Student Instructions for i-Human Virtual Simulation

NR325/NR330 Maggie Naganashe Scenario 2

PURPOSE:

The following information is to be used in guiding your preparation and participation in the virtual simulation scenario for this course. This document will provide applicable course outcomes in preparation for your simulation.

SCENARIO OVERVIEW:

Maggie Naganashe is a 62-year-old American Indian female with chronic renal failure. She also has a 15-year history of type II diabetes mellitus and a history of hypertension, and hyperlipidemia. She lives on an American Indian reservation and is a proud member of the Odawa tribe. Mrs. Naganashe reports that she was unable to go to her dialysis treatment this week because her husband had to use their only car for a job interview. She was admitted for shortness of breath, swelling, weight gain and fatigue.

LEARNER OBJECTIVES:

1. Utilize clinical reasoning skills to perform a health history and physical assessment on an adult patient. (CO 1, 2, 3, 4)

2. Construct a plan of care based by prioritizing assessment findings and nursing diagnoses (CO 4, 5, 6, 7)

3. Evaluate patient outcomes to determine the effectiveness of nursing interventions and need for ongoing care (CO 4, 8)

4. Communicate and collaborate with the patient, family, and interdisciplinary healthcare team members (CO 3, 6)

STUDENT ROLES DURING SIMULATION:

You are the staff nurse at the hospital who will be conducting a comprehensive assessment. After completing your assessment, you are expected to document your findings as a nurse’s note in SBAR format.

KEY FEATURES OF i-HUMAN:

· As the nurse, you are expected to complete the case scenario using the following tabs: EHR, History, Physical, Analyze, Actions, Nursing Notes, Summary

· There are required questions and/or additional information provided related to this case. The questions, information, and videos must be completed/reviewed prior to progressing to the next tab.

· Nursing Notes: At the end of the simulation, you will document your assessment findings using ISBAR.

CONFIDENTIALITY:

To preserve the educational value, integrity, and safety of the learning environment, you agree to maintain strict confidentiality about the proceedings of the simulation session, details of the training scenarios and the performance of all participants. You acknowledge that this expectation aligns with the guidelines related to the Health Insurance Portability and Accountability Act (HIPAA) as well as laws governing Protected Health Information (PHI) in client care environments.  You will not view, discuss, share, record or disclose any confidential information pertaining to the session. You understand that lapses in confidentiality are considered academic misconduct and could result in dismissal from the academic program. 

FICTION AGREEMENT:

You will suspend judgment of realism for any given simulation in exchange for the promise of learning new knowledge and skills, treating the simulated patients with the same care due an actual patient, act with a genuine desire to learn even when it may be difficult to do so.  

DUE DATE:

The virtual simulation is assigned to be completed during

Week 4
prior to your scheduled debriefing with faculty/peers.

SIMULATION TIMING:

· Pre-simulation preparation: 30-60 minutes

· Pre-brief: 15 minutes

· Run Time: 2.75 hours

· Debriefing: 60 minutes

ASSESSMENT & EVALUATION

Faculty will utilize your participation measurements in the i-Human case, and debriefing discussions to identify areas of opportunity for enhancement of your clinical growth. Your experiences in i-Human will contribute to your overall completion of clinical requirements for the course as documented on the Clinical Learning Evaluation tool.

i-Human Evaluation – What does my total score mean?

REVIEW AND COMPLETE PRIOR TO THE START OF THE VIRTUAL SIMULATION:

In order to prepare for the simulation, you are
required to complete the pre-simulation questions below and submit this prework to the faculty via uploading your responses in Canvas prior to the start of the virtual simulation. If you do not complete the pre-simulation questions and upload them, you will

not
be able to access or participate in the simulation.

1. Describe the fluid and electrolyte imbalance that occur with chronic renal failure.

2. What are key patient education concepts related to chronic kidney disease?

3. Explore the CDC Tribal Data, Information, and Resources at
www.cdc.gov/tribal/data-resources and read the following article.

Mitchell, F. (2012). Reframing diabetes in American Indian communities: A social determinants of health perspective.
Health & Social Work, 37(2):71–79.

[Note: This article can be located through the Chamberlain University Library.]

4. Describe risk factors and conditions that lead to health disparities for American Indians.

Immediately following the completion of the virtual simulation, you will complete the evaluation of the simulation using the link provided.

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Fifty-four-year-old Fred is complaining of a headache that started about 2 weeks ago. For the past 2 days, the headache has increased in severity, and he is photophobic and has uncial rigidity and projectile vomiting. CT scan results show an arteriovenous malformation in the basal artery and a small hemorrhagic bleed in the middle meningeal artery.

