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Updated: 4/2015

Sig Collins (Palliative Care) Simulation:


Student Copy (Level IV) – Group Simulation

Learning Objectives
1. Assess a patient in palliative care, including utilizing standard assessment tools.
2. Prioritize appropriate interventions based on clinical findings.
3. Utilize SBAR format when communicating with other health care providers.
4. Implement all required cares in a safe manner.
5. Evaluate care given.
6. Identify a primary nursing diagnosis for this patient.
7. Document all assessments, patient changes, and interventions.
8. Lead the discussion of a simulated care experience.

Prior to the Simulation:


1. Review the Edmonton Symptom Assessment System: Numerical Scale (Attached Below).
2. Review the FICA Spiritual History Tool (Attached Below).
3. Review the medication list and be familiar with medications ordered.
4. Bring a copy of the Simulation Clinical Intervention Worksheet to lab.

5. In addition, please review the references below on care of a patient in palliative care.
a. Nursing Drug Handbook
b. Ackley & Ladwig. (2014). Nursing Diagnosis Handbook.
c. Textbook Medical-Surgical Nursing. (Chapter 24)
d. WHO pain ladder: http://www.who.int/cancer/palliative/painladder/en/
e. Pain algorithm: http://www.intelli-card.com/photos/Pain.pdf
f. Equianalgesia: http://www.vhpharmsci.com/VHFormulary/Tools/Equianalgesic-dosing.htm
g. Spirituality in Cancer Care (PDQ ®) read through all sections of this PDQ:
http://www.cancer.gov/cancertopics/pdq/supportivecare/spirituality/HealthProfessional/page
1
h. Sleep Disorder (PDQ ®) read through all sections of this PDQ:
http://www.cancer.gov/cancertopics/pdq/supportivecare/sleepdisorders/Patient/page1
i. Edmonton Symptom Assessment System: http://www.racgp.org.au/silverbookonline/4-1.asp
j. Center for Spirituality and Healing: Overview of Mind Body Therapies, Healing Touch,
Spirituality in Healthcare: http://www.csh.umn.edu/modules
k. Palliative Care http://uptodate.com/contents/hospice Hospice: Philosophy of care and
appropriate utilization on the United States
http://www.cancer.org/research/survivaltreatmentresearch/palliative-care-research
l. Colostomy Care http://www.cancer.org/acs/groups/cid/documents/webcontent/002823-
pdf.pdf and http://www.cancer.gov/cancertopics/types/colorectal
m. Depression http://www.cancer.gov/cancertopics/pdq/supportivecare and
http://www.cancer.gov/cancertopics/pdq/supportivecare/depression/Patient/page3
Updated: 4/2015

What to Expect:

Students will perform in a variety of roles.

Groups will include 6 students (1 Patient, 2 family members, Primary and Secondary nurse, and 1
recorders).

 Complete the Hospice and Palliative Care Worksheet (Provided during lab)

1. Pre-briefing
a. Complete the Clinical Intervention Worksheet during report.
2. Simulation
a. You will be assuming care of Sig Collins. Students will be expected to perform all
pertinent physical and psychosocial assessments and interventions. Students will also
perform a FICA spiritual assessment, the Edmonton palliative care symptom assessment
which includes a sleep assessment, and provide for a patient in palliative care.
b. Simulation roles will be assigned and then students will complete the simulation,
incorporating the universal competencies. Please note: For simulation alone, students will
perform skills expected of a graduate nurse, e.g. calling the physician, receiving orders, etc.;
however, this does not change the expectations or limitations of the nursing student while in
the actual clinical setting.
3. Debriefing
a. The instructors will debrief the simulation with the students as a group.
b. Discuss the Nursing Process and Hospice and Palliative Care Worksheet.
Updated: 4/2015

North Hennepin Medical Center 101


7411 85th Ave No. Collins, Sig 099377-1
Brooklyn Park, MN 55445 3/24/XX Age 76
763-424-0759 Barbara White, MD
Edmonton Symptom Assessment System:
Numerical Scale
Regional Palliative Care Program

Please circle the number that best describes:

No pain 0 1 2 3 4 5 6 7 8 10 Worst
9 possible pain
Not tired 0 1 2 3 4 5 6 7 8 10 Worst
9 possible
tiredness
Not 0 1 2 3 4 5 6 7 8 10 Worst
nauseated 9 possible nausea

