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Difficulty: HardTherapeutic Communication

A nurse is caring for a client who recently underwent a total colectomy with the creation of a permanent ileostomy. During the first ostomy teaching session, the client abruptly pushes the supplies away, crosses their arms, and states, "I am never going to touch that disgusting thing. I would rather die than live with this bag attached to me." Which of the following is the most therapeutic response by the nurse?

  1. It sounds like you are feeling profoundly overwhelmed and distressed by this change to your body.Answer
  2. B
    It is completely normal to feel this way initially, but you will eventually adapt to managing the pouch.
  3. C
    Why do you feel that having the ostomy is worse than the severe illness you were experiencing before?
  4. D
    If you do not learn how to properly care for your stoma, you will be at a high risk for developing a severe skin infection.

Answer

The most therapeutic response is to reflect the client's feelings by stating that they sound profoundly overwhelmed and distressed by the change to their body.
The correct response utilizes the therapeutic communication technique of reflection. By stating that the client sounds profoundly overwhelmed and distressed, the nurse validates the client's intense emotions and alteration in body image without passing judgment. This approach keeps the lines of communication open, allowing the client to process their feelings of grief and disgust before the nurse attempts to proceed with ostomy education.

Step-by-Step Solution

1
Analyze the client's statement and nonverbal behavior.
The client is demonstrating severe distress, disgust, and an alteration in body image, accompanied by defensive body language (crossing arms, pushing supplies away).
Understanding the client's affective state is required to select an appropriate therapeutic communication technique.
2
Evaluate the nursing options against evidence-based therapeutic communication principles.
The nurse must prioritize acknowledging and validating the client's current emotional state before attempting any physical teaching or offering solutions.
Clients experiencing high anxiety or acute grief cannot effectively process educational information until their psychosocial needs are addressed.
3
Identify the response that best validates the client's feelings.
The response reflecting the client's feelings of being overwhelmed and distressed is the only option that facilitates open communication without judgment, minimization, or probing.
Reflection demonstrates active listening and encourages the client to elaborate on their emotions.

Key Concept

Therapeutic Communication: Reflection and Validation
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Topics

Therapeutic Communication

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