Chapter 20: Family Nursing

6. An older adult with two grown children is being discharged home and will need insulin injections and some assistance with activities of daily living. The client's son lives within 5 km of the client's home. The daughter tells the nurse that she doesn't know how to handle her parent's and her own children's needs. What should be the nurse's initial response? a. Work with the family in supporting caregivers. b. Tell the daughter to look into nursing home placement immediately. c. Arrange for the client to remain in the medical centre. d. Make decisions for the family on how to manage the care at home.

ANS: A The nurse must consider supporting family caregivers in order to develop better communication and problem solving for families. Building relationships for successful caregiving will improve care for the client. Nursing home placement should not be the nurse's initial response to caregiver strain. Arranging for the client to remain in the medical centre is not always feasible and does not address the problem of caregiver strain. It should not be the nurse's initial response in this situation. The nurse should not make decisions for the family, but rather work with the family to problem solve.

9. What is the optimum goal of effective communication within the family, according to the nurse's observing the family members and their interaction? a. Problem solving and psychological support b. Role development of individual members c. Socialization among individual members d. Better financial conditions for the family

ANS: A The optimum goal of effective communication within the family is to be able to problem solve and provide psychological support for members. Role development is not the optimum goal of effective communication within the family. Socialization among individual family members is not the optimum goal of effective communication within the family. Improving financial conditions for the family is not the optimum goal of effective communication within the family.

5. What is the nurse's ultimate goal when offering interventions to families? a. Suggesting new coping measures b. Increasing the family's autonomy in solving their own problems c. Providing families with specific guidelines on how to manage their time and resources more effectively d. Referring families to the appropriate support system

ANS: B The ultimate goal when offering interventions to the family is to help family members discover solutions that reduce or alleviate emotional, physical, and spiritual suffering. The nurse's role is to guide the family in problem solving. The nurse will assist the family to identify coping mechanisms that have been successful in the past and to explore with them new coping mechanisms with them. The intervention is collaborative and the client is encouraged to make his or her own decisions. The ultimate goal is to empower families. The nurse collaborates with the family to identify appropriate approaches to time and resource management. The ultimate goal is to empower families. At times the nurse may need to refer families to community resources when family functioning is impaired. The ultimate goal is to empower families.

7. Which of the following comments made by the nurse validates emotional responses? a. "Can you describe how your illness has touched your spiritual dimension?" b. "Your feelings are very normal considering what you've just been through." c. "It is essential that you reconsider having someone come in to help you while you are recovering." d. "Do not despair. Many families have survived exactly what you are going through."

ANS: B Validation of intense emotions can alleviate feelings of isolation and loneliness and help family members make the connection between a family member's illness and the family's emotional response. The question "Can you describe how your illness has touched your spiritual dimension?" shows how the nurse encourages illness narratives. The client describes how the illness touches his or her whole being, not only the physical dimension. The statement "It is essential that you reconsider having someone come in to help you while you are recovering" is an example of the nurse who is encouraging respite to a family caregiver. The statement "Do not despair. Many families have survived exactly what you are going through" minimizes the family's experience by failing to recognize the family's individuality.

1. When working with families, the nurse may view the family either as context or client. Which one of the following examples demonstrates the view of the family as context? a. The family's ability to support the client's dietary and recreational needs b. The client's ability to understand and manage his or her own dietary needs c. The family's demands on the client based on his or her role performance d. The adjustment of the client and family to changes in diet and exercise

ANS: B When the nurse views the family as context, the primary focus is on the health and development of an individual member existing within the client's family. The client's ability to understand and manage his or her own dietary needs demonstrates the view of the family as context. The family's ability to support the client's dietary and recreational needs demonstrates the view of the family as client. The family's demands on the client based on his or her role performance demonstrates the view of the family as client. The adjustment of the client and family to changes in diet and exercise demonstrates the view of the family as client. Nursing practice that focuses on family as client is also known as family systems nursing.

