Clinical scenarios

Pain assessment video transcript

Facilitator: Hello there. My name is Sue Wong – I’m a registered nurse. I’m one of the facilitators at UTS. You’ll be watching a role-play, and it’s a typical scenario that you may experience when you go out on clinical placement. You’ll be watching an interaction between myself, the student, and the patient; so hopefully, when you watch the video, you’ll gain something from it. Take it with you when you go out on your clinical placement, and enjoy and have fun.

Student: Hi, my name is Raza Zahidi. I’m a third year nursing student. I’ll be role-playing a first year nursing student, so hopefully you’ll pick up some ideas about how to communicate with patients and other nurses.

Patient: I am Jeannette Bryant. I am in hospital after having a knee replacement.

Husband: My name is Raymond Bryant. I’m here to see my wife, Jeannette, to see how she’s going.

Student: Hello Mrs Bryant.

Patient: Good morning, how are you?

Student: Good, how are you?

Patient: Not too bad thank you.

Student: My name is Raza Zahidi; I’m a first year student from UTS. I’m working with my facilitator today. We’ll be looking –

Facilitator: Hi –

Patient: Good morning –

Facilitator: – my name is Sue Wong.

Patient: – and I’m Jeannette.

Facilitator: Hello Jeannette.

Patient: Good morning, nice to meet you.

Student: We’re going to be looking after you today.

Patient: Thank you.

Student: Lovely flowers you’ve got there!

Patient: Aren’t they nice?

Student: [to Husband] Did you get them for her?

Patient: Yes. [Husband nods]

Student: How sweet! I understand that  you’ve had a knee replacement?

Patient: That’s right.

Student: How’s that going?

Patient: Not too bad.

Student: Yes?

Patient: Yes.

Student: OK; I’m just going to ask you just routine questions about your knee. Have you been experiencing any pain?

Patient: Yes.

Student: Yes?

Patient: Mmm. [nods]

Student: So it’s just on your knee, is it?

Patient: Yes.

Student: Yes, OK. So with a scale of zero to ten, ten being the worst pain you’ve ever experienced, what would you rate that?

Patient: I think, umm, round about a six.

Student: About a six, OK. Well, it seems like it’s a bit of a pain – umm, when did you first start getting it?

Patient: When I got back in bed after being up yesterday, it started to, you know –

Student: OK, OK – and what kind of – how would you describe the pain?

Patient: It’s around the knee, and when I move it, it’s quite severe.

Student: OK – that’s right.

Patient: I think I need something for it really.

Student: Yes, OK. How would you describe it? Generally people describe it, you know, into categories as either dull, or aching, or throbbing. How would you describe that?

Patient: I’d say ‘aching’ – you’re aware of it.

Student: OK, we’re going to have a look at what we can do for you. The physio’s going to come around later, and they’re probably going to get you to walk around, do a bit of exercises with the knee, OK, and we’ll see what we can do with the pain relief.

Facilitator: We’ll have a – we’ll have a look on your medication chart to see what the doctor has ordered for you.

Patient: Right.

Facilitator: OK, he’s ordered Panadol, or – umm – Panadeine Forte. Which one would you prefer?

Patient: I think the way it is at the moment, I need Panadeine Forte.

Facilitator: Alright then. OK, we’ll go and get that for you – we won’t be too long.

Patient: Alright.

Facilitator: Have you got hold of your buzzer there?

Patient: I think so – could you pass it to me please, Ray? Thank you.

Facilitator: So yes, just, just call if you need us in the meantime –

Patient: Alright.

Facilitator: – but we’ll go and get it, and we won’t be too long.

Patient: OK, thank you.

Facilitator: OK.

Student: Thank you.

--

Facilitator: OK, now the patient has requested for Panadeine Forte for her knee – for the pain in her knee –

Student: Right.

Facilitator: – so the order is for Panadeine Forte, one tablet, and it’s been signed, and it’s printed, doctor’s print , OK?

Student: OK.

Facilitator: Caroline here, she’s a registered nurse, so when you check out a medication from a drug cupboard, you must have two registered nurse – nurses – or enrolled endorsed nurse to check out the medication with you, OK?

Student: Yes, yes.

SRN: So what do you know about Panadeine Forte, Razia (sic)?

Student: Umm, all I know is, it’s an analgesic.

SRN: Uh-hmm [nods].

Student: Yes.

SRN: So if you wanted to find out more about a drug that you’re giving to a patient, where would you go to find that information?

Student: I’d use the MIMS.

SRN: Do you want to have a look at it, see what you can find out while we’re getting the drug out of the cupboard?

Student: Sure, yes.

SRN: I’m going to look it up in this book, which is the Schedule 4 book, which is the  book that you sign the medications out, so we keep an eye on how many drugs are being given and where they’re going to, so ‘cos they’re sort of, like –

Student: OK.

SRN: – ones we want to be careful with.

Student: I’ll just have a look what it exactly does. OK, so it’s an analgesic and anti-pyretic for moderate and severe pain.

SRN: Do you know what an antipyretic is?

Student: Umm – for fever?

SRN: Uh-hmm [nods].

Student: Yes.

SRN: Perfect, good. OK.

Student: So we’ve got the adverse side-effects are GI upset, constipation, drowsiness.

SRN: Yes –

Student: Yes.

SRN: – so when you give it to her, maybe if constipation is one of the big problems with Panadeine Forte, so you might want to talk to her a little bit about how to deal with that when you give it to her. Anyway, so Sue’s got the drug now, so let’s have a look.

Facilitator: OK, so I need to check it with Caroline. Panadeine Forte – expires twelfth, twenty-twelve, OK?

SRN: Uh-hmm – and the order – Panadeine Forte, one tablet, Dr. Chang, due now.

Facilitator: Yes. I’m going to give her one tablet.

Student: Uh-hmm.

Facilitator: So what we need to do is to make sure that the balance adds up.

SRN: And with the book I was showing you before, you just find the page, Panadeine Forte, and it’ll tell you how many there are in the cupboard. So there’s twenty-nine in the cupboard here, so we’re going to check that now, and then we’re going to check it after we’ve taken one out, to make sure that the balance is correct.

Student: Alright.

