Denham 4, 13
1. ____________________ is often seen in instrumental behaviors of caring, whereas ____________________ is an expressive caring behavior.
ANS: Doing for, being with Rationale: Doing for is often seen in instrumental behaviors of caring, where the priority is to tell, show, or do, whereas being with is an expressive caring behavior where the priority is to listen, notice, or respond.
8. Motivational interviewing techniques reflects which of the following premises? 1. Asking and listening are core communication skills needed when using motivational interviewing techniques. 2. This type of communication relies on the nurse's identification of the behavior needing to be changed. 3. This type of communication requires a nurse who can be directive and clear. 4. This type of communication is best used with an individual approach, rather than a family.
ANS: 1 Feedback 1 Being able to actively listen and asking the client to identify the changes are guiding principles to motivational interviewing. 2 For an effective outcome, the patient or family, rather than the nurse, must identify the necessary change. 3 A nurse's communication technique is more guiding when motivational interviewing communication is used. Directing will create more resistance. 4 A family can participate in a motivational interview.
5. A nurse who periodically asks himself "What makes me happy?" is engaging in which of the following processes? 1. Self-discovery that is helpful to building caring relationships 2. Egocentrism that threatens development of caring relationships 3. Self-indulgence important to developing resilience in nursing practice 4. Superficial assessment of his life
ANS: 1 Asking what makes one happy is a way of discovering one's personal strengths or limitations that can enhance or threaten establishing caring relationships.
12. The nurse is trying to hold a family care conference as her 12-year old patient is being discharged home with a chronic illness. Which response by a family member indicates a need for the nurse to teach about family-focused nursing care? 1. "Why should I be here? It is my sister who is sick, not me." 2. "We need to make a plan for home care so I can still work." 3. "I can't believe how this illness is affecting the whole family." 4. "What kind of resources will be available to us?"
ANS: 1 Feedback 1 Family-focused nursing care means looking at all members of the family and how they might be affected by the client's illness. 2 Family-focused care means working with the family to set goals, make plans to achieve them, and identify available resources to ensure success. 3 The nurse who understands family-focused nursing care knows that illness is a family affair and that all members can be affected by one member's illness. 4 Family-focused care means working with the family to set goals, make plans to achieve them, and identify available resources to ensure success.
4. Which of the following personal strengths enhance caring relationships? 1. Willingness to engage in regular self-reflection 2. Being an early adopter of technology 3. Efficiency in completing a variety of nursing tasks 4. Paying attention to finishing tasks in a timely manner
ANS: 1 Feedback 1 Regular self-reflection helps the nurse to identify personal strengths and limitations that can enhance or detract from establishing caring relationships. 2 Adopting technology does not represent a personal strength that could enhance caring relationships. 3 Being efficient is not a personal strength that could be used to enhance caring relationships. 4 Finishing tasks in a timely manner does not represent a personal strength that could be used to enhance caring relationships.
6. A patient who is known to the nurse requests pain medication shortly after the physician leaves the room after discussing the patient's poor prognosis. The nurse enters the room to find the patient in tears. What would be the action on the part of the nurse that best conveys being with the patient? 1. Sitting on the bed to talk to the patient 2. Giving the pain medication as soon as possible 3. Encourage the patient to rest 4. Change the subject to distract the patient from worrying
ANS: 1 Feedback 1 Sitting on the bed to talk to the patient lets the patient know the nurse is present and listening. 2 By giving the pain medication, the nurse is doing for the patient. 3 By encouraging the patient to rest, the nurse is leaving the patient alone and avoiding what might be considered a difficult subject. 4 Distracting the patient allows the nurse to avoid the subject and not be present with the patient.
1. Which of the following is the best rationale for a nurse to spend time communicating with a family member of a hospitalized patient? 1. The nurse often has information that needs to be shared with a family member who is a primary social structure caring for an individual. 2. A nurse's communication can supports the nurse's position of power in the health-care system caring for an individual. 3. Communication with family members is critical to increase a nurse's satisfaction with the role. 4. Nurses use communication to develop an efficient interprofessional team that exchanges information.
