Carel Mountain

Carel Mountain

GIFTS workshop

March 23, 2011

Rationale: To connect classroom content with worksite learning through the use of an ongoing case study format.

Description:

Case studies have long been the basis of providing clinical (or worksite) application of in class learning. Students participate, often reluctantly, in case study presentations.

This is the idea behind Sean Palmer, fourth semester nursing student, and ongoing case study persona. Sean Palmer is introduced in the first week of the class during the clinical application of Redirecting Angry Patients Successfully. Each subsequent case study builds on the next with Sean (or his family and close friends) having experiences that take the class material and apply it to real life situations. Sean’s first experience has him as the patient and the students are the nurses at Way Big Psychiatric Hospital. By the final scenario, Sean is back in school and a friend from prerequisites who is in the Dental Hygiene program has some serious mental issues. Throughout the scenarios the student is asked to make decisions about the care they are providing Sean or about how he should handle the situation (when he is the student nurse). By the end of the semester the students feel like they know Sean (not only through description but his picture is up on a Power Point slide in the classroom during the exercise). Many of them can relate to Sean’s experiences. These case studies provide the opportunity to discuss how to handle different situations, the decision making involved, and possibly provide additional tools that they can use in the clinical area.

This activity takes about 15 to 20 minutes and is used at the wrap up of the class period. The basis is taking what is learned in the classroom and applying it to real life or work situations.

Processing:

The instructor should have the students work in groups of two to three to answer the questions at the end. Once the students have sufficiently worked on the questions (about 5 minutes) the students are instructed to read the story out loud with popcorn reading. When the first set of questions is reached the teachers should direct the discussion so that students can share their answers and discuss the thinking and reasoning that led to those answers. There may not be a consensus within the group but this may assist them in clarifying their own thinking or way of interacting . Continue with this process until the activity is completed.

Shasta College

REGN 33

Mental Health Scenario II

It’s Friday night shift and you have been floated from the In-Patient Psychiatric Unit to the Crisis Intervention/ Psych ER at Way-Big General Hospital. The emergency department seems very busy and you remember that it is a full moon. Just after midnight a patient is brought in by his family and you recognize him from being on your unit previously. The patient is Sean Palmer, a 28 year old male fourth semester nursing student. Sean had his first break when he was assigned to go the Shock Trauma ICU at Mercy for his first rotation.

He is now at the psych emergency room after witnessing a shooting during his clinical rotation. While taking care of a patient on the STICU a family member came in wielding a gun and threatening to kill all of the nurses. In the process of subduing the family member the gun went off and the patient was killed. Sean was the student nurse assigned to the patient.

Initially following the incident Sean seemed to be fine. He attended class on Wednesday and Thursday but failed both of his online exams. By Friday he was speaking with garbled speech and was frightened of going out of his home. When asked by his fellow students if he was alright he responded “I am just jittery. I will be fine once I am back in clinical.”

In what order would the following need to occur?

______Validate that he has had a traumatic experience

______Recognize that he is in crisis mode

______Talk to Sean about how he has coped in the past

______Be aware of your own feelings that may be generated

A few weeks later Sean returns to the STICU where he immediately begins to perspire profusely. He is having difficulty concentrating on his patient and is unable to do even the simplest skills. He returns to the Psych ER. Rank the order of the following interventions for Sean:

______take him to see ______understand that his

his crisis counselor usual coping mechanisms are failing

______have him take a PRN ______Try to establish

rapport

Shasta College

REGN 33

Mental Health Scenario V

Sean Palmer, a nursing student in REGN 33/34, is attending his first clinical day at Crestwood Treatment Center. Sean has grown up in the Shasta Area and attended Shasta Union High School where he was active in swimming and music activities. Sean is looking forward to his rotation at Crestwood after a somewhat stressful clinical rotation at MMC. He arrives and is assigned a patient and then attends morning meeting. After the meeting Sean is hanging out in the day room when realizes that he sees someone he recognizes from high school. Matthew Phillips, a schizophrenic who has been on at Crestwood for the past three weeks, was a member of the swim team with Sean. They were in the same graduating class and had been casual friends. Matthew is standing with the other patients waiting for the smoke break to begin. He has grown a mustache but Sean is positive that this is the same person who was on the swim team with him.

Sean would like to talk to Matthew but doesn’t really know how to handle the situation. Which would be most appropriate at this point?

_____ Speak with the Team Leader _____ Go over and talk with Matthew

_____ Call the instructor _____ Look in Matthew’s chart to

see what brought him here

Later in the day, Sean attends the same group with his patient. This happens to be the same group that Matthew is in. During the group Matthew appears to be whispering to himself and casting furtive glances over his shoulder. Matthew always wears his red hood no matter what he is doing or where he is going. The staff had discussed this at morning meeting and stated that Matthew has delusions that the aliens are sending messages to him continually. Matthew believes that as long as he is wearing his red hood those messages can’t get through. The messages from the Aliens are often negative in nature and have instructed Matthew to become very destructive in the past. Matthew sees Sean during the group sessions and gives him a nod of recognition.

After group Matthew comes up to Sean and says “Hey, don’t I know you?” How should Sean respond?

When Sean comes back for his second day at Crestwood, Matthew seeks him out to talk. He says the matter is urgent and confidential. Matthew confides to Sean that he is receiving messages from the Chief Alien in charge telling him to cut himself. Sean knows that Matthew has made a previous suicide attempt based on other alien messages. Matthew tells Sean “My hood just isn’t working. What should I do?”

Decide on a plan of action for Sean and be prepared to defend your answer.