Community Home Visit with Postpartum Patient for Nursing Students
Simulation Scenario Template
Adaptation of California Simulation Alliance (CSA)
Draft 1
Nov. 17th, 2014
CSA REV template (12/15/08; 5/09; 12/09; 4/11; 1/14)
Revised COUPN January 2014
TABLE OF CONTENTS
ii
SECTION I
SCENARIO OVERVIEW
A. Title
B. Summary
C. Evidence Base
SECTION II
CURRICULUM INTEGRATION
A. Learning Objectives
1. Primary
2. Secondary
3. Critical Elements
B. Pre-scenario learner activities
SECTION III SCENARIO SCRIPT
A.
B.
C.
D.
E.
F.
G.
Case Summary
Key Contextual Details
Scenario Cast
Patient/Client Profile
Baseline patient/client simulator state
Environment / equipment / essential props
Case flow /triggers / scenario development
SECTION IV APPENDICES
A. Health Care Provider Orders
B.
B. Digital Images of Manikin / Milieu
C. Debriefing Guide
CSA REV template (12/15/08; 5/09; 12/09; 4/11; 1/14)
Revised COUPN January 2014
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SECTION I: SCENARIO OVERVIEW
Community Health Simulation with Post-Partum Patient
Original Scenario Developer(s):
Tori Howgego
Karyn Taplay
Date - original scenario
November, 2014
Validation:
Revision Dates:
2014
Pilot testing:
yes
QSEN revision:
Scenario Title:
Estimated Scenario Time: 1 hour
Debriefing time: 30 Minutes
Target group: Fourth year BScN students
Core case: Health assessment in the home of young postpartum mother and baby
CNO
1. Professional Responsibility and Accountability
2. Knowledge-based Practice:
 Specialized Body of Knowledge
 Competent Application of Knowledge
3. Ethics
4. Culturally sensitive care
5. Documentation
CPSI
Domain 1: Contribute to a culture of patient safety
Domain 2: Work in teams for patient safety
Domain 3: Communicate effectively for patient safety
Domain 4: Manage safety risks
Domain 5: Optimize human and environmental factors
Domain 6: Recognize, respond to and disclose adverse events.
CIHC
1. Interprofessional communication
2. Patient/client/family /community-centered care
3. Role clarification
4. Team functioning
5. Collaborative leadership
6. Interprofessional conflict resolution
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Revised COUPN January 2014
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Best Practice Guidelines:
1. Client Centered Care
2. Establishing Therapeutic Relationships
3. Professionalism in Nursing
4. Collaborative Practice
5. Interventions for Postpartum Depression
6. Integrating Smoking Cessation into Daily Nursing Practice
7. Working with Families to Promote Safe Sleep for Infants 0-12 Months of Age
8. Supporting and Strengthening Families Through Expected and Unexpected Life Events
9. Developing and Sustaining Nursing Leadership
10. Embracing Cultural Diversity in Health Care: Developing Cultural Competence
11. Enhancing Healthy Adolescent Development
12. Facilitating Client-Centered Learning
Brief Summary of Case:
Badia is a single 17-year old Muslim mother with a six-week old baby boy. She is experiencing her first home
visit with a community health nurse because she is considered to be a high-risk mother after her initial
assessment in the hospital. The simulation is designed to challenge the 4th year nursing students with
completing a home assessment and health teaching about smoking cessation, how to reduce the risk of
SIDS, knowledge of medications that she is taking and what else might be available, discussions about
postpartum depression, and describing community resources that are available. The student should review
current medications. The students should assess sleeping habits and nutrition of both mother and baby.
EVIDENCE BASE / REFERENCES (APA Format)
Berragan, L. (2013). Conceptualising learning through simulation: An expansive approach for professional
and personal learning. Nurse Education In Practice, 13(4), 250-255.
doi:10.1016/j.nepr.2013.01.004
Bethards, M. L. (2014). Applying Social Learning Theory to the Observer Role in Simulation. Clinical
Simulation In Nursing, 10(2), e65-9. doi:10.1016/j.ecns.2013.08.002
Brown, J. P., & Zaya, C. (2013). Designing adult code simulations for antepartum and postpartum nurses.
Journal of Obstetric, Gynecologic, & Neonatal Nursing, 42(s1), S7-S8. doi:10.1111/15526909.12056
Bryans, A. (2004). Examining health visiting expertise: combining simulation, interview and observation.
Journal Of Advanced Nursing, 47(6), 623-630. doi:10.1111/j.1362648.2004.03150.x
