Red Yoder is an 80-year-old farmer who lives alone in the farmhouse where he grew up. It is located 20 miles outside of town. Red has been a widower for 10 years. His son Jon manages the farm now, but Red is still involved in the decision making. Red's current medical problems include insulin dependent diabetes complicated by an open foot wound. He also has some incontinence and difficulty sleeping.
Red is awaiting a visit from the home health nurses. He relates that he has an open wound on his big toe that developed after walking in a new pair of shoes. When his daughter-in-law Judy saw the wound, she called the family doctor, who suggested a visit by the wound care nurse who works with the home health agency. Red agreed as long as his VA benefits cover the costs. Red is aware that his son and daughter-in-law have concerns about him living alone, but Red insists that while he needs a little help from Jon and Judy at times, he is still capable of caring for himself.
Simulation Scenarios 1, 2, and 3:
The first scenario occurs in Red's home during a visit by the nurses from the home health agency to assess the breakdown on his toe. During the assessment, Red reveals that he is having problems sleeping and some urgency incontinence. The scenarios depict a variety of situations including a trip to the hospital to rule out sepsis, psychosocial issues such as functional decline, alcohol use, and possible elder abuse.
The objectives focus on general assessment, appropriate use of assessment tools such as SPICES, the Katz Index of Independence in Activities of Daily Living assessment tool; the Pittsburgh Sleep Quality Index (PSQI), the Elder Mistreatment Assessment, and the Alcohol Use and Screening Assessment. In addition conflicts regarding living arrangements are addressed.
Red's Introductory Monologue
Simulation Scenario 1 occurs in Red's home during a visit by the nurses from the home health agency to assess the breakdown on his toe. During the assessment, the nurse discovers that Red is having sleeping problems and some urgency incontinence. He also makes statements that should cue learners that further assessments are needed of his diet, medication, and alcohol use, and to rule out elder abuse. Concerns expressed by the daughter-in-law about his ability to care for himself should prompt learners to use the Katz Index of Independence in Activities of Daily Living assessment tool. Other assessment tools recommended for this scenario include SPICES: An Overall Assessment Tool of Older Adults, the Pittsburgh Sleep Quality Index (PSQI), the Elder Mistreatment Assessment, and the Alcohol Use and Screening Assessment.
Red's second monologue: Occurs two weeks later
Simulation Scenario 2 takes place at the local hospital. Jon stopped by to check on Red after one of his friends from the VFW called to say that Red didn't make it for coffee. The nearest VA hospital is more than 100 miles away and the doctor told him that Red needed to be seen immediately. He is admitted for possible sepsis. The focus of this simulation is an emphasis on the atypical presentation of sepsis in the older adult.
Simulation Scenario 3 occurs five days later when Red is scheduled for discharge from the hospital. Jon thinks that Red should stay with him for now, but Red is sure he is able to care for himself at home as he has always done. Learners will need to determine how much, if any, functional decline has occurred while Red has been hospitalized. The risks and benefits of Red's living arrangements need to be analyzed in collaboration with Jon and Judy and the health care team.
Finish the Story Assignment
Learners have now seen Red at four snapshots in time. What do they think his life will be like three months from now?
Teri Boese, MSN, RN
Director, Simulation Center - International University of Nursing
St. Kitts, West Indies