Describe interventions and outcomes related to the scenario.

Primary nurse
Scenario: Acute pain (SDOH and implicit bias)
Report: A 42-year-old man, Ray, has been admitted from the emergency department (ED) with abdominal pain. He is now an inpatient admitted and diagnosed with acute pancreatitis. He has been treated for abdominal pain and nausea. He remains on normal saline fluid therapy.
Pain relief has not been consistently administered, and Ray shares with you that he has not felt his needs were adequately addressed by those who have taken care of him so far.
The clinician has ordered imaging for further diagnostics. As the nurse, you are told by the charge nurse that particular social issues may influence how Ray’s healthcare needs are met when he returns home. Uncovering what those issues are or could be will be up to you.
Directions
First, review the resources in the Supporting Materials section.
Next, in addition to the standards of care needed to ensure patient quality and safety, complete the following as you engage in the OMS simulation:
• Review doctor’s orders, emergency department (ED) notes, nurse’s notes, medical history.
• Obtain vital signs and perform abdominal exam.
• Assess Ray’s pain.
• Administer appropriate pain medication.
• Reassess pain.
• Review social history and screen for social determinants of health.
When you have completed the OMS scenario, complete the debrief. Use at least three scholarly, current (within the last five years) references to support your work.
Specifically, you must address the following rubric criteria:
1. Scenario Score: Complete the Oxford Medical Simulation (OMS) scenario. The score you receive on your scenario will be factored into your overall grade for this assignment. See the rubric for details.
2. Clinical Scenario: Summarize the clinical scenario you completed. Include an evidence-based theory that applies to the clinical scenario.
3. Background: Explain any previous experiences that helped support your clinical reasoning in the clinical scenario. Consider the following in your response:
o Nursing knowledge
o Previous clinical situations
o Personal experience
4. Assessing: Assess your initial thoughts upon receiving the report. Include your initial thoughts on the individual’s complaint, potential interventions, and desired outcomes.
5. Analysis: Analyze assessment information or results you received as you considered the scenario. Consider the following in your response:
o Additional assessment information or results you wanted
o Similarities to situations you have encountered in practice before
o Differences from situations you have encountered in practice before
6. Conclusion: Identify what the assessment findings led you to believe. Include the following in your response:
A. Pertinent pathology and/or psychopathology
B. How your initial thoughts changed or remained the same as you assessed more about the patient
7. Interventions and Outcomes: Describe interventions and outcomes related to the scenario. Consider the following in your response:
o The specific interventions you performed
o How you prioritized the interventions you performed
o An evidence-based theory that supports how you prioritized these interventions
o Outcomes you expected from the interventions
o Responses you obtained
8. Simulation Reflection: Reflect on the simulation experience. Include the following in your response:
A. Three things that went well, with rationale
B. Three things you would do differently, with rationale
C. A specific action you can take to improve your practice
What to Submit
Submit your completed debrief. Your submission should be a 2- to 3-page Word document with separate title and reference pages that are not part of the page count. Follow APA style standards for formatting and citing your sources.
Supporting Materials
The following resources support your work on this assignment:
Reading: CLEAR Toolkit
To access this resource, select CLEAR toolkit. This resource provides step-by-step instructions for identifying the underlying social causes of poor health conditions that you treat regularly. The steps are as follows:
1. Treat
2. Ask
3. Refer
4. Advocate
This resource will assist you in working through the OMS scenario.
Reading: Pancreatitis
To access this Shapiro Library resource, select HTML Full Text. This resource addresses how to care for an individual with acute pancreatitis. This resource will assist you in working through the OMS scenario.

The importance of reflective practice is recognized by the adoption of a reflective learning model in continuing medical education (CME). In recording your reflections it may be helpful to structure your thinking in terms of:
• What happened?
• What did you learn from the experience?
• What would you do differently next time?
You can then save your reflection to use as an example of learning development.