ANS: 1 Feedback 1 The family is the primary social structure that cares for family members and will be involved in caregiving when the individual returns home. 2 Nurses maintaining power over a family does not support a partnership. 3 Satisfaction with nurse's role does not offer the best rationale for communicating with families. Family satisfaction and family care are optimal goals. 4 The interprofessional team communication does not fully address the family role in caring for an individual. The efficiency of the team is not the best rationale for family communication.
10. A nurse is caring for a family with apparent language barrier. The nurse is preparing to discharge the patient who has been recently started on insulin and just learning to administer the medication and follow the dietary regime. Which of the following statements by the nurse reflects an understanding of communication in this context? 1. "I know this is a great deal of information to learn as you prepare for Mr. H to return home. If it's okay with you, I will come back later and we can review the information again." 2. "You probably have many questions. But they will get answered as you read these materials." 3. "Families have different ways of approaching the chronic disease of diabetes, but it is important for your family to understand the right way to approach this disease." 4. "I know it is difficult for Mr. H to accept this diagnosis, but it needs to be his disease to manage, rather than depend on you as his family."
ANS: 1 Feedback 1 This response demonstrates understanding that a new diagnosis and treatment regime may require repetition of information and time for acquisition of knowledge. 2 Assuming that a family can read and understand written materials does not consider health literacy. 3 Being directive with the way to manage an illness does not reflect an understanding of a family's need to partner with a nurse in identifying the directions. 4 Illness is a family experience and affair. The family is a system where an illness impacts the entire family and needs to be addressed by family system.
The Juarez family includes Maria, age 76, Juan, age 72, and three adult children. Maria has been managing a diagnosis of heart failure for approximately 10 years. Documentation suggests the family has had a great deal of stress with recent hospitalizations and caregiving in their home. The adult children voice their concerns about Maria's decision to complete an advanced directive. Which of the following demonstrate an insufficient understanding of family-focused nursing care and communication? 1. A nurse should make a statement such as, "Your family has had a great deal of distress lately; why don't you just let Maria make her own decisions." 2. A nurse's questioning techniques may help identify the family's beliefs and understandings about advanced directives. 3. A nurse should make a statement such as, "Your family has done a good job of caring for each other during this lengthy illness." 4. A nurse should attempt to clarify misunderstandings and share accurate information about the health status of the patient.
ANS: 1 Feedback 1 This statement fails to recognize the role of a family in decision-making. Even though maintaining patient autonomy is important, a family-focused nurse should also address the family's concerns. 2 This statement is correct because understanding the family's beliefs will require questioning techniques to provide family-focused nursing care. 3 This statement is correct because family-focused care commends a family for their strengths. 4 This statement is correct because family-focused care provides information about the status of an ill family member to a family.
2. The home health nurse visits a family for the first time. She meets a 40-year old woman and her 75-year old father, a 12-year old girl, and a 16-year old boy. She does not understand the language they speak in the home. The grandfather has limited mobility due to a stroke and appears confused. The nurse who learns to "think family" uses which of the following assessment practices? SELECT ALL THAT APPLY 1. Includes family members in client assessment. 2. Recognizes her own attitudes toward the family cultural practices. 3. Strives to understand the relationships of all family members and how each is affected by the client's illness. 4. Focuses her assessment on the grandfather because he is the only one who has an obvious illness.
ANS: 1, 2, 3 Rationale: Family-focused nursing care means including all family members in the assessment of the client and striving to understand the family relationships and how each member might be affected by the client's illness. It is necessary to recognize family cultural practices and one's own attitude toward them.
8. Which of the following situations reflects a time when doing for the patient takes priority over being with the patient? 1. A patient in active labor 2. When physical care is needed 3. A patient who takes a long time to feed herself 4. When the family member is doing the patient's dressing change incorrectly
ANS: 2 Feedback 1 A patient in active labor needs both being with and doing for by the nurse. 2 When providing physical care is a priority, the nurse must focus on doing for the patient. 3 Keeping a patient company by being with them when feeding themselves enhances the nurse-patient caring relationship. 4 Providing instruction to correct a family member's care of the patient means that the nurse needs to be with the family to instruct, listen attentively to questions, and evaluate progress.
