An adult client is admitted with back pain and found to have a metastatic tumor on the spine. The health care provider (HCP) explains that the client has few months to live and is likely to become totally paralyzed below the waist soon. The next day, the client tells the nurse of wanting to be discharged despite the HCP's recommendation that the client stay a few more days. Which is the most appropriate initial response by the nurse? A)"I understand your desire to leave, but it would be very risky." B)"I will ask the palliative care nurse to talk with you to help clarify your care goals." C)"I will let the HCP know that you want to be discharged and do everything I can to make it happen." D)"Tell me more about your need to leave the hospital."

Question

Quizplus · Accepted Answer

Knowing that this client has just received bad news with a limited prognosis, the nurse should anticipate that the client's urgent request for discharge may be due to concerns about needing to complete unfinished business while still functioning. Examples of end-of-life "business" include concerns about family, finances, business responsibilities, and dealing with property and possessions. To get more information, the nurse should assess the client's concern and the motivation behind the request by asking an open-ended question, such as "Tell me more about ______." It is important to gain the client's trust, to actively listen, and to avoid immediately jumping to problem-solving during this assessment (Option D). With the information gained from the assessment, the nurse will be able to problem-solve with the client while intervening and advocating as appropriate. (Option A) Although leaving may be risky for the client, the nurse's warning is not an appropriate initial action. (Option B) The nurse is not taking the time to listen but is passing this responsibility to another member of the team. A palliative care nurse referral may be appropriate in this situation, but the nurse needs more information and must take the time to listen to the client now. (Option C) This option does not acknowledge the HCP's concern about the client still needing to be hospitalized. The nurse must first understand the client's situation and then take this information to the HCP to negotiate for a solution that acknowledges the concerns of both. Educational objective: A client facing the end of life often has unfinished business that needs to be completed, which may motivate the client to become anxious or insist on discharge. The nurse should assess the client's concern and use this information to design a care plan that will allow the client to make necessary preparations while ensuring medical care to control symptoms.

An Adult Client Is Admitted with Back Pain and Found