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ACE.S Unfolding Cases

An unfolding case is one that evolves over time in a manner that is unpredictable to the learner. New situations develop and are revealed with each encounter. Every ACE unfolding case uses the highly regarded unfolding case model developed for Advancing Care Excellence for Seniors (ACE.S) . Each case includes the following:

These unfolding cases combine the power of storytelling with the experiential nature of simulation scenarios. They are intended to create a robust, meaningful experience for students, one that provides a simulated experience of continuity of care and that will help them integrate the Essential Knowledge Domains and Nursing Actions into their practice of nursing. We hope you will give them a try! Standardized/Simulated patients are recommended for all ACE simulations. If you are not already familiar with the Association for Standardized Patient Educators’ Standards of Best Practice, we encourage you to review them at .

Learn more about unfolding cases by visiting the  How to Use an Unfolding Case  page.

Henry and Ertha Williams

Julia morales and lucy grey, millie larsen, sherman "red" yoder.

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Assessing the Impact of Unfolding Case Study Scenarios during High-Fidelity Pediatric Simulation among Undergraduate Nursing Students

Associated data.

Data may be made available upon request from the corresponding author.

Simulation helps to prepare prelicensure nursing students for practice by providing opportunities to perform clinical skills and make decisions in a safe environment. The integration of nursing knowledge, skills, and decision-making abilities during simulated unfolding case-study scenarios may enhance student self-confidence and foster clinical judgement skills. The purpose of this study was to assess the impact of simulation using unfolding case-study scenarios on undergraduate nursing students’ self-confidence in pediatric nursing knowledge, skills, and clinical judgment/decision-making abilities. This mixed methods study included a pre- and post-survey design to evaluate undergraduate nursing students’ confidence in pediatric nursing knowledge, skills, and decision-making abilities after participation in both an instructor-led (guided) and a student-led (decision-making) simulation involving unfolding case-study scenarios. Friedman’s ANOVA analyses revealed that all 16-items demonstrated statistically significant differences between the three measured responses (pre-simulation and both post-simulation surveys). Post-hoc Wilcoxon signed-rank tests revealed statistically significant differences in student ratings pre-simulation and post-instructor-led (guided) experience for all 16-scored items. The qualitative themes identified were perception of experience, pediatric nursing care, assimilation of knowledge, and critical thinking. Unfolding case-study simulation experiences positively impact the learning, self-confidence, and clinical judgement of undergraduate nursing students.

1. Introduction

Simulation is a teaching technique that allows for student immersion in a guided learning activity or environment using dramatization of real-world situations and scenarios [ 1 , 2 ]. Simulation in healthcare education provides an opportunity for students to make patient care decisions while functioning in a safe and controlled environment [ 2 ]. Nursing students often experience anxiety during clinical experiences [ 3 , 4 ]. Diversification of learning experiences through a simulated scenario can help students to improve clinical judgement skills while also providing an opportunity for instructors to therapeutically discuss and allay student fears and anxieties [ 3 , 4 , 5 ]. The World Health Organization (WHO) supports the use of simulation in healthcare training and education programs to improve students’ skills, self-confidence, communication, teamwork, and decision-making capabilities [ 2 , 6 ].

Entry-level nurses are required to care for higher acuity patients than in previous years. New graduates’ ability to organize information, think critically, and use sound clinical judgment in a variety of patient situations is an expectation [ 7 ]. The National Council State Boards of Nursing (NCSBN) is moving toward the Next Generation NCLEX which assesses clinical judgment [ 8 ]. These changes to the exam are supported by the Clinical Judgment Model (CJM), which includes the following components: recognizing and analyzing cues, prioritizing hypotheses, generating solutions, taking action, and evaluating outcomes. Clinical judgment assists students as they transition to the role of the registered nurse in practice [ 8 ]. According to the Carnegie Report, simulation is a recommended way to link the classroom and clinical practice, and it allows students to utilize the Clinical Judgment Model in patient care scenarios [ 8 , 9 ]. Through high-fidelity simulation, faculty are able to assess students’ clinical judgment and provide constructive, real-time feedback.

