. Excerpts adapted and used by permission
from National League for Nursing's & Laerdal Medical Corporation's Simulation Design Template
(2008), and Northwest Medical Center's Scenario Planning Worksheet (last accessed March 2013).
3
SIMULATION DESIGN & PLANNING TEMPLATE
#2 Correct Treatment Choice
Timing Sequence
Expected
After daughter initially
Interventions
talks
Pt. During exam move
Nurse: Repeat BP
over to bed or exam
table and shuffle gait.
Conduct fall risk
Holds onto furniture to
assessment
get BP.
Verbalization
Create problem
Dgt comment after mom list
arrives at bed or exam
table: My mother is
SBAR report for
always tired and
ARNP
complains of dizziness
when taking a shower. I ARNP enters after
don’t know if she
daughter’s
should drive anymore.
comments
What do you think?
seeking report.
She has vivid dreams
and wakes early. She
complains about
constipation. Can you
look at her shoulder?
She has cramping in the
morning.
#3 Correct Treatment choice continued
Timing Sequence
Expected
Post ARNP report
Interventions
Verbalization
Son-in-law: My
Nurse Identify
mother-in-law seems
strategies to
really depressed. I am
empower family
afraid she will fall when and patient to use
showering or sitting
risk modification,
down. Her hand shakes assistive devices
a lot.
and support groups
in the community.
ARNP announces
considering
Parkinson's disease
diagnosis, scenario
ends.
HEET V Grant Simulation Scenario Template 2013. Excerpts adapted and used by permission
from National League for Nursing's & Laerdal Medical Corporation's Simulation Design Template
(2008), and Northwest Medical Center's Scenario Planning Worksheet (last accessed March 2013).
4
SIMULATION DESIGN & PLANNING TEMPLATE
Instructor Check List
(return to CHESC assistant at the end of class)
Pre-Scenario Check List
1.
2.
3.
4.
5.
6.
7.
8.
Equipment is staged as requested.
The learner has been oriented to the simulator.
The learner understands the guidelines/expectations for the
scenario.
Participants understand their assigned roles.
The time frame Expectations for simulation met: Yes No.
The time frame Expectations for debrief met:
Yes
No.
Audio/Visual Consent signed and turned into CHESC sheet.
Attendance sheet completed and given to CHESC staff.
Post Scenario
If you could change anything next time, what would it be?
Comments:
________________________________________________________
________________________________________________________
________________________________________________________
CHESC Assistant Name:
Did the person provide excellent support for the scenario?
Yes
No Comment
Instructor signature ________________________________
Date
________________________
HEET V Grant Simulation Scenario Template 2013. Excerpts adapted and used by permission
from National League for Nursing's & Laerdal Medical Corporation's Simulation Design Template
(2008), and Northwest Medical Center's Scenario Planning Worksheet (last accessed March 2013).
5
SIMULATION DESIGN & PLANNING TEMPLATE
Participant Check List
(return to Instructor at the end of class)
Pre-Scenario Check List
1.
2.
3.
4.
5.
I have been oriented to the simulator.
I understand the guidelines/expectations for the scenario.
I understand the assigned role.
My questions about the simulation have been answered.
I have all necessary equipment for the simulation.
Post Scenario
If you could change anything next time, what would it be?
Comments:
________________________________________________________
________________________________________________________
________________________________________________________
________________________________________________________
Participant Signature ____________________________________
Date
________________________
HEET V Grant Simulation Scenario Template 2013. Excerpts adapted and used by permission
from National League for Nursing's & Laerdal Medical Corporation's Simulation Design Template
(2008), and Northwest Medical Center's Scenario Planning Worksheet (last accessed March 2013).
6
SIMULATION DESIGN & PLANNING TEMPLATE
Simulation Post-Assessment Methods
Checklist
Tests
Evaluations
Turning Point
Jeopardy
Other
Optional Literature References
Debriefing Guidelines
(Remember to identify important concepts or curricular threads that are specific to your
program)
1. Leave the simulation room and go to a conference room, if possible. It allows for deescalation of emotions.
2. Solicit and validate emotions briefly. Validate simisms (the simulation isn’t 100% accurate
due to different equipment, personnel etc)
3. What went WELL in this simulation?
4. What DID NOT go well in this simulation?
5. If you could do it again, what would you do differently?
6. Summarize:
“What I hear you saying is . . .”
HEET V Grant Simulation Scenario Template 2013. Excerpts adapted and used by permission
from National League for Nursing's & Laerdal Medical Corporation's Simulation Design Template
(2008), and Northwest Medical Center's Scenario Planning Worksheet (last accessed March 2013).
