Week 4

Which of these techniques should the nurse use for introverted or shy personalities within a group? a. Active listening b. Multi-voting c. Brainstorming d. Nominal group technique

D

If a group member makes sure that everyone who wants to make a contribution to the group has an opportunity to do so, what role are they playing?

Gatekeeper

Multi-voting

follows brainstorming- vote for favorite ideas

Active listening

fosters respect and promotes trust

Nominal group technique

group members don't speak to each other but are asked to write down their ideas, discussions take place after info is collected, categorized, and prioritized

Recommendation for health literacy screening

instead of using tools such as TOFHLA or REALM, just approach all individuals as if they have low health literacy, and teach everything at a 4th to 6th grade level

Who facilitates honest and open sharing of diverse opinions and information?

opinion giver

Levels of affective domain

receptive- listens, pays attention responsive- participates/reacts valuing-accepts, appreciates, commits internal consistency- organizes values to fit together Adoption- incorporates new values into lifestyle

Affective Domain of learning

"'changes in interest, attitudes, and values" Confidence or lack there of discussion about attitudes about doing self-exams

Psychomotor domain

"visible, demonstrable performance skills that require some kind of neuromuscular coordination" Doing an exam on a model

5 steps of group formation

1. forming- agree on guidelines and purpose 2. storming- competition and conflict occurs, structure is needed and group purpose is clarified, need to encourage quiet members 3. norming- increased cohesiveness, leadership, and trust, work moves more quickly 4. performing- not all groups reach this stage, true independence occurs, work can be accomplished, little reliance on facilitator 5. Adjourning- conclusion of group activities, formal closure and acknowledgement of group work is needed

6 major levels of the cognitive domain

1. knowledge 2. comprehension 3. application 4. analysis 5. Synthesis 6. Evaluation

In regards to groups, which role is the group member who helps maintain harmony by conciliating different points of view and suggesting solutions? a. Mediator b. Encourager c. Summarizer d. Gatekeeper

A

The nurse is asked why it is important to teach psychomotor skills. What statement is the best answer? a. "Most health topics involve some sort of "self-care" that the learner will need to do be able to do following the class." b. "It is easier to teach psychomotor skills versus cognitive skills." c. "Psychomotor skills take more time to teach and it is good use of class time." d. "Cognitive skills are reinforced with psychomotor skills."

A

What role does the "opinion-giver" perform within a health education group? a. Facilitates the honest and open sharing of diverse views and information b. Frames diverse ideas and opinions into proposals or decisions c. Ensures that everyone who wants to can make a contribution d. Creates a warm climate of acceptance among group members

A

What technique of group facilitation can the nurse use to encourage creative ideas within a group? a. Brainstorming b. Active listening c. Multi-voting d. Proactive facilitation

A

Which is true of Tuckman and Jenson's five stages of group formation? a. Not all groups reach the "performing" stage. b. Group cohesion dissolves at the "norming" stage. c. Group members are independent at the "forming" stage. d. Competition and conflict exists at the "adjourning" stage.

A

Which statement is true about health literacy? a. Experts recommend that all clients be treated as if they have low health literacy. b. Most Americans have adequate health literacy skills. c. Clients with high health literacy rarely ask questions in a clinical encounter. d. Clients with low health literacy are more likely to admit they don't understand a medical form.

A

The nurse wants to use the domains of effective teaching to help organize a teaching plan. What domains should the nurse consider? (Select all that apply.) a. Affective b. Physical c. Spatial d. Cognitive e. Psychomotor

A D E

The leader of an Alzheimer's support group surveys the members of the group to determine the best time for the group to meet. Which of the following norms is being supported through this action? a. Maintenance norms b. Group norms c. Task norms d. Reality norms

A Maintenance norms create group pressure to affirm members and maintain their comfort. Maintenance behaviors include identifying the social and psychological tensions of members and taking steps to support those members at high-stress times. Maintenance norms often refer to things such as scheduling meetings at convenient times and in an accessible and comfortable space. Group norms set the standards for the group members' behaviors, attitudes, and perceptions. Task norms are the commitment to return to the central goals of the group. Reality norms occur when members reinforce or challenge and correct their ideas of what is real.

A nurse is implementing tertiary prevention strategies as part of the quality management process in the workplace. Which of the following best describes a strategy the nurse would have used? a. After evaluation of response to an actual fire, new procedures implemented in the fire response protocol are distributed to employees. b. Mock fire drills are carried out twice a year to assess response and readiness in the event of a real fire. c. At the yearly employee picnic, teams compete in putting out trash can fires and in racing while carrying mock victims, using safe evacuation techniques. d. All new employees complete a program on fire safety that details what to do in the event of a fire.

