Developing Simulated Learning Experiences

HI. I'm Steve Jordan from Grambling State University. We have our simulation lab up and running. We have purchased the NLN scenerios from Laerdal, but most of them are too advanced for our lower level nursing students. I have developed a lower level COPD scenerio. The student has to recognize a pt in respiratory distress, must apply O2, reposition the patient, give them a breathing treatment. Simple.

I need more ideas about some basic ideas about making some more scenerios for my lower level students.


Have you thought about basic ideas such as safety (bed rails, call light), HIPAA compliance, or dressing changes? These are very basic, but can be great learning blocks.



Hello Steve, for first year students we begin with just letting them complete a basic assessment of a client with some factor abnormal.  Nothing really big, but maybe rhochi or a wound that has a dressing.  Remember simple is best with these students as they are trying to understand patient interaction and routine care. 

A good scenario is recognition of IV med incompatabilities (i.e. Dilantin and anything!) 

A fresh post-op patient that needs TCDB exercises to clear atelectasis, this may involve a quick dressing change and assessment as well. 

Just some ideas. 

One idea I have heard about (we are still in the process of developing our simulation laboratory) is to have a manakin in a room simulated to be a home environment.  The students are making a home care safety assessment.  They have to find all the safety hazards in the room.
I agree that beginning students need to start with basic scenarios--hand hygiene, VS, assessment. We have an orientation to the lab day where students do a scavenger hunt in the lab to find various supplies (we try not to move them, much as a med room and supply cart int he hospital would be), find the heart sounds, pulses and B/P sounds on the mannequins (ours are medium fidelity), etc. The safety check for the home environment can also be done for the regular hospital bed the mannequin is in. Our students make it a competition to find the most safety issues--siderail down, bed not in lowest position, call light out of reach, extra pillow on floor, etc. Others can be things such as kinked foley tubing, IV not dripping, dressing dangling (they have to look under blanket), etc. This helps reinforce that what is in the "room" is really what the student has.


I seen the other great ideas.  For Lower level nursing student scenes we focus on the basic patient safety such as Lowering the bed, having call bell in reach, seizure precautioins, writing out the MAR from the doctor orders, and verifying allergies EACH and every time before giving medictions. Some of the basic skills of questioning the doctors hand writing or doctors order when the medication dose is TOO much for a child or elderly patient is also a good idea.

Other lower level nursing student scenes can be based on teaching the family member how to change a dressing, give a tube feeding, or clean  and dress a peg tube site. More complex tasks include doing a sterile dressing of a wound or trach when a doctor is calling requesting recent labs or patient update.

We have had the students question the medications and call the doctor then write the doctors order out properly.  Just calling the doctor and using the SBAR can be difficult for the higher level of nursing students.

Durcilla Williams, MSN, RN

Odessa College, Odessa, TX

I agree with starting with the basics of safety such as hand washing, standard precautions, patient ID, fall safety, identification of allergies, safe medication administration, assessment, communication, etc. These basic safety issues can then be reinforced in subsequent simulation experiences as the students progress through the program and the simulations become more complex.


Andrea D. Ackermann, PhD, RN
Mount Saint Mary College
Newburgh, NY


I agree as well. The National Patient Safety Goals offered by the Joint Commission created an simulation idea for me. I work as a faculty member at East Tennessee State University and work in the clinical setting with students. My particular students are in the hospital setting and I thought that I needed to come up with an extra layer of teaching in order for the students to understand and meet the requirements of the National Patient Safety Goals so I have made them into a scenario called “Reducing Risk”: Patient Safety Learning Activity and another scenario entilted “Clear Communication”: Enhancing Communication Among Healthcare Providers. These scenarios are only about 30 mintues each and the gest of the scenario are the safety goals are built into the scenario. Purposefully the scenario is set up for the safety issues to occur hoping that the student through their knowledge and crtitical thinking skills will intervene appropriately.


Andrea, I would be very interested in learning more about your "Clear Communication..." scenario. Sounds like a great idea! Thanks so much!

Cheryl Landis MSN RN


Dear Teressa,

     Would it be possible to see a sample of your clear commnuication scenarios:  Enhancing Communication among Healthcare Providers?  Sister Agnes

would you be willing to share your Clear Communication”: Enhancing Communication Among Healthcare Providers? sounds great!


I would love to view the scenario Clear Communication.  We are using the simulation in the 2nd and 3rd semester but would love to start in 1st.

Kelli Davis

I would like to view that as well...

Teresa, Would you be willing to share these scenarios?

Thank you!

i would like to get the clear communication scenarios ,, if you dont mind ,, it sounds great .

Picture of Marilyn Stoner
Re: lower level
by Marilyn Stoner - Wednesday, July 8, 2009, 4:18 PM
Hi Steve,

I have a series of end of life scenarios, see the current issue of Nursing Education Perspectives..I am away from home now, but I am happy to send the programming ands support material.