Simulation in nursing education can take on many different forms and is paramount to the production of well-prepared registered nurses who can incorporate skill and critical thinking into practice during emergent and critical patient care situations [ 10 , 11 , 12 ]. Additionally, simulation has been found to be an effective teaching strategy, allowing faculty and students to assess nursing knowledge, critical thinking, and technical skills [ 13 ]. Incorporating simulation into nursing curriculums has been positively received by students and has been shown to improve student knowledge and self-confidence and to contribute to reflection and meaningful learning. Attainment of knowledge and skill through simulation improves student performance, lessens anxiety about critical patient situations, improves the learner’s ability to function in critical situations, and contributes to patient safety [ 10 , 12 ].

Pediatric simulation allows students to apply knowledge obtained in the didactic environment to a clinical scenario and to obtain faculty feedback [ 13 , 14 ]. Lubbers and Rossman reported that undergraduate nursing students who participated in pediatric simulations had increased self-confidence and reported high satisfaction after their simulation experiences [ 15 , 16 ]. Similarly, Parker and colleagues found that undergraduate students in a pediatric simulation gained more confidence in clinical skills and were pleased with their participation in medium- and high-fidelity clinical simulations [ 14 ]. Furthermore, pediatric simulation can allow for exposure to clinical scenarios and situations that nursing students may not have the opportunity to experience in the traditional clinical setting.

During the COVID-19 pandemic, placements in pediatrics clinics have become more difficult. Thus, simulation has emerged as an important learning modality that allows students to gain the knowledge and skills necessary to function after graduation in the role of a registered nurse in pediatric settings.

The purpose of this study was to assess the impact of simulation using unfolding case-study scenarios on undergraduate nursing students’ self-confidence in pediatric nursing knowledge, skills, and clinical judgment/decision-making abilities.

2. Materials and Methods

2.1. study design and participants.

This mixed methods study included a pre- and post-survey design to evaluate undergraduate nursing students’ confidence in pediatric nursing knowledge, skills, and decision-making abilities after participation in both an instructor-led (guided) and a student-led (decision-making) simulation involving unfolding case-study scenarios. This study was conducted at a public, rural, liberal arts university in the Southeastern United States. The study was conducted according to the guidelines of the Declaration of Helsinki and was approved by the University Institutional Review Board (IRB) (protocol #11-05-202005, 8 December 2020). A signed informed consent statement was waived for this study by the IRB due to the voluntary nature of the survey. Students read a description of the study before volunteering to participate. Students completed the survey voluntarily and anonymously. No participant identifiers were collected. All demographic data were aggregated to determine the general characteristics of the participant sample.

The undergraduate bachelor of science in nursing (BSN) program is comprised of two years of nursing prerequisite courses, followed by admission to the upper division program and completion of two years of nursing-specific courses. The upper division program is typically comprised of approximately 230 nursing students. The undergraduate nursing pediatrics course is taught in the third/Senior I semester of the upper division program.

The participants in this study included a convenience sample of forty-three BSN/Senior I level students. All students were enrolled in the undergraduate nursing pediatrics course and were required to participate in two high-fidelity clinical simulations as part of the course’s clinical component. Students had previously participated in a simulation scenario with a standardized patient in their health assessment course, but none had experience with high-fidelity simulations during the nursing program before this experience. The simulations served as formative clinical assessments and did not influence course grades. Student participation in the pre- and post-simulation surveys was voluntary.

