Het doel van deze output is om negen verschillende scenario’s te ontwikkelen voor studenten uit het universitaire onderwijs en drie verschillende scenario’s voor studenten uit het hogeschoolonderwijs. Alle scenario’s zullen zich afspelen in klinische omgevingen en zijn dus relevant voor de gezondheidszorg. Aan het einde van deze output zullen de meest geschikte scenario’s geselecteerd worden. Bepaalde scenario’s zullen worden omgezet in virtual reality, andere zullen gebruikt worden voor educatieve video’s.
The translation of those scenarios took place in IO5 for VR scenario, IO6 for educational videos and IO7 for role plays
SCENARIO NO: 1
Provision of woman-centered care during labour and birth
Mia Schmidt, a 28-year-old woman, is pregnant with her first child and has been in the delivery room for two hours. She is lying on the bed, her husband is sitting at her side. The midwife has been coming in and out of the room to check on her but has not stayed for a longer time with her. Mia is in quite a bit of pain when she has a contraction, and is feeling uncertain and unsafe because she can no longer manage the pain. In order to be able to choose the most appropriate pain relief for the stage of labour that the woman is in, the midwife tells her that it would be helpful to perform a vaginal exam to assess her progress in labour. Mia is scared and does not want a vaginal examination, but is also afraid she won’t get good care/pain relief if she doesn’t let the midwife exam her vaginally. The midwife is challenged to provide woman-centered empathic intrapartum care.
SCENARIO NO: 2
Assessment and pain management in pregnant client with language barrier
The bell rings, and Meral Navid and her husband Hamid Navid arrive at the birthing suite. The midwife goes to the door to meet the new arrival. When she gets to the door, she sees a woman bent over, breathing through a contraction. The woman is wearing a hijab and is with her husband. Meral Navid is gesturing and does not feel confident speaking German, but she does understand many things. Her husband is trying to help by explaining the situation. The midwife introduces herself, and communicates with the couple to assess what should happen next.
SCENARIO NO: 3
Newborn with weight gain challenges: Sharing information and communicating risk
Mrs Lea Kowalsky, a 36-year-old woman had a C-section with her first child 4 days ago. She is set to leave the hospital with her baby boy Paul and is awaiting the results of the discharge examination. The midwife who is weighing the baby is aware that Mrs Kowalsky very much wishes to leave the hospital that day. The midwife sees that the baby has continued its weight loss, and she needs to communicate this and the associated risk to Mrs Kowalski. She recommends against leaving the hospital today. Mrs Kowalsky is very upset and feels sure that the breastfeeding would go better at home. She insists on being discharged. The midwife is challenged to communicate how another day in hopsital will be of benefit to Mrs. Kowalski and her baby.
SCENARIO NO: 4
Elderly patient after hip replacement: communicating with the confused/angry patient
Elder man (70s) in orthopaedics clinic, two days after having total hip replacement. He has mental problems (dementia, confusion) and due to his medical concurrent problems, he needs to be mobilized (standing up and walk with aid). He refuses to cooperate with the therapist.
SCENARIO NO: 5
Young patient with chronic musculoskeletal pain: Shared decision making with patient and family
Woman (40s) in chronic musculoskeletal pain (low back pain, somatization), with psychosocial problems (stress, anxiety, difficulties with sleep, kinesiophobia) that comes to physiotherapy clinic in order to get helped (doctor referral, otherwise she will have a surgery). The problem started after giving birth to her 3 years old son. Other therapies have not helped, she is disappointed, angry. The physiotherapist will propose a new therapy in order to help including exercisebehaviour change. She is accompanied by a member of her family (her father), she is divorced and she leaves at her parents’ house with her 3 children.
SCENARIO NO: 6
Empathy Cultural Diversity, working with interpreter: Immigrant patient with lung infection
Man (20s) refugee (Muslim), Arabic speaking (interpreter) living in a refugee camp had a lung infection and he is in the pulmonary clinic now (fear, breathing difficulty, difficulty of communication, female therapist issues*). His wife is with him. A female physio is in charge, she has to give information and demonstrate respiratory exercises to him before his discharge.
