Difficult conversations: Communicating a life-altering diagnosis

2023

Actor and Mannequin Simulation

Difficult conversations: Communicating a life-altering diagnosis

Communicating a difficult diagnosis or the findings of critical results to a client is a challenging but essential aspect of Advanced Practice Nursing practice. This is a fundamental clinical experience for MN and NP students that expands upon the theoretical understanding of specific topics addressed in their education program. Students may not have an opportunity to see or engage in these discussions in their clinical experiences so this simulation will provide students with an opportunity to apply their learning and develop therapeutic communications skills. Using the Serious Illness Conversation Guide (Ariadne Labs, 2016) as a framework for difficult discussions, this simulation will offer an immersive clinical experience to enhance preparedness and optimize comprehensive care to vulnerable patients.

Learning Outcomes

After completing these simulations the student will be able to:

Initiate and develop a therapeutic relationship with the client.
Communicate a difficult diagnosis or the findings of critical results to the client and/or family.
Use therapeutic communication strategies to ensure client-centered care.
Provide guidance, health teaching and therapeutic interventions as indicated.
Demonstrate a clinical encounter that fosters and ensures positive therapeutic relationships involving patient-informed treatment plans.

COPD Difficult Discussion

Matthew (he/him) is a 50-year-old cisgendered male that came to the Toronto Family Health Center last week for a persistent cough, occasionally productive x 3 months. Matthew reported his cough is typically worse in the mornings and his sputum is mostly clear and white. For the past 6 months, Matthew noticed feeling increasingly short of breath when exercising at the gym. He denied having any fever, chills, nausea, vomiting, or unexplained weight loss. The NP did a physical exam and referred Matthew to a nearby clinic to do a spirometry test. Matthew is now back at the office to review the results.

HSIL Difficult Discussions

Sana (she/her) is a 39-year-old cisfemale that came to the Toronto Family Health Centre two weeks ago for her routine pap smear. Her previous pap tests have been normal. Sana is now back at the office to review the results.

STI Difficult Discussions

Sarah (she/her) is a 23-year-old female that came to Toronto Family Health Center last week complaining of abnormal vaginal discharge and dysuria for one week. Sarah had recently become sexually active with one cisgendered male partner. She was unsure of his sexual history. She had been having unprotected vaginal intercourse with him for the past month and has been using the pull-out method. The NP completed the physical exam and collected cervical and vaginal swabs. Sarah is now back at the office to review the results of the tests.