Nursing Skills Sim Kit: Focus on Geriatric Medication ......+1.715.830.2040 (1055270-01) Nursing Skills Sim Kit: Focus on Geriatric Medication Administration 3 Table of Contents Scenario

Nursing Skills Sim Kit:

Focus on Geriatric Medication

Administration Scenario Guide

Nursing Skills Sim Kit: Focus on Geriatric Medication Administration

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Table of Contents

Scenario Guide Components 4

Scenario Structure 5

Scenario One – Subcutaneous Insulin Administration with Vision and Mobility Impairment 6

Pre-Brief 8

Scenario 12

Debrief 13

Sources 15

Scenario Two – Oral Medication Administration with Vision Impairment 16

Pre-Brief 18

Scenario 22

Debrief 23

Sources 25

Scenario Three – Oral Medication Administration with Mobility Impairment 26

Pre-Brief 28

Scenario 32

Debrief 33

Sources 35


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This Skills Sim Kit will focus on three different scenarios involving geriatric medication administration: evaluating a patient’s ability to self-administer subcutaneous insulin with a vision and mobility impairment; evaluating a patient’s ability to self-administer oral medications with a visual impairment; and evaluating a patient’s ability to self-administer oral medications with a mobility impairment.

Scenario Guide Components The scenario guide is composed of the following components. Approximate times are included.

Scenario Title Approximate Time

One Subcutaneous Insulin Administration with Vision and Mobility Impairment Pre-Brief 20 minutes Scenario 20 minutes Debrief 20 minutes

Two Oral Medication Administration with Vision Impairment Pre-Brief 20 minutes Scenario 20 minutes Debrief 20 minutes

Three Oral Medication Administration with Mobility Impairment Pre-Brief 20 minutes Scenario 20 minutes Debrief 20 minutes Total 3 hours


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Scenario Structure Each Scenario contains an Overview, Pre-brief, Scenario, and Debrief.

Scenario Sections

Each scenario follows the sections described below:

OVERVIEW Each scenario begins with an OVERVIEW of scenario objectives, materials needed, preparation instructions, and a brief patient description.

PRE-BRIEF The PRE-BRIEF activity is intended to capture participants’ attention and prepare them for the scenario. During this activity, participants are introduced to the topic of the scenario.

SCENARIO The SCENARIO activity in each scenario varies in its script and topic. Participants will be playing the role of nurse and patient using simulation products.

DEBRIEF Every scenario ends with a DEBRIEF activity intended to briefly review the scenario’s main points and the feelings of the participants.


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Scenario One – Subcutaneous Insulin Administration with Vision and Mobility Impairment

Scenario Objectives After completing this scenario, participants will be able to: • Verbalize and demonstrate empathy for a patient with a vision and mobility impairment • Evaluate a patient’s ability to self-administer subcutaneous insulin

Scenario Materials

Activity Materials Preparation Approximate

class time

PRE-BRIEF • Subcutaneous Insulin Administration Pre-Brief Student Worksheet

• Subcutaneous Insulin Administration Pre-Brief Student Worksheet – Answer Key

• Subcutaneous Insulin Administration Scenario Guidelines and Expectations

1. Print/photocopy Subcutaneous Insulin Administration Pre-Brief Student Worksheet and Subcutaneous Insulin Administration Scenario Guidelines and Expectations (one per participant)

20 minutes

SCENARIO Skills Sim Kit Component: • Diabetic Retinopathy Glasses • Geriatric Arthritis Simulator • Large Injection Pad • Mock/demo vial of long acting insulin

Environmental Props: • Chair • Table • Subcutaneous syringes/needles* • Alcohol swabs • Hand sanitizer or access to sink • Clean gloves • Sharps container

*May use injection pen

1. Prepare area as stated in the Scenario Setup

20 minutes

DEBRIEF • Subcutaneous Insulin Administration Debrief Instructor Resource

1. Optional: Display questions to students on a projector or print/photocopy Subcutaneous Insulin Administration Debrief Instructor Resource

20 minutes

Scenario Overview The purpose of this simulation is to understand the impact that vision and mobility impairment has on subcutaneous medication administration, and how to evaluate a patient’s ability to self-administer subcutaneous insulin.


