Simulation Design Template
Date: March 11, 2013
File Name: End-of-life
Discipline: Nursing
Student Level: 3rd semester ASN
Expected Simulation Run Time: 45 min
Guided Reflection Time: 60 min
Location: Simulation classroom
Location for Reflection: Debriefing room
Admission Date: March 10th
Psychomotor Skills Required Prior to Simulation
Today’s Date: March 11
th
Brief Description of Client
Name: Sandra B. United
Gender: F Age: 33 Race: Caucasian
Weight: 47.62 kg (105 lbs)
Height: 152.4 cm (5 feet 5 inches)
Religion: Catholic
Major Support: Mother, father, brother,
and friends.
Phone: 555-820-5307
Allergies: Sulfa
Immunizations: Current
Attending Physician/Team: Dr.
Timothy Jones
Past Medical History: Fibromyalgia,
chronic anemia, depression, tonicclonic seizures.
History of Present illness: Biopsy of
left shoulder nevi 8 months ago
revealed a melanoma that has now
metastasized to the bone and brain.
The patient has received seven,
monthly cycles of chemotherapy.
Physical, psychosocial, and spiritual assessment
Symptoms at end-of-life
Communication skills
Use of electronic vital sign equipment
Oxygen administration
Post mortem care and expiration checklist
documentation
Port needle removal
Foley catheter removal
Cognitive Activities Required prior to Simulation
[i.e. independent reading (R), video review (V), computer
simulations (CS), lecture (L)]
Pre-simulation assignment:
Read the End-of-Life Power Point lecture (L)
Read the journal article: (R)
Sherman, D. W., Matzo, M. L., Pitorak,
E., Ferrell, B. R., & Malloy, P. (2005).
Preparation and care at the time of
death: Content of the ELNEC
curriculum and teaching strategies.
Journal for Nurses in Staff Development,
21(3), 93-100.
Complete the Caring Conversations for Young
Adults (R) available via web link
http://www.practicalbioethics.org
Read the Missouri Advance Directive (R) available via
web link
http://www.caringinfo.org/files/public/ad/missouri.pdf
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Nursing. Reprinted with permission.
If you find this Simulation Design Template useful, we would appreciate hearing from you. Please send an email message with
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Ineffective disease control and
declining patient condition prompted
the patient to request Hospice services
one week ago. Yesterday, the mother
came from out-of-town to visit and was
alarmed by her daughter’s decrease in
level of consciousness and respiratory
difficulty which lead to an EMS call
and hospital admission. The patient’s
mother is struggling to accept the
daughter’s decision to stop aggressive
treatment and allow a natural death.
Social History: Single with no children.
Worked as a pharmaceutical
representative for Lilly and has traveled
extensively. Family lives out of the
area. Many supportive friends. Strong
spiritual support from a local church
congregation.
Primary Medical Diagnosis: Stage IV
malignant melanoma.
Surgeries/Procedures & Dates:
Surgical excision of right shoulder nevi
with port placement 8 months ago.
Nursing Diagnoses:
 Acute Pain
 Compromised family coping
 Death Anxiety
 Decreased cardiac output
 Fear
 Grieving
 Hopelessness
 Impaired oral mucous
membranes
 Impaired swallow
 Ineffective airway clearance
 Ineffective breathing pattern
 Powerlessness
 Spiritual Distress
 Social Isolation
 Self Care Deficit
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Nursing. Reprinted with permission.
If you find this Simulation Design Template useful, we would appreciate hearing from you. Please send an email message with
your comments to info@sirc.nln.org.
Simulation Learning Objectives
1.
2.
3.
4.
5.
6.
7.
Perform a physical assessment and analyze the findings to manage end-of-life symptoms;
Practice therapeutic support and compassionate end-of-life communication;
Assess spiritual needs and provide culturally sensitive nursing care;
Demonstrate a patient and family-centered approach to care;
Analyze the completed advanced directive and advocate to uphold the patient’s wishes;
Utilize nursing process to develop an individualized plan of care;
Evaluate personal beliefs and values that influence a nurse’s ability to provide care to the
dying;
8. Perform the nurse-to-nurse death verification and death documentation utilizing a
standardized expiration checklist.
