To understand patient behaviour regarding non-adherence to prescribed medications and develop effective communication and collaboration skills to address the problem.

To help participants understand the many reasons behind non-adherence to medication or non-compliance with medical advice:

• ask participants, "What do you think is the most common reason patients don’t follow medical advice?" Gather a few quick answers and discuss as a group briefly.
• ask participants to recall a time they avoided or delayed following advice (e.g., skipping exercise, ignoring dietary advice). Share how they felt and why they didn’t comply.

Scenario Overview

Patient: A middle-aged woman with a chronic illness (hypertension) who is sceptical about her prescribed medication and stopped taking it.

Relative: A family member concerned with changes in the relative’s condition recently. She brought the patient to hospital and has limited understanding of the situation.

Nurse: The primary healthcare provider responsible for identifying problems, educating the patient and relative on risks of non-compliance and proposing a solution.

Background: The patient is in A&E because of headache and fast heartbeat.

Setting
A consultation room in A&E.

Roles Key Behaviours

Patient (Middle-aged woman with hypertension):

Behaviours:

Express scepticism about the prescribed medication. Downplay the seriousness of their condition. Gradually engage and become more receptive if provided with clear information about the risks and benefits of compliance.

Tone:

Initially sceptical or dismissive, with a defensive undertone. Becomes neutral or curious when trust is built.

Attitude:

Defensive and distrustful of healthcare advice but open to reconsidering if presented with credible evidence.

Relative (Concerned Family Member):

Behaviours:

Show visible concern for the patient. Express frustration or confusion about the patient’s behaviour. Seek clarification from the nurse to better understand the patient’s condition and the risks of non-compliance. Demonstrate willingness to support the patient once informed about how they can help.

Tone:

Concerned and occasionally frustrated. Shifts to cooperative and supportive as the situation becomes clearer.

Attitude:

Willing to listen, learn and help.

Nurse:

Behaviours:

Use active listening to acknowledge the patient’s and relative’s concerns without judgment. Educate both the patient and relative on hypertension, its potential complications, and the importance of adherence to medication. Propose practical solutions.

Tone:

Empathetic, patient, and educational, ensuring both parties feel supported and informed.

Attitude:

Focused on collaboration, balancing the need to educate with the patient’s autonomy.

Simulation Flow

Set-up
Arrange a consultation room with a desk and chairs for the participants and a few simple props (e.g. a blood pressure cuff, clipboard, a few mock medication bottles, etc.).

Introduction
Brief participants about their roles privately.

Execution

The simulation begins with the nurse greeting the patient and relative and inquiring about the reason for their coming to A&E.

Participants work together to address the problem of patient’s non-adherence and develop a plan that would suit the patient better.

Resolution

The simulation ends when Anna agrees to see the doctor, resume the treatment and attend follow-up appointments. The nurse directs the patient to doctor’s office.

Learning outcomes

By the end of the simulation, the participants should be able to:

1. Educate patients and their families about the importance of adherence to treatment and the risks of non-adherence in a non-judgmental manner.
2. Employ communication strategies to build trust and encourage patient openness.
3. Collaborate with the patient and their family to develop a feasible treatment plan.
4. Reflect on their own approach to patients who resist treatment.

1. Self-reflection – the participants express their immediate emotional reactions to the simulation and non-compliant patients.
2. Analysis - explore together what happened during the simulation and why.
3. Highlight strengths and areas for improvement.
4. Summarise main takeaways from the session.