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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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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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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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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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Management of diabetic patient

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Scenario 1: Female patient, 39 years old with schizoaffective disorder, well known to the mental health services, type 2 diabetes and COPD. On admission very manic due to not taking medication thus deterioration in mental state. She is not managing well as she is taking drugs and alcohol. She is very unkempt and irritable in mood. Her vitals are done and she scored 90% on O2, B/P - 101/82, RRs - 22 and HR- 110

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18 months old baby with bronchiolitis:

Bronchiolitis is a viral infection that inflames the bronchioles, the smallest airways in the lungs of children. The inflammation and mucus build-up makes it hard to breath and cause wheezing.

S: Patient came in with his mother regarding wheezing, short of breath and high temperature.

B: The patient has a history of Asthma and poor immune system as well as being a regular to the ward.

A: Based on the history of the patient we requested a chest X-ray. We took blood work as well as viral swabs to send to the lab. Urine output would be low because they don't have enough fluids in their body.

R: Pain management e.g. ibuprofen, nebulizer and oxygen if needed. fluid given by IV/oral as well as having a asthma specialist coming to review.

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• The patient was admitted in a manic state due to not taking her medication, leading to a deterioration in her mental state.

• She is not managing well and is using drugs and alcohol.

• She is described as unkempt and irritable.

• Her vitals show an oxygen saturation of 90%, blood pressure of 101/82, respiratory rate of 22, and heart rate of 110.

• An A-E assessment has been conducted.

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Lilly Brown, 6 y/o. Mom brought her to A&E at 10:15 AM with severe abdominal pain and vomiting, suspected appendicitis. Pain was 9/10.

Pain and vomiting started around 5:00 AM

Mom gave her Paracetamol at home around 7:00 AM but she vomited it.

Loss of appetite

No previous medical history or hospital admission

Autistic (verbal)

Anxious

No known allergies

Up to date with vaccination

Not known to social services

Family involved and cooperating well towards care

Temperature: 38.9o

Heart rate: 120 bpm

Respiratory rate: 24 bpm in RA

Blood pressure: 96/90

SpO2: 97% in RA

A Airway open and patent

Awake and alert

Able to talk and answer questions

B Respiratory rate: 24 bpm in RA

Normal chest movement, normal and regular breathing pattern

No subcostal or intercostal recession noticed

Upon auscultation, equal bilateral breath sounds noticed

Normal, pink skin colour

C Heart rate: 120 bpm

Blood pressure: 96/90

Temperature: 38.9o

CRT less than 2 sec (central and peripheral)

IV access: on fluids

Looks warm to touch and well perfused

D Pain score 9/10

Nauseous and vomiting

Pupils equal and reactive

Alert and responsive, speaking, aware of surroundings

Cannula in situ VIP score 0

E abdomen distended and painful to touch

No rash or bruises noticed

Communication was difficult due to her autism diagnosis

Not very willing to cooperate, mom is helping

Vitals documented accurately and patient was escalated to the nurse in charge and consultant due to high temperature, heart rate and dehydration

Possible appendicitis (surgery) -> Nil By Mouth (difficult due to limited understanding because of ASD)

Decisions made by nurse in charge/ consultant/ mom

What worked:

Active listening worked well with mom

Quiet, calm voice (speak softly, one person at a time) with the patient

Using visual and sensory aids with the patient worked well

Transferred to a cubicle (quiet room) worked well with managing sensory overload

Extra-time was offered for the patient to understand and process information/ ask questions

Mom was involved in care

What did not work:

Crowded/ loud environment

Taking vitals without explanations or preparation using visual aids (touching the patient without explaining)

Giving complicated/ complex instructions

# data[].attributes.body
S: Situation
Hi i am a student nurse from the medical ward.  I'm calling regarding Mr john, a diabetic patient who is 60 years old and has started acting cold and sleepy. 2.4 mmol/L is his blood glucose level.

B. Background: Metformin and insulin are used to treat mr john type 2 diabetes. he  is presently receiving intravenous antibiotic treatment for a chest infection. Despite not eating much today, he took her insulin dose in the morning.

A=Clear.

B= RR 20, SpO₂ 97%.

C= HR 112, BP 95/60

Disability: 2.4 mmol/L of hyperglycemia.

Temperature exposure: 36.2°C; no indications of infection .

He is still sleepy even after I gave him oral glucose and checked him again; his glucose level is now 3.1 mmol/L.

