Task Instructions During Explained for Students (Easy Guide)

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Original Question

Task Instructions During the workplace simulated scenario’s, you will be required to perform as a student Enrolled nurse in a simulated health care setting. This is a formal assessment which will form part of your final result. The observation tasks noted in this assessment will be incorporated and assessed during your stage 3 practical simulated sessions. These observation tasks are to be assessor directed simulation that may include group work / role play. Students may access connect or any learning resources required to complete the observation questions. Case study Isabel James is a 71-year-old- Vietnamese woman, she has lived in Australia for 30 years. For the past 3 years Isabel has experienced intermittent mild nausea and vomiting which she has just passed off as a sensitive stomach. However, on a recent trip to Malaysia with her husband Bill (who is Australian) she had a very sore abdomen which she put down to the spicy food they had eaten, over the next 2 days the pain increased, they cut their trip short, and Isabel saw her GP at home. After extensive tests and referrals the diagnosis was pancreatic cancer with liver metastasis. Unfortunately, the cancer was aggressive and after many discussions with the specialist, treatment was considered futile. Isabel was given approximately six months to live, and the plan was to look at possible palliative care options. Isabel has been cared for at home for the past 4 mths by community healthcare staff, her husband and her daughter Anna. However her health has now started to deteriorate and the demands on her husband increased. Isabel began suffering from incontinence, weight loss, lack of appetite, nausea, insomnia, restlessness and increasing pain which has decreased her mobility. Bill has a heart condition and type 2 diabetes and the added care for Isabel is proving to be a strain on him. Anna is helping as much as she can, but she is busy with the demands of a family and small children of her own. Isabel has always had an active social and church life and a wide circle of friends, she has had a lot of difficulty accepting her diagnosis and at times feels angry and depressed. She has withdrawn from many of her friends and only sees those closest to her. Bill has asked the palliative team to discuss ongoing care options with his wife and daughter. Isabel didn’t want to go to hospital, so the best alternative is hospice-based care. Arrangements were made and Isabel was moved to a hospice within the week. Over the next two months, Isabel was cared for by a multidisciplinary team at the hospice. This included medical staff supporting Isabel with pain-relieving medication, nursing staff of which you are a part of are providing symptom management, comfort, hygiene, continence issues, skin integrity and mobility difficulties. Allied health staff helped with psychosocial comfort by providing massages and aromatherapy in order to reduce her anxiety and depression. Bill visits every day and Anna visits as often as she can, close friends also visit and assist Bill with food and his home care. All those who visit provide some aspects of care (such as feeding), reading to her or playing her favourite music. The past week has seen Isabel’s condition deteriorate. She doesn’t complain of pain a lot, however her facial expressions and non-verbal clues indicate pain. Isabel now has a syringe driver attached to a intima subcutaneous catheter system for continuous and intermittent pain relief (Appendix 3 for pain medication order) and she is now refusing food and fluids, she has a UTI that is not being treated by antibiotics. Anna is not happy about this and wants her mum to be given fluids and antibiotics. Isabel has an advanced Health Directive (Appendix 2) Isabel and Bill are both Roman catholic and since her diagnosis Isabel has increasingly turned to her church priest to help her understand what dying means and what happens when she dies. During this time in the hospice, you along with the multidisciplinary team provide and update Isabel’s care plan showing goals of care for emotional, spiritual and social symptom management to Isabel, this includes nursing interventions. In conjunction with the RN you have been assisting in creating and updating the care plan as required for Isabel’s care and in line with Isabel’s Advanced care directive. In the table below is a plan of care to address Isabel’s, emotional, educational, spiritual and social needs while in the hospice, provide at least one (1) nursing goal and one (1) nursing action you can implement to help Isabel reach these goals. Area of support At least one (1) nursing goal At least one (1) nursing actions / Intervention to achieve goals Social support Emotional Spiritual Education 2.You have been asked to conduct a symptom assessment on Isabel. Using the information from the scenario, complete the Symptom Assessment Scale (Appendix 1) developed by the Palliative Care Outcomes Collaboration (PCOC). 