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The Voice of Nursing Education

Henry and Ertha Williams

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Overview:

Henry Williams is a 69-year-old African American and retired rail system engineer who lives in a small apartment with his wife, Ertha. Henry and Ertha had one son who was killed in the war 10 years ago. They have a daughter-in-law, Betty, who is a nurse, and one grandson, Ty. Henry is concerned about Ertha because she is experiencing frequent memory lapses.

Monologue:

Henry was admitted to the hospital last night after he called the doctor and told him that he could not catch his breath. Henry has several medical problems including COPD, hypertension, and high cholesterol. Henry provides important details of how he views his current life situation.

Simulation Scenarios 1, 2, and 3:

The simulation scenarios focus on the physical and psychosocial changes that Henry encounters over the next few weeks. His failing health and his concern for his increasingly forgetful wife lead him through various transitions that affect his family and his living situation. The objectives focus on assessment and appropriate use of assessment tools such as SPICES, the Geriatric Depression Scale, the Modified Caregiver Strain Index, the Beers Criteria for Potential Inappropriate Medication Use in Older Adults, and the General Anxiety Disorder 7 (GAD-7). The objectives also focus on psychosocial issues with Henry's wife and their daughter-in-law's concern for their living arrangements; the proper use of the SBAR tool and making appropriate community referrals. 

Henry's Introductory Monologue:


Download an audio file

Download the script for the audio file

Download an Instructor Toolkit that contains suggestions for discussion of Henry's monologue

Simulation Scenario 1 takes place a few hours after Henry was admitted through the emergency room with an acute exacerbation of COPD. His O2 saturation has been at 88 percent. He is alert, oriented, and appears depressed. The admission has not been completed due to patient's shortness of breath. His neighbor brought him (and Ertha) in. Their daughter-in-law Betty came to get Ertha because of her problems with confusion. The learners will have cues to report labs and arterial blood gas results to the physician. They will also have cues to address Ertha's confusion. The assessment tools recommended for this scenario include SPICES: An Overall Assessment Tool of Older Adults, The Modified Caregiver Strain Index and The Geriatric Depression Scale. 


Simulation Scenario 2 occurs five days later. Henry is sitting in his wheelchair waiting to be discharged to the rehabilitation center where he will receive pulmonary rehabilitation. He will need teaching, medication reconciliation, and a plan care for his wife Ertha until an assisted living apartment is located and available for both of them. Students will need to use effective communication and use of SBAR to give a complete, safe hand-off report to the nurse at the rehabilitation facility. The assessment tools recommended for this scenario include the Modified Caregiver Strain Index and the Geriatric Depression Scale.


Simulation Scenario 3 takes place 15 days later as Henry is awaiting discharge from the rehabilitation center. He received pulmonary rehabilitation including education on how to pace himself, how to take his medications, when to do his breathing treatments and when to contact the doctor. This scenario will include how Henry, Ertha, and the family have been dealing with the changes in their health and living situation. Betty reveals that she had difficulty dealing with Ertha during the time she stayed with her, but believes things will be fine once Henry and Ertha are together again. She will take them to their assisted living apartment. Learners will review discharge instructions from the rehabilitation center, safety concerns, medications, and the role of the nurse in assisted living facilities. The assessment tools recommended for this scenario include the Transitional Care Model (TCM) and the Hospital Discharge Screening Criteria for High Risk Older Adults.


Finish the Story Assignment:

Learners have now seen Henry at three snapshots in time. What do they think his life will be like three months from now?


Author:

Jeanne Cleary, MA, RN
Professor - Director of Healthcare Simulation
Ridgewater College, Wilmar, MN