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Difficulty: MediumTherapeutic Communication

The healthcare provider has just informed a client with end-stage renal disease about the immediate need to begin hemodialysis. After the provider leaves the room, the client angrily yells at the nurse, "I absolutely refuse to do it! Being tied to a machine three days a week isn't living. I would rather just let nature take its course!" Which of the following responses by the nurse is the most therapeutic?

  1. You feel that starting hemodialysis will take away your freedom to live a meaningful life.Answer
  2. B
    The treatments only take a few hours a day, so you will still be able to do many things you enjoy.
  3. C
    If you refuse to start the dialysis, your condition will rapidly worsen and you will not survive.
  4. D
    You are very upset right now. I will come back in a little while when you have had time to calm down.

Answer

The most therapeutic response is to reflect the client's feelings by stating that they feel hemodialysis will take away their freedom to live a meaningful life.
The correct response demonstrates reflection and validation. It accurately names the client's underlying concern (loss of freedom and quality of life) without judging the client, minimizing their anger, or rushing to fix the problem. This encourages the client to continue sharing their fears, which is the foundational step in crisis intervention and care planning.

Step-by-Step Solution

1
Analyze the client's statement and emotional state.
The client is exhibiting anger, fear, and a sense of powerlessness over a life-altering medical intervention.
Identifying the primary emotion dictates the appropriate therapeutic intervention.
2
Evaluate the nurse's options against principles of therapeutic communication.
Responses that argue, minimize, or abandon the client must be eliminated. The response that actively listens and reflects the client's message without judgment must be selected.
The goal of therapeutic communication is to establish trust, validate emotions, and encourage the client to verbalize their concerns.
3
Select the response that best validates the client's feelings.
The reflective statement accurately captures the client's despair over losing their quality of life, allowing them to feel heard.
Reflection acts as a mirror for the client, confirming their feelings are understood and inviting further dialogue.

Key Concept

Therapeutic Communication: Reflection and Validation
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Topics

Therapeutic Communication

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