1. How is the concept of “disorders of brain function” related to Fred’s presenting symptoms?
2. What aspects of cerebral circulation would come into play in Fred’s case?

Instructions: 1 page or 1 page and half of length is fine. APA style. Discussion post. MUST have 3 references.

Review the agenda priorities of the current/sitting U.S. president and at least one previous presidential administration. Select an issue related to healthcare that was addressed by two U.S. presidential administrations (current and previous). Consider how you would communicate the importance of a healthcare issue to a legislator/policymaker or a member of their staff for inclusion on an agenda.

Your patient is a 23-year-old female. She presents with coughing and wheezing which she stated started about three weeks ago. She is currently 25 weeks pregnant. Her last prenatal visit was one month ago in another state. She has an appointment with the prenatal care provider next week, however her respiratory symptoms brought her to your office today.

History – Chickenpox as a child. Asthma as a child, diagnosed at age 8 for which she used a SABA when needed. She has not had the need to use an inhaler since she was 19. She takes only her prenatal vitamin. No other acute or chronic problems. She advises you that she is up to date on all immunizations except she has not had a flu shot (it is October).
Social – Non-smoker, no drug use. She relocated to your state two weeks ago to get away from an abusive domestic situation. She has no support network in this area and has not yet found employment. She has no medical insurance.

HPA – Non-productive cough x 3 weeks. Wheezing audible from across the room. She states it is like this all day and wakes her from sleep every night. She reports that she is fatigued even in the morning. No other complaints.

PE/ROS – Pt appears disheveled but clean. Wheezing in all lung fields. T 98, P 82 regular, R 28 no stridor. FH 130 regular. The remainder of the exam is WNL.

02 98% and FEV 70%

Directions:

1. Construct a narrative document of 4-5 pages (not including cover page or reference page)

2. Diagnose the patient based on the above findings and provide your rationale for how you arrived at the diagnosis.

3. Develop a treatment plan specifically for this patient, pharmacologic and non-pharmacologic.

4. Describe community resources (using your own community) currently available in your state/city to support this patient.

5. Provide a communication plan that you will use to ensure the patient is an active participant in the treatment plan. Refer to therapeutic communication concepts.

6. Utilize national standards, your pharm and/or patho book, and medical or advanced practice professional sources. Do not use patient-facing sources or general nursing texts.

7. Use references to support your concepts. Utilize correct APA formatting (7th edition) and mechanics of professional communication.

Before finalizing your work, you should:

·
Read the Assignment description carefully (as displayed above);

·
Consult the Grading Rubric (under Course Resources) to make sure you have included everything necessary.

Your writing assignment should:

· Follow the conventions of 
Standard American English (correct grammar, punctuation, mechanics, etc.);

· Be 
well organized, logical, and 
unified, as well as 
original and insightful;

· Utilize correct APA formatting, 7th edition.

· Submit to, and review results of Turnitin. Purdue University Global Student Conduct policy as it relates to plagiarism will be adhered to in this course.