9. Demonstrate post mortem care and safe handling precautions;
10. Practice interdisciplinary collaboration as death approaches and at the time of death.
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Nursing. Reprinted with permission.
If you find this Simulation Design Template useful, we would appreciate hearing from you. Please send an email message with
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Fidelity (choose all that apply to this simulation)
Setting/Environment
Medications and Fluids
ER
X Med-Surg
Peds
ICU
OR / PACU
Women’s Center
Behavioral Health
Home Health
Pre-Hospital
X Other: Oncology Unit
Simulator Manikin/s Needed: Sim Man as
33 year old dying female
Props:
Positioned on right side propped with pillows
Turban or bandana on head
Foley catheter in place with 50 ml dark yellow
urine
Left chest port accessed with infusion plug and
occlusive dressing
Round band aid labeled as Scopolamine patch
placed behind left ear
Purple nail beds
Purple blotching on toes and knees
Dry lips
Personal belongings: blanket, watch, ring,
necklace, clothing, slippers, and photo album.
Rosary
Bible
MAR
Active orders
Advanced directives
Graceful Passages Music CD and CD player
IV Fluids:
X Oral Meds: Roxanol (morphine) 20 mg
(20 mg/ml) oral solution; Ativan
(lorazepam) 1mg (2 mg/ml) oral solution;
Transderm Scop (scopolamine) 1.5mg patch
IVPB:
IV Push:
IM or SC:
Diagnostics Available
Labs
X-rays (Images)
12-Lead EKG
Other:
Documentation Forms
X Physician Orders
Admit Orders
Flow sheet
X Medication Administration Record
Kardex
Graphic Record
Shift Assessment
Triage Forms
Code Record
Anesthesia / PACU Record
Standing (Protocol) Orders
Transfer Orders
Other:
Recommended Mode for Simulation (i.e.
manual, programmed, etc.)
Scenario is ran manually
Equipment attached to manikin:
IV tubing with primary line
fluids
running at
mL/hr
Secondary IV line
running
at
mL/hr
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document may be reproduced as long as it retains the following copyright statement:
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Nursing. Reprinted with permission.
If you find this Simulation Design Template useful, we would appreciate hearing from you. Please send an email message with
your comments to info@sirc.nln.org.
X
X
X
X
IV pump
Foley catheter 50 mL output
PCA pump running
IVPB with
running at
mL/hr
02 per nasal cannula
Monitor attached
ID band: Sandra B. United DOB
12/25/1980
Other: Port accessed with infusion plug
Equipment available in room
X
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:
Roles/Guidelines for Roles
X Primary Nurse
X Secondary Nurse
Clinical Instructor
X Family Member #1: Patient’s mother is at
the bedside
Family Member #2
Observer/s
Recorder
Physician/Advanced Practice Nurse
Respiratory Therapy
Anesthesia
Pharmacy
Lab
Imaging
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:
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Nursing. Reprinted with permission.
If you find this Simulation Design Template useful, we would appreciate hearing from you. Please send an email message with
your comments to info@sirc.nln.org.
Social Services
Clergy
Unlicensed Assistive Personnel
Code Team
Other:
Report Students Will Receive Before
Simulation
Time: 0700
The patient is a 33 year old female diagnosed
The patient is ready to let go and experience a
with malignant melanoma with brain and bone
natural death. The patient’s mother is struggling metastasis. Chemotherapy treatments have
with her daughter’s decisions to stop
ineffectively controlled the melanoma and the
chemotherapy and admit to Hospice services.
patient’s condition has deteriorated. The
The mother is not ready to let her daughter go!
