1. Home Care Simulation Objectives
Focus on Heart Failure
Learning Objectives
Questions 1-2 (Pre-visit knowledge necessary for professional practice)
Learner will:
1. Identify demographic data necessary for planning nursing care.
2. Integrate relevant demographic data into planned interventions.
3. Synthesize information by writing a demographic assessment.
Questions 3-4(Pre-visit knowledge necessary for professional practice)
Learner will:
1. Demonstrate understanding of given disease processes as well as purpose and rationale
of given medication regimen.
2. Identify assessments that would monitor medication efficacy.
3. Identify assessment findings that would trigger physician contact or referral to ER
Performance Objectives
Questions 5-10
Learner will:
1. Assess both patient and home environment in a systematic &orderly manner.
2. Obtain and prioritize pertinent subjective and objective data.
3. Respond to abnormal physical assessment findings appropriately.
4. Communicate effectively with patient (verbal, nonverbal, teaching), utilizing strategies
that are patient-centered.
5. Formulate priority nursing interventions providing specific rationale.
6. Formulate measurable priority outcomes.
7. Write documentation of home visit clearly, concisely, and accurately.
8. Reflect on simulation experience.

2. Community Health Simulation
Home Care Scenario – Senior Level
Focus on Heart Failure
Fall 2014
You have been assigned to visit Mr. John Smith. Mr. Smith is 76 years old. He has resided in
his 2 story home located at 1859 Kapel Drive, Euclid, Ohio for over 30 years. His spouse passed
away 5 years ago. He has 2 adult children that live out of state. Mr. Smith recently was
discharged from the hospital following a 5 day hospitalization for congestive heart failure and
atrial fibrillation. A retired auto mechanic, Mr. Smith suffered a cerebral vascular accident in
2011 that has left him with residual right sided weakness.
PREVISIT PHASE: PREPARATION
This is your initial post hospitalization home visit.
1. Describe the demographics of the city in which Mr. Smith lives. Helpful information can
be found in the city website as well as the U.S. census.
2. Identify the community data that may be helpful in planning Mr. Smith’s care and
explain their relevance.
The hospital referral indicates that Mr. Smith was sent home on the following medication
regimen:
Metropolol 50 mg twice as day
Lisinopril 10 mg twice a day
Lasix 20 mg daily
Coumadin 2.5 mg daily
3. What are the diseases afflicting Mr. Smith? Explain the pathophysiology of each.
4. How will each of these medications impact the disease processes?
a. What assessments will you make?
b. Identify the findings would prompt contact with Mr. Smith’s primary
care provider.
5. How would you prepare for this first visit?

3. CONTACT PHASE
6. Describe the importance of the initial contact.
7. How would you explain your role to the patient?
ENTRY PHASE
You arrive for your visit and ring the doorbell. You hear Mr. Smith yell to come in. Upon entry
you do a visual assessment of the environment. You also note that Mr. Smith is sitting in a
recliner in the living room with a walker next to him. He is pleasant but does not stand to greet
you. There are soiled depends in the wastebasket. He states he has “accidents” due to his
“water pill”.
8. Assess the home environment. Is he safe? Are there
a. Hazards?
b. Impediments to his independence?
c. Recommendations that would make?
Refer to the CDC website:
http://www.cdc.gov/HomeandRecreationalSafety/Falls/CheckListForSafety.html
SEEING PHASE
After a few minutes of conversation, you learn Mr. Smith experiences dizziness with position
changes. He also reports his appetite is poor. He likes to sleep in his recliner because it is easier
for him breath sitting up. It is also difficult for him to climb the stairs to his bedroom.
9. Construct an orderly list of assessments that you would complete at this time.
a. Consider each of the assessment findings
b. Relate each of those findings to Mr.Smith’s disease processes and medications
He becomes tearful at times discussing his health problems and how they limit his ability to get
out of the house. He states he is “overwhelmed” at times with keeping up the house and taking
care of himself. He fears he will be put into a nursing home without some help
10. How would you conceptualize Mr. Smith’s “living situation” in a nursing
diagnosis?
11. What independent nursing interventions would you implement or recommend
to Mr. Smith.

4. When asked, Mr. Smith is not able to tell you about his medications.
He tells you to look in the kitchen for his medications.
12. What do you find? What can you do at this point? What should you do?
13. Review the medications you have found in the kitchen. How can you organize the
medications and help ensure Mr. Smith understands his regimen?
14. Complete a medication schedule with client-appropriate education provided.
TELLING PHASE
Review how you would organize and report the relevant data to the community physician.
Please write a report of this home visit for consideration by your home health
agency. You and your partner may work together or you may work separately. You should
complete this assignment within 1 hour of concluding your visit in Mr. Smith’s home.
The report should include:
 Your findings in the 3 main areas of the home visit: environmental, physical, and
psychosocial.
 Your nursing diagnosis of each of these 3 areas and supporting data
 List 3 interventions you would provide
 How often would you want to visit Mr. Smith?
Submit your report to the faculty member via email
Elizabeth Puffenbarger MSN, RN
e.puffenbarger@ursuline.edu