SIMULATION DESIGN & PLANNING TEMPLATE
Communication Senior Level
Program/Curriculum Specific Objectives:
Provide Therapeutic Communication to a young adult who is refusing a blood transfusion and discuss patient’s wishes to physician.
Measurable Objectives (minimum 2, maximum 10)
1.
Discuss patient’s decision with physician
2.
Interpret critical lab values
3.
Demonstrate therapeutic communication
4.
Utilizes AIDET and SBAR when communicating
Instructor’s Name Karen Paulsen Northwest Hospital & Medical Center
Denise Filiatrault North Seattle Community College
Date Submitted Spring 2013
Will There Be Any Pre-Simulation Lecture? X Yes Duration 5 min
Expected Scenario Time: 20 min Expected Debrief Time: 40 min
Report and Information Provided To Participants Prior To Simulation
This is Lisa Miller she is a 22 year old female who came to the ER vomiting blood. She had an EGD and they found and fixed a bleeding gastric ulcer. She has been admitted to the unit to receive two units of red blood cells (PRBC). She has a 9month old, is under a lot of stress at home, and her mother and husband are at the bedside.
Patient Name: Lisa Miller Gender: Female
Age: 22 Birth date: , 2/19/1991
Weight: 145lb
Height: 5’5”
ID band MR #00001234 Acct. # 1198765432
Hx. Present Illness: Vomiting blood for three days
Social History: Stay at home mom, daughter 9 months old, has been under additional stress at home
Religion: Jehovah Witness
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).
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SIMULATION DESIGN & PLANNING TEMPLATE
Support System: Parents, husband and church
Immunizations: up to date
Allergies: NKA
Attending Physician:
Past medical history: negative
Dr. Smyth
( Please indicate below roles to be assigned)
:
Primary Nurse Physician/ Advanced Practice Nurse
Family Member #1 Husband
Unlicensed Assistive Personnel/CNA/MA
Important Information Related To Roles:
Family Member #2 Parent
The mother (parent of patient) is very religious thus does not want her daughter to receive blood products. The mother is very strong in her opinion quoting from “The
Watch Tower Society”. Refusal of transfusions of whole blood or its four primary components (Red, White, platelets, plasma) is a non-negotiable religious stand and that those who respect life as a gift from God do not try to sustain life by taking blood, even in an emergency. This should be played by an instructor or a non-nursing student. This conversation escalates but not to the point of shouting, nor any violent behavior.
The husband, who is also Jehovah Witness, is not as devoted and wants his wife to have a blood transfusion because he is very scared of losing his wife and realizes how little energy she has to care for their baby. The husband continuously states that this rule was made in 1945, therefore is outdated. He is emotional and perhaps even states “if you really love your daughter you would allow this”. This should be played by an instructor or a non-nursing student. This conversation escalates but not to the point of shouting, nor any violent behavior.
The patient is unsure of what to do and is torn between her religion and the fact that she has no energy to care for their baby. She is also torn between her mother and husband’s opinion. She is emotional, crying but continues to be a part of the discussion.
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).
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SIMULATION DESIGN & PLANNING TEMPLATE
Moulage Woman, pale, diaphoretic (if possible), bluish fingertips, low urine output.
Mannequin
IV site : 3G or Task trainer arm
Site ____R arm_____ Gauge _20___
(choose all that apply to this simulation)
Setting/Environment
Med-Surg
Props:
Equipment attached to manikin:
Primary IV Fluid running at 100 ml/hr
Foley catheter 20 ml output; Urine color dark amber
O2 5L NC
ID band
Equipment available in room:
O2 delivery device
Other Props:
Emesis basin with small amt of blood; Kleenex with blood
Diagnostics Available:
Labs Values
Other: EGD report stating gastric ulcer repair
Documentation Forms:
Admit Orders
Physician Orders
MAR
Recommended Mode for Simulation
Programmed
Significant Lab Values Hgb 6.2, HCT 17.5
Physician Orders 2 units of PRBC stat.
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).
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SIMULATION DESIGN & PLANNING TEMPLATE
Stage 1
Initial Amount
Time in Initial
Stage- 5 mins
Baseline Vital Signs
T 37.3
PR 128
RR 26
BP 88/47
SPO2 92% 3L NC
Cardiac Rhythm
Sinus tach
Breath Sounds
Clear-WNL
Heart Sounds WNL diaphortetic
Abdominal Sounds
Hyperactive
Other Symptoms:
Lethargic but alert
Trending:
VS ↑ or↓ over time
Verbalization
(Pt/Manikin
Cues)
Very short of breath when speaking
Why do I feel so weak?
How come I don’t have any energy?
Why am I short of breath?
**
I can’t have blood!!!
**
Expected
Interventions
Introduce using
AIDET.
Explain the relationship between
Hgb/HCT and the patient’s signs and symptoms.
**
Explain what a blood transfusion will do.
**
Utilize techniques of therapeutic communication to interact with patient and family.
Respectful of opinions
**
Call MD via SBAR to discuss patient’s refusal of transfusion after communicating with family and patient
Alternate or Incorrect
Treatment Choice
That Will Affect
Outcome

