A nurse is planning intervention for counselling a maternal client who has been newly diagnosed with sickle cell anaemia. Which of the following would be the most important psychosocial intervention at this time?

1. A

   Provide emotional support

2. B

   Avoid the topic of the disease at all costs

3. C

   Allow the client to be alone if she is crying

4. D

   Provide the client with all of the information regarding the disease

Appeared in: DHS Staff Nurse - 2018 (Shift-2nd)

Explanation

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• When a client is newly diagnosed with a significant condition like sickle cell anaemia, they often experience a range of intense emotions such as shock, denial, fear, and anxiety.
• The primary nursing goal at this initial stage is to establish a trusting, therapeutic relationship.
• Providing emotional support validates the client's feelings, reduces feelings of isolation, and helps them begin the process of coping.
• According to principles of crisis intervention, addressing the client's emotional state is the priority before any other intervention, such as education, can be effective.

Why Other Options Were Wrong

• Option B: Avoiding the topic is a non-therapeutic communication technique. It blocks the client's ability to express their feelings and can be interpreted as the nurse being uncomfortable or unwilling to help.
• Option C: Leaving a client alone when they are crying can be perceived as abandonment. The therapeutic action is to offer presence, for example, by saying, 'I'll stay here with you,' which conveys support and empathy.
• Option D: Providing a large amount of information to a client who is in a state of emotional distress is ineffective. High anxiety levels prevent the client from processing and retaining complex information.

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Clinical Relevance

• Nursing practice connection: Use the key finding related to The concept tested is the application of therapeutic communication and psychosocial support for a client newly diagnosed with a chronic and serious illness to guide bedside assessment, documentation, and the next nursing action.
• Establishing a therapeutic relationship from the moment of diagnosis is fundamental to long-term patient adherence and positive health outcomes.
• Nurses must be skilled in assessing a patient's emotional readiness to learn. Providing education at the wrong time is ineffective and can increase patient anxiety.
• What if? If the client's family member, not the client, is asking for all the information? The nurse should still prioritize the client's emotional state, but can gently explain to the family that information will be shared when the client is more settled, while still offering the family general support.

How to Approach the Question

• First, identify the keywords in the question: 'newly diagnosed,' 'maternal client,' 'sickle cell anaemia,' and 'most important psychosocial intervention.'
• Recognize that 'newly diagnosed' points to an initial crisis phase where emotional reactions are paramount.
• The term 'psychosocial' directs you to focus on emotional and social needs, rather than purely physical or educational ones.
• Apply Maslow's Hierarchy of Needs or principles of crisis intervention. Emotional safety and support are foundational needs that must be met before higher-level needs like learning (cognitive) can be addressed.
• Evaluate each option: 'Provide emotional support' directly addresses the immediate psychosocial need. The other options are either non-therapeutic (avoiding the topic, leaving the client), or poorly timed (information overload).

Concept Tested & Keywords

• Concept Tested: The concept tested is the application of therapeutic communication and psychosocial support for a client newly diagnosed with a chronic and serious illness.
• Stem keywords: counselling, maternal client, newly diagnosed, sickle cell anaemia, psychosocial intervention
• Lead-in keywords: most important
• Clinical cues: The phrase 'newly diagnosed' is a critical cue, indicating the client is likely in a state of initial shock or crisis, making emotional support the priority over detailed education.

Question ID

QMttG3Ss6yRD1Oj-QBPOwb

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Reference Book

E6 Nursing Fundamentals Taylor p. 962-964

E6 Nursing Brunner Adult Health 3SA Vol 1 Part 3 p. 145-147