ACE+ triptych

ACE+ Unfolding Cases

An unfolding case is one that evolves over time in a manner that is unpredictable to the learner. New situations develop and are revealed with each encounter. Every ACE unfolding case uses the highly regarded unfolding case model developed for Advancing Care Excellence for Seniors (ACE.S). Each case includes the following:

  • A first-person monologue that introduces the family and the complex problems they are facing.
  • Simulation scenarios designed to help students practice assessing function and expectations of their patient(s), with links to appropriate evidence-based assessment tools. Suggestions for debriefing are included.
  • An innovative final assignment that asks students to finish the story.
  • Instructor toolkits with suggestions on how to use the various components of the unfolding cases and incorporate them into the curriculum.

These unfolding cases combine the power of storytelling with the experiential nature of simulation scenarios. They are intended to create a robust, meaningful experience for students, one that provides a simulated experience of continuity of care and that will help them integrate the Essential Knowledge Domains and Nursing Actions into their practice of nursing. We hope you will give them a try!

Standardized/Simulated patients are recommended for all ACE simulations. View the Guidance for finding Standardized Participants for ACE+ unfolding cases document for ideas on how to recruit appropriate SPs for use in the ACE+ cases. If you are not already familiar with the Association for Standardized Patient Educators’ Standards of Best Practice, we encourage you to review them at

Learn more about unfolding cases by visiting the How to Use an Unfolding Case page.

Note of Representation


The ACE+ unfolding cases were created as examples of LGBTQ+ patients. The LGBTQ+ population is diverse and cannot be fully represented in three unfolding cases. We encourage nurse educators to use and adapt the ACE+ cases as a starting point to help students learn how to provide dignified healthcare to LGBTQ+ people.

Unfolding Cases with LGBTQ+ People from Other ACE Programs