Simulation Design Template:
Jenny Brown-Simulation #2
Date:
Discipline: Nursing
Expected Simulation Run Time: approx.
20 minutes
Location: Jenny’s apartment
File Name: Jenny Brown
Student Level:
Guided Reflection Time: twice the amount
of simulation run time
Location for Reflection:
Admission Date: |
Today’s Date:
Brief Description of Client
Name: Jenny Brown
Gender: F Age: 23
Race:
Weight: 54.5 kg Height: 66 in
Religion: Christian – does not attend church services
Major Support: Eric (boyfriend) Support Phone: 555-555-5566
Allergies: No known allergies
Immunizations: Current, including influenza and Tdap
Attending Physician/Team: Shelley Northridge, CNM (works with two obstetrician/gynecologists in private
practice setting)
Past Medical History: Mild intermittent, exercise-related asthma as a child - resolved
History of Present Illness: 30 weeks pregnant. Typical IUP to date. Female fetus has cleft lip & palate
diagnosed by ultrasound at 18 weeks and confirmed to be present at 24-week ultrasound. Had a 3-day
voluntary admission to acute adult psychiatric unit for acute anxiety/panic attack after she learned about the
infant’s congenital anomaly. Also diagnosed with PTSD. She now receives individual and group counseling at
the nearby VA Medical Center.
Social History: Recent discharge from military service that included deployment to combat zones in Iraq.
College student studying construction management. Stable monogamous relationship with boyfriend Eric.
Primary Medical Diagnosis: IUP, 30 weeks; generalized anxiety disorder with panic attack, PTSD diagnosed
12 weeks ago
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Surgeries/Procedures & Dates: None
Nursing Diagnoses: Imbalanced nutrition: insufficient iron intake related to pregnancy; insufficient knowledge
of pregnancy-, childbirth-, and parenting-related issues; anxiety related to pregnancy and to diagnosis of cleft
lip & palate in fetus; risk for impaired attachment to infant related to cleft lip & palate of fetus; disturbed sleep
pattern – chronic – related to PTSD
Psychomotor Skills Required Prior to Simulation


Auscultation of FHR
Prenatal physical assessment
Cognitive Activities Required Prior to Simulation
[i.e. independent reading (R), video review (V), computer simulations (CS), lecture (L)]
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
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
Read introductory monologues for Jenny and Eric for background information (R)
Read chapter in maternity text related to focused antenatal assessment; focus on developing basic
knowledge of care as a foundation for caring for pregnant clients (including appropriate physical,
mental, and developmental milestones; this scenario focuses on 3rd trimester) (R)
Review elements of effective patient-centered education (R)
Prepare to provide anticipatory guidance re: pregnancy 30-40 weeks, labor-birth, and care of newborn
with cleft lip and palate (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 focused physical and psychosocial assessments 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.
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Simulation Scenario Objectives
1.
2.
3.
4.
Conduct a focused antenatal assessment.
Assess Jenny’s mental and emotional status.
Identify stressors and strengths in Jenny’s ability to contend with pregnancy and parenting.
Respond appropriately to patient questions about relationship issues, pregnancy, labor and
delivery, care of an infant with cleft lip and palate, and respond to patient issues of grief and loss.
5. Provide anticipatory guidance and teaching regarding remaining weeks of pregnancy, labor,
delivery and care of infant.
References, Evidence-Based Practice Guidelines, Protocols, or
Algorithms Used for This Scenario:
Maternal/Child Textbook - Focus on:
 Basic knowledge of caring for pregnant clients (including appropriate physical, mental, and
developmental milestones; this scenario focuses on 3rd trimester)
o Consider what preparations expectant mothers/parents might make during pregnancy and
adaptation to motherhood
o Consider the significance of the relationship between pregnant mothers and their partners as
it relates to the success of pregnancy and early parenting
 Patient education and anticipatory guidance regarding 3rd trimester pregnancy, labor-birth,
postpartum period, and care of newborn with cleft lip and palate
 Immediate and early newborn care of infant, especially one with cleft lip and palate
Online Resources:
American Cleft Palate-Craniofacial Association. http://www.acpa-cpf.org/
Reilly, S., Reid, J., Skeat, J. and the Academy of Breastfeeding Medicine Clinical Protocol Committee. (2007).