Past medical history
You correctly ascertained Ray’s past medical history of hypertension and renal issues.
Hide rationale” for Past medical history”
Rationale
In this scenario Ray’s past medical history is important – he’s had a renal transplant and history of hypertension. His recent admission for acute pancreatitis put him at further risk for ongoing problems if he is not monitored closely both in the hospital and when discharged home. Most of this information can be gleaned from the EMR; however, you may want to ask the patient for any additional information.
• Reference: The Importance of the History and Physical

ProfessionalismSystems-Based PracticeKnowledge for PracticeQuality & SafetyPerson-Centered Care

00:52

Critical
5 Rights of medication administration
You utilized the 5 rights of medication administration before administering medication to your patient
Hide rationale” for 5 Rights of medication administration”
Rationale
In order to reduce medication errors and harm it is an expected practice to use the “five rights of medication administration” before administering any medication to a patient (after receiving an order or scriipt) : the right patient, the right drug, the right dose, the right route, and the right time, are the basic rights. Note that in the context of treatment and administration, IV fluids are also considered a medication. Other “rights” have been added over time to further increase the safety and well-being of patients such as: right documentation, right client education, right to refuse, right assessment, and right evaluation. There is always a risk of giving the wrong pill, the wrong dose, or the wrong person’s medication.

If this happens, harm to the person can occur and some reactions can be deadly. It is therefore imperative to always verify a patient’s name and date of birth, ask about their allergy status, and review their MAR and fluid prescriiption record prior to administering medications and fluids.
• Reference: Nursing Rights of Medication Administration

ProfessionalismSystems-Based PracticeKnowledge for PracticeQuality & SafetyPerson-Centered Care

00:58

Critical
Medication Administration Record
You reviewed Ray’s current MAR
Hide rationale” for Medication Administration Record”
Rationale
Reviewing the MAR of any patient you’re caring for is of utmost importance. This document lists all the medications a patient has been prescribed while in the hospital, the time at which those medications are to be taken, and whether or not they’ve been administered. It is especially important to review the MAR during care transition points, such as when a patient moves from the ED to an inpatient unit. This is because there is a lot of activity which happens during transitions of care and there is a higher chance of things being overlooked. Check the MAR early to determine if anything is missing or appears to be out of place. If so, prioritize phoning the previous area of care to speak with the previous care provider to determine if any documentation is missing.
• Reference: How we fail black patients in pain

ProfessionalismSystems-Based PracticeKnowledge for PracticeQuality & SafetyPerson-Centered Care

00:58

Critical
Pain and rating
You asked about pain and had Ray rate it
Hide rationale” for Pain and rating”
Rationale
The importance of pain cannot be overlooked – it has been described as “the fifth vital sign” and is a requirement of proper patient care. There are numerous aspects to pain and many assessment tools to help review it, such as pain scales (0-10, faces, behavioral pain scale (BPS), etc.) and assessment mnemonics (OPQRSTU, SOCRATES, etc.). Pain is defined in an individual way. Nurse and pioneer in the field of pain management, Margo McCaffery, stated “whatever the experiencing person says it is, existing whenever and wherever the person says it does” should always be taken into account. In Ray’s case, his pain had not been addressed while in the ED and he continued to be uncomfortable. Patients should not expect to receive a lower standard of care because of their race, age or other irrelevant characteristics. Recognizing this occurs is the first step. Addressing and rectifying promptly must ensue immediately afterward.
• Reference: How we fail black patients in pain

ProfessionalismSystems-Based PracticeKnowledge for PracticeQuality & SafetyPerson-Centered Care

03:31

Critical
Verify name and date of birth
You verified your patient’s name and date of birth
Hide rationale” for Verify name and date of birth”
Rationale
The National Patient Safety Goals (NPSG) are set yearly as an industry standard and emphasize the use of patient identifiers as goal number 1 in promoting quality and patient safety in all levels of patient care. Healthcare providers should use two patient identifiers with every patient, every time. In order to prevent instances of mis-identification and near-miss error, two identifiers such as a patient’s full name, date of birth and/or medical identification (ID) number should be used for every patient encounter, confirmed both verbally and by a patient wristband visually.
• Reference: Two Patient Identifiers – Understanding The Requirements

