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Difficulty: MediumEnd of Life Care

A pediatric oncology unit is providing palliative care to a 15-year-old client with relapsed, refractory leukemia. The client's parents have explicitly requested that the healthcare team withhold the terminal prognosis from their child. During a routine assessment, the adolescent looks directly at the nurse and asks, "Am I dying?" What is the most appropriate initial action by the nurse?

  1. Explore the adolescent's thoughts by asking, "What has been happening to make you ask that question today?"Answer
  2. B
    Tell the adolescent, "Please try not to worry about that right now; we just need you to focus on resting."
  3. C
    Reply, "Because you are a minor, I am legally required to have your parents discuss this with you."
  4. D
    Instruct the unlicensed assistive personnel (UAP) to sit with the adolescent and provide a supportive presence.

Answer

The most appropriate initial action is to use therapeutic communication to explore the adolescent's thoughts by asking an open-ended question about what prompted their concern.
The correct action utilizes therapeutic communication by asking an open-ended question. This strategy allows the nurse to assess the adolescent's current emotional state, validates their concerns, and encourages them to share what they already know or suspect. It effectively maintains the nurse-client trust without forcing the nurse to immediately lie to the client or abruptly violate the parents' request before a family meeting can be arranged.

Step-by-Step Solution

1
Identify the client's developmental stage.
The client is a 15-year-old adolescent.
Adolescents are in Piaget's formal operational stage, meaning they have an adult-like understanding of the permanence of death and deeply value honesty and trust from healthcare providers.
2
Analyze the ethical and psychosocial conflict present in the scenario.
There is a conflict between the parents' request to withhold the truth and the adolescent's direct question seeking information.
The nurse cannot lie to the client, but abruptly disclosing the prognosis against the parents' wishes without a collaborative interdisciplinary approach can severely damage family dynamics.
3
Select the intervention that prioritizes immediate assessment and therapeutic communication.
Asking an open-ended question is chosen as the priority response.
This allows the nurse to assess what the client already knows or suspects, validates their fears, and buys time to involve the parents and care team in a guided disclosure process.

Key Concept

Therapeutic Communication and Developmental Considerations in End of Life Care
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Topics

End of Life Care

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