Throughout the course of his illness,a patient has denied its seriousness,even though his health professionals have explained prognosis of death very clearly.Physiologic signs now indicate that he will probably die within a short period of time,but he is still firmly in a state of emotional denial.The patient says to the nurse,"Tell my wife to stop hovering and go home.I'm going to be fine." How should the nurse respond?

Question

Quizplus · Accepted Answer

Not all patients go through all the traditional stages of grieving.It is not the nurse's responsibility to move patients sequentially through each stage of the dying and grieving process with the goal that everyone ends life accepting death.It is a nursing responsibility to accept and support people "where they are" and help them to express their feelings.Nurses need to understand patients,not change them.In this situation,denial may be very important to this patient,as an emotional defense and coping strategy. "You seem sure ...tell me ...what you are feeling" restates what the patient has said (indicating understanding)and encourages expression of feelings-both are supportive.Even though moving him through stages is not the goal in this situation,support does facilitate that. Telling the patient that his physical signs indicate that death is imminent is presenting truth and reality; however,the exact time of death is not always predictable.Forecasting the hour of death can have negative impact on the family as they anticipate the event with emotion and exhaustion.Presenting reality is appropriate in certain circumstances earlier in the dying process,but not in this situation because it has already been tried with no change in the patient.Presenting reality does not support the patient's needs at this time. Saying "It seems to me you would be feeling some anger ..." is directed toward moving the patient from denial and suggesting he should feel something he has not yet expressed.This is not therapeutic.Saying "It would be best for your family ..." presumes that the nurse knows more about what is "best" for the patient's family than the patient himself.This statement is also judgmental.

Throughout the Course of His Illness,a Patient Has Denied Its