Quality & SafetyPerson-Centered Care

03:39

Critical
Monitoring
You took some vital signs
Hide rationale” for Monitoring”
Rationale
Monitoring vital signs is a key component of an overall patient assessment and provides much valuable information with regards to the patient’s current status. Regular monitoring of vital signs is recommended for all admitted patients. The suggested frequency will vary according to context.
Systems-Based PracticeKnowledge for PracticeQuality & SafetyPerson-Centered Care

04:55

Critical
Morphine given
You administered morphine to help mitigate Ray’s ongoing pain
Hide rationale” for Morphine given”
Rationale
In this scenario, prescriiptions for analgesia and fluids were available to administer. Giving analgesia to any patient in pain is important. Inadequate pain relief in the form of treatment disparities has been studied for 20 years. African Americans, as well as Hispanics and Latinos, have incurred a higher level of unrelieved pain than white patients in the US, especially when it comes to opioid analgesics. Bias in this form can be an unconscious process that often goes unnoticed. The first step is recognition there may be implicit bias present. The next step would be to remove as much individual discretion as possible. This can be done by using clinical guidelines, standardized checklists, and system-wide protocols to prescribe and treat pain in a more equal manner.
• Reference: Analgesic Treatment Disparities for Pain in the United States

ProfessionalismSystems-Based PracticeKnowledge for PracticeQuality & SafetyPerson-Centered Care

08:27

What went well – important aspects
Important
Doctor’s orders
You reviewed Doctor’s orders
Hide rationale” for Doctor’s orders”
Rationale
Doctor’s orders are a key part of patient care and management. It is important to review these frequently and implement orders as directed. If ever you’re unsure of the reason behind particular orders, do ask for help from your colleagues. In this particular scenario, there were limited doctor’s orders available. Most were a continuation of orders from the ED, but important to addressing your patient’s pain. Regardless of the amount of orders, they should be reviewed and prioritized. Do note that existing orders and patient management plans do not exclude the need for a thorough patient assessment and application of the nursing process.
InterprofessionalismProfessionalismSystems-Based PracticeKnowledge for PracticePerson-Centered Care

01:12

Important
Emergency Medicine note
You reviewed the Emergency Medicine history note
Hide rationale” for Emergency Medicine note”
Rationale
History notes are left by the myriad healthcare professionals who are caring for any particular patient. To get a good sense of the overall plan, care, and management of any particular patient, reading through the most recent history notes is useful. How much of a patient’s history should be read will vary in each situation; but try and read all of the notes if possible. The Emergency Medicine (EM) team note is of particular importance. When a patient has been admitted from the ED to the unit, the note should describe how the patient presented, differential diagnoses, what/if the patient was treated while in the care of the EM team, and which services the EM team consulted and why. In Ray’s case, it became evident that some of the PRN medication that could have been given to alleviate more of his pain was not.
• Reference: Analgesic Treatment Disparities for Pain in the United States

ProfessionalismSystems-Based PracticeKnowledge for PracticeQuality & SafetyPerson-Centered Care

01:48

Important
Other history notes
You reviewed additional history notes
Hide rationale” for Other history notes”
Rationale
History notes are left by the myriad healthcare professionals who are caring for any particular patient. To get a good sense of the overall plan, care, and management of any particular patient, reading through the most recent history notes is useful. How much of a patient’s history should be read will vary in each situation. In this particular case, the radiology department was the only other team that had seen the patient to date. Their note was important to read as it describes Ray’s status post examination and confirmed the diagnosis of pancreatitis.
ProfessionalismSystems-Based PracticeKnowledge for PracticeQuality & SafetyPerson-Centered Care

