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Situation: A 55-year-old African woman named Amina has a history of sudden crushing chest pain at home.

Background: Amina has a history of hypertension, diabetes, and obesity. She reports feeling short of breath and lightheaded. She denies any recent trauma or illness.

Assessment: Given Amina's age, medical history, and presenting symptoms, the most likely diagnosis is a heart attack (myocardial infarction). Other differential diagnoses to consider include pulmonary embolism, aortic dissection, or unstable angina.

Recommendation: Amina should be immediately transported to the nearest emergency department for further evaluation and treatment. In the meantime, administer aspirin (if not contraindicated), monitor vital signs, and provide oxygen therapy if needed. Notify the hospital staff of the patient's condition and ensure rapid triage upon arrival. Time is of the essence in treating a potential heart attack, and prompt intervention can significantly improve the patient's outcome.

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Student nurse first day in clinical placement

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Situation: You are a third-year nursing student about to start your last placement as a student nurse.
Background: You are working a long day in a hospital ward.
Assessment: You are feeling excited and nervous about finishing your course and entering the NMC register.
Recommendation: You are working on a ward with your practice supervisor you have a small caseload of four patients with varying needs.
Decision: How would you deal with the following patients?  Be prepared to feedback to the larger group

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We are now going to spend the rest of our time with a period of debriefing.

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Lesson Goal
To gain knowledge and understanding of decision-making. Using scenario-based learning work in groups through a scenario.

Outcomes

1.  Students will discuss what constitutes decision making
2. Working through scenarios using decision-making tools
3. Explore how decisions are made

4. Participate in peer discussions and self-reflection.

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Please complete Evaluation for today's session

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Situation: 9-year-old Ravi has been diagnosed with asthma. His symptoms include coughing, wheezing, and shortness of breath, especially during physical activities.

Background: Ravi has been having a lot of time off school in the past 2 months due to respiratory infections. Parents are concerned that Ravi may be stressed due to preparing for transitioning from primary to secondary school.

Assessment: Ravi's asthma symptoms are impacting his daily activities and quality of life. It is essential to identify and avoid triggers, take prescribed medications regularly, and have an asthma action plan in place to manage exacerbations effectively.

Recommendation:

1. Work with the child's healthcare provider to develop an asthma action plan that includes daily medications, rescue inhaler use, and steps to take in case of an asthma attack.

2. Educate the child and his caregivers about asthma triggers and how to avoid them, such as staying away from smoke, dust, pet dander, or strong odors.

3. Encourage the child to stay active but monitor his physical activity and use a rescue inhaler before exercise if needed.

4. Ensure that the child has access to necessary medications, inhalers, and a spacer device for proper inhaler technique.

5. Regularly follow up with the healthcare provider to monitor asthma control and adjust treatment as needed.

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Situation: Malcom is a 25-year-old male with a history of depression and anxiety who has expressed suicidal thoughts and intentions.

Background: Malcolm has been struggling with feelings of hopelessness and worthlessness for several months. He has a history of previous suicide attempts and has recently experienced a significant stressor, such as a relationship breakup.

Assessment: Malcom is at high risk for suicide given his history of depression, anxiety, and previous suicide attempts. He may also be experiencing feelings of isolation and lack of support.

Recommendation: Malcom must be immediately assessed by a mental health professional, such as a psychiatrist, to determine the level of risk and develop a safety plan. Malcom should also be connected with local crisis intervention resources, such as a suicide hotline or emergency mental health services. Malcom needs to have ongoing support from mental health professionals, friends, and family members to help him through this difficult time.

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Assessment:

Jason- Carry out CYP mental health assessment , Admit Jason onto ward , Nurses to provide nursing care i.e. to administer medications such as lorazepam , ensure he's receiving adequate nutrition , get a one to one for him, make his room safe i.e. remove hazards such as wires and sharp objects etc.

Police should section him under section 136 until doctors can review him.

Frank-Keep Frank in hospital for more time as he hasn't been able to self mobilise post surgery which is a discharge requirement

Doctor to review

Arrange another physio review at later date

Review his living situation i.e. does he have anyone to care for him whilst recovering.

Upon discharge allocate district nurses to go review his wound and healing progress every 3 days.

Discharge Frank with appropriate analgesia for pain management

Mrs Armstrong- Continuous monitoring of GCS to ensure her state doesn't deteriorate

Treat the leg ulcer- clean and dress and apply compression and treat associated symptoms

Doctor should review for possible dementia or other neurological condition

Why didn't daughter bring her in sooner?

Upon discharge her home should be reviewed for fall risks

Abigail- Arrange for Abigail to start on therapy i.e. CBT that works on the premise of reversing maladaptive thought processes

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Jason’s

Jason’s behaviour and symptoms suggest Underlying issues such as anxiety, restlessness, potentially dissociative episodes (where a person disconnects from their thoughts and feelings, memories and sense of identity)

Anxiety and agitation:- behaviour seem in park with police which indicates signs of distress

nurse role would be to assess and addressed his immediate emotional  state to ensure his safety and well-being

Wandering behaviour: Jason seems to have a tendency to wander both in park and at home during night could indicate  restlessness, dissociation, or even cognitive impairment.

nurse would need to assess the frequency and possible triggers of behaviour.

Possession of knife and scissors:- concerns about Jason’s safety and safety of others.

Nurse:- nurse would assess whether these items were carried for self-harm purposes or if there's a different explanation, such as self-defense or a lack of awareness of the potential danger.

