Screen mockup may not contain final content.

Transcription

1 3.0 PMDB STORYBOARDS: TUTORIALS PART 2 OST = Onscreen text (Bolded) IT = Instruction text KC = Knowledge check VO = Voice over CC = Closed caption 3.1 Emotions Under Stress Lesson 1 ID: (Module\Activity\Screen) Tutorials\Emotions\Lesson1 Media Mock-Up: Screen mockup may not contain final content. OST Human Emotions Under Stress With very few exceptions, all humans share the same potential for a full range of emotional experience and expression. IT: Click each numbered step to learn more. Restart button available. Script / Interaction / Notes Upon clicking each number, text appears in 12 point font and animation change. Clicking another number, triggers first text shrinking into small text box, and new text appearing with animation change. Rolling over small text boxes enlarges font to 12 point. April 18, 2006 Page 1 of 47

2 Rage EMOTION HAS TO GO SOMEWHERE Love Anger Joy Fear, Anxiety Happiness Remorse, Guilt Acceptance Sadness Emptiness Depression 1. You have the potential ability to experience and express a full range of emotions in their true form. So does everyone else. Rage Love Anger Joy Fear, Anxiety Happiness Remorse, Guilt Acceptance Sadness Emptiness Depression Emotional Range #2 2. Managing our emotions and the way we express them is an important part of fulfilling our social contract with others and part of normal development. We are not free to express anything we feel at any time. Rage Love Anger Joy Fear, Anxiety Happiness Remorse, Guilt Acceptance Sadness Emptiness Depression Emotional Range #3 3. Sometimes we over-do it when we manage our emotions, going beyond merely regulating them to actually shutting them down. April 18, 2006 Page 2 of 47

3 Rage Love Anger Joy Fear, Anxiety Happiness Remorse, Guilt Acceptance Sadness Emptiness Depression Emotional Range #4 4. Although this numbing strategy might keep you safe during a trauma, surviving an abusive family, or avoiding a fight, it can have unwanted consequences if used in all situations. Avoiding emotions in their true form can become a habit very easily, especially if experiences in relationships, jobs, or the military teach us that certain emotions are unacceptable. Rage Love Anger Joy Fear, Anxiety Happiness Remorse, Guilt Acceptance Sadness Emptiness Depression Emotional Range #5 5. Emotional energy, once generated, HAS TO GO SOMEWHERE. Blocking an emotion s true channel of experience and expression does not eliminate that emotion. Where does that emotional energy go? Rage Love Anger Fear, Anxiety BLOCKED! Remorse, Guilt Joy BLOCKED! Happiness BLOCKED! Acceptance Sadness Emptiness Depression Emotional Range #6 April 18, 2006 Page 3 of 47

4 6. Blocked energy will bounce around until it finds an open channel of expression. Anger happens to be a common way for blocked energy to be expressed. Rage OPEN! Anger Joy Love Fear, Anxiety Happiness Remorse, Guilt Acceptance Expressed As Anger! Sadness Depression Emptiness User clicks Next to return to the tutorial. Emotional Range #7 Click Next to return to the tutorial. April 18, 2006 Page 4 of 47

5 3.2 Emotions Knowledge Check 1 ID: (Module\Activity\Screen) Tutorials\Emotions\KC1 Media Mock-Up: Screen mockup may not contain final content. OST Sometimes disruptive behavior seems to come from nowhere. Blocked channels for emotion may be the reason. IT: Drag the words to complete the paragraph about emotion under stress. We may over-do it when we manage our _(1)_, going beyond merely regulating them to actually shutting them down. Avoiding emotions in their _(2)_can become a habit very easily, especially if experiences teach us that certain emotions are _(3)_. Anger happens to be a common way for _(4)_ to be expressed. unacceptable (3) emotions (1) blocked energy (4) true form (2) Script / Interaction / Notes Dragging the words into correct spaces leaves them there. Dragging incorrectly resets the item in the list. When sentence is complete, feedback appears and items are highlighted in sentence. Feedback: Understanding the way emotions operate under stress increases April 18, 2006 Page 5 of 47

6 your ability to respond with flexibility to the unexpected. IT: Click Next to return to the tutorial. User clicks Next to return to the tutorial. April 18, 2006 Page 6 of 47

