To practice communication skills, specifically active listening skills, including paraphrasing, reflecting, and summarising to effectively engage with a confused and fearful patient.
Define the concept of active listening in healthcare settings. Review paraphrasing and reflective techniques and give examples of appropriate phrases. Ask the group to brainstorm similar phrases.
Remind the students of the usefulness of asking open-ended questions to encourage patients to share more information. Stress the need for final summarisation to ensure that they have understood the patient correctly. Briefly brainstorm summarising phrases and open-ended questions in contrast to closed questions.
You may find it helpful to hand out the Active Listening Phrase Guide.
Scenario Overview
Characters
Nurse: The nurse is assigned to talk to an elderly patient admitted for a suspected infection. The patient is confused and worried, the nurse needs to address the patient’s emotional and informational needs.
Patient: The patient is confused and visibly fearful, expressing concerns about their condition; They require more information.
Background
Unfamiliar surroundings, medical equipment and constant activity in the hospital ward contribute to the patients worry and confusion. Their earlier attempts at getting information were unsuccessful.
Roles Key Behaviours
Nurse:
Behaviours: Maintain calm and open body language (e.g., sitting at eye level, gentle nodding). Stay patient and empathetic, adapting responses to the patient’s level of understanding. Use active listening techniques.
Tone: Warm, soothing, and slow-paced to help calm the patient.
Attitude: Patient-centred and focused on reducing the patient’s fear and confusion while addressing their concerns.
Patient:
Behaviours: Speak incoherently at times, asking repetitive or fragmented questions. Display signs of fear and agitation, such as trembling hands, wide eyes or restless movements.
Tone: Nervous, shaky, and at times, pleading.
Attitude: Overwhelmed by the situation and seeking comfort and clarity but easily frustrated or further agitated if not reassured effectively.
Simulation Flow
Setup
Arrange the patient room with a bed and side chair. Place a notepad and pen on the nurse’s side table to simulate patient documentation. Provide optional props for realism.
Introduction
Brief the participants on their roles privately, emphasising the aim of practicing active listening skills.
Execution
The simulation begins with the nurse entering the patient’s room.
The patient looks visibly distressed and begins expressing concerns, saying things like, “Why am I here? Am I dying?” or “No one tells me what’s happening!”
Active listening is necessary to understand and address the patient’s concerns.
Resolution
The simulation concludes when the nurse demonstrates effective listening skills, and the patient expresses a noticeable reduction in fear and confusion.
Cf. Distractors, Disruptors and Twists List for possible modifications in the simulation .
By the end of the simulation, participants should be able to:
- Effectively utilise active listening skills to address a patient’s emotional and informational needs
- Utilise reflective techniques such as reflective statements, paraphrasing, summarising to build trust and understanding in patient interactions.
- Recognise and respond to emotional cues using empathy integrating nonverbal communication to enhance the patient’s experience.
- 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.
- Summarise main takeaways from the session.
Active Listening Phrase Guide
Acknowledging the patient’s emotions:
"It sounds like you’re feeling really scared and uncertain right now."
"I can see that this situation is overwhelming for you."
"I hear that you’re feeling unsure about why you’re here."
"You sound worried about what the tests might show."
Validating Concerns:
"I can see why you’d feel that way."
"It’s completely understandable to feel this way."
"It’s okay to feel this way, and we’ll work through it together."
"What you’re saying makes a lot of sense."
"It’s normal to feel scared in a situation like this."
"Anyone in your position would feel worried too."
"I understand why this is concerning for you."
Clarifying and Reflecting:
"So, what I’m hearing is that you’re worried about the test results. Is that correct?"
"You mentioned feeling like no one is listening. Let’s go over your questions together."
Providing Reassurance:
"Your concerns are important, and I’m here to help explain everything clearly."
"Let’s take it one step at a time. I’ll make sure you have all the information you need."
"I’m here to support you, and we’ll work through this together."
Encouraging the Patient to Share:
"Can you tell me more about what’s worrying you right now?"
"What specifically is making you feel unsure or scared?"
"Is there anything you’d like me to explain in more detail?"
Summarizing and Closing the Conversation:
"To summarize, you’re feeling [specific emotion] because of [specific concern]. Is that right?"
"To summarize, you want more information about what’s next. Is that right?"
"Let me make sure I’ve got this right: You’re worried about your condition and want to understand what we’re doing to help."
" Let me repeat what we discussed to make sure I’ve got everything correct."
“Does that sound correct to you? Is there anything I missed?”
“Based on what we discussed, here’s what we’ll do next…”
"Is there anything else you’d like to add or ask about?"
Paraphrasing
Paraphrasing restates the patient’s concerns or emotions to confirm understanding and encourage further communication.
Examples:
Patient: "Am I dying? No one is telling me anything."
Nurse: "You’re afraid that your condition might be serious, and you’re not getting enough information. Is that right?"
Patient: "What if these tests show something really bad?"
Nurse: "You’re worried about what the test results might reveal, right?”