- Provide a detailed overview of the events that took place during your simulation.
In this virtual simulation, I navigate a variety of life choices from the perspective of an
individual who is unemployed and experiencing both homelessness and food insecurity. I start
down to my last $1000. The simulation started by first giving me the options of a job to choose out of 3. The first option was working as an admin for $15/h with hours that varied and required experience, the second was a warehouse job 12pm-7pm $14/h and a requirement of the ability to lift 20lb and the last was a restaurant job with hours that varied and a pay of around $3/h + tip. I chose the second option. I then had to pick an insurance plan and chose to pick the most basic and affordable out of the 3 options I was given. After that it came the time to choose where I had to live, I picked the farthest place from work due to the price which meant I would have to pay a lot for travel costs but turned out it would still be overall cheaper for me. After renting an apartment I found that not all my stuff would fit so I chose to have a yard sale rather than renting a storage unit or asking a friend to keep it for me, in hopes of gathering some money and was able as a result to gain an extra $150. I was then called by a consumer agency for payment due regarding my car possession. I first hung up not sure if it was a fraudulent call but the moment, I was able to verify it was not fraudulent I made the payment requested. The next day I was faced with the choice of whether or not to attend my grandfather’s memorial which was several states away. It would have costed me 75 dollars and I had only $140, so I chose to skip it just in case anything were to come up. On day 8 my child was given a 10 dollar gift card that I chose not to keep and on day 9, I gave 20 dollars for a get well gift to a coworker who was sick. Day 10 was my pay day. I had a couple of bills due, and I chose to pay them both. After that, since I couldn’t cover expenses for a root canal due to lack of dental insurance, I had to make the choice to put it off. I was then fired with 345 dollars left, out of that money I gave 100 dollars to my mother. My stress level increased, and I was offered a smoke which I refused. The next day I spent 25 dollars on groceries buying enough food to last me for a bit in addition to that I had to let my pet suffer as I could not afford to put it to sleep or its treatment. I had to pay for supplies to fix a small leak that became a big leak, which costed me $50. On day 18 the landlord chose to raise rent and threatened to kick me out, so I asked for help from a friend. The next day my child needed to go on a field trip which was $15 and I chose not to pay. Since I have a child, I had to buy new shoes. Name brands may be important but so is money, so I went to the thrift store and spent 10 dollars instead of 100. I then began experiencing chest pains and although I had a family history of heart problems, I made the dangerous decision to not check it out. I was then offered the oppurtunity to go to a concert with friends but chose to stay with my kid and save money. I also faced the problem of dirty laundry piling up where I chose to ask help from a friend. I had the oppurtunity to gain $200 back when a friend of a friend needed a place to stay, which I used to pay some college loans. I then payed my gas bill which cost me $200 but could not afford the elctric bill. My bank then charged me $5 for overdraft, and I was left with 10 dollars on day 27. On day 28 I took a job that payed me 50 dollars but had to as a result miss my child school pay. I also had to not allow him to play in a school sport, as it would have cost me $50. Along the way my child needed help with math, so I chose to help him myself and luckily, I had the knowledge to. I made it through the month with $55 (but rent was also due the next day).
2. Was there anything that surprised you about the events that took place during your
simulation?
The thing that surprised me the most was when a choice I thought would be harmless led to me losing my Job and having to figure out how to manage the rest of my expenses for the remainder of the month.
3. What did you like/dislike about the experience?
I liked how I was given the option to ask a friend for help in certain situations. I also liked how realistic the choices were and how they really made you think and reflect. What I did not like was not getting the option to look for another job after being fired.
4. What did you learn about living in poverty?
I learned that when living in poverty every penny counts, money tends to become the most important thing, and health Is overlooked and not because you want to but because you have to. I also learned that when in poverty a person often will look for the cheaper option. Other things I learned that there tends not to be much time to spend with your kid if you have one. You never know when extra expenses come up so you always try to have backup money you can use. Lastly, it’s hard to give to people due to the poverty status..
5. What learning occurred for you in this experience overall?
I learned how much easier it is to treat people living in poverty poorly due to lack of resources to fight back. Also, if someone is poor and alone life becomes even harder as I remember having to ask a friend for help multiple times.
6. How can you apply this learning?
I can apply this learning by being more willing to help people living in poverty by offering support in any way I can. For example, volunteering in homeless shelters.
- What would you like to learn more about, related to this experience?
Ways to ensure better treatment and reduce mistreatment towards people living in poverty or ways to help kids growing up in families that are living with poverty to have similar opportunities as their peers like in regards to sports or school trips.
