Alice’s Delirium - A Theatre-based Simulation Scenario for Nursing

Sep 20, 2026

Simulation supports nursing education by letting learners practice knowledge and skills in a safe environment where mistakes can occur without compromising patient safety. This technical report describes a theatre-based simulation scenario, originally designed for a simulated patient and later adapted for hi-fidelity manikins and multiple nursing education settings at The Ottawa Hospital. After a 2016 demonstration, the scenario was increasingly adopted and adapted across departments to train nurses from novice to expert, including inpatient surgery continuing professional development.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages11

Reading Time28 min

AccessFree to download

Introduction

Learning objectives

Technical Report

Case summary

Open Access Technical Report DOI: 10.7759/cureus.2411 Received 03/19/2018 Review began 03/20/2018 Review ended 03/30/2018 Published 04/02/2018 © Copyright 2018 Dale-Tam et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 3.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Alice’s Delirium: A Theatre-based Simulation Scenario for Nursing Jennifer Dale-Tam 1 , Glenn D. Posner 2 1. Nursing Education, The Ottawa Hospital 2. Department of Innovation in Medical Education, University of Ottawa Corresponding author: Jennifer Dale-Tam, [jdale-tam@toh.ca](jdale-tam@toh.ca) Abstract As an educational methodology, simulation has been used by nursing education at the academic level for numerous years and has started to gain traction in the onboarding education and professional development of practicing nurses. Simulation allows the learner to apply knowledge and skills in a safe environment where mistakes and learning can happen without an impact on patient safety. The development of a simulation scenario to demonstrate the benefits of simulation education methodologies to a large group of nurse educators was requested by nursing education leadership at The Ottawa Hospital (TOH) . Since the demonstration of this scenario in the fall of 2016, there has been significant uptake and adaptation of this particular scenario within the nursing education departments of TOH. Originally written to be used with a simulated patient (SP),“Alice” has since been adapted to be used with a hi-fidelity manikin within an inpatient surgery department continuing professional development (CPD) program for practicing nurses, orientation for nurses to a level 2 trauma unit and at the corporate level of nursing orientation using an SP. Therefore, this scenario is applicable to nurses practicing in an area of inpatient surgery at varying levels, from novice to expert. It could easily be adapted for use with medicine nursing education programs. The case presented in this technical report is of the simulation scenario used for the inpatient surgery CPD program. Varying adaptations of the case are included in the appendices. Categories: Medical Simulation, Other Keywords: delirium, simulation, nursing, falls, nursing education Introduction Delirium can occur in 18%-50% of patients in acute care institutions, which can result in increased morbidity and mortality, especially in the elderly [1] . Although delirium is defined as an acute change in mental status from a patient’s baseline cognition, it is often attributed to underlying disease processes or other common contributing factors, such as narcotics used to treat postoperative pain [2] . Many times, delirium is dismissed by nurses. This is consistent with the personal observations of the primary author (JDT) of nurses practicing in inpatient surgical areas and through discussions with the nurses on the importance of delirium assessment. Therefore, the nursing continuing professional development (CPD) program decided to employ theatre-based simulation as an educational strategy to reinforce the importance of delirium assessment and appropriate interventions. Falls cost the Canadian healthcare system an estimated two-billion dollars annually and are the leading cause of injury during hospitalization [3] . Falls in the elderly are especially traumatic due to their frailty. Fora patient experiencing delirium, their risk of falls increases during their acute confused state; consequently, it was decided to include falls risk assessment as a secondary objective in this theatre-based simulation scenario. All theatre-based simulation sessions were conducted at the University of Ottawa Skills and Simulation Centre from January 2017 to the end of March 2017 with practicing The Ottawa Hospital (TOH) inpatient surgery nurses of varying years of e

FAQs

What educational purpose does the simulation scenario serve?

The scenario reinforces the importance of delirium assessment and appropriate interventions while enabling learners to practice in a safe environment without impacting patient safety.

How was “Alice” adapted over time?

Originally written for a simulated patient, “Alice” was later adapted for use with a hi-fidelity manikin in inpatient surgery continuing professional development and other nursing orientation contexts.

What knowledge and skills are nurses expected to practice in the session?

Nurses perform cognitive assessment using the CAM tool, identify delirium, complete falls risk assessment, apply universal fall precautions, and communicate appropriately using SBAR.

Sep 20, 2026

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