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Scenario Roles This scenario is designed to simulate the roles of both nurse and patient. If time allows, the scenario may be repeated and the roles may be reversed for optimal learning of empathy and skill. Assign two students to the following roles:

• Patient

• Nurse

Scenario Setup The setting is in a home. Ensure that there is a sink and/or hand sanitizer available. Position the patient sitting at a table during medication administration. Place the Diabetic Retinopathy Glasses and Geriatric Arthritis Simulator on the patient. Have insulin and supplies placed on the table.

Patient Description Name: Mr./Mrs. Taylor Brown (title based on preferred gender of student in patient role)

Age: 85

History of Present Illness: Mr./Mrs. Taylor Brown is a home care patient who has diabetic retinopathy and arthritis. They were recently seen in the ER, where it was found that they had not been taking their 10 units of long-acting insulin on a regular basis. A home care agency has been asked to evaluate Mr./Mrs. Brown’s ability to self-administer subcutaneous insulin.


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Pre-Brief 20 minutes

Purpose:

To gain empathy for the adult acute care patient and practice the skill of ambulation.

Materials:

• Subcutaneous Insulin Administration Pre-Brief Student Worksheet

• Subcutaneous Insulin Administration Pre-Brief Student Worksheet – Answer Key

• Subcutaneous Insulin Administration Scenario Guidelines and Expectations

Facilitation Steps:

1. Distribute the Subcutaneous Insulin Administration Pre-Brief Student Worksheet to participants prior to the scenario. You can also have them complete the pre-brief independently prior to the day of scenario.

2. Review answers to the Subcutaneous Insulin Administration Pre-Brief Student Worksheet.

3. Review the Subcutaneous Insulin Administration Scenario Guidelines and Expectations for the scenario.

4. Orient participants to the scenario area and products.

5. Assign the roles designated in the scenario.

6. Set the patient up with Diabetic Retinopathy Glasses and Geriatric Arthritis Simulator. Have the patient sit in chair next to table.

7. Give the scenario report to both students before beginning scenario.


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Name: _____________________________________ Class: ___________________________

Subcutaneous Insulin Administration Pre-Brief Student Worksheet

Complete the scenario preparation questions.

1. What is diabetic retinopathy?

a. Intraocular pressure

b. Damage to blood vessels in the eye

c. High sugar levels in the eye

d. Disease of the lens

2. Which of the following tasks would someone with diabetic retinopathy have difficulties with?

a. Driving at night

b. Reading

c. Fine motor activities

d. All of the above

3. What is osteoarthritis caused by?

a. Autoimmune disorder

b. Injury

c. Deteriorated cartilage

d. Lyme disease

4. Which of the following impact medication management at home?

a. Hand dexterity and grip strength

b. Cognition and vision

c. Cardiac and digestive health

d. A and B only


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Subcutaneous Insulin Administration Pre-Brief Student Worksheet – Answer Key







a. Driving at night

b. Reading


d. All of the above



b. Injury


d. Lyme disease





d. A and B only


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Subcutaneous Insulin Administration Guidelines and Expectations

(Based on the INACSL Standards of Best Practice: Professional Integrity)

When you come to the simulation, please be:

• Organized and prepared

• Accountable for one’s role and responsibilities

• Collaborative, supportive, nonintimidating, and respectful

• Able to share expertise and/or experiences in a safe, nonjudgmental manner

• Calm, compassionate, and creating a sense of trust

• Honest, mindful, and sensitive to cultural differences and ethical issues related to the simulation-based experience

• Aware of a safe learning environment

It is important that you follow the standards of practice, principles, and ethics of your profession.

Roles

You will be assigned the role of either the patient or the nurse. As the patient, you are to gain empathy for those with a vision and mobility impairment through the scenario. As the nurse, you are to evaluate your patient’s ability, with a vision and mobility impairment, to self-administer subcutaneous insulin. This includes correct prompting and education.

