Julia and Lucy debrief complete parts 1_2_3.

Julia and Lucy debrief complete parts 1_2_3. Julia Morales and Lucy Grey, Part 1 Guided Reflection Questions Opening Questions How did the simulated experience of Julia Morales and Lucy Grey’s case make you feel? I felt sad for Julia and her family, but understood Julia’s decision. I would have made the same choice if I was her. It was hard to watch her son try to talk her out of it. Lucy is a supportive partner and I could tell that she would miss her greatly but put Julias needs before her own. What nursing actions did you feel were appropriate within this scenario? As a hospice nurse, it was my duty to come out to the house and assess Julia to obtain a baseline of vitals and a head to toe assessment. Doing this allows the nurse to be aware of any changes that may occur. It was important to teach Julia and Lucy about her medications for pain, how to administer it and how often since Lucy would be administering the medication. It is important to have Lucy explain back to me that she understood the teaching about all meds. For example knowing how to properly apply the fentanyl patch, rotating sites every s days. I would assess the house for safety and make sure that a bedside commode would be delievered to the home as they stated its hard for Julia to make her way to the restroom and Lucy is unable to lift her on and off the toilet. I would then explain that we are there to keep Julia comfortable, and give support to her and her family. Scenario Analysis Questions* PCC What priority problem(s) did you identify for Julia Morales and Lucy Grey? Lucy stated that she is unable to assist Julia on/off the toilet, this presents a safety issue so it was decided that Julia would require a bedside commode to keep next to the bed. It is important to make sure that Julia is having regular bowel movements since the morphine can cause constipation, she is taking Colace as well to help with this. PCC/ What teaching measures and what other members of the health care team should be included T&C/I in the home health nurse visit for Julia Morales and Lucy Grey? Julia will need a CNA to come and assist with bathing so Lucy does not have to struggle with doing that on her own. The family and Julia will need a strong support system to assist them in navigating through this difficult time, especially when death draws near. It may also benefit them to have a chaplain from their church come and talk to them and offer spiritual support. PCC What potential barriers might Julia Morales and Lucy Grey encounter that would hinder active participation in Julia’s care? The one barrier was safety getting Julia to and from the bathroom and this was remedy by getting the patient a bedside commode. Lucy may have a difficult time taking on the role of fulltime caretaker so it may benefit her to have some time out of the house, having Julia’s son, friend of the family or one of the hospice staff to sit with Julia during that time. We need to take care of Lucy and assist with support. PCC/I What appropriate assessments were made to help you decide what interventions Julia Morales and Lucy Grey needed? The home assessment helped a great deal to make sure that we supplied all the necessary equipment to take care of the patient. Also, assessing Lucy’s ability to take care of Julia is important as I have mentioned above. During this time the patient should be comfortable, fed and hydrated, on top of managing pain and supplying oxygen. PCC/I What appropriate strategies could be implemented to empower Julia Morales and Lucy Grey in the management of Julia’s care? I believe just offering them support and encouragement will be a great tool that will allow them to accept the changes and give them the time they will need to be together. Im glad that Julia is going to be at home with family for her final moments. EBP What potential problems does Julia Morales face if the symptoms of her disease progression are not recognized and if actions are not initiated in a timely manner? The most important things to notice in order to keep Julia comfortable is maintaining her oxygen levels so that breathing will not be as hard, and keeping her pain under control. T&C/I What is the role of the home health/hospice interprofessional team, and what is the importance of teamwork and collaboration in the case of Julia Morales and Lucy Grey? The role of home health/hospice is to provide Julia with pain medication so that she is comfortable. They are also involved with the family’s well being offering support and referring them to resources to help them with coping both while Julia is alive and after her death. What potential environmental/safety hazards need to be assessed in the home care setting? It is important to assess all areas of the home for walking hazards like extension cords in the walkway, it is also important to check the bathroom and for grab bars, non-slick tubs or showers and a over the commode toilet that can also be a bedside commode when Julia is not able to walk to the bathroom. Keep all walkways well lit and make sure nothing is on the floor, including throw rugs as they can be a fall hazard. Providing Julia with a walker to ambulate is also important to reduce the risk of a fall. Concluding Questions Reflecting on Julia Morales and Lucy Grey’s case, were there any actions you would do differently? If so, what were these actions, and why would you have done them differently? I would have liked to have been able to have a more in depth conversation with the patient and family to really understand the needs that are unique to them. In a real life situation, I would be sure to let the patient and the family tell me any fears or concerns they have about hospice. The sim just tells them they will address their concerns with the interdisciplinary team and get back to them, but I was not able to hear the results of the what was decided. How would you apply the knowledge and skills that you obtained in the case of Julia Morales and Lucy Grey to an actual patient care situation? This case is helpful in teaching how to be supportive to both the patient and the family. We are no longer trying to improve health, we are there to provide the patient and her loved ones with