Figure 5. Simulated scenario script: “Managerial decision-making by nurses in the face of adverse events in a hospital” - Part 2. Ribeirão Preto, SP, 2019-2020.

Expected actions:
A: Assess airways; B: Check RR*, elevate the head of the bed; C: Perform non-invasive blood pressure measurement and HR check†; D: Assess the level of consciousness; E: Check peripheral venous access and measure body temperature. Others: Assess the patient’s general conditions (interview and physical examination); Implement safe medication administration practices and verify the nine rights of medication administration#; Contact the previous shift nurse responsible for the patient for information on the adverse even through a telephone call; Communicate the fact to the doctor (who is reached by phone), check for potential adjustment of antihypertensive medication schedule and administer the medication according to medical advice, double-checking the medical record; Advise the patient about the complication and which course of action will be taken; Record the activities performed in the medical record.
Evolution: Patient presents normalization of vital signs and no pain complaints.
Debriefing:
1. Questions to Players:
How did you feel (feeling/emotion) acting in the scenario? Could you describe the scenario experienced? What were the positive points? What would you do differently? What points could be improved? What will you take with you in your life? What learning did you get? What is the professional competence developed in this scenario? After participating in this scenario, what do you think about the exercise of decision-making competence?
2. Questions to Observers:
What are the positive points observed in this service? What learning did you get from it?
Summary: The discussion should permeate the nurse’s decision-making steps: assessment of patient’s general condition and priority care to its immediate needs, identification of team members responsible for patient care in both shifts, communication with physician on duty, medication administration, checking prescription and adjusting medication time and guidance of other team members. For a professional practice framework, the role of a nurse’s managerial decision-making competence should be highlighted, as well as the need to associate theory and practice; in addition, pathological processes and their symptoms should be well known to efficiently identify which decision-making to adopt. Carry out permanent education actions to the team on safe medication administration practices.
Environment: Medical clinic sector.
Participants:
1 student in the role of the nurse;
1 player in the role of the patient;
1 student in the role of the nursing technician;
1 player in the role of the nurse and doctor;
1 player in the role of the nurse.
Materials and equipment: patient’s medication tray (antihypertensive); hospital bed with ward sheets; cup and jar containing water; sphygmomanometer; stethoscope; bed identification card; trash can; peripheral venous access equipment; bedside table; portable oximeter; wig; patient identification bracelet; clock; telephone, clinical thermometer and medical records (history, medical diagnosis, prescription, nursing evolution, and vital signs).

*RR = Respiratory rate; ^†HR = Heart rate; ^#Check the nine rights of medication administration: right patient, right drug, drug compatibility, patient guidance, right to refuse drug, correct note, right dose, right route and the right time ²¹