7 3.3 Emotions Knowledge Check 1 Multiple Choice Alternate ID: (Module\Activity\Screen) Tutorials\Emotions\KC1- Multiple choice alternative Media Mock-Up: Screen mockup may not contain final content. OST Sometimes disruptive behavior seems to come from nowhere. Blocked channels for emotion may be the reason. Script / Interaction / Notes IT: Choose the phrase that best fits each blank. We may over-do it when we manage our _(1)_, going beyond merely regulating them to actually shutting them down. Avoiding emotions in their _(2)_can become a habit very easily, especially if experiences teach us that certain emotions are _(3)_. Anger happens to be a common way for _(4)_ to be expressed. Upon rollover, choices indent. (1) thoughts emotions* (2) blocked form true form* April 18, 2006 Page 7 of 47

8 (3) unacceptable* allowed (4) blocked energy* true form Upon clicking Submit, feedback and highlighted correct answer(s) appear. Submit button available. Feedback: Understanding the way emotions operate under stress increases your ability to respond with flexibility to the unexpected. IT: Click Next to return to the tutorial. User clicks Next to return to the tutorial. April 18, 2006 Page 8 of 47

9 3.4 Stress Lesson 1 ID: (Module\Activity\Screen) Tutorials\Stress\Lesson1 Media Mock-Up: Screen mockup may not contain final content. OST Levels of Stress Script / Interaction / Notes Understanding the five levels of stress will increase your ability to assess yourself and the patient in any potentially disruptive situation. IT: Rollover each stress level for details. Click to create list. Insert graphic of average stress response slide on the left with room for lists to be created on the right. Hotspots are highlighted. Normal Rollover on title: This level of anxiety is a part of day-to-day living. Moderate Rollover on title: As stress increases, the perceptual field decreases, becoming limited to the immediate task at hand. On rollover, examples appear for each list item. They disappear when mouse moves off item. Upon click, word or phrase populates list. April 18, 2006 Page 9 of 47

10 Severe Rollover on title: The perceptual field decreases even more as stress continues to increase. Panic Rollover on title: This is the most intense and destructive level of stress. Tension Reduction Rollover on title: This is the de-escalation phase and return to normal level of stress. A patient with a high potential for disruptive behavior may experience these levels a little differently, and be vulnerable to escalating more quickly than you might expect. Insert graphic of Stress Response of Patient w/high Potential for Disruptive Behavior. Knowledge check Upon click, KC opens in separate window. April 18, 2006 Page 10 of 47

11 3.5 Stress Knowledge Check 1 ID: (Module\Activity\Screen) Tutorials\Stress\KC1 Media Mock-Up: Screen mockup may not contain final content. OST How does a patient at high risk of disruptive behavior differ from an average person in expressing levels of stress? Script / Interaction / Notes IT: Choose your answer. A person at high risk may move more quickly to panic and remain there longer.* A person at high risk may skip a level entirely. A person at high risk may behave differently from an average person while in each phase. Upon rollover, choices indent. Upon click, feedback and highlighted correct answer(s) appear. Feedback: While everyone seems to experience the same levels and more or less the same phenomenon in each level, the person at high risk may move rapidly into a panic level and find it harder to deescalate from there. The correct answer is highlighted. IT: Click Next to return to the tutorial. April 18, 2006 Page 11 of 47

12 April 18, 2006 Page 12 of 47 User clicks Next to return to the tutorial.

13 3.6 Stress Lesson 2 ID: (Module\Activity\Screen) Tutorials\Stress\Lesson2 Media Mock-Up: OST Level of Stress Normal Screen mockup may not contain final content. Script / Interaction / Notes The way we feel and show stress varies with the individual and the situation. However, the relative intensity of stress levels can be compared and some general observations made. This will be one graphic for the chart and one graphic for the 5 senses that changes as user rolls over and clicks on the different sections of the graph. IT: Click each hotspot to learn more. Insert graphic that shows just the Normal part of the second graph and the 5 senses graphic. Hotspot is the appropriate section of the graph. The graph didn t show the section for normal. We need to be sure to add it to the animation. Normal stress sharpens the senses, increases motivation, and may enhance performance on routine activities. At this level of anxiety, we are the most alert and the perceptual field is actually enlarged, promoting optimal functioning. At this stage, we see, hear, and grasp more stimuli, enabling us to solve problems and learn effectively. April 18, 2006 Page 13 of 47

