The family of an 88-year-old man with an acute exacerbation of chronic obstructive lung disease is at his bedside. He is experiencing dyspnea and placement on a ventilator is suggested
The patient is DNR and does not want extreme measures taken, but is unable to speak for himself. One daughter supports placement on a ventilator while the other believes that it will only add to his suffering. Which of the following statements by a nurse might facilitate communication between these family members? 1. "Can you tell me if he has ever been on a ventilator before, and how he responded to it then?"
2. "Given this confusion, maybe we should discuss his DNR status; I can go get the information we have on file."
3. "I know that this is a difficult situation—perhaps you would like to talk with a clergy person to help in making the decision."
4. "I'm sure that it is difficult seeing your father like this, can we spend a few minutes talking about your concerns at this time?"
4
Feedback
1 Asking this question might prompt conversation, but it focuses more on patient response than on the daughters' opposing opinions.
2 A therapeutic conversation is intended to address concerns in the attempt to alleviate suffering; resorting to the DNR status request is something that best comes later in the conversation when the father's wishes are addressed.
3 Nurses are capable of dealing with family interaction and conflict because of their family-focused communication skills; a response like this might send the message that the nurse does not want to deal with the issue.
4 An open ended statement such as "tell me your concerns about this illness and hospitalization" can allow the family to share their illness story.
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