A Tertiary prevention involves activities that are carried out when evaluation indicates needed improvement. Thus, examining a response to an actual fire (it has already occurred) is an example of tertiary prevention. A program on fire safety is an example of primary prevention. The employee picnic activity and mock fire drills provide for evaluation of competency (screening) and are thus secondary prevention.

A nursing committee is responsible for evaluating the process of health care agency in their quality assurance efforts. Which of the following techniques would most likely be used by the committee members? (Select all that apply.) a. Client satisfaction survey data b. Peer review committee audit c. Patient discharge data over the past one year d. Confirmation of credentials of all health care providers employed

A B The primary approaches used for process evaluation are the peer review committee and the client satisfaction survey. The techniques used for process evaluation are direct observation, questionnaire, interview, written audit, and videotape of client and provider encounters. Once data are collected to evaluate nursing process standards, the peer review committee reviews the data to identify strengths and weaknesses in the quality of care delivered. Confirming credentials and examining patient discharge data are not typically used for process evaluation.

Which factor contributes to the possibility of relapse back into a negative health behavior? (Select all that apply.) a. Experiencing a poor support system b. Lacking effective coping skills c. Being depressed d. Being in the early stages of change e. Dealing with a high degree of personal stress

A B C E

Which points are relevant to leading an effective coalition meeting focused on community needs? (Select all that apply.) a. Distribute background materials in advance of the meeting. b. Maintain focus on the purpose of the meeting. c. Show respect for the expertise of the individual members. d. Assume responsibility for any resulting conflicts. e. Begin and end the meeting on time.

A B C E

What are the responsibilities of a community health nurse to the families being served? (Select all that apply.) a. Address issues affecting family health. b. Strive to eliminate disparities in the delivery of health care to families. c. Establish the health and wellness practices of the families. d. Promote the health literacy of family members. e. Advocate for family wellness.

A B D E

Which of the following strategies should be used when providing educational programs for children? (Select all that apply.) a. Use simple words to enhance understanding. b. Emphasize how to build learning from previous experiences. c. Use objects to help increase their attention. d. Emphasize the importance of the long-term consequences.

A C When providing educational programs for children, the nurse should use more concrete examples and word choices; use objects or devices to increase attention; incorporate repetitive behaviors into games to help with knowledge retention and acquiring new skills. When working with adults emphasis should be placed on previous experience. This is not as important when working with children as they have had more limited experiences. Children are not concerned with long-term consequences, rather they focus on consequences and activities that will occur in the near future (short-term).

Which of the following characteristics must a learner possess to successfully master psychomotor learning? (Select all that apply.) a. A sensory image of how to perform the skill b. An open mind to learning the new skill c. Opportunities to practice the skill d. The necessary ability to perform the skill

A C D Psychomotor learning is dependent on the learners meeting the following three conditions: having the necessary ability including both cognitive and psychomotor ability, having a sensory image of how to carry out the skill, having opportunities to practice the new skill. Having an open mind to learn a new skill is important. However, it is not necessary in order to master psychomotor learning.

What question should be asked of help identify a community committee's stakeholders? (Select all that apply.) a. Who has the greatest amount to lose by the proposed change? b. Who has been a long-term member of the community? c. Who can best successfully affect public opinion regarding proposed changes? d. Who can assist in providing resources needed for proposed changes? e. Who is most affected by the issue being considered?

A C D E

What strategies should a nurse employ when providing health teaching to a client? (Select all that apply.) a. Organize the content into units or components of like or related content. b. Proceed as if the client has the ability to purchase all suggested items. c. Employ metaphors and figurative language when speaking. d. Avoid the use of visual material, such as video and pictures. e. Check for understanding by frequently asking questions.

A E

What are the advantages of teaching health education in group settings?

Achievable tasks More resources Better decision making Synergy

A home health care agency has major problems but does not want consumers to know about these problems while the agency decides what should be done to improve them. Employees are not told to lie, but they are advised not to share information. Which of the following is the most likely outcome of this situation? a. As long as employees do not share what they know, the community will be uninformed. b. By law, comparative information will be available to the public via the Internet. c. Secrecy will prevail unless the local newspaper does an investigative report. d. Only a few informed persons will know about the problems.

B In 2003 the Home Health Care Quality Initiative (HHQI) was developed by the USDHHS to provide consumers with data on the quality of home health services. Home Health Compare, posted on the Medicare website, is a home health report card available to consumers nationwide. Because the information is available to the public via the internet, the community will be able to view this data at their will.

