Simulation Design Template:
Henry Williams-Simulation #1
Date:
Discipline: Nursing
Expected Simulation Run Time: 20
minutes
Location: Simulation lab
Admission Date:
File Name: Henry Williams
Student Level:
Guided Reflection Time: 20 minutes
Location for Reflection:
Classroom/debriefing area
|
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:
Patient was admitted last night with an acute exacerbation of COPD. He was not able to catch his breath and
his doctor told him to go to the emergency room. His neighbor brought him to the emergency room. He is
concerned about his wife, Ertha, who has problems with memory loss and seems confused at times. His
daughter-in-law, Betty, is a nurse. She mentioned that Henry appears depressed because his appetite has
diminished over the past 2 months and he has lost some weight. He has also lost interest in his previous
activities, such as following major league football and working on crossword puzzles. Betty will look after Ertha
while Henry is here.
Social History: Retired engineer for the transit system
Primary Medical Diagnosis: COPD, cardiovascular disease
Surgeries/Procedures & Dates: Appendectomy at age 15.
Nursing Diagnoses: Alteration in respiratory status secondary to exacerbation of COPD, activity intolerance,
anxiety, risk for depression
Henry Williams Simulation 1
© National League for Nursing, 2015
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Psychomotor Skills Required Prior to Simulation


General head-to-toe assessment
SPICES, the Geriatric Depression Scale, the Modified Caregiver Strain Index, the Beers Criteria for
Potential Inappropriate Medication Use in Older Adults, and the General Anxiety Disorder 7 (GAD-7)
assessment tools
Cognitive Activities Required Prior to Simulation
[i.e. independent reading (R), video review (V), computer simulations (CS), lecture (L)]




Basic knowledge of geriatric syndromes and the atypical presentation of older adults. (L, R)
SBAR or other standardized communication tool. (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 SPICES, Geriatric Depression Scale the Modified
Caregiver Strain Index and the Beers Criteria for Potential Inappropriate Medication Use in Older Adults
assessment tools. (R)
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.
2.
3.
4.
5.
Conduct a head-to-toe physical assessment.
Identify critical assessment needs of a geriatric COPD patient.
Use the SBAR or another standardized tool to communicate with other health care professionals.
Identify and report critical lab values for the geriatric client.
Identify geriatric syndrome(s) evident in the simulation.
Henry Williams Simulation 1
© National League for Nursing, 2015
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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.
SPICES - An Overall Assessment Tool:
Tool: http://consultgerirn.org/uploads/File/trythis/try_this_1.pdf
Video: http://consultgerirn.org/resources/media/?vid_id=4200873#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
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
Beers Criteria for Potential Inappropriate Medication Use:
Tool: http://consultgerirn.org/uploads/File/trythis/try_this_16_1.pdf
Video: http://consultgerirn.org/resources/media/?vid_id=4852321#player_container
The General Anxiety Disorder 7 (GAD-7):
Tool: http://www.scopecme.org/resources/tools/GAD7.pdf
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
Behavioral Health
Home Health
Pre-Hospital
Other: Geriatric
Medications and Fluids:
IV Fluids: see chart
Oral Meds: see chart
IVPB:
IV Push:
IM or SC:
Diagnostics Available:
Labs
X-rays (Images)
12-Lead EKG
Other:
Henry Williams Simulation 1
© National League for Nursing, 2015
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Simulator Manikin/s Needed:
SimMan® or Vital Sim male manikin
Props: glasses, hat, hearing aids or "forgot
them at home"
Equipment Attached to Manikin:
IV tubing with primary line lactated ringer’s
fluids running at 50 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 cannula 2 liters
Monitor attached
ID band
Other: oximeter
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: SBAR Form
Recommended Mode for Simulation:
(i.e. manual, programmed, etc.) either
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:
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: Reading and Medication Prep
Roles/Guidelines for Roles:
Primary Nurse
Secondary Nurse
Clinical Instructor
Family Member #1
Important Information Related to Roles:
Wife Ertha will come into the room. She is aware
that Betty dropped her off, but cannot recall
exactly who Betty is.
Henry Williams Simulation 1
© National League for Nursing, 2015
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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: 0730 Shift report
Henry Williams is an 80 year old male. He was admitted during the night with progressive shortness of breath.
His oxygen saturation on admission was 82% on room air. He has a history of COPD, coronary artery disease,
and is hard of hearing. His oxygen saturation has improved and is now running 88% on 2 liters of oxygen by
nasal cannula. His respiratory rate has been 24-30. His wife has gone home with a daughter-in-law and will
be back today. Due to his shortness of breath the admission is not complete. Blood pressure has been 134/88
pulse was 112 and respirations were 28. He is alert and oriented. The morning labs were just drawn and the
physician wants to know the arterial blood gases. He denies pain, just says he is tired.
Significant Lab Values:
refer to chart
Physician Orders:
refer to chart
Home Medications:
refer to chart
Henry Williams Simulation 1
© National League for Nursing, 2015
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Scenario Progression Outline
Timing
(approx.)
0-5 min
Manikin Actions
Afebrile, coughing and short of
breath. VS - BP 138/90, P - 112
R - 28; Oxygen saturation – 8688%
Expected
Interventions
May Use the
Following Cues


Role member
providing cue:
Secondary Nurse or
Nurse 2

Wheezes in lungs "I am really
short of breath and so tired"
"I don't sleep; I get anxious
worrying about my wife… Sit
me up, do something to help
me breathe"
5-10 min
"Am I due for a breathing
treatment? They said I would
get something soon" "Where
are my pills and inhalers?"




10-20 min
“I need my pills, I can give my
inhalers to myself, get those for
me. Sit down, Ertha, you are
making me nervous.”
Henry will have continued
shortness of breath and
decreased oxygen saturations if
medications and respiratory
treatments are not
administered.
“I’m going to need help at home




Vital signs
Initial overall
assessment of
client
Check oxygen
saturation: (will
be low)
Apply oxygen
Administer
SPICES
Medication
preparation and
safe
administration
Continued
Assessment
Administer
medication
Call results and
assessments to
MD using SBAR
communication
Review/read
back orders
Student should
assess for
depression and
potential
Cue: Cue student to
use SPICES tool for
assessment and/or
facility admission
tool.
Role member
providing cue:
Wife Ertha enters
the room.
Cue: Ertha states:
"Betty just dropped
me here…who is
she again?"
Role member
providing cue:
Ertha: "Can you
help Henry? I need
him to take care of
me…"
Cue: Nurse 2 should
point out that Ertha
can be distracting
but the focus is on
Henry if student
responds to Ertha
and ignores Henry
Henry Williams Simulation 1
© National League for Nursing, 2015
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with Ertha. She gets confused. I
don’t know if I can handle all of
this…”

caregiver strain
on patient
Notice that Ertha
seems to make
Henry more
stressed and
short of breath
and his need for
nursing
interventions.
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. What were the key assessments and interventions?
11. How were you able to use the ACES Framework with Henry’s situation? (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. Have student start Henry’s IV.
2. Have student chart.
3. This scenario could have Henry go into respiratory arrest, and the students would be required to
perform CPR.
Henry Williams Simulation 1
© National League for Nursing, 2015
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