Table 1 Example of simulation pre-brief

Background

Patient name: John Smyth

Age: 58

Next of Kin: Mary Smyth (Wife). Has one daughter (Jayne, 32) who lives in Australia.

Consultant: Dr Jones

Diagnosis: Stage IV Non-Small Cell Lung Cancer with bone and liver metastases. Diagnosed March 2014. Previously treated with palliative radiotherapy and chemotherapy.

John is a 58 year old gentleman with advanced lung cancer. He has been an inpatient in Medical Ward 2 for five days; you are the nurse responsible for his care. John was admitted initially for treatment of a chest infection and symptom management of severe back pain and right-sided abdominal pain. On admission he was commenced on IV antibiotics for his chest infection and was reviewed by the palliative care nurse specialist who increased the dose of his analgesics for pain control. Since admission John’s condition has progressively deteriorated and he is now in the active phase of dying. John and Mary have spoken at length with medical and nursing staff about his wishes for end of life. It has been agreed that John should remain in hospital for his end of life care as Mary could not cope on her own at home. Their daughter Jayne is on her way home from Australia and is hoping to arrive tomorrow.

John is now actively dying. He has been commenced on a syringe driver with 30mg of morphine for pain relief and midazolam 10mg for breathlessness. His wife is anxious that his breathing has become very rattley, she is concerned it is troublesome for John. She also wants to know how long John might have left as she is anxious her daughter could miss saying goodbye to her father.