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OB Unfolding Case


Submitter Information


Name: Carol F. Durham
Title: Director Clinical Education & Resource Center and Clinical Associate Professor
Credentials: Ed.D(c.), RN
Co-Authors:

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


Organization: UNC-Chapel Hill
Address 1: CB # 7460 Carrington Hall, School of Nursing
City: Chapel Hill
State: NC
ZIP: 27599-7460
Phone: 919-966-1753

Teaching Strategy


Competency Category(s):
Learner Level(s):
  • Pre-licensure ADN/diploma
  • Pre-licensure BSN
  • Continuing education

Learner Setting(s):
  • Skills or simulation laboratories

Strategy Type:
  • Simulation Exercises

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.

Strategy Implementation

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.


Submitted Materials


Media Type(s):
  • MS Word documents

File(s):


Additional Materials:

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


Evaluation Description


Evaluation – anecdotal

Students have consistently rated the experiences with the unfolding cases positively, stating they learned a great deal and wanted all their educational experiences to be presented in this format.