Julia Morales and Lucy Grey, Guided Reflection Questions Parts 1,2&3

Julia Morales and Lucy Grey, Guided Reflection Questions Parts 1,2&3 Julia Morales and Lucy Grey, Guided Reflection Questions Parts 1,2&3 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 a little awkward discussing some of the questions. I felt especially weird completing the caregiver strain assessment. It almost seemed like it was rude to ask a caregiver if they felt that their loved one was burdening them. Lucy’s tone of voice and replies indicated she was somewhat surprised we would ask some of the questions. For example, asking a caregiver if caring for a loved one is “inconvenient” may come off as harsh. It is very important to use your words wisely when completing these types of assessments and questionnaires What nursing actions did you feel were appropriate within this scenario? I did not do a full body assessment which I felt was appropriate. I assessed what was absolutely necessary, but skipped parts of the head to toe assessment that would not matter for palliative care. I did not take a full set of vital signs either. I focused on pulse oximetry since she does have oxygen ordered. Scenario Analysis Questions* PCC What priority problem(s) did you identify for Julia Morales and Lucy Grey? They needed help in identifying what supplies they will need for Julia’s home care and where they will obtain them. Another priority problem is that Lucy said that being Julia’s caregiver is somethings a physical strain. She said she is managing for the time being, but it is important to keep Lucy safe, especially if she is providing most of the care for Julia. Lastly, it is important make the psychosocial aspects of care a priority. In the beginning, Julia’s son made it clear that he is upset his mother is seeking palliative care and has decided not to go for another round of chemo. Throughout, we find out while Lucy is supportive of Julia’s decision is it sometimes upsetting to see her get weaker and face the reality that her condition is declining. 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? I could have taught them how to look up resources for support groups or other community groups. I could have also educated them on respite care should Lucy experience caregiver burnout. A nutritionist might be included in the home health care visit for Julia. Lucy makes Julia’s food, so they might be able to give Lucy some ideas when it comes to preparing nutritious food for Julia. It is important that Julia gets enough protein to prevent skin breakdown, and for fast wound healingshould she get any wounds. Another member of the health care team that should be included isa social worker. The social worker can help identify where to obtain supplies for Julia’s care. This was a concern Lucy voiced to me during the Let’s PREPARE assessment. PCC What potential barriers might Julia Morales and Lucy Grey encounter that would hinder active participation in Julia’s care? Lucy identified that it can sometimes cause physical strain. She stated that she is getting older and it can sometimes be hard on her. This will obviously not be able to go on forever, and she will need additional help in the future. As Julia’s condition declines, she may require more care than Lucy is able to give. As she gets weaker, she may not be able to transfer, and Lucy may need additional help. Another barrier is that Julia may require care that must be given by a nurse. Julia’s pain may get so severe that she requires IV pain medications that must be administered by the nurse. PCC/I What appropriate assessments were made to help you decide what interventions Julia Morales and Lucy Grey needed? Informal Caregivers of Older Adults at Home: Let’s PREPARE!, Katz Index of Independence in Activities of Daily Living, Modified Caregiver Strain index, and SPICES (older adult assessment). These all provided me with the information I needed to assess their readiness for homecare and client needs. PCC/I What appropriate strategies could be implemented to empower Julia Morales and Lucy Grey in the management of Julia’s care? Supportive strategies could be implemented to empower Julia and Lucy in the management of Julia’s care. If Lucy feels supported by the healthcare team, she can easily take care of Julia. Many of Lucy’s answered eluded to the fact that she knew a lot about Julia’s care, but she needs to know we will be there for her as a resource along the way. For example, Lucy answered one of the questions with, “I feel quite ready, but don’t worry. If I ever need help, I won’t hesitate to ask for it”. She is openly admitting she knows she might need help, and will reach out. If that time comes, it is important to be supportive and allow her to ask as many questions as necessary. 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? Julia is in hospice care, so the goal is not to cure the disease. If her symptoms progress, and they are not recognized, the worse that could happen is that she may be in pain. It is okay if her symptoms worsen or her disease progresses. In fact, it is the “goal” of this type of treatment in a way. Since the goal of treatment is not to fix the problem, we need to make sure the patient is always comfortable. The family needs to recognize the signs of pain that Julia may be not able to verbally communicate to them at a certain point in time.