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Strategy Submission

OB Unfolding Case


Carol F. Durham

Ed.D(c.), RN


Director Clinical Education & Resource Center and Clinical Associate Professor


Kathy Alden, RN, MSN, EdD(c), IBCLC Clinical Associate Professor, School of Nursing, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA, Camille Lambe, RN, PhD


UNC-Chapel Hill School of Nursing


Competency Categories:

Patient-Centered Care, Safety, Teamwork and Collaboration

Learner Level(s):

Continuing Education, Pre-Licensure ADN/Diploma, Pre-Licensure BSN

Learner Setting(s):

Skills or Simulation Laboratories

Strategy Type:

General Strategy

Learning Objectives:

Core-Competency: Patient Centered Care
The teaching strategy is designed to evaluate the following KSAs:
Knowledge: Integrates understanding of multiple dimensions of patient centered care: patient/family/community preferences, values; coordination and integration of care; information, communication, and education; physical comfort and emotional support; involvement of family and friends; transition and continuity
Attitude: Respects and encourages individual expression of patient values, preferences and expressed needs
Skill: Provides patient-centered care with sensitivity and respect for the diversity of human experience
Knowledge: Understands relationships among physical and emotional discomfort and human suffering
Attitude: Seeks to relieve pain and suffering, whether mental, physical or spiritual
Skill: Assesses presence and extent of pain and suffering & Assesses levels of physical and emotional comfort
Knowledge: Understands nursing roles in coordination and integration of care, transition and continuity
Attitude: Values shared responsibility and decision making, even when conflict occurs
Skill: Clearly communicates care provided and needed at each transition in care
Core-Competency: Teamwork and Collaboration
The teaching strategy is designed to evaluate the following KSAs: Knowledge: Understands the impact of effective team functioning on safety and quality of care
Attitude: Appreciates the risks associated with handoffs between providers and across transitions in care
Skill: Follows communication practices that minimize risks associated with handoffs among providers and across transitions in care
Core-Competency: Safety The teaching strategy is designed to evaluate the following KSAs:
Knowledge: Able to list general categories of errors and hazards in care
Attitude: Open to communication of potential or real errors from any member of the health care team, patient or family
Skill: Participates in data collection and aggregation of improvement data

Strategy Overview:

Just as the construction industry emphasizes the importance of using the “right tool for the job,” so it is with the choice of an instructional strategy in nursing education. There must be careful thought in selecting the instructional method best designed to meet specific learning objectives. Unfolding case scenarios provide a bridge between theory and clinical practice. Critical thinking and clinical decision making skills are developed and refined as students apply previous knowledge in simulated patient situations. Knowledge and skills attained from classroom and clinical experiences can be applied in patient care situations. The use of unfolding cases allows a condensing of vital learning experiences that assists the learner in developing clinical reasoning and decision-making skills. Additionally, a simulation can be repeated to allow students to correct misconceptions, fill in knowledge gaps and hone clinical skills. This can be beneficial in boosting self-confidence and self-esteem as students are learning to think and act like nurses. Unfolding cases can assist faculty in addressing problems related to lack of consistency in students’ clinical experiences. Students are placed throughout hospitals and community agencies, working on a variety of units. There is often a lack of consistency in student learning experiences. Even students assigned to the same unit will encounter individual patients with unique problems and needs. It is impossible to assure that every student who graduates from a nursing education program will have had the same opportunity to provide care for any specific type of patient. Many variables influence student learning experiences in the clinical setting. These include such things as patient acuity and diagnosis, facility access, time of day, as well as clinical and teaching expertise of clinical instructors and nursing staff. Use of well-developed case studies allows for greater consistency in learning experiences. Learning occurs in a controlled environment where groups of students are exposed to the same scenarios, under the same conditions.

Submitted Materials:

Additional Materials:

If additional information is desired please contact Carol Durham, Director, Clinical Education & Resource Center at and be CERTAIN to list in the subject line "QSEN teaching" otherwise the request may not be received.

Evaluation Description:

This synthesis/learning activity is designed to replace one day of clinical for students in OB. The course coordinator assigns students to the rotational pattern by dividing clinical groups into two groups of five students (five seems to be the maximum number to allow an effective experience with the patient simulator). Each clinical faculty assists with the simulation experience for his/her group. Students spend six hours in simulated obstetric clinical experiences, one hour with the human simulator (2 cases) and four hours rotating to 4-5 course specific unfolding cases (link to unfolding cases submission). This case actually builds on one of the unfolding cases and continues the patient care scenario into critical care. The patient for the unfolding case is Annie Foster and she is taken from a routine prenatal clinic visit through the course of events that end with her being critically ill in a surgical intensive care unit. The learner encounters Annie in one of the unfolding cases and then again as one of the patient simulator cases (see OB Sim script). Supporting materials are used throughout the case to make the experience as realistic as possible (see the additional unfolding Annie Foster files).

Depending on the objective of the simulated experience, there may or may not be pre-exercise assignments for the students. If the educator intends for the experience to be a synthesis of what the students have learned to date, then there are no pre-exercise assignments. However if the intent of the simulated exercises is to deliver content, then there would be pre-exercise assignments for the learners.

Unfolding cases can be developed from many clinical examples. A template for developing unfolding cases can be found in the unfolding case template file.
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