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ROLE PLAY

DISCHARGE PLANNING DIABETIC MELLITUS

PROUDLY PRESENT:

1. Siti Mariyah As Narator


2. Nurhasanah As Doctor
3. Endah Widya Astuti As Emergency Nurse
4. Ade Irma suryani As Primary Nurse
5. Aryani DwiRagupti Yuwono As Associate Nurse
6. Faroh Ningrum Widiastutik As Associate Nurse
7. Mardika Dwi Setiyani As Associate Nurse
8. Yuri wahyuni As Wife
9. Angga Saefullah As Husband (Patient)

FACULTY OF HEALT, BACHELOR OF NURSING,


UNIVERSITY OF MUHAMMADIYAH TANGERANG

2015

PROLOGUE

Assalamualaikum Wr Wb

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Good morning everybody, How are you today guys ? Introduce we are group one
and then Im Mariya As Narator, Angga Saefullah as Patient, Yuri As Wife, Nurhasanah As
Doctor, Endah As emergency Nurse, Ade As primary nurse, Faroh as associate nurse,
Mardika as Associate Nurse and Aryani As associate nurse. In this morning we will
roleplay about discharge planning of diabetic mellitus. Discharge planning should be done
since the patient was received in a health care agent, especially in hospitals where a
patient's span to stay increasingly short.

Discharge planning should include effective ongoing studies to obtain


comprehensive information about the changing needs of the patient, nursing diagnosis
statement, planning to ensure the needs of the patient in accordance with what is done by
health care giver (kozier, 2004)

Discharge planning

Aims to identify specific needs to maintain or attain maximum function after


coming home (carpenito, 1999). Discharge planning also aim to provide the best service to
ensure the sustainability of quality between home orphanage sick and effective
communication (discharge planning association, 2008).

The release of the planning process including the patient's physical, psychological,
social, cultural, and economic. Perry & Potter (2006) divides the process of planning the
release of more than three phases, namely acute services, transitional, and sustainable.
Check out on

SCENE 1
Setting : Edelwies Ward
Description : Patients get the care in the ward.

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Head Nurse : Hello, Good morning.
Patient + Wife : Morning nurse
Head Nurse : Is true Mr. Angga ?
Patient : Yes, Im Mr. Angga
Head Nurse : Welcome in the edelweis ward. Introduce, Im Endah as Head
Nurse in Edelweis Ward. And this Nurse Ade. How do you feel
today ?
Patient : I`am feel my wound is getting worse.
Head Nurse : No more questions mr ?
Patient : No Nurse
Head Nurse : OK sir, then the doctor will deal you coming soon. While waiting
for the doctor, I want to tell that the rule here for an hour visit is
limited due to ensuring clients. Visiting hours in the morning at
11.00 until 13.00, an afternoon visit from 17.00 until 19.00, visitors
who entered the room a maximum of 2 people, so if there is a family
of Mr visiting relatives over 2 provided room to take turns to visit.
Before proceeding there you want to ask? "
Patient : No thank you
Head Nurse : Nurse Ade will continue complete the patient record. I will go
back to the room
Patient :ok please nurse
Primary Nurse : Im take care of you in the ward from 10 a.m until 2 p.m. can I
complete your patient record, are you agree?
Patient : OK nurse, Iam agree.
Primary Nurse : Can you tell me your full name please?
Patient : My full name is Angga Saefullah.
Primary Nurse : When were you born?
Patient : I was born on Tangerang.
Nurse 1 : Whens your date of birth?

Patient : I was born is 9 June 1980

Nurse : Whats your mobile phone number?

Patient : My mobile phone number is 089-982-766-23

Primary Nurse : Can you tell me why you are here today?

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Patient : I had a leg wound that is getting worse.
Primary Nurse : Have you had serious illness in the past?
Patient : Yes I have diabetic mellitus.
Primary Nurse : Have you ever had any operations?
Patient : No, I havent any operations.
Primary Nurse : Are you taking any medication at the moment?
Patient : Yes I take medication diabetic mellitus.
Primary Nurse : Do you have any allergies to any medications?
Patients : No I dont have allergies to anything.
Primary Nurse : Can you tell me the usual food you eat ?
Patient : I more likes food and sweet drinks and ready meals
Nurse 1 : Whos your GP?

Wife : My husband first come to this hospital and we`re dont have GP.

Nurse 1 : Whos your next of kin?