R: Suggestion
Would you kindly provide Mr john an immediate review?
Despite taking oral glucose, he continues to exhibit symptoms of hypoglycemia. he might need to have his insulin dosage reviewed and receive IV glucose

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patient name: M (40 years old) (male)

setting: mental health ward E

diagnosis: schizophrenia, OCD

History:

diagnosed with schizophrenia 5 years ago

previous admission from prison due to attempted robbery

lives in flats on his own

goes to the gym

recently lost his job and is having financial difficulties

Presenting situation:

Staff are aware that he is not taking his medication and is becoming increasingly agitated, very stressed and at risk of endangering himself and others. Patient complains of neighbours at home making loud noises, disturbing his life; however, after speaking to the neighbours, this was not true. As a result of losing his job, he is stressed about losing his flat, so he needs support.

ABCDE assessment:

A-airway - check ability to speak and respond. The speech is clear but very loud. no airway obstruction

B-breathing - observe rate, rhythm, depth. Has irregular breathing. Continue to monitor.

C-circulation. - monitor pulse, BP, hydration. poor fluid intake. BP and pulse in normal range.

D-disability (mental health) - assess mood, thought content, cognition and risk. poor concentration, talks very loudly, mood swings and is very unpredictable.

E-exposure/environment - assess surroundings, self-care and hygiene. An untidy environment, a messy living space. Self-care and hygiene are very good.

SBAR handover:

S-situation:

"This is the mental health nurse on ward E. MR M, a 40-year-old male patient with schizophrenia and OCD. Has concerns of not taking medication, and has become increasingly agitated and has become a danger to himself and others."

B-background:

"he has a history of schizophrenia and OCD. He has been non-compliant with his medication and has reports of him becoming agitated, aggressive and a danger to society."

A-assessment:

"he is agitated, aggressive and shouts. vital signs are stable, but has mood swings and can become unpredictable."

R-recommendation:

"We recommend that he urgently gets referred to an approved mental health practitioner (AMHP). He should be on a 1:1 observation level and development of the updated care plan. We will continue to monitor his risk and the danger to himself and others. Will refer to social services for assistance with his financial struggles."

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A: Airway is a partially obstructed because of the build up of mucus but patient can still vocalise.

B: The patient has some wheezing and causes inter- coastal resection in the ribs, Because of the wheezing is causes a trachea tug to overreact. Oxygen therapy given to make stats come back to normal.

C: The O2 stats are at 92% even when they are meant to be above 94%. Heart rate is on the low levels and its at 85. The respiratory is low and is measuring at 32.

D: On the AVPU scale she is alert, crying and kicking its legs. On the GCS scale it is on the higher end of the motor response.

E: High temperature, we did a head to toe examination for rashes. Signs of infection is around the baby's mouth and nose because it's red and partially inflamed.

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post operative patient with shortness of breath and low oxygen saturation

(s) situation

mr john davies 68 year old male, 6 hours post abdominal surgery.

(B) background

smoker 40 pack years

fluid balance adequate urine output iv fluids running

(A) Assessment

Mr. Davies is showing signs of hypoxia and possible respiratory deterioration secondary to opioid-induced hypoventilation or atelectasis post-surgery. Early sepsis should also be considered due to raised temperature and low BP.

(R) Recommendation

Escalate immediately to the nurse in charge and surgical team.

Increase oxygen to high flow.

Sit patient upright to aid breathing.

Check latest blood results and fluid balance.

Continue to monitor closely — repeat observations every 5–10 minutes.

A – Airway

Patent but patient is drowsy and slow to respond.

No obstruction heard.

B – Breathing

Respiratory rate: 26/min, shallow.

SpO₂: 88% on 2 L oxygen.

Patient reports difficulty catching breath

C – Circulation

Pulse: 110 bpm (tachycardia), weak and thready.

BP: 96/58 mmHg.

Capillary refill

Skin: cool

Urine output in last hour: 20 mL.

D – Disability

Alertness: responds to voice

Blood glucose: 8.2 mmol/L.

Pupils equal and reactive.

Complains of feeling very tired.

E – Exposure

Temp: 37.8°C.

Surgical site: dressing slightly damp, no excessive bleeding.

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Case Scenario

A 52 Year old female patient with chronic asthma and mild hypertension, is admitted for asthma management. While assessing her she is alert and able to communicate but has a language barrier. Her respiratory rate is 22 bpm, and she appears slightly breathless. Her blood pressure is 140/96 mmHg, oxygen saturation 94% on room air, temperature 39.8, and the urine output has decreased over the past day. She is fully conscious with GCS of 15/15, wears hearing aids due to deafness, and reports sensitivity to sunlight.

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A  – Airway

· Airway patent; speaking but drowsy.