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 the home health/hospice Interprofessional team is to make sure Julia and Lucy are aware of the fact that she will be receiving palliative care, and the focus is on comfort not a curing the disease. It is also their role to support Julia and Lucy in their decision making, and help guide them along the way. Lucy may need guidance since she would like to provide a lot of the care for Julia herself. It is important for all team members to collaborate because the main priority is making sure Julia and Lucy’s wishes are upheld. The team should make sure they are all on the same page, and changes that need to be made based on Julia and Lucy’s decisions should be communicated to all team members. Julia and Lucy should not have to worry about communicating changes to the oncoming shift worker, or other members in the healthcare team. S What potential environmental/safety hazards need to be assessed in the home care setting? When asked if there were any modifications needed to make the home safer or to prevent falls or injury, Lucy replied that a walker and bathing chair might be necessary soon. This will help prevent falls and keep both Julia and Lucy safe. If Julia has an unsteady gait, and is unable to stand in the shower, Lucy may try to hold Julia up. Lucy already expressed the fact that she experiences physical strain sometimes, so this would not be a safe situation for either of them. Concluding Questions Reflecting on Julia Morales and Lucy Grey’s case, were there any actions you would do differently? If so, what are these actions, and why would you have done them differently? I would have gone into the situation more prepared. With vsim, it is sometimes hard to figure out what the next step should be. I would have had better transitions in the assessment questions. For example, I would have assessed Julia, and then asked if it was okay with her for me to ask her family some questions. I would have then proceeded with the rest of the assessment and prefaced the harder “caregiver role strain” questions with a statement letting them know we aren’t making assumptions, and these are questions we ask everyone. Like I mentioned before, asking someone if their loved one is a “burden” is a touchy subject, and should be approached with care and eased into. 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? I would know which questions to ask for which assessments. I did not ask all the right questions every time. For example, I did not pick all the right answers for the Let’s PREPARE! Assessment. This is because I did not ask enough questions to evaluate each category correctly. This was an assessment heavy module that required asking a lot of questions to get the desired information. *The Scenario Analysis Questions are correlated to the Quality and Safety Education for Nurses (QSEN) competencies: Patient-Centered Care (PCC), Teamwork and Collaboration (T&C), Evidence-Based Practice(EBP), Quality Improvement (QI), Safety (S), and Informatics (I). Find more informationat: Guided Reflection Questions Opening Questions How did the integration of Julia Morales’s dying in this simulated experience make you feel? I felt kind of uneasy about the situation. Even though this is a simulation, I felt that I had a duty to make the family feel comforted in such a hard time. It was not easy to check the pulse and reparations at the time of her death. I did not want to have to be the one to tell them their loved one had passed. What nursing actions did you feel were appropriate within this scenario? I felt that it was appropriate to educate Neil and Lucy about the dying process. I think it made them feel better to know that talking to her is appropriate, and that hearing is the last thing to go. I also think the comforting measures were appropriate. Telling them that she looks at peace and comfortable made them seem more at ease. Scenario Analysis Questions* PCC What priority problem(s) did you identify for Julia Morales and Lucy Grey? The priority for Julia was making sure she was comfortable in her last hours on earth. The priority for Lucy was making sure that she was aware that we were doing the best we could to make sure Julia was comfortable in her last hours. It was also a priority to comfort Lucy and educate her about the dying process. PCC/I What is the importance of therapeutic communication during the dying process and postmortem care? The importance of therapeutic communication during the dying process and postmortem care is making sure the family is comforted and is able to start the grieving process. With hospice, I believe the grieving process starts long before the person passes. Therapeutic communication is a tool that can guide the family through the grieving process and put their minds at ease. It allows us to do our job better as nurses because the family