Wife : I am Yuri Wahyuni

Nurse 1 : Whats his/her relationship to you?

Wife : Is Wife

Primary Nurse :OK check patient record is finish and now I will check your vital
signs. Are you ready?
Patient : Yes, I am ready nurse.
Primary Nurse : OK Mr. Angga. The purpose checking a blood pressure is to know
your blood pressure and know your condition. Are you understand
Mr. Angga?
Patient : Yes, I`am understand.
Primary Nurse : OK Mr. Angga, I will prepare to the equipment. Place in here and
this examination takes 3 to 5 minutes. Are you agree Mr. angga?
Patient : Yes, Im agree.
Primary Nurse : Excuse me, Mr. Angga are you ready to check your vital signs?
Patient : Yes, I am ready nurse.
Primary Nurse : Mr. Angga can you put a thermometer in your armpit?

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Patient : Yes, sure.
Primary Nurse : Mr. Angga beforehand please dry your armpit with a this tissue
Patient : OK.
Primary Nurse : Mr. Angga can you roll up your sleeves?
Patient : Yes, I can nurse.
Primary Nurse : (Check vital signs) Mr. Angga check vital signs is finish. Mr.
Angga the result your vital sign is good. Your blood pressure is
130/90 mmHg. Your pulse is 88 x/minutes. Your temperature is 37 0
C and your breathing is 18 x/minutes.
Patient : Nurse, what the result is normal?
Primary Nurse : Yes, Mr. Angga, the result is normal and before doctor come to the
ward, I will call nurse Aryani to check blood glucose level Mr.
Angga. Are you agree?
Patient : Yes nurse, Im agree.
Primary Nurse : Because you agree. I will go back to nurse station.
Patient : Thanks nurse.
Primary Nurse : If you need me again. Please Push the bell in the right your bed.

(Primary nurse tells condition Mr. Angga to nurse aryani, that Mr. Angga are ready
to check blood glucose level)

Primary Nurse : Nurse Aryani, This is form Mr.Angga, please you to check blood
glucose level and I want to report a new patient named Mr. Angga,
the age of 35 years. Requires blood examination to find out the
condition of the patient.
Assosiate Nurse 1 : OK, please wait. I will prepare to the equipment. Thank`s for
information.
Primary Nurse : Yes, you`re welcome.

(Practice to check blood glucose level)

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Assosiate Nurse 1 : Hello, Mr. Angga. Introduce Im Nurse Aryani. I will to check
blood glucose level for to find out the condition of Mr. Angga. Are
you ready?
Patient : Yes. I`am ready nurse.
Assosiate Nurse 1 : Mr. Angga before I check your blood glucose level, I will explain
the purpose of the examination of blood glucose levels, is to know
your blood glucose level in your body and so, that we can provide
appropriate interventions to Mr. Angga.
Patient : OK, Nurse.
Assosiate Nurse 1 : Mr. Angga check your blood glucose level takes 10 minutes, are
you ready Mr?
Patient : Yes nurses, I`am ready.
Assosiate Nurse 1 : OK Mr. Angga, please wait and I will prepare the equipment.
Patient : OK nurse, I will wait.
Assosiate Nurse 1 : Prepare the equipment is finish and know I will check your blood
glucose level, are you ready Mr?
Patient : Yes, I`am ready nurse.
Assosiate Nurse 1 : OKey, I`ll just put a test strip in the glucometer. And now can you
hold out your finger, please?
Patient : Yes, this is nurse.
Assosiate Nurse 1 : I can put the cotton swab on your finger now, I`m going to prick
the side of your finger with this lancet, I`ll put a drop of blood on
the test strip and I can put the cotton swab on your finger now.
Patient : OK, nurses please slowly.
Assosiate Nurse 1 : Check blood glucose levels has been completed. How you feel
after I do the examination?
Patient : I dont feel pain and how is the result nurses ?
Assosiate Nurse 1 : OK. Mr. Angga, the result is 270 mg/dL. I`ll record it on your
chart now.
Wife : What does it mean ?
Assosiate Nurse 1 : The result is high, because the normal value of blood glucose
levels when not fasting is 77-115 mg/dL.
Wife : OK, nurse.
Assosiate Nurse 1 : OK Mr. Angga Later, doctor will come to examination your
condition. Are you ready?
Patient : Yes, I`am ready nurse.
Assosiate Nurse 1 : OK. Any question again Mr. Angga?