· Action: Monitor for further drop in consciousness that may compromise airway.

B – Breathing

· RR 22/min, SpO₂ 96% on room air.

· Action: Continue to monitor; administer oxygen if saturations drop <94%.

C – Circulation

· HR 112 bpm, BP 94/58 mmHg, pale and clammy.

· Action: Recognise hypoglycaemia and circulatory stress. Prepare IV access if not in place.

· Immediate intervention:

· Recheck blood glucose after 10–15 minutes.

D – Disability

· Drowsy,

· Action: Repeat blood glucose check; monitor responsiveness and cognitive state.

· If improved → provide longer-acting carbohydrate (e.g., sandwich or milk).

· Continue observation for recurrence.

E – Exposure / Environment

· Inspect diabetic foot ulcer: dressing intact, no new discharge.

· Maintain warmth and dignity.

· Ensure safe environment (remove obstacles if confusion persists).

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Post operative patient with shortness of breath and low oxygen saturation

(s) situation

mr john davies 68 year old male, 6 hours post abdominal surgery.

(B) background

smoker 40 pack years

fluid balance adequate urine output iv fluids running

(A) Assessment

Mr. Davies is showing signs of hypoxia and possible respiratory deterioration secondary to opioid-induced hypoventilation or atelectasis post-surgery. Early sepsis should also be considered due to raised temperature and low BP.

(R) Recommendation

Escalate immediately to the nurse in charge and surgical team.

Increase oxygen to high flow.

Sit patient upright to aid breathing.

Check latest blood results and fluid balance.

Continue to monitor closely — repeat observations every 5–10 minutes.

A – Airway

Patent but patient is drowsy and slow to respond.

No obstruction heard.

B – Breathing

Respiratory rate: 26/min, shallow.

SpO₂: 88% on 2 L oxygen.

Patient reports difficulty catching breath

C – Circulation

Pulse: 110 bpm (tachycardia), weak and thready.

BP: 96/58 mmHg.

Capillary refill

Skin: cool

Urine output in last hour: 20 mL.

D – Disability

Alertness: responds to voice

Blood glucose: 8.2 mmol/L.

Pupils equal and reactive.

Complains of feeling very tired.

E – Exposure

Temp: 37.8°C.

Surgical site: dressing slightly damp, no excessive bleeding.

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Jimmy is 35 years old, in an acute ward. He suffers from schizoaffective disorder.

The past three days, Jimmy has been experiencing hallucinations, hearing voices in his head, a low mood, lack of sleep, disorganised thinking and speech and behaving bizarrely. He is also experiencing a false belief that the world is coming to an end, and he has to save everyone. Jimmy suffered from mild depression due to his mother's passing away from cancer

Appearance: Jimmy is restless, paranoid, hasn't eaten well, and hasn't had a shower for one week and is looking unkempt. He doesn't maintain eye contact when talking to him, nor does he engage in a conversation.

Airways- his airways are clear because he's having a conversation

Breathing- breathing fast (panting)

Circulation- respiration (22), blood pressure (110/90), heart rate (120) and saturation (89), temperature (37.1)

Disability- he is conscious, no pain, he is incoherent ( confused)

Exposure- looks skinny, pale and no pain or injury.

SBAR

Situation- Jimmy is 35 years old, in an acute ward. He suffers from schizoaffective disorder.

The past three days, Jimmy has been experiencing hallucinations, hearing voices in his head, a low mood, lack of sleep, disorganised thinking and speech and behaving bizarrely. He is also experiencing a false belief that the world is coming to an end, and he has to save everyone.

Background- 4 years ago, Jimmy suffered from depression due to his mother's passing away from cancer, as she was the only relative he had and they were very close, and he is on lithium and Olanzapine

Assessment- Jimmy has been experiencing hallucinations, hearing voices in his head, a low mood, lack of sleep, disorganised thinking and speech and behaving bizarrely. His respiration (22), blood pressure (110/90), heart rate (120) and saturation (89); he is incoherent and looks skinny, pale. Oxygen has been given due to low saturation.

Recommendation- he needs an urgent mental review. Saturation should be monitored

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7 year old female with chickenpox:

S: Mum and dad brought the child into A&E with severe chickenpox, headache and nausea.

B: Patient has history of asthma.

A: visibly distressed and irritable, blisters on the skin, temp: 39.2, HR: 120 bpm, appears dehydrated and reduced urine output.

R: review by paediatric team for further assessment and management. needs oral fluids or IV fluids if necessary. medication needed for fever.

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You are a second-year student nurse on a surgical ward.