2. Effective communication can assist a nurse to achieve which of the following desired health outcomes? 1. Readmissions with chronic disease exacerbations. 2. A nurse-individual-family relationship that supports quality nursing care. 3. Improved written documentation of errors in nursing. 4. Decrease in time spent communicating with difficult families.
ANS: 2 Feedback 1 Readmissions are not a desired health outcome. 2 Nurses who practice family-focused care recognize the importance of a relationship in providing quality nursing care for the individual and family. 3 Improved documentation of errors is not the highest priority for health outcomes. 4 Decreasing time communicating with families is not a goal of family-focused care.
1. Which of the following represents an intrinsic barrier to caring and learning ways to provide family care? 1. Understaffing 2. Fear of not knowing what to say to a family 3. Advances in technology 4. Cultural upbringing
ANS: 2 Feedback 1 Understaffing is an extrinsic barrier to caring. 2 Fear is a good example of an intrinsic barrier, or one that originates from within the nurse. 3 Technological advances are extrinsic barriers to caring. 4 Culture represents an outside force, or extrinsic barrier to caring.
3. What can the nurse do to overcome extrinsic barriers to caring? 1. Employ active listening skills with individuals and families. 2. Ask the family to identify their most important goal for well-being. 3. Sign up for the hospital committee on obtaining Magnet status. 4. Maintain a journal on personal insights about family interactions.
ANS: 3 Feedback 1 Active listening skills can be used to overcome intrinsic barriers to caring. 2 Setting family goals is one way a nurse cares for patients and families. 3 Working on a hospital committee to create change in the workplace could help overcome extrinsic barriers to caring. 4 Maintaining a journal would be one way a nurse might work to overcome intrinsic barriers to caring.
7. A nurse is caring for a male who has been informed of a prognosis of only several months before death. He wants to return to his home with hospice care. He has a wife and two daughters who do not support this decision. Which of the following communication principles should guide the nurse during this family situation? 1. A nurse guides families by staying focused solely on the patient's needs and wishes. 2. Families need to be informed that they are unable to provide the quality care needed in the home. 3. Exploring the family's beliefs about hospice, death, and their role can help families make decisions. 4. Helping family members understand the benefits of a patient dying at home produces the best outcomes.
ANS: 3 Feedback 1 At times the nurse guides a family by helping a family understand the unique needs and wishes of the entire family. This often helps resolve family conflicts and increase awareness of multiple perceptions in a family. 2 Taking the approach of telling a family the action to take limits their choices and support for a decision. 3 Examining families' beliefs is important to family decision-making. The unique beliefs of the family members must be explored for a family to reach consensus. 4 At times a family member's choices related to end-of-life care are best met at home, and at other times they are best met by the health-care system.
9. Which of the following situations reflects a time when doing for the family takes priority over being with the family? 1. At the end of the shift when the nurse knows she will be leaving the family 2. When the family needs to work through the answer rather than being provided an answer 3. When the family doesn't understand what is happening to their ill member 4. When the nurse wants to persuade the family of her point of view
ANS: 3 Feedback 1 Change of shift is not an appropriate reason for the nurse to focus on doing for the patient and not be present with the patient. 2 The nurse can best help the family work through a difficult situation by being with them, listening to how they process information, and responding to questions as needed. 3 One of the best things the nurse can to do for the family when they don't understand what is happening to an ill member is to provide direct information. 4 Persuading the family of one's point of view as a nurse limits the establishment of a caring nurse-family relationship.
11. Which of the following statements describe accurate information about family-focused communication? A nurse's communication with a family: 1. Usually focuses on the individual family member with an illness. 2. Usually begins with a nurse sharing personal information. 3. Aims to develop a caring relationship that sees the individual and family as the unit of care. 4. Most often requires a nurse to determine the direction for family-focused communication.
