One of these questions and answers make no sense whatsoever

[Luv2care0907]

I went and bought Saunders yesterday. I took the Assessment quiz. I would like someone to please tell me the rationale behind this question because I cannot understand how anyone in their right mind could choose this as the correct answer.

The question is this:

A 63-year-old woman whose husband died 2 months ago says to the visiting nurse, "My daughter came over yesterday to help me move my husband's things out of our bedroom, and I was so angry with her for moving his slippers from where he always kept them under his side of our bed. She doesn't know how much I'm hurting." Which statement by the nurse would be therapeutic?

1. "It's OK to grieve and be angry with your daughter and anyone else for a time."

2. "I know just how you feel because I lost my husband last summer."

3. "Although it's a troubling time for you, try to focus on your children and grandchildren."

4. "You need to focus on the many good years you both enjoyed together and move on."

Rationale: The therapeutic statement is the one that gives the client permission to grieve and acknowledges that anger is part of loss and that it may be aimed at the people who are trying most to help and are closest. Options 2, 3, and 4, are all non-therapeutic. They do not encourage the client to express feelings. :argue:

First of all, this does not take into account anyone else's feelings but the grieving wife. Venting anger at people that are probably suffering and hurting in many cases equal to the wife over a misplaced pair of shoes is the absolute worst thing that woman could do. Not only does she risk cutting off the people that love her leaving her with no one but she can severely damage these relationships for many years to come. How stupid is that to suggest that it is "ok to be angry with these folks that are trying to help her?" Anger is one of the most damaging, hurtful aspects of our interactions with people and I think it would have been better to have said something like this, "It's OK to grieve, but keep in mind that everyone is hurting over this person that must have been so important to your family." In reality, I have seen nurses intervene to communicate these needs to the family and it helps to avert the damage that anger could have potentially caused. Anger should be reserved for something that is really an issue. How many people in the real world would be able to resolve this in their minds afterward and say, "Oh, I understand that she was just angry over the loss of her husband and she loved me enough to vent on me over a pair of shoes I was trying to put away." Like nobody.

:chair:

Vera

[Atheos]

A was definitely the right answer. I am not sure how it can even be considered the best of several answers.

In the throes of grief other people's feelings really just don't matter very much and anyone trying to chide you for being angry would quickly find that they have effectively shut themselves out as the patient would no longer want you telling them anything.

[SunshineBSN]

Your reading into the question too much. The person you need to think about is the patient your talking to. Know the rules: Don't give advice (Option 3 and 4) and secondly, telling someone you understand how their feeling is a big no no because you dont know how their feeling(Option 1). Option 2 is the MOST therapeutic.

NCLEX wants you to critically think. THey want to know what you would choose the best. Focus on the client and what the subject of the question is asking you - what will help the client in the grieving process?

HOpe that helps

[HeartsOpenWide, RN]

Just reading #1 I knew it was the right answer. After reading the rest of the options, they only confirmed that the #1 option was correct.

First of all, this does not take into account anyone else's feelings but the grieving wife.

First of all, your patient is your patient, not the other people and their feelings.

How stupid is that to suggest that it is "ok to be angry with these folks that are trying to help her?" Anger is one of the most damaging, hurtful aspects of our interactions with people

Anger should be reserved for something that is really an issue

I suggest you review the stages of grieving; anger is one of them, and it is a very valid feeling--her husband dying is an issue. this might not be the most ideal answer, but it is the best answer out of the ones given.

[Luv2care0907]

Whatever happened to the holistic approach? Holistic means - characterized by comprehension of the parts of something as intimately interconnected and explicable only by reference to the whole. See, I saw that answer as advice and I was thinking critically. I recognized that there was more at stake here for this woman and I wouldn't have wanted to see further grief in her life caused by some irrational anger that she would later regret. Not only was it bad advice, but it was given to someone who was acting irrationally in her grief state. At least one of you concluded that you would backtrack once you had gained her trust.

If anyone concludes that I am judging her anger, you are grossly mistaken. I understand that she is angry and I do know what it is like to feel that kind of anger. I have not only experienced it myself but have helped others through their anger after such a loss. I have seen babies and children die in horrific ways. I have had friends lose loved ones. I have experienced loss.

What bothers me is that I dismissed that answer as the last one I would do because of the bad advice. I have to start thinking in terms of this one-sided business/client approach in order to pass this exam and totally forget all my holistic training from the past. :hdvwl: Clearly, all of you have mastered this.