A nurse is invited to join the utilization review team to help the agency avoid giving unnecessary care. Which of the following difficulties would the nurse most likely confront as client records are reviewed? a. Alternative care options rather than agency care are often encouraged. b. Not all clients fit the defined case standard and need more care than guidelines suggest. c. The agency is now accountable to its clients and their families. d. The nurse suggests the agency provide guidelines to professionals giving care.

B The major disadvantage of utilization review is that not all clients fit the classic picture presented by the criteria used to determine approval or denial of care. Alternative care options are many times not considered as it is assumed that clients fit the criteria that has been established. Utilization review does not provide agency guidelines as to how to provide care. Utilization review focuses on avoiding providing unnecessary care not on accountability to clients and families.

When evaluating an educational program, the nurse discovers that only 25% of community members met the learning objectives. Which of the following parts of the program should be improved? a. Learners b. Educator c. Objectives d. Content

B Ultimately, the educator is responsible for the success or failure of the educational process and the development of learner knowledge, skills, and abilities. If evaluation reveals that the learning objectives are not being met, the nurse must determine why the instruction is not effective. The educator is responsible for presenting the material creatively and meaningfully in new ways to increase learner retention and ability to apply the new knowledge. The educator determines how content can be tailored to the learner. The educator determines the objectives.

Which is a past screening tool used by practitioners to assess health literacy? SATA a. Health Educational Systems (HESI) b. Test of Functional Health Literacy (TOFHLA) c. Rapid Estimate of Adult Literacy in Medicine (REALM) d. Assessment Technologies Institute (ATI) e. Scholastic Aptitude Test (SAT)

B C

The nurse is scheduled to teach carbohydrate counting to middle-aged adults newly diagnosed with diabetes. Which of the following actions will the nurse need to take when teaching this population? (Select all that apply.) a. Emphasize that anyone with diabetes must know this information. b. Explain how to cope with being a guest at a dinner. c. Appeal to the need for autonomy and choice. d. Recognize that this audience will depend on the instructor to set goals for learning.

B C Because the nurse is working with middle-aged adults, the assumption can be made that they are members of Generation X. This generation tends to be self-directed, likes to work with teams, and may need to develop skills because they are not as likely to be as tech savvy. Members of this group can tolerate delayed gratification; they want clear information with practical value; and they are able to have fun and engage in games and activities when appropriate. Because of this, the best approach will be to use adult experiences and practical problems as learning motivators—for instance, appealing to adults' sense of autonomy and choice, basing examples on practical adult situations such as cooking meals or eating in restaurants, and discussing how clients can cope with possibly awkward situations such as being a guest at dinner but having diet restrictions. This generation tends to be self-directed so they most likely will not depend on the instructor to set goals for learning or need the instructor to emphasize how important it is to know this information. Members of this generation are likely to have the intrinsic motivation to accomplish these things on their own.

What principles can the nurse apply to maximize the teaching-learning process? (Select all that apply.) a. Limit the use of practical application. b. Make subject matter relevant to the client's interests. c. Adapt teaching to the client readiness level. d. Determine client attitudes toward the subject matter. e. Discourage interaction among learners

B C D

Group Facilitation Techniques

Brainstorming Multi-voting Nominal group technique Proactive Facilitation Active listening

Providing information on services provided at a local free clinic is an example of supporting which patient need? a. Assessment of health b. Behavioral role modeling c. Health literacy d. Reduction of health risks

C

Which skill is fundamental to a nurse's ability to enhance a patient's health literacy? a. Approaching the patient in a compassionate, caring manner b. Emphasizing the importance of patient compliance with the prescribed plan of care c. Providing information in a manner that the patient can easily understand d. Possessing a solid understanding of the care required of the specific patient

C

A nurse planned a presentation about the latest trends in disaster planning for the senior nursing students at the local college. However, when the nurse began to share the information, the students were talking to one another and essentially ignoring the nurse. Which of the following actions should be taken by the nurse? a. Tell a joke to get the students' attention. b. Nothing; let the instructor of the course handle the problem. c. Explain why the information is crucial to their current clinical practice. d. Ask the students why they are being so rude.

C Before learning can take place, you need to gain the learner's attention. One way to do this is by convincing the learner that the information about to be presented is important and beneficial to them personally. Asking the students why they are being so rude would not be a professional response by the nurse. The nurse should take responsibility for gaining the attention of the audience and not expect the instructor to do so. Gaining the students can best be accomplished by telling the students why it is important rather than telling a joke

The pharmacist sent up the wrong medication for the patient. The nurse filled out an incident report when the error was discovered. Which of the following best describes the likely outcome when the quality improvement team reviews the incident report? a. The nurse will receive a commendation for recognition of the error. b. The pharmacist will be disciplined. c. The CQI team will try to determine how the error occurred. d. The pharmacist will be reported to the state pharmacy board.