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Patient : No, nurses.
Assosiate Nurse 1 : OK. Mr. Angga If you need me again, you can call me or press the
bell on the right side of your bed.
Patient : Yes nurse, thanks you.

(Check blood glucose level is complete and now Doctor come tothe ward)

Setelah 10 menit kemudian dokter visite memeriksa pasien Wahyu. Setelah selesai
diperiksa PPmenyampaikan: kemungkinan penyakit pasien, perkiraan lama pasien
dirawat, intervensi keperawatan/medis yang biasa dilakukan di ruangan, biaya perawatan,

PP :selamat pagi Mr. angga?


Pasien :selamat pagi sus
PP :bagaimana peaan bapak setelah diperiksa dokter?
Pasien :baik sus, pusingnya sedikit berkurang
PP : o. Gitu ya Pak. Baik pak Wahyu disini saya akan meyampaikan
kemungkinan penyakit bapak yaitu DM, perkiraan perawatan bapak diruangan ini selama
1 minggu, kemudian untuk tindakan yang biasanya dilakukan untuk pasien seperti kondisi
bapak adalah rawat luka karena luka dikaki bapak apabila tidak dirawat akan semakin
parah dan sulit sembuh. Untuk biaya keperawatan dan lain-lain seperti obat dan alat nanti
akan direkap diruangan dan diserahkan ke keluarga bapak untuk dilunasi, bagaimana Pak
Wahyu, apakah sudah jelas?
Pasien :iya sus sudah cukup jelas
PP :baik pak Wahyu, selain saya nanti juga ada perawat Febi yang akan
merawat bapak selama diruangan ini. Untuk perawat Febi nanti akan merawat bapak pada
dinas sore, nanti akan saya perkenalkan ya pak
Pasien :iya sus
PP :baik pak wahyu, silahkan istirahat kembali, dan terima kasih atas
kerjasamanya
Pasien :baik sus

Assosiate Nurse 1 : Hi Doctor and Nurse. After I check blood glucose levels Mr Angga
the result is 270 mg/dL
Doctor : OK. Ill check Mr. Angga

(Doctor come to the room Mr. Angga to check)

Assosiate Nurse 2 : Hello, good morning Mr. Angga?


Patient : Good morning, nurse.
Assosiate Nurse 2 : How are you today Mr. Angga?

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Patient : Im not so good, because I feel pain the wound.
Assosiate Nurse 2 : OK. Mr. Angga. Can I see your wound?
Patient : Yes, Nurse. Please!
Assosiate Nurse 2 : Mr. Angga. I saw the wound worse. I will take care of the wound
now. Are you ready Mr. Angga?
Patient : Yes. Nurse. I`am ready.
Assosiate Nurse 2 : Mr. Angga before I take care the wound, I will explain the purpose
of caring for and cleaning your wound is a wound that you don`t
have your wound infection and get well soon.
Patient : OK nurse, and how a long time?
Assosiate Nurse 2 : Mr. Angga cleans your wound takes 10 minutes, are you ready Mr.
Angga?
Patient : Yes, I`am ready Nurse.
Assosiate Nurse 2 : Mr. Angga, Please wait and I will prepare the equipment.
Patient : OK. Nurse I will wait.
Assosiate Nurse 2 : Mr. Angga. I've finished preparing the equipment. are you ready?
Patient : Yes, Nurses i`am ready.
Assosiate Nurse 2 :
1. Maintain Privacy
2. Adjust the position of the patient so that the wound can be seen
clearly
3. Open the equipment
4. Wearing gloves
5. Moisten the plaster with alcohol / gasoline wash and opened by
using a pair of tweezers
6. Open the outer layer bandage
7. Clean around the wound and used plaster
8. Open a bandage ply in
9. Pressing the edge of the wound (all injuries) to remove the pus
10. Perform debridement
11. Clean the wound using liquid NaCl
12. To compress desinfektant and cover with gauze
13. Install plaster or verband
14. Tidy patients
Assosiate Nurse 2 : Mr. Angga if you feel pain, you can tell me.
Patient : Yes Nurse

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Assosiate Nurse 2 : Mr. Angga the care wound is finish. How do you feel now after I
wash the wound?
Patient : Yes nurse faroh. I feel better now.
Assosiate Nurse 2 : OK Mr. Angga. Can I help you again?
Patient : No. Nurse.
Assosiate Nurse 2 : OK. Mr. Angga. If you need me again. you can call me or push the
bell on the right of your bed.
Patient : OK. Nurse Faroh. Thank`s you for care my wound

SCENE 4
Setting : The Kenanga Ward

Description : (2 days later) Dischart Planning Diabetic Mellitus

Doctor : How is the condition Mr. Angga?