Facilitator: So we’ve got – [with SRN] – one, two, three, four, five, six, seven –

Facilitator: – plus one is twenty-nine – taking one.

Student: We need a medication cup.

SRN: So we might get you to write in this book in a minute, but have you used one of these before?

Student: I have, yes.

SRN: OK, so they’re a bit tricky sometimes with funny-shaped tablets.

Facilitator: That’s one tablet.

SRN: One tablet, yes.

Facilitator: One tablet. Counting it again.

SRN: OK – [with Facilitator] – one, two, three, four, five, six, seven –

SRN: – which is twenty-eight tablets.

Facilitator: Twenty-eight.

SRN: OK –

Student: I’ll write it down.

SRN: – we just need to do one more check, which is against the medication chart.

Facilitator: So, Panadeine Forte, OK? Panadeine Forte – Mrs Bryant – twenty twenty-twelve. That’s wonderful.

SRN: Beautiful.

Student: Yes.

SRN: So just fill in –

Student Just the date?

SRN: – yes, and the time, and then her full name.

Student: That’s Jeannette Bryant.

SRN: Yes, and then you just fill out the ‘Amount Given’ column – so we’re just giving her one. You can either write ‘one’ or ‘five hundred milligrams’, because it’s a five hundred milligram tablet.

Student: OK, and there’s twenty-ni … twenty-eight left now.

SRN: Twenty-eight left now, and you just need to write the doctor’s name who’s prescribed it in that column there.

Student: So that’ll be Dr. Chang?

SRN: Uh-hmm, Dr. Chang. Perfect.

Student: OK.

SRN: And I’m the witnessing person, so I’m going to sign there.

Facilitator: And I’m the one who’s giving it, so… there we go.

Student: OK.

SRN: And we can go and see her.

Facilitator: Thank you.

Student: Great.

SRN: Great.

Facilitator: Thanks, Caroline.

---

Facilitator: Hello Jeannette, we’re back with your Panadeine Forte.

Patient: Oh, thank you very much for that.

Facilitator: Caroline Hayes, who’s one of the registered nurses on the ward, she’s with me because we need to check the medication out with two nurses, umm, so, yes – so what we’ve got here…

Student: OK.

Facilitator: We’ve got Panadeine Forte –

SRN: Panadeine Forte, yes, five hundred milligrams – are you going to check – would you like to check her name?

Student: Yes, sure. We’re just going to ask you a few questions before we give you your medication; is that alright?

Patient: Yes, yes.

Student: OK, would you be able to tell me your full name?

Patient: Jeannette Bryant.

Student: Jeannette Bryant, yes, and your date of birth please?

Patient: The tenth of the second, thirty-two.

Student: Excellent. Are you allergic to anything?

Patient: Yes, penicillin.

Student: Excellent, OK, so…

Facilitator: Can we have a look at your ID band as well?

Patient: Yes.

SRN: Sorry, I’ve just got to lean over you a little bit to see –

Patient: That’s alright.

Facilitator: Jeannette Bryant – Jeannette Bryant – tenth of the second, nineteen thirty-two.

SRN: MRN double oh one, double oh one two – double oh one, double oh one two – perfect!

Facilitator: OK, now I’ve got the tablet over here – did you want to sit up a little bit?

Patient: Yes –

Facilitator: Yes?

Patient: – good, thank you.

Student: The water.

Facilitator: OK – have you got it?

Patient: Yes thanks – thank you. That’s right, thanks.

Facilitator: Did you get that down?

Patient: Mmm, yes.

Facilitator: Alright then, perfect. OK, well we’ll come back in about half an hour to maybe forty-five minutes, to see whether that Panadeine has worked for you.

Patient: Alright.

Faciltator: OK? So in the meantime, if there’s any other questions, or any concern that you many have, you just give us a call on the buzzer.

Patient: Yes, alright –

Facilitator: Can you reach…?

Patient: I’ve got, I’ve got the buzzer here. Thank you.

SRN: OK. Do you want to sign?

Facilitator: Yes.

SRN: Thanks, Mrs Bryant. See you, Mr Bryant.

Facilitator: There we go.

Student: OK.

Patient: Thanks a lot.

Student: Thank you.

Patient: Bye.

---

Student: Hi Jeannette, hello.

Patient: Hello.

Student: Now it’s been about thirty minutes – I’m just checking up on you.

Patient: Uh-hmm.

Student: Yes, how’s the pain going now?

Patient: It seems to be going a little bit better than what it was.

Student: Ah, that’s good, that’s good, yes. Just going to ask you a few questions again, and, yes, umm – with the pain, from a scale of zero to ten, what would you rate it now?

Patient: I’d say it’s gone down to about two.

Student: About two? Oh that’s great , yes.

Patient: Yes, yes.

Student: So we’re going to have the physio coming around pretty soon –

Patient: Right.

Student: – yes,  so that should help a lot, yes.

Patient: Oh good. I’ve had this … some constipation, though.

Student: Have you now, OK.

Patient: I was just wondering if it was the medication causing that.

Student: Yes, the medications sometimes do that as well, in particular with this medication, but generally it’s other factors as well, like, you know, lying down for too long, not moving around – yes, so if you have a bit more water and drink more, we’re going to speak to the dietician to have some more fibre in your food. That should help then, OK? Is there anything else you’d like?

Patient: No, not just yet thank you. I can always ring the buzzer.

Student: Great, OK, we’ll be out there if you need us.

Patient: Alright, thank you very much, both of you.

Facilitator: You’re welcome.

Preoperative checklist video transcript

Facilitator: Hi, my name is Flavia D’Souza. I’m a clinical facilitator for UTS. In this scenario, I’m facilitating Gloria as she completes a preoperative checklist for her patient.

Student: Hi, my name is Gloria Gomez. I’m a second year nursing student. In this scenario, I will be playing a role as a first year nursing student. A patient is going to have shoulder surgery tonight, and I will be checking the preoperation checklist.

Patient: I’m Tom Williams. I was playing soccer this morning, part of a competition. I’m doing pretty well – I was thinking of going for first grade one day – and someone just trips me. I go down hard, and I hit my shoulder and – look, I’m in the ambulance, I end up in hospital, and they tell me I’ve broken it, and it’s a bad one, and I needed surgery on it to get it fixed. It’s – it’s a disaster. I’ve missed the game; I’m probably going to miss the rest of the season. I’m worried it’s not even going to heal right, and maybe that’s the end of it for me. Like, I don’t want to be in hospital – I just want to go home.