3.Document areas of concern you identify in the Symptom Assessment Scale. ……………………………………………………………………………………………………………………………………………. ……………………………………………………………………………………………………………………………………………. ……………………………………………………………………………………………………………………………………………. ……………………………………………………………………………………………………………………………………………. ……………………………………………………………………………………………………………………………………………. ……………………………………………………………………………………………………………………………………………. Before you progress with the following tasks and interventions, read the extract from Isabel’s advanced care directive (Appendix 2) and identify Isabel’s wishes. You will be demonstrating elements of these in the following requirements. Review the information regarding pain management in the scenario and in Isabel’s advanced care directive. 4.Identify two (2) nursing actions you can implement for ongoing pain management for Isabel. These may include pharmaceutical or non-pharmaceutical / complementary therapies. Demonstrate implementation for at least one intervention. ……………………………………………………………………………………………………………………………………………. ……………………………………………………………………………………………………………………………………………. ……………………………………………………………………………………………………………………………………………. ……………………………………………………………………………………………………………………………………………. ……………………………………………………………………………………………………………………………………………. ……………………………………………………………………………………………………………………………………………. 5.Identify and verbally explain three (3) ways you can help to support Isabel’s family during her time in the hospice. ……………………………………………………………………………………………………………………………………………. ……………………………………………………………………………………………………………………………………………. ……………………………………………………………………………………………………………………………………………. ……………………………………………………………………………………………………………………………………………. ……………………………………………………………………………………………………………………………………………. ……………………………………………………………………………………………………………………………………………. 6.Identify and verbally explain effective communication techniques you can use to provide the family / carers with opportunities to confirm spiritual and cultural issues. ……………………………………………………………………………………………………………………………………………. ……………………………………………………………………………………………………………………………………………. ……………………………………………………………………………………………………………………………………………. ……………………………………………………………………………………………………………………………………………. ……………………………………………………………………………………………………………………………………………. ……………………………………………………………………………………………………………………………………………. 7.Review the information in Isabel’s advanced care directive in regard to mental health and identify and verbally explain the end-of-life needs you may implement to help Isabel with her depression. ……………………………………………………………………………………………………………………………………………. ……………………………………………………………………………………………………………………………………………. ……………………………………………………………………………………………………………………………………………. ……………………………………………………………………………………………………………………………………………. ……………………………………………………………………………………………………………………………………………. ……………………………………………………………………………………………………………………………………………. In the last week prior to Isabel passing, she becomes increasing confused, the medical team diagnose her with delirium. 8.Review the information in Isabel’s advanced care directive in regard to mental health, identify and verbally explain the end-of-life needs you may implement to help Isabel with her delirium. ……………………………………………………………………………………………………………………………………………. ……………………………………………………………………………………………………………………………………………. ……………………………………………………………………………………………………………………………………………. ……………………………………………………………………………………………………………………………………………. ……………………………………………………………………………………………………………………………………………. ……………………………………………………………………………………………………………………………………………. Over the past 2 months you have been caring for Isabel at various times and monitoring her condition. As she begins to deteriorate Isabel, Bill and Anna wish to know what to expect. 9.Provide a report on what you would say to Isabel and her family in regard to the stages of dying. Progress Notes Facility: (Affix identification label here) URN: Family Name: Given Name: Address: D.O.B.: ☐ M ☐ F ☐ I Date & Time Changes you may notice and what you can do to help 10.Identifies signs and symptoms of the dying patient, reports these to the RN and verbally explain how you can ensure that Isabel’s wishes are implemented. ……………………………………………………………………………………………………………………………………………. ……………………………………………………………………………………………………………………………………………. ……………………………………………………………………………………………………………………………………………. ……………………………………………………………………………………………………………………………………………. ……………………………………………………………………………………………………………………………………………. ……………………………………………………………………………………………………………………………………………. Isabel requires nursing support during care activities, such as hygiene cares. 11.Identify three (3) nursing actions you can use to support Isabel’s dignity during these times. ……………………………………………………………………………………………………………………………………………. ……………………………………………………………………………………………………………………………………………. ……………………………………………………………………………………………………………………………………………. ……………………………………………………………………………………………………………………………………………. ……………………………………………………………………………………………………………………………………………. ……………………………………………………………………………………………………………………………………………. 