patient stopped aggressive chemotherapy
On admission, the mother asked the physician
treatments last week and was admitted to
about further chemotherapy and a second
Hospice services. Her mother, who lives out-ofopinion. The physician advised the mother that
town, arrived yesterday to find her daughter
there were no more chemotherapy options and a weak, struggling to get out of bed, sleeping
second opinion would not provide new treatment most of the time, and experiencing respiratory
options. The patient’s mother has been awake all difficulty. Yesterday, the mother was alarmed
night at the daughter’s bedside.
by her daughter’s deterioration and called 911 to
have her daughter admitted to the Oncology
Significant Lab Values: WBC 1.0 mm/3,
Unit. Overnight, the patient’s condition
Hemoglobin 8.2 g/dL, Hematocrit 26%,
deteriorated. At 0600 this morning, the
Platelets 52,000 mm/3
physician was notified of persistent patient
moaning and deteriorating condition. Comfort
care orders were received. Orders for Roxanol
(morphine) oral solution, Transderm Scop
Physician Orders:
(scopolamine) patch, and Ativan (lorazepam)
Comfort measures only
Roxanol (morphine) 20 mg/ml every 4 hours prn oral solution were obtained and administered at
0615. The patient is nonresponsive and
pain
responds only to painful stimuli.
Transdern Scop (scopolamine) 1.5 mg
transdermal patch every 72 hours
Ativan (lorazepam) 1 mg (2mg/ml) oral solution
every 8 hours prn restlessness
Heparin 5ml (100 unit/ml) IV prn after
intermittent port infusion
Important Information Related to Roles:
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document may be reproduced as long as it retains the following copyright statement:
© Copyright, 2010. Simulation in nursing education: From conceptualization to evaluation. New York: National League for
Nursing. Reprinted with permission.
If you find this Simulation Design Template useful, we would appreciate hearing from you. Please send an email message with
your comments to info@sirc.nln.org.
References, Evidence-Based Practice Guidelines, Protocols, or Algorithms Used For
This Scenario (site source, author, year, and page):
American Association of Colleges of Nursing. (2008). Peaceful death: Recommended competencies
and curricular guidelines for end-of-life nursing care. Retrieved from
http://www.aacn.nche.edu/Publications/death.fin.html
Competencies Necessary for Nurses to Provide High-Quality Care to Patients and Families
During the Transition at the End of Life:
2. Promote the provision of comfort care to the dying as an active, desirable, and
important skill, and an integral component of nursing care.
3. Communicate effectively and compassionately with the patient, family, and health
care team members about end-of-life issues.
4. Recognize one's own attitudes, feelings, values, and expectations about death and
the individual, cultural, and spiritual diversity existing in these beliefs and customs.
5. Demonstrate respect for the patient's views and wishes during end -of-life care.
6. Collaborate with interdisciplinary team members while implementing the nursing
role in end-of-life care.
7. Use scientifically based standardized tools to assess symptoms (e.g., pain, dyspnea
[breathlessness] constipation, anxiety, fatigue, nausea/vomiting, and altered
cognition) experienced by patients at the end of life.
8. Use data from symptom assessment to plan and intervene in symptom management
using state-of-the-art traditional and complementary approaches.
9. Evaluate the impact of traditional, complementary, and technological therapies on
patient- centered outcomes.
10. Assess and treat multiple dimensions, including physical, psychological, social and
spiritual needs, to improve quality at the end of life.
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document may be reproduced as long as it retains the following copyright statement:
© Copyright, 2010. Simulation in nursing education: From conceptualization to evaluation. New York: National League for
Nursing. Reprinted with permission.
If you find this Simulation Design Template useful, we would appreciate hearing from you. Please send an email message with
your comments to info@sirc.nln.org.
11. Assist the patient, family, colleagues, and one's self to cope with suffering, grief,
loss, and bereavement in end-of-life care.
12. Apply legal and ethical principles in the analysis of complex issues in end-of-life
care, recognizing the influence of personal values, professional codes, and patient
preferences.