trusts the healthcare workers more when they communicate with them through this type of communication. PCC What potential barriers might affect Julia Morales’s wish to die peacefully? While this did not happen in this scenario, it is hard for someone to die peacefully if their affairs are not in order. She did have a living will and had advanced directives. In the last scenario, Lucy stated that the lawyer drafted up all their documents and they were prepared. That took the stress off of the family in those aspects. Another barrier could be if the healthcare proxy needs to step in, and does not honor the wishes of the patient. Once the patient is incapacitated and unable tomake their own decisions, the healthcare proxy is able to decide whatever he/she wants. For Julia to die peacefully, her wishes need to be respected, and she needs to be kept comfortable. The medical treatment is no longer based on finding a cure. PCC/I What strategies might empower Lucy Grey in making decisions about Julia Morales’s end-of-life care? Lucy needs to feel supported by the hospice care workers. She was prepared to be Julia’s caregiver and healthcare proxy, however, she could easily second guess her decisions in times like this. She needs to be reminded that Julia trusted her to make decisions, and they had this planned out when Julia was able to make decisions for herself. PCC What can the health care team members caring for Julia Morales do to cope with their grief over the patient’s death? The healthcare workers can cope by remembering the purpose of their job. Their “end goal” is making sure the patient passes away peacefully, and that the family is informed every step of the way. If Julia was in the least pain possible during her time in hospice care, and the family felt supported throughout the process then they fulfilled their duty. They should cope by feeling happy that the patient’s wishes were granted and they went peacefully. While they need to look at the positive aspects, they should make sure they acknowledge their feelings. It is normal to feel grief over a patient’s death, and these feelings should never be ignored. T&C What is the role of the home health/hospice nurse and interprofessional team after Julia Morales’s death? How was the situation-background-assessment-recommendation (SBAR) technique used to communicate with the primary care provider? Situation I am Alexa, a Hospice Nurse I am calling regarding patient Julia Morales I am calling because she has passed away Background Julia had stage 4 Lung cancer Her time of death was 0904 Assessment She seemed comfortable at the time of death. She was receiving a Fentanyl patch, Scopolamine patch, and Morphine liquid for pain Family was present at the time of death Recommendation I am going to call the funeral home and help the family make further arrangements S What measures can ensure Lucy Grey’s safety after Julia Morales’s death? There should be a mental health assessment done on Lucy to make sure she is mentally stable. Follow up with the family is part of the hospice team’s job. Any referrals for mental health services orsupport groups should be made on Lucy’s behalf. We should determine if Lucy requires any help making further arrangements. QI What measures can support Lucy Grey following Julia Morales’s death? . We can ask if they would like us to call any family members to take some of the burden off of the family. We can also call the funeral home and provide any post mortem care. At that time we can provide them with information on procedures following a death, including education on familysupport. We will make sure their needs and wishes are supported. We can help her through thegrieving process and make sure any referrals are made to support groups or for mental health services. 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? If it were possible in the simulation, I would provide more education about the dying process, and help comfort Lucy and Neil. I would have offered them time to be alone with their loved one. I would have also asked if they wanted more education on what happens after the patient dies in terms of post mortem care, and contacting funeral services. 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? I will be more prepared on what to do after a patient has passed away. I will know to call the provider, and educate the family on the next steps, procedure following a death, and be able to educate and support the family. I will be sure to ask the family if there is anyone they would like me to call for them. Iwill also ask if there is anything I can do in regards to their comfort and privacy. *The Scenario Analysis Questions are correlated to the Quality and Safety Education for Nurses (QSEN) competencies: Patient-Centered Care (PCC), Teamwork and Collaboration (T&C), Evidence-Based Practice (EBP), Quality Improvement (QI), Safety (S), and Informatics (I). Find more information at: Guided Reflection Questions Opening Questions How did the simulated experience in Lucy Grey’s case make you feel? I felt empathetic for Lucy. Seeing how much she has been through made me