14 Upon clicking hotspots, the 5 senses graphic and the list fade in. Perceptual field keen Taking in entire environment Processing information Level of Stress Moderate Insert graphic that shows just the Moderate part of the second graph and the 5 senses graphic. The person is focused on the here and now and does not take in as much outside information. They may not even hear information you are providing. Perceptual field narrows Focused on here and now Decreased information intake April 18, 2006 Page 14 of 47

15 Level of Stress Severe Insert graphic that shows just the Severe part of the second graph and the 5 senses graphic. The person experiences tunnel vision, not able to focus on more than one thing. Information processing is nearly impossible and complex motor skills will be deeply impaired. Perceptual field limited Focused on one thing Tunnel vision Processing of information severely limited Complex motor skills deteriorate Level of Stress Panic Insert graphic that shows just the Panic part of the second graph and the 5 senses graphic. April 18, 2006 Page 15 of 47

16 Perceptual field very narrow Unable to process information Unable to problem solve Dangerous to self or others The perceptual field, focused only on self, is so limited that the person is no longer able to process any outside stimuli. This person is at high risk for violent behavior. Feelings of anger, fear, or helplessness may emerge explosively. A "fight or flight" reaction may occur. Warning signals include: clenched fists, walking briskly, continuous pacing, throwing items, exaggerated response to annoyance, yelling, pressured and curt speech, quivering of the lips, rigid muscle tension, and biting or scratching. They are focused intently on themselves, their uncomfortable feelings, and whatever they are angry or fearful about. If someone becomes a physical threat, follow your facility procedures for therapeutic containment. Level of Stress Tension Reduction Insert graphic that shows just the Tension Reduction part of the second graph and the 5 senses graphic. Returning to normal level Perceptual field is keen April 18, 2006 Page 16 of 47

17 Taking in information Takes time Though you may never see this patient again, someone else will. For this reason, your actions to develop rapport with the patient will protect his or her dignity, helping to save face and smoothing the way for future interactions. The goal in tension reduction is to assist a patient in identifying what triggered the acting out and to troubleshoot how to prevent its recurrence. Through the whole process a calm, reassuring approach will assist the individual in returning to a normal level of stress. Knowledge check Upon click, KC opens in separate window. April 18, 2006 Page 17 of 47

18 3.7 Stress Knowledge Check 2 ID: (Module\Activity\Screen) Tutorials\Stress\KC2 Media Mock-Up: Screen mockup may not contain final content. OST Your perceptual field is deeply influenced by your level of stress. In the following situations, what level of stress do you imagine you might experience? IT: Drag each phrase to the appropriate image of a stress level. There are no right answers. Near-miss car crash Asking for a promotion Losing your balance at the edge of a cliff Going on a first date Watching a child run out into the street Stress Levels image of Normal image of Moderate image of Severe image of Panic Script / Interaction / Notes Dragging phrase to correct image makes it disappear. Images developed for the tutorial. April 18, 2006 Page 18 of 47

19 image of Tension Reduction Submit button available Feedback: Be aware of how much or how little a patient can process the information you may be trying to convey to them in a situation of increased stress. There are no right answers. IT: Click Next to return to the tutorial. Upon clicking Submit, activity resets. Use images of each stress level that depict perceptual field. User clicks Next to return to the tutorial. April 18, 2006 Page 19 of 47

20 3.8 Stress Knowledge Check 2 Multiple Choice Alternate ID: (Module\Activity\Screen) Tutorials\Stress\KC2- Multiple choice alternative Media Mock-Up: Screen mockup may not contain final content. OST Your perceptual field is deeply influenced by your level of stress. In the following situations, what level of stress do you imagine you might experience? IT: Choose the stress level for each situation if it were happening to you. There are no right answers. Near-miss car crash Normal Moderate Severe Panic Tension Reduction Script / Interaction / Note Upon rollover, choices indent. Asking for a promotion Normal Moderate Severe April 18, 2006 Page 20 of 47

