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PMDB Storyboards:Tutorials\Part 2 Filenet #: 003713480 v2 April 18, 2006 Page 1 of 47 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 Script / Interaction / Notes 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. 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.

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PMDB Storyboards:Tutorials\Part 2 Filenet #: 003713480 v2 April 18, 2006 Page 1 of 47

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 Script / Interaction / Notes 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.

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.

PMDB Storyboards:Tutorials\Part 2 Filenet #: 003713480 v2 April 18, 2006 Page 2 of 47

EMOTION HAS TO GO SOMEWHERE

Rage

Anger

Fear, Anxiety

Remorse, Guilt

Sadness

Depression

Emptiness

Acceptance

Happiness

Joy

Love

1. You have the potential ability to experience and express a full range of emotions in their true form. So does everyone else.

Rage

Anger

Fear, Anxiety

Remorse, Guilt

Sadness

Depression

Emptiness

Acceptance

Happiness

Joy

Love

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

Anger

Fear, Anxiety

Remorse, Guilt

Sadness

Depression

Emptiness

Acceptance

Happiness

Joy

Love

Emotional Range #3 3. Sometimes we over-do it when we manage our emotions, going beyond merely regulating them to actually shutting them down.

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Rage

Anger

Fear, Anxiety

Remorse, Guilt

Sadness

Depression

Emptiness

Acceptance

Happiness

Joy

Love

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

Anger

Fear, Anxiety

Remorse, Guilt

Sadness

Depression

Emptiness

Acceptance

Happiness

Joy

Love

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?

BLOCKED!

BLOCKED!

BLOCKED!

Rage

Anger

Fear, Anxiety

Remorse, Guilt

Sadness

Depression

Emptiness

Acceptance

Happiness

Joy

Love

Emotional Range #6

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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.

OPEN!

ExpressedAs

Anger!

Rage

Anger

Fear, Anxiety

Remorse, Guilt

Sadness

Depression

Emptiness

Acceptance

Happiness

Joy

Love

Emotional Range #7 Click Next to return to the tutorial.

User clicks Next to return to the tutorial.

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3.2 Emotions Knowledge Check 1

ID: (Module\Activity\Screen) Tutorials\Emotions\KC1 Media Mock-Up:

Screen mockup may not contain final content.

OST Script / Interaction / Notes 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) Feedback: Understanding the way emotions operate under stress increases

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.

PMDB Storyboards:Tutorials\Part 2 Filenet #: 003713480 v2 April 18, 2006 Page 6 of 47

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.

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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 Script / Interaction / Notes Sometimes disruptive behavior seems to come from nowhere. Blocked channels for emotion may be the reason. 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. (1) • thoughts • emotions* (2) • blocked form • true form*

Upon rollover, choices indent.

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(3) • unacceptable* • allowed (4) • blocked energy* • true form 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.

Upon clicking Submit, feedback and highlighted correct answer(s) appear. User clicks Next to return to the tutorial.

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3.4 Stress Lesson 1

ID: (Module\Activity\Screen) Tutorials\Stress\Lesson1 Media Mock-Up:

Screen mockup may not contain final content.

OST Script / Interaction / Notes Levels of Stress 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.

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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.

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3.5 Stress Knowledge Check 1

ID: (Module\Activity\Screen) Tutorials\Stress\KC1 Media Mock-Up:

Screen mockup may not contain final content.

OST Script / Interaction / Notes How does a patient at high risk of disruptive behavior differ from an average person in expressing levels of stress? 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. 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 de-escalate from there. The correct answer is highlighted. IT: Click Next to return to the tutorial.

Upon rollover, choices indent. Upon click, feedback and highlighted correct answer(s) appear.

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User clicks Next to return to the tutorial.

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3.6 Stress Lesson 2

ID: (Module\Activity\Screen) Tutorials\Stress\Lesson2 Media Mock-Up:

Screen mockup may not contain final content.

OST Script / Interaction / Notes Level of Stress – Normal 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. 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.

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.

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. The graph didn’t show the section for normal. We need to be sure to add it to the animation.

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• Perceptual field keen • Taking in entire environment • Processing information

Upon clicking hotspots, the 5 senses graphic and the list fade in.

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

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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.

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• 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

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• 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.

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3.7 Stress Knowledge Check 2

ID: (Module\Activity\Screen) Tutorials\Stress\KC2 Media Mock-Up:

Screen mockup may not contain final content.

OST Script / Interaction / Notes 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

Dragging phrase to correct image makes it disappear. Images developed for the tutorial.

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• 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.

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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 Script / Interaction / Note 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 Asking for a promotion • Normal • Moderate • Severe

Upon rollover, choices indent.

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• 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.