Rubric Title: MN553 Unit 4 Assignment Rubric

Assignment Criteria	Level III	Level II	Level I	Not Present
Criteria 1	Level III Max Points Points: 10	Level II Max Points Points: 8	Level I Max Points Points: 6	Not Present 0 Points
Diagnosing the patient	· An accurate diagnosis with correct staging is provided · Rationale for arrival at the diagnosis with support from national guidelines is provided	· An accurate diagnosis is provided with staging that may not be correct · Rationale for the diagnosis is provided without support	· An accurate diagnosis is provided with staging that may not be correct · Rationale for the diagnosis is provided without support	· Does not meet the criteria
Criteria 2	Level III Max Points Points: 10	Level II Max Points Points: 8	Level I Max Points Points: 6	Not Present 0 Points
Providing pharmacologic intervention	· Correct medications are prescribed to treat the diagnosis · Rational for medications prescribed adheres to national guidelines ·	· 50% of correct medications are prescribed · Rational to support prescribed medications is provided and adheres to national guidelines	· Less than 50% of the correct medications are prescribed · Rational to support the prescribed medications is not present or does not adhere to national guidelines	· Does not meet the criteria
Criteria 3	Level III Max Points Points: 5	Level II Max Points Points:	Level I Max Points Points:	Not Present 0 Points
Providing non-pharmacologic interventions	· Five or more non-pharmacologic interventions are provided	· Three or four non-pharmacologic interventions are noted	One or two non-pharmacologic interventions	· Does not meet the criteria
Criteria 4	Level III Max Points Points: 10	Level II Max Points Points: 7	Level I Max Points Points: 0	Not Present 0 Points
Writing a communication plan	· A communication plan which includes principles of therapeutic communication is developed	· A communication plan that does not include principles of therapeutic communication is developed	· Does not meet the criteria	· Does not meet the criteria
Criteria 5	Level III Max Points Points: 10	Level II Max Points Points: 7	Level I Max Points Points: 4	Not Present 0 Points
Community Resources	· Three or more local community resources are provided	· Two local community resources are provided	· One local community resource is provided or: · Resources are provided but they are not local to the community	· Does not meet the criteria
Criteria 6	Level III Max Points Points: 10	Level II Max Points Points: 8	Level I Max Points Points: 6	Not Present 0 Points
College-level academic writing	· Professional, peer-reviewed, advanced practice references are used · Grammar and mechanics of writing demonstrate graduate level work · Adheres to page number requirements	· The majority of references used are professional, peer-reviewed and advanced practice · Errors in grammar or mechanics of writing are present but do not interfere with readability · Adheres to page number requirements	· The majority of references used are professional, peer-reviewed and advanced practice · Errors in grammar or mechanics of writing are present but do not interfere with readability · Does not adhere to page number requirements	· Does not meet the criteria
Maximum Total Points	55	44	33	0
Minimum Total Points	45 points minimum	34 points minimum	1 point minimum	0

Read a selection of your colleagues’ responses and respond to at least two of your colleagues on two different days by expanding upon your colleague’s post or suggesting an alternative approach to the ethical issue described by your colleague. use 2 reference for each. Less than 1 page

1.Organizations use professional ethics to provide a framework for what behaviors are accepted and expected.  Professional ethics can be defined as “rules of acceptable conduct that members of a given profession are expected to follow” (American Psychological Association, n.d.).  As a doctorally prepared nurse, it is critical to understand the impact that an organization’s professional ethics can have on the success of an organization as well as patient outcomes.  A recent study conducted by Torkaman et al. (2020) investigated the relationship between professional ethics and organizational commitment and was able to show a positive correlation between professional ethics and nurses’ commitment to their organization.   A DNP-prepared nurse would be able to identify the importance of leveraging professional ethics in order to increase retention rates.  The DNP-prepared nurse could offer reimbursement for staff who attend ethics-based training to highlight the organization’s emphasis on these principles, strengthening nurses’ perceptions of the value of professional ethics within their organization.

                                                                                      Autonomy

            Autonomy in healthcare refers to the notion that patients should have the right to make their own decisions about their treatment.  Ethical dilemmas may arise when patients do not have the capacity to make decisions, and others (family members, Emergency Room (ER) staff, or legal guardians) have to step in to make these critical decisions for the patient.  Rejno et al. (2020) created vignettes to examine the importance of autonomy and dignity.  In one of these vignettes, a patient named David was in a motor vehicle accident and had to be sedated and placed on a respirator.  The ER team providing care to David has no knowledge of his wishes for care and, therefore, has to use their own judgment to provide life-saving measures.  In situations like this, “healthcare professionals can find support from basic ethical values, ethical guidelines such as those provided by the ICN and from learning not to prejudge what the dignity of identity might be for David; additionally, it is essential to protect the identity of every patient, viewing each as a unique person whose life stories are acknowledged, in order to preserve their dignity” (Rejno et al, 2020).  The DNP-prepared nurse should consider creating an ethics committee to help provide support and guidance to staff who need to provide care for patients who are unable to make decisions on their own.

                                                                      Issues in My Own Practice

            Over the years, I have worked in many different inpatient psychiatric settings, one being a consistently nationally-ranked hospital by US News and World Report.   One of the main differences that I observed in this organization was a strong emphasis on professional ethics.  Staff members took great pride in the fact that they were providing evidence-based best patient care in an organization that set forth professional expectations, which, for the most part, staff strived to follow.  When staff are provided with clear expectations, they feel more supported, are better equipped to deliver quality care, and are more invested in the organization.

            In the inpatient psychiatric setting, autonomy is an issue that we deal with quite regularly.  Oftentimes, patients are so mentally ill that they do not want to take medications that would help them to stabilize.  When this is the case, the Psychiatrist has to petition the court to have the patient committed and medicated against their will.  Staff members have to physically restrain these patients and provide intramuscular medications to them against their will.  As you can imagine, this frequently brings up ethical questions of patient autonomy.  In order to provide support, ethics committees are a valuable tool to help staff process complex patient cases.