Center for Practical Bioethics. (2012). Caring conversations for young adults. Retrieved March 1,
2013, from http://www.practicalbioethics.org
Matzo, M. L., Sherman, D. W., Lo, K., Egan, K. A., Grant, M., & Rhome, A. (2003). Strategies for
teaching loss, grief, and bereavement. Nurse Educator, 28(2), 71-76. doi:
10.1097/00006223200303000-00009
Matzo, M., Sherman, D. W., Sheehan, D. C., Ferrell, B. R., & Penn, B. (2003). Communication
skills for end-of-life nursing care: Teaching strategies from the ELNEC curriculum. Nursing
Education Perspectives, 24(4), 176-183. Retrieved from
http://searchproquest.com/docview/230596651?accountid=6143
Missouri Advance Directives. (2012). Planning for important healthcare decisions. Retrieved March
1, 2013, from http://www.caringinfo.org/files/public/ad/missouri.pdf
Sherman, D. W., Matzo, M. L., Pitorak, E., Ferrell, B. R., & Malloy, P. (2005). Preparation and care
at the time of death: Content of the ELNEC curriculum and teaching strategies. Journal for Nurses
in Staff Development, 21(3), 93-100.
Sherman, D. W., Matzo, M. L., Coyne, P., Ferrell, B. R., & Penn, B. K. (2004). Teaching symptom
management in end-of-life care: The didactic content and teaching strategies based on the End-of
Life Nursing Education Curriculum. Journal for Nurses in Staff Development, 20(3), 103-115. doi:
10.1097/00124645-200405000-00001
Smith-Stoner, M. (2009). Using high-fidelity simulation to educate nursing students about end-oflife care. Nursing Education Perspectives, 30(2), 115-120.
Quality and Safety Education for Nurses. (2012). Retrieved from
http://www.qsen.org/competencies/pre-licensure-ksas/
QSEN Competencies:
Patient-centered Care: Recognize the patient or designee as the source of control and full partner in
providing compassionate and coordinated care based on respect for patient’s preferences, values,
and needs.
Knowledge:
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document may be reproduced as long as it retains the following copyright statement:
© Copyright, 2010. Simulation in nursing education: From conceptualization to evaluation. New York: National League for
Nursing. Reprinted with permission.
If you find this Simulation Design Template useful, we would appreciate hearing from you. Please send an email message with
your comments to info@sirc.nln.org.


Integrate understanding of multiple dimensions of patient centered care: patient/family
preferences, values; information, communication, and education; physical comfort and
emotional support; involvement of family and friends.
Demonstrate comprehensive understanding of the concepts of pain, suffering, including
physiologic models of pain and comfort
Describe the limits and boundaries of therapeutic patient-centered care.
Discuss principles of effective communication


Skills:
 Elicit patient values, preferences and expressed needs as part of clinical interview,
implementation of care plan and evaluation of care
 Provide patient-centered care with sensitivity and respect for the diversity of human
experience
 Assess presence and extent of pain and suffering
 Assess levels of physical and emotional comfort
 Elicit expectations of patient and family for relief of pain, discomfort, or suffering
 Initiate effective treatments to relieve pain and suffering in light of patient values,
preferences, and expressed needs
 Recognize the boundaries of therapeutic relationships
 Assess own level of communication skill in encounters with patients and families
Attitude:
 Value seeing health care situations “through the patients’ eyes”
 Respect and encourage individual expression of patient values, preferences and expressed
needs
 Willingly support patient-centered care for individuals and groups whose values differ from
own
 Recognize personally held values and beliefs about the management of pain or suffering
 Appreciate the role of the nurse in relief of all types and sources of pain or suffering
 Appreciate shared decision-making with empowered patients and families, even when
conflicts occur
 Value continuous improvement of own communication and conflict resolution skills
Teamwork and collaboration: Function effectively within nursing and inter-professional teams,
fostering open communication, mutual respect, and shared decision-making to achieve quality
patient care.
Knowledge:
 Describe own strengths, limitations, and values in functioning as a member of a team.