physical and physicologal support during this time. Julia Morales and Lucy Grey, Part 2 Guided Reflection Questions Opening Questions How did the integration of Julia Morales’s dying in this simulated experience make you feel? I appreciated having this part of the sim, I couldn’t help but feel relieved for the patient that she was no longer in pain. At the same time, my heart went out to Lucy and Neil. I’m glad that it allowed me to see all the parts and calling the MD and funeral home and supporting the family. What nursing actions did you feel were appropriate within this scenario? I was called out to the home by Lucy to check on her because the family stated that her breathing was abnormal. Upon arriving to the home, I washed my hands, identified the patient and assessed her vital signs, especially respirations. It was too soon to give another dose of pain medication, patient appeared comfortable with abnormal respirations that even had some delay between breaths which is completely normal at this stage of actively dying. After checking the patients vital signs, I was then able to assess her heart sounds, and assess the general appearance of her skin that may indicate if death is imminent. Scenario Analysis Questions* PCC What priority problem(s) did you identify for Julia Morales and Lucy Grey? Julia’s respirations of 8 and become increasing labored with apnea noted at times. Lucy needed support and for me to explain Julia’s condition honestly. It appeared that Julia was at the end of her life upon intial assessment. Julia and Lucy had been partners for a long time, so it was important to be present for her and Julia’s son to answer any questions and comfort them. While offering education and support to the family, the patients her partner noticed that she appears to not be breathing . I reassessed the patients pulses, respirations and heart sound and found no signs of life. I checked again after 5 mins there no pulses, respirations or heart sounds. The patient was pronounced at this time. PCC/I What is the importance of therapeutic communication during the dying process and postmortem care? It is very important to use therapeutic communication during the dying process, the family want and needs honestly to understand what to expect. It is always a good idea to ask the family if they would like to participate in the postmortem care, it can be therapeutic for some to spend that time with their family member doing that one last thing for them. Some family members will decline and want the staff to do it, which is fine but allow them to sit in the room while its done. PCC What potential barriers might affect Julia Morales’s wish to die peacefully? If the patient is experiencing pain that would cause her to possibly not have a peaceful death. Administering the pain medication routinely will keep the pain down and allow the patient comfort. They will most likely not be alert enough to request medication. It can upset the family if they believe their loved one is in pain. I do agree with having the family to continue to talk to the patient and have conversations related to the actual imminent death out of the ear shot of the patient. PCC/I What strategies might empower Lucy Grey in making decisions about Julia Morales’s end-of- life care? As the nurse we need to support the family and let them be as much a part of it as they want to be. Being able to care for Julia at home and spend her last moments by her side can be therapeutic to family members. Making Lucy feel just as important as the patient is essential as we are also there to support her as much as the patient. What can the health care team members caring for Julia Morales do to cope with their grief over the patient’s death? Everyone griefs in different ways. I think that it is good to talk about it either to the social worker or amongst the team to get some closure. It is okay to cry, I believe listening to people get there feelings out is sometimes the best way to cope. T&C What is the role of the home health/hospice nurse and interprofessional team after Julia Morales’s death? The healthcare team is responsible for notifying the doctor, preparing the body and calling the funeral home. It is also important to support the family and help them with anything they may need, and most importantly to just be there. Complete the situation-background-assessment-recommendation (SBAR) technique form below to communicate with the primary care provider? What measures can ensure Lucy Grey’s safety after Julia Morales’s death? It would be a good idea to have family and hospice staff check on her frequently. It would also be beneficial to recommend a bereavement support group. Concluding Questions Reflecting on Julia Morales and Lucy Grey’s case, were there any actions you would do differently? If so, what were these actions, and why would you do them differently? I would have liked the sim to continue with the funeral homes arrival to show how that process is handled properly with the family involved. How would you apply the knowledge and skills that you obtained in Julia Morales and Lucy Grey’s case to an actual patient care situation? This part of the case was helpful in dealing with the process of what happens immediately after death, calling the provider and the funeral home. As well as being comfortive and supportive to the family and helping any way you are able. Julia Morales and Lucy Grey, Part 3 Debriefing Guide Opening Questions How did the simulated experience in Lucy Grey’s case make you feel? It was sad to see how much Lucy’s health had declined since Julia died. What nursing actions did you feel were appropriate within this scenario? This was one of several times that Lucy had shown up in the ER from a fall, I would complete an assessment and ask her questions about how she felt just before she fell and what had she been doing. It was noted that she became dizzy when standing up, I would assess orthostatic blood pressure reading’s. she also had a bandage on her arm and indicated she scrapped it. I would remove the bandage and cleanse and assess the area and recover with a clean dressing. I also found it affective to discuss with Lucy how she has been since Julia died, it was clear that she was depressed. The