Mr. John Davies, 68, is six hours post-colectomy. The HCA reports he looks breathless and drowsy.

1. On assessment: SpO₂ 88% on 2 L O₂, RR 26, HR 110, BP 96/58, Temp 37.8°C. He is anxious, pale, and clammy, responding to voice but slow.

2. Mr. Davies says, “I can’t breathe… please don’t let me die.” He lives alone, recently lost his wife, and worries about his dog at home. His fear and isolation seem to worsen his breathlessness.

3.You begin an A–E assessment, reassure him, sit him upright, and escalate using SBAR to the nurse in charge.

4. This scenario highlights how physical deterioration can be complicated by anxiety and social vulnerability, requiring clinical reasoning and compassionate communication.

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A to E assessment

Airway: Airway is open.

Breathing: No managing well (COPD). Patient needs oxygen with Salbutamol. Patient is wheezing. Her respiratory rate is 22 (high). Saturation of 90% patient needs oxygen.

Circulation: Hart rate 110 and the blood pressure is 101/82 (Tachycardia). Patient is type 2 diabetes therefore BM must be considered.

Disability: Patient is responding (conscious)

Environment: Temperature is 36.2C.

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Clinically,The patient had mild asthma symptoms with a raised respiratory rate, slight breathlessness, and mild hypertension. Her language barrier and deafness made communication difficult, increasing her anxiety and limiting her ability to express symptoms. With the support from the registered nurse, monitors her breathing, ensure correct inhaler use, encourage fluids, and escalate if her condition worsened. Written cues, visual aids, and clear speech worked well, while relying only on verbal communication did not. Her anxiety and communication barriers complicated assessment, highlighting the need for patient-centred care, improved communication tools, and better prioritisation in future practice.

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Nutrition: Support with meal planning and timing of insulin.

Education: Reinforce importance of not missing meals after insulin.

Social: Check if he has support at home for managing diabetes.

Foot care: Continue wound observation and liaison with podiatry.

Psychological: Explore any feelings of anxiety or frustration related to diabetes management.

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What was happening clinically? What decision had to be made?

Mental Health Deterioration

She is acutely manic — elevated mood, irritability, disorganisation, poor insight, and neglect of self-care.

Non-adherence to her psychiatric medication has likely caused relapse of her schizoaffective disorder.

Her substance use (alcohol and drugs) further destabilises mood and impairs her judgement and physical health.

She is at risk of self-neglect, aggression, and possibly harm due to disinhibition and poor decision-making.

2. Respiratory Compromise (COPD Exacerbation)

Oxygen saturation (SpO₂): 90% on room air → indicates hypoxia.

RR 22/min and wheezing → increased work of breathing.

Likely COPD exacerbation, possibly precipitated by:

Poor medication adherence (not using inhalers).

Ongoing smoking or drug use.

Possible infection (though temp normal).

3. Cardiovascular Response

Heart rate 110 bpm (tachycardia) → compensatory response to hypoxia, agitation, or possible substance effect.

Blood pressure 101/82 → low-normal; could drop further if dehydrated or intoxicated.

4. Metabolic / Diabetic Considerations

She has type 2 diabetes, but due to poor self-care and possible poor nutrition or alcohol use, she could experience:

Hypoglycaemia (if still taking insulin or oral meds without food).

Hyperglycaemia or DKA (if completely non-compliant).

Blood glucose (BM) needs to be checked urgently.

5. Assessment (decisions to be made)

Acutely physically and mentally unwell.

Primary problems:

1. Manic relapse due to medication non-adherence.

2. COPD exacerbation with hypoxia.

3. Substance misuse compounding both mental and physical illness.

4. Self-neglect and poor capacity for self-care.

Clinical Priorities

1. Stabilise physical health first — airway, breathing, circulation.

2. Administer controlled O₂ and bronchodilator therapy.

3. Monitor blood glucose and vitals closely.

4. Involve medical and respiratory teams urgently.

5. Psychiatric care (needs re-initiation of antipsychotic/mood stabiliser under supervision, possibly under the Mental Health Act).

6. Integrated care plan involving psychiatry, general medicine, and substance misuse services.

Needs oxygen therapy and bronchodilator (Salbutamol), but O₂ should be titrated carefully in COPD to avoid CO₂ retention.

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Our scenario is about a 52-year-old women, named Mrs. Elena Gomez. She is born and brought up in Spain. She came to the hospital because of the abnormally high temperature of 39.8 and blood pressure of 140/95mmHg. She visited the hospital with her husband. It was noted that she is deaf and speaks in Spanish and knows very limited English.