I having a core scenario like your oxygenation one can be the core of MANY simulation scenarios, have the simulator start on the floor, put the simulator in isolation, etc. Use Jeffries model and your program outcomes to plan for progressive immersion in the many skills (communication, safety, etc)

Marilyn Stoner
Picture of Shelley Yeager
Re: lower level
by Shelley Yeager - Thursday, July 9, 2009, 10:53 AM


If you are willing, I would love to review your end-of-life scenarios.  I am developing one for lower-level students this summer in preparation for the fall.


Shelley Yeager


You can revise the NLN to tailor them to your needs. Since I am hospital based, I had to make them more difficult to meet the needs of both new grads and experienced nurses.  I simply saved them with our facility's initials at the end so that I knew which ones to use. 

 We have also done some very simple ones for nursing schools though, like a sickle cell crisis with uncontrolled pain, simple assessment, pain assessment and calling the physician.  We also just turned on our COPD patient and they had to complete their History Interview on a patient with COPD, SOB and some anxiety.  One of the most fun ones was having the instructor play the patient in a rapid safety assessment check.  They receive report and orders on the patient and have to go in the room and find as many things wrong as they can in 5 minutes. Ex: candy and coke in a diabetics room, cigarretted hidden in the telemetry pouch, friends or relatives meds at the bedside, wrong IVF, wrong armband, TEDs in the trash.  One of the most fun is that we put Isolation equipment at the door- there was no order, but everyone put the equipment on! The point is to teach them to quickly survey the patient and environment every time they enter a room to ensure there is nothing wrong.



I really like your idea of the "Rapid Safety Assessment Check." I will use that in the fall with our nursing students.

Thanks for sharing, as well as for everyone else!

Gerald Songer RN



    I like your idea of rapidly safety assessment check.  Is this done before you begin class?  How often do you implement this strategy? 

Wow....what all great ideas. Thanks so much for your input. I have a lot of material to work with now. Any other people with ideas, please keep posting.


There are many great uses for simulation in early nursing courses.  You can create assessment scenarios, for instance.  The students need to enter the room, introduce themselves and the plan, and do a head-to-toe assessment.  You can have your "patient," ask questions during the exam like "is my blood pressure normal?" or "does my wheezing sound really bad?  It's hard to breathe," for instance.  Students need to demonstrate knowledge and understanding, not just demonstrate memorization of steps.  The patients can be normal, no need to have a problem.  They can also "practice" talking with patients and families, which can be a challenge for them.

We also use "teaching scenarios."  A patient may have diabetes, for instance.  The students need to explain how to check a blood sugar, or teach the signs and symptoms of hypo and/or hyperglycemia, and what to do about them.  You can use standardized patients for this type of scenario (faculty or staff work well!) You would want to have students prepare in advance so they would do a thorough job of teaching, and limit the topic, so they didn't prepare for teaching EVERYTHING about diabetes at one sitting, which wouldn't be realistic. The students can get quite creative, and if they are teaching in front of their classmates they are very motivated.

Med administration is another idea.  Students can practice the steps, proper patient identification, and patient teaching about the meds, all in the context of a scenario.

I would discourage you from focusing on "planting" errors, and having students find "what's wrong in this scenario."  They will lose trust in your teaching, and rather than learning the judgment required in nursing practice, just look for how you are "tricking" them today! Good luck!

Steve,  Talk to your faculty to get ideas.  Ask them what content areas are most difficult for their students.  Their responses should lead you to the areas where there is most need.  Also ask them to tell you about clinical situations when students did not perform as well as expected.  That should not only help give you ideas for writing the scenario, but it can also provide a way to involve faculty and get more "buy in."


Greetings. My name is Teressa Wexler and I am from East Tennessee State University's College of Nursing. I have a simulation that was created for those at the fundamentals level of the nursing program. You had mentioned basic; and this is as basic as it gets however, it is very effective. I have used it and shared it with other instructors here as well as other nursing programs and they have reported back the effectiveness as well. I entitled it: "What's Wrong With This Picture": A Focus on Fundamentals. I got the idea from the funny paper. Remember the pictures where you circle what is wrong or different with this picture?

I set up the simulation with basic things wrong that fundamental students have already had: such as respiratory distress, oxygen is on his forhead, patient is lying flat in bed, all side rails are up (so a restraint), etc. there are 12 things wrong in the scenario and the student has five minutes to identify the problems or things wrong and then through the nursing process intervene. Those in the audience through observation have to document what they discover wrong and on the paper (so not to disturb the simulation) write down what they find and their interventions. This is followed by a debriefing/discussion episode at the end. If the observation audience is large or you are limited on space and have problems with visibility of all observing, I also make a photo of 12 things wrong with the patient (can't do the lung sounds, have to add an extra one) and they have to identify and intervene by documenting it.