Because securing pediatric clinical sites during the COVID-19 pandemic became more challenging and some previously utilized sites were unavailable, there was an increased need to incorporate additional experiences for the students through simulation The objectives of the simulations were to improve student knowledge, self-confidence, nursing skills, communication skills, and decision-making/clinical judgement abilities associated with the care of the hospitalized pediatric patient. This was accomplished using two separate simulations with unfolding case-study scenarios. The first simulation occurred during the first clinical day of the semester and was instructor-led (guided) in nature. The adjunct clinical instructor provided teaching throughout the simulation scenario and guided students through three consecutive cycles of appropriate clinical decisions and care interventions based on patient presentation, needs/cues, and changes in patient condition. The adjunct instructor helped the students to refine clinical skills while critically thinking about how to make proper patient care decisions. The second simulation occurred at the end of the semester and required the students to lead the patient care scenario and to make critical decisions about best care interventions for the simulated patient. The objectives for each simulation ( Table 1 ) aligned with both course and program outcomes [ 17 , 18 ]. Prior to each simulation, students were assigned activities to complete and resources to review to ensure their familiarity with the simulation content, which is supported by the International Nursing Association for Clinical Simulation and Learning (INACSL) standards of simulation design [ 17 ]. In addition, a pre-briefing was conducted immediately before each simulation to orient students to the high-fidelity simulator, to the simulation environment, and to discuss professional expectations and confidentiality [ 17 ]. The high-fidelity simulator that is used for the pediatrics course is a school-aged Black/African American pediatric patient. This is the only high-fidelity pediatric simulator available at the university. The patient diagnoses used for the simulation were abdominal pain (Diabetic Ketoacidosis) and Sickle Cell Anemia (Sickle Cell Crisis). These diagnoses are common in the region and are typical of cases that the students may encounter on the local hospital floor during their Pediatric clinical rotations. Sickle cell anemia is common in the local African-American population. Thus, a sense of realism is added by portraying a school-aged African American sickle cell patient using a high-fidelity simulator that matches the patient description. One course coordinator and one adjunct clinical instructor conducted all pediatric simulations, which provided for a consistent simulation experience for all students. Both simulation facilitators have the educational background and nursing experience in pediatrics to guide students towards meeting the learning objectives [ 19 ]. Students participated in the simulations within their assigned clinical groups, which consisted of seven to eight students. The pediatric simulation experiences served as a formative evaluation method to nurture personal and professional growth and assist the students toward meeting the previously stated objectives [ 20 ].

Simulation Objectives.

2.2. Pediatric Simulation Scenarios

The first simulation experience was an instructor-led (guided) unfolding case-study scenario that was conducted at the beginning of the semester and included a school-aged child (high-fidelity simulator) who presented to the ED in an apparent sickle cell crisis. The purpose of the instructor-led scenario was to provide a comprehensive teaching and learning experience for students with step-by-step instructions and rationales for patients care. Students completed pre-assignment questions on sickle cell disease pathophysiology, medications, and care interventions. The adjunct clinical instructor guided the students through each step of the scenario, from patient presentation in the emergency department (ED), to admission to the Pediatric Intensive Care Unit (PICU), and then discharge to home. The unfolding scenario included three cycles of patient assessment, care implementation, and management. The adjunct instructor guided students through the challenges presented in the scenario and demonstrated how to make good clinical decisions by utilizing both the traditional nursing process and the clinical judgement model (recognizing and analyzing cues to form hypotheses, taking action by prioritizing hypotheses and generating solutions, and evaluating outcomes based on observation and experience [ 7 ]. Students had an opportunity to practice nursing skills including patient vital signs/assessment, age-appropriate therapeutic communication, pain assessment and management techniques, obtaining orders from a provider (course coordinator), implementing orders and prioritizing care, medication dosage and intravenous (IV) fluid rate calculation and administration, starting a peripheral IV, setup and administration of oxygen, IV pump manipulation and programming, administering a blood transfusion, calling report to another nurse (course coordinator), and discussing discharge teaching points. This guided process provided a comprehensive introduction to the simulated hospital setting and allowed students to mentally and physically prepare to enter the hospital setting the following week.