ABM Clinical Protocol #17: Guidelines for breastfeeding infants with cleft lip, cleft palate, or cleft lip and
palate. Breastfeeding Medicine, 2, 243-250. Available:
http://www.bfmed.org/Media/Files/Protocols/Protocol%2017_Revised%202013.pdf
Sample nursing care plan for infants with cleft lip and palate. Prentice Hall. Available:
http://wps.prenhall.com/wps/media/objects/354/362846/Child%20-%20Cleft%20Palate.pdf
Seattle Children’s Hospital. (2010). Cleft lip and palate: Critical elements of care. The Center for Children with
Special Needs (http://cshcn.org/). Available:
http://cshcn.org/sites/default/files/webfm/file/CriticalElementsofCare-CleftLipandPalate.pdf
Cleft Palate Foundation. (2010). Your baby’s first year. Author: Chapel Hill, NC. Available at:
http://www.cleftline.org/docs/Booklets/FYL-01.pdf
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Online Resources Related to Women Veterans:
A Profile of Women Veterans Today:
http://www.womenshealth.va.gov/WOMENSHEALTH/docs/WV_Profile_FINAL.pdf
Women Veteran’s Healthcare Fact Sheet:
http://www.womenshealth.va.gov/WOMENSHEALTH/docs/WH_facts_FINAL.pdf
Women Veterans Health Care FAQs:
http://www.womenshealth.va.gov/WOMENSHEALTH/docs/FAQ_041912_FINAL.pdf
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: home visit
Medications and Fluids:
IV Fluids:
Oral Meds:
IVPB:
IV Push:
IM or SC:
Diagnostics Available:
Labs
X-rays (Images)
12-Lead EKG
Other:
Simulator Manikin/s Needed:
Human patient simulator or standardized
patient
Props: Manikin dressed in street clothes
Documentation Forms:
Physician Orders
Admit Orders
Flow sheet
Equipment Attached to Manikin:
Medication Administration Record
IV tubing with primary line running at mL/hr
Medication Reconciliation Form
Secondary IV line
Kardex
IV pump
Graphic Record
Foley catheter mL output
Shift Assessment
PCA pump running
Triage Forms
IVPB with running at mL/hr
Code Record
02
Anesthesia / PACU Record
Monitor attached
Standing (Protocol) Orders
ID band
Transfer Orders
Other:
Other:
 Antepartum Patient History
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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:
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:

Antenatal Assessment Form
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
simulation may be conducted with a standardized
patient.
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:
Report Students Will Receive Before Simulation
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Time: 1030 weekday morning
Situation: Jenny Brown is 23 years old, and is 30 weeks pregnant with her first baby. You are making this
home visit because Jenny is enrolled in a pregnancy support program for low income women, and for follow-up
of a brief admission to a psychiatric unit when she was 18 weeks pregnant.
Background: When Jenny was 18 weeks pregnant she had an ultrasound that revealed that her female fetus
had a cleft lip and palate. Jenny became extremely agitated and needed to be restrained. She agreed to be
voluntarily admitted to a short stay inpatient unit and treated with a few doses of haloperidol. She did well and
was discharged 3 days later. Since that time Jenny has been participating in individual therapy with a
psychiatric mental health nurse practitioner and is in group therapy for women combat veterans at the nearby
Veterans Administration Hospital. She has been sleeping well at night but still has occasional nightmares and
difficulty falling asleep after they occur. She says that she still has feelings of anxiety and describes herself as
having “bad days” and “good days.” She thinks she is less withdrawn and that she is enjoying life more. She
describes her relationship with Eric as “up and down” because they “argue a lot about little things.” She is not
taking any medications except prenatal vitamins.
Assessment: Jenny says that they haven’t “gotten around to buying anything for the baby yet.” They are not
attending any childbirth preparation classes. At the last office visit with her certified nurse midwife, Jenny was
told that the baby is growing appropriately. The baby, a female, is frequently active in utero. Fetal heart rate
has been in the 130s. Jenny’s hemoglobin and hematocrit were a little low, so she was started on ferrous
sulfate. Jenny and Eric did meet with a neonatologist before Jenny was discharged from the acute psychiatric
unit but have not yet selected a pediatrician.
Recommendation: The purpose of your visit will be to complete a third-trimester antenatal assessment and
talk with Jenny about the remainder of her pregnancy and childbirth preparation. You need to address her
mental health status, her relationship with the baby’s father, and respond to any questions she might have
about the care of her newborn immediately after birth as it relates to the cleft lip and palate.
Significant Lab Values:
refer to chart
Physician Orders:
refer to chart
Home Medications:
refer to chart
Scenario Progression Outline
Timing
(approx.)
0-10 min
Manikin Actions
Expected
Interventions
May Use the
Following Cues
Sitting comfortably in chair;

Role member
Greet patient
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alert and oriented; cooperates
with physical exam, generates
questions, and answers all
questions.
