A patient with severe orthopedic injuries after an automobile accident is irritable, angry, and belittles the nurses who provide his care

Question

While the nurse is changing the dressing over a deep laceration, the patient screams, "Don't touch me! You are so stupid; you're only making it worse!" Which intervention would be most therapeutic? a. Wordlessly leave the room and ask to switch assignments with another nurse who may be more acceptable to the patient.
b. Apologize, explain that the dressing change is necessary to prevent infection, and jointly explore ways to decrease the discomfort involved.
c. State: "Since you believe we nurses aren't able to change your dressing, perhaps you would like to change it yourself.".
d. State: "This is frustrating for both of us, but there is no choice because your doctor has ordered this dressing change.".

Answer 1

B
Apologizing, explaining the need for the intervention, and jointly exploring options to reduce its discomfort make use of both validation and problem solving. Involving the patient in problem solving increases his sense of control over his circumstances. Loss of control over one's circumstances typically increases anxiety and often accompanies serious medical illnesses or trauma. If the nurse were unable to maintain a professional demeanor because of countertransference, leaving and switching assignments would be appropriate, but that situation is not indicated here. Suggesting the patient change his own dressing is a hostile response by the nurse designed to "put him in his place"; it may serve to vent the nurse's own frustration, but it is obviously not addressing the underlying causes of the patient's hostile acting out. Acknowledging that it is frustrating could be a helpful adjunctive intervention if accompanied by another response that addresses the root cause of the patient's acting out.