 Recognize contributions of other individuals and groups in helping patient/family/achieve
health goals.
Skills:




Demonstrate awareness of own strengths and limitations as a team member.
Act with integrity, consistency and respect for differing views.
Function competently within own scope of practice as a member of the health care team.
Integrate the contributions of others who play a role in helping patient/family achieve health
goals.
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Attitude:
 Acknowledge own potential to contribute to effective team functioning.
 Appreciate importance of intra-and inter-professional collaboration.
 Value the perspective and expertise of all health team members.
 Respect the centrality of the patient/family as core members of any health care team.
Safety: Minimizes risk of harm to patients and providers through both system effectiveness and
individual performance.
Knowledge:
 Delineate general categories of errors and hazards in care.
Skills:
 Demonstrate effective use of technology and standardized practices that support safety and
quality.
 Demonstrate effective use of strategies to reduce risk of harm to self or others.
 Use appropriate strategies to reduce reliance on memory (such as, forcing functions,
checklists).
Attitude:
 Value the contributions of standardization/reliability to safety.
Additional Recommended Readings:
Callahan, M., & Kelley, P. (2008). Final gifts. Understanding the special awareness, needs, and
communications of the dying. New York: Bantam.
Schagger, M. & Norland, L. (2009). Being present: A nurse’s resource for end-of-life
communication. Sigma Theta Tau International.
Wallace, M., Grossman, S., Campbell, S., Robert, T., Lange, J., & Shea, J. (2009). Integration of
end-of-life care content in undergraduate nursing curricula: Student knowledge and perceptions.
Journal of Professional Nursing, 25(1), 50-56. doi: 10.1016/j.profnurs.2008.08.003
Downloaded from http://sirc.nln.org with the permission of the National League for Nursing and Laerdal Medical. This
document may be reproduced as long as it retains the following copyright statement:
© Copyright, 2010. Simulation in nursing education: From conceptualization to evaluation. New York: National League for
Nursing. Reprinted with permission.
If you find this Simulation Design Template useful, we would appreciate hearing from you. Please send an email message with
your comments to info@sirc.nln.org.
Scenario Progression Outline
Timing
(approximate)
0730
Manikin Actions
Expected
Interventions
May Use the
Following Cues
Assessment Findings:
1. Positioned on
side, facing
patient’s mother.
Pillows propped
behind back.
2. Responds to
painful stimuli
but is unable to
communicate.
Moans with
repositioning.
3. Left chest port is
accessed with
Huber needle and
infusion plug.
4. Nail beds
cyanotic.
Extremities cool.
Purple blotching
of toes and knees.
5. Temp 99.6, B/P
80/46, HR 108, R
28, Pulse Ox 88%
1L.
6. Does not follow
commands or
track with eyes.
7. Rapid breathing,
with airway
congestion.
Scopolamine
patch intact
behind left ear.
8. Turgor is greater
than 3 seconds.
9. Abdomen is firm
with hypoactive
bowel sounds.
Last BM was 3
days ago.
10. Foley has 50 ml
Student:
1. Interact with
nonresponsive
adult female
patient (manikin)
and patient’s
mother (live).
2. Perform hand
hygiene.
3. Introduce self.
4. Consider if the
patient’s care may
be discussed with
the mother.
5. Take vital signs.
6. Ask patient,
“How are you
doing?” Attempt
to rate pain using
the FLACC scale.
7. Perform physical
assessment.
8. Increase oxygen
to 2 L/min per
NC due to Pulse
Ox reading of
88%.
9. Recognize
symptoms of the
dying process and
communicate
those findings to
the patient’s
mother.
Role member providing
cue:
Patient’s mother (live)
expresses concern
regarding the patient’s
condition change and
attempts to determine
relevance:
Cue: (Allow the students
time to complete
assessment before
initiating conversation).
1. “Her moaning
has decreased
since the night
nurse gave her the
liquid pain
medicine.”
2. “Why has she
stopped talking?”
3. “She seems
different today,
like she’s gazing
off into space!”