Facilitator: Hey Gloria, how are you going?

Student: Hey, well thanks. How are you?

Facilitator: I’m good, thank you. What are you doing today? Who are you looking after?

Student: I have three patients at the moment. I’ve got one which is more interesting, because he’s going to surgery today, this afternoon.

Facilitator: OK, what surgery is he going for?

Student: He’s going to, let m… it’s a shoulder, it’s a shoulder surgery.

Facilitator: OK, so what are you doing for him?

Student: Well, I have to do the preoperative checklist, and – yes, I’m not, I’m not pretty sure if I can do it by myself.

Facilitator: You did it with me a couple of times before and you really well. You asked the right questions, and you were able to explain everything to the patient. I think you can do it by yourself, and then we can discuss it later on.

Student: Ah, OK, that could be good.

Facilitator: Did you have any questions?

Student: Yes, actually I got it, I got one question – sometimes, the last time when we did it, it was with a woman, so it is easier to ask if she have makeup on or she doesn’t, but he’s a man –

Facilitator: Yes, yes…

Student: – I don’t know if actually I can ask him.

Facilitator: You see, some things are quite obvious. We can assess it for ourselves, if you’ve got makeup on or not. If not, you can take it as he doesn’t have makeup on.

Student: Ah right, OK.

Facilitator: But those that you can’t see, you need to ask him-

Student: OK.

Facilitator: – those things that you can’t see.

Student: Yes? OK.

Facilitor: Alright?

Student: That’s fine.

Student: OK.

Facilitator: OK. Alright then, I’ll see you later.

Student: So OK, see you later. OK, bye bye. Thanks.

---

Student: Hello Mr Williams. My name is Gloria Gomez; I’m a nursing student, first year, from UTS. I’m here at the moment for doing the pre-operation checklist for you. As long as I know, you were explained that you will be, you will be in a surgery today.

Patient: Yes, they told me.

Student: Do you have any other questions about this surgery, or is it everything clear for you?

Patient: When are we going to get on with it? I’ve been here all day, waiting.

Student: As long as I know – just let me check – your surgery is going to be at 6pm today. Umm – so, at the moment now I’m going to do a preoperative checklist, which is going to be a little bit of questions, and sometimes they are going to be uncomfortable for you, but just think that I’m going to do all this in order to have a good outcome in your surgery. OK?

Let me check your arm aid (sic) please. Can I have your full name, please?

Patient: Tom Williams.

Student: Your date of birth?

Patient: Still the first of the first nineteen-ninety – like it was the last time you asked!

Student: Yes, I know – it’s a little bit boring when someone asks you every five minutes your date of birth, but it is very important for us to always verify that we are working and we are doing the procedures with the right patient. Umm, yes, it’s something that we have to do, and I know it annoys everyone, but it, it’s for your own good.

OK, so do you have – what time did you have your last food at?

Patient: Breakfast this morning, I guess.

Student: Breakfast – umm, what time was it?

Patient: It would be – nine?

Student: Nine. What about your last drink?

Patient: Well I was drinking water at the game, that’d be eleven, I reckon.

Student: Eleven. OK. As long as I see, you don’t have glasses – what about contact lenses, do you have any –

Patient: No.

Student: – contact lenses? No? Hearing aid?

Patient: No.

Student: No. Good. Sorry about this question, but do you have any artificial limbs or prostheses?

Patient: No!

Student: Any denture?

Patient: No!

Student: No. OK, have you voided?

Patient: What?

Student: Passed urine? Have you passed urine today?

Patient: Yes, this morning.

Student: This morning. OK. I’m going just to check if you have prepared your operation site. I’m not going to do any painful thing for you – I’m going to try to do everything very slowly, like very careful of everything, OK? I’m just going to have a look, if you doesn’t mind. Uh-hmm, that’s great. OK, thank you. Umm - do you have any jewellery? Rings?

Patient: No.

Student: Can I have a look of your nails? Do you have any nail polish?

Patient: No!

Student: No, that’s fine. OK, have you had your shower today, after the…?

Patient: Yes, I’ve had my shower.

Student: OK. That’s pretty much it – do you have any comments, any questions, any enquiries to …?

Patient: When do I get to go home?

Student: Oh, that’s a – that’s a tough question now. I can’t – I’m not able to answer it to you; as long, the only thing I can tell to you now is your surgery is going to be at six, and you will be in recovery for up to all night, and yes, the doctor’s coming tomorrow to check how is everything going and he will be able to tell you what time are you going home, or if you are not leaving tomorrow.

Patient: Yes.

Student: OK? Do you have any other questions?

Patient: Why do I have to get this surgery? I’ve broken it before and they just put it in a cast, that was it.

Student: Yes, I know, I know this is a little bit tough, and you had a fracture before and it was healed just with cast, but this fracture’s a little bit more complex, so you need to really be fixed. Umm – the only way to fix this is not a cast, it is a surgery, so that’s why the surgery is going to be. Umm – we’ll be here when you come back from surgery; we’ll be always looking after you. You will be fine – you’ll be in the bed as always, and yes, we’ll be doing the best, our best, for you, all the time.

Patient: Alright.

Student: Yes do you have any more questions?

Patient: That’s – that’s fine.

Student: So do you have your buzzer there?

Patient: Yes.

Student: OK – and also, I’m afraid you can’t have anything to drink or to eat until six o’clock.

Patient: What, not even a glass of water?

Student: Not even a glass of water, I’m so sorry about that. That is because when – you will be exposed to a surgery which is with general anaesthetic, so you will be – all your muscles will be relaxed. So that all the – because of your muscles are relaxed, also your epiglottis is going to be relaxed. The epiglottis is the muscle which is in charge; it’s like, let’s say, like a cup – like a top – which doesn’t allow the food to go through the airways. So you can have like a choke, or any other risk in your surgery, while you are there. That’s why we are being advised to let you know that you are not able to have any drink or any food at all, until six. I’m so sorry about that – I know it’s a little bit complicated, but if you feel uncomfortable, or your mouth is dry, I will be happy to bring you some mouthwash –

Patient: No! I’ll be fine thanks!