12.Identify any legal / ethical issues that may potentially occur with Isabel’s deterioration and stages of dying and verbally explain to the RN how to respond to at least one issue. ……………………………………………………………………………………………………………………………………………. ……………………………………………………………………………………………………………………………………………. ……………………………………………………………………………………………………………………………………………. ……………………………………………………………………………………………………………………………………………. ……………………………………………………………………………………………………………………………………………. ……………………………………………………………………………………………………………………………………………. Sadly, Isabel passes away at the hospice surrounded by her family. While her husband and daughter were relieved that she was no longer in pain, they experienced overwhelming grief and loss at her death. Nursing staff assisted them in their bereavement process by offering psychosocial support and by facilitating empowerment, supporting them in the understanding that they contributed to a ‘good death’ for their loved one. 13.Identify and verbally explains the clinical signs and symptoms to establish that death has occurred for Isabel (the verification of death will be made by the relevant health professions, e.g. Medical practitioner) ……………………………………………………………………………………………………………………………………………. ……………………………………………………………………………………………………………………………………………. ……………………………………………………………………………………………………………………………………………. ……………………………………………………………………………………………………………………………………………. ……………………………………………………………………………………………………………………………………………. ……………………………………………………………………………………………………………………………………………. 14.After death has occurred and verified, identify and verbally explain at least three (3) ways you can provide care to the bereaved. ……………………………………………………………………………………………………………………………………………. ……………………………………………………………………………………………………………………………………………. ……………………………………………………………………………………………………………………………………………. ……………………………………………………………………………………………………………………………………………. ……………………………………………………………………………………………………………………………………………. ……………………………………………………………………………………………………………………………………………. 15.Demonstrate an example of the communication techniques you would use to guide patient and family / carers towards any required access to support services. ……………………………………………………………………………………………………………………………………………. ……………………………………………………………………………………………………………………………………………. ……………………………………………………………………………………………………………………………………………. ……………………………………………………………………………………………………………………………………………. ……………………………………………………………………………………………………………………………………………. ……………………………………………………………………………………………………………………………………………. 16.Identify and verbally explain how you can ensure that Isabel’s death care is respectful, dignified and that any cultural, customs, or religious / spiritual cares are met. ……………………………………………………………………………………………………………………………………………. ……………………………………………………………………………………………………………………………………………. ……………………………………………………………………………………………………………………………………………. ……………………………………………………………………………………………………………………………………………. ……………………………………………………………………………………………………………………………………………. ……………………………………………………………………………………………………………………………………………. 17.Identify and verbally explain at least four (4) ways you can care for Isabel’s body after death, including use of standard precautions. ……………………………………………………………………………………………………………………………………………. ……………………………………………………………………………………………………………………………………………. ……………………………………………………………………………………………………………………………………………. ……………………………………………………………………………………………………………………………………………. ……………………………………………………………………………………………………………………………………………. ……………………………………………………………………………………………………………………………………………. 18.Participate and contribute to a debriefing session once all other questions and demonstrations are completed for this scenario. You are to identify and reflect on your own needs for self-care You are to identify and verbally state how you would implement ways to maintain your social and emotional wellbeing. You are to verbally discuss ways yourself and your colleagues can access support and provide examples. Appendix 1 © PCOC UOW 2020 (Please complete or affix Label here) UPI: Surname First name: DOB: Symptom Assessment Scale Please use this form to ask the resident about the symptoms that bother, worry or distress them. This information will help us to meet their needs. 0 1 2 3 4 5 6 7 8 9 10 © TAFE Queensland Write the day or date in the first row. Use the scale above to choose a number between 0 and 10 that shows how bothered, worried or distressed the resident is. You can add other symptoms in the blank space at the bottom of the list. Suggested answers only Day or date Insert date Pain 9/10 Fatigue Suggested maybe around 7 -8 Breathing problems 1/10 Bowel problems 0/10 Nausea 4/10 Appetite 5/10 Difficulty sleeping 3/10 Other Scored by Resident (R), Staff (S), Family (F) Add up score Appendix 2 Extract from Isabel’s Advanced Health Directive Part 2b: Conditions of Appointment If you have appointed one or more Substitute Decision-Makers would you want them to make decisions together or separately? Please specify below: My husband is to make serious decisions about my health care. Part 3: What is important to me – my values and wishes When decisions are being made for me, I want people to consider the following: What is