NR 305 Discussion: Debriefing of Week 4 iHuman Neurovascular Assessment

Sample Answer for NR 305 Discussion: Debriefing of Week 4 iHuman Neurovascular Assessment Included After Question

Purpose

The purpose of this debriefing is to re-examine the experience completing the Week 4 iHuman Neurovascular Assessment assignment while engaging in dialogue with faculty and peers. In the debriefings, students:

  • Reflect on the simulation activity
  • Share what went well and consider alternative actions
  • Engage in meaningful dialogue with classmates
  • Express opinions clearly and logically, in a professional manner

A Sample Answer For the Assignment: NR 305 Discussion: Debriefing of Week 4 iHuman Neurovascular Assessment

Title: NR 305 Discussion: Debriefing of Week 4 iHuman Neurovascular Assessment

The neuro simulation was a bit of a challenge. I haven’t worked in a acute care setting in a while. I feel it makes a difference as it relates to priortizing care vs. Care in the home setting. I was confident in doing the physical assessment . I do feel the sceniro was realistic . Speaking with the spouse trying to find out what symptoms that ocurred at the home. The symptoms Mrs.  Granger presented with  facial dropping, elevated BP and decresded  O2 sats all realistic.

 If I were caring for a patient similar to Mrs. Granger I would use the Wong-Baker FACES Pain Scale that combines pictures and numbers to rate pain. I would have the patient point to the  picture that best describes her pain. I would also spend time with the family member to ask when the headache started,the location of the pain and the duration of the pain. Did she complain of other symptoms (ie) nausea & vomiting, visual changes and mental status change. An area of improvement assessment of the twelve cranial nerves .  

This simulation reinforced the importance of gathering key information from the time the call comes in for help.The importance of multi discplinary team and early discharge planning. This simulation has boosted my confidence. I will be reminded of what it has taken for the patient to get home and what i must continue to do to support the patient to remain at home.

I think this simulation went very well. A few days before I took this simulation, I actually had to go into a Neuro training for work and also had a patient that we needed to perform the NIHSS and neuro checks on throughout the shift. I think this scenario was realistic in a sense that the symptoms that she displayed were congruent with what a stroke patient would display. Symptoms included being forgetful, right sided weakness, hemiplegia, dysphasia, facial paralysis. 

If I could do anything differently, I would still try and focus more on the priority questions and to make sure that I do a complete neuro assessment first. I think I keep getting caught up on the number of questions we have. I feel like I struggle with prioritizing what can wait as opposed to needs to be done now. I wasn’t surprised about the feedback, only because I had literally taken that 4 hour class a few days prior so I knew what to look for. 

This simulation was a reinforcement for me. With the pre briefing, I made sure to verbalize everything that popped into my head before typing it. This also reinforced the BeFAST method for stroke patients for me. Balance-Eyes-Facial drooping-Speech-Time. I do wish we could have gotten more into the NIHSS, but I am sure I will get more of that in practice. 

This simulation was very familiar to me because I used to work in a Med-Surg ICU where the nurses were required to float to the stroke unit. For me, going through Mrs. Washington’s history and pulling out the necessary information was fairly straightforward. I was looking for Mrs. Washington’s last well-known time, what symptoms she had, what had she taken, and what happened after the event. I then looked through the meds, read what the husband reported to the nurse, and what the doctor’s conclusions were to try and paint a picture (so to speak) of what was going on with Mrs. Washington. I took all this information into the history questions and the physical assessment so that I knew exactly where to focus.

So, it has been a while since I floated to a stroke floor because I left the ICU about two years ago, and apparently my skills were a little rusty. During the history questions, I was lost as to what to ask Mrs. Washington because a lot of the information was already gathered. I struggled to figure out what the simulation was wanting me to ask her. Then going into the physical assessment, I completely forgot about all the cranial nerves until I had already completed like 40 unnecessary assessments. (facepalm!) I had to quickly use the last few allotted assessments to gather what information I could. In a real situation, I would have just gone back into the room (if I had left already) and completed the assessments I’d forgotten. I would have apologized to Mrs. Washington for the inconvenience but would have explained to her the importance of completing these necessary assessments.

The learning aspects for me that have been a common theme throughout all the simulations is that even as a nurse it is okay to make mistakes, it is okay to go back and do the assessment again, and it is okay to really lean into my nursing judgment and use my license. Now, making mistakes needs to be taken with a grain of salt. I’m not talking about medication or surgical mistakes. I mean the kind like I dropped the bedpan on the floor, I forgot to order a lunch tray, etc. Repeating or redoing an assessment, yes, can be an inconvenience, but my patient’s safety comes first – over inconvenience, over pride, over a non-compliant patient. I have the ability, as a nurse, to make decisions that will not only help my patients but ensure their safety and well-being while in my care. These simulations have really reinforced that ideal for me.