Why nurses explore the spouse’s role in encouraging self-care for a stroke patient with right-sided paresis.

In caring for a client with right-sided paresis due to stroke, what action should the nurse take regarding the spouse feeding the client?

• A. Instruct the spouse to require the client to feed independently.
• B. Suggest the spouse hire an aide to feed and bathe the client.
• C. Advise the spouse to consider an extended care facility for the client.
• D. Determine why the spouse is not encouraging self-care by the client.

Answer: (D)

Determining why the spouse is not encouraging self-care by the client is a valuable approach because it addresses underlying factors that may be impacting the care process. Encouraging clients to engage in self-feeding, even with assistance, is an important part of rehabilitation, especially for a patient recovering from a stroke. By exploring the spouse's perspective, the nurse can identify barriers—such as the spouse's fears, misconceptions about the client's capabilities, or lack of knowledge about appropriate assistance techniques. This understanding can lead to a more tailored support strategy that promotes the client's independence and dignity while also educating the spouse on how to encourage and facilitate self-care effectively. Providing motivation for the client to participate in their care enhances their recovery and fosters a sense of autonomy. It also helps to build a supportive environment in which the spouse can feel empowered and capable of helping the client in an appropriately balanced way. Engaging with the spouse in a constructive dialogue allows the nurse to guide the family toward better methods of support, ultimately benefiting the client’s rehabilitation process.

Let’s talk about a scenario that’s all too real in hospitals and home settings: a patient with right-sided paresis after a stroke, and the spouse who’s doing the feeding. The question isn’t about who can feed the patient best; it’s about how to support independence while keeping safety in check. When a nurse faces this situation, the most important first step isn’t rushing to fix the feeding routine. It’s understanding why the spouse isn’t encouraging self-care by the client.

Here’s the thing: stroke recovery hinges on rebuilding independent function, even if the recovery is partial. Encouraging self-feeding, with a little help when needed, is a big part of rehab. It helps the brain relearn and strengthens confidence in the patient. If the spouse steps in too eagerly—without addressing the underlying barriers—the patient might miss chances to regain meaningful function, and the caregiver can burn out. So, the right move is to ask a thoughtful, collaborative question: why aren’t you encouraging self-care?

Why the other options miss the mark

Let’s unpack the common choices and why they fall short in this scenario.

• A. Instruct the spouse to require the client to feed independently.

That sounds noble in theory, but it’s blunt and ignores the patient’s current abilities and safety concerns. If the client truly cannot manage a meal safely yet, pushing independence can raise aspiration risk or lead to frustration and failure. The nurse’s role isn’t to police behavior; it’s to support a measured plan that respects dignity and safety.

• B. Suggest the spouse hire an aide to feed and bathe the client.

Hiring help can be part of a broader care plan, but it doesn’t address the root cause. If independence is discouraged because of fear or misperceptions, outsourcing care may relieve immediate tasks but won’t help the patient relearn self-feeding or empower the spouse with the right techniques.

• C. Advise the spouse to consider an extended care facility for the client.

That’s a significant step and not something to decide without exploring options and goals with the patient and family. It shifts the focus from rehabilitation and home-based recovery to placement. It’s valid in some contexts, but as a first action, it bypasses important conversations about what’s possible in the current setting.

• D. Determine why the spouse is not encouraging self-care by the client.

This is the one that gets the conversation moving in a constructive direction. It’s about understanding beliefs, fears, and knowledge gaps. It acknowledges that caregiving is a two-way street: the patient deserves agency, and the spouse deserves support and clear, practical guidance.

A nurse’s practical approach: start with curiosity, then build a plan

So what does “determine why” look like in real life? Here’s a practical, compassionate pathway.

1. Open a collaborative dialogue

• Sit at eye level with both the patient and the spouse, if possible. Start with open-ended questions: “Can you tell me what you’re worried about when the patient tries to feed themselves?” or “What has been helpful for you so far, and what has felt overwhelming?”

• Listen for three things: safety concerns (risk of choking or aspiration), fears about the patient’s ability, and knowledge gaps about how to assist effectively.

2. Spotlight safety without shaming

• A right-sided paresis often means the left side of the body remains stronger, but the right side can be weaker and less coordinated. That makes swallowing safety and self-feeding technique critical. The goal is safe participation, not perfect performance.

• Explore signs of dysphagia, such as coughing during meals, pocketing food, or prolonged intake that wears everyone out. If dysphagia is suspected, involve a speech-language pathologist and consider a swallow evaluation.

3. Assess what the patient can do now

• Look for small, feasible steps toward self-feeding: lifting a utensil, bringing food to the mouth, guiding a bite with support. Even partial participation is progress.