C In quality improvement, people are asked to help identify problems and seek ways to improve system performance. Providing additional recognition or discipline would not be appropriate steps within the quality improvement process. Ongoing quality improvement focuses on what led to the error occurring.

The nurse gives a very informative and engaging presentation and then gives everyone in the audience a handout that outlines the presentation. Later, the nurse discovers that many of the handouts were thrown away before the audience left the building. Which of the following educational principles has the nurse forgotten? a. Audiences expect PowerPoint or video presentations, not lectures. b. People want photographs and images, not wordy outlines. c. Many Americans do not have a high reading level. d. The nurse gave them too much information too fast for them to want to cope with it all.

C Most health information is printed at a tenth-grade reading level, which is too difficult for almost half of the adult readers in the United States. If people cannot read or understand the material, they discard it. Although visual images are certainly helpful, this does not explain why the handouts were discarded. Audience expectations of the use of PowerPoint or video presentations or receiving too much information too fast does not explain why the handouts were thrown away. If the nurse covered information too fast, it is likely that the participants may have been more inclined to keep the handout.

Which of the following best explains why evaluation of client outcomes resulting from nursing intervention is so difficult? a. Few tools exist to measure client outcomes. b. Client records may not include appropriate data. c. Many other factors can also affect client outcomes. d. Measuring client outcomes is extremely time consuming.

C The major problem with outcome evaluation is determining which nursing care activities are primarily responsible for causing changes in client status. In nursing, many uncontrolled factors in the field, such as environment and family relationships, have an effect on client status. Appropriate data should be included in all documentation that is recorded by the nurse. Multiple tools exist to measure client outcomes. With appropriate processes in place, it is not time consuming to measure client outcomes.

The quality improvement team reviews the records of clients on a monthly basis to determine whether protocols for pain assessment were followed. Which of the following best describes this activity? a. Accreditation review b. Utilization review c. Retrospective audit d. Concurrent audit

C The retrospective audit, or outcome audit, evaluates quality of care through appraisal of the nursing process after the client's discharge from the health care system. Accreditation is often linked to governmental regulations that encourage programs to participate in the accrediting process to be reimbursed for services. A concurrent audit is a process audit that evaluates the quality of ongoing care by examining the nursing process. Utilization review is used to ensure that care is needed and that the cost is appropriate.

A nurse has identified a need to increase the quality assurance efforts within the home care agency. Which of the following has most likely occurred? a. Reduced government reimbursement (Medicare and Medicaid) b. Increased costs of providing care c. Increased number of client complaints and injuries d. Reduced number of incident reports

C The types of problems that may lead to increased quality assurance efforts include client complaints, injury, or death, poor documentation of care, with subsequent denials of reimbursement by third-party payers, lack of or inefficient service, and concerns about client or staff safety. Several factors may influence increased costs of providing care, which may or may not lead to it being a priority of increased quality assurance efforts. An increase in incidence reports, not a decrease, would lead to increased quality assurance efforts. Reduced government reimbursement may lead the agency to consider multiple aspects of care, which may or may not relate a need for increased quality assurance efforts.

What is the primary goal of total quality management? a. To enable organizations to publicize their quality approach to patient care b. To confirm the high standards desired in patient care c. To focus on the client and teamwork d. To discover and correct errors in task completion

C Total quality management is a management philosophy that includes a focus on client, continuous quality improvement, and teamwork. Under TQM, quality is defined as customer satisfaction. Quality assurance is the promise or guarantee that certain standards of excellence are being met for the client in the delivery of care. QI is defined as a structured approach to improving performance.

Which of these are signs an individual may have health literacy challenges? (Select all that apply.) a. Easily navigates diagnostic tests, procedures, or consultation processes b. Speaks very quickly in consultations c. Has difficulty completing health forms d. Is more passive in the clinical encounter and rarely asks questions e. Misunderstands prescription medication instructions

C D E

Three Domains of Learning

Cognitive Affective Psychomotor

Who helps the group frame diverse ideas and opinions into proposals or decisions that reflect the wishes of the group?

Consensus builder

How can the nurse create an environment that is conducive to learning? a. Ensure that the environment is not too comfortable. b. Restrict free expression. c. Assert authority and discipline. d. Create an atmosphere of helpfulness.