Cooking incident:- where he left the cooker unattended, leading to a smoke alarm, suggests possible lapses in judgment or awareness.

nurse:- whether this incident was an isolated event or part of a pattern of risky behavior.

Referral to crisis intervention team: shows that GP recognises severity of his symptoms and the need for immediate intervention.

nurse: follow up on the referral and coordinate with the crisis intervention team to ensure Jason receives appropriate evaluation and support.

Family dynamics and potential concerns: Jason behaviour:  his behavior suggests that there may be underlying family dynamics contributing to his distress.

Nurse:- potentially safeguarding, see family/ environmental e,g school social life dynamics. Ensure family is included in care plan and providing them with support and education needed

Frank:-

pain management control so he can mobilise

May be urinary retention

Bladder scan

Discharge planning

Rehab referral

Physio input regarding mobility

Walking aids

Occupational therapist referal Package of care may be needed as he may not have people who can look after him after discharge

Follow up with community nurses and GPs

Make sure patient is pain free and has passed urine, can tolerate food and fluids and also mobilise

Assess mental start and feeling about surgery due to past medical history of depression

Mrs Armstrong

pain management needs to be addressed

Check level of confusion

Mental capacity

Assess leg ulcers see if their is and signs of infection, involve tissues viability nurse

Check urine

See if their are any signs of dehydration

Reassurance of family members if Armstrong has capacity then ask if she is okay with informing family members of care plan ….. if no capacity too who has the right to make decisions on her behalf

Potential reason for confusion could be head injury, check pearl scores - neurological observations GCs score

Abigail

ensure everything is ready for Matilda in regards to cars and support ( Abigail 3 month old)

Could be postpartum depression or a potentially longer mental health condition

Ensuring that those who Abigail feel safe and happy with regularly visit her such as sister, husband and Ruth the health visitor

Maybe child in need referral for Matilda to ensure that they get the support that they need and have the appropriate intervention in place post discharge

Include husband in care plan and education as well as emotional support for him

MDT meeting:- review medications, therapy, mood monitoring, care plan

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Mrs Armstrong

Regular monitoring of GCS and monitoring confusion/aggitation

Work in collaboration with MDT in regards to chronic leg ulcers

Pain management

Document any changes

?Bloods ?Sepsis ?CT

Frank

Do not discharge him

Pain management

mental health review

physio review

Doctors review

Dietitian referral

When able to discharge - community team referral and GP follow up

Jason

CAMHS referral ?section

Offering parents support and education on managing a child with a mental health condition

Abigail

?post partum depression

Assist her in transferring to new ward

Communicate with Health Visitor regarding Abigail and Matilda staying in hospital

Child in need referral for baby - once Abigail is discharged

Support for whole family (husband)

Mental health services review

GP referral

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Prioritising/ risk assessment:

Completing risk assessment forms

Identifying and removing potential hazards

Conducting full body maps on newly admitted patients

Ethical legal issues:

Working with a patient that isn't under a mental health section may present problems i.e. patient self discharging and refusing treatment.

Mental capacity

informed consent

Discrimination - patient may not want to be treated by certain member of staff.

identifying problems/ planning:

Deliver culturally competent care

Problem solving

Shared decision making

Communicating with others:

Collaborative approach i.e. liaising members of the MDT in patients care

Non verbal and verbal communication

Written communication

Active listening , patient teach back

Building rapport to ensure communication is effective

Building trust

Evaluation and reflection:

Asking staff and patients how you can improve and change

Having debriefs after challenging scenarios i.e. after a restraint

Knowledge underpinning practice:

NMC code - professional code of conduct

Medical ethics

Empirical knowledge from text book and evidence based articles

ADPIE helps guide decision making amongst MDT

Experiential knowledge

Outlining key ideas to ensure everyone's on the same page

SMART goals

Supporting other in their learning i.e. peer education

Using a systematic approach:

Identify, prevent and treat actual or potential causes i.e. ABCDE approach

Using tools in a holistic way

It helps make available evidence more accessible to decision maker

Assessment objective:

Vital signs, BP , CRT, HR, RR, T etc

PEWS score

GCS

urine tests , ECG , X-ray, MRI

Collecting lab results

Touch feel listen

ABCDE assessment

Assessment subjective:

Collecting information through communication i.e. what patient reports

Collecting information through personal evaluation i.e. your own observations

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Nursing diagnosis: shortness of breath and chest pain

Goal: reduce the risk of cardiac problem, reduce the pain

Nursing intervention: monitoring vital signs, cardiac monitor, administer prescribed analgesia, pain assessment tool, oxygen therapy if needed, nebulizer

Rational: helps prevent blood clots from forming in the arteries and help to lower the risk for a stoke or heart attack

Evaluation: monitoring vital signs and assess symptoms, referral to cardiology team.

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Situation: Malcom is a 25-year-old male with a history of depression and anxiety who has expressed suicidal thoughts and intentions.

Background: Malcolm has been struggling with feelings of hopelessness and worthlessness for several months. He has a history of previous suicide attempts and has recently experienced a significant stressor, such as a relationship breakup.

Assessment: Malcom is at high risk for suicide given his history of depression, anxiety, and previous suicide attempts. He may also be experiencing feelings of isolation and lack of support.

Recommendation: Malcom must be immediately assessed by a mental health professional, such as a psychiatrist, to determine the level of risk and develop a safety plan. Malcom should also be connected with local crisis intervention resources, such as a suicide hotline or emergency mental health services. Malcom needs to have ongoing support from mental health professionals, friends, and family members to help him through this difficult time.