Clifford, C., Day, A., Cox, J., & Werrett, J. (1999). A cross-cultural analysis of the use of the Edinburgh
Post-Natal Depression Scale (EPDS) in health visiting practice. Journal Of Advanced Nursing,
30(3), 655-664.
Coleman, P., Dufrene, C., Bonner, R., Martinez, J., Dawkins, V., Koch, M., & ... Norman, G. (2011). A
regional partnership to promote nursing instructor competence and confidence in simulation.
Journal Of Professional Nursing, 27(6), 28-32.
Corbett, R., Miles, J., Gantt, L., Stephenson, N., & Larson, K. (2008). Schools of Nursing, Clinical
Partners, and Alumni Collaborate for Senior Nursing Simulation Scenarios: A Theory-based
Approach. Clinical Simulation In Nursing, 4(3), e49. doi:10.1016/j.ecns.2008.08.007
Gilliam, P., Pabst, P., & Spencer, S. (2013). Making High-Fidelity Simulation Relevant to the Home
CSA REV template (12/15/08; 5/09; 12/09; 4/11; 1/14)
Revised COUPN January 2014
TABLE OF CONTENTS
5
Setting. Nurse Educator, 38(5), 214-217. doi:10.1097/NNE.0b013e3182a0e3fd
Gloe, D., Sando, C. R., Franklin, A. E., Boese, T., Decker, S., Lioce, L., & ... Borum, J. C. (2013).
Standards of Best Practice: Simulation Standard II: Professional Integrity of Participant(s). Clinical
Simulation In Nursing, 9(s6), S12-4. doi:10.1016/j.ecns.2013.04.004
Kim-Godwin, Y., Livsey, K., Ezzell, D., & Highsmith, C. (2013). Home Visit Simulation Using a
Standardized Patient. Clinical Simulation In Nursing, 9(2), e55-61. doi:10.1016/j.ecns.2011.09.003
Ko, Y., Yang, C., Fang, C., Lee, M., & Lin, P. (2013). Community-based postpartum exercise program.
Journal Of Clinical Nursing, 22(15/16), 2122-2131. doi:10.1111/jocn.12117
Nehring, W., & Lashley, F. (2009). Nursing simulation: A review of the past 40 years. Simulation &
Gaming, 40(4), 528-552. doi:10.1177/1046878109332282
Onda, E. L. (2012). Situated Cognition: Its Relationship to Simulation in Nursing Education. Clinical
Simulation In Nursing, 8(7), e273-80. doi:10.1016/j.ecns.2010.11.004
Razurel, C., Bruchon-Schweitzer, M., Dupanloup, A., Irion, O., & Epiney, M. (2011). Stressful events,
social support and coping strategies of primiparous women during the postpartum period: a
qualitative study. Midwifery, 27(2), 237-242.
Sakai, J., Funayama, M., & Kanetake, J. (2007). The relationship between bedding and face-down death in
infancy: mathematical analysis of a respiratory simulation system using an infant mannequin to
assess gas diffusibility in bedding. Forensic Science International, 166(1), 14-20.
Shah, T., Sullivan, K., & Carter, J. (2006). Sudden infant death syndrome and reported maternal smoking
during pregnancy. American Journal Of Public Health, 96(10), 1757-1759.
Sobey, W. (2002). Barriers to postpartum depression prevention and treatment: a policy analysis. Journal
Of Midwifery & Women's Health, 47(5), 331-336.
Tamaki, A. (2008). Effectiveness of home visits by mental health nurses for Japanese women with postpartum depression. International Journal Of Mental Health Nursing, 17(6), 419-427.
doi:10.1111/j.1447-0349.2008.00568.x
Thombs, B. D., & Stewart, D. E. (2014). Depression screening in pregnancy and postpartum: How close
are we? Journal of Psychosomatic Research, 77(3), 244-245.
Wheeler, C. A., & McNelis, A. M. (2014). Nursing Student Perceptions of a Community-Based Home
Visit Experienced by a Role-Play Simulation. Nursing Education Perspectives, 35(4), 259-261.
doi:10.5480/12-932.1
SECTION II: CURRICULUM INTEGRATION
A. SCENARIO LEARNING OBJECTIVES
Do What
Perform a psychosocial and
environmental assessment
With What
High risk postpartum patient
Demonstrate
Knowledge of medications and
administration
For What
To identify knowledge base,
knowledge gap, community
resources, and areas of health
teaching
To identify side effects, risk
factors
Assess
New born baby
To identify risk factors associated
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Demonstrate
Therapeutic communication
Demonstrate
Cultural sensitivity care
Competency
(based on “What For”)
Identify knowledge base,
knowledge gap, community
resources, and areas of
health teaching
with mother smoking (Ex.
Respiratory issues, SIDS,
premature birth)
Through professional and
culturally sensitive care
To identify barriers that the
patient may be facing
B. Learning Outcome Assessment / Rubric
Demonstrated
Demonstrated
attributes align with
attributes need
required competency some
improvement to
align with
required
competency
Demonstrated
attributes need
major
improvement to
align with
required
competency