SCENARIO NO: 7
Young person with new diagnosis of cancer: the process of sharing bad news
A female patient in her early 40s is admitted to hospital with bowel obstruction. A CT scan on admission indicates a large mass blocking her large intestine and she is taken to theatre. The preliminary diagnosis of the excised mass indicates that this is cancerous. The mass is removed at surgery. The following day, the patient is visited by her mother and young daughter when the doctor comes in to share the bad news of the preliminary diagnosis of bowel cancer and explain the next steps in her management. The student is asked to communicate the bad news to the patient in an empathic way, explain the next steps in the patient’s management, deal with her initial shock and realization of her diagnosis combined with her worry of being the only parent of a young child and deal with environmental barriers to empathic communication.
SCENARIO NO: 8
Medical Consultation: patient with high cardiovascular risk
A 55-year-old obese man attends the GP clinic following an annual health review. The annual health review showed that he is at increased risk for cardiovascular disease (10 year risk of 32.2%) based on a number of risk factors (overweight, hypertension, raised cholesterol and blood sugar levels, smoking history and family history of cardiovascular disease).The patient is not concerned about his lifestyle but decided to attend this year’s annular health review as his brother was recently diagnosed with cardiovascular disease and because of his wife being concerned about his health. The student is asked to discuss with patient the results of his annual health review and his risk of cardiovascular disease and address any relevant lifestyle modifications such as diet, physical activity, smoking.
SCENARIO NO: 9
Adolescent with diabetes: shared decision making in challenging situations
A 17y.o. adolescent boy with Type I Diabetes, is attending the GP practice for review of hypoglycaemic episodes and his overall glucose control. The student is asked to explore potential reasons behind the patient’s challenges with his blood glucose control and insulin treatment including exploring behavioural issues such as missing insulin treatment because he feels that diabetes is an obstacle to normal living and he wants to be like his peers and use of substances like alcohol, smoking of cigarettes and cannabis. The student is asked to use his empathic skills to explore challenging issues around the boy’s health and behavior and discuss with him a mutually agreed treatment plan.
SCENARIO NO: 10
Elderly in nursing home: dealing with cultural beliefs and barriers
A young caregiver from India starts working in a nursing home for elders in Cyprus. He soon becomes popular among old persons in the home because of his friendly behaviour and high qualifications. However, an 80-year-old woman with mobility problems, when she sees him wearing his turban and finds out that he is of another cultural background, refuses to receive care from him. Due to understaffing in the home, there is no other caregiver to undertake her care.
SCENARIO NO: 11
Death of a young person: sharing bad news to family memberss
After a severe pile up accident, seven persons are brought to hospital and three of them are immediately directed by doctors to operating rooms for surgery, since their lives are in danger. Due to this incident, the hospital’s first aid unit is at a state of emergency. The injured persons’ families have learnt the bad news and have already arrived to the hospital. One of the injured, a young man of around 30 years old, despite doctors’ hard efforts, finally passes away. Due to complications in another operating room, the doctor has to leave and a nurse is now responsible to announce the bad news to his relatives. When she comes out of the room, she finds out that the only one waiting for the man who had died is a young woman who seems to be his wife and she is pregnant. The woman looks very upset. The nurse needs to inform the woman about her husband’s death.
SCENARIO NO: 12
Elderly with dementia: challenges in communicating with the confused patient
A woman home carer provides care to an 81-year-old man suffering from progressive senile dementia problems. She has been taking care of him for the past three years and he seems to trust her and have a good communication with her. However, at times he loses contact with reality, does not recognise her and, since she seems a stranger to him, he becomes aggressive towards her. She is sometimes afraid of his abrupt reactions. Today, in the morning, she tried to give him his medication and he, once again, did not recognise her and accept the treatment.
SCENARIO NO: 13
Registration for birth and discussing birth plan with recently migrated client
Mrs. Kurt has recently migrated from Turkey to Berlin and she is expecting her second child. She would like to know what to expect when she comes to the hospital when she is having her baby. The The midwife is discussing with her what her options are regarding the managment of the labour pain and the time follwoing the birth of the baby and where the care may differ from the care she has received when giving birth to her first child in Turkey.
SCENARIO NO: 14
Young person with disability: coping with difficult patients
A carer provides care to a young paraplegic man, who is unwilling to accept help and who has bursts of aggression from time to time because of his loss of independence. This morning, the carer tries to help him get out of bed and in his wheelchair, but the young man refuses to be helped and gives the carer a very hard time. He even assaults him verbally in a very disrespectful manner.
