Mental Health Case: Sandra Littlefield
Guided Reflection Questions
Opening Questions
How did the simulated experience of Sandra Littlefield’s case make you feel?
I found myself struggling to remain calm during the case. It was difficult to get any answers because she
kept coming back to how much pain she was in and requesting more medication despite me verbalizing
early on that she would not be receiving anymore per her orders. I can see how much patience is
required to work with patients with this personality disorder.
Talk about what went well in the scenario.
I think I was able to provide some helpful alternatives to pain medications and she seemed somewhat
receptive, although she would then revert to talking about pain medications. I also felt like she opened
up about how hard it was for her to be in jail without her support system, having suicidal ideation, and
her previous attempts. I felt like I was able to quickly catch manipulative behavior and redirect the
conversation well.
Reflecting on Sandra Littlefield’s case, were there any actions you would do differently? If so, what were
these actions and why?
I would have liked to ask more questions in regard to her previous suicide attempts and discuss a little
more in depth her current suicidal ideation such as plan, means, and method. She endorsed multiple
times thinking about ending her life as well as harming others. I felt more questions were needed in
regards to these topics.
Scenario Analysis Questions*
PCC/S What should be the nurse’s priority when caring for Sandra Littlefield?
The nurses priority should be the patient safety. She vocalized suicidal ideation and has a history
of past attempts which makes her a higher risk.
What action should be initiated to maintain personal safety?
The nurse should assess the scene safety before entering as well as have a plan to leave the
room if needed. She should also have the guard stay right outside the door during her
interaction with the patient and she should not turn her back on the patient at any point. I also
would make sure the nurse keeps 2 feet or more from the patient and does not block the patient
or the door which could cause the patient to escalate her behavior.
If the nurse did not recognize the importance of personal safety, what could be the
consequence?
From vSim for Nursing | Mental Health. © Wolters Kluwer.
Guided Reflection Questions
Opening Questions
How did the simulated experience of Sandra Littlefield’s case make you feel?
I found myself struggling to remain calm during the case. It was difficult to get any answers because she
kept coming back to how much pain she was in and requesting more medication despite me verbalizing
early on that she would not be receiving anymore per her orders. I can see how much patience is
required to work with patients with this personality disorder.
Talk about what went well in the scenario.
I think I was able to provide some helpful alternatives to pain medications and she seemed somewhat
receptive, although she would then revert to talking about pain medications. I also felt like she opened
up about how hard it was for her to be in jail without her support system, having suicidal ideation, and
her previous attempts. I felt like I was able to quickly catch manipulative behavior and redirect the
conversation well.
Reflecting on Sandra Littlefield’s case, were there any actions you would do differently? If so, what were
these actions and why?
I would have liked to ask more questions in regard to her previous suicide attempts and discuss a little
more in depth her current suicidal ideation such as plan, means, and method. She endorsed multiple
times thinking about ending her life as well as harming others. I felt more questions were needed in
regards to these topics.
Scenario Analysis Questions*
PCC/S What should be the nurse’s priority when caring for Sandra Littlefield?
The nurses priority should be the patient safety. She vocalized suicidal ideation and has a history
of past attempts which makes her a higher risk.
What action should be initiated to maintain personal safety?
The nurse should assess the scene safety before entering as well as have a plan to leave the
room if needed. She should also have the guard stay right outside the door during her
interaction with the patient and she should not turn her back on the patient at any point. I also
would make sure the nurse keeps 2 feet or more from the patient and does not block the patient
or the door which could cause the patient to escalate her behavior.
If the nurse did not recognize the importance of personal safety, what could be the
consequence?
From vSim for Nursing | Mental Health. © Wolters Kluwer.