Primary Nurse : For 2 days of threatment the patient condition improves. what is patient
have allowed to go home?

Doctor : OK, lets check to ward Mr. Angga

(Doctor and primary Nurse go to ward Mr. Angga)

Doctor : Good morning Mr. Angga?

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Patient : Good morning, doctor.

Doctor : How are you Mr. Angga?

Patient : I feel get better.

Doctor : OK, I will check your wound?

Patient : Yes doctor. Please check the wound.

Doctor : OK. Mr. Angga of the examination result, Mr Angga has been allowed to
go home. But need care at home.

Patient : Are you serious doctor?

Doctor : Yes, Mr. Angga. Because your condition is fine. To get home care we will
provide an explanation. Home care such as wound care, can be done by
nurses from outside of from inside the hospital. So you choose a nurse from
where?

Patient : I submit all your decisions

Wife : We choose a nurse from the hospital.

Primary Nurse : If if there are not understand please ask. Any question ?

Wife : No, Im already understand.

Primary Nurse : Because you choose a nurse from the hospital. Later I will give informed
consent to nurse wounds come to your home.

Wife : Yes nurses.

Doctor : OK before you go home. Ill call Nurse Mardika, to explain health
education. Please wait.

Patient : OK doctor. I will wait.

Primary Nurse : I will come back again to give informed consent related to wound care at
your home.

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Patient : OK nurse.

(Doctors give instructions to the nurse Mardika to provide an explain diet diabetes mellitus)

Doctor : Nurse Mardika, can you help me for give health education about diabetic
mellitus of Mr. Angga and family?

Assosiate Nurse 3 : OK. I will prepare to health education, after that I will to ward Mr. angga.

Primary Nurse : Nurse Mardika. I'll come to ward Mr. angga. Because Ill give informed
consent to Mr. angga related wound care at home.

Assosiate Nurse 3 : Yes nurse Ade, lets with me to ward Mr. Angga.

(Nurse Ade and Nurse Mardika entered the room mr. Angga to give an explanation the diet
of diabetic mellitus and give informed consent to Mr. Angga)

Primary Nurse : Hello Mr. Angga and Mr. Yuri. This is Nurse Mardika. She will to explain
health education about diabetic mellitus.

Patient : OK, Nurse Ade.

Primary Nurse : You and family agree to choose a nurse from the hospital to to wound care
at your home. This is informed consent that you should sign.

Patient : Ill sign informed consent.

Primary Nurse : I will come back to Nurse station. And Nurse Mardika Please Explain to
health education.

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Assosiate Nurse 3 : OK. How are you today Mr. Angga?

Patient : I`m feel getting better.

Assosiate Nurse 3 : Im happy to hear that. Im Nurse Mardika. I will give you and family
health education about diabetic.

Wife : Yes nurse, please.

Assosiate Nurse 3 : Are you ready?

Patient : I`am ready nurse.

(Nurse Mardika Explain health education about Diabetic)

Health education materials attached

Assosiate Nurse 3 : Signs and symptoms of how you feel ?

Patient : Increased urinary frequency, thirst, hungry.


Assosiate Nurse 3 : What is food and drink do you likes?
Patient : I more likes food and sweet drinks and ready meals.
Assosiate Nurse 3 : How much sugar you input when you are cooking ?
Wife : Almost two more spoons in each dish. Because I like sweet taste in
cooking.
Assosiate Nurse 3 : Any question again mr. angga and mrs. Yuri ?
Wife : What's can eat potatoes to every day? because my husband likes potato.
Assosiate Nurse 3 : Should be modified, do not settle and do not overdo it. Potatoes can be
added to vegetables. You have to do it because it will help the healing
process of wounds on your foot.
Wife : Yes, Im understand nurse
Patient : Ill keep my diet, in order to quickly recover.
Assosiate Nurse 3 : I'm sure you can do it. Can I help you again ?
Patient : No nurse. I think enough. We already understand. Thanks a lot nurse.

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Assosiate Nurse 3 : OK. I will come back to nurse station. But because you permissible to go
home, you can follow me to complete the affairs of administration.
Wife : Thank`s Nurse. And Ill follow you.

