A home care nurse is visiting an older adult client who tells the nurse that she is feeling tired, is unable to shop for groceries, and would like the nurse to shop for her. Shopping and performing personal errands for the client is prohibited in the nurse's job description. Which of the following is an appropriate nursing response?

Clients have the right to make informed decisions about their own healthcare, including the right to refuse treatment. It is important to respect the client's autonomy and honor their decision if they choose to refuse the treatment. The nurse should provide the client with information about the potential benefits and risks of the treatment, as well as any alternatives, and support the client in making an informed decision.
Let's examine why the other choices are incorrect:

A. "You will be discharged sooner if you have the prescribed ECT treatments." This statement does not address the client's right to refuse treatment and instead focuses on potential consequences of refusing. It is important to respect the client's autonomy and prioritize their right to make decisions about their own healthcare.

C. "You are admitted to a mental health facility and must follow the provider's orders." While clients in a mental health facility may have certain treatment plans, including ECT, it is still important to respect their right to refuse treatment. Admitting to a facility does not negate the client's right to make decisions about their own care.

D. "You have already signed the consent form, so you cannot refuse today's treatment." Signing a consent form does not mean that the client loses their right to refuse treatment. Consent forms are signed to acknowledge that the client has been provided with information about the treatment and has agreed to undergo it voluntarily. However, the client still has the right to change their mind and refuse the treatment at any time.

Answer: (D) Suppression

Rationale:

A) Dissociation: Dissociation involves a disconnection from reality or the separation of thoughts, memories, or identity from conscious awareness. In this scenario, the client is not displaying any signs of disconnecting from reality or avoiding awareness of the situation through dissociation, making this defense mechanism unlikely.

B) Projection: Projection occurs when an individual attributes their own unacceptable thoughts or feelings to others. The client in this situation is not blaming others or attributing their actions to someone else, so projection is not the defense mechanism being demonstrated here.

C) Intellectualization: Intellectualization involves using reasoning or logic to avoid emotional stress or anxiety. While the client does mention logical-sounding plans about things working out next week, their overall response does not primarily reflect an avoidance of emotion through reasoning, so intellectualization is not the correct choice.

D) Suppression: Suppression is the conscious decision to delay paying attention to an emotion or need in order to cope with the present situation. The client acknowledges the stress of being fired but chooses to push aside their distress by stating that "everything will work out somehow next week," indicating they are consciously choosing to set aside their anxiety for the time being. This aligns with the concept of suppression.