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Difficulty: MediumCoping Mechanisms

During mealtime at a long-term care facility, a practical nurse (PN) observes a resident who recently experienced a left-hemisphere stroke. The resident has been cleared to use adaptive utensils but pushes the tray away, begins to cry, and demands, 'I cannot do anything right anymore. You have to feed me!' Which action should the PN take to best support the resident's coping?

  1. Validate the resident's feelings of helplessness and offer to gently guide their hand for the first few bites.Answer
  2. B
    Ask the resident, 'Why are you refusing to use the adaptive utensils when the therapist said you were ready?'
  3. C
    Explain to the resident that they must move past this anger before they can reach the acceptance stage of their recovery.
  4. D
    Independently change the nursing care plan to designate total feeding assistance for all future meals.

Answer

The correct action is to validate the resident's feelings of helplessness and offer partial assistance to gently encourage independence.
Validating the resident's feelings acknowledges their emotional distress related to the loss of physical independence. Offering to guide their hand provides necessary support without completely taking over the task, which gently redirects the regressive behavior and promotes adaptive coping and rehabilitation.

Step-by-Step Solution

1
Analyze the resident's behavior (crying, demanding to be fed).
Identify this as a maladaptive coping response (regression and frustration) secondary to the loss of physical independence.
Understanding the underlying cause of the behavior is necessary to select a therapeutic intervention.
2
Evaluate the nursing options based on therapeutic communication and PN scope of practice.
Rule out 'why' questions, minimizing feelings with rigid grief expectations, and out-of-scope care plan modifications.
Non-therapeutic responses or out-of-scope actions can harm the therapeutic relationship or violate practice boundaries.
3
Select the intervention that balances emotional support with rehabilitation goals.
Validating the resident's feelings while offering to guide their hand provides immediate support without completely enabling the regressive behavior.
This gently shapes behavior back toward adaptive coping and utilizes the prescribed adaptive equipment.

Key Concept

Coping Mechanisms and Therapeutic Interventions
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Topics

Coping Mechanisms

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