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Module Six: OMS Simulation/Wilfred
Jennifer Andrews
Southern New Hampshire University
NUR 302: Clinical Judgement & Assessment
August 10, 2025
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Clinical Scenario Summary: Wilfred – Dementia with Difficult Behavior
Summary of Clinical Scenario:
In this clinical scenario, I assessed and managed a 78-year-old male, Wilfred, who
was found wandering and presenting with agitation, confusion, and signs of
combativeness. Upon initial interaction, Wilfred was difficult to examine, displayed
irritability and tachycardia, and appeared disoriented. The situation required careful
clinical judgment to balance diagnostic priorities with patient safety and comfort due to
the behavioral challenges associated with dementia.
My assessment included obtaining vital signs, calculating the Early Warning
Score (EWS) (with an error noted in recording the respiratory rate), and attempting a
physical exam. I obtained collateral history from his daughter, reviewed his medical
records, and considered his social history and support systems.
Management focused on ensuring a safe environment, performing an SBAR
handover, and requesting urgent medical review. Reassurance and communication were
key, although unnecessary questioning and failure to seek permission for examination
caused increased agitation. While I appropriately avoided unnecessary investigations
such as blood tests, I missed performing an EKG and did not complete a formal cognitive
assessment. Additionally, I failed to keep the nursing team updated.
Applicable Evidence-Based Theory:
Kitwood’s Person-Centered Care Theory in Dementia (1997)
This scenario aligns with Tom Kitwood’s theory of person-centered dementia
care, which emphasizes recognizing the personhood of individuals living with dementia.
The model underlines the importance of:
• Understanding behavior as communication rather than as a symptom to be suppressed.
• Providing care that emphasizes empathy, respect, and individualized approaches.
• Avoiding excess stimulation or unnecessary questioning, which can escalate distress in
dementia patients.
In Wilfred’s case, several aspects of my care aligned with Kitwood’s principles, such as:
, 3
• Efforts to communicate clearly and respectfully.
• Avoidance of invasive procedures (like blood tests) when not clinically necessary.
• Reassuring the patient and attempting to minimize further agitation.
However, I also violated key aspects of the theory when:
• I asked unnecessary questions that increased agitation.
• I failed to create a fully safe environment for Wilfred.
• I proceeded with an exam without explicit permission, which could compromise trust and
dignity.
Kitwood’s model highlights how relational and emotional environments
significantly influence the behavior and well-being of individuals with dementia.
Understanding Wilfred’s behavior through this lens reinforces the need for personalized,
empathetic care, effective team communication, and timely escalation when necessary
(O'Rourke et al., 2022, p 1596-1617).
This scenario reinforced the complexity of managing patients with dementia and
behavioral disturbance. A key takeaway was the need to balance clinical thoroughness
with compassionate, individualized care, supported by evidence-based frameworks like
Kitwood’s theory. It also highlighted the importance of communication, interprofessional
collaboration, and accurate clinical documentation to ensure patient safety and optimal
outcomes.
Background: Previous Experiences Supporting Clinical Reasoning
My clinical reasoning during the scenario with Wilfred, a patient with dementia
and difficult behavior, was shaped by a combination of nursing knowledge, previous
clinical exposure, and firsthand experiences, each of which influenced my assessment,
decision-making, and communication strategies.
Nursing Knowledge
My formal nursing education provided a solid foundation in:
• Assessment skills, including accurate documentation of vital signs and interpreting early
warning scores (EWS).
• Understanding the progression and behavioral symptoms of dementia, including
agitation, confusion, and combativeness.
• Principles of trauma-informed and person-centered care, emphasizing dignity, empathy,
and minimizing distress, especially in patients with cognitive impairments.
Module Six: OMS Simulation/Wilfred
Jennifer Andrews
Southern New Hampshire University
NUR 302: Clinical Judgement & Assessment
August 10, 2025
, 2
Clinical Scenario Summary: Wilfred – Dementia with Difficult Behavior
Summary of Clinical Scenario:
In this clinical scenario, I assessed and managed a 78-year-old male, Wilfred, who
was found wandering and presenting with agitation, confusion, and signs of
combativeness. Upon initial interaction, Wilfred was difficult to examine, displayed
irritability and tachycardia, and appeared disoriented. The situation required careful
clinical judgment to balance diagnostic priorities with patient safety and comfort due to
the behavioral challenges associated with dementia.
My assessment included obtaining vital signs, calculating the Early Warning
Score (EWS) (with an error noted in recording the respiratory rate), and attempting a
physical exam. I obtained collateral history from his daughter, reviewed his medical
records, and considered his social history and support systems.
Management focused on ensuring a safe environment, performing an SBAR
handover, and requesting urgent medical review. Reassurance and communication were
key, although unnecessary questioning and failure to seek permission for examination
caused increased agitation. While I appropriately avoided unnecessary investigations
such as blood tests, I missed performing an EKG and did not complete a formal cognitive
assessment. Additionally, I failed to keep the nursing team updated.
Applicable Evidence-Based Theory:
Kitwood’s Person-Centered Care Theory in Dementia (1997)
This scenario aligns with Tom Kitwood’s theory of person-centered dementia
care, which emphasizes recognizing the personhood of individuals living with dementia.
The model underlines the importance of:
• Understanding behavior as communication rather than as a symptom to be suppressed.
• Providing care that emphasizes empathy, respect, and individualized approaches.
• Avoiding excess stimulation or unnecessary questioning, which can escalate distress in
dementia patients.
In Wilfred’s case, several aspects of my care aligned with Kitwood’s principles, such as:
, 3
• Efforts to communicate clearly and respectfully.
• Avoidance of invasive procedures (like blood tests) when not clinically necessary.
• Reassuring the patient and attempting to minimize further agitation.
However, I also violated key aspects of the theory when:
• I asked unnecessary questions that increased agitation.
• I failed to create a fully safe environment for Wilfred.
• I proceeded with an exam without explicit permission, which could compromise trust and
dignity.
Kitwood’s model highlights how relational and emotional environments
significantly influence the behavior and well-being of individuals with dementia.
Understanding Wilfred’s behavior through this lens reinforces the need for personalized,
empathetic care, effective team communication, and timely escalation when necessary
(O'Rourke et al., 2022, p 1596-1617).
This scenario reinforced the complexity of managing patients with dementia and
behavioral disturbance. A key takeaway was the need to balance clinical thoroughness
with compassionate, individualized care, supported by evidence-based frameworks like
Kitwood’s theory. It also highlighted the importance of communication, interprofessional
collaboration, and accurate clinical documentation to ensure patient safety and optimal
outcomes.
Background: Previous Experiences Supporting Clinical Reasoning
My clinical reasoning during the scenario with Wilfred, a patient with dementia
and difficult behavior, was shaped by a combination of nursing knowledge, previous
clinical exposure, and firsthand experiences, each of which influenced my assessment,
decision-making, and communication strategies.
Nursing Knowledge
My formal nursing education provided a solid foundation in:
• Assessment skills, including accurate documentation of vital signs and interpreting early
warning scores (EWS).
• Understanding the progression and behavioral symptoms of dementia, including
agitation, confusion, and combativeness.
• Principles of trauma-informed and person-centered care, emphasizing dignity, empathy,
and minimizing distress, especially in patients with cognitive impairments.