4. “She’s had
nothing to eat or
drink, do you
think she’s
hungry and
thirsty?”
5. “Why is her
breathing
different?”
6. “Why does she
have those purple
patchy areas on
her skin?”
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dark yellow urine.
0800
ROTATE
1030
1. Pulse Ox
improved to 92 %
on 2L per NC.
1. Breathing is
shallow with
apnea and
decreased
respiratory rate.
2. Temp 99.8, B/P
46/30, HR 46, R
8, Pulse Ox 88%
on 2L NC.
1. Reassess Pulse
Ox.
2. Educate the
patient’s mother
regarding what to
expect at the time
of death.
3. Inform the
patient’s mother
that Sandra’s
wishes were
outlined in her
Advanced
Directive and that
she did not want
life prolonging
measures.
4. Reinforce that
comfort is a
priority.
5. Offer emotional
support.
6. Be empathetic
and
compassionate.
Role member providing
cue: Patient’s mother
Cue:
1. “The doctor said
she might be
getting near the
end.”
2. “What happens if
her heart stops?”
“Will you do CPR
and try to save
her?”
3. “Do you think
she’s going to die
soon?” “What
happens when
death gets close?”
4. “Do you think it
hurts to die?”
5. “Her priest
brought the
Graceful
Passages: A
companion for
living and dying
(2003) CD, do you
think we should
play it for her?”
Cue: Play the
Graceful Passages
music CD (Tracks 1012)
1. Assess the patient Role member providing
for changes.
cue: Patient’s mother
Focus on comfort, Cue:
positioning,
1. “This is so hard
symptom control,
to watch!”
and mouth care.
2. “She should not
2. Offer emotional
be dying at such a
support.
young age!” “I
3. Provide Kleenex.
should not out4. Listen, be
live my child!”
present, and
“She should still
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document may be reproduced as long as it retains the following copyright statement:
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Nursing. Reprinted with permission.
If you find this Simulation Design Template useful, we would appreciate hearing from you. Please send an email message with
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provide
therapeutic
communication.
Encourage the
patient’s mother
to share any
important last
conversations (for
example, I am
sorry, I love you,
it is ok to let go,
or, I will be
alright without
you).
Recognize the
beliefs and values
that influence the
mother’s ability to
grieve.
Encourage
reminiscence of
life’s memories,
happy times, and
achievements.
Assess spiritual
needs. Ask, is
there anyone we
could call to be
with you? Offer to
pray with
patient/mother.
Offer to contact
the patient’s
priest or the
hospital chaplain.
have her whole
life ahead of her!”
“I just don’t know
what I will do
without her!”
3. “Sandra and I had
a fight last week.”
“I tried to talk her
into a second
opinion.” “She
said that she was
too tired and too
weak to fight this
anymore.” “I got
angry and told her
she was giving up
and that I would
have no part of
it!” “We both
cried, I decided it
would be better to
talk about it later,
but we never did!”
1. Recognize the
patient has
stopped breathing
and death has
occurred.
2. Have a second
nurse assess the
patient to verify
death.
Role member providing
cue:
Patient’s mother
Cue:
1. “Oh no, is she
gone?” “Sandra!”
“Sandra!” “Do
something!” “Are
you sure you can’t
5.
6.
7.
8.
1048
Patient takes last breath.
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1120
Manikin has a foley and
port needle to be
removed.
3. Reinforce
Sandra’s wishes
were not to be
kept alive by life
prolonging
measures.
4. Be supportive.
Utilize
therapeutic
communication.
5. Notify the
hospital chaplain.
6. Document the
death using the
standardized
expiration
checklist.
7. Notify the
physician,
transplant
services, and
interdisciplinary
team members
that death has
occurred.
1. Begin post
mortem care.
Recognize the
patient is not a
candidate for
autopsy.
2. Remove the port
needle and the
foley catheter.
Recognize
bathing would be
performed if
necessary.
3. Position the
patient for the
final family
viewing.
