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Be ready to present what you have discussed to the wider group.

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How well did we listen to each other and make sure everyone understood what was being discussed?
→ Think about whether all voices were heard and if the group paused to check understanding.

Did we ask questions or seek clarification when something wasn’t clear?
→ Reflect on how comfortable you felt asking for more information or explaining things to others.

How effectively did we summarise our ideas and respond thoughtfully to each other’s contributions?
→ Consider whether your group built on each other’s ideas or just shared individual thoughts.

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Now that you've chosen your group scenario, continue working together to develop it in more depth. This activity is designed to help you build confidence and clinical insight before you create your final version after lunch.

As you work through your scenario, use both the SBAR communication tool and the ABCDE assessment framework to guide your thinking.

SBAR will help you structure clinical handovers and communicate clearly with the team.

ABCDE will support your clinical reasoning and help you prioritise care.

Ask yourselves:

What’s happening clinically — and what’s the likely cause?

How does the patient’s emotional or social situation affect their care?

What decisions need to be made — and who should make them?

How can you adapt your communication to meet the patient’s needs?

This is your chance to apply your knowledge in a realistic, team-based setting. Take your time, challenge each other’s thinking, and don’t hesitate to ask questions. The more you explore now, the more confident and prepared you’ll be to design a meaningful, complex scenario that reflects real nursing practice.

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Be ready to present what you have discussed to the wider group.

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Welcome

This is your shared space to create a realistic patient scenario using the A–E assessment framework. You’ll be drawing on your own clinical experiences to design something meaningful and practical — and your scenario will be used during Ward Day in simulated practice!

Before You Get Started

Take a few minutes in your group to talk through real-life scenarios you've encountered — either in placement or simulation. Think about situations that challenged you, taught you something new, or made you reflect.

These conversations will help you:

Understand how to structure a scenario using the A–E framework

Identify key elements of safe, person-centred care

Reflect on how your scenario links to NMC proficiencies.

What You’ll Do

In your group, you’ll:

1. Share and discuss clinical experiences that could be turned into a scenario.

2. Choose one scenario to develop together — ideally something that allows for meaningful assessment, prioritisation, and care planning.

3. Use the SBAR and A–E framework to guide your thinking and structure your scenario.

4. Complete the scenario template to draft and refine your work.

5. Post your ideas and drafts here, give and receive feedback, and reflect on how this prepares you for Ward Day and future practice.

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Enjoy your lunch. Please do not log off, mute your mikes and switch off your cameras.

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Using the health belief model to assess racial/ethnic disparities in cancer-related behaviors in an NCI-designated comprehensive cancer center catchment area | Cancer Causes & Control (springer.com)

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Color awareness: A must for patient assessment (myamericannurse.com)

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nihms712389.pdf

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The Health Belief Model helps predict public attitudes and actions around health issues. It is used implicitly or explicitly in many areas of medicine. The Health Belief Model assumes that people are largely rational in their thoughts and actions, and will take the best health-supporting action if they:

Feel that it is possible to address a negative health issue.

Have a positive expectation that taking the proposed action will be effective in addressing the issue.

Believe they are able to take the proposed action.

There are a number of sub-variables in the belief that a health-related action is valuable. These provide both factors to enable measurement of attitudes and also routes to persuading people to act in healthy ways.

Perceived susceptibility: This is the person's assessment of the likelihood of them getting the given condition. If, for example, they are younger and believe that the condition afflicts mainly older people, then they will be less likely to act to protect themselves. Education may correct misunderstandings about susceptibility, which is often grossly incorrect, typically due either to social folklore or individual denial.

Perceived severity: This is the person's view of how severely they would be impacted if they were affected by the condition. The most severe health impact is death, followed by disablement and pain. Duration is also important: a short, sharp pain may be preferable to a long ache. As with susceptibility, education can be specific about severity, including probabilities of survival and disablement.

Perceived benefits: This is the belief in how effective the advised medicine or action will be in mitigating the problems of the condition considered in severity. You can give a positive message about the benefits of taking specific actions, including accurate information about how effective medicines are at reducing susceptibility and severity. The message may also subtly include instructions in taking the recommended actions and indicate the timescales involved before benefits appear.

Perceived barriers: This is the person's perceptions of the difficulties they would encounter in taking the proposed actions, including both physical and psychological barriers. These may be addressed through various means of support, from financial through reassurance and assistance.

Cues to action: These are the prompts that are needed to move the person into the state where they are ready to take the prescribed action. These can include practical ways of nudging them, such as marked calendars, email reminders, how-to charts and so on.

Self-efficacy: This is the person's confidence and belief in their own ability to take the given action. If they think 'I cannot do this' or even 'I would find it difficult' then they may well shy away from action, even if they believe the action is essential or otherwise worthwhile. This self-belief can be bolstered with encouragement, hand-holding, training and other support.
THE MODEL
The model assumes the following causal linkages between constructs and other factors.

Likelihood of behaviour change is affected solely by the perceived threat from the disease.

Perceived threat is impacted by:

Perceived susceptibility and seriousness

Cues to action, including information and symptoms

General factors such as age, sex, race, personality and intelligence affect all of:

Perceived threat

Perceived susceptibility and seriousness

Perception of benefits vs. barriers

This model simply describes a combination of a personal risk analysis, followed by an evaluation of the proposed solution and its use. As a general method of addressing beliefs it offers a useful structure for a wider range of belief-change situations.

When seeking to change a person's belief, we first need to understand the model beneath the belief and then address the sub-elements. The Health Belief Model provides a useful framework that may either provide direct help or may inspire similar thinking.

Want to know more how this model can be used effectively in your daily dealings with patients and colleagues?

