Simulation Design Template:
Jenny Brown-Simulation #1
Date:
Discipline: Nursing
Expected Simulation Run Time: approx.
20 minutes
Location: Short stay acute psychiatric unit
File Name: Jenny Brown
Student Level:
Guided Reflection Time: twice the amount
of simulation run time
Location for Reflection:
Admission Date: Two days ago |
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: Marianne Hough, MD
Past Medical History: Mild intermittent, exercise-related asthma as a child - resolved
History of Present Illness: 18 weeks pregnant. Voluntary admission to acute adult psychiatric unit from
Emergency Department for evaluation following episode of acute agitation requiring restraint and
administration of repeated doses of IV benzodiazepine. Episode started in hospital Imaging Services
Department where 18-week female fetus was diagnosed with cleft lip & palate on ultrasound. Now stable,
awaiting further mental health evaluation and discharge teaching/planning.
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, 18 weeks; generalized anxiety disorder with panic attack, possible PTSD
Surgeries/Procedures & Dates: None
Nursing Diagnoses: Anxiety related to pregnancy and to diagnosis of cleft lip & palate in fetus; ineffective
coping due to chronic anxiety, possible post-trauma syndrome related to military service in combat setting in
Iraq; disturbed sleep pattern – chronic – related to anxiety/panic/possible PTSD
Jenny Brown – Simulation #1
© National League for Nursing, 2015
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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)]





Read introductory monologues: Jenny and Eric (R)
Read therapeutic communication techniques (R)
Review focused mental health assessment using tools to evaluate for depression, PTSD, suicide (R)
Review of elements of effective discharge teaching including communication about future mental health
care (R)
Review of elements of effective discharge teaching including communication about future mental health
care (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. Recognize changes in patient symptoms and/or signs of patient compromise.
5. Perform priority nursing actions based on clinical data.
6. Reassess/monitor patient status following nursing interventions.
7. Perform within scope of practice.
8. Demonstrate knowledge of legal and ethical obligations.
9. Communicate with client in a manner that illustrates caring for his/her overall well-being.
10. Communicate appropriately with physician and/or other healthcare team members in a timely,
organized, patient-specific manner.
Simulation Scenario Objectives
1. Use therapeutic communication techniques to establish rapport with Jenny.
2. Perform focused mental health assessment(s) appropriate for veterans with combat-related service.
3. Identify any assessment findings of concern in this situation.
Jenny Brown – Simulation #1
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References, Evidence-Based Practice Guidelines, Protocols, or
Algorithms Used for This Scenario:
Online resources:
A Profile of Women Veterans Today:
http://www.womenshealth.va.gov/WOMENSHEALTH/docs/WV_Profile_FINAL.pdf
Military Sexual Trauma: Women Veteran’s Health Care:
http://www.womenshealth.va.gov/WOMENSHEALTH/trauma.asp
Prins, A., et al. (2003). The primary care PTSD screen (PC-PTSD): Development and operating
characteristics. Primary Care Psychiatry, 9; 9-14.
National Center for PTSD - http://www.ptsd.va.gov/index.asp
The PTSD Toolkit for Nurses from the American Nurses Foundation.
http://www.nurseptsdtoolkit.org/index.php
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:
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
Documentation Forms:
Physician Orders
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Props: Manikin dressed in street clothes
Equipment Attached to Manikin:
IV tubing with primary line running at mL/hr
Secondary IV line
IV pump
Foley catheter mL output
PCA pump running
IVPB with running at mL/hr
02
Monitor attached
ID band
Other:
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
Admit Orders
Flow sheet
Medication Administration Record
Medication Reconciliation Form
Kardex
Graphic Record
Shift Assessment
Triage Forms
Code Record
Anesthesia / PACU Record
Standing (Protocol) Orders
Transfer Orders
Other:
Assessment Forms:
 Anxiety & Depression Scale
 Suicide Risk Assessment Tool
 Post Traumatic Stress Disorder
Screening Tool
 Traumatic Brain Injury Screening Tool
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:
Jenny Brown – Simulation #1
© National League for Nursing, 2015
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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:
Report Students Will Receive Before Simulation
Time: 0700, 2 days after admission to short stay acute psychiatric unit
Situation: Jenny Brown is 23 years old, admitted two days ago for acute agitation and anxiety. She is 18
weeks pregnant with her first baby. She was voluntarily admitted from the Emergency Department where she
was taken following an episode of acute agitation after ultrasound in the hospital’s Imaging Services
Department. She received several doses of IV haloperidol in the ED before being transferred to our unit.
Background: While she was in Imaging for a routine ultrasound, Jenny had to be restrained. Apparently she
became extremely agitated when the perinatologist told her that the fetus, a girl, has a cleft lip and palate. She
was transferred to the Emergency Department and given three 2 mg doses of IV haloperidol over
approximately 4 hours. Her suicide assessment was negative but she doubted her ability to safely care for
herself at home and she agreed to admission for evaluation. On the first day of admission, she received 2 mg.
oral haloperidol regularly, every 4 hours. Yesterday she only had two doses and seemed much more stable.
She still had difficulty sleeping and woke screaming from nightmares the first night. Last night she refused the
haloperidol and slept on and off but there were no nightmares.
Assessment: Vital signs: T: 98.6, Pulse: 76, regular; Respirations: 16, BP: 112/74. Admitting diagnosis was
panic attack with underlying generalized anxiety disorder and possible PTSD. She has no psychotic behaviors
and is well oriented X3. Her prenatal admission assessment was done per protocol and everything looks good.
Fetal heart rate is in the 130s. She’s also had the full psychiatric intake exam. Last night she slept poorly. She
cries from time to time and is worried about her baby. Her vital signs have been stable. She has suicide checks
ordered every 12 hours but so far those are all negative. She says she won’t harm herself because of the
baby. She has showered and is well groomed with a normal train of thought and full vocabulary. She maintains
eye contact when speaking. She has rapid, pressured speech at times. She is sometimes fidgety when seated
Jenny Brown – Simulation #1
© National League for Nursing, 2015
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and paces to calm herself. She’s been talking on the phone with her boyfriend from time to time all night – this
seems to help calm her.
Recommendation: She is due for a mental status check with depression, suicide, and PTSD evaluations –
the forms are on the chart. There will be a care conference later today to plan for discharge and follow-up, so
the team will need the results of your assessment.
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;
alert and oriented; answers all
questions.