Individual identifies
most areas of
knowledge and
identifies some gaps
of what is unknown
Individual identifies
some community
resources available
Individual identifies
and demonstrates
some health
teaching about
postpartum
depression and
smoking cessation
Individual identifies
some of the side
effects and risk
factors of current
medications


Individual does not
identify any side
effects or risk
factors of current
medications
Individual identifies
some of the risk
factors associated
with mother
smoking throughout
and after pregnancy
Individual

Individual does not
identify risk factors
associated with
mother smoking
throughout and
after pregnancy
Individual does not


Individual identifies all
areas of knowledge
known and gaps that are
unknown
Individual identifies a
variety of reliable
community resources
Individual identifies and
demonstrates all areas of
health teaching required
including postpartum
depression and smoking
cessation



Identify side effects and
risk factors of medications,
as well as any alternative
medications available

Individual identifies all
side effects and risk
factors of current
medications

Identify risk factors
associated with mother
smoking (Ex. Respiratory
issues, SIDS, premature
birth)

Individual identifies all
risk factors associated
with mother smoking
throughout and after
pregnancy
Individual demonstrates
thorough knowledge and


CSA REV template (12/15/08; 5/09; 12/09; 4/11; 1/14)
Revised COUPN January 2014




Individual does not
identify what is
known and
unknown from
knowledge of client
Individual does not
identify community
resources relevant
to client
Individual does not
identify or
demonstrate any
areas of health
teaching
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explanations of why
smoking increases risk of
SIDS, premature birth,
and respiratory issues
Demonstrate professional
and culturally sensitive care
(depending on the
complexity level of the
simulation – standardized
patient or Muslim the
cultural component can be
caring for teens)

Identify cultural barriers
that mother might be
dealing with



Individual demonstrates
thorough cultural
assessment
Individual continuously
demonstrates culturally
sensitive care throughout
simulation

Individual identifies
cultural barriers that
mother is dealing with
Individual addresses
barriers professionally
and provides support



demonstrates
limited knowledge
and explanations of
why smoking
increases risk of
SIDS, premature
birth, and
respiratory issues
Individual
demonstrates
limited cultural
assessment
Individual
demonstrates
aspects of cultural
sensitivity
throughout
simulation
Individual identifies
some cultural
barriers that mother
is dealing with
Individual addresses
some of the barriers
professionally and
provides limited
support




demonstrate
knowledge or
explanations of why
smoking increases
risk of SIDS,
premature birth,
and respiratory
issues
Individual does not
demonstrate
cultural assessment
Individual does not
provide culturally
sensitive care in
simulation
Individual does not
identify cultural
barriers that mother
is dealing with
Individual does not
address barriers
professionally and
with support
C. PRE-SCENARIO LEARNER ACTIVITIES
Knowledge
Prerequisite Competencies
Skills/ Attitudes

Identify what is known and unknown about patient


Identify possible areas of health teaching


Review assessment from Healthy Babies that
identified client as high-risk

Brief description of patient
CSA REV template (12/15/08; 5/09; 12/09; 4/11; 1/14)
Revised COUPN January 2014
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SECTION III: SCENARIO SCRIPT
A.
Case summary
Badia Allee is a 17-year-old Muslim primiparous mother who gave premature birth at 35 weeks to a
baby boy 6 weeks ago. The baby was born breach, weighed 5 pounds 3 ounces at the time of birth, and
scored a 5 on his first APGAR score, and 7 on his second APGAR score. Badia has been a smoker
since she was 14 and continued to smoke throughout her entire pregnancy. She got pregnant with a boy
she had been dating at the time, who has since left her life. Badia is an only child, however her parents
have shunned her since they found out about the pregnancy because she was not married. Badia worked
at McDonald’s throughout her pregnancy and is currently trying to take online courses to finish her
secondary education but is having difficulty. Badia was rated as high-risk from the Healthy Babies
community health nurse for multiple reasons, including her young age, lack of family support, premature birth with low birth weight, single mother, and chain cigarette smoker. Badia has agreed to have
a nurse visit her in her apartment for an initial assessment.
-
B. Key contextual details
Badia is bottle feeding her baby because he would not eat at the time of birth
Badia wants to re-kindle her relationship with her parents
She thinks the baby might have a cold because he coughs a lot
The baby is sleeping in the crib face down at night most of the time
Badia is feeling somewhat depressed since the birth but has not told anyone
Badia smokes a pack of cigarettes/day but tries to smoke outside
Badia has poor nutrition habits because she does not have time to cook with a new-born baby
C. Scenario Cast
Patient/Client





