DEMENTIA

Setting Rural Community Health Clinic

Patient

You are a 79 year old woman who lives on her own. You have one son who lives in the
city who helps you when he can. Recently he has paid for a gardener and a cleaning lady
to visit you regularly. He has also arranged for a neighbour to do your shopping. You
have come to ask the community health nurse who knows your family for help because
you are having a real problem with all these helpers but won’t want to complain to your
son. You are finding life very difficult because the cleaning lady is obviously hiding and
taking things and putting others in the wrong place. Your neighbour claims to have
bought groceries that you can never find. When you complain she says that you forget
where you put them. The gardener is obviously stealing lots of your tools and claims to
have come when you know he hasn’t.

Task

• Explain to the nurse that you are finding it more and more difficult to cope
because these people are taking advantage of you.
• Say you have got to a point where you don’t like to go out yourself because
nothing seems the same and sometimes you get lost.
• Admit that you are a bit forgetful but insist that the real problem is the people
who are supposed to be helping you.
• Answer the nurse’s questions as best you can.
• Finally agree to her suggestion to contact your son.

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Setting Rural Community Health Clinic

Nurse

A 79 year old woman who lives in your community has come to see you. You
have known her and her son for several years and are concerned by how she
appears to have aged recently and seems very agitated. You also know that the
people her son arranged to help her are completely trustworthy. You want her to
agree to let you contact her son as soon as possible to explain her situation to
him.

Task

• Be sympathetic and understanding of her problems.

• Ask if there are any others things that are making her life difficult –
does she think her memory is not as good as it used to be.
• Ask if she is eating well and cooking for herself without difficulty.
• Stress that you know her son cares for her and would want to be
informed of her present situation.
• Ask her permission to phone him so that he can help with finding a
solution to make her life easier.
 COMPLAINT AGAINST HOSPITAL STAFF

Setting Private Hospital

Patient

You are Sonia Afleck, a young married woman who had an emergency appendectomy
last night. Twice during the night you pressed the nurses call bell for assistance. On the
first occasion you needed pain relief and it took at least 20 minutes before anyone
answered the call. On the second occasion you needed assistance to go to the toilet. You
rang the call bell but because of the delay in response you were forced to struggle to the
toilet yourself. When the nurse finally arrived she reprimanded you for getting out of bed
unassisted. You are upset and angry and want to be discharged today. You ask to see
the nurse manager.

Task

• Express anger at the poor response to you calls for assistance and at the
attitude of the nurse who reprimanded you.
• Claim you would be better off at home where you mother and husband would
look after you.
• Agree that there are occasions there may be problems with fully staffing a
busy surgical ward but that does not excuse nurse reprimanding you.
• Admit you still require regular pain relief and help in walking.

_____________________________________________________________________

Setting Private Hospital

Nurse

You are the nurse manager of a very busy surgical ward. There were four emergency
operations last night. Due to a flu epidemic the night shift was understaffed so less
experienced on-call nursing staff filled in. On your morning round you check on Sonia
Afleck who had an emergency c-section appendectomy last night. She is upset and angry
about the poor nursing care she has received. She wants to be discharged today.

Task

• Ask about what happened to upset her.

• Explain the ward’s staffing situation last night.
• Address her anger at nurses.
• Discuss her present condition and usual hospital recovery time.
• Explain why it would not be in her interests to be discharged today, especially
without consultation with her surgeon.
 EAR ABSCESS

Setting Children’s Hospital ward

Patient

The patient is your three year daughter Elizabeth. She is being admitted
to hospital for treatment of an ear abscess. This is the first time your child
has been in hospital and you are anxious about how she will manage. You
can’t be at the hospital all the time as you have two other children aged
Joan aged 5 and Sam aged 7. The nurse has requested information about
your daughter’s normal routine at home.

Task

• Explain your concerns to the nurse.

• Answer the nurse’s questions about your daughter’s routine. Give
a brief answer. Wait for the nurse to ask further questions.
• Ask about the flexibility of visiting hours.

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__________

Setting Children’s Hospital ward

Nurse

Elizabeth, a three year old girl has come with her mother to be admitted
with an ear abscess. Her mother is anxious about how she will settle in.
You need information about the child’s normal routine and habits to
prepare a nursing care plan.

Task

• Reassure the mother about the care Elizabeth will receive.

• Ask whether she has any siblings she usually plays with at home .
• Ask about her normal routines at home
o Usual bedtime – morning or afternoon sleep?
o Food preferences – able to feed herself?
o Is she fully toilet trained?
o Has she brought any favourite toys or books with her?

• Outline visiting hours – 11am – 8pm but stress that overnight

stays are possible in a special visiting room.
 HEAD LICE

Setting Community Health Clinic

Patient

You are the mother of three children aged 3, 4, 6. You have just
discovered your 6 year old daughter has head lice. You are upset and
embarrassed as you always wash the children’s hair regularly. You have
never encountered this problem before.

