This week’s in-class activities will allow you to practice challenging and diffi

This week’s in-class activities will allow you to practice challenging and difficult conversations with
patients and/or their support people. To prepare for class, review Chapter 6 in Cho & Cooley, and The
Joint Commission Quick Safety issue 47. You may also wish to review Chapters 3, 4 & 5 in
Cho & Cooley to prepare for this class.
Note: there are two parts to this assignment. In the first part you will reflect on your own experiences
with challenging conversations. In the second part you will choose a case study and prepare some
statements you will use to role-play the case study in class. Both sections need to be completed.
1. Think of a time you had a challenging or difficult conversation with a patient or their support
person. Perhaps you had to discuss a difficult diagnosis. Perhaps you needed to confront
someone who was not following hospital rules, or who was not adhering to medical advice (and
was being confrontational about it). Perhaps this person was openly abusive to you or another
member of your team.
A. First, think of a time when this conversation went well. Describe the scenario and what you
did and said that led to the good outcome.
B. Now, think of a time when you had a difficult or challenging conversation and it did not go
well. Using what you have learned from the readings, what might you have done differently.
Write a script for yourself – because practicing the actual words we might say in a given
situation is the only way we will learn to say these words when the time arises.
C. It is important to realize that even if we say or do the right things, and respond with
compassion and caring, not all difficult or challenging conversations will have what we think
of as a good outcome. Nor will all conflicts be resolved. What might you say to a patient or
their family if resolution does not happen? What other resources might you tap into to help
resolve the issue?
2. In class I will ask you to practice difficult and challenging conversations. The following are
scenarios you can choose to role play. After reading through the scenarios, indicate which one
you will practice, and write a possible response to each of the following communication steps:
A. Use Skill Set One (Chapter 3 in Chou & Cooley) to
1. Establish rapport
2. Elicit the list of all concerns
3. Negotiate a shared agenda
B. Use ART (Ask, Respond, Tell) to check understanding, to express empathy or to deliver
information:
1. Ask the patient or support person their perspective on the situation.
2. How would you respond to them with active listening?.
3. Tell them your perspective.
C. Now pivot to teaching, to explaining what you want the patient or their support person to
do differently.
1. What type of open-ended questions might be appropriate for this situation?
2. How would you elicit their ideas and expectations?
3. What types of emotions might the event trigger in the patient or their support person?
How would you respond to these using PEARLS?
4. Imagine they are being cooperative. What type of teaching is needed?
Case Studies: Difficult and Challenging Situations
Choose one of the case studies to write up for Step 2.
Case Study 1: It is a typical evening in the ED. Mr. T is in pain and has been waiting for an hour because
you have been tending to a hospital emergency. He is quite angry when you finally get to the room.
Before you can even introduce yourself, he responds with, “I have been waiting for help for hours. No
one here seems to care. I am going to call my lawyer when I g