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The Health Belief Model & Understanding Patient Behaviour

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The Health Belief Model helps predict patient behaviour and actions around health issues. It is used implicitly or explicitly in many areas of medicine.

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Identifying AEFI in diverse skin colour - The Melbourne Vaccine Education Centre (MVEC) (mcri.edu.au)

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Blood Pressure: Korotkoff Sounds | Ausmed Explains...

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Understanding the audio-visual skill of blood pressure reading

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Understanding the audio-visual skill of blood pressure reading

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LearningTools: Blood Pressure Basics - Audio-Visual Coordination Skills

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This is a comprehensive A to E assessment

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Nursing students ABCDE assessment framework

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Now it’s your turn to bring everything together. In your group, you’ll create a short but realistic patient scenario that reflects the kind of complexity you're learning to manage as a second-year nursing student.

Step-by-Step Instructions

1. Start with the basics
Provide your patient's name, age, and reason for admission. Keep it simple but believable — think about patients you’ve met in practice.

2. Choose one or two key clinical signs or symptoms
These should drive the scenario. What’s the main concern? What’s changing or deteriorating?

3. Use the ABCDE assessment to structure your thinking
Go through each step:

Airway – Is it clear? Any risks?

Breathing – Rate, effort, oxygen needs?

Circulation – Pulse, BP, perfusion?

Disability – Consciousness, pain, confusion?

Exposure – Temperature, skin, environment?

Think about what you’d expect to see — and how you’d respond.

4. Apply SBAR to communicate your findings
Practise handing over your scenario clearly and professionally. What would you say to a senior nurse or doctor?

5. Include one or two nursing actions or decisions
These could be:

Escalating concerns

Providing comfort or reassurance

Starting a clinical intervention

Coordinating with the wider team

Make sure your scenario feels authentic and achievable. Think about how it reflects the real-world challenges of nursing — balancing clinical care with compassion, communication, and safety. Remember: one of your colleagues will be working through your scenario tomorrow, so make it clear, structured, and meaningful.

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Video: how to undertake a manual blood pressure

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Video: how to undertake a manual blood pressure

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Improve Article 👀

Blood pressure (BP) measurement often appears in OSCEs and you'll be expected to confidently carry out the procedure. This blood pressure measurement OSCE guide provides a clear step-by-step approach to measuring blood pressure, with an included video demonstration.

Gather equipment

Gather the relevant equipment for measuring blood pressure:

Stethoscope

Sphygmomanometer: ensure you have an appropriately sized cuff. A cuff that's too small may overestimate BP, and a cuff that is too large will underestimate BP.

Introduction

Wash your hands and don PPE if appropriate.

Introduce yourself to the patient including your name and role.

Confirm the patient's name and date of birth.

Briefly explain what the procedure will involve using patient-friendly language: "Today I would like to measure your blood pressure, this will involve inflating a cuff around your arm whilst listening to your pulse with my stethoscope. The procedure shouldn't be painful, but it may feel a little uncomfortable when the cuff is fully inflated and you might experience some pins and needles in your hand. If at any point you want me to stop, just let me know."

Gain consent to proceed with blood pressure measurement.

Position the patient sitting on a chair, with their arm comfortably placed at approximately heart level.

Check if the patient has a preference as to which arm to use. Avoid using an arm that has local pathology such as post-mastectomy lymphoedema.

Ask the patient to adequately expose their upper arm on the relevant side by rolling up their sleeve.

Check if the patient has any pain before proceeding with blood pressure measurement.

You might also be interested in our collection of 900+ OSCE Stations, including a range of practical procedure stations.

Attaching the blood pressure cuff

1. Check that the blood pressure cuff size is appropriate for the patient's arm and that it is fully deflated.

2. Confirm the location of the brachial artery by palpating medial to the biceps brachii tendon and lateral to the medial epicondyle of the humerus.

3. Wrap the blood pressure cuff around the patient's upper arm, lining up the cuff marker with the brachial artery.

Measuring blood pressure

Estimate an approximate systolic blood pressure

To begin with, you need to determine an approximate systolic blood pressure. This is helpful in preventing over-tightening of the cuff during the accurate measurement of blood pressure.

1. Ensure the valve on the blood pressure cuff is closed.

2. Palpate the patient's radial pulse, located at the radial side of the wrist, with the tips of your index and middle fingers aligned longitudinally over the course of the artery.

3. Inflate the blood pressure cuff until you can no longer feel the patient's radial pulse. Note the reading on the sphygmomanometer at the point at which the radial pulse becomes impalpable. This reading is an approximate estimate of the patient's systolic blood pressure.

4. Open the valve and deflate the blood pressure cuff.

Measure the blood pressure accurately

Now that you have an approximate systolic pressure, you can perform an accurate assessment of systolic and diastolic blood pressure.

1. Close the valve on the blood pressure cuff.

2. Position the diaphragm of your stethoscope over the brachial artery.

3. Re-inflate the cuff 20-30 mmHg above the systolic blood pressure you previously estimated.

4. Then slowly deflate the cuff at around 2-3 mmHg per second.

5. Using your stethoscope, listen carefully for the onset of a pulsatile noise. The first of these pulsatile noises is known as the first Korotkoff sound. The pressure at which the first Korotkoff sound becomes audible represents the patient's systolic blood pressure.

6. Continue to deflate the cuff, whilst listening through your stethoscope until the pulsatile sound completely disappears. The final pulsatile noise you hear is known as the fifth Korotkoff sound and represents the patient's diastolic blood pressure.

7. If the patient's blood pressure is outside of the normal range you should repeat the assessment on the same arm after a few minutes and also consider assessing blood pressure using the patient's other arm.