feel bad for her, and help me understand her case. It was no surprise that she was feeling depressed, and sad without Julia around. It helped me guide my assessments. What nursing actions did you feel were appropriate within this scenario? I felt it was appropriate to use therapeutic communication and to conduct assessments focusing on mental health and safety. It was also appropriate to check her vitals since her blood pressure was a bit high. Scenario Analysis Questions* PCC/S What priority problem(s) did you identify for Lucy Grey? Safety was my number one priority with Lucy. Not only was I concerned with safety regarding her fall, but regarding her mental health as well. With mental health, we always want to make sure that there are no signs of suicidal ideation. Conducting mental health screenings was very important. PCC How might the death of a spouse or significant other impact the biological and psychological well-being of the surviving partner? The death of a spouse or significant other can cause many psychological and physiological issues. They can have troubles sleeping, lose their appetite, and have a lack of energy. Individuals may also exhibit signs of depression, anxiety, panic disorders, immune system impairment, endocrine changes, and cardiovascular issues. Any type of stress, including the stress of grieving a loved one, can increase your blood pressure, and cause many other problems related to that. Palpitation are common with those going through a loss. People can also abuse drugs and alcohol during these times. 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? It is important to screen for depression and anxiety during these times. It is also important to make sure her increase in blood pressure is due to stress, and not an underlying disorder. She should have follow up visits with her primary care provider. Lucy should also follow up with a mental health/bereavement counselor to help cope with her depression and anxiety.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 Grey can suffer from a heart attack or stroke. She has increased blood pressure. If this is not relieved, and it goes on it can be detrimental to her health. She can also suffer from a fall or other accident since she is not sleeping well at night and reported feeling more tired than usual. If she is not eating properly, not sleeping, and not practicing proper hygiene, her immune system is likely down and she can develop an infection. PCC/I What appropriate assessments were made to help you decide what interventions Lucy Grey needed? General Anxiety Disorder 7 (GAD-7), Geriatric Depression Scale assessment, and Morose Fall Risk assessment were performed. I asked various questions about her mental wellbeing, as well as performed a get up and go test to assess her gait. S What safety measures should Lucy Grey and her niece take to decrease Lucy’s risk for injuring herself from a fall in the future? If lying down, Lucy should rise slowly to sit, then rise slowly to stand. If sitting, she should rise slowly from a seated position. She should stop and make sure she is not light headed. Her gait was a bit unsteady, so maybe the use of an assistive device would be beneficial. If lucy will be taking any medication that might make her dizzy or lethargic, she should use assistive devices to walk. It is important to make sure rooms in the house are free of clutter, and there are no tripping hazards. It is also important to make sure Lucy is wearing proper footwear. 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? If I could, I would give Lucy further information on support groups and social activities that might appeal to her. I would ask her more about her interests and try to get her involved in something that will get her out of the house and maybe make her less lonely. I would have also performed a head to toe assessment since she did have a fall. I focused don a neuro assessment to make sure there was no trauma to her head. I should have also made sure I did a skin assessment since she did fall. She had a wound on her elbow, so I should have addressed that since there was not a proper bandage on it and it wasn’t cleaned. I could have then told Neil how to help her take care of it at home. How would you apply the knowledge and skills that you obtained in Lucy Grey’s case to an actual patient care situation? I would know how to approach a situation that may seem awkward the first time you see it. Doing a mental health screening is never easy. In fact, Lucy even made a comment about how depressing some of the questions were that we had to ask. It is important to ease into it and use a calm soothing voicewhen doing a screening like this. However, it is also important to be straight up and not beat around the bush to make sure you get the accurate information you require. *The Scenario Analysis Questions are correlated to the Quality and Safety Education for Nurses (QSEN) competencies: Patient-Centered Care (PCC), Teamwork and Collaboration (T&C), Evidence-Based Practice (EBP), Quality Improvement (QI), Safety (S), and Informatics (I). Find more information at: