1. To build emotional resilience by managing stress and staying composed during a high-pressure interaction.
2. Practice de-escalation techniques and communication skills effectively.
3. Practice the management of patients who want to self-discharge against medical advice (AMA).

Review stress-relief techniques and quick stress recovery methods (e.g. self-affirmations).

Review legal frameworks governing AMA discharges.

Briefly revise summarising and validating statements. ( Active Listening Phrase Guide).

Scenario Overview

Characters

Nurse: Calm, patient, and professional.

Patient: Agitated, loud, and resistant.

Background

A patient frustrated with the perceived lack of care wants to leave AMA. Non-compliance has worsened his condition, making discharge risky. The nurse is tired and stressed, but applying stress management and de-escalation techniques, manages to gradually de-escalate the conflict.

Setting

Hospital room, tense atmosphere.

Roles Key Behaviours

Nurse:

Behaviours:

Maintain open and relaxed body language. Acknowledge the patient’s feelings and concerns without becoming defensive. Provide clear, concise explanations about the risks of leaving AMA. Offer alternative solutions or compromises to meet the patient halfway. Practice stress management techniques to stay composed despite fatigue and frustration.

Tone:

Calm, steady, and empathetic. Firm yet respectful when explaining risks and hospital policies.

Attitude:

Patient-centred, focusing on safety and collaboration while managing their own stress. Persistent in de-escalating conflict but willing to acknowledge the patient’s autonomy if they remain adamant about leaving.

Patient (Agitated, Loud, and Resistant):

Behaviours:

Speak loudly, interrupt the nurse, and use frustrated or accusatory language. Show resistance to suggestions or instructions by dismissing the nurse’s explanations. Display physical signs of agitation, such as pacing, crossing arms, or clenching fists. Gradually de-escalate in intensity.

Tone:

Initially loud, irritated, and defensive.

Attitude:

Distrustful and focused on their dissatisfaction with the care provided. Open to calming down if they perceive the nurse as being genuinely empathetic.

Simulation Flow

Setup

Arrange the room to simulate a hospital environment.

Provide props like a patient bag, personal items like a towel, a medical chart, etc.

Introduction

Brief participants on their roles and objectives privately.

Highlight the importance of practicing coping mechanisms and stress management.

Emphasize that the focus is not on resolving the issue immediately but on handling stress and emotions effectively. You may wish to hand out Persuasive Phrases Guide.

Execution

The simulation begins with the patient pacing, yelling, and complaining about the hospital’s poor quality of care.

The nurse takes a moment to breathe and ground herself, then enters the room.

She acknowledges the patient’s frustrations calmly, gradually using active listening, encourages dialogue, addressing specific complaints while explaining why discharge is not safe and suggests possible compromises.

Resolution

The patient begins to calm down as his concerns are validated and solutions are proposed.

The nurse remains calm and composed, even if the patient does not fully comply.

The simulation concludes with the patient agreeing to a compromise or a next step (e.g., seeing the doctor).

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

1. Manage patient frustration and resistance to treatment without losing emotional control.
2. Understand the ethical and legal context of AMA discharges
3. Demonstrate empathy and use effective communication to address the patient's concerns.
4. Evaluate the patient’s understanding of the risks of leaving the hospital against medical advice (AMA).
5. Apply de-escalation skills in emotionally charged situations

Debriefing Plan

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