Not depressed 0 1 2 3 4 5 6 7 8 10 Worst


9 possible
depression
Not anxious 0 1 2 3 4 5 6 7 8 10 Worst
9 possible anxiety
Not drowsy 0 1 2 3 4 5 6 7 8 10 Worst
9 possible
drowsiness
Best appetite 0 1 2 3 4 5 6 7 8 10 Worst
9 possible appetite
Best feeling of 0 1 2 3 4 5 6 7 8 10 Worst
wellbeing 9 possible feeling
of wellbeing
No shortness 0 1 2 3 4 5 6 7 8 10 Worst
of breath 9 possible
shortness of
breath
Other 0 1 2 3 4 5 6 7 8 10
problems 9

Date_____________________________________ Time__________________________________
Completed by (check one)
Patient
Caregiver
Family

http://www.palliative.org/PC/ClinicalInfo/AssessmentTools/esas.pdf
Updated: 4/2015

North Hennepin Medical Center 101


7411 85th Ave No. Collins, Sig 099377-1
Brooklyn Park, MN 55445 3/24/XX Age 76
763-424-0759 Barbara White, MD

FICA Spiritual History Tool : The FICA Spiritual History Tool was developed by Dr. Puchalski and a group
of primary care physicians to help physicians and other healthcare professionals address spiritual issues with
patients. Spiritual histories are taken as part of the regular history during an annual exam or new patient visit, but
can also be taken as part of follow-up visits, as appropriate. The FICA tool serves as a guide for conversations in
the clinical setting. The acronym FICA can help structure questions in taking a spiritual history by healthcare
professionals.

F – Faith and Belief

Do you consider yourself spiritual or religious?" or "Do you have spiritual beliefs that help you cope with stress?"
If the patient responds "No," the health care provider might ask, "What gives your life meaning?" Sometimes
patients respond with answers such as family, career, or nature.
________________________________________________________________________
________________________________________________________________________
_______________________________________________________________________
I – Importance

"What importance does your faith or belief have in our life? Have your beliefs influenced how you take care of
yourself in this illness? What role do your beliefs play in regaining your health?"
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
C – Community

"Are you part of a spiritual or religious community? Is this of support to you and how? Is there a group of people
you really love or who are important to you?" Communities such as churches, temples, and mosques, or a group
of like-minded friends can serve as strong support systems for some patients.
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
A – Address in Care

"How would you like me to address these issues in your healthcare?"


________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
The George Washington Institute for Spirituality and Health (GWish) Warwick Building, Suite 313, 2300 K
Street NW, Washington, DC 20037 Telephone: (202) 994-6220 | Fax: (202) 994-6413 | Email: caring@gwish.org
Updated: 4/2015

Student Nurse:____________________________________ Simulation Clinical Intervention Worksheet


Date 0700 0800 0900 1000 1100 1200 1300 1400

Pt Initials Vital Signs Vital Signs Daily wt.


Age O2 Sats O2 Sats Bath
Room Pain score Pain score Linen change
Wt IV IV IV IV IV IV IV IV Repositioning
Diagnosis Drains and Tubes
Clear pump (NG/GT, Foley, CT, JP etc)
Empty/mark/
record drainage
I/O I/O I/O I/O I/O I/O I/O I/O Totals
Meds: Y / N Meds: Y / N Meds: Y / N Meds: Y / N Meds: Y / N Meds: Y / N Meds: Y / N Meds: Y / N
Diet Need med cards Reassess after Pain meds Attach 24 hour List of meds

Review risk
scores:
Braden_____
IV Falls_____
Other cares

Allergies

Precautions
EMR √ ___ Hygiene ___ Re √ Focused Report to
H→T ___ ADL's ___ Labs √ New orders co nurse-Post
MD Equip √___ Tx ___ √ New orders √Your charting conference
Pertinent Lab: End of shift report
Nurses Note ___
(pre-approved)
Education PF ___
Update POC ___

Priority of Care THIS shift: Students should have at least hourly contact with staff nurse assigned to the
patient.

Beginning of Shift Report/Notes:


Updated: 4/2015

Scheduled & PRN Medications (Note time to be administered on timeline)

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