Role
High fidelity simulator
Mid-level simulator
Task trainer
Hybrid (Blended simulator)
Standardized patient
Brief Descriptor
(Optional)
Confederate/Actor (C/A) or Learner (L)
1. Student nurse visiting
home
2. Instructor or student
playing role of patient
D.
Last name:
Allee
Gender: Female Age: 17
Spiritual Practice: Muslim
Patient/Client Profile
First name:
Ht: 165cm
Wt: 175 lbs
Ethnicity: Arabic
1. Past history
Smoker - 1 package per day of cigarettes
CSA REV template (12/15/08; 5/09; 12/09; 4/11; 1/14)
Revised COUPN January 2014
Badia
Code Status: Full Code
Primary Language spoken: English,
Arabic
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Primary Medical Diagnosis
Postpartum Depression
2. Review of Systems
CNS
Cardiovascular
Pulmonary
Asthma
Renal/Hepatic
Gastrointestinal
Endocrine
Heme/Coag
Musculoskeletal
Integument
Developmental Hx
Psychiatric Hx
Depression – parents shunned her when they found out she was pregnant
Social Hx
Alternative/ Complementary Medicine Hx
3. Current
medications
Medication allergies:
Food/other allergies:
none
none
Reaction:
Reaction:
Drug
Tri-Cyclen Lo
Dose
40 mg
Route
po
Frequency
Once daily
4. Laboratory, Diagnostic Study Results
Na:
Ca:
Hgb:
PT
ABG-pH:
VDRL:
LDL cholesterol:
K:
Mg:
Hct:
PTT
paO2:
GBS:
HDL cholesterol:
Cl:
Phos:
Plt:
INR
paCO2:
Herpes:
HCO3:
Glucose:
WBC:
Troponin:
HCO3/BE:
HIV:
BUN:
Cr:
HgA1C:
ABO Blood Type:
BNP:
SaO2:
CXR:
EKG
E. Baseline Simulator/Standardized Patient State
(This may vary from the baseline data provided to learners)
1. Initial physical appearance
Gender: Female
Attire: Sweatpants and sweater
Alterations in appearance (moulage):
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ID band present, accurate
ID band present, inaccurate
ID band absent or not applicable
Allergy band present, accurate
Allergy band inaccurate
Allergy band absent or N/A
2. Initial Vital Signs Monitor display in simulation action room:
√
No monitor display
BP:
CVP:
AIRWAY:
Lungs:
Sounds/mechanics
Heart:
Monitor on, but no data
displayed
HR:
PAS:
ETC0²:
Left:
RR:
PAD:
FHR:
Right:
Monitor on, standard display
T:
PCWP:
SpO²:
CO:
Sounds:
ECG rhythm:
Other:
Bowel sounds:
Other:
3. Initial Intravenous line set up
Saline lock Site:
#1
IV #1
Site:
Fluid type:
Main
Piggyback
IV #2
Site:
Fluid type:
Main
Piggyback
4. Initial Non-invasive monitors set up
IV patent (Y/N)
Initial rate:
IV patent (Y/N)
Initial rate:
IV patent (Y/N)
NIBP
ECG First lead:
Pulse oximeter
Temp monitor/type
5. Initial Hemodynamic monitors set up
A-line Site:
Catheter/tubing Patency (Y/N)
6. Other monitors/devices
Foley catheter
Epidural catheter
Amount:
Infusion pump:
Fetal Heart rate monitor/tocometer
ECG Second lead:
Other:
CVP Site:
PAC Site:
Appearance of urine:
Pump settings:
Internal
External
Environment, Equipment, Essential props
Recommend standardized set ups for each commonly simulated environment
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Revised COUPN January 2014
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1. Scenario setting: (example: patient room, home, ED, lobby)
Home setting
(rent controlled one bedroom or bachelor apartment)
Magazines (seventeen magazine, Jay-14), posters of teen singers (from inside magazines)
baby bottles, cigarettes and ash tray, pop and packaged junk food items, throw carpet, hair
straightener/curling iron, baby toys and stuffed animals in the crib, birth control pills, colorful
pillowcase and blankets, baby clothes and blankets, chair, bed, crib, diapers, couch
2. Equipment, supplies, monitors
(In simulation action room or available in adjacent core storage rooms)
Bedpan/ Urinal
Foley catheter kit
Straight cath. kit
IV Infusion pump
Nasogastric tube
Defibrillator
PCA infusion pump
Feeding pump
ETT suction catheters
Code Cart
Epidural infusion
pump
IV fluid additives:
Pressure bag
Oral suction catheters
12-lead ECG
Central line Insertion
Kit
IV fluid
Type:
3. Respiratory therapy equipment/devices
Nasal cannula
Face tent
BVM/Ambu bag
Nebulizer tx kit
4. Documentation and Order Forms
Health Care
Med Admin
Provider orders
Record
Progress Notes
Graphic record
Simple Face Mask
Non re-breather mask
Flowmeters (extra supply)
H&P
Lab Results
Anesthesia/PACU
