Question

A client receives a diagnosis of cancer after a biopsy of a suspicious lymph node. The client states, "You must have made a mistake, I want a second opinion." Which stage of grief is the client experiencing? A. Denial B. Anger C. Bargaining D. Despair

Short answer

A. Denial

Step-by-step solution

Identify the Stage of Grief

The client's statement reflects disbelief and difficulty in accepting the diagnosis. This is indicative of the first stage of the Kübler-Ross model, which is Denial. Denial is a defense mechanism to cope with the initial shock of a negative reality, such as a cancer diagnosis.

Key concepts

Kübler-Ross Model

The Kübler-Ross Model, also known as the Five Stages of Grief, is a framework that outlines a series of emotions experienced by people undergoing grief and loss, such as the death of a loved one or receiving a serious medical diagnosis like cancer.

The model includes the following stages:

• Denial: This is a defense mechanism where the person refuses to accept the reality of the situation. It's a temporary response that gives the individual more time to adjust to distressing news.
• Anger: As the truth of the situation begins to take hold, feelings of frustration and irritation may arise. The person may lash out, placing blame on others or the circumstance.
• Bargaining: The individual may attempt to negotiate to escape or delay the reality of the situation, often involving 'What if' and 'If only' statements.
• Depression: Reality sets in, leading to feelings of sadness, regret, and grief. The person may become quiet, withdrawn, and reflective.
• Acceptance: In this final stage, the individual comes to terms with the reality of their situation and starts adjusting to it.

Understanding this model is imperative for healthcare professionals, as it helps them to recognize and empathize with the emotional state of their patients. Patients may not progress through the stages in order and may revisit stages, reflecting the personal and non-linear nature of the grieving process.

Cancer Diagnosis Coping

Coping with a cancer diagnosis can be an incredibly stressful and life-altering experience. The initial response often includes a range of emotions and may align with the stages of the Kübler-Ross model.

Here are several coping mechanisms that individuals might adopt:

• Information Seeking: Gathering details about the diagnosis, treatment options, and prognosis can help individuals gain a sense of control.
• Social Support: Leaning on friends, family, or support groups provides emotional comfort and practical assistance.
• Professional Counseling: Therapists and counselors who specialize in dealing with chronic illnesses can offer strategies to manage the emotional fallout of a diagnosis.
• Stress Reduction Techniques: Practices such as meditation, mindfulness, and relaxation exercises can alleviate stress and improve psychological well-being.
• Positive Reframing: Focusing on the positives, setting goals, and celebrating small victories can help maintain a hopeful outlook.

Healthcare providers must recognize these coping strategies and support their integration into a patient’s care plan, ensuring a comprehensive approach to treatment that includes psychosocial support.

NCLEX-RN Examination Psychosocial Integrity

The NCLEX-RN examination includes a component that tests a nurse’s ability to provide care in respect to psychosocial integrity. This involves understanding the emotional, mental, and social factors that can affect a patient's illness, treatment, and the healing process.

Nurses must be adept at:

• Assessing Psychosocial Responses: Identifying emotional responses, behavioral changes, and psychological concerns related to illnesses, such as depression or anxiety.
• Providing Emotional Support: Offering compassion, understanding, and comfort to patients while facilitating coping strategies.
• Advocating for the Patient: Ensuring that a patient’s preferences and needs are communicated and considered in the treatment plan.
• Education: Teaching patients and their families about the psychosocial aspects of illness and the importance of ongoing support.

By focusing on psychosocial integrity, nurses contribute to a patient’s holistic recovery, recognizing that healing is not solely physical. Furthermore, this care ethos aligns with ethical nursing practice and promotes patient-centered care.