01:54

Important
Hand hygiene and PPE
You correctly carried out hand hygiene and donned PPE to help prevent the spread of infection
Hide rationale” for Hand hygiene and PPE”
Rationale
Sanitizing your hands and donning personal protective equipment (PPE) before patient contact is a key method of maintaining patient and staff safety. Ensure you don and doff PPE such as gown, mask, gloves and eye protection in accordance with local policies.
• Guideline: CDC hand hygiene guidance

Systems-Based PracticeKnowledge for PracticeQuality & Safety

02:58

Important
Abdominal exam
You correctly examined the abdomen in a patient with ongoing abdominal pain
Hide rationale” for Abdominal exam”
Rationale
Examining the abdomen is important to localize an area of reported pain and search for any other signs. In Ray’s case, his reported pain level did not abate, therefore an updated examination of the abdomen would be warranted to determine if there were any changes from the previous findings.
• Reference: Accuracy of abdominal auscultation for bowel obstruction

ProfessionalismSystems-Based PracticeKnowledge for PracticeQuality & SafetyPerson-Centered Care

05:28

Important
SDOH questionnaire: Employment
You correctly asked about employment
Hide rationale” for SDOH questionnaire: Employment”
Rationale
The link between employment and health is one of reliance. Having a job allows for the employed to live in healthier neighborhoods, access quality education and healthcare, secure childcare services, and buy more nutritious food. Unemployed patients are at higher risk for poor health and can develop stress-related conditions such as stroke, heart attack, heart disease, or arthritis. These patients are also at a higher risk of being diagnosed with depression. Asking about employment is one of the Social Determinants of Health questions that can glean more about a patient’s health status, since employment affects so many other factors in a patient’s life.
• Reference: How Does Employment, or Unemployment, Affect Health?

ProfessionalismSystems-Based PracticeKnowledge for PracticeQuality & SafetyPerson-Centered Care

09:47

Important
SDOH questionnaire: Housing
You correctly asked about housing
Hide rationale” for SDOH questionnaire: Housing”
Rationale
The stability and conditions where people live, play, and age affect a wide range of health, functioning, and quality-of-life outcomes. This can put some groups at a higher risk for illness and a return to the hospital once discharged. Inquiring more deeply into social history, including the stability and long-term security of a person’s housing situation, as well as the health and safety of their living conditions, is crucial. This information allows for the identification of those who may benefit from community services and targeted assistance.
• Reference: Healthy People 2030 – Social Determinants of Health

ProfessionalismSystems-Based PracticeKnowledge for PracticeQuality & SafetyPerson-Centered Care

09:52

Important
SDOH questionnaire: Education
You correctly asked about education
Hide rationale” for SDOH questionnaire: Education”
Rationale
Education makes it more likely a person can access quality healthcare, find employment that pays a living wage, and live in a safe, non-polluted environment — all factors that affect well-being. In fact, people who live in lower socioeconomic conditions are at greater risk for a host of health issues, including higher rates of disease, mental illness, and premature death according to Healthy People 2030. Healthy People 2030 will focus on initiatives that provide high-quality educational opportunities for children and adolescents — and on helping them do well in school.
• Reference: Healthy People 2030 – Social Determinants of Health

ProfessionalismSystems-Based PracticeKnowledge for PracticeQuality & SafetyPerson-Centered Care

09:56

Important
SDOH questionnaire: Personal safety
You correctly asked about personal safety
Hide rationale” for SDOH questionnaire: Personal safety”
Rationale
Conditions where people live, learn, work, play, worship, and age affect a wide range of health, functioning, and quality-of-life outcomes. These conditions can put some groups at a higher risk for injury or illness. Racial/ethnic minorities and people with low incomes are more likely to live in neighborhoods with high rates of violence, unsafe air or water, and other health and safety risks. Knowing whether your patient is exposed to these risks allows hospital and social agencies to direct services where needed.
• Reference: Healthy People 2030 – Neighborhood and Built Environment

Population HealthProfessionalismSystems-Based PracticeQuality & SafetyPerson-Centered Care