record
Standing (protocol)
orders
Code Record
Other
Describe:
ED Record
Medication
Transfer orders
reconciliation
Nurses’ Notes
Dx test reports
Actual medical record binder, constructed
per institutional guidelines
5. Medications (to be available in sim action room)
# Medication
Dosage
Route
#
Cipralex
10
MG
o.d
PO
1
PO
2 Ortha- Tri-Cylen Low 1 tab o.d
CSA REV template (12/15/08; 5/09; 12/09; 4/11; 1/14)
Revised COUPN January 2014
Incentive
spirometer
Wall suction
Chest tube kit
Chest tube equip
Dressing ∆
equipment
Blood product
ABO Type:
# of units:
Medication
ICU flow sheet
√
Prenatal record
Dosage
Route
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CASE FLOW / TRIGGERS/ SCENARIO DEVELOPMENT STATES
Initiation of Scenario: A community health nurse who works for public health has been notified of a high-risk pati
been sent home from the hospital with her new baby boy. Then nurse calls the patient ahead of time to ask if it wo
comes to her house to see how things are going with her new baby. The patient agrees that she would like a visit f
health nurse, and is looking forward to her arrival.
1ST PHASE OF THE SCENARIO:
- BUILDING RAPPORT AND
DESIRED LEARNER ACTIONS & TRIGGERS TO MOVE TO NEXT STATE
RELATIONSHIP WITH
CLIENT
-
ASSESSMENT OF CLIENT’S
ENVIRONMENT
Nurse begins to form a
therapeutic relationship
with client.
Operator
Play sound of baby crying in
background
Nurse will introduce
Triggers:
herself when she comes
to the door and will sit
Baby is laying in crib
with the client facing her. facedown
Nurse acknowledges that
baby is crying and laying
facedown in the crib
when she arrives.
2ND PHASE OF SCENARIO:
- ASSESSMENT OF NEW
Client is sitting in chair and
welcomes nurse into her
home.
Learner Actions
Debriefing Poin
Learner demonstrates how to
appropriately approach the client
in her home environment.
Discuss why the
sit where he/she
Learner demonstrates the
beginning of a therapeutic
relationship through establishing
trust and building rapport.
Learner assesses the
environment and identifies
reasons it may not be “babyproof”.
Discuss what we
did not go well i
and rapport.
Discuss if the lea
done anything d
could do it again
Recognition of o
of the impressio
and assumption
that may exist.
DESIRED ACTIONS & TRIGGERS TO MOVE TO NEXT STATE
BORN BABY
-
IDENTIFY RISK FACTORS
COLLABORATE WITH
CLIENT TO DETERMINE A
PLAN OF ACTION TO
REDUCE RISK FACTORS
Nurse begins conversation
with client about how things
are going at home with her
Triggers:
Nurse asks client if she is
enjoying living on her own
with the new baby.
CSA REV template (12/15/08; 5/09; 12/09; 4/11; 1/14)
Revised COUPN January 2014
Learner Actions:
Recognizes clients concern about
feelings of postpartum
depression
Debriefing Poin
Discuss the impo
collaborating wi
determine goals
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13
newborn baby.
The client is cooperative and
tells the nurse that she is
feeling stressed and does not
know how to handle it. She is
feeling down in the dumps
and does not always want to
care for her baby when he is
crying.
The nurse completes a
newborn assessment of the
baby and will listen to HR
and RR.
Client responds either yes
or no.
Nurse asks if she can do an
assessment of her baby and
listen to heart rate and
respiratory rate.
Identifies risk factors associated
with baby’s health and safety
including risk of respiratory
infection, SIDS, and injury from a
unsafe environment.
Collaborates with client to
determine a plan of action
Client allows nurse to
assess baby.
Conversation about safety
hazards in house and gives
client suggestions on how
to “baby-proof”.
Nurse identifies some risk
factors that the baby has in
the environment he is
currently living in.
Nurse discusses a plan of
action with the mother to
improve baby’s health and
safety in home.
Client is cooperative and
wants to learn more about
how she can improve the
living conditions for the
baby.
3RD PHASE OF THE
SCENARIO:
- Health teaching with
client about smoking
cessation
- Advocating for client
- Support client’s
priorities of care
- Discuss medications
DESIRED ACTIONS & TRIGGERS TO MOVE TO NEXT STATE
CSA REV template (12/15/08; 5/09; 12/09; 4/11; 1/14)