The second simulation occurred on the final clinical day of the semester and involved a scenario of a school-aged child (high-fidelity simulator) presenting to the ED with complaints of abdominal pain. The student-led scenario included the same structure and flow as the instructor-led scenario. However, the student-led scenario was designed to allow students to work more independently using the knowledge and skills gained throughout the semester. The instructor is present to answer questions and to re-direct as needed, but students lead and determine patient care decisions, thus influencing the simulated patient’s outcomes. Students completed pre-simulation work to explore potential disease pathologies/diagnoses associated with this patient presentation. The design and flow of this student-led (decision-making) unfolding case-study scenario was similar to the first simulation. However, this experience was student-led with minimal instructor interaction. This scenario, like the first, included three cycles of patient assessment, care implementation, and management, with students making independent decisions about the prioritization of care. Students simultaneously used critical thinking skills and clinical skills to collect information needed to formulate a proper patient diagnosis and care management plan. The simulated patient’s condition could improve or decline depending on the decisions made during the simulation scenario. A debriefing session at the conclusion of the scenarios allows students to discuss lessons learned and the impact of the experience on their knowledge and skills [ 17 ].

2.3. Evaluation Methods

A survey was deployed through the online course management system and was available for anonymous participant completion before the first simulation experience and after both the instructor-led and student-led scenarios. Survey items captured demographic information and measures of student self-confidence in pediatric nursing knowledge, skills, and clinical judgment to assess the impact of the use of pediatric simulation. The survey was adapted from the Perceived Confidence in Pediatric Knowledge and Skills Questionnaire utilized in a prior study with permission [ 15 ]. The original survey was evaluated for content validity by an expert panel and demonstrated a high level of internal consistency reliability both overall (α = 0.97) and for each subscale/domain (α = 0.83–0.93). The authors did not further evaluate the adapted survey instrument for measures of validity or reliability. The 16-item survey was structured to evaluate the four steps/domains of the nursing process (assessment, planning, implementation, and evaluation), with four corresponding evaluative items under each domain. Survey items were scored using a 5-point Likert scale from 1 (completely lacking confidence) to 5 (very confident). Five open-ended questions were also administered with both of the post-simulation surveys to allow students an opportunity to further express their perceptions of the experiences.

2.4. Data Analysis

Data were analyzed using SPSS statistical packaging software version 27 (Armonk, NY, USA) [ 21 ]. Item scores were reported as medians and were analyzed as ordinal data [ 22 ]. The pre-simulation survey, instructor-led post-simulation survey, and student-led post-simulation survey responses were compared for statistically significant differences using Friedman’s ANOVA testing with an alpha set at 0.05. Post-hoc Wilcoxon signed-rank tests with Bonferroni correction were used to follow up the significant findings with an adjusted alpha of 0.0167 indicating significant differences in median score responses.

Qualitative analyses of the open-ended responses were conducted using Microsoft Excel and directed content analysis [ 23 , 24 ]. Directed content analysis allows for the examination of data with minimal interpretation, limiting the investigator’s pre-conceived perception or biases during the analyses. Two authors coded text responses using keywords, labeled high-frequency words as nodes, and determined appropriated corresponding categories for each node. The researchers who conducted the initial analyses did not participate in the simulation experiences, thus limiting investigator bias. Constant comparative techniques and re-examination of the nodes and categories allowed for the emergence of themes about the pediatric simulation experiences. A third investigator (course coordinator and simulation participant) reviewed and separately coded the text. A final team session was conducted to combine and refine findings, although very few differences in each independent analysis were evident.

3.1. Student Characteristics

All 43 students who were enrolled in the pediatrics course completed the pre-simulation survey. Forty (93%) completed the instructor-led post-survey and 26 (60.5%) completed the student-led post-survey ( Table 2 ). Characteristics of this cohort of students closely represent the typical demographic makeup of all students who are enrolled in the upper-division program. The students were mostly young and under 25 years of age (72%), female (88%), and had either no clinical work experience or less than three years of experience (90.7%). Race/Ethnicity of the class cohort included 35 (81.4%) White/Caucasian, 7 (16.3%) Black/African American, and 1 (2.3%) Asian.

Student Demographics.