Task

• Respond to the nurses questions.

• Ask about any natural remedies you can use as you don’t like
chemicals.
• Ask about whether your other children will be infected also.

________________________________________________________

Setting Community Health Clinic

Community Nurse

A young woman, the mother of three children aged 3, 4, and 6 has come
to the clinic and tells you she has just discovered her eldest daughter has
head lice. She is upset and embarrassed and assures you she always
washes the children hair regularly. She has no experience in dealing with
the situation as it has never happened before.

Task

• Reassure the mother and explain that head lice are contagious
and anyone no matter how regularly they wash their hair can get
head lice.
• Suggest the mother contact any school or kindergarten her
children attend as it quite probable other children are also
affected.
• Recommend and explain the use of a head lice comb.
• Suggest the mother visit the local pharmacy to obtain a herbal
product with natural (non chemical) pyrethrins.
• Say that because head lice spread when people play, cuddle or
work together, it is important to check the whole family.
• Offer to provide the client with a detailed leaflet on treating and
controlling head lice.
 JAUNDICE BABY

Setting Maternity Hospital Ward

Patient

You are an 18 year old mother who delivered a baby boy 3 days ago
without complication. It is your first baby. He is slightly underweight at
2.7kg. He is breast feeding but during the last 24 hours, he has not been
feeding well. He is sleepy and becoming jaundiced. You were supposed to
be discharged home today but the nurse recommends that you stay. You
want to return home as soon as possible as you don’t like hospitals and
you have not been sleeping well. You had a friend whose baby was
jaundiced and she did not need to stay in hospital for treatment.

Task

• Ask the nurse if it is possible to go home today.

• Explain that you really prefer to be at home instead of hospital.
• Ask for information about jaundice. What causes it?
• Be anxious about the side effects of the treatment for jaundice.

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Setting Maternity Hospital Ward

Nurse

Your patient is an 18 year old girl who has just delivered a baby boy 3
days ago. The baby is healthy but a little underweight at 2.7 kg and has
become jaundiced. He is breast feeding but for the last 24 hours, he has
not been feeding well. Your patient would like to be discharged today as
was originally planned but you recommend that she stays until a blood
test is taken and the results are known, in case her baby needs treatment
for the jaundice.

Task

Give the patient information and advice on the condition. You may like to
include some of the following points:

• That the patient and baby should stay in hospital longer.

• Why a blood test is necessary.
• What causes jaundice in new born babies.
• How common is it and how serious.
• What treatment will be needed if the blood results are higher
than normal.
 MYOCARDIAL INFARCTION

Setting Hospital Ward

Patient

You are a 42 year old male who arrived at the hospital via ambulance 10
days ago after suffering from acute sub-sternal chest pain radiating to left
arm. You have been diagnosed with myocardial infarction. You are a
businessman, married with 3 children. Your condition is now stable,
however, you are restless and worried that you will have to make big
changes to your lifestyle. Seek reassurance from the nurse.

Task

• Express nervousness about future health.

• Ask if all the medications are necessary.
• Will you be able to work soon?
• Express concern that it will be hard to make changes to your
lifestyle.
• Request advice about suitable diet/ exercise routine.

___________________________________________________________
Setting Hospital Ward

Nurse

Patient is a 42 year old male who arrived at the hospital via ambulance 10
days ago after suffering from acute sub-sternal chest pain radiating to left
arm. Patient has been diagnosed with myocardial infarction. Patient is a
businessman, married with 3 children. His condition is now stable,
however, he appears restless and worried about his condition. He is
overweight and is a smoker. He has high blood pressure.

Task

• Provide comfort and stress the importance of a gradual transition

back to normal life.
• Reassure the patient that he can expect a full recovery if he
follows doctor’s advice.
• Discuss importance of taking medications regularly.
• Discuss the importance of giving up smoking.
• Provide advice on what assistance is available to assist in quitting
smoking.
• Provide advice on suitable diet and exercise.
• Discuss importance of regular rest periods between activities.
• Respond to patient questions and provide reassurance
 POOR NUTRITION

Setting State School

Parent

You are Leanne Wilson, a sole parent with three children - Ronnie aged 8, Dexter
aged 12 and Marie aged 14. The school nurse has asked you come to the school
at 9.30 pm to discuss concerns about Ronnie’s general health. You know recent
school reports indicate he visited the school nurse frequently last term
complaining of tiredness and headaches. You work Monday – Friday, 7am –
2.30pm at a local factory. Although you are worried about Ronnie you are upset
about taking time off work to come to the school this morning. It means your
pay will be reduced. You would have preferred to come after work around 3pm.
You rely on Marie to get herself and her brothers ready for school. Often they
don’t have time for breakfast.