ANS: 3 Feedback 1 Family-focused communication addresses a family member with an illness as well as the family. 2 A nurse sharing personal information sets a tone of the nurse being focused on self, rather than the family. 3 Family-focused communication addresses the need for nurses to care for individuals and the family. 4 The family often identifies the direction and priority for communication.
7. The nurse notices that family members appear upset shortly after learning about the patient's poor prognosis from the physician. What would be the action on the part of the nurse that best conveys being with the family? 1. Tell the family you can see they would prefer to be by themselves. 2. Maintain a cheerful, upbeat attitude in the face of the family's distress. 3. Make eye contact and ask the family what is troubling them. 4. Ask the family if they want to talk to their minister.
ANS: 3 Feedback 1 Leaving the family by themselves when they appear upset is detrimental to being with the family and building a caring nurse-family relationship. 2 Maintaining a cheerful attitude when the family is upset is detrimental to being with the family and building a caring nurse-family relationship. 3 Making eye contact and attempting to talk to the family lets them know the nurse is present for them and conveys being with the family. 4 Asking the family if they want to talk to their minister conveys doing for the family.
4. Which of the following factors of a health-care system foster effective family-focused communication? 1. An environment that uses complex technology. 2. A nurse's stance that health-care providers maintain power in a relationship. 3. Educational materials that consider the health literacy of families. 4. A family's fears and anxiety about an individual member's illness.
ANS: 3 Rationale: A technological environment, a nurse's stance of power, and family's concerns in a health-care system introduce possible barriers to communication. Written documents and education materials that consider health literacy have the opportunity to provide information and reduce anxiety.
1. Which of the following statements about the nursing practice of being with are accurate? SELECT ALL THAT APPLY 1. Being with puts the nurse at risk for burn-out. 2. Being with adds more time to providing individual care. 3. Being with can be conveyed through tone of voice, eye contact, and body language. 4. Being with requires the nurse to have an open mind and understand a variety of perspectives.
ANS: 3, 4 Rationale: The nurse is at higher risk for burn-out when he does not practice being with patients and families. The idea that being with the patient takes more time is a myth that can act as a barrier to developing a caring relationship. The nurse conveys being with through modulating his tone of voice, eye contact, and body language. Having an open mind and understanding a variety of perspectives are important aspects of the nurse's capacity for being with patients.
10. Which of the following examples of nursing actions that demonstrate being with is inaccurate? 1. Being emotionally present to another 2. Seeking to understand another point of view 3. Learning what matters most to each patient and family 4. Assessing the patient's physical well-being
ANS: 4 Feedback 1 Being emotionally present is an important aspect of being with another. 2 Seeking to understand another person's point of view is an important aspect of being with another. 3 Seeking to understand what matters most to another is an important aspect of being with another. 4 Assessing the patient's physical well-being is an important aspect of doing for the patient.
5. Which of the following reflect inaccurate assumptions of family-focused care? 1. Communication in a family and health-care setting can influence health. 2. Effective therapeutic communication is at the core of family-focused care. 3. Nurses can facilitate communication among family members to support family health. 4. Family members can be expected to reach out to nurses when they need information.
ANS: 4 Feedback 1 Communication among family members and in a health-care system can influence health and outcomes. 2 Therapeutic communication is a basis for family-focused care. 3 Family focused nursing care facilitates family communication that supports health 4 A nurse must expect to initiate an interaction with a family that is experiencing distress and concerns during times of family health concerns. Families need nurses to initiate a partnership and relationship.
3. The nurse is beginning a shift caring for a 26-year-old adult female who has just been admitted to the critical care area of a hospital with a pneumonia and respiratory failure. The nurse is told that the patient's parents are anxiously sitting in the waiting room. Which of the following statements best reflect a nurse's understanding of the communication needs of the parents? 1. "I will hurry with my assessment of your daughter so you can spend time with her after I leave." 2. "Why don't you go have a cup of coffee while I assess your daughter?" 3. "Since your daughter is an adult, I really can't share any information with you about her condition." 4. "All of this is probably frightening for you. Would you like to come with me into the room so I can explain equipment and information to you while I care for your daughter?"
