Care of a Patient with COPD Exacerbation

This simulation scenario prepares students in prelicensure programs to use clinical judgement skills to identify, manage, and report worsening shortness of breath in an elderly patient with a history of COPD. This resource is aligned with several AACN Essentials domains and is desgined for immediate instructional use.

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What’s Included:

  • AACN-aligned learning objectives and Essentials sub-competencies
  • Detailed patient case and clinical deterioration timeline
  • Prebriefing guidance and facilitator readiness checklist
  • Structured scenario flow with decision points
  • Rapid Response and SBAR communication expectations
  • Micro-debrief and full debrief question sets
  • Progression Indicators (developing vs. developed)
  • Coaching rubric and observation checklist

Entry-Level Nursing Practice Scenarios: An Overview

Domain 1: Knowledge for Nursing Practice
1.3. Demonstrate clinical judgment founded on a broad knowledge base.
a. Incorporate knowledge from nursing and other disciplines to support clinical judgement.

Domain 2: Person-Centered Care
2.1. Engage with the individual in establishing a caring relationship.
a. Demonstrate qualities of empathy.
b. Demonstrate compassionate care.

2.3. Integrate assessment skills in practice.
c. Perform a clinically relevant, holistic health assessment.
e. Distinguish between normal and abnormal health findings.

2.7. Evaluate outcomes of care.
a. Reassess the individual to evaluate health outcomes/goals. 
b. Modify plan of care as needed.

2.9 Provide care coordination.
d. Recognize when additional expertise and knowledge is needed to manage the patient.

Domain 6: Interprofessional Partnerships
6.1. Communicate in a manner that facilitates a partnership approach to quality care delivery.
b. Use various communication tools and techniques effectively. 
e. Communicate individual information in a professional, accurate, and timely manner.

Domain 9: Professionalism
9.1 Demonstrate an ethical comportment in one’s practice reflective of nursing’s mission to society.
d. Change behavior based on self and situational awareness.

9.2. Employ participatory approach to nursing care.
g. Communicate in a professional manner.

 

Clinical Judgment
Communication
Compassionate Care

Sub-competency Developing Developed
1.3c Incorporate knowledge from nursing and other disciplines to support clinical judgment.
  • Describe how patient and environmental factors influence clinical decision-making.
  • Provide an evidence-based rationale for adjusting plan of care to reflect contextual challenges and opportunities.  
  •  Integrate patient and environmental factors into the decision-making process.
  • Incorporate knowledge of cultural, ethical, and legal considerations into one’s clinical reasoning to make informed clinical judgments. 
2.1a Demonstrate qualities of empathy.
  • Listen to patients using verbal and nonverbal cues to understand their needs and concerns.
  • Use simple, patient-centered language when explaining procedures or plans of care.
  • Use open-ended questions to elicit patient values and preferences, documenting them accurately in the medical record.
  • Anticipate patients’ needs based on non-verbal cues and the clinical context, responding with appropriate emotional and clinical support.  
  • Leverage communication skills to elicit verbal and nonverbal information to inform the plan of care.
  • Ensure patient preferences are consistently revisited and reflected in interdisciplinary team discussions. 
2.1b Demonstrate compassionate care.
  • Demonstrate presence through eye contact, active listening, and appropriate verbal/nonverbal actions.
  • Identify individual preferences to begin incorporating them into actions and conversations.
  • Remain fully present even in high-stakes or emotionally charged situations.
  • Integrate individual patient preferences and emotional support into every interaction.
  • Engage with healthcare team members to create a seamless, person-centered care experience, respecting holistic needs.
2.3c Perform a clinically relevant, holistic health assessment.
  • Identify and prioritize assessments addressing the patient’s immediate needs and presenting symptoms.
  • Collect subjective and objective data to support clinical decision-making.

     
  • Apply clinical judgment to determine assessment, sequencing and urgency.
  • Adjust assessment priorities in real-time based on clinical judgment and patient feedback.
  • Prioritize assessments based on the patient’s immediate needs and presenting symptoms.
2.3e Distinguish between normal and abnormal health findings.
  • Recognize and analyze normal and abnormal health findings.
  • Consult clinical guidelines and evidence-based resources to verify deviations from normal findings.
  • Differentiate between findings requiring urgent versus routine follow-up and communicate appropriately with healthcare team members.
  • Identify patterns in abnormal findings and correlate them with potential underlying conditions.
  • Use abnormal findings to prioritize interventions and refine care plans.
  • Synthesize normal and abnormal findings in relation to the patient’s disease process.
2.7a Reassess the individual to evaluate health outcomes/goals.
  • Conduct routine reassessments to evaluate progress toward health goals.
  • Compare current findings with baseline data to identify changes in the individual’s condition.
  • Share reassessment results with the healthcare team to facilitate coordinated evaluation and decision-making.
  • Integrate physical, emotional, social, and cultural factors into reassessments to comprehensively evaluate health outcomes.
  • Synthesize patterns and trends in reassessment data, linking them to the effectiveness of interventions.
2.7b Modify plan of care as needed.
  • Identify necessary adjustments to the plan of care based on feedback from the patient and team members.
  • Propose changes based on clinical guidelines and emerging patient needs.
  • Engage the individual in discussions about plan of care adjustments to align with their preferences and values.
  • Collaborate with the interdisciplinary team to ensure care plan modifications are holistic and evidence based.
  • Provide a clear, evidence-supported rationale when modifying the care plan in discussions with the team or patient.
2.9d Recognize when additional expertise and knowledge is needed to manage the patient.
  • Acknowledge when additional expertise is required and seek assistance as needed.
  • Utilize available resources and services to access the necessary expertise.
6.1b Use various communication tools and techniques effectively.
  • Utilize standardized communication tools and techniques to convey patient information accurately and concisely during handoffs and team discussions.
  • Adapt communication tools to the context and audience.
6.1e Communicate individual information in a professional, accurate, and timely manner.
  • Document and share information using standardized communication tools concisely and respectfully within required timeframes.
  • Contribute concise, accurate information in a professional manner to facilitate timely decision-making and continuity of care.
9.1d Change behavior based on self and situational awareness.
  • Recognize personal emotions, biases, or stress levels during clinical experiences and describe their potential impact on interactions with patients or team members.
  • Adjust communication style or approach when responding to feedback or observing changes in patient needs or care priorities.
  • Seek input from peers or instructors to identify specific actions or behaviors that could improve performance in different situations.
  • Adapt real-time clinical practices and communication strategies to align with dynamic patient care needs, team dynamics, and environmental factors.
  • Demonstrate proactive problem-solving and flexibility by modifying approaches to address challenges or unexpected changes in clinical settings.
  • Incorporate self-reflection and situational analysis into decision-making, consistently improving the quality of care and fostering positive professional relationships.
9.2g Communicate in a professional manner.
  • Use clear, concise, and respectful language in all communications with patients, families, and healthcare team members.
  • Demonstrate active listening skills and ensure understanding in patient interactions.
  • Document patient care and interactions using appropriate medical terminology and formats. 
  • Modify communication strategies to engage diverse audiences effectively.
  • Address misunderstandings or conflicts with a respectful and solutions-focused approach.
  • Provide constructive and actionable feedback to peers while fostering a supportive team environment.