I need two responses to two different Students post for this week’s discussion. The topic for this week’s discussion thread is called client challenges. Each response can be 150 to 200 words reply with at least one scholarly article attached.

STUDENT 1 POST:Cassandra
: Ivona Y
STUDENT POST:
1. Create a scenario depicting an interaction between an NP and a client. Describe the setting and type of encounter.
Scenario: Talkative Client
Setting: Primary care clinic.
Encounter: Mr. Johnson, a 45-year-old male client is scheduled for a routine check-up. As the nurse practitioner (NP) enters the examination room, she finds Mr. Johnson already seated and engaged in a lively conversation with the nurse.

1. Describe the client’s challenging behaviors related to the topic assigned.
Mr. Johnson is extremely talkative, dominating the conversation with jokes, stories, questions, and tangents. He interrupts frequently and struggles to stay on topic, making it difficult for the NP to gather necessary information and provide effective and timely care.

1. Examine the potential impact of the client’s behavior on the client-provider relationship.
Mr. Johnson’s talkativeness may lead to frustration and impatience on the part of the NP. The NP may feel overwhelmed or rushed, while Mr. Johnson may perceive the NP as dismissive or uninterested in his concerns, straining the provider-patient relationship.

1. Analyze techniques to enhance communication with the client and address the client’s behavior.
Providing excellent, patient-centered care is the goal for the NP. Research shows, more than 75% of patients prefer a patient-centered approach to communication. Patient-centered care involves prioritizing patients’ perspectives on their treatment, encouraging their active participation in healthcare decisions, and empowering them to take charge of their own well-being. When dealing with talkative patients, it’s crucial to understand the underlying reason for their talkativeness and adjust communication methods accordingly (Noordman et al., 2019). The following techniques can be employed:
1. Setting boundaries: Politely redirecting the conversation back to the relevant topics and setting expectations for the appointment’s duration can help manage Mr. Johnson’s talkativeness.
2. Closed-ended summaries: Using closed-ended summaries, the NP can summarize key points of the discussion in a concise manner to keep the conversation focused. Closed-ended summaries, can help prevent interruptions and keep the conversation on track (Noordman et al., 2019)
3. Empathetic interruptions: When necessary, the NP can interrupt Mr. Johnson with empathy and understanding, gently guiding the conversation back on track.
4. Humor: Using appropriate humor can help diffuse tension and create a more relaxed atmosphere, making it easier for both parties to communicate effectively. Humor can be a helpful strategy to maintain a positive provider-patient relationship (Noordman et al., 2019).

1. Create sample documentation for the encounter.
Chief Complaint: No specific complaint. Routine check-up appointment.
History of present illness: Mr Johnson is a 45 year-old male with no past medical history who presents today for his routine check-up. He is talkative and engaged in conversation upon entering the examination room.
Review of Systems: Limited due to patient’s talkativeness. Patient reports no new symptoms since last visit.
Management Plan: Continue current home prescriptions with no changes. Implement communication strategies to manage patient’s talkativeness during future visits. Patient scheduled for routine follow-up in six months.

Reference:
Noordman, J., Post, B., Dartel, A. A. M., Slits, J. M. A., & Olde Hartman, T. C. (2019). Training residents in patient-centred communication and empathy: Evaluation from patients, observers and residents. BMC Medical Education, 19(1), 128. https://doi.org/10.1186/s12909-019-1555-5Links to an external site.

STUDENT POST 2: IVONA Y
Argumentative client
46 y. o. F Pt presents for an outpatient visit with URI symptoms of a sore throat, cough, and nasal congestion for 5 days. Pt is Negative for tonsillar exudates, cervical adenopathy, and fever. The NP used the Modified Centor Clinical Prediction Rule for Group A strep infection and has determined the patient has a -1 score. According to the Modified Centor Clinical Prediction Rule for Group A Strep Infection, a score of 0 or -1 points indicates to not test for, nor treat strep (Hollier, 2021). The patient is demanding a prescription for a “Z-Pack” because “It has helped in the past”. When the NP indicates that the patient does not need an antibiotic to treat her symptoms, the patient argues that she needs the “Z-Pack” in order to get getter.
This is a challenging behavior because the patient is convinced that she needs an antibiotic and feels she needs to argue with the provider until she receives the prescription. The argumentative behavior may elicit some providers to just prescribe the antibiotic to please the patient and improve patient satisfaction scores.
The impact on the patient/provider relationship from argumentative patients can be detrimental for both the patient and the provider. The patient can lose trust in their provider thus affecting overall health care. On the provider end, the provider may be tempted to succumb to the patient’s demands due to time constraints or satisfaction scores. It has been shown however, that offering delayed antibiotic prescribing if symptoms worsen can alleviate patient concerns, thus improving satisfaction (Tonazzi, Prenovost, & Scheuermann, 2022).
Communication techniques to use when engaging with an argumentative patient includes allowing the patient to express their opinion by actively listening to them, acknowledging their opinions with restating the opinion, and provide empathy for their concerns. Allowing patients to share their thoughts and providing validation to their concerns, can restore the collaborating patient/provider relationship. Once the collaborating patient/provider relationship is restored, the provider is more likely to have the opportunity to explain evidence-based practices in health care treatment.
Sample documentation in this case might be as follows:
46 y.o F patient presents for an outpatient visit with URI symptoms of a moderate sore throat, mild cough and clear nasal discharge x 5 days. Pt is negative for tonsillar exudates, cervical adenopathy, fever, rash, and nuchal rigidity. The Centor score for GABHS is -1 indicating no treatment or testing. Upon explanation to the patient that antibiotics are not indicated for her symptoms, she persisted antibiotics are needed. Upon allowing the patient to voice her concerns and partnering with her in her health care treatment, the patient became receptive to the explanation of antibiotic resistance and the need for antibiotic stewardship. Additionally, the patient was provided education on viral infection signs and treatment, versus bacterial infection signs and treatment. Delayed antibiotic prescribing is offered to this patient in the event her symptoms worsen indicating bacterial infection. Patient is instructed to call the office in 3-5 days if symptoms worsen or to call sooner if she develops severe fever or cough, purulent mucus, moderate to severe facial pain, nuchal rigidity, rash, swollen lymph nodes, or inability to swallow.

References
Hollier, A. (2021). Clinical Guidelines in Primary Care (Fourth ed.). Lafayette: Advanced Practice Education Associates.
Tonazzi, S., Prenovost, L., & Scheuermann, S. (2022). Delayed antibiotic prescribing to reduce antibiotic use: An urgent care practice change. BMJ Open Quality, 11(1). doi:10.1136/bmjoq-2021-001513