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Difficulty: HardTherapeutic Communication

A client with terminal lung cancer has recently been transitioned to comfort care measures. While the practical nurse is assisting with morning hygiene, the client angrily pushes the washbasin away and states, 'Why is everyone acting like I am already gone? You have all just stopped trying!' Which of the following responses by the practical nurse are therapeutic? Select all that apply.

  1. It sounds as though you are feeling very frustrated and abandoned right now.Answer
  2. B
    Why do you believe that the staff has stopped trying to care for you?
  3. You seem very angry this morning. Please tell me more about what you are experiencing.Answer
  4. D
    The medical team is doing everything possible to keep you comfortable, so please do not be upset.
  5. I will sit here with you for a while, just in case you would like to talk.Answer
  6. F
    Let us finish your morning care first, and then we can discuss these negative thoughts.

Answer

The therapeutic responses involve reflecting the client's feelings of frustration and abandonment, making an observation while encouraging the client to elaborate, and offering a supportive presence by sitting with the client.
Therapeutic communication with a distressed, grieving client must prioritize validation, active listening, and emotional support. Acknowledging the client's frustration (reflection), noting their anger while inviting them to share (making observations/exploring), and providing a quiet presence (offering self) directly address the client's emotional crisis without judgment.

Step-by-Step Solution

1
Analyze the client's statement and emotional state.
The client is experiencing anger, fear, and feelings of abandonment related to their terminal diagnosis and recent transition to comfort care.
Understanding the underlying emotion (anger masking fear or anticipatory grief) is essential to selecting a response that addresses the client's psychosocial needs rather than reacting defensively to their aggressive behavior.
2
Evaluate each option for validated therapeutic communication techniques.
Reflecting feelings, making observations combined with open-ended exploration, and offering self are recognized therapeutic techniques.
These techniques validate the client's distress, encourage the expression of difficult emotions, and demonstrate the nurse's unconditional supportive presence.
3
Identify and eliminate options containing non-therapeutic communication blocks.
Asking 'why', defending the healthcare team, invalidating feelings, and changing the subject to focus on hygiene tasks must be eliminated.
These communication blocks shut down therapeutic dialogue, cause defensiveness, and prioritize the nurse's agenda over the client's immediate emotional crisis.

Key Concept

Therapeutic Communication
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Topics

Therapeutic Communication

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