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Difficulty: MediumEnd of Life Care

A practical nurse is conversing with the spouse of a client who has advanced amyotrophic lateral sclerosis (ALS) and recently entered hospice care. The spouse states, "I keep telling my wife that everything is going to be fine and she just needs to stay positive, but she just cries." Which of the following is the most appropriate response by the nurse?

  1. It is hard to see her upset, but allowing her to cry and express her feelings without pressure is important right now.Answer
  2. B
    It is normal for her to be in the depression stage right now, but she will soon move into the acceptance stage.
  3. C
    Why are you telling her that everything will be fine when you both know her condition is terminal?
  4. D
    You should keep encouraging her to stay positive because maintaining hope is the best medicine for her right now.

Answer

The most appropriate response acknowledges the spouse's difficulty while advocating for the client's need to express sadness openly.
The correct answer utilizes therapeutic communication by first validating the spouse's feelings (acknowledging it is hard to see a loved one upset) and then providing gentle education. It advocates for the client's psychosocial needs, emphasizing that expressing negative emotions like sadness is a healthy and necessary part of the end-of-life process.

Step-by-Step Solution

1
Analyze the spouse's statement to identify the underlying dynamic.
The spouse is providing false reassurance and toxic positivity, which is suppressing the client's ability to express genuine grief.
Understanding the communication barrier helps determine the best therapeutic intervention.
2
Evaluate the nursing options based on principles of therapeutic communication in end-of-life care.
Responses offering advice, asking 'why', or predicting strict grief stages are non-therapeutic.
The nurse must support both the client and family while advocating for the client's emotional needs.
3
Select the response that validates the spouse's feelings while guiding them toward a more supportive approach.
The response validating how hard it is to see a loved one cry, while explaining the importance of expressing sadness, is chosen.
This approach is empathetic, avoids communication blocks, and promotes a healthy grieving environment.

Key Concept

Therapeutic Communication in End of Life Care
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Topics

End of Life Care

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