Role member
providing cue:
Patient
Cue:
“I feel awful about how I acted
in the ultrasound room.”
“I feel much better now but I’m
still so worried about my baby
and how she will do with… her
problem. I don’t know if I’ll be
able to take care of her. I’m
worried about Eric, my
boyfriend, because I really need
his help and support now but
he’s got to be freaked out by all
of this. I have to be able to go
back to school because we are
really counting on my
graduation. Everybody’s
counting on me… my folks,
Eric… and I want to be a really
good mom.”

Greet patient
Introduce self
Wash hands
Check patient ID
Establish
therapeutic
communication
(interest and
concern)
Verify reason for
admission from
patient
perspective
Jenny Brown – Simulation #1
© National League for Nursing, 2015
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10-20 min
“Can you help me understand
what’s going on with me?”

“I will answer any questions you
have, really. Everyone here has
been so nice. I wish I could take
you all home with me so I could
ask you things and get help
when I need it. I think I’m going
to need a lot of help.”
Note: Jenny’s answers are on
attached assessment tools.





Explain purpose
of assessment
tools and
encourage
Jenny to answer
the questions
and add any
details that she
feels are
important.
Complete
focused mental
health
assessments
Anxiety and
Depression
Scale (adapted)
Primary Care
PTSD Screen
(PC-PTSD)
Suicide
Assessment
Traumatic Brain
Injury
Role member
providing cue:
Cue:
Note to facilitator:
See forms that
follow for Jenny’s
responses to
questions on
assessment forms
Anxiety and Depression Scale and Scoring (Adapted for Interview)
Possible nursing prompts: “When you answer, please use the terms: ‘definitely,’ ‘sometimes,’ ‘not much,’ or
‘not at all.’ If you forget to use one of those words, I will remind you.”
“Would you say, ‘definitely,’ ‘sometimes,’ ‘not much,’ or ‘not at all’?”
Question:
Jenny’s Responses for
Scenario:
1. Do you have trouble sleeping at night?
Sometimes
2. Do you feel anxious or stressed for apparently
no reason at all?
Sometimes
3. Do you feel miserable or sad?
Not at all, just scared
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4. Does leaving your house make you feel
anxious?
Not often
5. Have you lost interest in things that you used
to enjoy?
Not at all
6. Do you feel like your heart is racing?
Sometimes
7. Do you have a good appetite?
Definitely
8. Do you sometimes feel scared or frightened
when there is no reason to do so?
Not often
9. Do you ever feel like the world would be better
without you in it?
Not at all
10. Do you feel restless or fidgety?
Sometimes
11. Are you more irritable than usual?
Sometimes
12. Do you feel as if it’s hard to get things done?
Not at all
13. Do you seem to worry all the time?
Not often
Score:
Scoring:
Questions 1-6,
8-13
Question 7
Scoring
Interpretation:
Definitely
3
0
0-7
Minimal concern
Sometimes
2
1
8-10
Borderline concern
Not often
1
2
11+
Concerning – may need
further intervention
Not at all
0
3
Anxiety Questions: # 2, 4, 6, 8, 10, 11, 13
Depression Questions: # 1, 3, 5, 7, 9, 12
Source:
Snaith R.P. The Hospital Anxiety and Depression Scale. Health and Quality of Life Outcomes 2003;1:29
http://www.hqlo.com/content/1/1/29; http://www.abiebr.com/node/410
Jenny Brown – Simulation #1
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Suicide Risk Assessment Screening Questions
Question:
Possible Nursing Prompts:
1. Are you feeling hopeless about the
Jenny’s Responses for
Scenario:
No
present/future?
2. Have you had thoughts of taking your
Yes
life?
3. When did you have these thoughts?
Right after I found out about the
baby’s problem (cleft lip &
palate).
4. Do you have a plan to take your life?
If yes, tell me what you’ve been
thinking (or about your plan).
No. I realized right away that I
would never hurt myself or my
baby. I’d never hurt a fly. I want
to be the best mom possible. I
need help but I’m not crazy.
If yes, can you tell me about
that time?
No, never. I would never hurt
myself or anyone else.
5. Have you ever had a suicide
attempt?
Although the nursing role does not involve establishing a diagnosis of suicide risk, the nurse should notify a
licensed independent provider of the findings of any positive screen and take precautions to protect the safety
of the patient.
Source:
VA Suicide Risk Assessment Guide available at:
http://www.mentalhealth.va.gov/docs/VA029AssessmentGuide.pdf
Primary Care Post Traumatic Stress Disorder Screen (PC-PTSD)