Confidentiality Agreement

This simulation requires confidentiality of the performances and scenario content. By signing below, I agree to be a participant in this simulation. I understand that the content of this simulation is to be kept confidential to maintain the integrity of the learning experience. I also understand that it is unethical for me to share information in any way regarding student performance with persons outside this simulation.

Name (printed) ______________________________ Signature ______________________________


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Scenario 20 minutes

After assigning roles, read the following report to students.

Report: Mr./Mrs. Taylor Brown (title based on preferred gender of student in patient role) is an 85-year-old home care patient who has diabetic retinopathy and severe arthritis. They were recently seen in the ER where it was found that they had not been taking their 10 units of long-acting insulin on a regular basis. A home care agency has been asked to evaluate his/her abilities to self-administer subcutaneous insulin. Today, a nurse is visiting to evaluate how they prepare and administer insulin and to identify any possible issues. This is a mock demonstration of self-administration. Injections will be done on the injection pad.

Allow students time to gather their thoughts before starting. Remind students not to prompt one another and to stay within their roles. The “patient” is to follow the “nurse’s” directions and may discuss what he/she is feeling. The “nurse” is to assist the “patient” with their insulin administration.

Note: The scenario should be paused if any real-life safety issue occurs. Once the issue is addressed, the scenario can continue. Roles can be reversed so that both students can experience the simulator.

Scenario Events and Expected Actions: State Event Expected Actions of Patient Expected Actions of Nurse

One Introduction • Acknowledges nurse • States identifiers

• Knocks, washes hands • Identifies self • Explains purpose for presence • Identifies patient

Two Drawing up Insulin

• Follows nurse’s prompts • Attempts to draw up correct amount

• Prompts patient to draw up 10 units of long acting insulin

• Watches how patient draws up the insulin

Three Insulin Administration

• Follows nurse’s prompts • Attempts to administer insulin

correctly into the injection pad

• Prompts patient to administer the insulin • Watches for issues with insulin administration

Four Closing • May thank nurse • Thanks the patient for demonstration • Asks if anything else is needed before leaving • Leaves patient safe • Washes hands before leaving


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Debrief 20 minutes

Purpose:

To reflect on and discuss the scenario experience.

Materials:

• Subcutaneous Insulin Administration Debrief Instructor Resource

Facilitation Steps:

1. Review debriefing rules • Confidentiality

• Scenarios are to be kept confidential to maintain the integrity of the learning experience

• It is unethical to share information in any way regarding student performance with persons outside the scenario

• Safe space • This is a safe, non-discriminatory

learning environment for constructive feedback

2. Work through the debriefing questions on the Subcutaneous Insulin Administration Debrief Instructor Resource as a group.

3. Praise the students for their efforts.


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Subcutaneous Insulin Administration Debrief Instructor Resource

Group Questions 1. Describe the objectives that you were able to achieve.

2. Which objectives were you unable to achieve (if any)?

3. Which objectives did you do well?

4. If you were able to do this again, how would you handle the situation differently?

Patient Questions 1. How did you feel throughout the simulation experience?

2. What part of the simulation was the most challenging?

Nurse Questions 1. How did you feel throughout the simulation experience?


Ending Questions 1. What are your main take-away points of this simulation?

2. Is there anything else you would like to discuss?


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Sources

Coyne, K. S., Margolis, M.K., Kennedy-Martin, T., Baker, T.M., Klein, R., Paul, M.D., Revicki, D.A. (2004). The impact of diabetic retinopathy: perspectives from patient focus groups. Family Practice. 21(4): 447-453.

Craven, R. F. (2017). Fundamentals of Nursing: Human Health and Function. Wolters Kluwer.

