University of South Dakota Vermillion, South Dakota Department of Nursing. Simulation Scenario Communication: Professional & Inappropriate Behavior

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1 Title: To cite this reference Simulation Scenario Communication: Professional & Inappropriate Behavior Overview Professional & Target Group: First Year Concept: Communication Inappropriate Behavior Nursing Students Dreke, C. (2012). Simulation scenario; Communication: Professional & inappropriate behavior. Unpublished manuscript., at Vermillion. Time Allotment (each simulation is designed to be run in a two hour block of time which equals four clinical hours): Prep: Campus specific (see preparation requirements). Prebriefing: Campus specific (first year students should be longer than second year students according to evidence-based practice [EBP] standards). Simulation: minutes (no longer than 30 minutes). Debriefing: Campus specific (first year students shorter than second year students according to EBP standards). If the simulation episode runs less than two hours faculty should consider running the simulation again, creating concept maps, creating teaching plans, performing webquests, or implementing other activities that would be beneficial to the students' learning. DocuCare Information: The student is assigned to care for a 65-year-old female patient who has HTN, Hypercholesterolemia, and an open lesion on her left leg (or arm). The patient is on a medical unit. The patient is sitting on her bed when the student enters her room following AM report. In order to show what not to do in clinical two faculty members would be needed for the scenario. One would play the patient and one would play the nurse/student.

2 Communication: Professional & Inappropriate Behavior 2 AACN Essentials: VIII Curriculum Alignment Population: Adult Caucasian female patient Concepts Exemplar Communication Interpersonal Relationships Knowledge Objectives and Outcomes Area Scenario Objectives Course Outcomes Recognize violations of HIPAA and possible consequences of these actions. Differentiate between professional and unprofessional communication. 3.1 Skills Attitudes Identify professional and unprofessional behaviors. Values the importance of effective interprofessional communication during the delivery of safe patient care Student Preparation Prerequisite assignment (the following information should be sent to the students prior to the scheduled simulation). Students are expected to bring their laptop, drug book, and primary text. Complete the (Professional Behavior_Student Prep) document.

3 Communication: Professional & Inappropriate Behavior 3 Simulation Setup Manikin Settings: (If using Initial Vital Signs Manikin): Pulse: 94 Blood pressure: 180/110 Pulse ox: 92% Respiratory rate: 22 Temperature: 98.7 Cardiac rhythm: Sinus rhythm Lung sounds: Clear Bowel sounds: Normal Other: Change in Vital Signs How many minutes until change? Pulse: Blood pressure: Pulse ox: Respiratory rate: Temperature: Cardiac rhythm: Lung Sounds: Other: Equipment List Hospital bed Computer Stethoscope Saline lock to right arm None Scenario Setting: Setting: Inpatient Time of day of scenario: 0800 Patient Condition Clothing: Patient gown Props: Moulage: Meal tray Cell phone Hospital dining menu Wound to lower leg or arm Roles for Students Observers for 1 st portion of the simulation What not to do in Clinical When running scenario correctly: Primary nurse Secondary nurse Observer Recording nurse Medication nurse Documents MAR Medication Dosage Route Hydralazine 20 mg/2ml IV (small vial) Dose: 10 mg Norvasc 10 mg tablet PO Zocor 20 mg tablet PO Bacitracin Ointment 1 application Topical Concentration Package

4 Communication: Professional & Inappropriate Behavior 4 Patient Demographics Last Name: Smith Patient Background First Name: Pat Gender: Female Age: 65 DOB: 4/7/XX Ht: 5 4 Wt: 135 lbs Ethnicity: Caucasian Religion: Lutheran Language: English English Proficiency: Yes Other: History of present illness: Wound to extremity for 4 days. Primary Medical Diagnosis: Extremity wound Central nervous system Cardiovascular Pulmonary Renal/Hepatic Gastrointestinal Musculoskeletal Integument Developmental history Psychological history Social history Alternative/ Complementary Hypertension, Hypercholesterolemia Open wound to arm or leg Medication allergies NKA Reaction: Food/other allergies Reaction:

5 Communication: Professional & Inappropriate Behavior 5 Prebriefing Give students the opportunity to discuss their feelings and fears (can use the round table approach) and then have discussion. Divide students into pairs or small groups and discuss examples of the different forms of therapeutic communication (i.e. using silence, accepting, etc.). 1. Discuss the student prep (worksheet, journal articles, readings, etc.). a. Can discuss each of the questions on the prep. 2. Can discuss topics related to lecture of communication. 3. Discuss professional communication. 4. Discuss SBAR. 5. If this is the student s first simulation, provide them with an orientation to the room, where supplies are located, etc. 6. Any questions? The above items are listed to assist faculty in leading a prebriefing discussion with students. Feel free to use all or some of the above items depending on the needs of the student group.

