Clinical Decision Making in a Nursing Simulation Scenario

Clinical Decision Making in a Nursing Simulation Scenario

1. Scenario: Mr. Patience is an 86-year old widow currently living on his own in a small apartment. He is increasingly frail and has recently been diagnosed with prostate cancer. The community nurse is scheduled to assess eligibility for placement in long term care. When the nurse(s) arrives, Mr. Patience is in a chair, incontinent and ‘not quite right’, which is unusual for him. His sister/brother is visiting and is concerned.

   • Critical Thinking Model
     • Nursing Process
       • Assessment/ Diagnosis
         • data, information, desired outcomes and intervention regarding the client were determined
           • pre-briefing worksheet
             • Information
               • Client is 86 year old and lives alone. Client is frail and diagnosed with prostate cancer. Patient is incontinent an s say the he is not 'feeling quite right'
                 • Priorities/ Diagnosis
                   • 1. Client is an elderly individual and lives alone
                     • high risk for falls, due to frailty
                     • urinary function declines lead to incontinence
                   • 2. Client is 'not feeling quite right'
                     • prostate cancer complications: pain, change in bowel patterns
                     • complications regarding incontinence: UTI (pain, discomfort), pressure ulcer (pain, discomfort)
       • Planning
         • pre-breifing worksheet
           • change and wash client for incontinence, and rule out any complications, for example pressure ulcer, pain
             • Client Outcomes
               • determine eligibility to be placed in long term care facility
               • rule out and prevent any risks and complications from current diagnosis
               • address and family member concers regarding client
           • interview client and family member about client's ability to perform ADL's and how involved the family member can be with the care
           • for any abnormal, unusual, suspicious finiding contact agency and report them immediately
       • Evaluation
         • Lasater's Clinical Judgement Rubric
           • evaluates the ability to notice, interpret, respond, and reflect.
             • be more calm, note the dynamic between the client and the family member, could identify strengths and weakness performed, and uses some prompts
               • score of 22, accomplished-developing clinical judgement
             • the individual’s ability to remain composed, communicate appropriately, remain competent in nursing skills, and observe and interpret any patterns or information that is most relevant to the client in a complex situation
         • Peer Debreifing Worksheet
           • highlights any missing assessments and interventions and enabled students to reflect on similar decisions they would have made or missed, to highlight what went well, and what they could do in similar or future situations
             • receive consent, obtain a health history from the patient or family member, and assess and include the family dynamic in the planning stage of the nursing process
       • Implementation
         • the client was not responding to questions, seemed agitated and was saying "who are you! go away"
         • bruises apparent on arms, asked family member about the but the family member was hesitant, indirect, and tried to change topics
           • using previous knowledge, Maslow's hierarchy of needs, and CNO conflict prevention and management
             • ***New Client Priority***
               • client safety and security is compromised
                 • Since, suspicious finding arose contact agency and inform them about suspected elderly abuse
                   • Intervention: contact agency and report suspected elderly abuse, reccomend that client be placed in long term-care and if safe try to remove client from harm
         • the family member did not want the nurse to continue assessment and was being over-protective