Blood pressure abnormalities

Blood pressure abnormalities may include:

Hypertension: blood pressure of greater than or equal to 140/90 mmHg if under 80 years old or greater than or equal to 150/90 mmHg if you're over 80 years old.

Hypotension: blood pressure of less than 90/60 mmHg.

Narrow pulse pressure: less than 25 mmHg of difference between the systolic and diastolic blood pressure. Causes include aortic stenosis, congestive heart failure and cardiac tamponade.

Wide pulse pressure: more than 100 mmHg of difference between systolic and diastolic blood pressure. Causes include aortic regurgitation and aortic dissection.

Difference between arms: more than 20 mmHg difference in blood pressure between each arm is abnormal and may suggest aortic dissection.

To complete the procedure

Once a blood pressure recording has been obtained, remove the blood pressure cuff.

Explain to the patient that the procedure is now complete.

Discuss the blood pressure results with the patient, including any further steps that may need to occur (e.g. follow-up, further investigations, initiation of treatment).

Thank the patient for their time.

Dispose of PPE appropriately and wash your hands.

Document the lowest blood pressure recording in the patient's notes.

Reviewer

Michelle Spence
Senior Nurse Practitioner

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Blood Pressure Measurement - OSCE Guide | BP Reading | Geeky Medics

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A step-by-step guide to blood pressure (BP) measurement in an OSCE setting, with an included video demonstration.

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Vital Signs: Temperature, Pulse, Respirations & Blood Pressure - Clinical Skills | @LevelUpRN

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Using the Royal Marsden Manual - go to page 950.

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Before jumping into designing your own complex patient scenario, take time to reflect as a group on experiences from clinical practice. These real-life examples are powerful learning tools — they help you think like a nurse, balancing clinical signs with the emotional, psychological, and social needs of your patients.

As second-year students, you're expected to go beyond the basics. When discussing your experiences, consider:

What was happening clinically?

How did the patient’s emotional or social context affect the situation?

What decisions had to be made — and who made them?

What communication strategies worked well, and which didn’t?

Think about how physical symptoms might be complicated by fear, confusion, or social vulnerability. These layers are what make nursing care truly person-centred.

Use these discussions to:

Practise clinical reasoning and prioritisation

Explore how to adapt your communication style

Identify what felt challenging and how you might improve next time.

Once you've worked through the examples and shared your insights, you'll be ready as a group to design your scenario with confidence, clarity, and a deeper understanding of what safe, compassionate care looks like in practice.

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Keep it simple and realistic — think about what you might encounter on a ward.

Use yesterday's and today’s learning to guide your choices (e.g., wound care, confusion, medication safety).

Think about how you would document and communicate your findings.

Make sure your scenario demonstrates safe, person-centred care.

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Use the scenario template below to post your group’s scenario.

Feel free to comment on other groups’ ideas — constructive feedback is welcome!

Your facilitator will review and support your scenario development.

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Welcome to Today’s Session!

🕘 Start Time: 9:00 AM
🍽️ Lunch Break: 12:00–1:00 PM
🏁 Finish Time: 4:00 PM

💬 Breaks:
We recognise that everyone works differently, so instead of scheduling fixed breaks, we invite you to negotiate break times within your groups. This gives you the flexibility to pause when it suits your flow best.

Today is about thinking critically, working collaboratively, and learning deeply! 💡✨

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Aim

To empower students to design and analyse realistic patient scenarios that demonstrate early recognition of deterioration and professional nursing responses.

Learning Outcomes

By the end of this activity, students will be able to:

1. Demonstrate clinical proficiency by creating a patient scenario that integrates physical, psychosocial, and contextual complexity (NMC: Practise effectively).

2. Apply evidence-based assessment tools (e.g. ABCDE, NEWS2) to identify and respond to deterioration (NMC: Preserve safety).

3. Communicate professionally and effectively using SBAR within team-based scenario planning (NMC: Promote professionalism and trust).

4. Reflect on ethical decision-making and teamwork, showing respect, accountability, and collaborative practice (NMC: Prioritise people).

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Just a quick heads-up about what to expect in tomorrow’s session!

🗓️ Date: [Insert date]
🕘 Start Time: 9:00 AM
🍽️ Lunch Break: 12:00–1:00 PM
🏁 Finish Time: 4:00 PM

The scenario you developed will be played out by another group during Ward Day, with one team member handing over the patient case you’ve developed—so make it count!

In your nursing-specific groups, you’ll explore early recognition of deterioration. This is your chance to apply clinical knowledge, think critically, and consider how physical, psychological, and social factors shape nursing decisions.

What to Bring

Clinical knowledge and critical thinking

Curiosity, creativity, and collaboration

A readiness to reflect and act professionally

Preparation Task

Before the session: ✅ Review today’s created scenarios
✅ Download your scenario template
✅ Start your Professional Development Plan
✅ Reflect on one area of practice you want to strengthen this term

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RCN Position Statement on Simulation-Based Learning

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RCN Position Statement on Simulation-Based Learning

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RCN position on the use of simulation-based learning in pre and post registration education | Royal College of Nursing

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RCN position on the use of simulation-based learning in pre and post registration education

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NMC Simulated Practice Learning Guidance

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NMC Simulated Practice Learning Guidance

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Relating to: Standards for pre-registration nursing programmes

During the Covid-19 pandemic, we introduced emergency standards allowing education institutions and their practice learning partners to deliver a proportion of practice learning through simulation. Following an extensive review, we have now made this a permanent standard, allowing up to 600 hours of simulated practice learning within the 2,300 practice learning hours students must complete.