SCENARIO NO: 15
Elderly with dementia at nursing home: dealing with refusal to accept help and with communication problems
A carer provides care to an 85-year-old woman who suffers from dementia. The woman does not recognise the carer and refuses to accept help. The carer tries to calm her down and to convince her to accept help.
SCENARIO NO: 16
LGBTQ person: Offering care to an LGBTQ person
A middle-aged man who suffers from Multiple sclerosis (MS) has been at a care home for two weeks. His male partner visits him. His carer does not know that the man is gay, so he is surprised when he enters the room and sees the two men having an intimate moment. The carer needs to interact with the couple showing empathy and understanding to diverse people.
SCENARIO NO: 17
Carer with burnout
A carer is stressed because of the workload and other issues that arise at the nursing home where he works, such as problems in his relationship with colleagues, difficult patients, lack of understanding from the management. Lately, he has been taking days off, giving health problems as a justification. The manager of the nursing home is worried, because he cannot afford having less employees, so he decides to talk to the carer to find out what the matter is.
SCENARIO NO: 18
Empathy: Empathetic behaviour in social interactions
A young woman was involved in a car accident six months ago. She was in a coma for a month and while doctors had said she would not make it, she eventually recovered. She now uses a wheelchair. She faces many difficulties in her daily life: she cannot move easily in the city, she needs help for her daily needs, she feels that people around her feel sorry for her. She goes out for coffee with an old friend of hers and a friend of her friend. When she arrives at the cafe, she has trouble getting through because of a parked car and because of the way the tables are placed. She tries to talk about her current situation, looking for empathy from her friends, but the latter try to change the topic because they feel uncomfortable and do not know how to respond.
SCENARIO NO: 19
Mother of child with vomiting and slow weight gain
Student’s/learner’s Instructions: You are a medical student in year 5 or 6 of a six-year medical programme. You are currently doing your General Practice (GP) placement. The GP is running late and has asked you to speak to Mrs Maria Spirou before he/she comes to see her. Mrs Spirou has requested an appointment with the doctor for her 5-month-old daughter Teresa as she is worried about her weight gain.Student Task: Take a detailed history from Mrs Spirou regarding the presenting complaint and explore her concerns in regards to Tereza’s health.
SCENARIO NO: 20
Child with sore throat and fever
Student’s/learner’s Instructions: You are a medical student in year 5 or 6 of a six-year medical programme. You are currently doing your General Practice (GP) placement. The GP is running late and has asked you to speak to Mrs. Maria Spirou before he/she comes to see her. Mrs. Spirou has requested an appointment with the doctor for her 5-month-old daughter Teresa as she is worried about her weight gain. Student Task: Take a detailed history from Mrs. Spirou regarding the presenting complaint and explore her concerns in regards to Tereza’s health.
SCENARIO NO: 21
Communicating with an elderly and their carer- information gathering
Student’s/learner’s Instructions: This is a session with two simulated patients per group (a parent with the relative). The scenario tackles the issues of how to communicate with a carer to elicit information about the patient. A carer is someone that knows the patient well and can give additional information about the patient (e.g. a family member, a friend, a caregiver, a neighbour, social worker). The role of the carer is important as individuals with a neurological problem or a cognitive impairment (such as memory problems) may not be able to share information about the nature, extent and degree of their problems. In the scenario, the patient will be able to provide some information to the student but the carer (relative) will need to step in to complement that information. Students will need to seek consent from the older adult if it’s ok for the accompanying person to be present and to contribute during the consultation if required. Student Task: Mr./Mrs. Leonidas/Leoni Charalambous has noticed some problems with his/her hearing so he/she has come to see the GP; he/she is accompanied by his/her nephew/niece who can help with the information if needed.
SCENARIO NO: 22
Information giving- shared decision making, patient with musculosceletal problems
Student’s/learner’s Instructions and Task: You are a final year medical student at the orthopaedic department of a hospital for your placement and you are asked by the consultant to talk to Christina/Chris Morrison. The patient was examined by the consultant who arrived at the diagnosis of a torn meniscus and she suggested a few treatment options for them. The consultant asked the patient if it would be ok for you to practice your information giving and shared decision-making skills with them and the patient has agreed. Your tasks are to:
1. Explain what a torn meniscus is and the treatment options available
2. Address the patient’s questions and concerns
3. Agree on a treatment plan through a shared decision-making process.