Therapeutic Communication and Mental Health Assessement
- Provide a summary of the key points in the scenario.
In this scenario the focus was on completing a mental health assessment during a home visit with a focus on therapeutic nurse-client relationship.
2. What thoughts/feeling/emotions did you have during the simulation? Has your
perspective changed since completing the simulation? If so, how?
I felt very cautious and tried to be observant of my surroundings and client behaviors to get a better sense of the situation and how to go about it. There were also times I was unsure of what choices to make as I was not sure how the client may perceive my actions and therefore was unable to make a guess on what the client’s reaction could be. Some of the choices, especially the ones I got wrong, gave me a new perspective on certain areas of how a mental health assessment should look like. For instance, how expressing concern or offering a list of resources could negatively affect a client who is already in distress.
- What values/concepts guided your decision-making during the simulation?
Whenever I had to make a decision, I tried to keep in mind the client’s well-being, comfort level and potential reaction, trying my best to avoid anything that could make the client feel stressed out.
4. What went well during the simulation? What do you believe contributed to this success?
I believe that the part that went well during the simulation was the assessment specifically when Inquiring about the bruises and during the suicide risk assessment. I believe what contributed to this success is the learning I have gained from classes and the mistakes I had made in previous choices.
5. At what point(s) during the simulation did you feel unsure of your decisions? What
learning need have you identified based on this?
At first, everything was going smoothly, but when confronted with an unexpected person, I got stuck and was unsure what to do. Also, when attempting to gather more data I found myself unsure on how to go about it without offending the client.
6. What new learning goal do you have because of this simulation? Write a new SMART
goal below, identifying and citing at least three specific and credible resources you will
use to meet this new learning goal.
By the end of this semester, I will know what to do to de-escalate a situation that may seem to be escalating. I will do this by reviewing the RNAO website for tips (https://bpgmobile.rnao.ca/node/849), reading an article on deescalating a situation (https://www.nursingtimes.net/roles/mental-health-nurses/de-escalating-anger-a-new-model-for-practice-25-07-2016/) and lastly by finding information from a website (https://nurseslabs.com/5-ways-nurses-can-deal-aggression-workplace/).
7. How will you apply this simulation and its teachings to your nursing practice?
I will apply this simulation and its teaching in my nursing practice by practicing some of the skills and approaches that were demonstrated in this simulation, when faced with similar situations.
Communication with a Patient with Different Priorities Sim Reflection
- Newfoundland and Labrador have the highest mortality rates in Canada due to heart
disease. What factors do you think contribute to this?
I think factors that contribute to these high mortality rates are the high percentage of people experiencing unhealthy eating, smoking and other risk factors like obesity or physical inactivity.
2. Motivational interviewing is an essential nursing skill for health promotion and client
education. Based on the Transactional Model of Change, which stage of change would
this client be in? How might this influence her readiness for making a health behaviour
change? What nursing interventions are most effective in these situations?
Based on the Transactional Model of change the client would most likely be in their 3rd stage (preparation). The client is showing signs of being ready to take action within the next 30 days. She is starting with small steps toward change, and she believes changing her behavior will lead to a healthier life. Nursing interventions that could be effective in this situation are involving family members in supporting the patient, collaborating with a dietitian or nutritionist to provide a more comprehensive nutritional guidance, and providing opportunities for patients to ask questions and discuss concerns to make necessary lifestyle changes.
3. Conflict within the therapeutic relationship is often covert. It is important that nurses
can identify and appropriately respond to the conflict to facilitate positive outcomes.
Describe the sources of conflict within the given scenario. Discuss how the nurse
effectively or ineffectively managed this conflict?
One source of conflict given in this scenario was when the nurse approached the client to do the assessment without explaining what exactly she was going to do. So when the nurse wanted to do start with the measurement due to client’s weight insecurity a negative reaction resulted. I think although the nurse was not initially effective within the situation, she did a good job when she apologized for her actions and gave a clear explanation to the client that helped her understand, deescalating the whole situation as a result.
4. The two most influential determinants of health were identified. What other social
determinants of health are impacting the client’s ability within the scenario to make
health behaviour change? What actions could the nurse take to address these issues?
Other social determinants of health impacting client’s ability within the scenario other than the two most influential ones were Income, social status, and physical environment. An action I believe the nurse could take to address these issues is to connect the client with multiple resources to help her address the issues in her life.
5. The subject of food insecurity is highlighted within the scenario. What factors influence
food security for clients living in rural communities? What local resources could the
nurse offer the client?
Factors that affect Insecurity are income, affordable housing, availability or access to food and family size. Then nurse could offer local resources to the client like assistance programs or food banks and pantries.