Bridget Nelson Hardy and Peggy Nelson

Simulation Scenario 1 takes place in an acute care setting. Peggy fell at home and sustained a left hip fracture. She had an open reduction internal fixation of her left hip and is one day post-op. Bridget is at the bedside, verbalizing concern that her mother is moaning in pain and mumbling incoherently. Prior to hospitalization, Bridget says that Peggy was becoming increasingly forgetful and was confused at times. Bridget is concerned that her mother is not able to manage the use of PCA for pain control and worried that she may not be able to return to her home and live independently.

Peggy was discharged from the hospital 14 days ago and has been in a rehabilitation facility for one week. Her pain is well controlled, and her delirium has resolved, but she is confused at times and Bridget is concerned about her mother’s ability to return to her own home. Peggy tearfully asks Bridget to promise she will not put her in a nursing home. Bridget agrees and mentions that she has a sibling who lives out of state and has not been providing any assistance.

Six months have passed since Peggy fractured her hip. She returned to her own home. Daughter Bridgit visits daily and arranged for supplemental hired help. Peggy continues to exhibit signs of dementia and has fallen several times since returning home. During this visit by the home health nurse, caregiver Bridget is verbalizing anxiety about her mother’s safety and is contemplating long-term placement for her mother. Caregiver Bridget is tearful and very conflicted since she “promised” her mother that she would not put her in a nursing home. She is also concerned about how she will manage the cost of long-term care.