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.
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.
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.
Hey Gloria, how are you going?
Hey, well thanks.
How are you?
I'm good, thank you.
What are you doing today?
Who are you looking after?
I have three patients at the moment.
I've got one which is more interesting, because he's going to surgery today, this afternoon.
OK, what surgery is he going for?
He's going to, let m... it's a shoulder, it's a shoulder surgery.
OK, so what are you doing for him?
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.
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.
Ah, OK, that could be good.
Did you have any questions?
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 -- Yes, yes...
-- I don't know if actually I can ask him.
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.
Ah right, OK.
But those that you can't see, you need to ask him-
OK.
-- those things that you can't see.
Yes?
OK.
Facilitor: Alright?
That's fine.
OK.
Alright then, I'll see you later.
So OK, see you later.
OK, bye bye.
Thanks.
--- 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.
Yes, they told me.
Do you have any other questions about this surgery, or is it everything clear for you?
When are we going to get on with it?
I've been here all day, waiting.
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?
Tom Williams.
Your date of birth?
Still the first of the first nineteen-ninety -- like it was the last time you asked!
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?
Breakfast this morning, I guess.
Breakfast -- umm, what time was it?
It would be -- nine?
Nine.
What about your last drink?
Well I was drinking water at the game, that'd be eleven, I reckon.
Eleven.
OK.
As long as I see, you don't have glasses -- what about contact lenses, do you have any --
No. -- contact lenses?
No?
Hearing aid?
No.
Good.
Sorry about this question, but do you have any artificial limbs or prostheses?
No!
Any denture?
No!
No.
OK, have you voided?
What?
Passed urine?
Have you passed urine today?
Yes, this morning.
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?
No.
Can I have a look of your nails?
Do you have any nail polish?
No!
No, that's fine.
OK, have you had your shower today, after the...?
Yes, I've had my shower.
OK.
That's pretty much it -- do you have any comments, any questions, any enquiries to ...?
When do I get to go home?
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.
Yes.
OK?
Do you have any other questions?
Why do I have to get this surgery?
I've broken it before and they just put it in a cast, that was it.
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.
Alright.
Yes do you have any more questions?
That's -- that's fine.
So do you have your buzzer there?
Yes.
OK -- and also, I'm afraid you can't have anything to drink or to eat until six o'clock.
What, not even a glass of water?
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 --
No!
I'll be fine thanks!
-- so that you can...
You will be fine?
OK!
OK, so if you have any question, anything, just let me know, OK?
I'm fine.
OK, bye.
--- Maria, how did you go?
I was watching you from there.
Oh, yes, I think I did well -- I'm not quite sure, but ... yes ...
What did you think you did well, and what ... yes?
I think the most challenging aspect in this situation, it was to deal with this patient
which was in a very bad mood -- Uh-hmm.
-- 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 -- 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?
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 --
Yes, yes -- -- 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...
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.
Ah yes, I've got everything here -- I checked --
Good, you've got the X-rays and you've ticked everything, good.
Yes, that looks good.
Yes, I just forgot to ask him about the personal belongings --
OK.
-- 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.
But did you go ask -- go back and get that ...?
Yes, I did.
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 --
Uh-hmm.
-- 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.
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.
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.
Oh, that's a good relief!
Thank you!