Comfort care and family concerns
HardBereavement Support for Daughter After Mother's Passing
Setting: Hospital ward. Your role: Ward Nurse
You are speaking with Ms Laura Bennett, daughter of Mrs Joan Bennett, who passed away peacefully in the ward last night at 82 years old. Ms Bennett is visibly distressed and has approached you with practical questions, but also seems to need emotional support.
- Acknowledge the profound loss of Ms. Bennett's mother, Mrs. Joan Bennett, directly and without minimising the impact of her recent passing.
- Permit Ms. Bennett to express her emotions freely, maintaining a supportive presence and offering silence rather than immediate solutions.
- Answer any practical questions Ms. Bennett raises regarding immediate arrangements, such as contacting the funeral director or collecting personal belongings, briefly and concretely.
- Offer specific resources like the hospital's bereavement counselling service and details for a local grief support group named 'Hope's Anchor', explaining their purpose.
- Leave the door open for future support by suggesting a follow-up phone call in two days or another meeting on the ward next week, providing a specific contact method.
Practise this cardSocial support during recovery
MediumPost-hip-replacement fatigue and social isolation
Setting: Patient's home. Your role: Community health nurse
You are a Community Health Nurse visiting Mr. George Wilson, 72, who is recovering at home after a hip replacement surgery six weeks ago. Your routine follow-up visit aims to assess his physical progress, but he has mentioned feeling unusually tired and isolated, impacting his motivation for rehabilitation exercises.
- Greet Mr. Wilson and confirm the purpose of today's visit, specifically acknowledging his recent mention of fatigue and feelings of isolation.
- Gather a focused history regarding his fatigue, including onset, duration, severity, impact on daily activities, and any associated symptoms. Inquire about his social interactions and daily routine.
- Clarify his current mobility levels, pain management, sleep patterns, and dietary intake, linking these to potential causes of fatigue and isolation.
- Explain the likely causes of his persistent fatigue and feelings of isolation, relating them to his post-surgical recovery and reduced social engagement. Propose a collaborative plan to address both his physical recovery and social support needs.
- Confirm Mr. Wilson's understanding of the plan and his willingness to participate in suggested strategies, such as connecting with local support groups or modifying his rehabilitation schedule.
Practise this cardAnika's Asthma: Second Opinion on Cat Trigger
Setting: Hospital ward. Your role: Paediatric Ward Nurse
Mr. Ravi Patel, father of 10-year-old Anika, has approached you for a second opinion regarding his daughter's asthma management. Anika was recently treated for a wheezing episode. He is questioning the previous doctor's advice that their family cat, Mittens, is the primary trigger.
- Acknowledge Mr. Patel's right to seek a second opinion about Anika's asthma triggers and reassure him that it is a normal and valid concern.
- Refrain from judgement or critical remarks about the previous clinician's assessment or recommendations regarding Anika's potential asthma triggers.
- Review and discuss Anika's recent wheezing episode, her current symptoms, her inhaler technique, and potential environmental triggers beyond pet dander, such as pollen.
- Share an independent assessment of Anika's asthma triggers and management, providing a balanced perspective on the likelihood of pet dander versus other factors, and reinforcing correct inhaler usage.
- Support Mr. Patel's ultimate decision on how to proceed with Anika's asthma care, ensuring he feels informed and empowered, whether he decides to investigate triggers further or adhere to the current plan.
Practise this cardSupporting a person with dementia
MediumDischarge Planning for Mrs. Shah with Dementia
Setting: Community health centre. Your role: Community Health Nurse
Your patient, 85-year-old Mrs. Asha Shah, who has dementia, was recently discharged from hospital after treatment for a urinary tract infection (UTI) which significantly worsened her confusion. Her daughter and primary carer, Ms Priya Shah, is at the community health centre to discuss her mother's ongoing care at home, as she is feeling overwhelmed.
- Confirm Ms. Shah's understanding of her mother's recent UTI and how it has impacted her dementia symptoms.
- Review Mrs. Shah's current medication list, including the new antibiotic (Ciprofloxacin 250mg twice daily for 7 days) and her regular Donepezil 5mg daily, and identify specific red flags for infection recurrence or worsening dementia.
- Coordinate appropriate community support services for Mrs. Shah at home, considering Ms. Shah's full-time work schedule and her mother's needs.
- Arrange a follow-up appointment for Mrs. Shah with the geriatrician or community nurse within one week to monitor her progress.
- Set a clear safety-net plan, including who to contact (e.g., GP, emergency services) if Mrs. Shah's condition rapidly deteriorates (e.g., severe confusion, falls) and what immediate steps Ms. Shah should take.