This new standard has been made permanent because we recognise that simulated practice learning methods are becoming increasingly sophisticated, helping students to build their confidence and skills in a range of situations, including some they may not encounter frequently in practice.
Overview
During the review of our programme standards, we worked with subject matter experts and gathered evidence about the use of simulated practice learning within nursing programmes. The review facilitated a change of definition for simulation across our programme standards, as well as amendments and additions to standards that relate to simulation.

The new definition for simulation is:

"An educational method which uses a variety of modalities to support students in developing their knowledge, behaviours and skills, with the opportunity for repetition, feedback, evaluation and reflection to achieve their programme outcomes and be confirmed as capable of safe and effective practice."

We also amended and moved a standard which relates to technology and simulation being used effectively and proportionately to help with nursing education. The new standard is as follows:

"Ensure technology and simulation opportunities are used effectively and proportionately across the curriculum to support supervision, learning and assessment."

The new standard now sits within the curriculum section of the standards for pre-registration nursing programmes, rather than the practice learning section. We moved the standard as we felt it was important that Approved Education institutions (AEIs) are encouraged to use technologies and simulation methods across a variety of areas in nursing curricula.

Simulation and technologies offer diverse approaches to learning, teaching, assessment and student support, such as AEIs being able to provide virtual reality immersion experiences that allow students to explore anatomy; or through users of services sharing their own health and care experiences. These methods help students to have a more enhanced and well-rounded education.

As technologies and methodologies continue to develop and be applied to programmes, their effectiveness can be evaluated by the AEIs adopting them. This experience, and any learning, can be shared across the sector to help create best practice.

Specifically for practice learning, we have added a new standard which states the following:

"Provide 2,300 practice learning hours, of which a maximum of 600 hours can be simulated practice learning."

Simulated practice learning can replicate, support and complement practice learning scenarios through a wide variety of methodologies. These methodologies can include the use of actors and role play to portray clinical scenarios; the use of immersive rooms, which can depict any situation from a hospital environment to a motorway emergency; as well as the use of virtual reality to carry out simulated clinical assessments.

By providing simulated practice learning in these ways, students can engage in immersive, interactive and experiential learning where they can hone their skills in a safe environment. This environment allows a student to repeat, gain feedback, evaluate and reflect on their practice, preparing them to deliver the safe, effective and kind nursing care expected of registered professionals.

Simulated practice scenarios must be contextualised and supervised to reflect practice learning with real people.
Principles
Simulated practice learning is delivered through a variety of methods across different settings and core principles should always be fulfilled.

Simulated practice learning must:

Meet the Standards for pre-registration nursing programmes for practice learning[2].

Meet the Standards for student supervision and assessment[3].

Those supervising simulated practice should be appropriately prepared to do so.

Demonstrate achievement of the learning outcomes that would have been experienced in a practice setting.

Be used to enhance practice learning.
Simulation provides opportunities to explore diverse areas of practice and experience situations less frequently encountered in the practice setting.

Enable active engagement in practice learning.
Students need to learn to practise, not just about

Delivery of simulated practice learning should include evaluation of the quality and impact of simulation methodologies. Simulation methodologies should be designed to enhance practice learning in terms of learning outcomes, and may also include effectiveness and impact on care of people.

We encourage AEIs and practice learning partners to share learning with each other to strengthen the effectiveness of simulated practice learning.

Wherever simulated practice learning is offered, students should be made aware that it is part of their practice learning. An appropriately prepared practice supervisor must be present during simulated practice learning to support student learning.
[1] NMC programme standards review, Harlow, Traverse and Britain Thinks reports. London. Available at: www.nmc.org.uk/education/programme-of-change-for-education/how-we-reviewed-our-pre-education-programme-standards/how-we-reviewed--our-education-programme-standards/ [2] NMC Standards for pre-registration nursing programmes. London. Available at: www.nmc.org.uk/standards/standards-for-nurses/standards-for-pre-registration-nursing-programmes/ [3] NMC Standards for student supervision and assessment. London. Available at: www.nmc.org.uk/standards-for-education-and-training/standards-for-student-supervision-and-assessment/
Simulated practice learning FAQs

What is considered simulated practice learning?

Simulated practice learning, as part of the 2300 practice learning hours required within pre-registration nursing programmes, can help students achieve their programme learning outcomes by providing authentic, contextualised and supervised practice experiences.

Simulated practice learning can also offer students a safe and supported environment to practise and develop the skills required to meet our standards of proficiency for pre-registration nursing programmes. AEIs should assure the quality and effectiveness of simulated practice learning they provide through accessing and responding to feedback from students and other stakeholders.

What is not considered simulated practice learning?

Activities that support theoretical or practice learning, but which are not contextualised or supervised, would not meet the requirements for simulated practice learning. 'Contextualised' scenarios reflect practice with people, and are not for example, isolated activities such as clinical skills training, completing a workbook, or watching a video about patient care.

Care that is delivered remotely via telephone or in virtual wards to people is not simulated practice learning but is actual practice learning.

What is the difference between simulation and simulated practice learning?

"An educational method which uses a variety of modalities to support students in developing their knowledge, behaviours and skills, with the opportunity for repetition, feedback, evaluation and reflection to achieve their programme outcomes and be confirmed as capable of safe and effective practice."

This definition covers a vast range of methodologies that support theoretical and practice learning.

Simulated practice learning can complement practice learning by giving students the opportunity to experience scenarios less often encountered as part of their 2300 hours of actual practice learning. Simulated practice is also contextualised for the student to make it as realistic and authentic as possible, and it must be supported by suitably prepared practice supervisors.

What types of simulated practice learning are there?