3.2. Pediatric Nursing Knowledge, Skills, and Decision Making/Clinical Judgement Abilities

Friedman’s ANOVA analyses ( Table 3 ) revealed that all 16-items demonstrated statistically significant differences between the three measured group responses (pre-survey, instructor-led simulation post-survey, and student-led simulation post-survey), with pre-post median range 2.0–5.0, χ 2 range 13.9–41.7, and p -value range = <0.001–0.001. Furthermore, students’ self-perception ratings of knowledge, skills, and self-confidence improved over the duration of the semester and after each simulation experience for six of the 16 scored items (pre-post median range 2.0–5.0, χ 2 range 14.7–32.2, p -value range = <0.001–0.001). Post-hoc Wilcoxon signed-rank tests revealed statistically significant differences in student ratings pre-simulation experience and post-instructor-led experience for all of the 16-scored items ( Table 4 ) (pre-post median range = 2.0–4.0, Z -score range = −5.2–2.9, p -value range = <0.001–0.003). While median response scores increased throughout the semester and between simulation experiences for six of the survey items, differences in those group responses were not statistically significant after applying Bonferroni adjustment.

Presurvey, Instructor-led Postsurvey, and Student-led Postsurvey Responses (Medians).

Analyzed using Friedman’s ANOVA.

Presurvey and Instructor-led Postsurvey Responses (Medians).

3.3. Qualitative Responses

Directed content analysis of the five open-ended survey questions revealed four themes: perception of experience, pediatric nursing care, assimilation of knowledge, and critical thinking ( Table 5 ). Perception of Experience shifted between the first and second simulations. Prior to the first simulation, 70% (28/40) felt nervous about the unknown, and 15% (6/40) expressed feelings of excitement and anticipation. One student stated, “I did not know what to expect and was nervous about it”. However, prior to the second simulation, only 30% (8/26) expressed sentiments of nervousness, and the excitement and anticipation grew to 42% (11/26). One student remarked, “I was nervous for the first simulation, but going into the second simulation I felt much more prepared and excited”.

Participant Responses and Coding Scheme.

The second theme focused on Pediatric Nursing Care. Prior to this course, students had only taken care of and interacted with the adult population. Students conveyed feelings of increased confidence regarding the care of pediatric patients and enhanced communication skills after the simulation experience. One student commented, “I am extremely confident in my ability to take care of a pediatric patient after these simulations. They really help tie in all the information we have learned and how to put it to use in the real world”. Another student said, “This simulation improved my understanding and skill of pediatric nursing care as well as improved my communication skills between other healthcare providers”.

Assimilation of Knowledge and Critical Thinking were the final two themes. One student felt the simulations “really helped to put the whole picture together; from admission, to calling the doctor for orders, to assessing, intervening, and modifying the plan of care as needed based on the patient’s situation”. Another student voiced, “It helped bridge the gap between what we learn in lecture and how to apply it to the clinical setting”. Finally, students enjoyed the opportunity to critically think about the scenarios. One expressed, “It helped me develop my critical thinking skills to understand why each intervention is done”.

4. Discussion

Both quantitative data and open-ended survey responses revealed overwhelmingly positive student feedback about the impact of the simulation experiences on their knowledge, skills, and self-confidence in performing as a nurse in a pediatric hospital setting. While students found both experiences beneficial, they reported the most improvement in learning and comfort from the instructor-led simulation and the most improvement in critical thinking and assimilation of knowledge during the student-led simulation.

These findings align with current research on the benefits of pediatric simulation to improve student knowledge, self-confidence, and satisfaction [ 25 ]. Likewise, our findings are reflective of those in a previous qualitative study by Teles and researchers, wherein students felt more comfortable caring for children and their families and with the use of pediatric nursing equipment after participation in the pediatric simulations [ 26 ]. Gilfoyle and team found that pediatric resuscitation simulation-based educational interventions significantly improved clinical performance and teamwork [ 27 ]. During the student-led simulation debriefing, students voiced that they enjoyed working together with their group members to critically think and to collaborate on potential diagnoses and appropriate prioritization and planning of care. In addition, the simulation may increase the clinical judgment of students. This is supported by Sherrill, who encouraged the use of simulation as a way to apply the Clinical Judgment Model, which may increase preparedness for the Next Generation NCLEX [ 8 ].

