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Difficulty: MediumEnd of Life Care

A practical nurse is caring for a client with metastatic breast cancer who is receiving home hospice care. The client is transitioning to the active phase of dying, and the client's partner is sitting at the bedside. Which actions by the nurse appropriately support the psychosocial needs of the client and partner? (Select all that apply.)

  1. Encourage the partner to continue talking to the client, explaining that hearing is often the last sense to be lost.Answer
  2. B
    Inform the partner that the client's current anger must be resolved before they can reach the acceptance stage of grief.
  3. Offer to contact the family's preferred spiritual leader or a hospice chaplain, if desired by the partner.Answer
  4. D
    Reassure the partner by stating, "I know exactly how you feel; time will heal the pain you are experiencing."
  5. Provide privacy for the client and partner to share intimate moments while remaining available nearby.Answer
  6. F
    Ask the partner, "Why do you think the client is refusing to eat today?"

Answer

The therapeutic actions are encouraging the partner to talk to the client, offering spiritual support, and providing privacy for the couple.
Appropriate psychosocial end-of-life care involves supporting the emotional and spiritual needs of both the client and their family. Encouraging the partner to speak to the client acknowledges that hearing remains intact until the very end of life, promoting connection. Offering spiritual support respects the family's specific cultural and religious beliefs. Providing privacy allows for meaningful, intimate closure while ensuring the nurse remains accessible if interventions are needed.

Step-by-Step Solution

1
Analyze the clinical scenario and the nursing goal.
The client is in the active phase of dying at home, and the goal is to provide psychosocial and emotional support to the client and their partner.
Identifying the phase of care determines which interventions are appropriate and therapeutic.
2
Evaluate the options for therapeutic communication and supportive actions.
Supporting sensory connection (hearing), facilitating spiritual resources, and providing privacy are recognized as highly therapeutic psychosocial interventions in end-of-life care.
These actions respect the dignity, cultural needs, and emotional processes of the family unit.
3
Identify non-therapeutic approaches and misconceptions about grief.
Assuming grief follows a strict timeline, using clichés to comfort, and asking interrogating 'why' questions are identified as non-therapeutic and harmful.
Such actions invalidate the family's feelings and block open, therapeutic communication.

Key Concept

Psychosocial Support and Therapeutic Communication at the End of Life
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Topics

End of Life Care

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