Shadow Health Assignments: Complete Guide for Nursing Students

What are Shadow Health assignments?

Shadow Health assignments are virtual clinical simulations used in nursing courses. You “meet” a digital patient, type questions to take a health history, use on-screen tools to perform a physical exam, document your findings and complete follow-up activities such as care plans, SBAR reports or reflection questions. The patient answers in natural language, shows emotion and responds to how you communicate, so the simulation tests clinical reasoning and therapeutic communication, not just memorized facts.

Schools use Shadow Health because it gives every student the same patient, unlimited practice without risk to real people, and detailed data on performance. It also supports the clinical judgment skills tested on the Next Generation NCLEX (Elsevier, n.d.-a; Dickison et al., 2019), and well-designed simulation follows the Healthcare Simulation Standards of Best Practice (INACSL Standards Committee, 2021).

Shadow Health courses and patients

Elsevier groups the simulations into collections. The table lists the main undergraduate and graduate collections and some of the patients you may meet (Elsevier, n.d.-a, n.d.-b). Your course may use only some of these assignments.

How Shadow Health is graded

Each assignment produces a DCE score. Your instructor decides how the parts are weighted, so always read the course rubric. The parts usually include:

The subjective and objective items are often combined into a Student Performance Index (SPI). Depending on the instructor’s settings, you may see a running subjective data score in the interview guide, be allowed to reopen a completed attempt to ask more questions or do a more thorough exam, and complete either a graded Care Plan Activity or an ungraded SBAR activity after the exam (Elsevier, n.d.-c).

Step-by-step: how to complete a Shadow Health assignment

1. Read the instructions and rubric. Note the passing score, minimum time, number of attempts and which activities are graded.
2. Prepare like a real clinical day. Review the body system in your textbook (for example, Jarvis & Eckhardt, 2024), normal versus abnormal findings, and the patient’s chief complaint.
3. Complete the orientation and pre-brief. Learn how to type questions, use exam tools and open the chart.
4. Introduce yourself and confirm identity. Begin with your name, role and purpose, and confirm the patient’s name and date of birth.
5. Take a thorough history (subjective data). Ask about the chief complaint, history of present illness, past medical and surgical history, medications and allergies, family history, social history and review of systems.
6. Perform the physical exam (objective data). Follow the correct sequence: inspection, palpation, percussion, auscultation (for the abdomen: inspection, auscultation, percussion, palpation).
7. Respond to education and empathy cues. Acknowledge feelings and teach when the patient shows a knowledge gap.
8. Document your findings. Use professional terminology and include pertinent positives and negatives.
9. Complete post-exam activities. Answer care plan, SBAR, prioritization or reflection questions thoughtfully.
10. Review your results. Study missed findings and use them to prepare for the next assignment.

Interviewing tips: ask better questions

Most lost points come from the interview. The patient only reveals what you ask about, so be systematic.

• Use OLDCARTS for every symptom: Onset, Location, Duration, Characteristics, Aggravating factors, Relieving factors, Timing and Severity. Add associated symptoms and what the patient has tried.
• Ask one question at a time, in clear, simple language. Compound questions such as “Do you smoke or drink?” may only get one answer.
• Follow up on every positive finding. If Tina says she has asthma, ask about triggers, inhaler use, last exacerbation and hospitalizations.
• Rephrase if the patient doesn’t understand. Try “Do you have any medical problems?” if “past medical history” gets no answer.
• Cover the full review of systems and social history: tobacco, alcohol, drugs, diet, exercise, sleep, stress, occupation, living situation, safety and sexual health.
• Clarify medications: name, dose, frequency, reason, side effects, adherence, OTC drugs and supplements.
• Close the interview with “Is there anything else you’d like to tell me?”

Empathy and education phrases that work

Physical exam tips

• Perform hand hygiene and explain each step to the patient before you do it.
• Be complete: examine both sides, all lung fields (anterior and posterior), all four heart areas plus Erb’s point, and all four abdominal quadrants.
• Use the right tool: diaphragm for high-pitched sounds, bell for low-pitched sounds; otoscope, ophthalmoscope, reflex hammer and penlight where indicated.
• Compare with normal: note abnormal findings and recognize when a finding needs follow-up questions.
• Don’t forget vital signs and general survey.

Documentation tips

• Separate subjective (what the patient says) from objective (what you observe and measure) data.
• Use precise terms: “Lungs clear to auscultation bilaterally; expiratory wheezes in right lower lobe,” not “lungs sound weird.”
• Include pertinent negatives, such as “denies chest pain, fever or night sweats.”
• Write in your own words. Compare your note against the model documentation shown after submission, and learn from the differences.
• For graduate courses, organize notes in SOAP format with differential diagnoses and a plan. See our guide to SOAP notes, care plans and concept maps.

Common mistakes to avoid

• Rushing through the interview to finish quickly, then missing scored findings
• Skipping the introduction, identity check or closing
• Asking yes/no questions only, instead of open-ended questions
• Ignoring emotional cues and missing empathy or education points
• Performing exam techniques out of order or on one side only
• Copying documentation from online sources instead of writing your own
• Waiting until the deadline, leaving no time to reopen an attempt

A word on academic integrity

Frequently asked questions

Related reading: Developing a capstone project from practicum experience and Type 2 diabetes case study.

Conclusion

Shadow Health assignments let nursing students practice interviews, physical exams, documentation and clinical reasoning with realistic digital patients. To do well, understand how your DCE score is calculated, prepare the body system in advance, interview systematically with OLDCARTS and a full review of systems, respond to empathy and education cues, perform complete exams in the correct sequence, and document in your own professional words. Treated as real clinical practice rather than a box to tick, Shadow Health builds the skills you will use at the bedside and on the NCLEX.

References

Dickison, P., Haerling, K. A., & Lasater, K. (2019). Integrating the National Council of State Boards of Nursing Clinical Judgment Model into nursing educational frameworks. Journal of Nursing Education, 58(2), 72–78. https://doi.org/10.3928/01484834-20190122-03

Elsevier. (n.d.-a). Shadow Health: Undergraduate. Retrieved October 17, 2026, from https://www.elsevier.com/products/shadow-health/undergraduate

Elsevier. (n.d.-b). Shadow Health: Graduate. Retrieved October 17, 2026, from https://www.elsevier.com/products/shadow-health/graduate

Elsevier. (n.d.-c). Shadow Health in Sherpath Vantage: Assignment options guide. Retrieved October 17, 2026, from https://evolve.elsevier.com/education/shadow-health-in-sherpath-vantage-assignment-options-guide

INACSL Standards Committee. (2021). Onward and upward: Introducing the Healthcare Simulation Standards of Best Practice™. Clinical Simulation in Nursing, 58, 1–4. https://doi.org/10.1016/j.ecns.2021.08.006

Jarvis, C., & Eckhardt, A. (2024). Physical examination and health assessment (9th ed.). Elsevier.