Revised COUPN January 2014
Recognizing tha
may be differen
Principles of har
Challenges expe
discussing and c
action with the
Awareness of so
of health that ar
clients situation
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14
Nurse discusses smoking
with client and determines
how often she smokes/day.
Triggers:
Nurse identifies the ashtray
and pack of cigarettes in
the room.
Learner Actions:
Nurse begins health teaching
with client about smoking
cessation.
Debriefing Poin
Awareness of re
while discussing
smoking during
Client states that she smokes
1 package of cigarettes/day
Nurse asks the client how
oftem she smokes
Nurse supports client for her
decision to quit or not to quit.
Advocacy for cli
Principles of har
Nurse begins smoking
cessation with client and
determines level of
readiness to quit.
Client is willing to talk
about smoking cessation
Nurse identifies community
resources available to the client
that may help with smoking
cessation.
Nurse uses the 5A’s (Ask,
advise, assess, assist, and
arrange) to help with
smoking cessation.
4TH PHASE OF THE SCENARIO:
- CONCLUSION OF THE
Nurse uses the 5A’s
resource to assist with
smoking cessation
Nurse discusses
medications that client is
currently taking, and
suggests alternatives that
may help with depression
and smoking cessation.
Nurse suggests alternative
methods for quitting smoking
including the patch, e-cigarettes,
and nicotine gum.
Nurse also suggests medications
that can help with depression
and smoking cessation, and
identifies other supports as well.
DESIRED ACTIONS & TRIGGERS TO MOVE TO NEXT STATE
THERAPEUTIC ENCOUNTER
-
CREATING POSSIBILITIES
FOR ONGOING
RELATIONSHIP WITH
CLIENT AND CONTINUED
HOME VISITS
Nurse concludes therapeutic
relationship with client.
Client is thankful for nurses
home visit.
Nurse discusses options for
future visits with client, and
other community agencies
that would be helpful
resources for the client
Triggers:
Nurse has finished health
teaching with client, has
completed a new born
assessment, and has
discussed medications and
alternative options
Nurse sits down with client
and thanks her for her time.
Learner Actions:
Learner identifies the ability to
continue care with client for
further needs (i.e referrals to
community resources)
Continues to demonstrate
strategies to build trust and
rapport with client for continuing
care.
Demonstrates cultural sensitivity
CSA REV template (12/15/08; 5/09; 12/09; 4/11; 1/14)
Revised COUPN January 2014
Debriefing Poin
Conclusion of th
encounter and a
an ongoing relat
Importance of tr
this relationship
has shared feeli
depression and
family support s
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15
Client thanks nurse for her
support and time.
throughout entire home visit.
Nurse suggests when to
plan another home visit and
reviews plan of action with
client.
Scenario End Point:
Client plans to use community resources and plans another home visit with nurse.
Suggestions to decrease complexity:
Client does not have to be Muslim and shunned by parents
Client is not a smoker
Suggestions to increase complexity:
Client is not willing to cooperate with nurse
Client does not want nurse to assess her baby
Client is not compliant with smoking cessation
Parents show up at home visit and are ashamed of their daughter’s actions; nurse now has to deal with parents re
supporting the client
Introduce client to students in second year while the patient is pregnant, to enhance
CSA REV template (12/15/08; 5/09; 12/09; 4/11; 1/14)
Revised COUPN January 2014
TABLE OF CONTENTS
16
CASE FLOW / TRIGGERS/ SCENARIO DEVELOPMENT STATES
Initiation of Scenario: A community health nurse who works for public health has been notified of a high-risk patient who has just
been sent home from the hospital with her new baby boy. Then nurse calls the patient ahead of time to ask if it would be okay if she
comes to her house to see how things are going with her new baby. The patient agrees that she would like a visit from a community
health nurse, and is looking forward to her arrival.
1ST PHASE OF THE SCENARIO:
- BUILDING RAPPORT AND
DESIRED LEARNER ACTIONS & TRIGGERS TO MOVE TO NEXT STATE
RELATIONSHIP WITH
CLIENT
-
ASSESSMENT OF CLIENT’S