21 Panic Tension Reduction Losing your balance at the edge of a cliff Normal Moderate Severe Panic Tension Reduction Going on a first date Normal Moderate Severe Panic Tension Reduction Watching a child run out into the street Normal Moderate Severe Panic Tension Reduction Submit button available Feedback: Be aware of how much or how little a patient can process the information you may be trying to convey to them in a situation of increased stress. There are no right answers. IT: Click Next to return to the tutorial. Upon clicking Submit, activity resets. User clicks Next to return to the tutorial. April 18, 2006 Page 21 of 47

22 3.9 Interventions Lesson 1 ID: (Module\Activity\Screen) Tutorials\Interventions\Lesson1 Media Mock-Up: Screen mockup may not contain final content. OST Staff Intervention Script / Interaction / Notes Understanding the different levels of stress and their symptoms helps in early intervention, which you can employ at any level of stress. The type of intervention you choose will depend, at least in part, on your assessment of the patient s stress level. The goal is always to maintain rapport with the patient. This includes matching the intensity of your response to the intensity of the event. Insert graphic of table: Stress Level Normal Moderate Severe Panic Tension reduction Staff Action Prevention opportunity Verbal and non-verbal Limit setting Personal safety skills or therapeutic containment Therapeutic rapport April 18, 2006 Page 22 of 47

23 Knowledge check Upon click, KC opens in separate window. April 18, 2006 Page 23 of 47

24 3.10 Interventions Knowledge Check 1 ID: (Module\Activity\Screen) Tutorials\Interventions\KC1 Media Mock-Up: Screen mockup may not contain final content. OST Which intervention is appropriate at each level of stress? Script / Interaction / Notes IT: Drag and drop the appropriate intervention to each level of stress. Interventions Personal safety skills or therapeutic containment (Panic) Prevention opportunity (Normal) Limit setting (Severe) Therapeutic rapport (Tension Reduction) Verbal and non-verbal (Moderate) Stress Levels image of Normal image of Moderate image of Severe image of Panic image of Tension Reduction April 18, 2006 Page 24 of 47 Dragging the phrases into correct spaces leaves them there. Dragging incorrectly resets the item in the list. Upon clicking Submit, feedback

25 Submit button available. Feedback: There is always the possibility of intervention to prevent or deescalate a potentially disruptive situation. The correct answer is highlighted. IT: Click Next to return to the tutorial. and highlighted correct answer(s) appear. User clicks Next to return to the tutorial. April 18, 2006 Page 25 of 47

26 3.11 Interventions Knowledge Check 1 Multiple Choice Alternate ID: (Module\Activity\Screen) Tutorials\Interventions\KC1- Multiple choice alternative Media Mock-Up: Screen mockup may not contain final content. OST Which intervention is appropriate at each level of stress? IT: Choose the appropriate level of intervention for each level of stress. Script / Interaction / Notes Upon rollover, choices indent. Normal Personal safety skills or therapeutic containment Prevention opportunity* Moderate Verbal and non-verbal* Prevention opportunity Severe Therapeutic rapport Limit setting* April 18, 2006 Page 26 of 47

27 Panic Personal safety skills or therapeutic containment* Verbal and non-verbal Tension Reduction Limit setting Therapeutic rapport* Submit button available Feedback: There is always the possibility of intervention to prevent or deescalate a potentially disruptive situation. The correct answers are highlighted. IT: Click Next to return to the tutorial. Upon clicking Submit, feedback and highlighted correct answer(s) appear. User clicks Next to return to the tutorial. April 18, 2006 Page 27 of 47

28 3.12 Interventions Lesson 2 ID: (Module\Activity\Screen) Tutorials\Interventions\Lesson2 Media Mock-Up: Screen mockup may not contain final content. OST Non-Verbal Interventions Script / Interaction / Notes The single most important non-verbal communication you can convey is empathy. IT: Click the photo to learn more. A genuinely warm and caring attitude allows an individual to be heard and understood. It can be very effective in de-escalating a potential crisis. If your usual demeanor is not one of empathy, attempting to express it during a crisis may be very difficult. Insert list box with header or icon for each list. April 18, 2006 Page 28 of 47 Upon clicking the photo, text floats onto screen. Lists are side by side on screen Use the list boxes already developed, but add header or icon for each list. DO for 1 st list and THINK for 2 nd list.