09:59

Important
SDOH questionnaire: Finances
You correctly asked about finances
Hide rationale” for SDOH questionnaire: Finances”
Rationale
Financial resources strongly determine how well patients are able to maintain their health and well being. The inability to afford healthy foods, health care, safe and healthy housing, are just a few factors that can affect one’s potential to avoid chronic illness or disease. Financial stability is closely related to all the other Social Determinants of Health as the common denominator to each of them.
• Reference: Healthy People 2030 – Economic Stability

Population HealthProfessionalismSystems-Based PracticeQuality & SafetyPerson-Centered Care

11:20

Important
SDOH questionnaire: Food access
You correctly asked about food access
Hide rationale” for SDOH questionnaire: Food access”
Rationale
Food insecurity can be linked to negative health outcomes for adults and children. Making an inquiry about a patient’s concern about food access or affordability is very important. Knowing about any shortfalls in this area can guide healthcare practitioners to direct patients and their families to and Federal, State or community resources available to them to help supplement their needs.
• Reference: Healthy People 2030 – Social Determinants of Health

Population HealthProfessionalismSystems-Based PracticeQuality & SafetyPerson-Centered Care

11:25

Important
SDOH questionnaire: Transportation
You correctly asked about transportation
Hide rationale” for SDOH questionnaire: Transportation”
Rationale
Transportation barriers arise when individuals are unable to reach healthcare facilities or pharmacies to access essential medical services and medications. Identifying these barriers is the first step in formulating a plan to help mitigate the effects of poor transportation options for patients.
• Reference: Public Transportation In The US: A Driver Of Health And Equity

ProfessionalismSystems-Based PracticeKnowledge for PracticeQuality & SafetyPerson-Centered Care

11:31

Important
SDOH questionnaire: Utilities
You correctly asked about utilities
Hide rationale” for SDOH questionnaire: Utilities”
Rationale
Patients having difficulty in paying utility bills or being at risk for utilities being shut off should be identified as part of a Social Determinants of Health screening. “Utility Stress” can be caused by difficulties paying water, electricity, gas or telephone bills by their due date. Individuals with disabilities or chronic illnesses that may need increased access to essential services such as electricity, water, or telephone may ration these utilities in order to make ends meet. This can further jeopardize their health and well-being in doing so.
• Reference: Utility Stress as a Social Determinant of Health

Population HealthProfessionalismSystems-Based PracticeQuality & SafetyPerson-Centered Care

11:36

Important
SDOH questionnaire: Child Care
You correctly asked about child care
Hide rationale” for SDOH questionnaire: Child Care”
Rationale
Access to child care is an important component to employment stability, financial security, and an opportunity for economic mobility. Therefore, financial security plays a pivotal role in supporting overall health and well-being, encompassing housing, nutrition, social connections, and access to both physical and mental health services. Asking whether your patient has access to child care, when needed, is an important social history question that could affect other social determinants. One can be contingent upon another.
• Reference: Child Care and Early Education is a Social Determinant of Health—For Children and Adults

InterprofessionalismProfessionalismSystems-Based PracticeKnowledge for PracticePerson-Centered Care

11:40

Important
Reassess pain
You remembered to reassess Ray’s pain after giving pain medication
Hide rationale” for Reassess pain”
Rationale
To effectively meet your patient’s needs, their pain should be reassessed after each intervention to evaluate its effect and determine whether modification is needed. The time frame for reassessment can be dependent upon the route of medication administration. Time frames are also directed by hospital or unit policies and procedures.
• Reference: Improving the Quality of Care Through Pain Assessment and Management

ProfessionalismQuality & SafetyPerson-Centered Care

15:02

Important
Patient communication
You reassured Ray about his condition and kept him updated on his care
Hide rationale” for Patient communication”
Rationale
Research demonstrates the most important patient experience issue is the care or lack of care regarding psychosocial and emotional needs. This is in contrast to the culture which generally emphasizes medical-technical skill and efficiency.
• Reference: The AACN/QSEN Competencies (Patient-Centered Care)

