A woman whose sister-in-law died of cancer is herself diagnosed with breast cancer after a mammogram. Her doctor has advised a lumpectomy followed by radiation and chemotherapy
The patient is awaiting surgical, oncology, and radiation consults and is scheduled for surgery the day after tomorrow. She tearfully tells the nurse, "I keep thinking about how there is something growing inside me that could kill me. It's like living with a bomb inside you, and you don't know if or when it's going to go off.". Which nursing intervention would be most likely to be helpful? a. Interact frequently with the patient, and provide books and games to help her stay busy and distract her from her negative thinking.
b. Validate her feelings, and with her permission, have a member of a breast cancer survivor's support group visit her in her hospital room.
c. Provide support and validate her feelings, then offer to have the hospital chaplain stop by to talk with her.
d. Sympathize with her concerns, but remind the patient that she has not even had the surgery yet, and the treatments may well rid her of cancer.
B
The patient is just beginning to cope with a very serious and potentially fatal diagnosis and is dealing with a variety of thoughts and concerns. Others who have been where she is have likely had similar experiences and can validate her feelings and discuss her concerns in a very genuine manner that would be difficult for those who have not dealt personally with this disease to match. Distraction can be helpful for reducing anxiety temporarily but does not help the patient process or cope with her questions and fears. Suggesting the chaplain would be appropriate if the patient had spiritual needs, but that is not clearly indicated here; further, the patient might perceive this as indicating that staff believe her disorder will prove fatal. Sympathy is rarely therapeutic, and noting that treatment has not yet begun implies that she should not be distressed, at least until the results of treatment are known. This is a disconfirming, nontherapeutic response that in essence tells her that her feelings are wrong.
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