Practise this cardPostnatal mood and support
HardPostnatal Support and Cultural Modesty Request
Setting: Community health centre. Your role: Community health nurse
Ms Chloe Evans, a 31-year-old new mother, presents to the community health centre 3 weeks postpartum due to significant tearfulness and poor sleep, often only getting 2-3 hours of broken sleep. Your primary goal is to assess her postnatal mood and provide appropriate support, while also addressing a specific cultural request she may have regarding the gender of her clinician.
- Listen — to Ms Evans' request for a female nurse, without interrupting or making assumptions about her cultural background or the reasons behind it.
- Understand — the cultural context of Ms Evans' modesty concerns after childbirth with genuine curiosity, asking open-ended questions to learn more about her personal beliefs without judgment.
- Assess — the clinical feasibility of accommodating Ms Evans' request for a female nurse, considering staff availability and the urgency of her symptoms of tearfulness and 2-3 hours of sleep.
- Propose — a specific accommodation or compromise, such as arranging for a female nurse if available, or suggesting a female support person to be present during the consultation if a female nurse is not immediately available, to ensure she receives timely care for her postnatal symptoms.
- Confirm — with Ms Evans that the proposed accommodation is acceptable to her, ensuring she feels heard, respected, and comfortable proceeding with the assessment of her postnatal mood and sleep difficulties.
Practise this cardPain control after surgery
MediumPost-Cholecystectomy Pain Management Discussion
Setting: Pre-admission clinic. Your role: Pre-admission clinic nurse
Ms. Laura Bennett, 38, is scheduled for a cholecystectomy (gallbladder removal) next week. She has expressed concerns about managing pain after her previous C-section, which she found very difficult. She is here today to discuss post-operative pain control strategies.
- Greet Ms. Bennett and confirm her reason for visiting the pre-admission clinic today regarding post-operative pain concerns.
- Gather a focused history regarding her previous pain experience after her C-section 5 years ago, including the type, severity, duration, and what helped or didn't help.
- Clarify her current understanding of pain management options and any specific concerns she has about mobility or breathing exercises post-surgery.
- Explain the multi-modal pain management plan for her upcoming cholecystectomy, including regular analgesia, nerve blocks, and the importance of early mobilisation and deep breathing exercises, in patient-accessible language.
- Confirm Ms. Bennett's understanding of the plan and agree on next steps, such as who to contact if she has further questions before surgery.
Practise this cardVaccination benefits and concerns
HardShingles Vaccine for Warfarin Patient: Second Opinion
Setting: Community vaccination clinic. Your role: Community health nurse
Ms Priya Shah, daughter and carer for her 85-year-old mother, Mrs Asha Shah, has come in for a second opinion. Mrs Shah's GP recommended the Shingles vaccine, but Priya is concerned because her mother takes Warfarin and she found conflicting information online about injections and bleeding risks.
- Acknowledge Ms Shah's right to seek a second opinion and reassure her that it's a responsible approach to her mother's care.
- Withhold any judgment or criticism regarding the previous GP's advice, focusing instead on the clinical facts.
- Review the clinical question with Ms Shah, discussing the specific concerns about her mother's age, Warfarin use, and the Shingles vaccine.
- Share an independent assessment of the Shingles vaccine's suitability for an 85-year-old patient on Warfarin, providing clear reasoning based on current guidelines.
- Support Ms Shah's ultimate decision about her mother's vaccination, ensuring she feels empowered and confident in her choice.
Practise this cardBlood thinner safety
MediumWarfarin Adherence Review
Setting: Hospital ward. Your role: Registered Nurse
Ms Priya Shah (36), a primary school teacher, was discharged 5 days ago after a DVT diagnosis and started on Warfarin 5mg daily. She is back for a follow-up blood test and her INR result indicates inconsistent medication intake. You need to address this with her.
- Explore Ms Shah's reasons for inconsistent Warfarin intake since discharge, without judgment, to understand the specific barriers she's facing.
- Validate the challenges Ms Shah has experienced with her new medication regimen while gently reinforcing the critical importance of consistent Warfarin use for DVT prevention.
- Co-design a revised, practical plan for taking Warfarin daily, incorporating Ms Shah's existing daily routine and addressing her identified barriers (e.g., using a pill organiser, linking to an existing habit).
- Safety-net what Ms Shah should do if she struggles to follow the new Warfarin plan or experiences any unexpected side effects like increased bruising or bleeding.
- Schedule a specific follow-up phone call in 3 days to check on her adherence to the revised Warfarin plan and assess any concerns.
Practise this card