ENVIRONMENT
Nurse begins to form a
therapeutic relationship
with client.
Operator
Play sound of baby crying in
background
Nurse will introduce
Triggers:
herself when she comes
to the door and will sit
Baby is laying in crib
with the client facing her. facedown
Nurse acknowledges that
baby is crying and laying
facedown in the crib
when she arrives.
Client is sitting in chair and
welcomes nurse into her
home.
CSA REV template (12/15/08; 5/09; 12/09; 4/11; 1/14)
Revised COUPN January 2014
Learner Actions
Debriefing Points:
Learner demonstrates how to
appropriately approach the client
in her home environment.
Discuss why the learner chose to
sit where he/she did.
Learner demonstrates the
beginning of a therapeutic
relationship through establishing
trust and building rapport.
Learner assesses the
environment and identifies
reasons it may not be “babyproof”.
Discuss what went well and what
did not go well in building trust
and rapport.
Discuss if the learner would have
done anything differently if they
could do it again.
Recognition of own response/bias
of the impressions from the client
and assumptions of stereotyping
that may exist.
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17
2 PHASE OF SCENARIO:
- ASSESSMENT OF NEW
ND
DESIRED ACTIONS & TRIGGERS TO MOVE TO NEXT STATE
BORN BABY
-
IDENTIFY RISK FACTORS
COLLABORATE WITH
CLIENT TO DETERMINE A
PLAN OF ACTION TO
REDUCE RISK FACTORS
Nurse begins conversation
with client about how things
are going at home with her
newborn baby.
The client is cooperative and
tells the nurse that she is
feeling stressed and does not
know how to handle it. She is
feeling down in the dumps
and does not always want to
care for her baby when he is
crying.
The nurse completes a
newborn assessment of the
baby and will listen to HR
and RR.
Triggers:
Nurse asks client if she is
enjoying living on her own
with the new baby.
Learner Actions:
Recognizes clients concern about
feelings of postpartum
depression
Debriefing Points:
Discuss the importance of
collaborating with client to
determine goals.
Client responds either yes
or no.
Identifies risk factors associated
with baby’s health and safety
including risk of respiratory
infection, SIDS, and injury from a
unsafe environment.
Recognizing that client’s values
may be different nurses.
Nurse asks if she can do an
assessment of her baby and
listen to heart rate and
respiratory rate.
Client allows nurse to
assess baby.
Conversation about safety
hazards in house and gives
client suggestions on how
to “baby-proof”.
Nurse identifies some risk
factors that the baby has in
CSA REV template (12/15/08; 5/09; 12/09; 4/11; 1/14)
Revised COUPN January 2014
Collaborates with client to
determine a plan of action
Principles of harm/risk reduction
Challenges experienced in
discussing and creating a plan of
action with the client.
Awareness of social determinants
of health that are relevant to
clients situation.
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18
the environment he is
currently living in.
Nurse discusses a plan of
action with the mother to
improve baby’s health and
safety in home.
Client is cooperative and
wants to learn more about
how she can improve the
living conditions for the
baby.
3RD PHASE OF THE
SCENARIO:
- Health teaching with
client about smoking
cessation
- Advocating for client
- Support client’s
priorities of care
- Discuss medications
Nurse discusses smoking
with client and determines
how often she smokes/day.
DESIRED ACTIONS & TRIGGERS TO MOVE TO NEXT STATE
Triggers:
Nurse identifies the ashtray
and pack of cigarettes in
the room.
Client states that she smokes Nurse asks the client how
CSA REV template (12/15/08; 5/09; 12/09; 4/11; 1/14)
Revised COUPN January 2014
Learner Actions:
Nurse begins health teaching
with client about smoking
cessation.
Debriefing Points:
Awareness of responses to client
while discussing her choices about
smoking during pregnancy
Nurse supports client for her
Advocacy for client and her rights
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19
1 package of cigarettes/day
often she smokes
decision to quit or not to quit.
Nurse begins smoking
cessation with client and
determines level of
readiness to quit.