29 Actions you can take Be in a supportive stance to facilitate the use of personal safety skills if these become necessary. Be calm. If you can't be calm, act calm. Keep eye contact, smile, and keep hands open and visible. Listen. Nod your head to demonstrate that you are paying attention. Respect personal space. Maintain arm/leg distance away from individual. Avoid touching an angry patient as it may be misinterpreted. Approach the patient from an angle or from the side. Convey that you are in control, by demonstrating confidence in your ability to resolve the situation. Demonstrate supportive body language. Avoid threatening gestures, such as finger pointing. Avoid laughing or smiling inappropriately. Things to be aware of Anxiety triggers or escalates anxiety. Crutches, canes, and walkers extend beyond arm/leg distance away from an individual but are still considered part of personal space. Approaching a patient straight on may be perceived as confrontational. Knowledge check Upon click, KC opens in separate window. April 18, 2006 Page 29 of 47

30 3.13 Interventions Knowledge Check 2 ID: (Module\Activity\Screen) Tutorials\Interventions\KC2 Media Mock-Up: Screen mockup may not contain final content. OST A number of natural responses may actually escalate a potentially disruptive situation. Which of the following actions can be easily misinterpreted? IT: Choose all that apply. Laughing to lighten the mood* Going directly towards a patient* Going towards a patient from either side Lightly touching a patient s shoulder* Getting close to the patient to speak very softly* Putting your hands in your pockets to appear casual* Submit button available. Feedback: Responding in effective ways to de-escalate a potentially disruptive situation may mean learning actions that are not April 18, 2006 Page 30 of 47 Script / Interaction / Notes Upon rollover, choices indent. Upon clicking Submit, feedback and highlighted correct answer(s) appear.

31 normally natural for you. IT: Click Next to return to the tutorial. User clicks Next to return to the tutorial. April 18, 2006 Page 31 of 47

32 3.14 Interventions Lesson 3 ID: (Module\Activity\Screen) Tutorials\Interventions\Lesson3 Media Mock-Up: Screen mockup may not contain final content. OST Verbal Interventions In conjunction with non-verbal communications that convey empathy, your words can impact a potentially disruptive situation, leading to reduced stress and safety for all concerned. IT: Rollover the hotspots for examples of good verbal interventions. Giving recognition Rollover on phrase: Good Morning, Mr. Thompson. Accepting Rollover on phrase: Uh hum, I follow what you said. Offering self Rollover on phrase: I ll sit with you awhile. Script / Interaction / Notes On rollover, examples appear for each list item. They disappear when mouse moves off item. Clicking closed caption triggers list in text box. VO: Good Morning, Mr. Thompson. Uh hum, I follow what you said. I ll sit with you awhile. April 18, 2006 Page 32 of 47

33 Asking open-ended questions Rollover on phrase: And then? Tell me about it. Placing the event in time or in sequence Rollover on phrase: Was this before or after you called here? Making observations Rollover on phrase: You appear tense. I notice that you re biting your lips. Encouraging comparison Rollover on phrase: Have you had similar experiences? Restating Rollover on phrase: Patient: I can t sleep. I stay awake all night. Nurse: You have difficulty sleeping. Focusing Rollover on phrase: I can understand how frustrated you must be let s focus on getting this resolved. Giving information Rollover on phrase: Mr. Jones, I m here to explain the procedure you re about to experience. Seeking clarification Rollover on phrase: What is the main thing you would like accomplished? Presenting reality Rollover on phrase: I see no one else in the room. That sound was a car backfiring. Seeking consensual validation Rollover on phrase: Tell me whether my understanding of it agrees with yours. Insert list box with header or icon for each list. Actions you can take Develop your use of a variety of verbal interventions for potential situations. Things to be aware of And then? Tell me about it. Was this before or after you called here? You appear tense. I notice that you re biting your lips. Have you had similar experiences? Patient: I can t sleep. I stay awake all night. Nurse: You have difficulty sleeping. I can understand how frustrated you must be let s focus on getting this resolved. Mr. Jones, I m here to explain the procedure you re about to experience. What is the main thing you would like accomplished? I see no one else in the room. That sound was a car backfiring. Tell me whether my understanding of it agrees with yours. Lists are side by side on screen Use the list boxes already developed, but add header or icon for each list. DO for 1 st list and THINK for 2 nd list. Be aware of your tone of voice and body language and what s going on around you, as well as your choice of words. April 18, 2006 Page 33 of 47

