An older man who had radical surgery for oral cancer is refusing to see visitors and is losing weight, despite aggressive nutrition therapy. The nurse assesses this man for ineffective coping, related to dysfunctional grieving

Question

Which of the following patient outcomes of nursing care is the most important to implement in response to his mental health status? a. Is able to discuss how his coping mechan-isms are overwhelmed.
b. Performs daily self-feedings through a gastrostomy tube.
c. Effectively uses nonverbal forms of communication.
d. Exhibits self-confidence in regaining a sense of control.

Answer 1

D
The most important element of the nursing plan of care for this older adult is to create and strengthen self-confidence to improve his sense of control; doing so is likely to help him effec-tively manage the other aspects of his health care. The nurse helps create and improve this self-confidence by observing for strengths and integrating them into his daily care and by res-ponding with empathy and encouragement to his expressions of fears, emotions, and desirable goals. Helping this patient gain self-confidence is the most important outcome because this man has clinical indicators for depression—social isolation and weight loss.
Before this patient can benefit from discussing his stressors or from patient teaching, the nurse must establish a trusting, caring relationship and build some self-confidence because, at this point, this individual feels hopeless and believes that he has no control. The patient displays a lack of readiness for expressions about emotions, coping, or his stressors; by enhancing his self-confidence, the nurse prepares him to discuss coping mechanisms and stressors. This patient also displays a lack of readiness for learning a new psychomotor activity. Performing daily self-feeding is an outcome that gains importance as the day for discharge approaches. Effectively using nonverbal forms of communication is important for basic communication; however, he displays a lack of readiness for receiving help to achieve this outcome.