important to me: my family + friends are very important to me, and I would like them to receive all support necessary when I pass. I would like sacraments of Penance, Anointing of the Sick, and Holy Communion at the end of life. Outcomes I wish to avoid: If I have a mental health episode, I will prefer to be given treatment to ensure I’m comfortable and not in pain. If I am unable to recognise my family + friends + can’t communicate, I do not want any health care to prolong my life. My dying wishes: If I am dying, I want to be in a comfortable environment surrounded by my family and friends. I make the following binding refusal/s of particular health care: (If you are indicating refusal of health care, you must state when and in what circumstances it will apply as your refusal(s) must be followed, pursuant to section 19 of the Act, if relevant and applicable). If I have a terminal illness, I do not want any life sustaining treatment. Please just keep me comfortable and pain free until I die. I refuse any treatments aimed at sustaining or prolonging my life including. CPR Assisted ventilation. Artificial nutrition or hydration antibiotics Upon my death. I consent to giving any needed organs, tissues, or parts Appendix 3 © TAFE Queensland Observation Checklist (Single Observation) Instructions: Where there is multiple sub-points for an observation criteria and a student does not satisfactorily demonstrate all of the sub-points listed, please provide feedback to the student by identifying which of the sub-points were not demonstrated satisfactorily. This observation checklist will be incorporated into the stage 3 practical simulation workbook. Attempt 1 Attempt 2 Date __/__/__ Date __/__/__ During the demonstration of skills, did the student satisfactorily: Y N Y N Demonstrate nursing interventions for end-of-life stages for one person. Provides care plan for symptom management to show at least one (1) goal of care and one (1) nursing action for education, psychological and spiritual support for the patient. ☐ ☐ ☐ ☐ Conducts a symptom assessment and identifies areas of concern ☐ ☐ ☐ ☐ Documents areas of concern identify in the Symptom Assessment Scale. ☐ ☐ ☐ ☐ Identifies two (2) nursing actions to implement for ongoing pain management for Isabel. Demonstrates implementation for at least one intervention ☐ ☐ ☐ ☐ Identifies and verbally explains three (3) ways to support Isabel’s family during her time in the hospice. ☐ ☐ ☐ ☐ Identifies and verbally explains effective communication techniques to use to provide the family / carers with opportunities to confirm spiritual and cultural issues. ☐ ☐ ☐ ☐ Reviews the information in Isabel’s advanced care directive in regard to mental health, identifies and verbally explains the end-of-life needs to help Isabel with her depression. ☐ ☐ ☐ ☐ Review the information in Isabel’s advanced care directive in regard to mental health, identifies and verbally explains the end-of-life needs to help Isabel with her delirium. ☐ ☐ ☐ ☐ Provide a report on what to say to Isabel and her family in regard to the stages of dying. ☐ ☐ ☐ ☐ Identifies signs and symptoms of the dying patient, reports these to the RN and verbally explains how you can ensure that Isabel’s wishes are implemented. ☐ ☐ ☐ ☐ Identifies three (3) nursing actions you can use to support Isabel’s dignity during these times. ☐ ☐ ☐ ☐ Identifies any legal / ethical issues that may potentially occur with Isabel’s deterioration and stages of dying and verbally explains to the RN how to respond to at least one issue. ☐ ☐ ☐ ☐ Identifies and verbally explains the clinical signs and symptoms to establish that death has occurred for Isabel. ☐ ☐ ☐ ☐ After death has occurred and verified, identifies and verbally explains at least three (3) ways to provide care to the bereaved. ☐ ☐ ☐ ☐ Demonstrates an example of the communication techniques used to guide patient and family / carers towards any required access to support services. ☐ ☐ ☐ ☐ Identifies and verbally explains how to ensure that Isabel’s death care is respectful, dignified and that any cultural, customs, or religious / spiritual cares are met. ☐ ☐ ☐ ☐ Identifies and verbally explains at least four (4) ways to care for Isabel’s body after death, including use of standard precautions. ☐ ☐ ☐ ☐ Participates and contributes to a debriefing session once all other questions and demonstrations are completed for this scenario. identifies and reflects on own needs for self-care identifies and verbally states how to implement ways to maintain own social and emotional wellbeing. verbally discusses ways self and colleagues can access support and provide examples. ☐ ☐ ☐ ☐ Based on the criteria demonstrated above, the student performance was: S U S U ☐ ☐ ☐ ☐ Feedback on Performance References Assessment forms https://www.uow.edu.au/ahsri/pcoc/palliative-care/assessment-forms/#:~:text=The%20PCOC%20Symptom%20Assessment%20Scale,manage%20what%20matters%20to%20patients.

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