Question

Simulation

This is Becky, the nurse in the emergency Department. I am caring for Robert jones a 60-year-old African- American male. We admitted him at at 4:30   this morning. He reported increased shortness of breath and weakness.    His vitals were: blood pressure 80 over 62, R 30 pulse 164 and in a-fib. We gave him a 1000 milliliter bolus of sodium chloride to bring his blood pressure. He was recently in the hospital for atrial fibrillation and stage three   ulceration. He is been on home antibiotics. Past medical history includes chronic renal failure, type two diabetes, peripheral vascular disease, coronary   artery disease, and atrial fibrillation. The client’s social history includes smoking one pack of cigarettes per day and consumes three to five alcoholic drinks per week. He has difficulty adhering to his diabetic management plan. Laboratory findings include sodium 128 potassium 5.1, BUN, creatinine of 3.0 total bilirubin of 2.8 globular filtration rate 45 calcium 8.7 digoxin level 0.6. His WBC is 16.1 hemoglobin 9.3, and hematocrit 28.2 his chest x-ray findings include: right lung opacities greater than left lung. His ECG revealed atrial fibrillation. The client currently has a 20 gauge in the left forearm with IV fluids of .9%sodiumchloride at 100milliliters per hour. He is on 2 liters of 2 nasal cannula and his 02 sat is 91%. He is resting in bed now. I’ll bring him up to the telemetry unit in a few minutes.

Question

1. Reflect on ethical dilemmas uncovered during scenario.

2. Discuss cultural considerations.

3. Discuss educational needs of the client who has multiple disease processes.

4. Describe an “Aha” moment you experienced during the simulation. What are some of the aspects of the client’s care that you did not feel they were prepared for?

Answer 1

Ans) 1) Ethical dilemma:

- Examples of ethical dilemmas may include the following:
Your critically ill family member is in the hospital and the doctors and nurses are turning to you to make medical decisions on the patient's behalf.
You are a patient and are too sick to speak for yourself.

2) Cultural consideration:

- The purpose of this paper is to provide speech-language pathologists with information that addresses cultural perceptions about stuttering and suggestions for assessment and treatment of stuttering in African Americans. The psychometric properties of the Stuttering Inventory for African Americans are discussed. Results indicate that this scale is reliable and valid. Overall, African Americans had positive perceptions about stuttering. Suggestions for evaluation and treatment of stuttering are provided.

3) Take advantage of technology. Technology has made patient education materials more accessible. Educational resources can be customized and printed out for patients with the touch of a button. Make sure the patient’s individualized needs are addressed. Don't simply hand the patient a stack of papers to read. Review them with patients to ensure they understand the instructions. Answer questions that arise. Some resources are available in several languages.
Determine the patient’s learning style. Similar information may be provided by a range of techniques. In fact, providing education using different modalities reinforces teaching. Patients have different learning styles. Find out if your patient learns best by watching a DVD or by reading. A hands on approach where the patient gets to perform a procedure with your guidance is often the best method.
Stimulate the patient’s interest. It's essential that patients understand why this is important. Establish rapport, ask and answer questions, and consider specific patient concerns. For example, some patients may want detailed information about every aspect of their health condition. Others may want just the facts, and do better with a simple checklist.
Consider the patient’s limitations and strengths. Does the patient have physical, mental, or emotional impairments that impact the ability to learn? For example, they may need large print materials. If the patient is hearing impaired, use visual materials and hands on methods instead of simply providing verbal instruction. Always have patients explain what you taught them. Often people will nod "yes” or say that they comprehend what is taught even if they have not really heard or understood. Consider factors such as fatigue and the shock of learning a critical diagnosis when educating patients.
Include family members. Involving family members in patient teaching improves the chances that your instructions will be followed. In many cases, you will be providing most of the instruction to family members. Families play a critical role in health care management.
Teaching patients and their families can be one of the most challenging, yet also rewarding elements of providing nursing care. First-rate instruction improves patient outcomes dramatically.

4) Eureka! We believe that this is a common aspect of simulation and have labelled it. 'the eureka moment' ..