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Zorluk: Çok zorSupport Systems

A hospice nurse is evaluating the home support system for a client with terminal cancer. The client is alert, oriented, and has explicitly stated a wish to remain at home. The client's spouse is the primary caregiver but suffers from severe rheumatoid arthritis, which causes difficulty opening medication bottles and drawing up oral syringes. The couple's estranged adult child recently moved in to assist, but the spouse refuses to let the child administer liquid morphine, stating, 'I do not trust them with narcotics, so I struggle to do it myself.' The adult child privately reports to the nurse that the spouse often delays the client's scheduled doses by over an hour because of severe hand pain. Which action by the nurse is the priority?

  1. A
    Speak privately with the adult child to teach them how to administer the morphine when the spouse is experiencing severe joint pain.
  2. B
    Notify Adult Protective Services of potential medical neglect, as the spouse's physical limitations are delaying the client's scheduled pain management.
  3. Observe the spouse's physical ability to prepare the medications and facilitate a family meeting to establish safe, agreeable caregiving roles.Cevap
  4. D
    Recommend that the client be transferred to an inpatient hospice unit because the current home environment is unsafe for medication administration.

Cevap

The correct action is to observe the spouse's physical ability to prepare the medications and facilitate a family meeting to establish safe, agreeable caregiving roles.
The priority intervention when a support system is fractured by mistrust and physical limitations is to objectively assess the barrier and facilitate open communication. By observing the spouse's actual ability to manage the medication, the nurse gathers objective data. Facilitating a family meeting brings the conflict into a therapeutic space where the nurse can mediate, help the family establish boundaries, and integrate the adult child into the support system in a way that the spouse finds acceptable, all while honoring the client's wish to remain at home.

Adım Adım Çözüm

1
Analyze the clinical situation and the client's wishes.
The client is alert and wishes to stay home. Pain management is being delayed due to the primary caregiver's physical limitations.
Establishing the baseline of client autonomy and identifying the physical barrier to care.
2
Identify the root cause of the barrier within the support system.
The delay is caused by a family conflict (mistrust) that prevents the primary caregiver from utilizing the available secondary support (the adult child).
Understanding whether the issue is a lack of resources or an inability to use existing resources due to psychosocial dynamics.
3
Evaluate the proposed interventions against therapeutic communication and the nursing process.
Going behind the spouse's back, calling state authorities, or transferring the client all bypass the necessary steps of assessment and mediation.
Nursing interventions must be the least restrictive, promote trust, and follow the assessment-first rule.
4
Select the intervention that addresses both the physical and psychosocial needs.
Directly assessing the spouse's physical ability while providing a structured, mediated environment (family meeting) to safely integrate the adult child into the care plan.
This optimizes the existing support system, respects client autonomy, and resolves the conflict therapeutically.

Anahtar Kavram

Family Dynamics and Support System Optimization in Hospice Care
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Konular

Support Systems

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