2. The nurse is observing for the signs of a healthy family. While assessing a healthy family, what would the nurse expect to find? a. Change is viewed as detrimental to family processes. b. A passive response exists to stressors. c. The structure is flexible enough to adapt to crises. d. Minimal influence is exerted on the environment.

ANS: C A healthy family has a flexible structure that allows adaptable performance of tasks and acceptance of help from outside the family system. The structure is flexible enough to allow adaptability but not so flexible that the family lacks cohesiveness and a sense of stability. The healthy family is able to integrate the need for stability with the need for growth and change. It does not view change as detrimental to family processes. The healthy family demonstrates control over the environment and does not passively respond to stressors. The healthy family exerts influence on the immediate environment of home, neighbourhood, and school.

8. A client is unable to independently perform colostomy care due to arthritis. What should the nurse do first? a. Offer to assist the client to learn to manage the care. b. Arrange for home care services to care for the colostomy. c. Inquire as to family members who may be able to assist with the care. d. Suggest that the client attend a colostomy self-help support group.

ANS: C The nurse should first find out if there is anyone in the family or neighbourhood who would or could assist with the colostomy care. It is important to focus on the family first and then make referrals when appropriate. Offering to assist the client to learn to manage care does not change the fact that the client has arthritis and cannot manage the colostomy care. The nurse should first determine if there are family members or friends to perform the client's colostomy care, and if not, then refer to home care. Attending a support group will help with emotional support, but it will not meet the client's need for assistance with colostomy care.

10. The nurse suspects that there is physical abuse present after visiting an older client in her home. She has been receiving care from her family for several months. In recognition of the pattern of family violence, which of the following does the nurse know is true? a. Mental illness is a major cause of abuse. b. Abuse is primarily seen in lower-income families. c. Spouses are the most frequent abusers. d. Family members and family caregivers are the most frequent abusers of older adults.

ANS: D Family members and family caregivers are the most frequent abusers of older adults. Caregiving can be stressful, causing a decline in the health of the caregiver and care receiver and leading to the development of abusive relationships. Mental illness may increase the incidence of abuse within the family, but is not the major cause of abuse. Abuse occurs across all social classes. Spouses are classified as family members, but the most frequent abusers of older adults are family members and family caregivers, and this includes all caregivers.

3. The nurse is visiting a client and family in the community for the first time. How should the nurse begin completing a client's family assessment? a. Gathering the health data from all the family members b. Testing the family's ability to cope c. Evaluating communication patterns d. Determining issues that are pertinent to the client's well-being

ANS: D The nurse begins the family assessment by determining issues that are pertinent to the client's well-being. During the assessment the nurse, client, and family collaboratively engage in conversation to systematically collect information and reflect on the issues important to the client's well-being. Gathering health data from the family members is not the starting point for a family assessment. Testing a family's ability to cope is not where the nurse should begin a family assessment. Evaluating communication barriers would not be an initial action of the nurse when completing a client's family assessment.

4. In assessing the family, how should the nurse define "family"? a. Identifying those members who are related biologically b. Applying one of the family forms that are recognized by society c. Referring to family forms that social scientists and legislators have identified d. Accepting that "family" is defined by individuals

ANS: D The nurse must think of "family" as defined by each individual. The nurse can think of family as a set of relationships that the client identifies as family or as a network of individuals who influence each other's lives, whether or not there are actual biological or legal ties. In other words, the family is each person's definition of who or what constitutes it. Biological relationship is one of the many types or forms of family that defines family. Different definitions have resulted in heated debates among social scientists and legislators. The nurse must realize that families are as diverse as the individuals that compose them and that their various definitions must be respected. A socially recognized form of the family is only one of the many family types or forms. Different definitions have resulted in heated debates among social scientists and legislators. The nurse must realize that families are as diverse as the individuals that compose them and that their various definitions must be respected. A family form that is identified by social scientists and legislators is only one of the many ways of defining what is a family. Different definitions have resulted in heated debates among social scientists and legislators. The nurse must realize that families are as diverse as the individuals that compose them and that their various definitions must be respected.