Mental Health Case: Sandra Littlefield
Guided Reflection Questions
Opening Questions
How did the simulated experience of Sandra Littlefield’s case make you feel?
This simulation was frustrating. Sometimes I did not pick the most therapeutic response to her
interjections. It is hard to hold firm boundaries with the patient and not be drawn into her splitting
behavior. It was dicciult to do an assessment and teach coping strategies when the patient would always
go refers back to her physical pain.
Talk about what went well in the scenario.
I think I did well in trying to focus on when the patient felt her best and when to educate on
medication management and coping strategies.
Reflecting on Sandra Littlefield’s case, were there any actions you would do differently? If so, what
were these actions and why?
In my initial attempt, I forgot to complete an updated vitals assessment. I did the observation
assessments in order to complete the mental status examination. This is important to complete to watch
for changes and objective signs of pain.
Scenario Analysis Questions*
PCC/S What should be the nurse’s priority when caring for Sandra Littlefield?
The nurses priority when caring for Sandra Littlefield is safety. The nurse should be concerned
with Sandra’s safety as people with BPD struggle with mood, self-esteem, and impulse control. The nurse
should also assess for her safety as well as the other staff’s safety. The patient has a history of aggressive
behavior durin past incarcerations.
What action should be initiated to maintain personal safety?
To maintain personal safety, the nurse should assess the scene upon arrival and before entering.
In prisons, the nurse could also make sure a guard is near to assist if need be. For psychiatric patients,
the nurse should keep the door open and have an exit available as well as maintain the patient’s leg
distance away. In addition, avoid turning her back on the patient.
If the nurse did not recognize the importance of personal safety, what could be the
consequence?
If the nurse does not recognize the importance to personal safety, the nurse could be harmed by
the patient. The patient could then also try to harm others or themselves.
From vSim for Nursing | Mental Health. © Wolters Kluwer.
Guided Reflection Questions
Opening Questions
How did the simulated experience of Sandra Littlefield’s case make you feel?
This simulation was frustrating. Sometimes I did not pick the most therapeutic response to her
interjections. It is hard to hold firm boundaries with the patient and not be drawn into her splitting
behavior. It was dicciult to do an assessment and teach coping strategies when the patient would always
go refers back to her physical pain.
Talk about what went well in the scenario.
I think I did well in trying to focus on when the patient felt her best and when to educate on
medication management and coping strategies.
Reflecting on Sandra Littlefield’s case, were there any actions you would do differently? If so, what
were these actions and why?
In my initial attempt, I forgot to complete an updated vitals assessment. I did the observation
assessments in order to complete the mental status examination. This is important to complete to watch
for changes and objective signs of pain.
Scenario Analysis Questions*
PCC/S What should be the nurse’s priority when caring for Sandra Littlefield?
The nurses priority when caring for Sandra Littlefield is safety. The nurse should be concerned
with Sandra’s safety as people with BPD struggle with mood, self-esteem, and impulse control. The nurse
should also assess for her safety as well as the other staff’s safety. The patient has a history of aggressive
behavior durin past incarcerations.
What action should be initiated to maintain personal safety?
To maintain personal safety, the nurse should assess the scene upon arrival and before entering.
In prisons, the nurse could also make sure a guard is near to assist if need be. For psychiatric patients,
the nurse should keep the door open and have an exit available as well as maintain the patient’s leg
distance away. In addition, avoid turning her back on the patient.
If the nurse did not recognize the importance of personal safety, what could be the
consequence?
If the nurse does not recognize the importance to personal safety, the nurse could be harmed by
the patient. The patient could then also try to harm others or themselves.
From vSim for Nursing | Mental Health. © Wolters Kluwer.
