SFU-012 - Module 4 (Model answer)

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Model Answer

Expected Outcome

Reflection Task (15 minutes)

Document and Present (15 minutes)

Hear from a professional in this role to see how they might approach this task. The following pages are a detailed model answer for the work simulation on the Healyh Care Industry, geared towards a student interested in becoming a Paramedic.

Create Task (30 minutes)

Analysis Task (20 minutes)

Research Task (20 minutes)

Preparation Task (10 minutes)

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Step one: Understanding basic principles. In preparation, a video from YouTube was selected that explained the importance of a primary survey. Here is the link: https://www.youtube.com/watch?v=ea1RJUOiNfQ Step two: Understanding specific principles. In an emergency care setting, a structured nursing assessment is crucial for determining a patient's immediate health needs and planning interventions. The primary focus in emergency assessments is on the ABCs (Airway, Breathing, Circulation), as any compromise in these areas poses a life-threatening risk. History-taking also plays a vital role in understanding pre-existing conditions, while a head-to-toe assessment provides a systematic approach to identifying injuries or abnormalities. For paramedics, quick and accurate nursing assessments can mean the difference between life and death, making these skills critical in the pre-hospital environment.

Preparation task (10 minutes):

Understanding the Key Components of a Nursing Assessment: Objective: List the steps involved in conducting a comprehensive nursing assessment, including gathering patient history, performing a head-to-toe assessment, and documenting findings.

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Step two: Research: Common Injuries to Consider:

• Head trauma (e.g., concussion, skull fractures)
• Spinal injuries (e.g., cervical spine fracture)
• Internal bleeding (e.g., abdominal trauma)
• Pneumothorax (collapsed lung due to chest injury)
• Bone fractures (e.g., ribs, legs)
• Hypovolemic shock (due to significant blood loss)

Step one: Patient History Collection: The patient is semi-conscious and unresponsive to verbal commands, but has a weak pulse. Bystanders mention that the accident occurred roughly 10 minutes ago, and the patient has no visible medical tags or identification. The patient appears to have been wearing a seatbelt and there are no signs of ejection from the vehicle.

Research task (20 minutes):

Now that you understand both the role a paramedic plays within an emergency and the importance of the initial methods of assessment, you need to begin to familiarise yourself with these methods in order to apply them in a scenario. In this case, you need to use your skills to support a patient in serious need of help. Objective: Choose a patient scenario (e.g., trauma, medical emergency) and gather relevant information from the scene and the patient. Scenario: A 45-year-old male involved in a car accident

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Paramedics play a crucial role in emergency and non-emergency care situations. Often, as the first responders on the scene, the information they gather and the choices they make can make a huge difference in a patient’s treatment and recovery. Knowledge building and quick thinking can turn the tide in serious medical situations. This part will help you interpret and prioritise the gathered information to guide the physical assessment. Objective: Organise and interpret the gathered information to prioritise care and identify the most likely conditions or injuries. Use a differential diagnosis approach to refine the assessment process, ensuring that critical issues are addressed first.

Step one: Prioritised Plan for the Physical Examination: Based on the patient’s involvement in a car accident, the most likely injuries include head trauma, chest injuries, fractures, and internal bleeding. Using a differential diagnosis approach, I would prioritise the assessment as follows:

• Airway: Check if the airway is clear, and if necessary, perform airway manoeuvres or insert an airway device.
• Breathing: Assess for any breathing difficulties or abnormal lung sounds, considering potential pneumothorax or rib fractures.
• Circulation: Monitor heart rate, pulse, and signs of shock or internal bleeding.
• Head-to-toe: Focus on identifying visible injuries such as fractures, deformities, and bruising, as well as hidden injuries like abdominal bleeding.

Analysis task (20 minutes):

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• Airway: I would first check if the patient has a clear airway by looking, listening, and feeling for any obstructions. If the patient cannot maintain their airway, I would use the jaw-thrust manoeuvre or insert an airway device such as an oropharyngeal airway.
• Breathing: I would inspect the patient’s chest for any deformities or wounds that might indicate rib fractures or pneumothorax, listen for breath sounds, and assess the rate and depth of breathing. Any respiratory distress would be managed by providing supplemental oxygen or, if necessary, performing a needle decompression.
• Circulation: I would assess the patient’s pulse, blood pressure, and skin signs to evaluate circulation. In the case of suspected shock, I would initiate fluid resuscitation and continue monitoring for internal bleeding or cardiac arrest.