International Nursing Association for Clinical Simulation and Learning (2016). INACSL Standards of Best Practice: Simulation. Retrieved from https://www.inacsl.org/inacsl-standards-of-best-practice-simulation/

https://www.inacsl.org/inacsl-standards-of-best-practice-simulation/


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Scenario Two – Oral Medication Administration with Vision Impairment

Scenario Objectives After completing this scenario, participants will be able to: • Verbalize and demonstrate empathy for a patient with a vision impairment • Evaluate a patient’s ability to self-administer oral medications

Scenario Materials

Activity Materials Preparation Approximate class time

PRE-BRIEF • Oral Medication Administration Pre-Brief Student Worksheet

• Oral Medication Administration Pre-Brief Student Worksheet – Answer Key

• Oral Medication Administration Scenario Guidelines and Expectations

1. Print/photocopy the Oral Medication Administration Pre-Brief Student Worksheet and Oral Medication Administration Scenario Guidelines and Expectations (one per participant)

20 minutes

SCENARIO Skills Sim Kit components: • Medication Management Sim Kit • Diabetic Retinopathy Glasses Environmental Props: • Chair • Table • Hand sanitizer/sink

1. Prepare area as stated in the Scenario Setup

20 minutes

DEBRIEF • Oral Medication Administration Debrief Instructor Resource

1. Optional: Display questions to students on a projector or print/photocopy the Oral Medication Administration Debrief Instructor Resource

20 minutes

Scenario Description The purpose of this simulation is to understand the impact that vision impairment has on medication administration and how to evaluate a patient’s ability to self-administer oral medications.


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• Patient

• Nurse

Scenario Setup The setting is in a home. A sink and/or hand sanitizer should be by the entrance to the patient’s room. The patient will be positioned sitting at a table during medication administration. Place the Diabetic Retinopathy Glasses on the patient. Have the nurse bring in the geriatric medication kit.

Patient Description Name: Mr./Mrs. Drew Davidson (title based on preferred gender of student in patient role)

Age: 87

History of Present Illness: Mr./Mrs. Drew Davidson is a home care patient who has diabetic retinopathy. They were recently seen in the ER, where it was found that they had not been taking their medications on a regular basis. A home care agency has been asked to evaluate his/her abilities to self-administer oral medications.


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Purpose:

To understand the impact that vision impairment has on medication administration and how to evaluate a patient’s ability to self-administer oral medications.

Materials:

• Oral Medication Administration Pre-Brief Student Worksheet



Facilitation Steps:

1. Distribute the Oral Medication Administration Pre-Brief Student Worksheet to participants prior to the scenario. You can also have them complete the pre-brief independently prior to the day of scenario.

2. Review answers to the Oral Medication Administration Pre-Brief Student Worksheet.

3. Review the Oral Medication Administration Scenario Guidelines and Expectations for the scenario.

4. Orient the participants to the scenario area and products.


6. Set the patient up with the Diabetic Retinopathy Glasses and have the patient sit in chair next to table.

7. Give the scenario report to both students before beginning the scenario.


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Name: ___________________________ Class: ___________________________

Oral Medication Administration Pre-Brief Student Worksheet







2. What is are symptoms of diabetic retinopathy?

a. Shadows in vision from specks floating in the eye

b. Cloudy and blurry vision

c. Infection causing redness

d. Loss of sight in one eye


a. Driving at night

b. Reading


d. All of the above

4. What percentage of people with diabetes develop diabetic retinopathy?

a. 1-15%

b. 20-45%

c. 50-85%

d. 80-95%


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Oral Medication Administration Pre-Brief Student Worksheet – Answer Key






2. What are some of the symptoms of diabetic retinopathy?

a. Shadows in vision from specks floating in the eye

b. Cloudy and blurry vision

c. Infection causing redness

d. Loss of sight in one eye


a. Driving at night

b. Reading


d. All of the above

4. What percentage of people with diabetes develop diabetic retinopathy?

a. 1-15%

b. 20-45%

c. 50-85%

d. 80-95%


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Oral Medication Administration Scenario Guidelines and Expectations











Roles

You will be assigned either the patient or nurse role. As the patient, you are to gain empathy for those with a vision impairment. As the nurse, you are to evaluate your patient’s ability, with a vision impairment, to self-administer oral medications.





