Simulation Scenario Mood/Affect: Adolescent Depression Overview Title: Adolescent Depression Concept: Mood-Affect To cite this reference Target Group: Second Year Nursing Students Jorgensen, K. & Luken, R. (2012). Simulation scenario; Mood/affect: Adolescent depression. Unpublished manuscript., University of South Dakota at Vermillion.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: 15-20 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: An adolescent is admitted to an inpatient adolescent psychiatric unit after an attempted overdose of Ambien. She is currently living with her father after her mother was killed in a motor vehicle accident.
Mood/Affect: Adolescent Depression 2 AACN Essentials: VII, VIII, IX Curriculum Alignment Population: Adolescent female Concepts Mood-Affect Violence Exemplar Depression Suicide Knowledge Skills Attitudes Objectives and Outcomes Area Scenario Objectives Course Outcomes Student will demonstrate an understanding of coping strategies used by adults and adolescents. Student will complete an assessment focusing on identification of suicide risk and prevention. Student will utilize a minimum of two therapeutic communication techniques. 4.3 1.1, 1.2, 2.2, 5.1 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 book to simulation. The following prep should be completed prior to attending as well. Adolescent Depression_Student Prep 4.1
Simulation Setup Mood/Affect: Adolescent Depression 3 No Simulation Setup
Mood/Affect: Adolescent Depression 4 Patient Demographics Last Name: Grey Patient Background First Name: Erin Gender: Female Age: 15 Ht: 5 4 Wt: 55.4 kg Ethnicity: Caucasian Religion: No preference Language: English English Proficiency: Strong Other: Immunizations up-to-date. Father guardian and major support system. Mother killed in MVA one year ago. History of present illness: 15-year old female patient on day two of inpatient adolescent unit admission. Patient is two days post intentional overdose on 15 Ambien 10 mg tablets. The pills were prescribed to father. Patient refuses to discuss the overdose and has asked to be discharged several times. Primary Medical Diagnosis: Major Depressive Disorder without psychotic features Central nervous system Cardiovascular Pulmonary Renal/Hepatic Gastrointestinal Musculoskeletal Integument Developmental history Psychological history Social history Minor facial acne Depression lasting one year related to mother s death in a MVA. Admits to smoking occasionally. Drinks 2-3 beers socially. Admits to smoking marijuana a few times. Surgical/Procedure History Medication allergies NKDA Reaction: Food/other allergies NKA Reaction: Home Medications Fluoxetine (Prozac) 20 mg po daily
Prebriefing 1. Describe the presentation of depression. 2. Discuss the risk factors for depression in adolescents. 3. Discuss the treatment options for depression. 4. Identify topics that should be included in patient education. 5. Describe how you think the patient may be presented to you during this simulation. 6. Explain how you might communicate and care for this patient. 7. Any questions? Mood/Affect: Adolescent Depression 5 The above items are listed to assist faculty in leading a prebriefing discussion with students. Feel free to use some or all items depending on the needs of the student group.
Scenario Mood/Affect: Adolescent Depression 6 Change of shift report to students (if applicable): I am reporting on Erin Grey, 15 years old, admitted to inpatient adolescent unit last night after being found unresponsive on the bathroom floor by her father. In the ED it was determined the patient had ingested 15 Ambien pills (10 mg/pill). Patient reports that she took her father s sleeping pills because she wanted to go to sleep and not wake up. Patient refuses to answer questions about suicide. Patient lives with father. Mother deceased in single car MVA 1 year ago. Patient has no pertinent medical history and reports no known drug allergies. Father reports that patient was seeing a counselor after her mother s death but has refused to go to sessions for the past six months. Patient is awake but drowsy and lethargic. Suicide precautions are ordered and being maintained. Patient oriented x3. She denies pain. Patient complains of nausea. No vomiting noticed. She states that she is angry and does not want to talk about the pills or her feelings. Patient is currently stable and respiratory status is uncompromised. Skin is pink, warm, and dry. Labs and ECG done last evening on admission were within normal limits but the patient was too upset to complete the Beck Inventory last evening so please do that this morning while you are doing your shift assessment. Timing Patient/Nurse actions live faculty Expected interventions May use the following cues: 15 minutes Erin sitting at a table, leaning back in chair, and appearing drowsy. Erin states, I m not going to answer any more questions. Erin is very guarded during first few minutes of interview but gradually begins to open up about her feelings of anger, frustration, and sadness after losing her mother. Nurse introduces self. Identifies patient. Nurse explains that they will complete a head-totoe assessment and complete the Beck s Depression Scale. Uses therapeutic communication skills. Identify suicidal ideation. Role member providing cue: Erin can ask nurse, Aren t you going to check if I m still alive? sarcastically if nurse does not complete a head-to-toe assessment.
Mood/Affect: Adolescent Depression 7 5 minutes Secondary nurse enters and rudely states, You need to go to the anger management group right now. You re late! Erin angrily states, I don t feel like sitting in another stupid therapy session! I want to get the hell out of here! Secondary nurse responds angrily, Sounds and looks to me like you have anger management problems. This isn t a vacation and you aren t given choices. Primary nurse shows professionalism when dealing with secondary nurse. Primary nurse uses therapeutic communication skills to decompress the situation. Erin and the secondary nurse can continue to escalate situation if primary nurse does not attempt to defuse the situation.
Mood/Affect: Adolescent Depression 8 Debriefing Debriefing / Guided Reflection Questions for this Simulation: How does everyone feel right now? 1. How did you feel throughout the simulation experience? 2. Describe the objectives you were able to achieve? 3. Which ones were you unable to achieve (if any)? 4. Did you have the knowledge, skills, and attitude to meet the objectives? 5. Were you satisfied with your ability to work through the simulation? 6. To Observer: Could the nurses have handled any aspects of the simulation differently? 7. If you were able to do this again, how would you have handled the situation differently? 8. What did the group do well? 9. What did the team feel was the primary nursing diagnosis? 10. What were the key assessments and interventions? 11. Is there anything else you would like to discuss? The above items are listed to assist faculty in leading a debriefing discussion with students. Feel free to use some or all items depending on the needs of the student group.
Mood/Affect: Adolescent Depression 9 Supporting Documents Forms Patient Chart Information/Forms http://www.cawt.com/site/11/documents/members/evaluation/beckdepres sioninventory1.pdf Adolescent Depression_Chart Script/Roles Provide both patient and secondary nurse with a copy of the scenario. No script required for primary nurse. Recommendations For Online Use This simulation could be performed in the mobile simulation unit and streamed to distance students. Students at a distance could participate in the pre-briefing and debriefing sessions using webinar.