Title: Client with Anxiety

Authors: Kcarter (Author); Marie Rutherford (Author); Credondo (Author)
Licence: CC BY-NC-SA 4.0

Therapeutic Communication: Anxiety

Therapeutic Communication Game Simulation: Client with Anxiety

Introduction

Credits: by Marie Rutherford (Author); kcarter (Author); Credondo (Author); licence CC BY-NC-SA 4.0

Welcome

Welcome to the simulation learning experience. During this experience you will be interacting with a scenario between a health care administrator (HCA) and a client. The experience is presented in the following format:

- Scenario description
- Video scenes
- Questions for points
- Prompts to move to the next level
- Opportunity to play again

(Click the proceed button in the upper right to continue.)

Learning Objectives

Credits: by Kcarter (Author); Marie Rutherford (Author); credondo (Author); licence CC BY-NC-SA 4.0

Learning Objectives

- Recognize the impact of poor therapeutic communication in health care settings.
- Identify the benefits of therapeutic communication techniques in health care settings.
- Adjust communication to meet the client's health care needs in health care settings.

(Click the proceed button in the upper right to continue.)

** Please be advised that some viewers may find the following scenes upsetting or triggering**

Question 2

Q: Question 2. Which of the following statements is the most therapeutic response?
- “There are no spies here, Mrs. Sampson, only us.” (Incorrect: Incorrect. Your initial approach should be non-confrontational. Challenging her statements in the orientation phase can interfere with trust building. Try again.)
- “Don’t worry, everything will be all right now that you’re here.” (Incorrect: Incorrect. Offering false reassurance can inhibit further communication. Try again.)
- “There is no reason to be so upset, Mrs. Sampson. Please calm down.” (Incorrect: Incorrect. Minimalizing the patient’s emotions is inappropriate. The patient must begin to face her problems and feelings in order to start coping with them. Try again.)
- “You look like you’re listening to something, Mrs. Sampson. What do you hear?” (Correct!: Correct! Commenting on her behavior and investigating her hallucinations for safety concerns is important when assessing a patient with acute paranoid schizophrenia.)

Question 3

Q: Question 3. Which of the following statements is the most therapeutic response to Allison?
- “I know this feels scary for you, Mrs. Sampson, but I am here to help you in a positive way.” (Correct!: Correct! Offering empathy and support provides the patient hope for improvement.)
- “There aren’t any cameras in this room, Mrs. Sampson.” (Incorrect: Incorrect. Challenging the patient with acute paranoid schizophrenia is not therapeutic in the orientation phase. Try again.)
- “If you would have taken your medications as prescribed, you wouldn’t be feeling this way, Mrs. Sampson.” (Incorrect: Incorrect. Blaming the patient, even if she made poor choices, is not effective in the orientation phase of a patient with acute paranoid schizophrenia. Try again.)
- “Let’s turn on the TV, and see if that helps you to relax, Mrs. Sampson.” (Incorrect: Incorrect. When a patient with acute paranoid schizophrenia is agitated, it is better to create a quieter, less stimulating environment. Try again.)

Question 4

Q: Question 4. Which of the following is the best response to Allison’s statement?
- “If you try to leave, Mrs. Sampson, I will have to call security.” (Incorrect: Incorrect. Threatening the patient with acute paranoid schizophrenia experiencing hallucinations can increase her agitation. Please try again.)
- “You have to stay here until you take your medications, Mrs. Sampson.” (Incorrect: Incorrect. Arguing with the patient with acute paranoid schizophrenia can increase her agitation. Please try again.)
- “You seem like you’re getting more tense, Mrs. Sampson. Can you share with me what you’re feeling?” (Correct!: Correct! Identifying her emotions and asking for validation is the first step in helping this patient manage her emotions. You can also assess whether or not her hallucinations are commanding her to hurt herself or others.)
- “Please calm down, Mrs. Sampson. Everything will be fine once your medications start working again.” (Incorrect: Incorrect. Offering false reassurance may inhibit further communication. Please try again.)

Patient Video 3

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Patient Video 4

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Conclusion

[Image: Patty R. Sampson]

While treatment helps relieve many symptoms of schizophrenia, most people who have the disorder must learn how to cope with symptoms throughout their lives.  To read more about schizophrenia, visit What is Schizophrenia? by the National Institute of Mental Health at:
http://www.nimh.nih.gov/health/topics/
schizophrenia/index.shtml

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Scenario Description

Credits: by kcarter (Author); mrutherford (Author); credondo (Author); licence CC BY-NC-SA 4.0

Scenario Details

Anxiety Scenario

Anxiety disorders impact the daily lives of approximately 11.6% of Canadians 18 years or older and 27% of people with anxiety disorders, report that their daily life has been highly impacted by their disorder, and 95% of those reported seeing a health care provider for assistance (Government of Canada, 2015).

In this experience you will meet a client who suffers from anxiety and is coming to see their health care provider about a medication adjustment. The first person they encounter is the health care administrator (HCA).

Let's see how it goes!

(Click the proceed button in the upper right to continue.)

Debriefing

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Today you provided nursing care for a patient experiencing symptoms of schizophrenia.

1. How do you feel the scenario went?

2. Review your understanding of the learning objectives for the scenario.  Contact your instructor if you have any questions regarding this content.

3. Apply the nursing process:
     a. What were your priority assessments when providing care for Patty?
     b. What were your goals/outcome criteria for Patty?
     c. What were your priority interventions for Patty?
     d. What would you include in the evaluation process after caring for Patty?