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3.9 Interventions Lesson 1

ID: (Module\Activity\Screen) Tutorials\Interventions\Lesson1 Media Mock-Up:

Screen mockup may not contain final content.

OST Script / Interaction / Notes Staff Intervention 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 Staff Action Normal Prevention opportunity Moderate Verbal and non-verbal Severe Limit setting Panic Personal safety skills or therapeutic

containment Tension reduction Therapeutic rapport

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Knowledge check

Upon click, KC opens in separate window.

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3.10 Interventions Knowledge Check 1

ID: (Module\Activity\Screen) Tutorials\Interventions\KC1 Media Mock-Up:

Screen mockup may not contain final content.

OST Script / Interaction / Notes Which intervention is appropriate at each level of stress? 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

Dragging the phrases into correct spaces leaves them there. Dragging incorrectly resets the item in the list. Upon clicking Submit, feedback

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Submit button available.

Feedback: There is always the possibility of intervention to prevent or de-escalate 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.

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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 Script / Interaction / Notes Which intervention is appropriate at each level of stress? IT: Choose the appropriate level of intervention for each level of stress. Normal • Personal safety skills or therapeutic containment • Prevention opportunity* Moderate • Verbal and non-verbal* • Prevention opportunity Severe • Therapeutic rapport • Limit setting*

Upon rollover, choices indent.

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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 de-escalate 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.

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3.12 Interventions Lesson 2

ID: (Module\Activity\Screen) Tutorials\Interventions\Lesson2 Media Mock-Up:

Screen mockup may not contain final content.

OST Script / Interaction / Notes Non-Verbal Interventions 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.

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 1st list and “THINK” for 2nd list.

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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.

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3.13 Interventions Knowledge Check 2

ID: (Module\Activity\Screen) Tutorials\Interventions\KC2 Media Mock-Up:

Screen mockup may not contain final content.

OST Script / Interaction / Notes 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

Upon rollover, choices indent. Upon clicking Submit, feedback and highlighted correct answer(s) appear.

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normally “natural” for you. IT: Click Next to return to the tutorial.

User clicks Next to return to the tutorial.

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3.14 Interventions Lesson 3

ID: (Module\Activity\Screen) Tutorials\Interventions\Lesson3 Media Mock-Up:

Screen mockup may not contain final content.

OST Script / Interaction / Notes 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.

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.

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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

• Be aware of your tone of voice and body language and what’s going on around you, as well as your choice of words.

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 1st list and “THINK” for 2nd list.

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Knowledge check

Upon click, KC opens in separate window.

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3.15 Interventions Knowledge Check 3

ID: (Module\Activity\Screen) Tutorials\Interventions\KC3 Media Mock-Up:

Screen mockup may not contain final content.

OST Script / Interaction / Notes What type of intervention does each phrase exemplify? 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) 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)

Dragging phrases to correct type of intervention triggers list.

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• 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.

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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 Script / Interaction / Notes What type of intervention does each phrase exemplify? IT: Choose the type of verbal intervention for each example. 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*

Upon rollover, choices indent.

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• 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.

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3.17 Interventions Lesson 4

ID: (Module\Activity\Screen) Tutorials\Interventions\Lesson4 Media Mock-Up:

Screen mockup may not contain final content.

OST Script / Interaction / Notes Alternative Interventions 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 1st list and “THINK” for 2nd list.

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• 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.

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3.18 Interventions Knowledge Check 4

ID: (Module\Activity\Screen) Tutorials\Interventions\KC4 Media Mock-Up:

Screen mockup may not contain final content.

OST Script / Interaction / Notes 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.

Upon rollover, choices indent. Upon click, feedback and highlighted correct answer(s) appear. User clicks Next to return to the tutorial.

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3.19 Limit Lesson 1

ID: (Module\Activity\Screen) Tutorials\Limit\Lesson1 Media Mock-Up:

Screen mockup may not contain final content.

OST Script / Interaction / Notes Limit Setting 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 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.

Clicking on photo triggers text floating out and onto screen.

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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.

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

Lists are side by side on screen Use the list boxes already developed, but add header or icon for each list. “DO” for 1st list and “THINK” for 2nd list. Upon click, KC opens in separate window.

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3.20 Limit Knowledge Check 1

ID: (Module\Activity\Screen) Tutorials\Limit\KC1 Media Mock-Up:

Screen mockup may not contain final content.

OST Script / Interaction / Notes 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)

Feedback: Remaining rational in an emergency requires self-awareness and

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.

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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.

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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 Script / Interaction / Notes 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)_. (1) • supplying answers • issuing threats* (2) • effective • unenforceable*

Upon rollover, choices indent. Upon click, feedback and highlighted correct answer(s) appear.

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(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.