34 Knowledge check Upon click, KC opens in separate window. April 18, 2006 Page 34 of 47

35 3.15 Interventions Knowledge Check 3 ID: (Module\Activity\Screen) Tutorials\Interventions\KC3 Media Mock-Up: Screen mockup may not contain final content. OST What type of intervention does each phrase exemplify? Script / Interaction / Notes IT: Drag each phrase to the type of verbal intervention it exemplifies. Intervention types Restating (1) Asking open-ended questions (2) Presenting reality (3) Giving information (4) Placing the event in time (5) Dragging phrases to correct type of intervention triggers list. Phrases I don t see anybody in the hallway right now. (3) I m going to tell you where to sit down now. (4) How did you feel when that happened? (2) Was that before we got the test results? (5) I hear you saying that you were ignored. (1) April 18, 2006 Page 35 of 47

36 What would you like to tell me about that? (2) So, you think that someone is following you? (1) You need to take your prescription to the pharmacy.(4) The only people in this room are the two of us. (3) Submit button available. Feedback: Developing a variety of verbal interventions is key to being flexible in a potentially disruptive situation. IT: Click Next to return to the tutorial. Upon clicking Submit, feedback and highlighted correct answer(s) appear.. User clicks Next to return to the tutorial. April 18, 2006 Page 36 of 47

37 3.16 Interventions Knowledge Check 3 Multiple Choice Alternate ID: (Module\Activity\Screen) Tutorials\Interventions\KC3- multiple choice alternative Media Mock-Up: Screen mockup may not contain final content. OST What type of intervention does each phrase exemplify? IT: Choose the type of verbal intervention for each example. Script / Interaction / Notes Upon rollover, choices indent. That sound was a truck back-firing. Asking open-ended questions Presenting reality* How did you feel when that happened? Restating Asking open-ended questions* I m going to tell you where to sit down now. Giving information* Placing the event in time Was that before we got the test results? Placing the event in time* April 18, 2006 Page 37 of 47

38 Asking open-ended questions I hear you saying that you were ignored. Restating* Giving information Submit button available. Feedback: Developing a variety of verbal interventions is key to being flexible in a potentially disruptive situation. IT: Click Next to return to the tutorial. Upon clicking Submit, feedback and highlighted correct answer(s) appear. User clicks Next to return to the tutorial. April 18, 2006 Page 38 of 47

39 3.17 Interventions Lesson 4 ID: (Module\Activity\Screen) Tutorials\Interventions\Lesson4 Media Mock-Up: Screen mockup may not contain final content. OST Alternative Interventions Script / Interaction / Notes Suggesting an activity that requires movement, if only from one area of a room to another, may serve to de-escalate the situation and provide the opportunity for non-verbal and/or verbal interventions. Medication may be appropriate for some patients. Insert list box with header or icon for each list. Actions you can take Walking Working out in the gym Offering a cold beverage Turning on some music Guided relaxation/visualization Exercising Moving to a designated Quiet Room Lists are side by side on screen Use the list boxes already developed, but add header or icon for each list. DO for 1 st list and THINK for 2 nd list. April 18, 2006 Page 39 of 47

40 Medication Things to be aware of A hot beverage, such as coffee, can be used as a weapon. Music that relaxes one patient may do the opposite to another. Relaxation/visualization exercises are much more effective if they have been learned and practiced during periods of less stress. The use of a punching bag may actually escalate the stress. Knowledge check Upon click, KC opens in separate window. April 18, 2006 Page 40 of 47

41 3.18 Interventions Knowledge Check 4 ID: (Module\Activity\Screen) Tutorials\Interventions\KC4 Media Mock-Up: Screen mockup may not contain final content. OST Alternative interventions can be very helpful, but must be chosen and handled carefully. Why? IT: Choose your answer. They generally require leaving the safety of the building. Only specially trained staff should attempt these. What may work well to calm one patient may escalate another.* Feedback: Alternative interventions may change the energy and provide a chance for other interventions to de-escalate a situation. The correct answer is highlighted. IT: Click Next to return to the tutorial. Script / Interaction / Notes Upon rollover, choices indent. Upon click, feedback and highlighted correct answer(s) appear. User clicks Next to return to the tutorial. April 18, 2006 Page 41 of 47