Thank you all for responding. It helps me to think in terms of this other approach.

Vera

[yvesul]

I recognized #1 as the right answer even before I read the other responses. After I read them, I was even more confident in my belief that #1 was the correct response.

Anger is an OK emotion. It's a natural response and can be a positive force when channeled in a constructive direction. The nurse's job in this situation is to first acknowledge and accept the patient "where she's at" at the moment. After giving the patient a chance to vent her emotions, then and only then, will the nurse be successful in helping the patient find positive ways to deal with her feelings of anger.

After the nurse has provided a safe, accepting environment for the patient to vent the force of her emotions ... the patient will probably be more able to see that the daughter meant no harm, no disrespect, etc. ... that the daughter is probably also grieving for her dead father ... and needs to have HER grief acknowledged, too. Gradually, the widow can be helped to see that the daughter was "just trying to help" and that it would be best (and fair) to try to maintain a positive relationship with her daughter as both women grieved the loss of their husband/father.

Also, response #1 is provides an open invitation to the widow to talk further about her feelings and establish a trusting relationship with the nurse. The 3 wrong answers all shut down the widow's further communication and explanation of her feelings. They redirect her focus on other things rather than on the primary issues that are causing the problems. By avoiding the primary underlying issues, those issues will just be buried -- and be likely to resurface again as they are left unresolved.

I so totally agree.

[Luv2care0907]

In her posting history she said she was a NICU nurse 18 years ago, but let her license lapse...therefore she's taking NCLEX again.

Right. I have been home educating my 6 children for the last 18 years. Now before you judge me :) , my son is in college hoping to become an engineer and has been consistently scoring top of his class in Algebra 2. He just made the only 100 a few days ago. My other son has experienced the exact same thing. My daughter scored the highest score in Ohio, where she lives now, for an essay. She happens to be horrible at math. Those are my three oldest. One of the neatest things about home education was being able to take what I had learned in nursing and use it in terms of teaching. When we discussed medical issues, it was like second nature to me. When they were very young, I taught them all sorts of first aid techniques. My oldest daughter is working to become a nurse or a physical therapist. She hasn't decided yet. Temporarily, she is working in an assisted living facility as an aid. She also was caring for an elderly lady here one on one and did a great many functions of a nurse including vital signs, bathing, and encouragement.

I loved being a nurse. But I'm glad to have given so many years to my children to make them successful. It was worth it for me personally. Both of these jobs for me involve caring for people, which is why I became a nurse in the first place. I hope that aspect of nursing hasn't changed.

Vera

[truern]

Vera, not judging you at all :)

I think any sacrifice for one's children will be greatly rewarded!

Good luck with NCLEX :)

[nursemike, ASN, RN]

I also saw 1.) as the only correct answer. To me. I think it helps to seperate the feeling of anger from what one does with it. Anger itself is not negative or irrational. In some circumstances, it may be the most appropriate response. Giving the patient permission to feel whatever she feels is not the same as giving her permission to do whatever she feels like. In the scenario, the daughter tresspassed on the mother's territory, and the mother was angry.

Lashing out at the daughter would not be a constructive resolution of that anger, but that's beyond the scope of the question. The anger could as easily motivate the mother to explain that she was not ready to make the changes the daughter initiated, and needed more time to grieve in her own way.

Now, in my family, it never goes quite that smoothly. The angry person snaps at the other, the offended person reacts defensively, but then steps back and remembers they love the angry one, a calmer discussion ensues and things are worked out, understanding increases. Not textbook. But our bonds are strong enough that one wrong remark under stress does not lead to a lifetime estrangement.

As the nurse in the scenario, my next response would likely be, "Why do you think she moved the shoes?"

I don't think I've ever had a perfectly therapeutic exchange. I'd probably end up trying to advise the patient to explain to the daughter why moving the shoes upset her. But in real-life situations, I have found being as therapeutic as I can manage to be helpful.

ETA: If I had more time to think, I might ask, "Why did her moving the slippers upset you?" or reiterate, "Leaving the slippers in their usual place is part of your grieving process." But, as noted, I'm far from adept at this therapeutic crap, so I'll let my original answer stand, because in a real-world exchange I would probably be wrong about half the time. Still, even being partly therapeutic helps.