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Scenario 20 Minutes

After assigning roles, read the following report to students.

Report: Mr./Mrs. Drew Davidson (title based on preferred gender of student in patient role) is an 87-year-old home care patient who has diabetic retinopathy. They were recently seen in the ER, where it was found that they had not been taking their medications on a regular basis. A home care agency has been asked to evaluate their abilities to self-administer oral medications. Today, a nurse is visiting to evaluate how Mr./Mrs. Davidson takes their medications and to identify any issues. This is a mock demonstration of self-administration. No pills are actually being taken.

Allow students time to gather their thoughts before starting. Remind students not to prompt one another and to stay within their roles. The “patient” is to follow the “nurse’s” directions and may discuss what he/she is feeling. The “nurse” is to assist the “patient” with taking their medications.





Two Sets up Medications

• Follows nurse’s prompts • Figures out what medications

to take and how many

• Prompts patient to set up medications • Watches how patient sets up medications

Three Medication Administration

• Follows nurse’s prompts • Removes caps from bottles

and counts out pills to take

• Prompts patient to open bottles and take out correct number of pills

• Watches for issues with medication preparation

Four Closing • May thank nurse • Thanks the patient for demonstration • Asks if anything else is needed before leaving • Washes hands before leaving • Leaves patient safe


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Debrief 20 minutes

Purpose:


Materials:

• Oral Medication Administration Debrief Instructor Resource

Facilitation Steps:




• Safe space • This is a safe, non-discriminating


2. Work through the debriefing questions on the Oral Medication Administration Debrief Instructor Resource as a group.



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Oral Medication Administration Debrief Instructor Resource












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Sources

Coyne, K. S., Margolis, M.K., Kennedy-Martin, T., Baker, T.M., Klein, R., Paul, M.D., Revicki, D.A. (2004). The impact of diabetic retinopathy: perspectives from patient focus groups. Family Practice. 21(4): 447-453.






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Scenario Three – Oral Medication Administration with Mobility Impairment

Scenario Objectives After completing this scenario, participants will be able to: • Verbalize and demonstrate empathy for a patient with a mobility impairment • Evaluate a patient’s ability to self-administer oral medications

Scenario Materials

Activity Materials Preparation Approximate class time

PRE-BRIEF • Oral Medication Administration Pre-Brief Student Worksheet



1. Print/photocopy Oral Medication Administration Pre-Brief Student Worksheet and Oral Medication Administration Scenario Guidelines and Expectations (one per participant)

20 minutes

SCENARIO Skills Sim Kit Component: • Geriatric Medication Management Sim Kit • Geriatric Arthritis Simulator

Environmental Props: • Chair • Table • Hand sanitizer/sink

1. Prepare area as stated in Scenario Setup 20 minutes

DEBRIEF • Oral Medication Administration Debrief Instructor Resource

1. Optional: Display questions to students on a projector or print/photocopy the Oral Medication Administration Debrief Instructor Resource

20 minutes

Scenario Description The purpose of this simulation is to understand the impact that mobility impairment has on medication administration and how to evaluate a patient’s ability to self-administer oral medications.


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• Patient

• Nurse

Scenario Setup The setting is in a home. A sink and/or hand sanitizer should be available. The patient will be positioned at a table during medication administration. Place the Geriatric Arthritis Simulator on the patient. Have the nurse bring in the Geriatric Medication Management Sim Kit.

Patient Description Name: Mr./Mrs. Kelly Barrons (title based on preferred gender of student in patient role)

Age: 77

History of Present Illness: Mr./Mrs. Kelly Barrons is a home care patient who has severe arthritis. They were recently seen in the ER, where it was found that they had not been taking their medications on a regular basis. A home care agency has been asked to evaluate their abilities to self-administer oral medications.


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Purpose:

To understand the impact that mobility impairment has on medication administration and how to evaluate a patient’s ability to self-administer oral medications.

