To practice handling conversations with relatives while maintaining a balance between empathy and adherence to patient confidentiality.
Discuss the current legal requirements and institutional guidance on confidentiality. Discuss if/when it is appropriate to breach confidentiality.
Brainstorm techniques for empathetic communication and de-escalation techniques. Brainstorm what general support resources are available in your institution: educational brochure, counselling services, support groups, online fora, etc.
Scenario Overview
Characters: Nurse, mother, father. The patient is not present during this interaction.
Background
A 23-year-old patient was admitted to hospital due to substance abuse complications. He gave explicit instructions to maintain confidentiality of his diagnosis.
Setting
Hospital hallway where the parents confront the nurse.
Roles Key Behaviours
Nurse:
Behaviours:
Acknowledge the parents’ emotions without disclosing any confidential information due to the patient’s explicit request. Redirect the conversation to the support and care being given to the patient without revealing the sensitive details of the diagnosis.
De-escalate the tension by calmly presenting hospital confidentiality policies and offering general resources or next steps for family support.
Tone:
Calm, empathetic, and firm when discussing confidentiality. Reassuring and supportive to help alleviate parental distress.
Attitude:
Respectful of the patient’s and compassionate toward the parents.
Mother of the Patient:
Behaviours:
Display visible emotional distress, such as crying, trembling, or raising voice slightly when asking questions about the child’s condition. Seek reassurance from the nurse, potentially appealing emotionally or asking for exceptions to confidentiality rules.
Tone:
Initially emotional and pleading, with moments of heightened intensity. Softens when met with empathy and reassurance.
Attitude:
Deeply concerned and protective. Open to calming down if the nurse remains empathetic and respectful.
Father of the Patient:
Behaviours:
Maintain a calm but serious demeanour, asking pointed or direct questions about their child’s diagnosis. Attempt to reason with the nurse. Show signs of frustration becoming more insistent. Respond positively to clear, respectful explanations of confidentiality policies and resources for support.
Tone:
Firm and measured.
Attitude:
Logical and focused on finding solutions, protective but less overtly emotional than the mother. Open to de-escalation when the nurse maintains professionalism and empathy.
Simulation Flow
Setup
Arrange a realistic hospital hallway setting.
Introduction
Outline the objectives and scenario. Brief participants on their roles privately. Emphasise the importance of staying in character and following the confidentiality rules by the nurse.
Execution
The simulation begins with the parents approaching the nurse outside the patient’s room.
Parents express their concerns and try to elicit information from the nurse.
Nurse responds empathically and professionally while adhering to confidentiality rules.
Resolution
Nurse directs parents to support resources (brochures, pamphlets counselling services, support groups) and/or encourages them to speak with the patient directly.
Simulation concludes when the conversation reaches a clear resolution.
By the end of the simulation, participants should be able to:
- Understand the general principles of confidentiality.
- Explain confidentiality obligations clearly to non-medical individuals.
- Communicate empathy without breaching confidentiality.
- Manage emotional and challenging interactions effectively.
- Demonstrate the ability to provide support by identifying and offering appropriate general support resources.
Possible Twist to Action
The mother accuses the hospital of negligence or threatens to report the issue to higher authorities.
The father claims to know the diagnosis and tests the nurse’s reaction to verify it.
- Self-reflection – the participants express their immediate emotional reactions to the simulation.
- Analysis - explore together what happened during the simulation and why.
- Highlight strengths and areas for improvement.
- Summarize main takeaways from the session.