A patient with severe orthopedic injuries after an automobile accident is irritable,angry,and belittles the nurses who provide his care.While the nurse is changing the dressing over a deep laceration,the patient screams,"Don't touch me! You are so stupid;you're only making it worse!" Which intervention would be most therapeutic?

Question

Quizplus · Accepted Answer

Apologizing,explaining the need for the intervention,and jointly exploring options to reduce its discomfort make use of both validation and problem solving.Involving the patient in problem solving increases his sense of control over his circumstances.Loss of control over one's circumstances typically increases anxiety and often accompanies serious medical illnesses or trauma.If the nurse were unable to maintain a professional demeanor because of countertransference,leaving and switching assignments would be appropriate,but that situation is not indicated here.Suggesting the patient change his own dressing is a hostile response by the nurse designed to "put him in his place";it may serve to vent the nurse's own frustration,but it is obviously not addressing the underlying causes of the patient's hostile acting out.Acknowledging that it is frustrating could be a helpful adjunctive intervention if accompanied by another response that addresses the root cause of the patient's acting out.

A Patient with Severe Orthopedic Injuries After an Automobile Accident