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Difficulty: MediumCoping Mechanisms

An adult client with end-stage chronic obstructive pulmonary disease (COPD) is receiving palliative care on a hospice unit. During a visit, the client's eldest child insists that the nursing staff arrange for an immediate physical therapy evaluation, stating, "We need to build up my parent's stamina for our family hiking trip next month." Which of the following is the most therapeutic nursing response?

  1. A
    I understand you want your parent to get stronger, but at this stage of the disease, our focus is entirely on comfort measures.
  2. B
    Why do you feel that physical therapy is necessary when your parent is currently struggling to breathe at rest?
  3. It sounds like you have wonderful memories of hiking together. This must be a very difficult time for you.Answer
  4. D
    I will contact the primary healthcare provider right away to see if we can get a physical therapy order added to the chart.

Answer

The most therapeutic response is to reflect the feelings and acknowledge the special memories, stating: 'It sounds like you have wonderful memories of hiking together. This must be a very difficult time for you.'
The correct response utilizes the therapeutic techniques of empathy and reflecting feelings. Denial is a protective, temporary coping mechanism often seen in the early stages of grief. By focusing on the emotional meaning behind the adult child's statement (the cherished memories of hiking), the nurse validates their feelings and establishes a supportive relationship. This approach allows the individual to feel heard and understood without the nurse having to either confront the denial aggressively or support the unrealistic medical plan.

Step-by-Step Solution

1
Analyze the clinical scenario and the family member's behavior.
The adult child is exhibiting denial, a common defense mechanism in anticipatory grief, by planning an unrealistic future hiking trip despite the client's end-stage terminal illness.
Recognizing the underlying psychological state (denial and acute grief) is essential for selecting an appropriate therapeutic intervention.
2
Evaluate the nursing response options against principles of therapeutic communication.
Responses that confront the denial bluntly, ask 'why', or feed into the unrealistic expectation with false reassurance are non-therapeutic.
In the initial stages of severe grief, stripping away a protective coping mechanism without first providing emotional support can cause extreme distress and damage the nurse-client relationship.
3
Select the response that best addresses the underlying emotion.
The response acknowledging the special memories and validating the difficulty of the situation provides necessary emotional support.
Therapeutic communication prioritizes exploring feelings and showing empathy, which creates a safe environment for the family member to eventually process reality.

Key Concept

Therapeutic communication and management of denial in anticipatory grief.
Estimated Time:1m 15s
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Topics

Coping Mechanisms

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