Although Saied and Cardoza and Hood found that overall student self-efficacy decreased after simulation, we found no indicators of this in either our qualitative or quantitative analyses [ 13 , 25 ]. Conversely, students voiced that they felt that the pediatric simulation experiences were some of the most beneficial clinical learning opportunities they had experienced thus far in the program because of the opportunity to perform skills that they would not likely encounter in the hospital setting as a student nurse.


Although the simulation experiences have been conducted in the described format for multiple semesters at this university, this was the first formal evaluation of student perceptions of knowledge, skills, and satisfaction. Previously, informal feedback during debriefing sessions has been used to modify and improve the simulation structure and flow to maximize the student learning experience. The surveys were conducted in an anonymous manner with no academic penalty for non-participation. However, it is possible that students felt obligated to participate or to respond positively to the survey questions because of their status as students enrolled in the course. Future analyses across multiple cohorts and locations could provide further insight as to the benefit of these experiences and what elements should be added to enhance student critical thinking and assimilation of knowledge. Additionally, students should be tracked and surveyed six-twelve months post-graduation to determine the impact of the simulation experiences on preparation for practice. Some students chose not to complete the final survey, which was held during the last week of the semester. Students voiced being fatigued and time restraints as reasons for not completing the final study. One student offered the suggestion to add an actor as a family member during the scenarios to help students navigate therapeutic communication with the family.

5. Conclusions

Simulation experiences that are incorporated throughout the nursing curriculum can improve student knowledge, performance, and preparation for practice. Additionally, simulation provides students an opportunity to gain experience in areas where clinical placements are scarce. Pediatric simulation experiences are important to positively impact both the learning and self-confidence of undergraduate nursing students. While simulation experiences can be conducted in a variety of ways, the incorporation of high-fidelity simulators and equipment with simultaneous patient care management during a given scenario may maximize students’ clinical judgment and assimilation of knowledge. Incorporation of unfolding case-study scenarios into simulation experiences can improve students’ self-confidence in nursing knowledge and skills and can enhance decision-making/clinical judgement abilities needed for success on both the Next Generation NCLEX-RN exam and in practice as a registered nurse.

Author Contributions

Conceptualization, A.C.M. and B.L.; Data curation, A.C.M., T.A.P. and T.P.G.; Formal analysis, A.C.M., T.A.P. and T.P.G.; Investigation, A.C.M. and B.L.; Methodology, A.C.M. and B.L.; Project administration, A.C.M.; Writing—original draft, A.C.M., T.A.P. and T.P.G.; Writing—review and editing, A.C.M., T.A.P. and T.P.G. All authors have read and agreed to the published version of the manuscript.

This research received no external funding.

Institutional Review Board Statement

The study was conducted according to the guidelines of the Declaration of Helsinki, and approved by the Institutional Review Board of Francis Marion University (protocol #11-05-202005, approved 8 December 2020).

Informed Consent Statement

Patient consent was waived by the IRB due to survey being administered online. All data were deidentified aggregate data.

Data Availability Statement

Conflicts of interest.

The authors declare no conflict of interest.

Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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Unfolding Case Studies: Experiencing the Realities of Clinical Nursing Practice 1st Edition

This comprehensive workbook contains a compilation of unfolding cases across the discipline of nursing, and includes unique aspects of nursing regarding spirituality, family issues, community as client, and gerontology concerns. It integrates concepts of age, setting, role development, and ethical/legal issues. Users gain a simulated experience in prioritizing nursing problems, identifying appropriate teaching strategies, documenting nursing care, and critically analyzing the totality of common situations encountered in professional nursing practice. Unfolding case models deal with obstetrics, pediatrics, mental health, medical surgery, and assorted cases regarding such issues as: falls in the elderly, urinary incontinence, aging, sleep-rest changes, managing staff conflict, public health nursing, vital signs, confidentiality, and spirituality. For educating student and staff nurses in various nursing programs.

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101 Primary Care Case Studies: A Workbook for Clinical and Bedside Skills

Editorial Reviews

From the inside flap.

