Question

The nurse is repositioned a confused patients from a supine position to a side-lying position. The nurse had asked the patient to shift her weight accordingly, but the patient has not responded to the nurse's request. How should the nurse respond?

A: reposition the patient without the patient's assistance.
B: ask the patient if she is feeling confused.
C: rephrase the direction in different terms
D: enlist the assistance of a colleague

Answer 1

The nurse should rephrase the direction in different terms when a confused patient does not respond to instructions for repositioning. This approach caters to the patient's comprehension levels. If repeated attempts fail, seeking another nurse's help would be the next appropriate step.

Step-by-step explanation:

When a nurse encounters a confused patient who does not respond to instructions for repositioning from a supine position to a side-lying position, the nurse should opt for C: rephrase the direction in different terms. Given that the patient is confused and did not shift her weight as requested, it's likely that the patient did not understand the instruction. Therefore, the nurse should attempt to communicate in a simpler or clearer way that the patient might better understand. If this approach does not work, enlisting the assistance of a colleague may be necessary for safety reasons. Asking the patient if she is feeling confused (option B) is less likely to be helpful, as the patient may not be able to accurately assess or communicate their state of confusion. Simply repositioning the patient without the patient's assistance (option A) is generally a last resort, as it could lead to injury or distress for the patient.