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Difficulty: MediumCoping Mechanisms

A 24-year-old client suffered a traumatic amputation of their right dominant hand in an industrial accident earlier today. After recovering from anesthesia, the client points to their backpack and says to the nurse, "Could you hand me my sketchbook and pencils? I need to finish a portrait for my gallery show tomorrow." Which of the following is the most therapeutic nursing response?

  1. Art seems to be a major part of your life. How are you feeling about everything that has happened today?Answer
  2. B
    Your right hand was amputated in the accident, so you will not be able to work on the portrait tonight.
  3. C
    Why are you worried about a gallery show when you just survived a life-threatening industrial accident?
  4. D
    Try not to worry; physical and occupational therapy will teach you how to paint beautifully with your left hand.

Answer

The most therapeutic response is to acknowledge the importance of art to the client and use open-ended communication to explore their current feelings, allowing them to process the trauma at their own pace.
The client is using denial, an initial coping mechanism that acts as a psychological shock absorber against the overwhelming reality of the traumatic amputation. The correct response acknowledges what is important to the client and uses an open-ended question to gently focus on their emotions. This therapeutic approach does not validate the unrealistic plan, nor does it harshly confront the denial, allowing the client a safe space to process the profound loss at a tolerable pace.

Step-by-Step Solution

1
Identify the client's current behavioral cues and coping mechanism.
The client is exhibiting denial regarding the traumatic loss of their hand, acting as if the life-altering surgery did not occur.
Denial is a common, initial protective defense mechanism against sudden, overwhelming emotional trauma and loss.
2
Evaluate the nursing communication options against psychiatric nursing principles for handling denial.
Confronting the denial, asking 'why', and giving false reassurance are identified as non-therapeutic communication techniques.
These approaches block communication, provoke defensiveness, or strip the client of a necessary psychological defense before they are ready to cope with reality.
3
Select the response that fosters a therapeutic alliance.
Acknowledging the client's interest in art and asking an open-ended question about their feelings is the priority action.
This gently focuses on the client's emotional state without validating the unrealistic plan or harshly shattering the protective denial.

Key Concept

Therapeutic Communication for Denial as a Coping Mechanism
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Topics

Coping Mechanisms

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