42 3.19 Limit Lesson 1 ID: (Module\Activity\Screen) Tutorials\Limit\Lesson1 Media Mock-Up: Screen mockup may not contain final content. OST Limit Setting Script / Interaction / Notes Limit setting techniques place some external control on the situation when a patient s stress level increases from moderate to severe, lowering the stress, and facilitating decision-making. IT: Click the photo for details. Insert appropriate photo. Limit Versus Threat Clicking on photo triggers text floating out and onto screen. A common misunderstanding is to confuse setting limits and issuing threats. Setting limits de-escalates; threats signal the patient that the situation is more hopeless than they had perceived, and may precipitate a violent crisis. April 18, 2006 Page 42 of 47

43 What you say must be believable. There is a difference between telling someone Go sit in that chair so I can get on the phone to help you, and If you don t shut up, I m going to put an IV in your arm. A threat tends to be unenforceable, and the patient may well react to this evidence that you are out of control yourself. Your awareness of yourself is critical, and learned behaviors that reduce your own stress are essential. You must remain rational in an emergency. Insert list box with header or icon for each list. Lists are side by side on screen Use the list boxes already developed, but add header or icon for each list. DO for 1 st list and THINK for 2 nd list. Actions you can take Breathe deeply, and assess your own level of stress. Know your facility s procedure for getting immediate assistance. Things to be aware of You may perceive the encounter as a power struggle that you want to win. It s better to recognize your need for assistance and get help than to get involved in a power struggle. Initiating your facility s procedure for immediate response to disruptive/violent behavior may be indicated. Knowledge check Upon click, KC opens in separate window. April 18, 2006 Page 43 of 47

44 3.20 Limit Knowledge Check 1 ID: (Module\Activity\Screen) Tutorials\Limit\KC1 Media Mock-Up: Screen mockup may not contain final content. OST Why is it important to distinguish between limit setting and issuing threats? IT: Drag each phrase to complete the paragraph. Do not confuse setting limits and _(1)_. Threats tend to be _(2)_ If your own _(3)_is racing and your _(4)_ is closing in, your ability to set limits clearly and calmly will be seriously compromised. Don t get involved in a _(5)_. unenforceable (2) issuing threats (1) heart (3) perceptual field (4) power struggle (5) Script / Interaction / Notes Dragging the words into correct spaces leaves them there. Dragging incorrectly resets the item in the list. When sentence is complete, feedback appears and items are highlighted in sentence. Feedback: Remaining rational in an emergency requires self-awareness and April 18, 2006 Page 44 of 47

45 learned behaviors that reduce your own stress. Avoiding power struggles is critical to de-escalating a potentially disruptive situation. IT: Click Next to return to the tutorial. User clicks Next to return to the tutorial. April 18, 2006 Page 45 of 47

46 3.21 Limit Knowledge Check 1 Multiple Choice Alternate ID: (Module\Activity\Screen) Tutorials\Limit\KC1- Multiple choice alternative Media Mock-Up: Screen mockup may not contain final content. OST Why is it important to distinguish between limit setting and issuing threats? IT: Choose the best word or phrase for each blank. Do not confuse setting limits and _(1)_. Threats tend to be _(2)_. If your own _(3)_is racing and your _(4)_ is closing in, your ability to set limits clearly and calmly will be seriously compromised. Don t get involved in a _(5)_. Script / Interaction / Notes Upon rollover, choices indent. Upon click, feedback and highlighted correct answer(s) appear. (1) supplying answers issuing threats* (2) effective unenforceable* April 18, 2006 Page 46 of 47

47 (3) perceptual field heart* (4) perceptual field* heart (5) power struggle* perceptual field Submit button available. Feedback: Remaining rational in an emergency requires self-awareness and learned behaviors that reduce your own stress. Avoiding power struggles is critical to de-escalating a potentially disruptive situation. IT: Click Next to return to the tutorial. Upon clicking Submit, feedback and highlighted correct answer(s) appear. User clicks Next to return to the tutorial. April 18, 2006 Page 47 of 47