(Nurse Mardika finished explain health education about diabetic, and then she come to the
Nurse station)

Assosiate Nurse 3 : Hello Nurse Ade. Mrs. Yuri already come.


Primary Nurse : Yes thanks. Please have a sit.
Wife : Thanks nurse.
Primary Nurse : Mrs. Yuri, all already complete. but still there is a recipe that you should
take in Pharmacies. Two days later, nurse faroh will come to your house to
care the wound Mr. Angga.
Wife : I will wait for arrival of nurse faroh.
Primary Nurse : Nurse dika can you help me.
Assosiate Nurse 3 : Yes Nurse.
Primary Nurse : Please, you usher Mr. Angga to lobby in hospital because Mr. Angga will
go home.
Assosiate Nurse 3 : Ill usher Mr. Angga and family to lobby hospital.

(Nurse Dika and Wife come to ward)

Assosiate Nurse 3 : Mr. angga, Ill usher you to lobby in hospital. Are you ready ?
Patient : Please Wait 5 minute Nurse, Ill prepare.
Assosiate Nurse 3 : OK.
Wife : Nurse, we are ready.
Assosiate Nurse 3 : Can you sit to wheelchair ? I help you
Patient : Yes, Of course.

(Nurse Dika usher Mr. Angga and family to lobby hospital)

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Assosiate Nurse 3 : OK. I hope your condition is getting better Mr. Angga
Patient : Thanks a lot nurse.
Wife : Thanks to treatment during this time to my husband.
Assosiate Nurse 3 : Youre welcome. Be careful!

(Mr. Angga and family go to home)

SCENE 5
Setting : At Home Mr. Angga
Description : Nurse Faroh going to home Mrs. Angga for
change dressing wound.

Assosiate Nurse 2 : TOK.. TOK.. TOK Excuse me..

(Mrs. Yuri Open the door)

Assosiate Nurse 2 : Is true Mr .Angga's home ?


Wife : That's true, please entry.
Assosiate Nurse 2 : OK thank you. I'm nurse faroh, as appointment yesterday. I will
take care of the wound Mr. Angga.
Wife : Yes, I have wait you let's follow me in my room
Assosiate Nurse 2 : Yes, Are you doing a blood sugar test your husband in this
morning?

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Wife : I have check. The result 210 mg/dl and I give insulin for my
husband.
Assosiate Nurse 2 : It's really good Mrs.

(Nurse and wife entry to bed room)

Assosiate Nurse 2 : How are you today Mr. Angga?


Patient : I feel get better
Assosiate Nurse 2 : Today, I will change a dressing your wound, Are you ready?
Patient : Yes, I'm ready nurse.
Assosiate Nurse 2 : Mr. Angga. Before I dressing your wound, I will explain the
purpose take care of the wound is a wound that you don`t have your
wound infection and get well soon.
Patient : OK nurse, and how a long time?
Assosiate Nurse 2 : Mr. Angga cleans your wound takes 10 minutes, are you ready Mr.
Angga?
Patient : Yes, I`am ready nurse.
Assosiate Nurse 2 : OK, I prepare the tools
1. Maintain Privacy
2. Adjust the position of the patient so that the wound can be seen
clearly
3. Open the equipment
4. Wearing gloves
5. Moisten the plaster with alcohol / gasoline wash and opened by
using a pair of tweezers
6. Open the outer layer bandage
7. Clean around the wound and used plaster
8. Open a bandage ply in
9. Pressing the edge of the wound (all injuries) to remove the pus
10. Perform debridement
11. Clean the wound using liquid NaCl
12. To compress desinfektant and cover with gauze
13. Install plaster or verband
14. Tidy patients

(OK finish, while do a change dressing wound and The wound is getting better)

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Assosiate Nurse 2 : How do you feel, after I take care your wound?
Patient : Yes I feel more comfortable.
Assosiate Nurse 2 : I see your wound is getting better?
Patient : Are you serious?
Assosiate Nurse 2 : Yes iam serious, I hope you can keep the nutrition so that the
wound is improving and his blood sugar back to normal.
Patient : OK, I will do it, thank you for a change dressing my wound.
Assosiate Nurse 2 : OK. Can i help you again?
Patient : No. Thank you nurse.
Assosiate Nurse 2 : Ok, if you need help me again, you can be phone me at number
0899-034-6671. get well soon Mr.Angga.
Patient and wife : See you later nurse.

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