Alternative Text Option: Client in Altered State


Welcome to the simulation learning experience. During this experience, you will be interacting with a scenario between the client, the Health Care Administrator (HCA) and a nurse. The experience is presented in the following format:

  • Scenario description
  • Video scenes
  • Questions for points
  • Prompt to move to the next level
  • Opportunity to play again

Scenario Details

Many Canadians experience an altered mental status, and it can affect aspects of their lives, including health and well-being. Additionally, it can affect activities of daily living.

In this scenario, we meet Ken, a resident in a long-term care facility who is experiencing an altered mental state. Ken encounters Claire, the HCA and the RN on duty; both are involved in the care and support of residents at this facility.

Learning Objectives

  • Recognize the impact of poor therapeutic communication in health care settings.
  • Identify the benefits of therapeutic communication techniques in health care settings.
  • Adjust communication to meet the client’s health care needs in health care settings.

Please be advised that some viewers may find the following scenes upsetting or triggering.

Altered State Video Scene 1

Congratulations, you have reached level 1! To reach level 2, choose your next move.

Do you want to answer a question for  3 points?

Question: Consider the video you just watched. What blocks to effective therapeutic communication did you observe? Choose all apply.

  1. HCA argues with the client when they state, “that’s impossible.”
  2. The HCA frown and distance is congruent with her statement “that’s impossible,” demonstrating she may not like the client.
  3. The HCA’s greeting implies she is annoyed he is out of his room

Solution: Answer 1 and 2 are correct. HCA argues with the client when they state, “that’s impossible.” When a  client is in an altered state, they are confused, and the HCA must adjust their communication style to help the client. The HCA’s greeting is polite, she is not annoyed.

Watch the video again to restart the level?

Do you want to answer a question for  2 points?

Question: Consider the video you just watched. What effective therapeutic communication techniques did you observe? Choose all that apply.

  1. The HCA acknowledged that the client may need help.
  2. The HCA attempts to calm the client with her warm demeanour.
  3. The HCA does greet the client with a polite hello and ask “are you okay”.

Solution: Answers 1 and 3 are correct. She does greet and asks the client, “are you okay”. Unfortunately, HCA’s body language and argumentative statement “that’s impossible” will likely exacerbate the client’s state.

Let’s see what happens next!

Altered State Video Scene 2

What did you notice about the HCA’s responses? To earn more points, choose your next move.

Answer a question for 2 points.

Question: Consider the scene that you just watched. What ineffective therapeutic communication did you observe? Check all that apply.

  1. The HCA argues with the client, and this escalates to what could be perceived as a threat when the HCA says, “calm down, or I will have to take you back to your room.”
  2.  The HCA attempts to re-orientate the client by stating, “I thought you had two sons and not a daughter.”
  3.  The client acknowledges that they are forgetting, but the HCA ignores what the client is saying, does not acknowledge or address what the client has said.
  4. The client is becoming more agitated and upset, but the HCA does not recognize this, nor do they adjust their communication.

Solution: All answers are correct. If the HCA does not adjust their communication, the client’s mental state will be exacerbated. While verbally she re-orientates the client the HCA’s non-verbals are incongruent and the entire interaction could be interpreted as argumentative, but in this case makes the client more upset.

Re-watch the video

Will this get better? Stay tuned!

Altered State Video Scene 3

Doesn’t seem to be going well, Let’s see what happens next.

Altered State Video Scene 4

Congratulations, you have made it to level 3! To continue to earn points choose from the following.

Answer a question for 2 points.

Question: Consider the video that you just watched. What did you identify between team members that was ineffective? Choose all that apply.

  1. The nurse arrives to the scene to help, but she interrupts the HCA and speaks directly to the client.
  2. The nurse says, “we want to help you,” implying it is a team conversation.
  3. The nurse raises her voice and says, “it doesn’t look like you have it under control.”

Solution: All the options are correct. By speaking directly to the client, the nurse has interrupted the HCA discounting the HCA role with the client, and doesn’t know what she is trying to help with, because she has not spoken with the HCA. The HCA is offended and responds with I have it under control. A better response from the HCA is to inform the nurse what has been happening in the conversation. A better response from the nurse would have been to address the HCA before the client. By the nurse raising her voice, an argument begins, and the client’s state is exacerbated. It is never appropriate for team members to argue in front of a client.

Re-watch the video for 1 point.

Now let’s see how communication can be improved.  Stay tuned!

Altered State Video Scene 3

Seems to be going better, let’s keep watching.

Altered State Video Scene 4


Did you notice that the team members adjusted their communication in the last two scenes?

  • Why did the team members adjust their communication?
  • How do you think the team members knew that they needed to adjust their communication?
  • What was the immediate result you noticed in the client’s verbal and non-verbal communication?
  • What specific therapeutic communication techniques did the team members use?


Therapeutic communication with clients and team members is essential. HCAs should be aware that clients in altered states need to be communicated with differently. Similarly, therapeutic communication techniques can be used among team members to ease communication. HCAs should continue to develop their therapeutic communication competencies by recognizing and adjusting their behaviours to meet the client’s health care needs.

Therapeutic communication is complex and requires a lifetime commitment of reflection, practice, making mistakes, and learning from those mistakes.


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Therapeutic Communication for Health Care Administrators Game Simulations Copyright © 2022 by Kimberlee Carter; Marie Rutherford; and Connie Stevens is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License, except where otherwise noted.

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