D

What is the most important role of the community health nurse? a. Leader b. Surrogate c. Advocate d. Educator

D

A nurse is using the technique of motivational interviewing when working with a client. Which of the following statements by the client indicates the client is ready to make the change? a. "It's important to change." b. "I should change." c. "I want to change." d. "I am willing to change."

D Motivational interviewing uses the term "change talk" to refer to statements by the client that he or she is motivated and willing to make change. An easy to use mnemonic is "DARN-CAT" which refers to desire, ability, reason, need, activation, commitment, and taking steps. "I am willing to change" demonstrates activation, a client who is ready, prepared, and willing to make the change. The incorrect statements refer to the client who is preparing to make the change, but not yet ready to implement the change.

A home-care nurse is encouraging the administration of the agency to increase their quality assurance efforts. Which of the following best describes a negative outcome from this activity? a. An agency deficiency may become visible. b. Employees at the agency will have to commit extra time to complete this process. c. Some agency processes may be questioned. d. An individual may be found at fault and then become fearful of being involved.

D Quality assurance (QA) focuses on the care a client receives within the system and is concerned with the accountability of the provider. A major problem with quality assurance efforts, done by the quality assurance team, is that individuals may be found to be at fault and hence may be fearful of reporting problems or errors. Total quality management/continuous quality improvement are concepts that give direction for managing a system of care, whereas quality assurance focuses on the care a client receives within the system. Continuous quality improvement focuses on processes and possible deficiencies of the organization as a whole so that everyone is involved.

Stakeholders developing a new community-oriented clinic plan want to include a quality assurance (QA) program. Which of the following would be the first step in measuring the structure component? a. Requirements of accrediting agencies b. Criteria that will be used to measure quality c. Standards the QA program wishes to achieve d. Philosophy and objectives of the organization

D The philosophy and objectives of an agency define the structural standards of the agency. Identification of standards and criteria for quality assurance begins with writing the philosophy and objectives of the organization. Criteria to measure quality including requirements of accreditors and standards of the QA program are not part of the structural standards of a quality assurance program.

Which of the following best describes one of the main problems in ensuring quality for health care in the United States? a. We all agree on what quality is but not on how best to measure it. b. Finances are the basis of clinical decisions, not quality of care. c. Consumers believe American health care is high-quality and the best in the world. d. Every hospital and health care agency has its own approach to data collection and documentation.

D Very little is known about quality of care in this country because a variety of definitions of quality are used and it is difficult to get comparable data from health care providers and agencies. All consumers, including private citizens, insurance companies, industry, and the federal government, are concerned about achieving the highest quality outcomes at the lowest possible cost. Consumers want more information about quality. Both consumers and providers have a vested interest in improving the quality of the health care system.

What percentage of american adults have "below basic" health literacy skills? a. 1% b. 5% c. 10% d. 15%

D or 30 million people

What role is done if a group member puts in effort to create a warm climate of acceptance within the group, where all contributors are welcomed?

Encourager

What is the most important role of a CHN?

Health Educator

5 teaching methods

Lecture Discussion Demonstration Teach-back Role Playing

Who summarizes what is taking place so that important ideas and decisions are not lost?

Summarizer

Proactive Facilitation

actively facilitating discussion of problems, issues, concerns, or questions. Include a meeting agenda- and send it out in advance. Facilitator to avoid sides

When considering social learning theory, what patient-focused issue is considered most important for a person considering a change in a health-related behavior? a. How difficult it is to make the change b. Ability to make the change c. Support of family and friends d. The impact the change will have on health

b

The patient is inquired about several different smoking cessation programs. When considering the transtheoretical model, in which stage of change is the patient currently? a. Action b. Precontemplation c. Preparation d. Maintenance

c

What is the importance of having "opinion leaders" represented on a community committee focused on making changes to existing health service delivery systems? a. Final recommendations of the committee must reflect the opinions of the community. b. Opinions are important to the information-gathering stage of committee work. c. Their points of view are generally well-accepted by the individual community members. d. All sectors of the community should be represented on the committee.

c

What is the recommended reading level of medical literature? a. Seventh to eight grade b. First to third grade c. Fourth to sixth grade d. Ninth to twelfth grade

c

Which is true about health education in groups? a. The views expressed are narrow and predictable. b. Group members come from homogenous backgrounds and experiences. c. The nurse is not the only expert in the group. d. Tasks are established that only individuals can accomplish.

c

Cognitive domain

recall or recognition of knowledge and the development of intellectual abilities and skills. Includes 6 major levels teaching via a power point