4. Prepare the room.
Gather and bag
personal
belongings.
do CPR?”
2. “I love you
Sandra!” “I love
you with all my
heart!” “I will
miss so much!”
3. “What should I
do now?”
4. “I need to step
out to make some
phone calls.”
Cue: The instructor role
playing the mother then
steps behind a screen in
the room so that the
students can perform
post mortem care and
complete the death
notification process.
Role member providing
cue: Patient’s mother
Cue: “Can I see Sandra
to say goodbye?”
Cue: Patient’s mother
steps to the bedside to
say the final goodbye.
Patient’s mother cries,
holds her daughter’s
hand, rest her head on
her daughter’s arm, and
kisses her daughter on
the forehead.
Mother states, “I don’t
know what I will do
without you!” “I love
you!” “I am going to
miss you so much, but I
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Demonstrate
effective and
compassionate
communication.
6. Be supportive
during family
viewing and final
goodbye. Remove
the patient’s
jewelry. Give the
personal
belongings to the
patient’s mother.
7. After the patient’s
mother leaves,
obtain the body
bag and prepare
the toe tag.
5.
know someday I will see
you again in heaven!”
Patient’s mother leaves
with her daughter’s
personal belongings.
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.
Is there anything else you would like to discuss?
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If you find this Simulation Design Template useful, we would appreciate hearing from you. Please send an email message with
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Complexity – Simple to Complex
Suggestions for Changing the Complexity of This Scenario to Adapt to Different
Levels of Learners
1. The patient could be lethargic but capable of communicating with the students.
2. The patient could have uncontrolled pain that warranted a student to collaborate with the physician
or a palliative care team member in order to obtain and administer newly ordered comfort care
medications.
3. The patient’s mother could arrive at the hospital to find that her daughter is dying or has died.
4. The setting could be in a home environment with hospice services instead of an acute care setting.
5. The dying patient could be pediatric patient with a young adult parent at the bedside.
6. The dying patient could be geriatric with a middle aged adult child at the bedside.
7. Additional family members could be present at the bedside with conflicting beliefs and opinions
regarding aggressive treatment versus natural death.
8. An estranged family member could arrive ready to make amends and say final goodbyes.
9. Cultural diversity could be incorporate to include cultural differences regarding beliefs and values
that pertain to death.
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Expiration Checklist
Cessation of vital signs
Cessation of vital signs verified by
Cessation of vital signs time
Pronouncement
Patient pronounced by
Time patient pronounced
Pastoral care notification
Name of Chaplain notified and time
Family notification
Name of persons notified and time
Contact number
Physician notification
Name and time of attending physician notified
Name and time of second physician notified
Autopsy
Organ/tissue donation
Time organization notified
Organization representative name
Is patient eligible to donate
Family approached regarding
Approached by
Organ donation approval
House supervisor notification
Name of house supervisor notified
Time house supervisor notified
Emotional support
Bereavement memories
Mementos
Post mortem care
Isolation precautions
Body identifiers
Care of body
Expiration comments
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SITUATION (3/11/13 Shift Report)
Initials/DOB/Sex:
12/25/80
Sandra B.
United
Female
Adm. Dx: Melanoma
metastatic to brain and
bone
Code Status: DNR
S
Jones
Oncologist
Admit DR.
Room: 7560
Adm. Date:
Yesterday
Consult DR.
Shoults
Neurologist
Surgery: Port-a-cath placed for chemotherapy 8 months ago.
History of this admission: diagnosed with metastatic melanoma 8 months ago. Enrolled in Hospice last week with DNR orders.
Family called 911 yesterday due to increased drowsiness and difficulty breathing.
BACKGROUND
Labs/Procedures/Tests: MRI-8
months ago showed extensive
lymph node involvement
Past History: Fibromyalgia, Chronic Anemia,
Depression
B
Allergies: Sulfa
MRI 3 months ago-Extensive
bone and brain metastasis.