The types of simulated practice learning that AEIs can use is vast, reflecting creativity and innovation within the sector. There is not an exhaustive list of simulated practice, but examples include using actors to role play clinical scenarios, as well as use of virtual reality to carry out assessments.

Simulated practice learning will include a range of technologies or methodologies, we encourage AEIs to be innovative and share learning with each other to enhance student education.

Why is simulated practice learning beneficial for students?

Simulated practice allows students to practise, repeat, reflect and learn practice skills and proficiencies, all overseen by practice supervisors.

Some AEIs have conducted 'a gap analysis' which highlights learning opportunities that are not always easy to achieve for students, such as care of a deteriorating patient, identifying sepsis, and conducting a mental health assessment.

Simulated practice learning can offer students the opportunity to experience these uncommon scenarios which will allow them to practise skills and proficiencies that may be hard to achieve in some practice settings.

Can academic staff fulfil the role of practice supervisor and/or assessor in the facilitation of practice learning through simulation?

Academic staff can fulfil the roles of: practice supervisor or practice assessor, or academic assessor. A practice supervisor can be a staff member registered with a professional regulator such as the NMC, GMC or HCPC who has been prepared for the role. They should meet the standards for student supervision and assessment and have the right knowledge and skills.

Academic staff cannot be both practice supervisor and practice assessor for the same student. Academic assessors cannot be both practice supervisor and practice assessor for the same student.

What happens if an AEI has already been approved to deliver up to 600 hours of simulated practice learning hours though RN6(D)?

Recovery standard RN6(D) will now be withdrawn and standard R3.4 will replace it. However, AEIs who have already been approved to deliver recovery standard RN6(D), using up to a maximum of 600 hours of simulated practice learning as part of the 2,300 practice learning hours, can continue to do so.

Those AEIs using recovery standard RN6(D) will still be required to provide reports and a final evaluation as outlined in their original approval letter. After final evaluation, monitoring of simulated practice learning will continue for all programmes through the annual self-monitoring report*. AEIs should not submit further applications for RN6(D).
*The annual self-monitoring report is a report that AEIs, and their practice learning partners, must submit every year to show how they continue to meet our standards and requirements.
What happens if an AEI had their programme approved against the standards of proficiency for registered nurses, which would permit them to deliver a number of hours of simulation?

As part of their original programme approval, AEIs may have been permitted to deliver a certain number of hours of simulation. Some of these hours of simulation may fulfil the criteria for simulated practice learning, but some may not. AEIs should review their curricula, consider whether simulated activity being delivered meets the principles of practice learning, and confirm in the 2022/2023 annual self-monitoring report the number of simulated practice hours they are delivering.

If an AEI is including any simulated practice learning hours as part of the simulation hours agreed through approval, and who wish to continue or increase the number of simulated practice learning hours they deliver (up to 600 hours), they will be required to modify their programme through a major modification (desktop)* to make this permanent change.
*If an AEI wants to make a major modification to an already approved programme, they must request that modification through our online portal, QA link. More information on how we assess the proposed modification can be found in section 4.3 of our QA handbook. Available: www.nmc.org.uk/globalassets/sitedocuments/qa-link/quality-assurance-handbook.pdf
Can an AEI continue to deliver up to 300 hours of simulated practice learning that was implemented through RN5?

Recovery standards RN5 and RN5.1 will now be withdrawn and replaced by standard R3.4. Recovery standard RN5 permitted AEIs to use virtual and simulated practice learning effectively and proportionately within nursing programmes, up to a maximum of 300 hours within the 2,300 hours of practice learning.

AEIs currently delivering simulated practice learning through RN5 and who wish to continue, will be required to modify their programme through a major modification (desktop) to make this permanent change.

Can simulated practice learning be used for a student nurses' final placement?

Best practice, which is that a students' final placement should be in a practice placement setting, remains the same. This is so students can demonstrate the confidence and proficiency required to become a registered professional prior to qualification and transition into employment. This should be signed off as such by the education institution.

Can simulated practice hours can be included in nursing associate programmes?

The standards for pre-registration nursing associate programmes state that nursing associate students on a work-placed learning route:

"are released for a minimum of 20 percent of the programme time, which is assured protected learning time in external practice placements, enabling them to develop the breadth of experience required for a generic role"

This means that simulated practice learning cannot replace the minimum 20 percent of hours that should be used for protected learning time in an external practice placement. However, simulated practice learning can be used proportionately for some of the other hours.

Simulated practice learning can be included proportionately on direct entry Nursing Associate programmes.

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Supporting information for implementation of simulation and simulated practice learning in pre-registration nursing programmes only

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Council of Deans Report: Simulation in Nursing Education

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Council of Deans Report: Simulation in Nursing Education

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British Journal of Nursing – Simulated Practice Learning

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British Journal of Nursing – Simulated Practice Learning

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Simulated practice learning in nurse education - British Journal of Nursing

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SPL not only involves individual skill development but also fosters teamwork and communication skills, which are essential components of modern nursing practice. In simulated scenarios, students often work in teams, mimicking the collaborative nature of healthcare delivery. By engaging in multidisciplinary simulations, students enhance their ability to communicate effectively, solve problems as a team and perform under pressure – skills crucial for patient safety and high quality care.

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As a group, take a moment to reflect on what you want to achieve in this session. Discuss and agree on a shared learning aim and outcome—this will help guide your focus and make your learning more meaningful.

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Agreed aim and learning outcomes......

*Create a patient scenario by including physical, psychosocial, and contextual complexity -principles and NMC code

*NEWS2 and ABCDE - to identify and manage patient deterioration.

*communicate effectively and professionally ( SBAR) - Clear , collaborative information exchange.

