A terminally ill 70 years old lady has fears of being alone and constantly wants someone near her. Which of the following actions by the nurse would be most appropriate to deal with her loneliness?

Appeared in: AIIMS Jodhpur SNO-2023

Explanation

This action directly addresses the patient's stated fear of being alone through the therapeutic use of self.
Providing presence is a key nursing intervention for psychological distress in dying patients, assuring them they are not abandoned.
Therapeutic touch, such as holding a hand, is a powerful non-verbal tool that communicates caring, reduces anxiety, and offers comfort.
Active listening allows the patient to express her fears and feelings, which is crucial for emotional processing and feeling validated at the end of life.

Option A: This is a form of environmental distraction. While pleasant, it does not address the patient's core need for human connection and can be perceived as avoidance of her emotional needs.
Option C: Using television is an impersonal distraction that can increase feelings of isolation by substituting human interaction with electronic noise.
Option D: This response is dismissive and invalidates the patient's feelings. It offers a cognitive solution to an emotional crisis, which is inappropriate and untherapeutic for a dying patient.

Visual 1: Infographic: 'Pillars of Psychosocial Support in Palliative Care.' This visual would show Presence, Therapeutic Communication, Symptom Management, and Family Support as the four pillars supporting the patient.
Visual 2: Illustration: 'The Power of Presence.' A simple, respectful drawing of a nurse sitting quietly by a patient's bedside, holding their hand, to illustrate the concept visually.

Clinical Relevance

Nursing practice connection: Knowing Psychosocial care for terminally ill patients, specifically addressing loneliness and fear of abandonment helps nurses interpret findings accurately and avoid errors in routine assessment, medication administration, and patient teaching.
A nurse's role in end-of-life care extends beyond physical tasks to providing crucial emotional and psychological support. This is a core competency of holistic nursing.
Recognizing and directly addressing a patient's expressed fears, rather than using distractions, is fundamental to building trust and providing compassionate care.
What if the patient was non-verbal or unconscious? In that case, therapeutic touch and silent presence become even more critical. The nurse should still talk to the patient, as hearing is believed to be the last sense to be lost.

How to Approach the Question

First, identify the core problem presented in the clinical scenario. Here, the patient's problem is explicitly stated: 'fears of being alone' and 'loneliness'.
Next, analyze the lead-in phrase 'most appropriate action'. This requires you to evaluate which option directly and most effectively addresses the patient's core problem.
Evaluate each option's therapeutic value. Ask yourself: 'Does this action provide direct human connection and emotional support, or is it a distraction or dismissal?'
Eliminate options that are impersonal (TV), indirect (window), or dismissive (lecturing).
Select the option that involves direct, compassionate, human-to-human interaction, which is the gold standard for addressing fear and loneliness in end-of-life care.

Concept Tested & Keywords

Concept Tested: Psychosocial care for terminally ill patients, specifically addressing loneliness and fear of abandonment.
Stem keywords: terminally ill, 70 years old, fears of being alone, loneliness
Lead-in keywords: most appropriate
Clinical cues: The patient's constant desire for someone to be near her is a direct expression of her primary fear.

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Practise the full AIIMS Jodhpur SNO-2023

Attempt every question from this paper in a timed mock, then review the full solution for each one.