Kim Johnson Guided Reflection

How did the simulated experience of Kim Johnson’s case make you feel?

The simulation didn’t make me feel any certain way. I consider a basic (but vital) skill we learned in 110 that we will use throughout our career, but contamination can occur. Knowing the correct steps to fix it and prevent infection is key.

Talk about what went well in the scenario.

I think discarding the catheter and preparing a new one after contamination went well. To me its obvious that that’s what you need to do. It was a good way to try to “trick” you, but also a very plausible thing that could happen in real life.

Reflecting on Kim Johnson’s case, were there any actions you would do differently if you were to repeat the scenario? If so, how would your patient care change?

 I redid the scenario because of educating the patient is vital in care for the patient and I forgot it the first time. So, the second time I did it, I added the education and got 100%.

Scenario Analysis Questions*

PCC What priority problem(s) did you identify for Kim Johnson?

Bladder management is a big one. Considering she is parapalegic, educating her about bladder management is important, along with tips on how to prevent incontinence.

S Identify safety hazards in Kim Johnson’s patient care situation.

Risk for infection, safety of the patient due to the contamination.

S Identify potential complications from using improper sterile technique during intermittent catheterization.

UTI, which could lead to worse such as sepsis, if not treated properly after the fact.

PCC/T&C How would you would correct the nurse’s actions specific to the contamination of the sterile field?

Making sure they discard everything that was contaminated, and prepare a new kit and explaining where they contaminated the first time so they know how to avoid it now.

QI/I Which federal and state programs offer benefits to support Kim Johnson’s care?

Infection control board, QSEN, ANA, WHO, CDC

Concluding Questions

Describe how you would apply the knowledge and skills that you obtained in Kim Johnson’s case to an actual patient care situation.

Like ive stated before, this is 100% a plausible real life scenario, and one thing ive been taught is to bring anextra set of gloves or an extra kit in the room. This way if only 1 thing (we’ll say the lubricant package) is contaminated, you can get a different one out of the second kit. Or if you contaminate your gloves halfway through, you can just change them out instead of starting over because you have to leave the sterile field.

Compare how urinary elimination in the V-sim and BPH are different.

In the simulation, Kim Johnson is a parapalegic with inadequate bladder management who requires urinary catheterization. Due to her paralysis, she has a neurogenic bladder. A neurogenic bladder means someone lacks bladder control due to a brain, spinal cord or nerve problem. This differs from BPH for a multitude of reasons.

BPH stands for benign prostatic hypertrophy. So the full definition of BPH is a prostate gland enlargement which causes urinary difficulty. The obvious fact to know Kim did not have this, is that she does not have a prostate gland, because she is a woman. Also, it is not cause from brain, spinal cord, or nerve problem. To conclude, BPH only occurs in aging adult males, while neurogenic bladder occurs with any brain, spinal cord, or nerve damage.

Nursing interventions for neurogenic bladder

Education on bladder training, and teaching how to self-catheterization (or a family member how to with the above scenario) I&Os, Q8 bladder scans.

Nursing interventions for BPH

Assessing for urinary retention, I&Os, Q8 bladder scans. 

*The Scenario Analysis Questions are correlated to the Quality and Safety Education for Nurses (QSEN) competencies: Patient-Centered Care (PCC), Teamwork and Collaboration (T&C), Evidence-Based Practice (EBP), Quality Improvement (QI), Safety (S), and Informatics (I). Find more information at: http://qsen.org/