* Demonstrate ethical awareness by reflective and ethical principles( autonomy, beneficence, non-maleficence, an justice)

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Used ABCDE and NEWS2 to recognise and manage patient deterioration.

Communicate clearly and professionally using SBAR for safe information exchange.

Apply ethical principles – autonomy, beneficence, non-maleficence, and justice – in decision-making.

Demonstrate person-centred, safe, and evidence-based care guided by the NMC Code.

Reflect on teamwork, accountability, and professional growth in clinical practice.

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In this session we hope to achieve the following learning outcomes:

Improve critical thinking skills - Analysing and evaluating of the issue to form a judgement or a conclusion.

Improve communication skills - Implenting a person centered approach when communicating with the service users i.e eye contact, body language, avoiding medical terms when speaking to patients. Communicating effectively as a team through handovers, SBAR etc

Improve our ability to work as part of a team as nurses but also alongside other professionals (MDT) - Respecting each other others opinions. Being transparent and open-minded.

Improve our confidence in dealing with critical mental health conditions

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AIMS OF THIS SCENARIO

The aim was to observe, assess, and respond appropriately to a patient exhibiting signs of acute psychosis, particularly paranoia and auditory hallucinations. It was also an opportunity to practice de-escalation skills, maintain patient safety, and communicate effectively with the multidisciplinary team (MDT) using the SBAR framework.

IMPACT

This situation had a significant impact on my learning and professional development. It helped me:

Recognise early warning signs of psychotic agitation and paranoia.

Understand the importance of maintaining a calm, non-threatening approach.

Appreciate how effective communication can prevent escalation and maintain safety.

Develop confidence in using structured reporting tools like SBAR when escalating concerns.

ACTUAL FACTS

The patient, a 29-year-old male, was pacing, talking loudly to himself, and appeared to respond to unseen stimuli.

He stated, “They’re watching me and trying to hurt me,” which indicates paranoid delusions.

His speech was pressured, and his affect was tense.

The environment was becoming increasingly unsafe for both the patient and others.

I maintained a safe distance, used a calm tone, and notified the nurse in charge immediately for support.

NEW EXPERIENCE I HAD

This was one of my first experiences directly observing acute psychotic symptoms and practising de-escalation in real time. I learned:

How vital non-verbal communication (body language, tone, eye contact) is when engaging with a paranoid patient.

The importance of teamwork and situational awareness in an acute mental health setting.

How to structure and deliver clinical information quickly and clearly using the SBAR tool.

HOW THIS WILL BE USEFUL GOING FORWARD

I will use this experience to build my confidence when managing distressed or psychotic patients.

I will apply the SBAR framework when escalating concerns to ensure clear, concise, and professional communication.

It will enhance my ability to identify early signs of relapse or agitation, allowing timely interventions.

I will continue developing therapeutic communication skills to support patients safely and empathetically

USING SBAR

S – Situation:
A 29-year-old male patient is becoming increasingly agitated and paranoid. He is pacing around the ward, talking to himself, and expressing beliefs that people are watching and trying to hurt him.

B – Background:
He has a diagnosis of schizophrenia and was recently admitted following a relapse due to non-adherence to medication. He has been stable for the past few days but has shown increasing anxiety and isolation since this morning.

A – Assessment:
Currently showing active psychotic symptoms and paranoia. There is a potential risk of self-harm or aggression due to perceived threat. Environment becoming tense.

R – Recommendation:
Immediate review by the nurse in charge or duty psychiatrist. Implement de-escalation measures, ensure other patients are safe, and consider PRN medication if clinically indicated. Continue close observation and document all behavioural changes.

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To develop our confidence and competence in recognising and managing a deteriorating patient using the A–E assessment framework and SBAR communication, ensuring safe, person-centred, and evidence-based care.

Shared Learning Outcome

By the end of the session, we will be able to:

Systematically assess a patient using the A–E approach.

Accurately identify and interpret abnormal vital signs using NEWS2.

Communicate effectively and escalate concerns using SBAR.

Work collaboratively as a multidisciplinary team to prioritise care and make safe clinical decisions.

Reflect on how our actions align with the NMC proficiencies and improve patient safety.

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Patient Scenario: John – Respiratory Deterioration (A–E Assessment)

Patient Information

Name: John Williams

Age: 70 years

Setting: Medical Ward

Admission reason: Shortness of breath (admitted yesterday)

Medical history: Chronic Obstructive Pulmonary Disease (COPD), Hypertension, heavy smoker (~40 cigarettes/day)

Social background: Lives alone, receives carer visits three times daily, mobilises with a zimmer frame.

SBAR Communication

S – Situation

John, a 70-year-old man admitted yesterday with shortness of breath, has become more breathless and anxious. His current observations are: SpO₂ 85% on room air, RR 23, Pulse 115, Temperature 38.5°C, and BP 128/76 mmHg.

B – Background

Known history of COPD and hypertension.

Smokes heavily (40 cigarettes per day).

Lives alone with carers visiting three times a day.

Currently on IV antibiotics for a suspected infective exacerbation of COPD.

Was stable on 2L oxygen yesterday with SpO₂ 91%, but oxygen was discontinued earlier this morning.

🩺 A–E Assessment

A – Airway

Airway patent, no signs of obstruction.

Patient is speaking in short sentences due to breathlessness, which indicates respiratory distress.

No stridor, but voice slightly hoarse due to increased work of breathing.

B – Breathing

Respiratory rate: 23 breaths/min (tachypnoeic).

SpO₂: 85% on room air – significantly below the target range for COPD patients (88–92%).

Chest expansion: Reduced bilaterally, indicating poor air entry.

Auscultation: Expiratory wheeze and coarse crackles heard at the bases — consistent with a chest infection and airway narrowing.