Student: – so that you can… You will be fine? OK! OK, so if you have any question, anything, just let me know, OK?

Patient: I’m fine.

Student: OK, bye.

---

Facilitator: Maria, how did you go? I was watching you from there.

Student: Oh, yes, I think I did well – I’m not quite sure, but … yes …

Facilitator: What did you think you did well, and what … yes?

Patient: I think the most challenging aspect in this situation, it was to deal with this patient which was in a very bad mood –

Facilitator: Uh-hmm.

Student: – so I didn’t know what to do, how to talk to him – how to empathise with him – because he was a little bit dry, like –

Facilitator: I think you did quite well in the situation that you were in, and seeing you were doing it for the first time, I think you did well, but as you keep doing it, you will develop more therapeutic communication skills, and you’ll be able to, umm, help him come out with how he’s feeling by just empathising with him and asking, saying, ‘oh, I understand you’re feeling really bad today’, and you know? But you did quite well there. What else did you have any problems with?

Student: Actually, I think I did well asking a couple of questions, but I didn’t know how to ask him about limbs, artificial limbs and dentures, and –

Facilitator: Yes, yes –

Student: – some stuff which is a little bit like, intimidating the patient – he, maybe he feels that – he felt that I was intimidating him, asking  him for dentures, or maybe prostheses, or…

Facilitator: Yes; you see some questions can be quite uncomfortable, but, umm, they’re very important to us, because the patient’s safety depends on them. For example, dentures – if he has a small denture or just a single tooth denture, that can be very dangerous because the patient can either swallow it, or they can get into the lungs, so it’s really important that you ask the question, and as you keep doing it, you will develop that skill to ask them in a, in a more appropriate manner.

Student: Ah yes, I’ve got everything here – I checked –

Facilitator: Good, you’ve got the X-rays and you’ve ticked everything, good. Yes, that looks good.

Student: Yes, I just forgot to ask him about the personal belongings –

Facilitator: OK.

Student: – so I have to came up, came back again, ask him – umm, I did everything but I forgot it, to do it the first time.

Facilitator: But did you go ask – go back and get that …?

Student: Yes, I did.

Facilitator: Good. Let’s go through the paperwork – umm, you’ve got labels there, so that’s good, and that’s your checklist – that’s good. Now, umm, make sure all the documentation is right –

Student: Uh-hmm.

Facilitator: – umm, and that’s the consent, good. Yes, alright, OK, good. I think you can keep doing it now, so you can check all your preop patients before they go to the theatre.

Student: Yes, I just wanted to ask you something. I don’t, I don’t know if it’s quite normal to find that kind of patient, because some – I felt just so bad.

Facilitator: Yes, look, don’t think – see, it’s not, nothing to do with you. Most often, it’s the situation that they are in, and they are feeling, umm, either angry or sorry for themselves, and it is, umm, that is how they react. I think you did quite well, and it’s nothing to do with the way you behaved, or anything that you did.

Student: Oh, that’s a good relief! Thank you!

Intro Patient 01

Nurse:  Hi, I’m Gretel Fortmann. I’m a second year nursing student here at UTS and  I’ll be running through some role?play scenarios with a patient here in the  nursing labs, just to show you some of the situations that you might  encounter as you go out on clinical practice. 

In the scenario I’m about to undertake, I’ll be meeting a patient for the first 

time and just going through and taking her blood pressure. 

Patient: Hello, I’m Sue Felix. I’m Gretel’s patient today. I’ve had surgery on my spine,  and this is a couple of days after the operation. 

 

Nurse: Good morning Ms Felix, good morning  

 

Patient: Good morning. 

 

Nurse: Good morning, how are you? 

 

Patient: I’m not too bad thank you. 

 

Nurse: Good, that’s fantastic. My name’s Gretel Fortmann; I’m a second year nursing  student just doing my clinical placement here in the hospital. The Registered  Nurse – I’m not sure if you’ve met her yet – Mary Jones, she’ll be supervising  me today.  

 

Patient: I don’t think I’ve met her so far, no, no. 

 

Nurse:  Well, I’m sure she’ll be coming in and out today; she’s on the ward, so… Now,  is there a name you’d prefer me to call you, or is Ms Felix fine? 

 

Patient: Oh, you  can call me Sue. 

 

Nurse: Oh, Sue, fantastic, well I’ll do that then. Now Sue, I need to take your blood  pressure – is that OK? 

 

Patient: Yes, of course. 

 

Nurse: Fantastic – have you had it taken before? 

 

Patient: Yes, yes. 

 

Nurse: Good, so you know what to expect with the cuff then… right… I’ll just get this  out… How did you sleep last night, Sue? 

 

Patient: Not too badly – still pretty uncomfortable. 

 

Nurse: Ah, that’s a shame – well, let me know if things change, and if you’d like me 

 

to speak to Mary, the Registered Nurse. 

 

 

Patient: So you’re here on practice in the hospital? 

 

 

Nurse: I am, yes, that’s right – I’m here on my clinical placement. With my university, 

 

um – throughout the year we come to the hospital, just to practice some of 

 

our skills that we’re learning – skills such as these. How long have you been 

 

on the ward for? 

 

 

Patient: Oh, a couple of days now. 

 

 

Nurse: Have you had any people come to visit you yet? 

 

 

Patient: Yes, yes, my son and his family came to see me. 

 

 

Nurse: Oh fantastic  Does he have a big family? 

 

 

Patient: Um ? just one child, that’s my granddaughter, yes. 

 

 

Nurse: Oh lovely – and does he have a nice partner? 

 

 

Patient: Oh she’s lovely – she’s… 

 

 

Nurse: Oh, aren’t you lucky  

 

 

Patient: She’s like having another daughter, although she prefers to think of me as a 

big sister, she says  

 

 

Nurse: Oh, I’m sure that’s much better, in any case  There we go – is that 

comfortable for you? 

 

 

Patient: It is, yes, yes – it’s alright. 

 

 

Nurse: Good. [Nurse'takes'blood'pressure.]'There we go, that’s all done there – 

thank you. 

