ACE+ triptych

Zachary Alex Miller



Zach is a 14-year-old who lives with his parents and three siblings. This unfolding case follows them over a year and a half beginning with a school nurse visit to discuss gender identity and sexual orientation, followed by a hospitalization due to an accident, and ending with a home visit following discharge.


Scenario 1 Scenario 2 Scenario 3

This scenario takes place when Zach arrives at the school nurse’s office to ask questions about gender identity and sexual orientation. He has been feeling like he just doesn’t fit with any group of people. He has finally gathered the courage to discuss these topics with someone. However, he doesn’t want his family or friends to know he is meeting with the school nurse.

This scenario takes place on a pediatric hospital unit one year later. They have changed their name to Alex (middle name) and use the pronouns they/them/theirs. They were hit by a car while riding their bike home from a friend’s house. The injuries Alex sustained were a deep wound to their right lower torso, a fractured right wrist and some bruises and small cuts to the right side of their body.

This scenario takes place in Alex’s home two days after discharge from the hospital. In this scenario students assess Alex’s wound and mental health. Alex opens up to the nurse about being bullied at school and is seeking advice on how to cope with being “different” from others.


Finish the Story Assignment

Learners have now seen Alex at three snapshots in time. What do they think their life will be like three months from now?

Author Information

Lee-Anne Stephen, MN, RN
University of Fraser Valley