Use of accessory muscles (neck and shoulders) and nasal flaring observed, showing increased effort to breathe.

Patient appears anxious and fatigued, sitting upright and leaning forward (“tripod position”) to aid breathing.

Plan: Reapply oxygen at 2–4L via nasal cannula or venturi mask to maintain SpO₂ between 88–92%, and inform senior staff immediately.

C – Circulation

Heart rate: 115 bpm (tachycardic); pulse: 110, regular.

Blood pressure: 128/76 mmHg (within normal range).

Capillary refill: 3 seconds (slightly delayed, indicating reduced peripheral perfusion).

Temperature: 38.5°C – consistent with ongoing infection.

Skin: Pale, warm, and clammy. No central cyanosis, but bluish nail beds noted — a sign of poor oxygenation.

Peripheral pulses palpable but weak.

Plan: Monitor vital signs closely, continue IV antibiotics, ensure IV line is patent, and maintain adequate hydration.

D – Disability

Patient is alert and oriented (A on AVPU) but appears anxious and restless, likely due to breathlessness.

GCS: 15/15 (normal).

Pupils: Equal and reactive to light.

Reports headache and tiredness, possibly due to hypoxia and infection.

No signs of confusion or agitation at this stage.

Plan: Reassure patient, monitor level of consciousness for any deterioration (especially if CO₂ retention suspected).

E – Exposure

Temperature: High at 38.5°C — indicates infection.

No rashes, bruising, or open wounds visible.

Chest wall symmetrical with no surgical incisions.

IV cannula site clean, dry, and patent; IV antibiotics currently running.

Urinary catheter in situ — draining clear amber urine; good urine output, indicating hydration status maintained.

No pressure areas or skin breakdown noted.

Plan: Maintain patient’s dignity with appropriate covering, check catheter care and documentation, and continue regular skin checks.

⚕️ Summary / Plan

NEWS2 Score: 6 (high risk — requires urgent review by medical team).

Immediate actions:

1. Escalate findings to nurse in charge/medical team using SBAR.

2. Apply oxygen to maintain SpO₂ 88–92%.

3. Position upright to aid breathing.

4. Administer nebulised bronchodilators and continue antibiotics as prescribed.

5. Monitor vital signs every 5–10 minutes until stable.

6. Prepare for ABG to assess CO₂ retention and oxygenation.

7. Offer reassurance, maintain safety, and ensure emergency equipment is available.

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At the end of this session, as a group and team we should be able to understand and demonstrate how to:

Create a patient scenario that includes physical, psychosocial, and real-life factors, demonstrating my clinical skills.

Use evidence-based tools like ABCDE and NEWS2 to assess and respond to patient deterioration safely.

Communicate clearly and professionally using SBAR when working with a healthcare team.

Reflect on ethical decision-making and teamwork, showing respect, responsibility, and working well with others.

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Patient Name: Antony Joseph

Age: 67

Reason for Admission: Found collapsed at home (Admitted yesterday)

Key Clinical Signs/Symptoms Driving the Scenario

Anthony is clinically deteriorating, with acute confusion and circulatory instability in the context of chronic disease, social isolation, and mental health history. This raises concern for delirium due to sepsis or hypoglycaemia, requiring immediate intervention and multidisciplinary input.

Physical Health Assessment using the ABCDE:

• A – Airway: Patent

• B – Breathing: Slightly laboured, oxygen sats borderline

Respiratory rate: 22 bpm

Oxygen saturation (SpO2): 94%

• C – Circulation: Hypotensive and tachycardic

Blood pressure (BP): 85/55 mmHg

Pulse rate: 110 bpm

NEWS2 Score: 9

Blood glucose: 4.1 mmol/L

• D – Disability:  New confusion (delirium suspected), history of depression

• E – Exposure: Cool peripheries, poor hygiene, unkempt appearance

Temperature: 38°C

SBAR Communication

S – Situation
Anthony Joseph, a 67-year-old male, admitted following a collapse at home. He is confused, hypotensive, and tachycardic. NEWS2 is 9.

B – Background
He is known to have history of type 2 diabetes, hypertension, and depression. He lives alone in a rural setting, poor social support. He always misses medication and often self-neglect himself, because he has no one to support him.

A – Assessment

Low blood pressure, increased pulse rate, and signs of acute confusion. Needs urgent glucose check, septic screen, and hydration. He is at risk of delirium or underlying infection.

R – Recommendation
Request urgent medical review. Recommend blood glucose monitoring, blood cultures, IV fluids, and full MDT input including liaison psychiatry, social services, and diabetes specialist nurse.

Nursing Decision/Actions

Escalate to the liaison psychiatry team for an urgent mental health and cognitive assessment and initiate a safeguarding referral due to concerns of self-neglect and social vulnerability.

Provide calm, clear verbal reassurance, re-orient John frequently, and offer a consistent, compassionate presence to reduce agitation and confusion.

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1.Name: Mr. Taylor John

Age: 77 years

2.Background:

Mr. John is a 77-year-old retired truck driver, a long-term smoker who lives alone, isolated after his wife's death. He has a medical history of Chronic Obstructive Pulmonary Disease (COPD). He was admitted following a fall at home.

Presenting Concerns

Mr. John appears short of breath and pale. He reports feeling “dizzy and weak” before the fall.

3.ABCDE Assessment

A – Airway

Airway clear — patient able to talk but in short sentences due to breathlessness.

No visible obstruction, but at risk of sputum retention due to COPD.

B – Breathing

Respiratory rate: 26 breaths/min (tachypnoeic)

Oxygen saturations: 86% on room air . Oxygen Therapy started-4L

Breath sounds: widespread wheeze and reduced air entry bilaterally

Using accessory muscles to breathe.

