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Difficulty: Very hardCoping Mechanisms

A 68-year-old client is admitted to an inpatient hospice unit with end-stage chronic obstructive pulmonary disease. The client's adult child, who lives in another country and has not visited in five years, arrives at the facility. Within minutes, the adult child begins shouting in the hallway, stating, 'You are all completely neglecting my parent! The bed linens are wrinkled, the oxygen tubing is twisted, and none of you have any idea how to provide proper care!' The nurse recognizes this behavior as a defense mechanism utilized to cope with overwhelming anticipatory grief. Which of the following is the most therapeutic nursing response?

  1. A
    Why are you yelling at the staff when we have been working diligently to keep your parent comfortable?
  2. B
    I understand you may be feeling guilty about being away for so long, but shouting at the staff is not acceptable.
  3. It sounds like you are very worried about your parent's comfort. Let us step into a quiet room so we can discuss your concerns together.Answer
  4. D
    Please do not worry; I can assure you that our hospice team is highly trained and providing excellent care.

Answer

The most therapeutic response is to state, 'It sounds like you are very worried about your parent's comfort. Let us step into a quiet room so we can discuss your concerns together.'
This response is correct because it utilizes the therapeutic techniques of reflection and offering self. By stating 'It sounds like you are very worried,' the nurse addresses the true underlying emotion driving the displacement (fear and grief) rather than arguing about the surface-level false accusations. Moving to a quiet room removes the highly anxious individual from the hallway audience, which helps de-escalate the immediate anger, protects the unit milieu, and provides a safe space for the family member to process their emotional distress.

Step-by-Step Solution

1
Identify the underlying psychosocial dynamic occurring in the clinical scenario.
The adult child is experiencing profound anticipatory grief and guilt over their long absence, which is unconsciously displaced as anger directed at the nursing staff.
Recognizing the defense mechanism of displacement prevents the nurse from taking the accusations personally and reacting defensively.
2
Evaluate the communication techniques used in each option against therapeutic psychiatric nursing standards.
Options involving 'why' questions, false reassurance, or unsolicited psychoanalytic confrontation are non-therapeutic. The option utilizing emotional reflection and offering self is therapeutic.
During an acute emotional crisis, the nursing priority is to de-escalate the situation by validating the core emotion and establishing a safe, private environment for expression without destroying the individual's protective coping mechanisms.

Key Concept

Therapeutic Communication in Response to Displacement and Maladaptive Coping
Estimated Time:1m 30s
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Topics

Coping Mechanisms

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