Activity: Turn patient every 2
hours
A
V.S.: T 99.2, B/P 80/46,
HR 108, R 28, Pox 88%
Neuro
Weight:
Admission: 105 lbs
Today: 105 lbs; 47.62 kg
Labs: see below
ASSESSMENT
GU
Foley
I & O: Input 100ml
Urine: 100ml
GCS: 5
Purposeful movement with
painful stimulation
Skin
Color/Temp/Turgor: Pale. Cool extremities. Turgor >3.
Nail beds cyanotic. Purple blotching toes/knees.
Rhythm/Tones: Tachycardia
CV
Edema: -
Pacer/AV Wires: NA
Peripheral Pulses: Weak/=, cap refill 5 sec
Metabolic
Attach Strip with interpretation: NA
Pain/
Comfort
02 Sat: 88 % on 2L per min per NC
Moaning in pain at 0615 and administered
Meds: Roxanol 20 mg/ml at 0615
Scopolamine 1.5 mg transdermal patch at 0615
Ativan 1mg (2 mg/ml) oral solution at 0615
Comfort care only.
Lungs
Breath Sounds: Diminished throughout with airway rattle.
Drains/Incisions/Closure Device/Dressings: Right Port
Trach: NA
Bubble/Osc:NA
IV Site
#1
GI
Bowel Sounds: normoactive X4
NG/FT: NA
Abdomen: distended/ firm
Skills/Education/Discharge?:
R
Last BM: unknown
R port
Insertion Date
Hanging
Adj/gtt
yesterday
#2
Other Information:
RECOMMENDATION
To Do or Report:
Dr. Jones was called at 0600 and new orders were received. New
comfort medications were administered at 0615.
Patient’s mother has been at the bedside all night. Patient’s father has
driven to St. Louis University to pick up the patient’s brother.
Patient’s Initials/Student’s Name:
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Nursing. Reprinted with permission.
If you find this Simulation Design Template useful, we would appreciate hearing from you. Please send an email message with
your comments to info@sirc.nln.org.
D
sg
ACTIVE PHYSICIAN ORDERS
Pt Name: Sandra B. United
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
DOB 12/25/80
Room 7560
Allergies: Sulfa
Bed rest
Comfort care
DNR
Vital signs every 4 hours
I&O every shift
Diet as tolerated
Use port for IV access
Roxanol (morphine) 20 mg/ml every 4 hours prn pain
Transdern Scop (scopolamine) 1.5 mg transdermal patch every 72 hours
Ativan (lorazepam) 1 mg (2mg/ml) oral solution sublingual every 8 hours prn restlessness
Heparin 5ml (100 unit/ml) IV prn after port use
Medication Administration Record
Date
Scheduled
Dosage
Medications
Time
Route
Due
3/11/13 Transdern Scop
(scopolamine)
1.5 mg
Transdermal
Every 72
hours
Transdermal
3/14/13 0615
Date
Dosage
Time
Route
Due
20 mg/ml
1 mg (2mg/ml)
5ml (100 unit/ml)
0615
0615
1630
Sublingual
Sublingual
Intravenous
Every 4 hours prn
Every 8 hours prn
After intermittent
use or every 4
weeks.
PRN
Medications
3/11/13 Roxanol (morphine)
3/11/13 Ativan (lorazepam)
3/10/13 Heparin
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Simulation Evaluation for________________________
Date:_________________________
QUESTIONS:
Strongly
Agree
Agree
Disagree
Strongly
Disagree
I feel this exercise has helped me to apply knowledge
1 rather than just memorize knowledge.
I learned something beneficial through this
2 simulation.
3 This simulation enhanced my critical thinking skills.
4 This simulation was facilitated smoothly.
5 This simulation promoted communication skills.
6 I feel I had a safe environment to share my ideas and
thoughts.
7 This simulation was beneficial to my education.
8 The simulation helped to uncover some knowledge
deficiencies in myself.
9 The supplies needed were readily accessible.
Question Comments:
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your comments to info@sirc.nln.org.
Unsure