Task

• Explain the work problems caused by having to come up to the school

this morning.
• Acknowledge that you have been a bit worried about Ronnie
complaining about tiredness and headaches at school. You work hard
and go to bed early. The kids when they are tired. Generally they
watch a bit of TV.
• Say that Ronnie seems to be OK at home after he has a bowl of coco
pops and some soft drink when he gets home in the afternoon.
• Point out you leave for work at 6.30am so can’t be responsible for
getting breakfast for the family.

___________________________________________________________
Setting State School

Nurse

You are the school nurse at a State School. Ronnie Wilson aged 8 has been sent
to you quite frequently after school commences complaining of tiredness and
headaches. He sparks up after a rest and some milk and biscuits. You suspect he
is regularly missing out on breakfast although he says his older sister always
looks after him well because his mother has to go to work. You have made an
appointment for Ms Wilson to come to your office at 9.30 today.

Task

• Explain why you arranged the appointment.

• Ask about Ronnie’s general health.
• Ask about family routines in relation to meals and bed times.
• Discuss importance of a proper diet including a nourishing breakfast
and suggest how this might be achieved.
• Make an appointment for a follow-up visit.
 POST-SURGERY ACTIVITY

Setting Hospital Ward

Patient

You are Harry Jones aged 78. You are a bachelor who lives on his own.
You were admitted to hospital to have a large lesion removed from your
back. You know you’ll be discharged in the next few days but meantime
you want to make the most of the rest and the hospital food. You want
the nursing staff to leave you in peace but a nurse says its time to get up
and have a shower. You are feeling quite cranky.

Task

• Point out that you will be home in a few days and there will be
plenty of time to shower then.
• Explain that at your age you need rest not exercise.
• Argue that a shower will only wet the dressing on your shoulder.

___________________________________________________________
__________

Setting Hospital Ward

Nurse

Your patient, Harry Jones aged 78, is in hospital after surgery to remove
a large lesion from his back. He is recovering well and you want him to
get up and walk about and to have a shower. You have observed that he
has neglected his personal hygiene and appearance.

Task

• Encourage the patient to have a shower, wash his hair and

generally get cleaned up. Be tactful as he can be quite cranky if
he doesn’t want to do something.
• Say you will place a waterproof dressing over the lesion area.
• Stress the importance of exercise and good hygiene in ensuring a
speedy recovery.
 RHEUMATOID ARTHRITIS

Setting Suburban Health Clinic

Patient

You are a 45 year old male who has had rheumatoid arthritis. Your hands,
wrists, knees and feet are swollen and hurt all the time. The pain wakes
you up at night when you try to roll over. You also have a rash which is
itchy and therefore you seek advice regarding a change of medication.
You have come to the clinic today for evaluation and recommendations.
You have a physical job which is becoming harder to do due to your
condition.

Task

• Explain your current symptoms.

• Inquire about possible change in medication due to rash.
• Demonstrate concern about ability to work.

___________________________________________________________
__________

Setting Suburban Health Clinic

Nurse

Mr David Watts is a 45 year old male who has had rheumatoid arthritis for
5 years. Was seen by the doctor for generalised skin rash due to side
effect of medication and asked to return in one month. He has come to
the clinic today for evaluation and recommendations. Examination reveals
mild rash and inflamed joints.

Task

• Elicit patients current condition.

• Explain that the mild rash is not uncommon with this medication,
and stress that patient should continue with medication in order
to control the arthritis and reduce inflammation.
• Explain importance of regular rest and avoidance of strenuous
activities and exercise until symptoms reduce.
• Recommend moisturiser to ease itchiness cause by rash.
 VACCINATION

Setting Children’s Hospital Ward

Patient
You are a the parent of a young boy aged 4 who was admitted through
the Children's Emergency Department for acute meningoencephalitis as a
result of a complication following mumps. He has fully recovered and is
ready to be discharged home. You are unaware that a vaccine is available
in Australia which protects against mumps. You would like further
information and guidance regarding vaccinations. You also have a 2 year
old son and have only lived in Australia 6 months. You are concerned
because some people say that vaccinations are dangerous.

Task

Ask the following questions:

• Has your child has fully recovered?

• What vaccinations are available?
• What are the advantages & disadvantages of vaccinations?
• Are there any side effects from the vaccination?
• Are they expensive?

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Setting Children’s Hospital Ward

Nurse
A young boy aged 4, was admitted to hospital through the Children's
Emergency Department for acute meningoencephalitis as a result of a
complication following mumps. He has fully recovered and is ready to be
discharged home. His parents are unaware that a vaccine is available in
Australia which protects against mumps. They would like further
information and guidance regarding vaccination for Mumps. They also
have a 2 year old son and have only lived in Australia 6 months.

Task

Explain to the parent:

• That the boy has fully recovered.

• The importance of a full vaccination program for both children.
• What vaccination is required for mumps and when to have it.
• The risks and benefits of the vaccination for mumps.
• Explain any side effects that might occur from the vaccination.
• That vaccination is a requirement of many schools.
• That vaccinations can be obtained from free health clinics.