C – Circulation

Heart rate: 117 bpm (tachycardic)

BP: 90/85 mmHg (low and narrow pulse pressure)

Capillary refill: 4 seconds

Skin: pale

Capillary blood glucose (CBG): 2.9 mmol/L (hypoglycaemic)

D – Disability

Conscious but slightly confused and lethargic

GCS: 14 (E4 V4 M6)

Reports feeling light-headed before the fall.

E – Exposure

Temperature: 38.0°C (pyrexia)

No visible injuries from the fall

Chest hyperinflated (consistent with COPD)

Environment: lives alone, struggling since job loss

NEWS2 Score Calculation

Parameter   Observation NEWS2 Points

Respiratory rate   26     3

SpO₂   86% on air   3

Oxygen therapy    yes       2

Temperature  38.0°C      1

Systolic BP  90 mmHg     3

Heart rate   117 bpm     2

Level of consciousness  Alert but confused      1

Total NEWS2 Score:            15 (High risk – urgent review required).

4.SBAR Communication

Situation:

This is nurse sarah from 10 north ward. I’m calling about Mr. Taylor John, a 77-year-old male admitted after a fall at home. He’s now short of breath, hypotensive, and hypoglycaemic.”

Background:

“Mr. John has COPD and is a long-term smoker. He lives alone and reports feeling dizzy before the fall. Since admission, he’s become increasingly breathless and febrile.”

Assessment:

“Currently: RR 26, SpO₂ 86% on room air started oxygen therapy to 92/4L , HR 117, BP 90/85, Temp 38°C, CBG 2.9 mmol/L. He’s pale , and slightly confused. His NEWS2 score is 15, indicating severe deterioration.”

Recommendation:

“I’m concerned about a possible COPD exacerbation with infection and hypoglycaemia. I recommend urgent medical review, IV glucose administration, and possible nebuliser therapy. Would you like me to escalate to the critical care outreach team?"

Nursing Actions / Decisions

Physical Needs

Escalated immediately to the nurse in charge and medical team.

Administered oxygen and reassessed SpO₂ levels.

Monitored vital signs continuously and updated NEWS2 chart.

Sat patient upright to ease breathing.

Reassured patient and ensured safety after his fall.

Noted social concerns (living alone, job loss) for referral to the multidisciplinary team and discharge planning.

Mental Health Needs

Acknowledged history of depression and possible worsening of mood.

provide reassurance, empathy and active listening

Document and refer to the mental health teams.

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Patient Profile

Name: Sarah Michelle

Age: 52 years

Gender: Female

Admission Date: 14/10/2025

Occupation: Currently unemployed due to health issues; previously worked as a teacher.

Marital Status: Divorced, no children.

Reason for Admission: Migraine, Poor sleep

Primary Medical Diagnosis: Type 2 diabetes, Arthritis, and depression.

Background and History

Medical History

·      Type 2 diabetes (Diagnosed 4 years ago)

·      Arthritis (Diagnosed 5 years ago)

·      Depression (Diagnosed 3 years ago)

Social History:

Sarah reports having lost contact with her family members. She also reported that she rarely contacts her friends. Sarah resides in a small apartment.

Current presentation

Sarah, a middle-aged woman with a five-year history of Type 2 Diabetes, Arthritis, and Major Depressive Disorder, is currently experiencing severe, constant migraines unresponsive to over-the-counter pain relief medication, alongside several weeks of poor sleep. Sarah usually enjoys going for walks as a form of exercise; however, she reports that since the past few weeks, she has not been able to engage in that daily activity. Sarah has also reported that she has not been in contact with any family member for the past 12 months. Sarah also enjoyed socialising with her friends from work however, she reports that she has lost interest in socialising with her friends over the past weeks. Sarah reports that she spends her time in her apartment. Sarah also reports that she lost interest in most of her daily activities such as housekeeping, cooking. Sarah appears in a low mood, and she reports that she recently lost her job. Sarah also reports that she has been living on state benefits.

Initial assessment

A to E (Airway, Breathing, Circulation, Disability, Exposure) assessment should be carried out to identify and address any life-threatening issues, particularly given Sarah's complaints of severe, constant pain.

Sarah’s vitals should be taken.

Mental Health Assessment – Mental State Examination Worksheet

The Mental State Examination (MSE) Worksheet will be used to provide a structured, objective assessment of Sarah’s current psychological functioning. This assessment will focus on areas such as her Appearance, like presenting unkept and behaviour, where signs of self-neglect (lack of housekeeping and cooking) and social withdrawal (spending all time confined to the apartment) will be observed. The assessment will document her low mood and potentially restricted Affect or emotional expression, while also evaluating the characteristics of her Speech and Thought. Crucially, the MSE will systematically assess Anhedonia or the inability to experience pleasure, specifically noting the reported loss of interest in socialising and daily activities, and examining her Perception and Insight to identify any perceptual disturbances and assess her understanding of her current physical and mental decline.

Mental Health Risk Assessment – Training Mental Health Checklist

To determine Sarah’s immediate safety, the Training Mental Health Checklist will be used for her risk assessment. Given her social isolation (no family contact for 12 months), recent job loss, loss of interest in daily activities, and existing diagnosis of Depression, she is considered at elevated risk. The checklist will be used to investigate whether Sarah is at risk of suicide and self-harm by directly and sensitively asking about current thoughts, plans, intent, and access to means. The checklist will also be used to assess Sarah’s risk to others. This checklist will also be used to assess Sarah’s level of vulnerability by focusing on areas like her financial stress, lack of support, and potential medication non-adherence.