Thomas Sykes is a 17-year-old male who lives in an inner-city apartment with his sister Keisha and Keisha’s 3-year-old son, Torrey. His mother passed away 10 years ago from complications associated with uncontrolled diabetes and obesity and Thomas moved-in with Keisha, who became his legal guardian. Thomas has gained 60 pounds in the last year. He is 5 feet, 11 inches and now weighs 240 pounds. He recently changed schools and has not made friends. This unfolding case follows Thomas over several weeks beginning with an initial clinic visit, followed by hospitalization on a psychiatric unit, and concluding with a home visit following discharge.
Thomas’ Introductory Monologue
Thomas reveals that he has been skipping school and spends most of his time alone or with Torrey, playing video games and watching television. He states that “Everyone would be better off without me.”
Simulation Scenario 1 takes place in the clinic. The nurse learns that Thomas has been bullied in school and on social media. Administration of a suicide severity rating tool confirms that Thomas is having suicidal thoughts and has thought of several plans to end his life.
Simulation Scenario 2 occurs one day after Thomas was admitted to an inpatient psychiatric unit. Learners are expected to engage in therapeutic communication and provide information about the medication that has been prescribed to treat his depression.
Simulation Scenario 3 occurs during a home visit two weeks after Thomas is discharged. Learners are expected to interact therapeutically and discuss his diet, medications, and feelings about returning to school.
Finish the Story Assignment
Learners have now seen the Thomas and his family at three snapshots in time. What do they think his life will be like three months from now?
Tonya A. Schneidereith, PhD, CRNP, PPCNP-BC, CPNP-AC, CNE, CHSE-A
University of Maryland, School of Nursing