Sincerely, Kellie Glendon and Debbie Ulrich

From the Back Cover

About the Author

DEBORAH. L. ULRICH, PhD, RN is an experienced nurse educator who has influenced nurse educators through journal articles, national presentations, and a recent book on interactive group learning. Her strategies have challenged educators to experiment with new ways of teaching and learning. Debbie has been a nurse educator for the past 30 years in diverse educational settings.

Excerpt. © Reprinted by permission. All rights reserved.

To the student.

The purpose of this workbook is to help you practice the critical skills of problem solving and applying information to common situations you encounter in your practice of professional nursing. The role of the professional nurse has become exceedingly more complex, as nurses must care for clients in shorter time periods and in a variety of settings such as home, hospital, outpatient clinics, and rehabilitation facilities. No longer do nurses have extended periods of time to process information and plan care. As insurance plans dictate shorter stays and/or fewer visits, nurses must be able to analyze situations, plan interventions, and respond quickly to ever-changing situations.

The "Unfolding Cases Model" (Glendon and Ulrich, 1997) will give you practice in the skills you will need in the workplace. You will be asked to analyze realistic cases that unfold sequentially and follow the typical progression of common conditions or disorders. All cases are interspersed with focused questions to be answered by groups of students using common cooperative learning strategies (see Table 1). By using the case as a study guide prior to class, you will have some time to explore these focused questions individually, prior to your group involvement. This prior preparation will increase the effectiveness of the group strategy. Your instructor will brief you about the strategy she or he wishes you to use, as well as the process of how to report your group's findings to the entire class. An important aspect of learning and using critical thinking is being able to examine the varied perspectives of others. This cooperative learning group strategy exposes you to the alternative ideas and ways of thinking of your peers, thus multiplying the learning potential of the case. At the end of each case you will be asked to complete a reflective writing assignment that will allow you to investigate your individual thoughts, feelings, and ideas related to nursing practice issues or situations (see Table 2). In nursing practice we are frequently exposed to situations that oppose our personal values and beliefs. These cases will give you an opportunity to explore these issues and help you identify the nursing role. Your instructor may collect the cases prior to class discussion to determine your level of preparation for discussion of the case. In any instance, prior individual preparation will benefit both you and your group as you process the case in class.

This book is designed to help you adapt to the new ways your instructors will be teaching in the new millennium. Research has shown that students learn best when they are actively involved in the process of learning and are not passive recipients of the teacher's expertise. You will notice that your instructors are using the lecture method less often and are relying on newer interactive group strategies. This can be very disturbing to you as a student who is used to previous methods that required you to merely take notes on what the instructor presented and regurgitate the same information back to them on a test. Now, in this model, the instructor poses a case and asks you and your peers to process it. They won't be just giving you the right answers. Your first impulse might be to think your instructor is not doing anything and that you are teaching yourself. This is a common feeling, but it is far from the truth. The instructor is merely changing his or her role in the teaching and learning process from being the center of knowledge to being one of manipulating the environment so that students can be involved in and discover the connections of things in an active fashion. Being actively involved will increase your learning. In the traditional lecture method, students quickly learn that it is not really necessary to read or prepare much prior to class because the teacher will tell them in the lecture everything that is really important. This way of thinking is erroneous in that today's world is filled with volumes of ever-changing information and no one could possibly know everything. Therefore, the most important job of the teacher is to create focus and teach you how to think. Information will change, but the skill of problem solving and critical thinking will benefit you forever. That is the purpose of this "Unfolding Case Model." (Glendon and Ulrich, 1997)

In traditional methods, the majority of time you spend with the teacher is when she or he is presenting you with new information in a lecture. Until you have had the time to process that information, you are unaware of what you do not understand or what questions you have. It is when you are alone reviewing your notes and trying to process and apply information that you really need the teacher's help. In the new learning paradigm, students need to prepare individually by doing the reading assignments and/or looking at the case prior to class. Class time should be the time when the instructor helps students process information that they have already been exposed to through their own reading. The "Unfolding Case" method actualizes this line of thinking. In using this book, you need to read through the case before doing your reading assignment to help you emphasize the important content in the reading. As you read, jot down possible solutions to each of the focused questions. This~will help you as you interact with your peers to process the case in class. Your instructor will tell you which cooperative learning strategies to use and how to report your findings as a group. He or she may also use this same model at the end of a clinical for a post conference or as a clinical make-up assignment. As you complete the cases, it is our hope that you will work with your instructor and expand your ability to learn and grow as a professional.