 

 

Patient: Is it normal? 

 

 

Nurse: Your blood pressure’s well within the normal range, so nothing to worry 

about there. There we go – now Sue, is there anything else I can get for  you? 

 

 

Patient: I don’t suppose there’d be a magazine or something like that, that I could 

have a look at, would there? 

 

 

Nurse: I can definitely check on the ward for you –  

 

 

Patient: Thank you 

 

Nurse: – sometimes patients leave them behind, or people bring them in, so I’ll see  what I can find for you. Have you got your button with you? 

 

Patient: Yes, yes, it’s under the bedclothes here. 

 

Nurse: Oh fantastic. Well, if you’ve got any questions or if your pain changes, then  just let me know – you just buzz there –  

 

Patient: Thank you. 

 

Nurse:  –  alright. 

 

 

 

Introduction to patient 2 video transcript

Nurse: In the following scene you’re about to watch, I’ll be meeting a patient for the first time and taking their blood pressure. You might see, though, that in this interaction I’m actually focusing on performing the clinical aspect of the nursing interaction, but I’m actually forgetting the therapeutic and interpersonal part of my interaction. See if you can spot how that makes the patient feel. [Nurse'moves'to'bedside.] 

Hello, good morning. 

 

Patient: Good morning. 

 

Nurse: Hi. Mrs Felix, how are you? 

 

Patient: Um, I’m alright – and it’s not ‘Mrs’ Felix 

 

Nurse: Ah, yes, alright, I’m sorry, sorry. I’m Gretel; I’m a nursing student, alright? So, 

I’ve got to take your blood pressure, is that OK? 

 

Patient: Yes, yes. 

 

Nurse: Good. [Nurse'makes'preparations.] OK, good, just rolling up your sleeve…  

 

Are you feeling OK? 

 

Patient: Yes, I’m in quite a lot of pain still – the operation, you know? 

 

Nurse: Alright. Just give me your hand here. [Nurse'takes'blood'pressure.]  

 

Did you sleep OK last night? 

 

Patient: Well, I was in quite a lot of pain – it’s, um, it still hurts a lot. 

 

Nurse: Right. Alright, thank you. 

 

Patient: Is it – is it OK? 

 

Nurse: Yeah, no, the systolic’s about 120 and the diastolic is 88. 

 

Patient: [Patient'murmurs.]'

 

Nurse: Well, it just – it just means it’s fine. There we go. Thank you  

 

Patient: Thank you  

[Nurse'fills'out'notes.]  

 

 

Nurse: Goodbye  

Helping patient to mobilise video transcript

Nurse: In this scenario, I’ll be continuing my care of the patient. I will be helping her 

from the bed into a commode chair, and assisting her to have a shower. 

 

Hello, Sue. 

 

Patient: Hello. How are you? 

 

Nurse: I’m good thank you. How are you going? 

 

Patient: Not too bad. Gretel, isn’t it? 

 

Nurse: Yes, that’s right. 

 

Patient: Yes, yes. 

 

Nurse: Now, I was just wondering – do you feel up to having a shower? 

 

Patient: Oh, that would be good, yes. 

 

Nurse: Oh fantastic  Fine, no worries – well, firstly, did you bring anything that you 

want to change into, or any toiletries? 

 

Patient: I’ve got pyjamas in the cupboard there, and there’s a bag of toiletries too. 

 

Nurse: Fantastic. I’ll just get that ready there… Now, Sue, I understand you’ve had 

some surgery on your spine, so I can imagine you’d be quite anxious that you 

don’t experience any discomfort or do anything to L 

 

Patient: It’s pretty painful – it’s quite hard to move. 

 

Nurse: Not a problem – so what I’ll  – I’ll just explain to you what we’ll be doing. So 

I’ll sit you up into the bed, and then I’ll lower the bed down so that you can 

get comfortably out of it, and if at any time you experience any discomfort or 

pain, just stop and you can take a break, or we can just take it from there. 

Alright? 

 

Patient: OK, yep. 

 

Nurse: Just winding you up a little bit… there we go… now I’ll just lower the bed 

down for you. How are you going there? 

 

Patient: Alright, it’s OK. 

 

Nurse: Good, I’ll just bring you down now. 

 Patient: UhLhuh.

 

Nurse: OK – I’m just going to pull back the bed covers. There we go… 

 

Patient: OK L  

 

Nurse: I’m here for you if you need a bit of a hand. That’s good, that’s good. Alright… 

 

Patient: OK L  

 

Nurse: OK, fantastic. 

 

Patient: Right… 

 

Nurse: I’m just going to help you pop on some shoes, so that you don’t accidentally 

slip – there we go… 

 

Patient: These look really elegant, don’t they  

 

Nurse: Oh they’re not too bad – just wriggle your foot in there. 

 

Patient: I should have brought some slippers. 

 

Nurse: I’ll just do your laces up so you don’t trip. There we go… 

 

Patient: Thank you. You’re so used to being able to reach down and do it, you know. 

Thank you. 

 

Nurse: Alright, so what I’m going to do – I’ll just bring the commode chair over here 

and pop the brakes on – is that close enough for you to reach there? 

 

Patient: Yes, that’s good, yes. 

 

Nurse: Let me just put the brakes on. There we go – and if you just then want to 

slowly get up, and then you can just swivel around. There you go, good. 

 

Patient: Oh… 

 

Nurse: L and just reach behind you there L  

 

Patient: Yep. 

 

Nurse: Good on you. 

 

Patient: OK. 

 

Nurse: You alright?  

Patient: Yes, yes.

 

Nurse: I’ll just put the footrest down – there you go. Are you comfortable there, 

Sue? 

 

Patient: It’s OK.  

 

Nurse: Lovely, that’s just your towels. Alright, now I’ll just take you with me to go 

and have a shower. 

 

Giving handover to RN video transcript

Nurse: In the scene you’re about to watch, I’m going to meet up with my Registered 

Nurse who’s supervising me, and I’ll give her some feedback on the patient 

care that I’ve already administered. 

 

Registered nurse: Hi Gretel. 

 

Nurse: Oh, hi Mary  

 

RN: How’d you go with Sue in the shower? 

 

Nurse: Yeah, I went good – she’s fine – um – er – is that what you meant? 