I love the creativity that simulation allows and have alot of basic scenarios that I don't mind sharing. Too much to post to this post. However, if you or others are interesting in these feel free to contact me at: or 423-439-4605.




Dear Steve,

I know I am joining this conversation a little late. I teach in a PN program and we also have found the simulations that can be purchased too high level for our students. We have developed several PN level simulations that we use with our Vital-Sim manikins. They require the student to complete an assessment, determine what is going on with the patient, and determine the correct course of action using a set of orders. If you are interested in seeing them, please let me know.

Melody Bethards

Des Moines Area Community College


Melody, I would be interested in some of your simulations for the beginning student if possible.

P.S. I attended the very excellent Iowa nurse educator conference this summer. Kudos to all involved in planning!



As director of the Foundations course, I developed simulation scenarios that address each of the basic nursing skills.  Every skill had a brief scenario with doctor's orders that were presented as part of the instructor skill demonstration. These were used as student practice scenarios with a key to verify concepts behind the skill.  Then at checkoff students were presented a scenario to follow and required to implement the skill and document it.  This worked great!  It made the "pt" more real. In fact, following the doctor's order was so ingrained in them that the next semester check-offs they were requesting the scenario and doctor's orders before starting the checkoff instead of just going in and performing the skill on a "mannequin." lol


Pamela, would you mind sharing these scenarios? We'd love to incorporated basic skills check-offs in our fundamental course.
Thanks, Lori Anderson
I am also interested in this. Thanks

I would be really interested too! Especially for our Open lab Fridays!


Kari Congenie


Would you be willing to share?

Hello I just read your post and I would very much like to use the simulation scenarios for basic nursing skills. Is there anyway to send them to Hoping this thread is still active. Thankyou
Would love any ideas for first year nursing students. Want to keep them engaged.
Hi Kristine,

I am wondering if you've looked through the Library at CHSIERPS: hope this helps.

Warm regards,

Andrea Sehmel
Grays Harbor College
Aberdeen, WA


I am a new simulation laboratory coordinator. I am very interested in your scenarios if you are willing to share please contact me.


Hello Pam,

I see that this discussion took place several years ago, but I hope you still receive this message.  I am very interested in learning more about the simulations you have developed.  I tech the Fundamental Nursing Skills course at Ball State University and am looking for activities to help students apply what they are learning.  I appreciate any ideas you can send my way.


Marcy Shafer


Hi Steve-

I think an area of weakness for many students is communicating to a patient- attended a SIM workshop where a student interviewed the simulated patient. Also ,the sim lab could be set up with the mannequin and a number of safety issues- students could work together to ID safety issues.

Pat McCauley

Picture of Susan Prion
Ideas for Lower Level Nursing Student Scenerios
by Susan Prion - Wednesday, March 3, 2010, 12:34 PM
We have had great success in integrating a patient safety-SBAR simulation into the first clinical semester for our pre-licensure students. We use trained acting students as standardized patients and ask our nursing students to conduct a head to toe assessment including a safety assessment. The "patients" are in character, but are also instructed to try to get out of bed and to actually fall (safely, of course) if the nursing students don't respond to their risky behavior. It has been very effective in helping students to focus on both safety and also to give them important practice in communicating with the patient and their colleagues in a realistic setting.

If you want to read more, please see the article just published about this experience in the latest Clinical Simulation in Nursing journal. The citation is as follows:

DeBourgh, G. A. & Prion, S.K. (2010, March-April). Using simulation to teach prelicensure nursing students to minimize patient risk and harm. Clinical Simulation in Nursing, 6 (1), e1-e10. doi:10.1016/j.ecns.2009.12.009.

Please contact me if you have additional questions.
Susan Prion

I teach at Jefferson State Community College in Birmingham, AL where we are doing the ground work for a sim lab. With first semester students (PN and ADN) I incorporate simulation into every campus lab experience. Though the focus may be ADLs, the "patients" have ID bands, attached equipment (IV, foley, oxygen mask), and maybe an incision (with or without a dressing). Students are expected to adapt care based on age, culture, physician's orders, events,etc. Initially, the students are asked to do a brief assessment as they enter the room. They are to gather initial data without touching or talking to the patient. I may be a family member, neighbor, transporter, lab tech, physician, charge nurse, etc. that interrupts care. Also, as I circulate among the "patient rooms" I ask for any ID'd problems, interventions used,  and give pointers & feedback. The lab session ends with students sharing how they implemented the nursing process.



There are some ideas on my website that are free for everyone to have. Some of them are very appropriate for low level students and we even use them for PN students sometimes. Here is the site:  The site is free and is paid for by ads. So, if you like what you see, can you pass us along? Thanks!

Lori Budd, MSN, MBA, RN

CEO One Stop Simulation


I suggest that you go and look at the course objectives for your first clinical nursing course and take your subject matter from those.  You can weave patient safety goals, communication, and team work into those simulations but the "topic" should flow from your course objectives and program outcomes.