Step two: ABC Assessment

A DORA (Dynamic On-scene Risk Assessment) is a systematic evaluation process used in emergency situations to ensure both patient and paramedic safety. In the case of an accident, this involves assessing environmental risks such as vehicle hazards, fire, or unstable debris. By identifying these risks early, paramedics can make informed decisions about how to approach and treat the patient safely. It is crucial for maintaining safety while delivering effective care.

Step one: What is a DORA?

Paramedics must perform a comprehensive nursing assessment and document findings - it’s not just about making quick decisions and providing emergency treatment on the scene. There are several assessments to conduct with any patient in an emergency, each being important in different ways. Objective: Explain the importance of a thorough nursing assessment in the pre-hospital environment, including how it guides immediate interventions and impacts patient outcomes. Describe how different factors like the mechanism of injury, patient history, and vital signs influence the assessment process.

Create task (30 minutes):

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After completing the initial assessment, I would reassess the ABCs, monitor vital signs regularly, and document all findings. This includes any changes in the patient's condition, interventions performed, and responses to those interventions. Documentation should be detailed and include vital signs like heart rate, blood pressure, oxygen saturation, and mental status.

Step four: Reassess and Record

• Starting with the head, I would palpate the skull for any signs of fractures or hematomas and check the pupils for responsiveness.
• Moving to the neck, I would stabilise the cervical spine and palpate for any misalignment, swelling, or tenderness.
• I would then assess the chest for symmetry, breath sounds, and possible rib fractures. The abdomen would be palpated for tenderness, rigidity, or swelling that could indicate internal bleeding.
• Finally, I would assess the extremities for deformities, tenderness, and range of motion, and immobilise any fractures.

Step three: Head-to-Toe Physical Assessment:

Create task (30 minutes):

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Step one: Report presentation Compile the assessment findings into a concise and accurate report. Patient Report Form: PC: Semi-conscious 45-year-old male involved in a car accident, weak pulse, no visible bleeding. HPC: Car accident occurred 10 minutes ago; patient was wearing a seatbelt. OA: Patient found semi-conscious with weak pulse, bystanders state no immediate loss of consciousness; no external bleeding visible. OE:

• A: Airway partially obstructed, cleared with jaw-thrust manoeuvre.
• B: Shallow breaths, decreased breath sounds on the left side; chest trauma suspected.
• C: Weak radial pulse, signs of hypovolemic shock.
• D: Glasgow Coma Scale: 10/15 (E3, V2, M5).
• E: No external bleeding, but abdominal tenderness and deformity in the left leg.

PMH: Unknown. MEDS: Unknown. ALLERGIES: None identified on-scene.

For paramedics, it’s not just about assessing the patient there and then - you need to be able to create reports that can help outline the circumstances as they are, clearly and concisely, so that others within the multidisciplinary team can get a thorough account of the information that can influence their own care delivery. Objective: Summarise the key findings from your nursing assessment and create a structured report that clearly communicates the patient’s condition and the steps taken.

Document & present (15 minutes):

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Step one: Reflection on the Assessment Process: This simulation highlighted the importance of staying calm and methodical during high-pressure situations. One of the most challenging aspects was prioritising the patient’s needs while considering the potential for unseen injuries like internal bleeding. The ABCs proved essential in ensuring immediate threats were managed first, particularly securing the airway and stabilising circulation. Communication with bystanders provided valuable context, but a more structured way of gathering information from non-verbal patients needs improvement. This exercise reinforced the necessity of thoroughness in documentation and patient reassessment to ensure no critical details are missed.

A paramedic’s career is one of continual improvement - taking the time to think about how things were handled, considering how they could’ve been improved, and putting this into practice. By taking time to reflect and improve, paramedics like you are leading the way in delivering exceptional care, often at times when patients need it most. Objective: Reflect on the assessment process, the decisions made, and the overall experience. Develop a reflective piece on your assessment process, identifying strengths and areas for improvement in your clinical practice.

Reflection task (15 minutes):

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Expected Outcome

Through this simulation, I have successfully conducted a comprehensive nursing assessment, prioritised patient care, and documented all relevant findings. This experience improved my ability to perform under pressure, handle critical decision-making, and communicate findings efficiently, which will greatly benefit future paramedic roles.