 

RN: Well, I meant how did she go with – because of her operation and the pain 

she had before, how did she mobilise in the shower, and was she able to help 

herself? 

 

Nurse: Ah OK, alright – so when I transferred her from the bed to the commode 

chair, um, she mobilised with minimal assistance and, um, when I was 

showering her, she washed herself for the most part, so she didn’t require 

too much assistance from me. 

 

RN: Oh that’s great – and going back to bed, she was alright? 

 

Nurse: Yes, just much of the same, so she M again, she just needed minimal 

assistance from me and didn’t complain of any pain. 

 

RN: That’s good, and how’s the blood pressure?  

 

Nurse: Her blood pressure was 120 over 80, so I didn’t think that that was out of any 

sort of abnormal ranges. 

 

RN: So did you have a look at what her blood pressure had been before? 

 

Nurse: Yep, when I noted it down I had a look at the previous two um measurements 

and it was much of the same, so sort of in the same range. 

 

RN: Oh that’s great, good, thanks, well done. 

 

Nurse: Oh thank you, no worries. 

 

 

Explaining care to patient video transcript

Patient: Hello, my name’s Amanda Miller. I’m a lecturer with the ELSSA Centre, UTS. 

In the following scene, I play a hospital patient who’s waiting to have a gall 

bladder operation. 

 

Nurse: My name is Jo Garcia, and I’m a UTS student nurse. In the following scene, I’ll 

be roleplaying a clinical situation in which I’ll be assessing a patient’s cannula 

site, and answering any questions she might have before she goes for her 

surgery. 

 

Good morning  Hello, my name’s Jo Garcia, and I’m a UTS nursing student, 

and today I’m here working with your RN, Mary Jones, to help get you ready 

for the operation. Um – you can call me Jo, but what would you like me to 

call you today? 

 

Patient: Oh, just call me Amanda. 

 

Nurse: OK, great Amanda – um, now how are you feeling about your operation this 

afternoon? 

 

Patient: Oh, not too bad – it’s just a really long wait, all day. 

 

Nurse: Yes, it can be boring, waiting, but, um – we’ll see, I might be able to get you 

some magazines or something to help the time pass a bit quicker. 

 

Patient: OK. 

 

Nurse: Now, has someone come and explained to you that you can’t eat or drink 

anything this morning?  

 

Patient: Oh, they said something like that this morning. 

 

Nurse: Yes, so from six o’clock this morning until your operation, you can’t have 

anything to eat or drink, unfortunately, but that’s for safety with the 

operation. Now, that’s why the doctor has put this cannula in your arm – now 

you look a little bit confused about that  Um – this is your cannula U  

 

Patient: Oh, right… 

 

Nurse: U now, has someone explained to you what that is? 

 

Patient: No, not really. 

 

Nurse: No, OK, well the way it works is it has a small tube that sits inside the vein in 

your arm there, and it means that this fluid that’s hanging here, um, can run 

down through the tube and then into your bloodstream, and that will keep you hydrated so that you don’t get dehydrated because you’re not eating or 

drinking today before the operation, yeah. 

 

Um, now I just need to assess the site , just to check a few things – has it 

been any pain at all? 

 

Patient: No, only when they put the needle in, of course. 

 

Nurse: Yes, at first it can hurt, but um no pain once that stopped hurting? 

 

Patient: Nothing else, no. 

 

Nurse: … and what I’m checking for is that there’s no swelling, or heat, or irritation, 

or pain along there, because that would suggest that there’s – that you’ve got 

phlebitis, which is when the blood vessel U the vein the tube is sitting in U is 

irritated by the tube, but that looks like that’s not the case – and also, 

infiltration, which is when the little tube is actually sitting not in your vein but 

in the tissue next to it and so the fluid sort of swells up around the tiss… U 

around the vein, instead of going into the vein. But there’s U  that doesn’t look 

like there’s any complications at all U  

 

Patient: … which is good … 

 

Nurse: U which is great, so nothing to worry about, but do you have any other 

concerns, or anything I can do to help? 

 

Patient: Well, I’m still feeling a bit thirsty – I was wondering if I – I can’t even have 

maybe a cup of tea, or something like that? 

 

Nurse: No, I’m sorry, I can’t get you a cup of tea – you can’t have anything to eat or 

drink up until the operation, but if your mouth is dry, I can get you a 

mouthwash, which might help to rinse your mouth – would you like that? 

 

Patient: Oh, it’s not too bad at the moment, maybe later. 

 

Nurse: OK. Well, if you change your mind and you’d like it, just let us know, because 

that’s no trouble. Have you got your buzzer?  

 

Patient: Yes, it’s over here. 

 

Nurse: OK, fantastic – well, just give us a ring if we can do anything for you. Now I’m 

just going to write in your notes that, um, I’ve assessed your cannula and that 

it’s working well and that there’s no complications with it, and also then I’ll 

go and see if I can run up some magazines for you, or something, that will 

help pass the time a bit quicker for you. 

 

Patient: So will I see you later on?  

Nurse: Yes, I’m on for this whole shift so I’ll be here ‘til you go to the operation, so if 

there’s anything that you need, just ring the buzzer and I’ll come in and see 

what I can do for you. 

 

Patient: OK, thanks Jo. 

 

Nurse: See you later, Amanda. 

 

Patient: Bye. 

 

Debriefing with facilitator​ video transcript

Clinical facilitator: Hello, my name is Sandra Rischmiller. I’m a clinical facilitator with the university. In the following scenario, I’m doing a roleplay with one of our student nurses in the nursing laboratories. We hope to demonstrate to you the type of interaction and communication that goes on between a Clinical 

Facilitator and a student nurse when they are in the clinical situation. 

We are looking at showing you the way in which the clinical facilitator tries to assist the student nurse to really think about their Clinical Practice, to identify what they’ve learned from that clinical practice, and how to prepare themselves for their next clinical practice by identifying their own goals and objectives that they would like to meet. In this way, we hope that between the two of us, the student nurse will actually have a clinical experience that is very effective, and one which they will also enjoy. 

Hello Jo – have you had a good day today? 

Student nurse: Yes, I have thanks, Sandra. 

