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Question

Difficulty: MediumGrief and Loss

A healthcare provider has just informed a 45-year-old client that their progressive illness is now considered terminal. After the provider exits the room, the client sits motionless in bed, staring blankly at the wall without speaking. Which of the following is the most appropriate initial nursing action?

  1. Pull up a chair, sit attentively beside the client, and state, 'I am going to stay here with you for a while.'Answer
  2. B
    Advise the client that talking about their feelings is a necessary step to begin the grieving process.
  3. C
    Conclude that the client's stoic demeanor is a cultural coping practice and step out to provide privacy.
  4. D
    Promptly contact social services to begin arranging for hospice care and advance directives.

Answer

Pull up a chair, sit attentively beside the client, and state, 'I am going to stay here with you for a while.'
The correct action is to offer a quiet, supportive presence. When a client receives a terminal diagnosis, the initial reaction is typically profound shock, numbness, or denial. During this phase, the client is often unable to process complex information or articulate their feelings. Sitting attentively with the client (therapeutic use of self) demonstrates empathy, provides emotional safety, and allows the client to process the news at their own pace without feeling pressured to speak.

Step-by-Step Solution

1
Analyze the client's clinical presentation following the delivery of difficult news.
The client is exhibiting silence, a flat affect, and immobility, which are classic manifestations of the initial shock and denial stage of grief.
Accurate assessment of the client's emotional state is required to select an intervention that matches their current readiness to process the information.
2
Evaluate the nursing action choices against the principles of therapeutic communication and prioritization.
Offering a silent, supportive presence addresses the client's immediate psychosocial needs without forcing premature conversation, making cultural assumptions, or inappropriately prioritizing future planning.
Therapeutic presence is the safest and most supportive initial intervention for a client experiencing an acute psychological crisis.

Key Concept

Therapeutic communication and presence during the acute shock phase of grief
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Topics

Grief and Loss

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