Designing Scenario-based Training for Nurses, Part 1


The American Association of Critical-Care Nurses (AACN) provides news, information, and continuing education about the latest evidence-based research and best practices in acute and critical care nursing. When updating its Essentials of Critical Care Orientation (ECCO) online program, AACN decided to create more experiential learning through patient case studies.

Long used in medical education, patient case studies provide examples to learn by. In the new 77 hours of online ECCO training, case studies drive a scenario-based experience in which nurses care for virtual patients, make real-time care decisions, and receive performance feedback through natural consequences. In developing the curriculum and instruction with AACN, Enspire has gained knowledge and experience on how to design scenario-based training for nurses.

Think Like a Nurse

Critical care nursing is a highly specialized field. Dealing with severely ill and injured patients, critical care nurses employ an enormous amount of healthcare knowledge, skills, and critical thinking in their work. From interpreting and acting upon subtle changes in a patient’s hemodynamic or blood lab values, to recognizing disease pathophysiology and worsening progression, nurses continuously monitor, assess, diagnose, plan, implement, and evaluate treatment responses. With input from AACN and its subject matter experts, Enspire adopted a clinical judgment model (Tanner, 2006) of a continuous cycle of notice-interpret-respond-reflect.

Couple Didactic Content with Patient Care

Using the clinical judgment model as a foundation, the curriculum and instruction followed a learn-by-doing approach with learners receiving a new patient into their care in each assignment.


Figure 1: A Scenario-based Learning Approach

Initial learning activities require handling the immediate care priorities of the patient. Through patient assessments and nursing decisions, learners apply critical care nursing knowledge and skills. Didactic content is dispersed throughout the patient scenarios. For example, as the learners consider diagnoses, they may explore the etiology and pathophysiology of related diseases and disorders. After working through several learning activities, the learner returns to the patient care scenario to apply the new knowledge and skills.

Provide Just-in-time Resources

Because critical care nursing embodies a massive store of knowledge and skills, the program had to provide easy access to common job aids. Drug lists, diagnostic normal values, treatment algorithms, and more are stored in a handy resources section. A basic anatomy and physiology section and an extensive medical dictionary are also available for the nurse unfamiliar with a new term or needing a refresher on a body system process. As learners work through the patient case studies, necessary information is only a click away.


Figure 2: Anatomy & Physiology Resource


Offer Reflection on Practice and Debriefs

In hospitals, nurses new to critical care are coached and/or mentored by more experienced nurses who are called “preceptors.” ECCO also features a virtual preceptor. Often introducing patient scenarios or providing advice from an experienced clinical perspective, the virtual preceptor also leads learners through case debriefs.


Figure 3: Preceptor Conversation

The debriefs occur through branching conversation simulations. The virtual preceptor asks “what-if” and “do-over” questions:

  • What if the patient’s blood pressure did not improve? What would you do?
  • What were the first indications of a heart problem?
  • The next time you encounter a similar situation, how would you handle it differently?
  • Retrospectively, what may have prevented the complication?

Reflection on practice and meaningful feedback are powerful instructional methods. In a Part 2 blog post about the AACN ECCO program, Enspire will share some of the specific tools and templates designed for a 77-hour curriculum and instruction for nurses.