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.

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.

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.

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.

🕘 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! 💡✨

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).

🗓️ 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

*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)

• 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

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.

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.

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.

• 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.

  
  

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.

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.

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.