“Thank you for coming. I think
things are going okay. Some
days are good but sometimes I
just can’t get going. My nurse
midwife told me two weeks ago
that the baby is growing right on
schedule and I know she’s
moving around a lot. I think Eric
and I need to buy a few things
but when we talk about what we
need, we usually end up
arguing. It’s a girl and we are
glad to know we will have a
daughter. We have been
thinking about names. Eric likes
old fashioned names like Emma
but I like names that are more
interesting. I’ve been thinking
about naming her Mackenzie.
I’m sure we’ll figure something
out before she’s born. I do have
a lot of questions.”
10-20 min
The following is a list of
questions that Jenny might ask.
Faculty should decide which
ones are most appropriate for
their students at this point in
their course and how many to
include in the time allotted for
the scenario. The focus is on
good patient teaching.


My belly is getting so big.
How much bigger will I
get?
I’ve already gained about
15 pounds. How much
more weight am I
supposed to gain?
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Introduce self
Wash hands
Establish
therapeutic
communication
(interest and
concern)
Verify reason for
home visit from
patient
perspective.
Conduct prenatal
assessment.
providing cue:
Patient
Cue:
Respond
appropriately to
Jenny’s
questions.
At end of visit,
summarize what
they discussed
and set date for
next
appointment.
Role member
providing cue:
Cue:
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I guess I have a little bit of
anemia – is that bad?
Should I be eating anything
special?
My nurse midwife talked
about childbirth preparation
classes. Should we take
those? What kinds of
things will they teach us?
I’m pretty busy with school
and Eric works long hours
so I’m not sure we have
time for classes.
What kinds of physical
symptoms can I expect in
these last months of my
pregnancy?
Is it okay to have sex
between now and the time
the baby is born?
I walk about 2 miles to
campus every day. Is it
okay to keep doing that?
Can I keep going to yoga
class? It’s a special
prenatal yoga class at the
YWCA.
When and how do I pick a
pediatrician? How can I tell
who would be a good one
for our baby, especially
with her problems?
My friend had a preemie.
How could I tell if I was
going into labor too soon?
What signs should I look
for?
My mom sent me an article
about something called,
“pre-etampsia” or
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something like that. What
is it? It sounded very scary,
like it could lead to real
problems. How would I
know if I was getting that?
Are there any other
physical symptoms that
should worry me or I
should tell someone about
while I’m pregnant?
My nurse midwife asked
me what kind of anesthesia
I want to have when the
baby is born. I want to “go
natural” and not have any
medications, but if I need
some, how do I decide
which is one is best?
What’s going to happen
when the baby is born?
Who will be at the delivery
to take care of her? Is she
going to have to go to the
NICU right away? When
will we be able to hold her
and spend some time with
her?
I know I am getting better
from a mental health
perspective. I’m sleeping
better. But sometimes
when I think about the
baby, I wish that she could
have been perfect.
I think I want to breastfeed,
but I’m not sure. Some
people tell me I won’t be
able to because of the
baby’s cleft lip and palate.
My nurse midwife says I
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might be able to. What do
you think? What are the
advantages of
breastfeeding? How long
would I have to do it? If I
do breastfeed, who could
help me with it after the
baby’s born?
I don’t want you to think I’m
a problem drinker or
anything but now and then
I would like to have a beer
with dinner or something. I
know I can’t drink now
but… when can I drink
alcohol again?
Debriefing/Guided Reflection Questions for This Simulation
(Remember to identify important concepts or curricular threads that are specific to your program)
1.
What concerns, if any, did you have about Jenny’s health status (physical, emotional, mental)?
2.
How did you feel throughout the simulation experience?
3.
How confident were you that you had the skills and knowledge to address Jenny’s health status?
4.
Describe the objectives you were able to achieve.
5.
Which ones were you unable to achieve (if any)?
6.
Did you have the knowledge and skills to meet objectives?
7.
Were you satisfied with your ability to work through the simulation?
8.
To observer: Could the nurse(s) have handled any aspects of the simulation differently?
9.
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?
10. If you were able to do this again, how could you have handled the situation differently?
11. What did the group do well?
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12. What did the team believe was the primary nursing diagnosis?
13. What were the key assessments and interventions?
14. How were physical and mental health aspects interrelated in this case?
15. What concerns, if any, do you have about the parenting ability of Jenny and/or Eric?
16. Is there anything else you would like to discuss?
Specific Debriefing Questions for this Scenario:
1. If you have ever been pregnant, or know someone who has been, how did that experience influence
your participation in the scenario?
2. Were Jenny’s questions about her pregnancy, labor, delivery, and newborn care what you expected?
How were they different?
3. How might you assess whether or not Jenny and Eric are beginning to form an attachment to the fetus?
4. What would you focus on during the next prenatal visit?
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