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unfolding case study review nursing

unfolding case study review nursing

A comprehensive literature review on unfolding case studies in nursing education

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Session presented on Saturday, April 9, 2016, and Friday, April 8, 2016:

Present generation students do not prefer traditional teaching methods. Students recognize the need to be engaged in discussions to learn. Unfolding case study being one of the innovative teaching strategies can be incorporated into the nursing classrooms to bridge the theory clinical gap. With the help of unfolding case study the nursing instructor is able to bring a near real patient to the classroom enabling students to connect the relationship between different concepts. Incorporation of unfolding case studies in nursing classrooms improves the critical thinking skills and clinical reasoning skills of nursing students and prepares them to meet the challenges of delivering present health care. Nursing faculty is at the forefront for making transitions in nursing education from instructor led classroom to student centric classrooms. In order to properly integrate unfolding case study into the classrooms nursing faculty should have a deep understanding of unfolding case study. This presentation explains what is unfolding case study and what are the advantages of using unfolding case studies in nursing classrooms based on a literature review conducted. The presentation also discusses some barriers that prevent nurse educators from adopting unfolding case study as a teaching strategy. Besides discussing barriers for the use of unfolding case study, the literature review explores the ways for integrating unfolding case studies into nursing classrooms. The difference between case study and unfolding case study is presented. Mentoring plays a significant role in empowering faculty to use unfolding case studies into the classrooms. With successful incorporation of unfolding case studies into nursing curriculum, newly graduated nurses would feel more confident providing care. The quality and safety in health care delivery will be promoted. Mortality rate related to medical errors will eventually decrease. Sentinel events will be reduced. Patients and family members will start to form good relationship with new grad nurses resulting in staff retention, contributing to the delivery of quality care that meet excellence.

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  1. Fundamentals of Nursing Test Success: An Unfolding Case Study Review: 9780826193933: Medicine

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  1. How to Use Unfolding Case Studies as a Clinical Replacement Activity

    Just like high fidelity simulation provides a replication of the clinical setting plus the thinking, unfolding case studies are low fidelity

  2. Why KeithRN Unfolding Case Studies Can Transform the Virtual

    Unfolding Reasoning is the most complex KeithRN case study and is 8 to 10 pages in length but provides higher level clinical reasoning questions

  3. Using Unfolding Case Studies to Develop Clinical Forethought in

    The advantage of unfolding case studies is that they reveal information incrementally, which mirrors nursing practice. Experienced nurses faced

  4. ACE.S Unfolding Cases

    An unfolding case is one that evolves over time in a manner that is unpredictable to the learner. New situations develop and are revealed with each

  5. Assessing the Impact of Unfolding Case Study Scenarios during

    The qualitative themes identified were perception of experience, pediatric nursing care, assimilation of knowledge, and critical thinking.

  6. Unfolding Case Studies: Experiencing the Realities of Clinical

    Unfolding case models deal with obstetrics, pediatrics, mental health, medical surgery, and assorted cases regarding such issues as: falls in the elderly

  7. Unfolding case studies in nursing education

    In part two, Larry Slater discusses how case-based learning in the classroom is a way for faculty to bring their experience as practitioners

  8. Free Nursing Case Studies & Examples

    Unfolding means that the case study progresses via a developing scenario. The nursing student is given assessment data and asked to developing a nursing care

  9. “Perioperative Unfolding Case Study”—A Lesson in Quality and Safety

    Unfolding case studies present the opportunity for learners to develop and improve their critical thinking and problem-solving skills to

  10. A comprehensive literature review on unfolding case studies in

    Incorporation of unfolding case studies in nursing classrooms improves the critical thinking skills and clinical reasoning skills of nursing