NURSING

NR325/NR330 Butch Sampson Scenario 2 (NLN)

The following information is to be used in guiding your preparation and participation in the scenario for this course. This document will provide applicable course outcomes in preparation for your simulation.

SCENARIO OVERVIEW:

Butch Sampson, age 68, was exposed to Agent Orange while serving in Vietnam. Chronically homeless, Butch has Type 2 diabetes resulting in the removal of two toes. Butch is in a Veterans Administration hospital for surgical debridement of the great toe.

Butch is being discharged from the VA hospital to a transitional housing facility. The client is somewhat resistant because of all the rules that must be followed.

STUDENT ROLES DURING SIMULATION:

During pre-briefing, you will be assigned one of these roles according to the description below to participate in the simulation as a nurse. After completing your assessment, you are expected to document your findings as a nurses note in SBAR format.

Charge Nurse:

The charge nurse is responsible for the overall organization of safe, quality patient care. You are the team leader and serve as a resource to all interdisciplinary members and are responsible for appropriate delegation of duties. You will serve as the point person for communication and can anticipate speaking with the physician or other primary care provider, ancillary support services, and others directly involved with the care being provided. You must be knowledgeable about the patient’s condition and able to dictate orders obtained and assist with implementation if needed. Additionally, be prepared to prioritize care and anticipate future needs.

Documentation Nurse:

The documentation nurse is responsible for recording of all patient event activities during the simulation with the exception of medication administration. You are responsible for documenting assessments, interventions, and outcomes on the designated tool (paper or electronic). Be prepared to read back and verify your documentation when requested and/or clarifying the details. Additionally, you will be part of the interdisciplinary team and will contribute observational assessment findings to include but not limited to changes in vital signs, alerts, psychosocial needs, and anticipated care.

Assessment Nurse:

The assessment nurse is responsible for overseeing a comprehensive assessment of the patient. This includes but is not limited to obtaining vital signs, head-to-toe assessment of all systems, and psych/social assessment of the patient. You will be prioritizing care, executing independent interventions, collaborating with interdisciplinary team members, anticipating the needs of the patient/family, and re-assessing or continually monitoring the patient for any changes in condition. You are responsible for implementing all non-medication related interventions, verbalizing your findings to the team, and recommending any actions/interventions required. Additionally, you will be providing appropriate education to the patient and family/significant others.

Medication Nurse:

The medication nurse is responsible for all actions and documentation related to safe administration of medications. You will identify and correct any medication errors related to prescribing or distribution. This may include speaking with the physician or primary care provider. Prior to administering medication, you will assure the “Rights of Medication Administration”. You must be knowledgeable regarding the action and expected effects of the medications being administered and are responsible for monitoring and reporting any adverse reactions or unforeseen consequences of administration. Part of your role includes verifying medication calculations with a colleague and identifying any incompatible drug combinations.

Observer Nurse:

The observer is a non-participant role and will not communicate directly with the simulation team. The observer nurse will view the simulation in the briefing room through Learning Space as it is occurring. There may be multiple observer nurses in each scenario. The observer nurse will be given an observation guide to complete during the simulation. The data you collect will help the team during the debriefing process and facilitate an open and active discussion regarding the simulation experience. You will be an active participant in the debriefing and will be encouraged to share your observations and thoughts. Please keep in mind that your observations should be conveyed in a respectful, educational manner. The goal is to work together as colleagues in providing safe and effective care.

CONFIDENTIALITY:

To preserve the educational value, integrity and safety of the learning environment, you agree to maintain strict confidentiality about the proceedings of the simulation session, details of the training scenarios and the performance of all participants. You acknowledge that this expectation aligns with the guidelines related to the Health Insurance Portability and Accountability Act (HIPAA) as well as laws governing Protected Health Information (PHI) in client care environments.  

You will not view, discuss, share, record or disclose any confidential information pertaining to the session. You understand that lapses in confidentiality are considered academic misconduct and could result in dismissal from the academic program. 

FICTION AGREEMENT:

You will suspend judgment of realism for any given simulation in exchange for the promise of learning new knowledge and skills, treating the simulated patients with the same care due an actual patient, act with a genuine desire to learn even when it may be difficult to do so.  

LEARNER OBJECTIVES:

1. Assess knowledge of self-care for type 2 diabetes including diet, medications, and care of foot.​

2. Complete medication reconciliation.​

3. Provide discharge teaching.

COURSE OUTCOMES:

The NR325/NR330 standardized simulation enables the student to meet the following priority course outcomes:

CO 1: Provide effective professional nursing care for adult patients and their families in acute care settings using the nursing process. (PO 1)

CO 4: Apply critical thinking strategies to make good clinical decisions in the adult patient clinical setting. (PO 4)

CO 6: Relate knowledge and principles of legal, ethical, and professional standards to clinical practice in the acute care setting, with adult patients and their families. (PO 6)

**Although this scenario can address multiple course outcomes, faculty and students should focus on the course outcomes listed above**

DUE DATE:

The standardized simulation will be conducted during Week 1 to ensure students are prepared to meet the objectives.

SIMULATION TIMING:

· Pre-brief: 20 minutes

· Prebrief Skills Review (OPTIONAL): 30 minutes

· Run Time: 30 minutes

· Debrief: 60 minutes

REVIEW AND COMPLETE BEFORE THE START OF PRE-BRIEFING:

In order to prepare for the simulation, you should complete your assigned reading for the course. In addition, you should be prepared to complete and document a thorough nursing assessment along with completing the following skills:

· Glucose regulation

· Nursing Care: Altered glucose regulation

· Diabetes mellitus type 2

· Cultural Awareness

· Social Determinants of Health

· Utilizing I-SBAR for reporting

Please keep in mind you will also be required to recognize a variety of signs and symptoms linked to abnormalities in these skills.

Therefore, in order to prepare for the simulation, you are required to complete the pre-briefing questions below and submit them to the faculty facilitating the simulation before the start of the pre-briefing. If you do not complete the pre-briefing questions below and submit them to the faculty facilitating the simulation before the start of pre-briefing, you will not be permitted to participate in the simulation.

Use the textbook and other resources to answer the following questions:

1. How does the nurse adapt discharge planning instructions to support wound healing and optimal foot care?

2. Many medications, such as sulfonylureas used to treat diabetes type 2, can be damaging to the liver. To which assessments and therapeutic communication details will the nurse attend during all interactions?

3. The nurse focuses on which aspect Butch’s current challenges to support improving and maintaining his health: homelessness or lack of consistent primary care?

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