Possible nursing prompt: “Would you say ‘yes’ or ‘no’?”
Base Question:
In your life, have you ever had any experience that was so
frightening, horrible, or upsetting that, in the past month, you:
1. have had nightmares about it or thought about it when
you did not want to?
Jenny’s Responses
for Scenario:
Yes
Jenny Brown – Simulation #1
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2. tried hard not to think about it or went out of your way to
avoid situations that reminded you of it?
3. were constantly on guard, watchful, or easily startled?
4. felt numb or detached from others, activities, or your
surroundings?
Yes
Yes
Yes
Although the nursing role does not involve establishing a diagnosis of PTSD, current research suggests that
the results of the PC-PTSD should be considered "positive" if a patient answers "yes" to any three items. The
nurse should notify a licensed independent provider of the findings of any positive screen.
Sources:
United States Department of Veterans Affairs National Center for PTSD; Professional Section
http://www.ptsd.va.gov/professional/provider-type/doctors/screening-and-referral.asp
http://www.ptsd.va.gov/PTSD/professional/pages/assessments/assessment-pdf/pc-ptsd-screen.pdf
3-Question TBI Screening Tool
Question:
1. Did you have any injury or injuries during your
deployment from any of the following:
 bomb fragment?
 bullet?
 any type of vehicle including airplanes?
 fall/injury?
 blast (improvised explosive device, RPG, land
mine, grenade, etc.?
 something else?
Possible Nursing
Prompts:
Jenny’s Responses
for Scenario:
If yes, ask about the type
of injury.
Yes, an IED exploded
and the truck I was
riding in crashed into
another truck in our
convoy.
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2. Did any injury received while you were deployed
result in your:
 being dazed, confused, or “seeing stars”?
 not remembering the injury?
 losing consciousness (being “knocked out”) for
any length of time?
 having symptoms afterward like headache,
dizziness, irritability, etc.?
 head injury (closed or open) that required medical
treatment?
3. Are you currently experiencing any of the following
problems that you think might be related to a possible
head injury or concussion:
 headaches?
 dizziness?
 memory problems?
 balance problems?
 ringing in the ears?
 irritability?
 sleep problems?
 other? (please be specific):
[No verbal response
necessary; make note of
each positive answer.]
No to each.
No to each.
[No verbal response
necessary; make note of
each positive answer.]
I get headaches and
I’m kind of crabby a
lot, but I don’t think it’s
from the crash. I was
fine right away and
never had any
problems.
Although the nursing role does not involve establishing a diagnosis of PTSD, current research suggests that
the results of the PC-PTSD should be considered "positive" if a patient answers "yes" to any three items. The
nurse should notify an appropriate licensed provider of the findings of any positive screen. Patient
endorsement of items in #2 meets criteria for positive TBI screen. Confirm symptoms of concussive
symptoms or head injury through clinical interview.
Source:
Schwab, K. A., Baker, G., Ivins, B., Sluss-Tiller, M., Lux, W., & Warden, D. (2006). The Brief Traumatic Brain
Injury Screen (BTBIS): Investigating the validity of a self-report instrument for detecting traumatic brain injury
(TBI) in troops returning from deployment in Afghanistan and Iraq. Neurology, 66(5)(Supp. 2), A235.
This is a work of the U.S. government and is not subject to copyright protection in the United States. It may be
reproduced and distributed in its entirety without further permission from GAO
(http://www.gao.gov/assets/280/271994.html).
Jenny Brown – Simulation #1
© National League for Nursing, 2015
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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.
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. How were physical and mental health aspects interrelated in this case?
11. What were the key assessments and interventions?
12. Is there anything else you would like to discuss?
Specific Debriefing Questions for this Scenario:
1. Were Jenny Brown’s presenting symptoms and responses what you expected? How were they
different?
2. Did you find it easy or difficult to talk with Jenny? Explain.
3. Do an SBAR to the discharge planning team that includes your recommendations about discharge
planning for Jenny.
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