VSIM Andrew Davis GUIDED REFLECTION

MENTAL HEALTH CASE II Mental Health Case: Andrew Davis Guided Reflection Questions Opening Questions 1. How did the simulated experience of Andrew Davis’ case make you feel? I felt calm and confident with this scenario. I felt prepared, which contributed to my calmness. I also felt a little sad because I could tell that Mr. Davis was disappointed in himself, and that is a very lonely place to be – to feel like a leader who has let his flock down. 2. Talk about what went well in the scenario. I looked up the assessment tool online and printed off a copy of it so that I could keep track of each item as I asked Mr. Davis the assessment questions. This helped me know what observational assessments to complete as well. I feel like I knew when to stop the VSim, wich is a really nice feeling. 3. Reflecting on Andrew Davis’ case, were there any actions you would do differently? Ifso, what were these actions and why? I would take Mr. Davis’ blood pressure as part of his vital signs assessment. I checked off that I did that (I make a checklist of the assessments/medication administration/ education I need to complete), but I did not actually do it. So, I’d slow down and double check my work. ScenarioAnalysisQuestions* 4. PCC What issues have you identified that could be barriers to a successful treatment for Andrew Davis? -Mr. Davis may not feel like he wants to be in a group therapy session, perhaps he would feel embarrassed. Mr. Davis has feelings of shame, and shame that goes unaddressed can be a big barrier to successful treatment. Mr. Davis asked if he would be able to ever drink again, which alerts me to a possibility of relapse. 5. How would you address the denial? I did not experience Mr. Davis talking about denial. The only time that came up was during the pre-simulation questions, which I figure are hypotheticals. So, there was no actual observed denial on my shift. If there were denial, here is what I would do: I’d give him some feedback about his blood lab work (the liver fx numbers don’t lie), and I’d ask him if he felt any of the physical or emotional symptoms. I could ask him about how he feels his relationships are going; I could also ask how he feels he is doing in reaching his goals at work as a pastor and as a member of the school board. 6. PCC/I Identify a support group that would be beneficial to Andrew Davis related to his position in the community. Alcoholics Anonymousis a well-known program that incorporatesfaith into its mission. Another group, Hope Quest ( actually has a support group/training group that is specifically focused on ministers and their families. 7. PCC/I Identify support groupsthat would be beneficial to Andrew Davis’ family. Alanon is a great support group for family members ofsomeone with addiction. Also, another group, Hope Quest ( actually has a support group/training group that is specifically focused on ministers and their families. 8. S/PCC Andrew Davis is currently in Stage I of alcohol withdrawal. As he moves into Stage II (24 to 72 hours) and then into Stage III (after 72 hours), what behaviors should be assessed for and what safety measures should be initiated? (from Boyd, M. Psychiactric Nursing: Contemporary Practice , 6 th ed. Pg 539) Stage II – HR 100-120bpm, elevated systolic BP, elevated temperature. Obvious diaphoresis. Itermittent confusion, transient visual and auditory hallucinations, painful anxiety and restlessness, insomnia and nightmares, visible tremors, rare convulsions, anorexia, nausea and vomiting Stage III - HR 120-140bpm, elevated systolic and diastolic BP, elevated temperature, marked diaphoresis. Marked disorientation, confusion, disturbing visual and auditory hallucinations, delusion r/t hallucinations, misidentification of objects (a chair is a man), gross uncontrollable tremors and convulsions, agitation and extreme restlessness, panic,rejecting all fluid and food. We need to check BP, HR, nausea, agitation, headache, and mental status are important. We also need to ensure that seizure precautions are initiated with oxygen, bed rail covers, and suction equipment. ConcludingQuestions 9. How would you apply the skills and knowledge gained in the Andrew Davis case to an actual patient situation in different acute care units (emergency room, intensive care unit, obstetrics unit, etc.)? It’s important to see the person and not the illness as the thing that we are treating. While Mr. Davis feels shame about his condition, that is not something that I need to cary with me while providing care. It reminds me of an experience that I hope will continue to inform how I deliver care: When I was in high school, my mother worked at a level 1 trauma center in New Orleans, Charity Hospital. I remember her telling stories every week about how she would advocate for her patients – young men who were in gangs who arrived with major gunshot wound trauma due to a drug deal gone wrong. She would say how others didn’t want to give those young men care because they’d just get better and keep doing what they’re doing, but my mom would advocate intently for her patients and ensure that they were given all the care that they required and deserved. She saw each person as a soul to care for – not to judge. I hope to do the same thing.