7
SIMULATION DESIGN & PLANNING TEMPLATE
Beck's Depression Inventory
This depression inventory can be self-scored. The scoring scale is at the end of the questionnaire.
Questions 1-11
Questions 12-21
1. 0 I do not feel sad.
1 I feel sad
2 I am sad all the time and I can't snap out of it.
3 I am so sad and unhappy that I can't stand it.
2. 0 I am not particularly discouraged about the future.
1 I feel discouraged about the future.
2 I feel I have nothing to look forward to.
3 I feel the future is hopeless and that things cannot
improve.
3. 0 I do not feel like a failure.
1 I feel I have failed more than the average person.
2 As I look back on my life, all I can see is a lot of
failures.
3 I feel I am a complete failure as a person.
4. 0 I get as much satisfaction out of things as I used to.
1 I don't enjoy things the way I used to.
2 I don't get real satisfaction out of anything anymore.
3 I am dissatisfied or bored with everything.
5. 0 I don't feel particularly guilty
1 I feel guilty a good part of the time.
2 I feel quite guilty most of the time.
3 I feel guilty all of the time.
6. 0 I don't feel I am being punished.
1 I feel I may be punished.
2 I expect to be punished.
3 I feel I am being punished.
7. 0 I don't feel disappointed in myself.
1 I am disappointed in myself.
2 I am disgusted with myself.
3 I hate myself.
8. 0 I don't feel I am any worse than anybody else.
1 I am critical of myself for my weaknesses or mistakes.
2 I blame myself all the time for my faults.
3 I blame myself for everything bad that happens.
9. 0 I don't have any thoughts of killing myself.
1 I have thoughts of killing myself, but I would not carry
them out.
2 I would like to kill myself.
3 I would kill myself if I had the chance.
10. 0 I don't cry any more than usual.
1 I cry more now than I used to.
2 I cry all the time now.
3 I used to be able to cry, but now I can't cry even
though I want to.
11. 0 I am no more irritated by things than I ever was.
1 I am slightly more irritated now than usual.
2 I am quite annoyed or irritated a good deal of the time.
3 I feel irritated all the time.
12. 0 I have not lost interest in other people.
1 I am less interested in other people than I used to be.
2 I have lost most of my interest in other people.
3 I have lost all of my interest in other people.
13. 0 I make decisions about as well as I ever could.
1 I put off making decisions more than I used to.
2 I have greater difficulty in making decisions more than
I used to.
3 I can't make decisions at all anymore.
14. 0 I don't feel that I look any worse than I used to.
1 I am worried that I am looking old or unattractive.
2 I feel there are permanent changes in my appearance
that make me look
unattractive
3 I believe that I look ugly.
15. 0 I can work about as well as before.
1 It takes an extra effort to get started at doing
something.
2 I have to push myself very hard to do anything.
3 I can't do any work at all.
16. 0 I can sleep as well as usual.
1 I don't sleep as well as I used to.
2 I wake up 1-2 hours earlier than usual and find it hard
to get back to sleep.
3 I wake up several hours earlier than I used to and
cannot get back to sleep.
17. 0 I don't get more tired than usual.
1 I get tired more easily than I used to.
2 I get tired from doing almost anything.
3 I am too tired to do anything.
18. 0 My appetite is no worse than usual.
1 My appetite is not as good as it used to be.
2 My appetite is much worse now.
3 I have no appetite at all anymore.
19. 0 I haven't lost much weight, if any, lately.
1 I have lost more than five pounds.
2 I have lost more than ten pounds.
3 I have lost more than fifteen pounds.
20. 0 I am no more worried about my health than usual.
1 I am worried about physical problems like aches,
pains, upset stomach, or constipation.
2 I am very worried about physical problems and it's
hard to think of much else.
3 I am so worried about my physical problems that I
cannot think of anything else.
21. 0 I have not noticed any recent change in my interest in
sex.
1 I am less interested in sex than I used to be.
2 I have almost no interest in sex.
HEET V Grant Simulation Scenario Template 2013. Excerpts adapted and used by permission
from National League for Nursing's & Laerdal Medical Corporation's Simulation Design Template
(2008), and Northwest Medical Center's Scenario Planning Worksheet (last accessed March 2013).
8
SIMULATION DESIGN & PLANNING TEMPLATE
3 I have lost interest in sex completely.
INTERPRETING THE BECK DEPRESSION INVENTORY
Now that you have completed the questionnaire, add up the score for each of the twenty-one
questions by counting the number to the right of each question you marked. The highest possible
total for the whole test would be sixty-three. This would mean you circled number three on all
twenty-one questions. Since the lowest possible score for each question is zero, the lowest
possible score for the test would be zero. This would mean you circles zero on each question.
You can evaluate your depression according to the Table below.
Total Score________________Levels of Depression
1-10____________________These ups and downs are considered normal
11-16___________________ Mild mood disturbance
17-20___________________Borderline clinical depression
21-30___________________Moderate depression
31-40___________________Severe depression
over 40__________________Extreme depression
A PERSISTENT SCORE OF 17 OR ABOVE INDICATES THAT YOU MAY NEED
MEDICAL TREATMENT.
HEET V Grant Simulation Scenario Template 2013. Excerpts adapted and used by permission
from National League for Nursing's & Laerdal Medical Corporation's Simulation Design Template
(2008), and Northwest Medical Center's Scenario Planning Worksheet (last accessed March 2013).
9
SIMULATION DESIGN & PLANNING TEMPLATE
Resources:
American Parkinson Disease Association, http://www.apdaparkinson.org/
Awakenings, Oliver Sacks (1973, rev. ed. 1990) Paperback, Vintage Books.
Drug Treatment for Parkinson's Disease
WebMD
http://www.webmd.com/parkinsons-disease/guide/drug-treatments
May 24,2013.
McCormick, Margaret J., Johanna Romero de Slavy, and Bonnie Fuller. "Embracing technology: using
an unfolding case simulation to enhance nursing students' learning about Parkinson disease." Journal
of Neuroscience Nursing Feb. 2013: 14+. Health Reference Center Academic. Web. 5 Apr. 2013.
Document URL
http://go.galegroup.com/ps/i.do?id=GALE%7CA316458671&v=2.1&u=lynn16881&it=r&p=HRCA&
sw=w
National Parkinson Foundation, http://www.parkinson.org/
Parkinson's Disease, Case study, Clinical trial sketch,
http://www.mindspring.com/~cjalverson/_parkinsonsdisease.htm
May 24, 2013.
Parkinson's Disease: Hope Through Research
Prepared by:
Office of Communications and Public Liaison
National Institute of Neurological Disorders and Stroke
National Institutes of Health
Bethesda, MD 20892
http://www.ninds.nih.gov/disorders/parkinsons_disease/detail_parkinsons_disease.htm#221463159
May 24, 2013.
Parkinson's Disease: Challenges, Progress, and Promise
Prepared by:
Office of Communications and Public Liaison
National Institute of Neurological Disorders and Stroke
National Institutes of Health
Bethesda, MD 20892
http://www.ninds.nih.gov/disorders/parkinsons_disease/parkinsons_research.htm
May 24, 2013.
Stieber Roger, K., Medved, M, Living with Parkinson’s Disease-Managing Identity Together,
International Journal of Qualitative Studies on Health and Well Being, March 30, 2010,
http://www.ncbi.nlm.nih.gov.offcampus.lib.washington.edu/pmc/articles/PMC2875966/
HEET V Grant Simulation Scenario Template 2013. Excerpts adapted and used by permission
from National League for Nursing's & Laerdal Medical Corporation's Simulation Design Template
(2008), and Northwest Medical Center's Scenario Planning Worksheet (last accessed March 2013).
10
SIMULATION DESIGN & PLANNING TEMPLATE
Walter BK and Leverenz JB. Cognitive Impairment in Parkinson’s Disease. Dementia, Editor
McNamara
P, Pub: Praeger, Volume 2, Chapter 12, 2011.
Non medication treatments for depression
Nintendo Wii May Enhance Parkinson's Treatment- mentions improvement in depression
Northwest Parkinson's Foundation.
http://www.nwpf.org/News.aspx?Item=2884
May 24, 2013.
Beck's Depression Inventory
http://www.cawt.com/Site/11/Documents/Members/Evaluation/BeckDepressionInventory1.pdf
May 24, 2013.
Depression (major depression)
Alternative medicine By Mayo Clinic staff
http://www.mayoclinic.com/health/depression/DS00175/DSECTION=alternative-medicine
May 24, 2013.
Non-pharmacological treatment of depressive disorders: a review of evidence-based treatment options.
Rev Recent Clin Trials. 2012 May;7(2):141-9.
Dirmaier J, Steinmann M, Krattenmacher T, Watzke B, Barghaan D, Koch U, Schulz H.
Source: University Medical Center Hamburg-Eppendorf, Department of Medical Psychology,
Martinistraße 52, 20246 Hamburg, Germany. dirmaier@uke.de
http://www.ncbi.nlm.nih.gov/pubmed/22353197 May 24, 2013.
HEET V Grant Simulation Scenario Template 2013. Excerpts adapted and used by permission
from National League for Nursing's & Laerdal Medical Corporation's Simulation Design Template
(2008), and Northwest Medical Center's Scenario Planning Worksheet (last accessed March 2013).
11