6 Communication: Professional & Inappropriate Behavior 6 Scenario Change of shift report to students (if applicable): Pat Smith is a 65-year old female patient who was admitted with an open lesion to her extremity (arm or leg). She has a history of HTN and Hypercholesterolemia. She is up ad lib in her room. She has a saline lock to her right forearm. (Have one faculty give report while the faculty member who is receiving report does not listen). Timing Patient actions live faculty Expected interventions May use the following cues: 5-7 Minutes Patient is sitting up on the edge of the bed, waiting for her breakfast tray. 5-7 Minutes Patient: Fine. I slept all night for a change. What s your name and what are you here for? (look worried when the student starts talking and doesn t indicate what she is there for or what her name is). Patient: Looks really confused and wonders why she is being offered such strange items for breakfast. (looking at a hospital dining menu). Student (Faculty): Good mornin to ya honey! How you feeling on this fine day? Student (Faculty): Anything I can get for you- like a beer or even some pretzels! Student nurse enters room, chewing gum, swinging her stethoscope around her arm and has her cell phone readily available in case of an important call. She is wearing a low cut top with tight pants and sandals. Student is getting really close to the patient and this makes the patient uncomfortable. Student is laughing but doesn t seem to realize that her behavior is making the patient uncomfortable.

7 Communication: Professional & Inappropriate Behavior Minutes Patient: Maybe but I have high cholesterol and high blood pressure. I don t think beer and pretzels are on my diet. Patient: Well, no, but did you look at my chart? I thought the nurses were supposed to know what was wrong with their patient. How can you take care of me if you don t know what my problems are? Patient: That sounds a little odd but should you be telling me all this? Student (Faculty): Oh, I m just kidding. Just trying to liven things up a bit around here. This place is really dull, if you know what I mean! Student (Faculty): Oh really! Is that why you have that awful sore on your leg? It looks yucky! Student (Faculty): Oh, Honey, I have just been so busy lately. I m getting married in a few weeks, ya know! So much on my mind. That fiancé of mine, he s no help at all and my mother I think she ll end up in the looney hospital before this is over. My future mother-inlaw is worse. Why she actually wants me to tell her where we are going on our honeymoon. Imagine the nerve! Student (Faculty): Well sure, why not? Just trying Breakfast tray is delivered to the room. Student gives it to the patient without checking name or looking to see what kind of diet is being given to the patient.

8 Communication: Professional & Inappropriate Behavior 8 Patient: Well, I don t really remember. I was married a long time ago. Patient: Well, I don t know about that but could you do me a big favor? Patient: Well, you know my neighbor, Bob Knight, he was admitted here last night. I saw his wife. Can you find out why he is in here? If it wouldn t be too much trouble. to get better acquainted. And letting you know why I didn t get all the information I need. Just too busy, staying up late and all. You know how it is! Student (Faculty): Couldn t be that long ago. You look really great for someone your age. Student: Sure, anything Student (Faculty): Why sure, what could it hurt? Oh, but just a minute let me take this call. It might be important. It s from my honey. Student is yawning and making no effort to cover this up. She has moved to the patient s bed and is sitting quite close to the patient. Cell phone rings and student talks on the phone about the wild night of partying last night and how tired she is. Conversation ends with, I gotta go, can t wait until tonight. Patient just waits until the conversation is finished.

9 Communication: Professional & Inappropriate Behavior 9 Patient: I won t tell anyone. Patient: Wait til that story gets around the neighborhood. Why sure, I ll just pull him up here on the computer. Oh my, looks like he doesn t want any information released red lined- you know. Oh well, just promise me you won t tell anyone where you got this information. Student (Faculty): Well it looks like he and his wife got in a fight and he ended up having surgery on his jaw.

10 Communication: Professional & Inappropriate Behavior 10 Debriefing Start by asking students about their feelings/thoughts related to the experience. It is okay to let the students lead the discussion at first. Utilize the questions below at your discretion. Debriefing / Guided Reflection Questions for this Simulation: For scenario What not to do in Clinical : 1. What do you think was wrong in the scenario? 2. What were the violations of HIPAA? How should the student have responded to the request for information on the patient s neighbor? 3. What information was appropriate for the nursing student to share about herself? What s wrong with disclosing too much personal information? 4. What are some examples of unprofessional language? Why is this offensive to some patients? 5. What made the student s appearance unprofessional? 6. What other unprofessional behaviors did the student demonstrate? 7. How would you evaluate this student? Student demonstration of correct professional behavior for the nurse 1. How did you feel throughout the simulation experience? a. Emotions (are students angry, happy, confused, etc.) 2. Discuss what things are on student s minds. 3. Were you satisfied with your ability to work through the simulation? 4. Was the audience able to tell a difference when the student used professional communication with the patient versus unprofessional communication? a. If so what was the difference? 5. How can professional communication impact patient care?

11 Communication: Professional & Inappropriate Behavior 11 a. Positively b. Negatively 6. To Observer: Was there anything the nurse could have done differently in the simulation? 7. If you were to do this again, how would you handle the situation differently? 8. What did the group do well? The above items are listed to assist faculty in leading a debriefing discussion with students. Feel free to use all or some of the above items depending on the needs of the student group.

12 Communication: Professional & Inappropriate Behavior 12 Supporting Documents Forms Patient Chart Information/Forms Professional Behavior_Chart Scripts/Roles None Recommendations For Online Use This simulation could be performed in the mobile simulation unit and streamed to distance students. Students at a distance could then participate in the pre-briefing and debriefing sessions using webinar.