Weekly SJT Examples (10th November)
Ranking Question
On the morning ward round, your registrar states that one of your patient's is medically fit and can be discharged if the occupational therapist feels it is appropriate. The occupational therapist has assessed the patient and believes it is safe for her to go home with a care package that has been arranged. It is reaching the end the day when one of the nurses informs you that the patient says she does not feel safe to go home. The patient's bed is required for an elective admission the following day.
Rank in order the following actions in response to this situation (1 = Most appropriate, 5 = Least appropriate)
A. Ask the patient about her fears
B. Ask a senior colleague to address the patient's concerns
C. Ask the bed manager if he can find another bed for the elective patient
D. Explain to the patient that the bed has already been allocated and she has to go home
E. Ask the occupational therapist to come and speak to the patient with you
Answer:
AEBCD
Rationale:
This question assesses your ability to place the patient at the centre of your focus. Primarily, you must address your patient's concerns (A) and involving other members of the team may help to find a solution (E) - the first and second most appropriate responses. It is preferable to speak to the patient yourself before involving a senior (B) which ranks third. Forcing the patient to go home is potentially dangerous (D) which is the worst option, so trying to arrange another bed for the elective would be a better option (C) than this.
Multiple Choice Question
You are the FY1 on call for the evening in the medical admissions unit. The nurse asks you to sign a self-discharge form for a patient you have never met. She states the patient has taken an intentional paracetamol overdose. The nurse and the patient's boyfriend say they are unable to convince the patient to stay. She is in the corridor threatening to leave.
Choose the THREE most appropriate actions to take in this situation.
A. Refuse to sign the self discharge as you have never met the patient.
B. Get security to help detain the patient under the mental health act.
C. Get advice over the phone from the off site psychiatric liaison officer.
D. Ask the nurse to talk to the patient whilst you have a look through the notes to determine if she is in any immediate danger.
E. Talk to the patient yourself to explore why she wants to self-discharge.
F. Ensure the nurse informs the patient she is leaving against medical advice and sign the form.
G. Advise the boyfriend to call 999 if the patient makes another attempt to end her life.
H. Sign the self-discharge form and make a note to book an urgent outpatient psychiatric follow-up.
Answer:
CDE
Rationale:
This question assesses your ability to deal with a patient who wishes to self-discharge but may still be at risk. Just because the nurse and the patient's boyfriend have not managed to convince the patient to stay does not mean you will be unable to, therefore you should explore the reasons behind her desire to leave (E). In any situation you will benefit from knowing more about the patient's background (D). The psychiatric liaison officer may be able to advise you on what to do next (C). (G) and (H) do not address the immediate problem. You, rather than the nurse should advise the patient of leaving (F) against medical advice and the associated risks. (A) does not help the situation and is not very professional. As an FY1 you are probably not qualified to section someone (B) and therefore should seek help from seniors instead.
On the morning ward round, your registrar states that one of your patient's is medically fit and can be discharged if the occupational therapist feels it is appropriate. The occupational therapist has assessed the patient and believes it is safe for her to go home with a care package that has been arranged. It is reaching the end the day when one of the nurses informs you that the patient says she does not feel safe to go home. The patient's bed is required for an elective admission the following day.
Rank in order the following actions in response to this situation (1 = Most appropriate, 5 = Least appropriate)
A. Ask the patient about her fears
B. Ask a senior colleague to address the patient's concerns
C. Ask the bed manager if he can find another bed for the elective patient
D. Explain to the patient that the bed has already been allocated and she has to go home
E. Ask the occupational therapist to come and speak to the patient with you
Answer:
AEBCD
Rationale:
This question assesses your ability to place the patient at the centre of your focus. Primarily, you must address your patient's concerns (A) and involving other members of the team may help to find a solution (E) - the first and second most appropriate responses. It is preferable to speak to the patient yourself before involving a senior (B) which ranks third. Forcing the patient to go home is potentially dangerous (D) which is the worst option, so trying to arrange another bed for the elective would be a better option (C) than this.
Multiple Choice Question
You are the FY1 on call for the evening in the medical admissions unit. The nurse asks you to sign a self-discharge form for a patient you have never met. She states the patient has taken an intentional paracetamol overdose. The nurse and the patient's boyfriend say they are unable to convince the patient to stay. She is in the corridor threatening to leave.
Choose the THREE most appropriate actions to take in this situation.
A. Refuse to sign the self discharge as you have never met the patient.
B. Get security to help detain the patient under the mental health act.
C. Get advice over the phone from the off site psychiatric liaison officer.
D. Ask the nurse to talk to the patient whilst you have a look through the notes to determine if she is in any immediate danger.
E. Talk to the patient yourself to explore why she wants to self-discharge.
F. Ensure the nurse informs the patient she is leaving against medical advice and sign the form.
G. Advise the boyfriend to call 999 if the patient makes another attempt to end her life.
H. Sign the self-discharge form and make a note to book an urgent outpatient psychiatric follow-up.
Answer:
CDE
Rationale:
This question assesses your ability to deal with a patient who wishes to self-discharge but may still be at risk. Just because the nurse and the patient's boyfriend have not managed to convince the patient to stay does not mean you will be unable to, therefore you should explore the reasons behind her desire to leave (E). In any situation you will benefit from knowing more about the patient's background (D). The psychiatric liaison officer may be able to advise you on what to do next (C). (G) and (H) do not address the immediate problem. You, rather than the nurse should advise the patient of leaving (F) against medical advice and the associated risks. (A) does not help the situation and is not very professional. As an FY1 you are probably not qualified to section someone (B) and therefore should seek help from seniors instead.