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

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.

• 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.

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: 38.9^o

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: 38.9^o

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

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

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."

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.

(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.

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.

· 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).

(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.

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

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.

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.

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.

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.

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.

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.

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.