ProfessionalismPerson-Centered Care

15:24

Important
Consent to examine
You asked permission to examine the patient prior to doing so
Hide rationale” for Consent to examine”
Rationale
While most patients are generally aware of what happens during a physical examination, the question of whether this equates to implied consent for everything that happens during the visit is unclear. As there is no fixed answer, it is prudent to ask for and obtain explicit consent prior to any physical interaction. Explaining to the patient what is going to happen next and obtaining their permission to do so is informed consent. This facilitates a better rapport and helps to build trust during patient interactions. It can also be helpful to begin the exam with less invasive assessments and then proceed to those which are more physically revealing or uncomfortable. For example, in a cardiac exam you may begin by examining pulses and capillary refill prior to exposing the chest to auscultate heart sounds.
• Reference: Informed Consent, when and why.

Quality & SafetyPerson-Centered Care

15:33

Important
Question asked by Charge Nurse: Pain Management
You correctly identified “acetaminophen and morphine” as the appropriate choices to adequately treat Ray’s pain
Hide rationale” for Question asked by Charge Nurse: Pain Management”
Rationale
Patients should not experience a lower standard of care because of their race, age, or any other irrelevant characteristic. However, implicit associations (unconscious, uncontrollable, or rational processes) may influence our judgments resulting in bias.
• Reference: Racial Bias in pain assessment and treatment recommendations

ProfessionalismSystems-Based PracticeKnowledge for PracticeQuality & SafetyPerson-Centered Care

19:41

Important
Question asked by Charge Nurse: First action to eliminate individual discretion
You correctly identified “awareness of potential implicit bias or microaggression” as the appropriate first choice in eliminating individual discretion when treating pain on individuals of color.
Hide rationale” for Question asked by Charge Nurse: First action to eliminate individual discretion”
Rationale
Being aware of the possibility that you, as a clinician, could harbor an unconscious bias towards a patient is the first step in addressing the inequity that can occur when treating patients of color. The use of clinical guidelines, standardized checklists, and system-wide protocols lessens the risk of individual discretion — and therefore bias — to influence patient care.
• Reference: How we fail black patients in pain

ProfessionalismSystems-Based PracticeKnowledge for PracticeQuality & SafetyPerson-Centered Care

20:08

Important
Question asked by Charge Nurse: Identify value of social history questions
You chose “determining the patient’s needs in order to help facilitate solutions” as the reason in depth social history questions are important
Hide rationale” for Question asked by Charge Nurse: Identify value of social history questions”
Rationale
Asking detailed questions about social history can uncover challenges related to access to education, economic stability, and issues within social, community, and neighborhood environments. Health care access and quality can be ascertained using questions or scoring tools that focus on the Social Determinants of Health. Conditions that are identified play a significant role in readmissions to the hospital. Understanding that barriers like the affordability of medications and inadequate transportation for follow-up appointments can significantly contribute to re-hospitalizations underscores the importance of facilitating a patient’s smooth transition from hospital to home. Collaborating with community partners to assist with any or all social services available to your patient can make the discharge transition more successful in the long-run and eliminate relapses and re-hospitalizations.
• Reference: Healthy People 2030: Social Determinants of Health

ProfessionalismSystems-Based PracticeKnowledge for PracticeQuality & SafetyPerson-Centered Care

20:37

What went well – additional aspects
Additional
Pain scale guideline
You referred to a numeric rating scale (NRS) or Visual Analog Scale (VAS) regarding the level of Ray’s pain
Hide rationale” for Pain scale guideline”
Rationale
VAS and NRS are valuable tools in pain management for their ability to translate the subjective experience of pain into objective quantifiable data. This information is crucial for effective pain treatment, ongoing assessment, and ensuring patient comfort and satisfaction. Appropriate and effective pain medication can be ordered by the physician and administered by the nurse using this simple and quick scoring. It is not without flaws, however, and the probability of duplication as well as gaps in therapy can occur. Other scoring methods are available that might be better suited for certain individuals such as: children, non-verbal patients, cognitively impaired patients and patients who may be sedated.
• Reference: Strategies to Enhance Patient Care and Compliance with Pain Order Duplications and Gaps