4. What takeaway(s) did you learn from this virtual simulation that you will take into your future clinical practice?

Scenario Feedback

Please consider taking a moment to provide feedback on this scenario by visiting the following link:  bit.ly/openRN

These Nursing Open Educational Resources were developed under a $2.5 million grant from the Department of Education.  However, those contents do not necessarily represent the policy of the Department of Education, and you should not assume endorsement by the Federal Government.  For more information about the Open RN project, go to www.cvtc.edu/OpenRN. Suggested attribution when using this scenario: “This Therapeutic Communication - Schizophrenia Virtual Simulation was created by Chippewa Valley Technical College as part of the Open RN project, and is licensed under CC BY 4.0.”

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Question 4

Q: Question 4. Which of the following is the nurse’s best response?
- “OK. Use the call light if you need anything.” (Incorrect: Incorrect. Most often, it is better to “provide a presence” than to allow your own distress to cause you to exit the room. Please try again.)
- “You should take a break and go home and rest.” (Incorrect: Incorrect. Offering advice is not as therapeutic. It is better to offer options and encourage the mother to choose which option is best for her. Please try again.)
- “Why do you want me to leave?” (Incorrect: Incorrect. Asking “why” can be misinterpreted and cause defensiveness. Please try again.)
- “I’ll sit here for a little while with you and Laura if that’s OK.” (Correct!: Correct! Offering self and “providing presence” is one of the most powerful strategies a nurse can use when comforting dying patients and their families.)

Anxiety Scene 1

Credits: by OER Conestoga (Originator); licence CC BY-NC-SA 4.0

Congratulations Level 1 Reached

Q: Congratulations, you have reached level 1!

To reach level 2, choose your next move.
- Do you want to answer a question for 2 points?
- To restart the level watch the video again.

Scn 1 Answer a Question

Answer A Question about Scene 1

Q: Consider the video you just watched.

Do you think that the health care administrator displays compassion to the client?
- No, the health care administrator does not demonstrate compassion with the answer "nope" (correct) (Correct you are on the path to level two! The answer "nope" dismisses the client's concern about how long the wait will be and the quick request for the client's demographic information focuses the communication back on the task and away from the client.)
- Yes, the health care administrator is honest with the client when they state "nope" (Oops! Not quite, you might want to try again. The short dismissive "nope" is not a therapuetic response because it doesn't show compassion and is stated abruptly.)

Let's see what happens next.

Scene 2 N

Credits: by kcarter (Author); Mrutherford (Author); credondo (Author); licence CC BY-NC-SA 4.0

Watch Scene 1 Again

Now, answer a question

Your Choices Are

Q: What did you notice about the client?

To earn more points choose your next move.
- Answer a question for 3 points
- What did you notice about the client's communication for 2 points
- Re-start the level by watching the video again.

SC 2 Answer A Question

Answer A Question

Q: Does the HCA's response reassure the client that their health care needs will be met?
- Yes, the client's records need to updated to ensure compliance with medical record keeping. (The client has already indicated that the reason they want to see the doctor is about their anxiety. The HCA has not acknowledged the anxiety and by ignoring the client's emotional need and focussing on tasks the client's anxiety is exacerbated.)
- No, the HCA is still focussed on tasks and misses that the client' is feeling anxious. (correct) (Correct, The client has already indicated that the reason they want to see the doctor is about their anxiety. The HCA has not acknowledged the anxiety and by ignoring the client's emotional need and focussing on tasks the client's anxiety is exacerbated.)

Will this get better, stay tuned!

Task Focused 3N

Credits: by OER Conestoga (Author); licence CC BY-NC-SA 4.0

SCN 2 What did you notice about the client?

Post Scene 2 Question

Q: What did you notice about the client's response to not receiving an answer to how long the wait will be?
- The client gives a sigh and seems mildly annoyed. (correct) (Correct, The sigh is the first indication that the client is not having their needs met.)
- The client seems fine as they answered the health care administrator's question about work details. (Incorrect, go back and watch the video again. What the clients reaction to not having their question answered.)

WIll this get better, stay tuned!

SC2 N

Task focused Scn3

Level 3 Branch

Q: Congratulations, you have made it to level 3!

To continue to earn points choose from the following.
- Answer a question for 2 points.
- Re-watch the video to start the level again

Level 3 Answer A Question

Scn 3 Questions

Q: Do you think the health care administrator should be aware of what is happening in the waiting area?
- Yes (correct) (Good, The health care administrator should be watching the waiting room and notice that this client was pacing, had sweaty palms, looked at watch, and quickly walks to the desk.)
- No (Incorrect, The health care administrator should be watching the waiting room and notice that this client was pacing, had sweaty palms, looked at watch, and quickly walks to the desk.)

How will the health care administrator answer the client's question. Stay tuned!

SCN 4 N

Doesn't look like the client's health care needs will be met. Let's see how this could be done differently.

Scn 3 P

Seems to be going better, let's keep watching.

Scn 4 P

Reflection

Compare and Contrast

Did you notice the HCA adjusted their communication in the last two scenes?

- Why did the HCA adjust their communication?
- How do you think the HCA knew that they needed to adjust their communication?
- What was the immediate result you noticed in the client's verbal and non-verbal communication?
- What specific therapeutic communication techniques did the HCA use?

Summary Slide

Summary

Summary

Therapeutic communication with clients is essential. Clients who experience anxiety are focused inward. HCA should continue to develop their therapeutic communication competencies by recognizing and adjusting their behaviours to meet the client's health care needs.

Therapeutic communication is complex and requires a lifetime commitment of reflection, practice, making mistakes, and learning from those mistakes.

Game Over

Congratulations you have completed the game!

Credits: Trophy; by macrovector; 2021; source https://www.freepik.com/free-vector/golden-winners-cup_4320674.htm#query=game%20trophy&position=1&from_view=keyword; licence CC BY 4.0

Credits: Client and Health Care Administrator Images; by OER Conestoga; 2021; licence CC BY-NC-SA 4.0