ANS: 4 Feedback 1 Leaving the family alone in the room with a newly admitted patient fails to take advantage of the opportunity to build a family partnership and nurse-family relationship. 2 Suggesting a family leave during a time when they are anxious does not minimize their uncertainty or address their concerns. 3 Confidentiality can be maintained while informing family members and exchanging information. 4 A nurse can anticipate distress in family members when there is an acute illness. The nurse can plan to include the family, invite the family, and explain the environment to minimize the anxiety.
2. Which of the following represents an extrinsic barrier to caring and learning ways to provide family care? 1. An attitude that caring is innate and cannot be learned 2. An assumption that family care takes too much time 3. Fear of becoming too involved with the individual or family 4. An expectation to meet workplace outcomes
ANS: 4 Feedback 1 Nurse attitudes represent intrinsic barriers to caring. 2 Assumptions made by the nurse represent intrinsic barriers to caring. 3 The nurses fears represent intrinsic barriers to caring. 4 Expectations from others in the workplace are extrinsic to the nurse but can act as barriers to caring.
11. The nurse is teaching a class on family-focused care in critical care environments. Which response from a nursing student indicates a need for additional teaching? 1. Families need information and support. 2. Families want to be involved in caregiving activities. 3. It is important to ensure that the family can be with the patient. 4. The nurse should protect the family from getting too involved in the illness experience.
ANS: 4 Feedback 1 Providing information and support is an important aspect of family-focused care in the critical care environment. 2 Involving families in caregiving activities is an important aspect of family-focused care in the critical care environment. 3 Ensuring the family can be with the patient is an important aspect of family-focused care in the critical care environment. 4 Involving the family in the illness experience is an important aspect of family-focused care in the critical environment.
9. A nurse is visiting a patient who has been discharged to home for a follow-up evaluation. The patient was diagnosed with diabetes many years ago. She has been hospitalized multiple times with infections and renal insufficiency. She now needs dialysis on a regular basis. Which of the following actions would support a therapeutic relationship between the nurse and family? 1. The nurse needs to limit the time given to the family to tell their story to stay focused on the patient. 2. The wound care and weight assessments are the priorities during this visit. 3. Using linear questioning techniques will help the family share their understandings of the situation. 4. Spending time assessing the patient's symptoms and the family's experiences will produce best outcomes.
ANS: 4 Feedback 1 Technical skills and relationship skills can be blended during nursing care. Limiting the time with the family may disrupt the future relationship. Telling the illness story may give the nurse essential information needed for future care. 2 The wound and weight gain are a priority, but family information may also be necessary at this time to determine future directions. 3 Circular questioning techniques are more likely to help a family share their understandings. 4 Family-focused care identifies the patient and the family as the recipients of care. Assessing the patient's symptoms and the family's experience creates a therapeutic conversation and relationship.
6. Julie is a 42-year-old wife and mother who has recently experienced a mastectomy for breast cancer. The nurse enters the room to check vital signs and sees tears in the eyes of Julie and her husband. Which of the following statements by the nurse reflect accurate understanding of approaches to communication in a therapeutic relationship? 1. "I know this is a difficult time for you and your family. It is probably best if we wait and talk about your concerns when you a little stronger." 2. "I think it will be helpful if you both remain hopeful and stay focused on the positive." 3. "I know this is a stressful time for you; would you like to visit with the chaplain?" 4. "You seem to be troubled, which is understandable. In what ways can I be the most helpful to you at this time?"
ANS: 4 Feedback 1 Waiting to talk about concerns may not be the family's choice. It may be difficult to have patient and husband focused on this topic in the future. 2 Encouraging a family to stay hopeful and positive does not acknowledge their current experience. 3 Referring the family to the pastor may not match their spiritual needs, and the chaplain may not have the information they need at this time. 4 Calling attention to their distress acknowledges their experience. Allowing the family to indicate their priority concerns at this time and offering assistance in the area the family chooses allows them to direct the conversation. This statement allows the family to gain trust in the nurse.