Student unable to calm family

Student leaves the family

Student reacts inappropriately
(yelling, raising voice, etc)

Student voices his/her own religious beliefs
Confederate
Actions/Additional
Role Player Cues
During discussion of transfusion and an argument breaks out between husband and mother. Patient may be involved as well if needed.
Mother insistent of no transfusion.
Husband wants a transfusion.
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).
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SIMULATION DESIGN & PLANNING TEMPLATE
Pre-Scenario Check List
1.
Equipment is staged as requested.
2.
The learner has been oriented to the simulator.
3.
The learner understands the guidelines/expectations for the
scenario.
4.
Participants understand their assigned roles.
5.
The time frame Expectations for simulation met: Yes No .
6.
The time frame Expectations for debrief met: Yes No .
7.
Audio/Visual Consent signed and turned into CHESC sheet.
8.
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).
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SIMULATION DESIGN & PLANNING TEMPLATE
(return to Instructor at the end of class)
Pre-Scenario Check List
1.
I have been oriented to the simulator.
2.
I understand the guidelines/expectations for the scenario.
3.
I understand the assigned role.
4.
My questions about the simulation have been answered.
5.
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).
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SIMULATION DESIGN & PLANNING TEMPLATE
Checklist
Evaluations
Jeopardy
Tests
Turning Point
Other
Optional Literature References
Therapeutic Communication website: http://www.lscc.edu/academics/nursing/CN%20I%20Forms/techstherapeuticcommunication.pdf
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).
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SIMULATION DESIGN & PLANNING TEMPLATE
Reference
Agency for Healthcare Research and Quality. (2010). Patient safety indicators.
Retrieved from http://www.ahrq.gov/professionals/systems/hospital/qitoolkit/
Institute for Healthcare Improvement. (2011). SBAR technique for communication: A situational briefing model. Retrieved from http://www.ihi.org/knowledge/Pages/Tools/SBARTechniqueforCommunicationASituationalBri efingModel.aspx
StuderGroup. (2008). Developing your own personal AIDET worksheet.
Retrieved from http://www.studergroup.com/aidet
Quality and Safety Education for Nurses. (2013). QSEN institute competencies.
Retrieved from http://qsen.org/competencies/pre-licensure-ksas/
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
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
Item
Na
K
CL
CO2
Glucose
BUN
CREAT
Ca
Mg
AST
ALT
DEPARTMENT OF LABORATORY MEDICINE
Affix
Patient Label
Run Date/Time
Result L/N/H Reference Range
135-145 meq/L
3.5-5.0 meq/L
100-108 meq/L
22-26 meq/L
70-110 mg/dL
8-20 mg/dL
0.5-1.5 mg/dL
8.2-10.2 mg/dL
1.8-2.6 mg/dL
8-50 units/L
8-50 units/L
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
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

SIMULATION DESIGN & PLANNING TEMPLATE
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).
12