ACE.P Unfolding Case – Thomas Sykes

By Tonya Schneidereith

“My name is Thomas….Thomas Sykes…and I’m 17. I live in an apartment with my sister, Keisha, and her 3-year-old son Torrey…Keisha just found out that I’ve been skipping school and said she was worried about me and I need to see a doctor. Says she thinks I’m depressed… I don’t need anything or anybody. I hate my life. I’ll just disappear and Keisha won’t have to worry about me anymore. Everyone would be better off without me.”

And so begins the story of Thomas Sykes, one of the three new unfolding pediatric cases in the series of NLN Advancing Care Excellence (ACE) simulations. These powerful ACE.P cases are different from many simulations used to educated future nurses. They are not focused on acute, episodic events, but instead have a community focus alongside many of the social determinants of health, including:

  • Economic stability
  • Education
  • Social and community context
  • Health and health care
  • Neighborhood and built environment

Thomas is a young man struggling with many issues including obesity, depression, and cyber-bullying. He is living with his sister in a new home. He is skipping school. His sister is concerned about him and takes him to see a pediatric nurse practitioner to be evaluated for depression. This is the setting for simulation #1, where learners are required to complete a suicide assessment tool, placing them in a position to ask difficult and uncomfortable questions, such as “Have you had any actual thoughts of killing yourself?” and “Have you started to work out or worked out the details of how to kill yourself?”

The second scenario takes place on an inpatient psychiatric unit where learners provide care in an environment more closely related to typical clinical experiences. Here, in part, learners are expected to safely administer a medication and provide therapeutic communication.

The third simulation is a post-discharge home visit. In this experience, learners are to address nutrition and complete another suicide assessment tool. This provides an opportunity to see the progress that Thomas has made in his home setting, allowing for a more complete view of this patient’s journey.

These simulations, including chart materials and teaching strategies, are available for free download on the NLN ACE.P website. There is also an ACE.P Framework with Essential Nursing Actions and Knowledge Domains that can be used to align the simulations with your curriculum. The simulations can be adapted for use outside of the simulation lab, including classroom simulations, table-top simulations, and case studies. Finally, because of the complexity of Thomas and his story, these simulations can be incorporated into other courses in the nursing curriculum beyond pediatric nursing, including psychiatric nursing, nutrition, and community health courses.

So, take some time to learn more about Thomas. Listen to his monologue. Hear his story. Think of the powerful impact that his simulations can have on your students. How will his story help prepare them to address the social determinants of health? How will Thomas help them learn how to ask really difficult and uncomfortable questions? How will learners think beyond the scenario to ponder Thomas’ future health needs?

I challenge you to find where your curriculum addresses the complex topics found in Thomas’ simulations. If you can’t, please consider including his simulations for your learners. His story will not only help prepare our students to be more compassionate nurses, but will help prepare them to better deal with the multifaceted struggles facing our most vulnerable pediatric patients.


Reference (2018). Social determinants of health. Healthy People 2020.

2 thoughts

  1. I was not sure if you receive this but I thought you might be interested in the case that is presented. NSG 152 uses one of the NLN unfolding cases for a day long simulation.


    Elizabeth Powell MS, RN, CNE Associate Professor Department of Nursing John Tyler Community College 800 Charter Colony Parkway Midlothian, VA 23114 Phone # 804 622-8710



  2. Thanks for letting me know, Liz. These cases have a great deal to offer students and I’m thrilled to know your students are learning from them!

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