  References

American Psychological Association. (n.d.) Dictionary of Psychology. https://dictionary.apa.org/professional-ethicsLinks to an external site.

Rejno, A., Ternestedt, B.-M., Nordenfelt, L., Silfverberg, G., & Godskesen, T. E. (2020). Dignity at stake: Caring for persons with impaired autonomy.Links to an external site.Links to an external site. Nursing Ethics, 27(1), 104–115. https://doi.org/10.1177/0969733019845128

Torkaman, M., Heydari, N., & Torabizadeh, C. (2020). Nurses’ perspectives regarding the relationship between professional ethics and organizational commitment in healthcare organizations. Journal of Medical Ethics & History of Medicine, 13(17), 1–10.

2.   Ethics are one of the main pillars of nursing care and uphold the quality and integrity of interventions delivered. Ensuring that ethical considerations are taken when constructing the framework for a healthcare organization can ensure that those involved feel connected to a deeper and valuable meaning within their work and are also meeting the ethically based qualifications to deliver said care (Torkaman et al., 2020).

            Along with ensuring the providers are qualified to deliver appropriate care, the setting must also be appropriate for the level of patient acuity. Telehealth has undoubtedly increased access to care, providing resources to individuals who may not have sought psychiatric support prior to virtual appointments. An ongoing assessment by federal and state regulators has been the appropriateness of prescribing certain medications, including buprenorphine products for medication-assisted treatment (MAT) in the use of substance use disorders. Additionally, fully virtual psychiatric providers have also experienced the need to carefully screen the mental health symptoms for severity and ensure a patient is appropriate for telehealth level of care (LOC).

            The Doctor of Nursing practice (DNP) is a change agent supportive of guiding these processes not only at their but as regulations change and adapt. The DNP can play an integral role in collecting new data on care outcomes and translating this data into information that can be disseminated to and understood by non-healthcare professionals. Doing so can promote the ongoing availability of telehealth measures, with focus on increasing access to care. The DNP serves as an expert reviewer to examine outcomes with particular attention to interventions that provide therapeutic outcomes and assessing for gaps in practice. This is of particular concern with telepsychiatry, as progressive steps have been implemented over time to proactively identify individuals who may be at risk for self-harm or are experiencing high-acuity symptoms out of reasonable scope of telehealth care (Fiorini et al., 2020).

            Much like general psychiatry services, there are even fewer psychiatric providers providing specialty substance use disorder treatment. Throughout the pandemic, access was increased to MAT treatment and the previous requirement for a specialty waiver and training to prescribe buprenorphine was waived and consolidated by the Omnibus bill (SAMHSA, 2023). This allows all prescribers with schedule III authority to prescribe buprenorphine products to their patients with opiate use disorder, pending state law allowability. Prescribers have also been permitted to prescribe to patients via telehealth, given all other aspects of MAT treatment are completed including urine drug screening and engagement in psychotherapy per state requirements Mahmoud et al., 2022). These permissions may not continue if they are not continuously extended, and the patients utilizing the prescribers who are available in their area due only to telehealth will be without a MAT prescriber once they end. DNPs can present and advocate for ongoing advancements in safe but broadened prescribing practices for MAT, with respect for the seriousness of buprenorphine prescribing and also the management and severity of opiate use disorder in the United States.

References

Fiorini, R. A., De Giacomo, P., & L’Abate, L. (2020). Towards resilient telehealth support for clinical psychiatry and psychology: a strategic review. Studies in Health Technology and Informatics, 213, 275–278.

Mahmoud, H., Naal, H., Whaibeh, E., & Smith, A. (2022). Telehealth-based delivery of medication-assisted treatment for opioid use disorder: a critical review of recent developments. Current Psychiatry Reports, 24(9), 375–386. https://doi.org/10.1007/s11920-022-01346-z

Substance Abuse and Mental Health Services Administration (SAMHSA). (2023). Waiver elimination (MAT Act). https://www.samhsa.gov/medications-substance-use-disorders/waiver-elimination-mat-act

Torkaman, M., Heydari, N., & Torabizadeh, C. (2020). Nurses’ perspectives regarding the relationship between professional ethics and organizational commitment in healthcare organizations. Journal of Medical Ethics and History of Medicine, 13(17), 1–10. https://doi.org/10.18502/jmehm.v13i17.4658