CF: Yes? and I thought what we might do is just, you know, get you to have a look 

at what you’ve been doing today with the patient you’ve got on your w… the 

RN had several patients, but there was one in particular you were going to 

focus on – so maybe we could start with you just telling me a little bit about 

the patient you had, and perhaps what you have learned about that patient 

as a person. 

 

SN: Yeah, well today, I was paired with Mary Jones who is RN on the ward, and 

she had four patients allocated in one room, but I sort of helped her out with 

looking after a certain patient, and she was a lady, and she was, had come in 

the n… last night for – she was having her gall bladder removed this 

afternoon. 

 

CF: Ah right. 

 

SN: So, she had been, um, given a cannula this morning at 6a.m. and was nil by 

mouth until the surgery this afternoon, so one of the aspects of the care I had 

to give her was, um, the RN asked me to go and assess the cannula site, 

because she had some maintenance fluids running, and um, so we were 

checking the new cannula that had been put in. 

 

So I went in to talk to her, and introduced myself and things, and I asked if I 

could look at her cannula site, and she looked at me very confused, and then 

she –  I sort of subbed (? not sure about this word) that she didn’t really know 

what the cannula was or what it was doing, why there was a bag hanging 

next to her, so I sort of explained to her what it was – and it sort of surprised me because I thought that, like, that somebody would have told her this 

already, because – 

 

CF: Yes, you do tend to assume that, don’t you? 

 

SN: Yeah, so she – I think that she really liked that she was given an explanation, 

and then after that she sort of seemed like she was very happy to work with – 

um – with me, and I think she could see that I was going to explain what I was 

doing, which was good. And so I explained the cannula site and I said there 

was– um – there were no problems with it, she didn’t have any pain, and 

there was no swelling or anything. So I tried to take her through what the 

complications could be –   

 

CF: Oh great, yeah. 

 

SN: – like, what I was looking for when I was assessing a site, and yes, she didn’t 

um –  so I’d asked her at the beginning if she had been explained that she 

was ‘nil by mouth’ and that she couldn’t eat or drink anything, and she said 

that yes, she hadn’t been given breakfast and that was, she understood that, 

but then she asked me if she could have a cup of tea – and so I’m – 

 

CF: [Laughs.] Obviously something missing  

 

SN: – yeah, and um, so I think that she thought a cup of tea would just be 

something simple that she could have – 

 

CF: Mmm… 

 

SN: – but then, so I had to sort of explain to her that she couldn’t have a cup of 

tea, and why it was important that she couldn’t have ANYTHING in her 

stomach, and that the fluids should help her not get dehydrated. But I 

thought that was really interesting because – um, someone had told her not 

to have anything to eat or drink, but she still asked for a cup of tea, so I think 

that showed me that, like, you need to sort of reinforce things, or confirm 

that she understood exactly what that meant – could’ve been important. 

 

CF: Absolutely – I think you find that, don’t you? You can find that with a lot of 

patients – you explain something to them and then walk away, assuming that 

they actually understood – 

 

SN: Yes. 

 

CF: – but if you don’t actually go back and perh… at a later stage – and ask the 

patient something that would allow them to explain what it is they actually 

know, you often find out they really only understood part of what you were 

saying. 

 SN: They were just nodding 

 

CF: Why do you think patients, people do that? 

 

SN: I think maybe they don’t want to, like, cause any trouble by getting it 

clarified, and they might think that we assume they understand, and they’ll 

just go along with it and won’t cause any problems. 

 

CF: Yes, that’s excellent, and it’ll be a great learning experience for you, to be 

able to follow the patient right the way through, and then perhaps also see 

whether some of the things you explained to the patient before she went are 

still there when she comes back. 

 

SN: Yes, yes – because there’ll be lots of, sort of, elements of her care that I’ve 

seen Mary, her RN, explain to her today before she goes, but I assume we’ll 

have to sort of go over some of that. sort of, again – 

 

CF: UhXhuh. 

 

SN: – in terms of, like, the PCA and how to use it, and that sort of thing, and 

wound care, because she’ll have an incision from the operation – so I think 

it’ll be really interesting to see what is involved in her postXop care tomorrow. 

 

CF: Yes, that’ll be an excellent idea – and looking at you having… working with 

that patient tomorrow, have you got any… have you got any ideas about 

what things you could do yourself, independently, and say, maybe, what 

things you could do that you would need your RN to supervise you on? 

 

SN: Yes, there’s a few areas that we’ve covered in quite a bit of detail in class that 

I feel confident that I could sort of assist with, and maybe an area that could 

be – I could have a fluid balance chart – 

 

CF: Yes… 

 

SN: – which I could, like, fill it out throughout the shift, and then get that, that 

can be, like, coXsigned by my RN – but I could sort of take responsibility for 

that for the shift. 

 

CF: Yes. 

 

SN: And also, my RN let me do some practice progress notes today, after, um – 

 

CF: Oh excellent, yes  

 

SN: I know that I’ve learned some other things in class, but I’d like to sort of just 

observe, sort of, the documentation with the PCA, because I haven’t really 

had chance to actually practise that, but I think tomorrow would be a really good opportunity to see it in action, in a clinical setting, and also wound care 

for a new surgical wound, and just the general care that the RN provides for a 

patient that’s just had surgery. So there’ll be a bit of observing, but I’ll try and 

sort of see if  I can get in and help wherever I can, like just sort of … 

 

CF: Yes, well you should probably, once, you know, if  you’re working with the 

same RN tomorrow that you did today, then she’s going to know something 

about you – um, and will also know something about your ability to care, and 

responsibility, and also she’ll be aware whether you would report things 

promptly, so you’ll probably find, if it’s the same RN, there’ll be a bit more 

trust there, and you should be able to manage the patient’s observations, 

with the exception of the PCA, for example, on your own. Perhaps she might 

want you to demonstrate a set, but after that you’d probably find that she’d 

be happy– 

 

SN: –  take responsibility for that… 

 

CF: –  for you to take responsibility for that. The patient will have a catheter in – 

you, I’m sure you’ve, er, probably emptied catheter bags before – 

 

SN: Yes. 

 

CF: –  or measured hourly – she might be on hourly measurement there, and you 

should be able to be responsible for that as well. Um – she’ll probably, she 

might have a nasoXgastric tube in, so is that, would that be a new experience 

for you? 