Client is willing to talk
about smoking cessation
Nurse identifies community
resources available to the client
that may help with smoking
cessation.
Nurse uses the 5A’s (Ask,
advise, assess, assist, and
arrange) to help with
smoking cessation.
4TH PHASE OF THE SCENARIO:
- CONCLUSION OF THE
Nurse uses the 5A’s
resource to assist with
smoking cessation
Nurse discusses
medications that client is
currently taking, and
suggests alternatives that
may help with depression
and smoking cessation.
Principles of harm/risk reduction
Nurse suggests alternative
methods for quitting smoking
including the patch, e-cigarettes,
and nicotine gum.
Nurse also suggests medications
that can help with depression
and smoking cessation, and
identifies other supports as well.
DESIRED ACTIONS & TRIGGERS TO MOVE TO NEXT STATE
THERAPEUTIC ENCOUNTER
-
CREATING POSSIBILITIES
FOR ONGOING
RELATIONSHIP WITH
CLIENT AND CONTINUED
HOME VISITS
Nurse concludes therapeutic
relationship with client.
Client is thankful for nurses
home visit.
Triggers:
Nurse has finished health
teaching with client, has
completed a new born
assessment, and has
CSA REV template (12/15/08; 5/09; 12/09; 4/11; 1/14)
Revised COUPN January 2014
Learner Actions:
Learner identifies the ability to
continue care with client for
further needs (i.e referrals to
community resources)
Debriefing Points
Conclusion of therapeutic
encounter and ability to establish
an ongoing relationship
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20
Nurse discusses options for
future visits with client, and
other community agencies
that would be helpful
resources for the client
discussed medications and
alternative options
Nurse sits down with client
and thanks her for her time.
Client thanks nurse for her
support and time.
Continues to demonstrate
strategies to build trust and
rapport with client for continuing
care.
Importance of trust and support in
this relationship because client
has shared feeling of postpartum
depression and does not have a
family support system.
Demonstrates cultural sensitivity
throughout entire home visit.
Nurse suggests when to
plan another home visit and
reviews plan of action with
client.
Scenario End Point:
Client plans to use community resources and plans another home visit with nurse.
Suggestions to decrease complexity:
Client does not have to be Muslim and shunned by parents
Client is not a smoker
Suggestions to increase complexity:
Client is not willing to cooperate with nurse
Client does not want nurse to assess her baby
Client is not compliant with smoking cessation
Parents show up at home visit and are ashamed of their daughter’s actions; nurse now has to deal with parents reactions while
supporting the client
Introduce client to students in second year while the patient is pregnant, to enhance
CSA REV template (12/15/08; 5/09; 12/09; 4/11; 1/14)
Revised COUPN January 2014
TABLE OF CONTENTS
21
APPENDIX A: HEALTH CARE PROVIDER ORDERS
Patient Name:
Diagnosis:
DOB:
Age:
MR#:
 No Known Allergies
 Allergies & Sensitivities
Date
Time
HEALTH CARE PROVIDER ORDERS AND SIGNATURE
Signature
CSA REV template (12/15/08; 5/09; 12/09; 4/11)
Revised COUPN January 2014
TABLE OF CONTENTS
22
APPENDIX B: Digital images of manikin and/or scenario milieu
Insert digital photo here
Insertdigital
digitalphoto
photohere
of initial
Insert
scenario set up here
Insert digital photo here
Insert digital photo here
CSA REV template (12/15/08; 5/09; 12/09; 4/11)
Revised COUPN January 2014
TABLE OF CONTENTS
23
APPENDIX C: DEBRIEFING GUIDE
General Debriefing Plan
With Video
Individual
Group
Debriefing Guide
Debriefing Materials
Objectives
Debriefing Points
√ Culture
Without Video
QSEN
CPSI Competencies to consider for debriefing scenarios
Teamwork/Collaboration
√ Identify safety risk
√ Communication
√ Issues in environment
√ Respond to safety risk
Sample Questions for Debriefing
Interprofessional Competencies to consider for debriefing scenarios
Role Clarification
Interprofessional Teamwork Functioning
Patient/Family /Client/ Community
Collaborative Leadership
centered care
Interprofessional Communication
Sample Questions for Debriefing
CSA REV template (12/15/08; 5/09; 12/09; 4/11)
Revised COUPN January 2014