ACE.S triptych

Julia Morales and Lucy Grey


Julia Morales, age 65, and Lucy Grey, age 73, are partners who have been together for more than 25 years. They are retired and have spent the past several years traveling together. Julia has lung cancer, which has been treated with chemotherapy and radiation, and now she wishes to stop treatment. Lucy is supportive and feels she will be able to care for Julia in their home. Lucy's past medical history includes a knee replacement. Their support system includes Julia's son, Neil, and Lucy's niece, Nora.


The introductory monologue takes place in Julia's home prior to an initial home health nurse visit. In the monologue, Julia discusses her life, including raising a son to adulthood, then meeting Lucy. She reviews her history with cancer and relates her understanding of home hospice care and her desire to die at home. She expresses concern about leaving Lucy alone. 

Scenario 1 Scenario 2 Scenario 3

Simulation Scenario 1 involves a visit by the home health agency nurse. Learners are expected to complete a physical and functional assessment of Julia and her nursing care needs, as well as an assessment of the home with a focus on safety. Julia inquires about hospice services, but her son, Neil, urges her to try one more round of chemotherapy. Lucy is supportive of Julia's decision and tries to comfort Neil. Learners will assess Lucy's caregiver strain, and articulate what hospice care means for the patient and family. The assessment tools recommended for this scenario include SPICES: An Overall Assessment Tool of Older Adults, the Katz Index in Activities of Daily Living, and Informal Caregivers of Older Adults at Home: Let's PREPARE!

Simulation Scenario 2 takes place in the home two months later. Julia is barely responsive and has Fentanyl patches for pain. Nursing care consists primarily of performing an appropriate patient assessment and ensuring patient comfort. Julia dies during this scenario and the learner provides support for the family. During debriefing, discussions may include how nurses manage their own emotions and self-care after the death of a patient.

Simulation Scenario 3 takes place in the emergency department. Lucy called 911 once again after another fall at home. Her blood pressure is slightly elevated. Otherwise, Lucy is found to be in good health. Objectives relate to assessing her safety, her fears, the grieving process, and her need for assistance at home. The assessment tools recommended for this scenario include SPICES, The Hendrich II Fall Risk Model, the Geriatric Depression Scale, and the Generalized Anxiety Disorder 7 (GAD-7).


Finish the Story Assignment

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

Author Information

Mary L. Cato, MSN, RN 
Oregon Health & Science University
Portland, OR


The Julia Morales and Lucy Grey unfolding case content was reviewed in 2019.