Multiple Organ Dysfunction



Case Summary Demetri Ivanivitch is a 23-year-old male (pronouns he/him) migrant worker from Belarus.  He was informed by Public Health that he tested positive for COVID-10 after screening by his employer.  He was put in self-isolation and followed by Public Health in the community. His only initial symptom was the loss of taste and smell.  Over the course of three days, the patient began experiencing increased shortness of breath (SOB).  He called 911 and was brought to the ER for assessment.   He was intubated and is now being transferred to the Intensive Care Unit (ICU).

Target Audience: Nursing Students (Intermediate to Advanced) and Graduate Nurses

Keyword: Geriatrics, Fluid Volume Deficit, Electrolytes

Learning Outcomes


Learning Outcomes

  1. Communicates with team members in a critical care setting to determine priority actions to maximize patient outcomes.

  2. Performs a comprehensive assessment of a critically ill patient to determine the next steps in care.

  3. Performs critical interventions in response to assessment findings to provide essential care and prevent further deterioration in clinical status.

  4. Anticipates modifications required for the care of a patient with suspected COVID-19 based on best practice guidelines.
Self Assessment Rubric

Self-Assessment Rubric

The use of this customized learning outcomes rubric, based on self-regulated learning (SRL) theory, allows student self-assessment of the game content and targeted learning outcomes.  Each rubric also describes competency indicators which levelled from the novice to competent learner. Below each learning outcome, users can provide additional comments/reflections/rationale to support scoring. The self-assessments rubric can be used to:
  1. Assess success on preparation for the simulation
  2. Assess performance during the simulation
  3. Guide the post-simulation debriefing in order to identification remedial learning requirements.
Further, the rubric can be used by the simulation facilitator for evaluation purposes or by examining the difference between instructor assessment scores and students’ self-assessment of the understanding of course criteria.
For the Multiple Organ Dysfunction (MODS)  Learning Outcome Assessment Rubric (word document) – click here

For the Multiple Organ Dysfunction (MODS) Learning Outcome Assessment Rubric (pdf) – click here
Game Link

  English Game LinkClick here  
  1. The game works best using Google Chrome or Firefox.  The game does not have full functionality when using your cell phone.
  2. You will be shown a video of an interaction between a nurse and a patient, their family and/or other medical staff.
  3. Following each video, you will be asked to select the most appropriate response.
  4. Please note that sound is required to fully understand the interactions within the video.
  5. It is preferred you use Google Chrome or Firefox to maintain optimal audio/visual output.
  6. The game will take approximately 20-30 minutes to complete.
  7. You may complete the virtual simulation game as many times as you like.
Virtual Debrief

  The Can-Sim Virtual Simulation Games are an online resource that can be used as either presimulation preparation, stand-alone games, or as a teaching resource in or outside of the classroom.  According to The International Nursing Association for Clinical Simulation and Learning (INACSL) Standards of Best Simulation Practice (2016), debriefing is a critical aspect of the simulation experience. Debriefing after simulation provides the opportunity for self-assessment and peer evaluation by giving feedback to others. Therefore, it is important that after any simulation, a debriefing should take place. Options for debriefing a virtual simulation game debriefing include:

  1. Embedded feedback debrief: CAN-Sim Virtual Simulation Games (VSG) are designed to provide the player with immediate feedback to selected responses in the form of an Embedded Debrief.  Aligned with the game’s learning outcomes, the player is required to answer a series of multiple-choice clinical decisions key points during the game.  Upon selecting a response, the player will be shown a video clip portraying the outcome of their chosen response with a written rationale on why their decision was either correct or incorrect. Correct responses will advance the game to the next video and corresponding decision point.

  2. Self-debrief: Use the provided game-specific Learning Outcomes Assessment Rubric to reflect on perceived self-competence specific to game learning outcomes. It is recommended that completion of the Learning Outcomes Assessment Rubric should be done before and after playing the virtual simulation game.  Using the Learning Outcomes Assessment Rubric, reflect on areas of perceived competence and areas needing further improvement.  We have provided suggested reading resources to support further learning.

  3. In-person debrief: This form of debriefing involves a traditional face-to-face debrief with a facilitator. This debrief can be performed in the classroom or lab setting.

  4. Synchronous online debrief: This involves an online debrief immediately following gameplay guided by a simulation facilitator using a video-conference software (ie. Zoom, Adobe Connect). Similar to an In-person Debrief, the synchronous online debrief uses an online platform.

  5. Asynchronous online debrief – This asynchronous involves a debrief using a discussion board platform where participants post responses to reflective debriefing questions. Other participants and facilitators then respond to reflective postings.
Reflective Questions

Reflective Questions

  1. You are a new graduate nurse working in the ICU and are assigned to this patient.  You feel anxious and overwhelmed due to the complexity and critical condition of the patient. How would you manage this situation?

  2. There is unlicensed assistive personnel (UAP) working on the unit during your shift.  They ask if they can do anything to help.  What activities would be appropriate to delegate to the UAP?

  3. What safety measures should be considered when providing care to a paralyzed and sedated patient?

  4. You are assisting a nurse who is assigned a ventilated patient in the ED. The ventilator alarm sounds repeatedly.  The assigned nurse always silences the alarm and continues with care.  What actions would be appropriate for the assisting nurse in this situation?

  5. The assigned nurse has just left the room.  You are already donned in enhanced personal protective equipment (PPE) and providing care to your patient. The ventilator alarm sounds.  As this is an urgent situation, do you need to doff and redon new PPE before providing care to the patient?


Robba, C., Battaglini, D., Pelosi, P., & Rocco, P. R. (2020). Multiple organ dysfunction in SARS-CoV-2: MODS-CoV-2. Expert Review of Respiratory Medicine14(9), 865-868.

Sauaia, A., Moore, F. A., Moore, E. E., Haenel, J. B., Read, R. A., & Lezotte, D. C. (1994). Early predictors of postinjury multiple organ failure. Archives of Surgery129(1), 39-45.

Trueland, J. (2020).  COVID-19 and sepsis:  what do the similarities mean for nurses and patients?  Retrieved from

Wu, T., Zuo, Z., Kang, S., Jiang, L., Luo, X., Xia, Z., … & Deng, M. (2020). Multi-organ Dysfunction in Patients with COVID-19: A Systematic Review and Meta-analysis. Aging and Disease11(4), 874.


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