After coming in A and E, patient was admitted because of the rising temperature and breathlessness. Our major concern is that this could be a sign of sepsis. On checking the vital signs, the observations indicated towards the sepsis as she complains of shortness of breath and rising temperature cold be indicating any infection. The constant high temperature and shortness of breath was a sign of deterioration.

On the basis of ABCDE assessment, we took the further decisions. So the observations were:-

A – the patient is alert and is able to communicate what she is feeling with help of her husband.

B- respiratory rate was noted to 22bpm. She was also complaining of shortness of breath. The patient has a history of asthma.  The oxygen saturation noted was 94% with mild distress.

C- the pulse rate is 100 and blood pressure is 140/95mmHg.  There is no bleeding reported internally or externally.

D- The patient is deaf. Further, she is alert and responsive

E- there is no wound or rashes on the body. The skin is intact. Temperature is 38.9 which is the major concern.

SBAR – Mrs. Elena Gomez (Suspected Sepsis)

Situation:

Mrs. Elena Gomez, a 52-year-old woman originally from Spain, has been admitted from A&E with a high temperature of 39.8°C and breathlessness. She has a history of asthma and is showing potential signs of sepsis.

Background:

The patient is deaf and speaks only Spanish with very limited English. Her husband is present and assists with communication. She presented with a persistent fever and increasing shortness of breath over the last 24 hours. No known drug allergies have been reported.

Assessment:

Airway: Clear; patient alert and able to communicate via her husband.

Breathing: RR 22 bpm, SpO₂ 94% on room air, mild respiratory distress, shortness of breath reported.

Circulation: Pulse 100 bpm, BP 140/95 mmHg; no bleeding or signs of poor perfusion.

Disability: Alert, GCS 15/15; communication barrier due to deafness and language.

Exposure: Skin intact, no rashes or wounds. Temperature 38.9°C; ongoing pyrexia likely linked to infection.

The nursing actions taken included initiating the sepsis screening and closely monitoring Mrs. Gomez’s vital signs every 15 minutes to identify any signs of deterioration. Intravenous access was prepared for the administration of fluids and antibiotics once prescribed, and blood cultures were obtained in line with the sepsis six protocol. As Mrs. Gomez is deaf and speaks limited English, written communication, visual cues, and interpreter support were used to explain procedures and provide reassurance. Her husband was involved appropriately to support communication while ensuring that Mrs. Gomez remained the primary focus of care. These actions aimed to maintain patient safety, promote understanding, and deliver person-centred, compassionate nursing care.

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Now that your group has selected a scenario, work together to build it in more detail.
In Year 2, you are developing your ability to recognise the deteriorating patient, prioritise care, and escalate concerns clearly and confidently.
This phase helps you practise your skills before you finalise your simulation design after lunch.

Use the ABCDE assessment framework, SBAR communication, and your growing understanding of clinical deterioration to guide your decisions.

As a team, think through the following questions to deepen your scenario:

1. What is happening clinically—and what is the likely cause of deterioration?

What early cues suggest that the patient is becoming unwell?

How will your ABCDE assessment help you organise your priorities?

Which findings need immediate attention?

2. How do staffing levels and skill mix influence your decisions and escalation?

Who is available to assist you (supervising nurse, HCA, doctors)?

What can you safely manage as a Year 2 student?

At what point must you escalate?

How will you communicate the urgency to the right person?

3. What leadership actions are needed to keep the patient safe?

At Year 2, leadership includes:

Recognising and responding to clinical deterioration

Prioritising care in the correct sequence

Communicating clearly and assertively

Using closed‑loop communication when working with peers

Initiating escalation early and appropriately

4. How do the patient’s emotional, social, or cultural needs shape your communication?

Consider how these factors influence your approach:

Anxiety or distress

Language barriers

Cultural beliefs about illness or care

Privacy or dignity needs

Involvement of family or carers

How will you adjust your tone, explanations, and reassurance?

5. What decisions need immediate action—and who is best placed to take them?

Which ABCDE problems require urgent intervention?

What actions fall within your scope as a Year 2 student?

What must be delegated or escalated to the supervising nurse or doctor?

How will you check that delegated tasks are completed?

6. How will you structure a clear, effective SBAR handover?

Use SBAR to communicate with confidence:

S – Situation: What is happening right now?

B – Background: What relevant information does the team need?

A – Assessment: What did your ABCDE assessment reveal?

R – Recommendation: What action do you think is needed?

Your SBAR should demonstrate developing confidence and an understanding of safety‑critical communication.