Southern CT State University
A group of nursing students decided to create a simulation scenario that involved a code blue scenario whereby their peers were charged with identifying that their patient was a DNR/DNI. The patient was a 74-year-old widower with early signs and symptoms of Alzheimer’s disease. The patient’s adult daughter was his power of attorney and carried on her person her father’s detailed living will, which specified that in the event he require intubation and placement on a ventilator, he would “prefer to choose death” and be with his wife of 20 years, whom had died four weeks prior of a brain aneurysm.
As the psychosocial history was provided by the group of student nurses who created this scenario, the second group of participants took notes in silence. The simulation began with a nurse-to-nurse report in the Emergency Department (ED), whereby presenting symptomatology and past medical history was provided. The 74-year-old male patient was in a motor vehicle accident with his adult daughter and was suspected to have internal bleed. Intravenous access was obtained and Normal Saline 0.9% was administered at 100 mL/hr in the left arm and the baseline ECG was sinus tachycardia.
Vital signs were: BP-123/80, P- 114, R-21, T- 97.7 F, and an O2 saturation of 93% on 2 L of oxygen via nasal cannula. No known allergies. The patient was alert but nonverbal and restless as he lay on the stretcher. His daughter had sustained minor injuries and was at his bedside crying and repeatedly stating, “Daddy I am so sorry. Please forgive me.”
The scenario progressed with the patient receiving a CT scan with contrast. Upon return from the CT scan, the patient was nonresponsive and a code blue was called. The patient’s adult daughter (a student nurse from the scenario creation team) screamed at the ED nurse and physician (a student nurse from the scenario creation team) to save her father. Chest compressions were started, and the patient was bagged, but minimal air was going through, and his oxygen saturations steadily declined.
The physician stated, “We will have to intubate him.” The nurse (a student nurse from the participant group) noticed the DNR/DNI bracelet on the patient’s right ankle. The nurse asked another nurse (a student peer from the participant group) to take her place at the bedside to record the code blue event and talked to the daughter about her father’s wishes. The patient’s daughter was crying and wiping tears from her eyes (real tears at this point), removed her father’s living will from her handbag and said, “He doesn’t want this. Help me to make it better. I am so sorry Daddy.”
The nurse (also now crying real tears) hugged the daughter and said, “It is your decision. We can stop.” The daughter, in silence, nodded her head and hugged the nurse. The nurse notified the health care team, the code ended, and the simulation ended. The debriefing that normally lasts no more than eight minutes continued for 20 minutes. Through tears shed by students and faculty, vulnerabilities in nursing were shared and hugs and support provided. What I learned was that the scenario far met more than the objectives of identifying symptoms suggestive of physical decline; the administration of emergent care to a trauma patient; and recognition of a DNR/DNI status. The simulation scenario taught my students the greatest gift that a nurse educator can witness in the growth of the nursing students they mentor: compassion and care that is without judgement and seeks to improve the plights of others. I cried too that day, as I was at that time—unbeknown to my students—also a daughter of a father with Alzheimer’s disease whose health was declining. As I watched the scenario and completed the debriefing, it gave me great peace to know that these future nurses would be a great gift to the profession of nursing and to future patients and their family members.