Subarachnoid haemorrhage is a life-threatening event that presents with a number of discrete signs and symptoms making diagnosis problematic. A delay in diagnosis significantly increases morbidity and mortality and therefore places vulnerable patients at risk. Advanced nursing assessment and management is imperative to promote optimum patient outcomes and therefore decrease morbidity and mortality in acutely ill patients. In this article a case study is discussed with reference to relevant literature to explore an evidence-based approach to the nurse's role, care and management of an acutely ill neuroscience patient with subarachnoid haemorrhage. In keeping with the reflective case study approach, Gibbs's reflective cycle (1988) and case study guidelines by Aitken and Marshall (2007) are used to identify areas of effective clinical practices and identify gaps in the literature. On the basis of this evaluation, suggestions for clinical improvements are made. A reflective cycle can identify areas where clinical practice could be improved. It is hoped that this article will help nurses critically reflect on their own practice in the care and management of an acutely ill patient with subarachnoid haemorrhage.