Materials:

• Oral Medication Administration Pre-Brief Student Worksheet



Facilitation Steps:

1. Distribute the Oral Medication Administration Pre-Brief Student Worksheet to the participants prior to the scenario. You can also have them complete the pre-brief independently prior to the day of scenario.

2. Review answers to the Oral Medication Administration Pre-Brief Student Worksheet.

3. Review the Oral Medication Administration Scenario Guidelines and Expectations for the scenario.

4. Orient the participants to the scenario area and products.


6. Set the patient up with the Geriatric Arthritis Simulator and have them sit in a chair next to the table.

7. Give the scenario report to both students before beginning the scenario.


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Name: ___________________________ Class: ___________________________

Oral Medication Administration Pre-Brief Student Worksheet




b. Injury


d. Lyme disease

2. What is are symptoms of osteoarthritis?

a. Joint pain and stiffness

b. Increased flexibility

c. Deformed joints

d. Bone weakness

3. Which of the following tasks would someone with arthritis have difficulties with?

a. Picking up a pill on a flat surface

b. Opening a screw cap bottle

c. Popping a pill out of a blister pack

d. All of the above





d. A and B only


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Oral Medication Administration Pre-Brief Student Worksheet – Answer Key



b. Injury


d. Lyme disease

2. What is are symptoms of osteoarthritis?

a. Joint pain and stiffness

b. Increased flexibility

c. Deformed joints

d. Bone weakness

3. Which of the following tasks would someone with arthritis have difficulties with?

a. Picking up a pill on a flat surface

b. Opening a screw cap bottle

c. Popping a pill out of a blister pack

d. All of the above





d. A and B only


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Oral Medication Administration Scenario Guidelines and Expectations











Roles

You will be assigned either the patient or nurse role. As the patient, you are to gain empathy for those with a mobility impairment. As the nurse, you are to evaluate your patient’s ability, with a mobility impairment, to self-administer oral medications.





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Scenario 20 minutes

Prior to beginning the scenario (but after assigning roles), read the following report to students.

Report: Mr./Mrs. Kelly Barrons (title based on preferred gender of student in patient role) is a 77-year-old home care patient who has severe arthritis. They were recently seen in the ER, where it was found that they had not been taking their medications on a regular basis. A home care agency has been asked to evaluate Mr./Mrs. Barrons abilities to self-administer oral medications. Today, a nurse is visiting to evaluate how they take their medications and to identify any issues. This is a mock demonstration of self-administration. No pills are actually being taken.

Allow students time to gather their thoughts before starting. Remind students not to prompt one another and to stay within their roles. The “patient” is to follow the “nurse’s” directions and may discuss what he/she is feeling. The “nurse” is to assist the “patient” with learning to take their oral medications.





Two Sets up Medications

• Follows nurse’s prompts • Figures out what medications

to take and how many

• Prompts patient to set up medications • Watches how patient sets up medications

Three Medication Administration

• Follows nurse’s prompts • Removes caps from bottles

and counts out pills to take

• Prompts patient to open bottles and take out correct number of pills

• Watches for issues with medication preparation

Four Closing • May thank nurse • Thanks the patient for demonstration • Asks if anything else is needed before leaving • Washes hands before leaving • Leaves patient safe


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Debrief 20 minutes

Purpose:


Materials:

• Oral Medication Administration Debrief Instructor Resource

Facilitation Steps:




• Safe space • This is a safe, non-discriminatory


2. Work through the debriefing questions on the Oral Medication Administration Debrief Instructor Resource as a group.



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Oral Medication Administration Debrief Instructor Resource












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Sources

Beckman, A., Bersten, C., Parker, M. G., Thorslund, M., & Fastbom, J. (2005). The difficulty of opening medicine containers in old age: a population-based study. Pharmacy World and Science. 27(5): 393-8.




Documents

Nursing Skills Sim Kit: Focus on Geriatric Medication ......+1.715.830.2040 (1055270-01) Nursing Skills Sim Kit: Focus on Geriatric Medication Administration 3 Table of Contents Scenario