social worker would be notified to help Lucy find a bereavement group. She is also not eating well. The recommendation for meals on wheels was helpful. I believe it may also benefit Lucy to have home health come check on her a couple times a week, as well as Neil, Julia’s son to call her daily. Scenario Analysis Questions* PCC/S What priority problem(s) did you identify for Lucy Grey? Lucy was experiencing orthostatic hypotension, which was most likely the cause of her falls. She was also suffering with depression which probably caused her not to eat as well. She also has a bandage on her arm. To address the orthostatic hypotension I would explain to Lucy how to get up from a sitting position slowly, dangling her legs before standing. I would then assess the scrap on her arm, cleanse and rebandage and explain Lucy and Neil the proper care of the area daily. I would discuss support groups with Lucy and other community services to help her during this difficult time, and notify the social worker to follow up. PCC How might the death of a spouse or significant other impact the biological and psychological well-being of the surviving partner? When we think of griefing our first thought would not be "Fight or Flight" response causing an increase in adrenaline, but as Dr. Elizabeth Harper Neeld reports in her article "Physical Stress of grieving", the loss of a loved one can provoke this type of panic. This can cause anxiety and fear. This causes stress in the body as well as anxiety which affects the mind. Fear is also continues to put your body in this fight or flight continuously cycle, This can cause your body to become physically exhausted as well as contribute to depression. It is probably frightening to have to go on with the person you have spent most of your life with. Being unsure of what to do or how to live by yourself can induce extreme fear, anxiety and depression. Lucy’s stated she was having anxiety and fear when alone, which she stated she never had before. Lucy appears to be suffering from all three anxiety, fear and depression and these are ultimately causing stress which can contribute to her health declining more rapidly. Resources to consult for more information: • (Biological and physiological effects after the death of a spouse) • Utz, R., Caserta, M., & Lund, D. (2012). Grief, depressive symptoms, and physical health among recently bereaved spouses. Gerontologist, 52(4), 460-471. PCC What strategies could be implemented to address physical and psychosocial problems associated with Lucy Grey’s ineffective coping skills in the loss of Julia Morales? Lucy would benefit from attending a bereavement support group as well as talking to a counselor or social worker individually. Neil calling daily will also be a comfort to her, it should give her something to look forward to. Physically, Lucy may benefit from the use of a walker since her gait is weak and she has had multiple falls. She also needs to get proper nutrition, so the meals on wheels suggestion in the sim would be very beneficial to make sure she was getting at least one full meal a day. EBP What potential problems does Lucy Grey face if her symptoms are not recognized and if actions are not initiated in a timely manner? Lucy could suffer from a serious injury from her falls, her safety in her home needs to be addressed. She also runs the risk of becoming dehydrated and malnourished if she does not start eating better even if its just an ensure and a small snack and schedule for the meals on wheels to provide her with a hot meal daily. Lucy’s depression and grief will take some time to pass, but she may benefit from moving into an assisted living facility to get more help. PCC/I What appropriate assessments were made to help you decide what interventions Lucy Grey needed? Lucy’s gait was assessed, it was also noted that she is having episodes of orthostatic hypotension which can cause more falls, she should monitor her blood pressures and was educated on how to rise from a sitting position safely. She is definetly showing signs of depression and the provider was notified and will be addressing. The scrape on her arm was assessed, cleansed and dried with a new dressing applied. The wound on her arm needs to cleansed and redressed daily to prevent infection. Lucy and Neal were educated on proper care of area. S What safety measures should Lucy Grey and Neal take to decrease Lucy’s risk for injuring herself from a fall in the future? It will be a good idea to assess Lucy’s house for safety hazards, making sure there are no throw rugs, walkways are clear of clutter. She also needs to be mindful of her blood pressure. She would probably benefit from the use of a walker help with balance. Lucy would also benefit from a life alert bracelet/necklace in case she was alone again and had a fall she would be able to get help right away. Neal will be calling daily to check in on Lucy. Concluding Questions Reflecting on Lucy Grey’s case, were there any actions you would do differently? If so, what were these actions, and why would you do them differently? I wish that I would have been able to ask Lucy questions that would allow her to go into more depth to get a better understanding of all the problems that she may be having. I know that in the sim she is adamant about going back home, but I would have liked to explore the idea of an assisted living facilty. It would provide her the help she requires, cook 3 meals a day for her and she would be around other people her age to form friendships. I believe being alone all the time may be adding to her grief/depression and socializing may give her the sense of belonging again. How would you apply the knowledge and skills that you obtained in Lucy Grey’s case to an actual patient care situation? This was helpful to see the whole picture from being there for the family through the loss and also seeing the after effects months later and how the spouse/partner is deeply affected. Often times I only get to see the family when I am taking care of their loved one in the hospital and don’t have the opportunity to follow up. This sim helped me to see even after the death the family is still affected and requires continuous support throughout the stages of grief.