 

SN: Yes, yes – I haven’t seen a patient with that before, so um… 

 

CF: UhXhuh. 

 

SN: I – we’ve briefly looked over that sort of in our tutorials, but it’s not 

something that I’ve seen, so um… 

 

CF: And what, out of looking back on today, what do you think you learned out of 

today? 

 

SN: Umm… I think one of the most important things I learned was that the patie… 

like, having a relationship with the patient, so that they felt comfortable to 

ask questions and ask for clarification – 

 

CF: Yes, yes  

 

SN: – and also to notice that Amanda didn’t actually say, “Oh, what’s a cannula?” 

and didn’t ask that, but I could see from her face that she was confused and 

sort of, the importance of those visual cues. The patient won’t always say, ask 

for clarification but might be wanting it, so it’s important to be observant in that sort of area. So they’re just sort of simple things – it wasn’t like a – like  

rocket science that I – 

 

CF: No  

 

SN: – like it wasn’t like a new procedure or anything, but it was just that, being 

able to deal with the patients better so I could keep that in mind for the 

future. 

 

CF: Well, you – you, you know, you’ve learned one of the foundations of nursing 

really, haven’t you? 

 

SN: Yeah, and that prac… actually, you don’t see it until you’re, like, actually in 

the situation that you realise, that just that, like, simple interaction is one of 

the most important elements. 

 

CF: UhXhu. It is, and it means that you’re using your observational skills, which 

you’re learning in class but actually don’t’ really come to fruition, shall we 

say, until you’re actually in the situation. And I think it probably also shows 

how well you are progressing, because when you first start in nursing, you’re 

so overwhelmed with all of the things that you need to learn and you get on a 

very busy ward sometimes, and there’s so much going on that you don’t 

know where to start, and your focus often tends to be on the concrete, or, 

you know, a specific procedure, whereas now, where you’re at the end of 

second year, you can see that your skills are really moving outwards. 

 

I mean, you’re looking at, “OK, how can I manage the nasoXgastric tube or the 

dressing?” but you’re also bringing in those skills such as observation and 

being aware of nonXverbal communication from the patient; you’re sort of 

looking at the patient as a whole, rather than just, “Oh, I’ve got to do 

something about the wound,” so I’d say, you know, you’re definitely 

progressing. 

 

Do you feel that you’re meeting your own personal objectives? We’ve got 

objectives in the subject outlines that you have to meet, and you’ve 

identified some of the things today – learning the preXop care for a surgical 

patient, that sort of thing – but you come to clinical with some objectives for 

yourself . Every student is independent, in terms of what their background is, 

and what experiences they’ve had, so everybody should have a particular set 

of objectives for them. Some people have been on nothing but surgical 

wards, and some people may have been on medical and suddenly they’re on 

a surgical, so they’re going to have slightly different objectives. What about 

yours? Have you got some personal ones that you want to meet? 

 

SN: Well, this is my first placement on a surgical ward, so I was actually a bit 

excited to get that sort of experience – um, one of the goals that I was sort of 

wanting to look at was sort of, yeah, that element of continuity of care, and seeing how, for a patient that’s going through surgery – like, having surgery – 

how, like, they prepare and how they are afterwards, and sort of see, like, 

look at that sort of personal sort of element and how they change over that 

time.  And – so that was more – yeah, and sort of, and at the end, like, one of 

my goals is just to build on confidence all the time – 

 

CF: – your confidence, yes… 

 

SN: – and – 

 

CF: – your confidence, because you’re beginning to see where that line is, or 

you’re certainly identifying, for yourself, that line between what I can do 

independently and when I need to contact my Registered Nurse or somebody 

else, um, here to manage this particular situation, so it’s – I think – being able 

to identify what you can and can’t do, and how far you can go is a real asset, 

and it’s a very complex skill to develop, really, as a student, I think. 

 

SN: It takes more and more practice, so it should be good prac too. 

 

CF: Absolutely, yes. I’ll be around in the morning, just to check that you’re alright, 

and just to see whether your negotiations with the Nursing Unit Manager 

have, you know, been followed through – just being aware that sometimes 

the ward can change overnight, and if the patient, say, takes a turn during the 

night or something, and her condition, say, deteriorates quite severely, it 

might well be that they won’t want to place a student with her, so what I’d 

like to suggest to you before you go off today is that you also have another 

look at the patients that are on the ward, um, to see if there is another 

patient that you could fall back on. 

 

It’s always good to have a second plan, and perhaps take the time to, say, 

maybe read that patient’s notes so you’ve got some familiarity with them, 

and then if tomorrow the Nursing Unit Manager says, “Well, look, I’m sorry, 

we can’t follow through on your request,” you can say, “Oh well, I’ve got 

another patient in mind  Is that a possibility?” Because otherwise, if you 

don’t take that control, and they think you don’t really know what it is you 

want to do, they’ll just put you somewhere – 

 

SN: Yes. 

 

CF: – whereas, if you can approach them with the idea, “These are the things I 

want to learn, and I’ve looked at the patients on the ward, and identified a 

couple more that would enhance my learning experience…” 

 

SN: I should have that background – 

 

CF: – yeah, that’s it. You need – if you can negotiate all the time, and when 

somebody says, “What would you like to do?” not “Everything”, not “I’m not sure,” or “I don’t know,” or “ Whatever you want,” but can be specific, you’ll 

find that they’ll respond, because they’re busy people, and if they have to try 

and stop to think for you, then the answer, as you know, it doesn’t work 

really very well because you’ll end up doing things, you know, that perhaps 

you’ve already done in the past and feel confident about. So, if you can 

identify for yourself, and bring that out… 

 

SN: Be all prepared for our morning handover, then? 

 

CF: Yes, that’s the idea, come really wellXprepared. Oh, it sounds like you’re 

progressing very well, and you’re managing your own learning experiences 

through negotiation with the Nursing Unit Manager and your Registered 

Nurse. You’re identifying very clearly where your boundaries are – um, I think 

you’ve been very sensitive to that patient’s needs, and that’s extremely 

important. 

 

SN: Thank you. 

 

CF: You’re very welcome.