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Difficulty: MediumTherapeutic Communication

A nurse is caring for a client in the emergency department who has just experienced a spontaneous abortion at 10 weeks of gestation. The client is crying and states, "If only I had not gone for that long run yesterday, my baby would still be alive." Which of the following is the most therapeutic response by the nurse?

  1. A
    Please do not blame yourself; physical exercise does not cause a miscarriage.
  2. B
    Most early pregnancy losses are due to genetic abnormalities, not anything you did.
  3. It sounds like you are feeling responsible for the loss of your baby.Answer
  4. D
    Why do you think that your exercise routine is related to losing the pregnancy?

Answer

The most therapeutic response reflects the client's feelings of responsibility and guilt, stating, "It sounds like you are feeling responsible for the loss of your baby."
The correct response uses the therapeutic technique of reflection. By restating the core emotion (feeling responsible), the nurse validates the client's feelings of guilt and grief. This opens the door for the client to explore their emotions further in a safe, non-judgmental environment. It addresses the emotional need before attempting to provide medical education.

Step-by-Step Solution

1
Analyze the client's statement and emotional state.
The client is experiencing acute grief and expressing profound guilt, erroneously blaming a recent physical activity for the spontaneous abortion.
Understanding the core emotion (guilt/grief) is essential for selecting a response that addresses the client's immediate psychological needs.
2
Evaluate the nursing responses based on therapeutic communication principles.
Responses providing medical facts, reassurance, or asking 'why' fail to validate the client's current emotional distress. The response that reflects the client's feelings acknowledges the emotion without agreeing with the incorrect premise.
Therapeutic communication prioritizes the validation of the client's feelings over providing immediate education, reassurance, or rationalization.

Key Concept

Therapeutic Communication: Reflection and Validation
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Topics

Therapeutic Communication

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