• Consider adaptive tools: built-up handles on utensils, non-slip plates, plate guards, and sip cups. These tools aren’t a verdict on ability; they’re a bridge to independence.

4. Decode the spouse’s barriers

• Fear is powerful. The spouse may fear choking, aspiration, or humiliation if the patient fails in front of others.

• Beliefs about capability matter too. The spouse might assume that the patient cannot manage even simple tasks, or they may be unsure how to provide the right kind of help.

• Knowledge gaps show up as questions: “What’s the best way to support without taking over?” “Which cues signal when to step back?” “How do I prompt without discouraging?”

5. Co-create a gentle, staged plan

• Set a shared objective: “Today we aim for the patient to participate in feeding for X minutes with supervision and appropriate aids.”

• Define roles clearly. The nurse can model techniques, the spouse can practice, and the patient can attempt steps at a pace that respects their energy and safety limits.

• Map out contingencies: what to do if coughing occurs, how to pause for a break, when to switch to assisted feeding, and how to re-engage after a pause.

6. Educate with practical, ready-to-apply strategies

• Demonstrate a step-by-step feeding approach: patient cues, spoon or utensil technique, pacing, and how to check for readiness to swallow.

• Teach safe positioning: upright or slight forward lean, head alignment, and ensuring the swallowing posture is supported during meals.

• Practice how to hand over control: offering a bite but allowing the patient to initiate, with the spouse ready to assist without driving the hand-over-hand approach too aggressively.

• Discuss meal timing and energy management: smaller, more frequent meals may be better than longer, exhausting sessions.

7. Bring in the care team and resources

• Involve the rehabilitation nurse, the occupational therapist, and the speech-language pathologist when needed. They can provide tailored exercises, assistive devices, and specific feeding strategies.

• Connect the spouse with caregiver support groups, education materials, and practical tips for home care. Support is not a luxury; it’s a crucial element of recovery.

8. Set follow-up and celebrate small wins

• Schedule brief reassessments to see what’s working and what’s not. Celebrate tiny successes—the first independent scoop, the first self-initiated sip, the first meal without a cue.

• Refine the plan based on feedback, not just on outcomes. If a technique isn’t resonating, try another approach.

The bigger picture: dignity, autonomy, and a sustainable care dynamic

This approach isn’t just about meals. It’s about building a care ecosystem that respects the patient’s autonomy while securing safety. When the spouse feels supported and equipped, caregiving becomes sustainable rather than draining. The patient gains agency, even in the face of limitations. And the nurse fulfills a critical role: not just as a clinician, but as a facilitator who helps families navigate fear, learn new skills, and lean into progress.

A few practical tangents that matter

• Communication is mission-critical. Clear, calm language reduces confusion for both patient and spouse. Use simple prompts, pause for responses, and repeat or rephrase as needed.

• Small wins compound. A patient who can grasp a utensil for a single bite today may handle a larger portion tomorrow. Momentum matters.

• Expect emotional waves. Spouses may feel sadness, frustration, or relief in quick succession. Acknowledge those feelings. A brief pause to acknowledge emotion can reset the moment and prevent a fault line in care.

• Real-world tools help. Non-slip mats, reflective cutlery, weighted utensils, or built-up handles aren’t gadgets; they’re practical aids that lower the barrier to participation.

Framing the conversation with care, not criticism

If you’re in the nurse’s chair, remember that the goal isn’t to call out a fault or assign blame. It’s to illuminate why a barrier exists and to co-create a path forward. When you ask, “Why aren’t you encouraging self-care?” you’re inviting the spouse into a collaborative solution, not scoring a point.

This mindset aligns with a broader philosophy in patient care: autonomy isn’t all-or-nothing. It’s a spectrum, and you’re helping move the needle along that spectrum. You’re saying, with warmth and clarity, “We believe in your partner’s ability to contribute; we’re here to support you both with practical steps, education, and a plan that keeps safety front and center.”

Bringing it home

Right-sided paresis after a stroke changes daily life, for patient and caregiver alike. The nurse’s first move—asking why self-care isn’t being encouraged—opens a door to understanding, learning, and progress. It’s a doorway to a care rhythm that balances safety with independence, fosters dignity, and helps the whole family feel more capable.

If you’re navigating a similar scenario in your setting, carry this simple guide with you: listen actively, assess safety and capabilities, educate with concrete techniques and tools, involve the whole care team, and keep the focus on gradual, meaningful gains. With patience and clear communication, feeding becomes more than a task—it becomes a stepping stone to recovery, resilience, and renewed confidence for everyone at the table.