ProfessionalismSystems-Based PracticeKnowledge for PracticeQuality & SafetyPerson-Centered Care

02:03

Additional
Guidelines
You reviewed available guidelines
Hide rationale” for Guidelines”
Rationale
With the wealth of information available and constant updates to care and management, policies, and procedures, guidelines are often the most practical way to stay up-to-date. Reviewing guidelines prior to carrying out any procedure is recommended. Guidelines are often different between institutions and sometimes even between units, so be sure to check local guidelines at your institution.
• Reference: The CLEAR Toolkit: Training frontline health workers to ask about and act upon the social causes underlying poor health

ScholarshipInformaticsSystems-Based PracticeKnowledge for PracticeQuality & Safety

02:08

Additional
Available charts
You looked at the available charts, such as the fluid balance chart
Hide rationale” for Available charts”
Rationale
Reviewing all available forms and charts related to a patient’s assessment is warranted as the patient’s status is not yet fully known or established while investigations are ongoing. Reviewing existing patient charts such as the fluid balance record, patient height and weight form, skin assessment chart, etc. help inform an impression of a patient’s overall health status. The importance of these charts depend on each patient’s specific context and situation.
ProfessionalismSystems-Based PracticeKnowledge for PracticeQuality & SafetyPerson-Centered Care

02:14

Additional
Introduce yourself
You appropriately introduced yourself to Ray
Hide rationale” for Introduce yourself”
Rationale
Therapeutic communication skills can help build trust, rapport and respect in the patient-nurse relationship. Always begin your interactions with an introduction.
• Reference: ABCDs of Professional Introductions: Teaching Nursing Students the Most Fundamental of All Communication Skills

Quality & SafetyPerson-Centered Care

03:15

Additional
Preferred pronouns
You asked about the preferred pronouns the patient would like you to use
Hide rationale” for Preferred pronouns”
Rationale
Some people prefer male, female, or gender neutral pronouns to describe them. Consistently asking about name and pronoun preferences is an important first step in building a therapeutic relationship and becomes more automatic with practice. If you make a mistake by using the wrong pronoun, apologize and correct the pronoun.
• Reference: Pride in Practice: Gender pronouns: A provider’s guide to referring to transgender patients

ProfessionalismPerson-Centered Care

04:02

Additional
IV patency
You correctly checked the patency of Ray’s IV site
Hide rationale” for IV patency”
Rationale
Checking IV patency (along with all other in-situ IV-associated equipment) should be a regular part of your patient assessment. You should check not only for patency but also the site itself for signs and symptoms of phlebitis or infection.
ProfessionalismSystems-Based PracticeKnowledge for PracticeQuality & SafetyPerson-Centered Care

05:18

Additional
Permission to ask SDOH questions
You asked permission prior to asking in depth social history questions of a sensitive nature
Hide rationale” for Permission to ask SDOH questions”
Rationale
By asking permission to have a conversation regarding Social Determinants of Health, you are acknowledging the potential sensitivity of some questions and give permission for the patient to decline at any point.
• Reference: Patient-Centered SDOH screening conversation guide

ProfessionalismPerson-Centered Care

08:56

Additional
Exams
You examined other body systems relevant to the Ray’s situation
Hide rationale” for Exams”
Rationale
When taking over the care of a new patient, performing your own assessment is expected after hand-off. There may be protocols set forth by individual institutions as to the frequency of those assessments; however, if the patient is new to you, always a good idea to get an updated one with both vital signs and physical examination.
• Reference: Frequency of Vital Signs and Physical Assessment

ProfessionalismKnowledge for PracticeQuality & SafetyPerson-Centered Care

15:52

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