Millie Larsen is an 84-year-old Caucasian female who lives alone in a small home. Her husband, Harold, passed away a year ago and she has a cat, Snuggles, who is very important to her. Millie has one daughter, Dina Olsen, who is 50, that lives nearby, and is Millie's major support system. Her current medical problems include: hypertension, glaucoma, osteoarthritis of the knee, stress incontinence, osteoporosis, and hypercholesterolemia.
Millie is at the clinic for routine examination and medication follow up. She is taking several anti-hypertensive medications, diuretics, and analgesics. During the monologue, Millie provides important details of how she views her current life situation.
Simulation Scenarios 1, 2, and 3
Several weeks have passed since the clinic visit, and Millie is now in the hospital with a diagnosis of urinary tract infection and dehydration. Her presentation is atypical and she is confused. The scenarios depict varied situations Millie encounters during her brief hospital stay. The objectives focus on assessment, appropriate use of assessment tools such as the SPICES and Hendrich Falls Risk, and Confusion Assessment Method (CAM); communication skills; conflict between Millie and her daughter on living arrangements; functional assessment; discharge teaching; and making appropriate referrals.
Millie's Introductory Monologue
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Simulation Scenario 1 is set at the 3:00 PM shift change. Millie has been in her room on the medical-surgical unit for about six hours. She was in the Emergency Department overnight because there were no available beds on the medical units. Due to her confusion, Millie did not take her medications properly in the days prior to admission and as a result, her blood pressure is very elevated. Millie's daughter, Dina is at the bedside and is quite concerned about the confusion and elevated blood pressure. The learner receives hand-off report from the previous nurse and is expected to perform a general assessment as well as use the SPICES and Confusion Assessment Method (CAM) tools. Objectives for this scenario include the identification and use of appropriate assessment tools for older adults, recognition of an elevated blood pressure and notification of Millie's primary care provider using SBAR format.
Simulation Scenario 2 occurs at 7:00 AM the following morning. Millie has had a near fall while ambulating to the bathroom. Her confusion has begun to clear and her blood pressure is improving. During the handoff report, the nurse tells the learner that the fall risk assessment has not been done, and discharge teaching should begin, since she is expected to be discharged tomorrow. Millie's daughter has just arrived and is concerned about Millie going home alone when discharged. During the simulation, the learner in this simulation is expected to perform a general assessment, fall risk assessment, and functional assessment (Katz ADL). Additionally, the learner will recognize the conflict developing between Millie and her daughter regarding whether it is safe for Millie to go home alone. In debriefing, discussions may focus around the risks to Millie if she does go home alone versus her desire to go home.
Simulation Scenario 3 occurs two hours later at 9:30 AM the next morning. Millie's primary care provider has written discharge orders and Millie is going home. The learner is expected to do an assessment, and complete medication teaching and other discharge teaching. The focus is on the transition of care from the hospital back to the home setting.
Finish the Story Assignment
Learners have now seen Millie at four snapshots in time. What do they think her life will be like three months from now?
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Cynthia Reese, PhD, RN, CNE
Associate Dean of Nursing, Lincoln Land Community College