family dynamics Chapter 10
a. Family Structure b. Family Functioning c. Developmental assessment 1. Who lives with you? 2. What aspects of your family do you enjoy the most? 3. How are problems solved?
1 A 2C 3B
An emergency department nurse is assessing a child that lives in a car with family members. Which area should the nurse assess closely? a. Ears b. Eyes c. Head d. Hands
ANS: A Children of homeless families are often in fair or poor health and have higher rates of asthma, ear infections, stomach problems, and mental illness. Eyes, head, and hands are not as likely to be negatively affected as the ears
The nurse is caring for an older-adult patient who has no apparent family. When questioned about family and the definition of family, the patient states, ―I have no family. They're all gone.‖ When asked, ―Who prepares your meals?‖ the patient states, ―I do, or I go out.‖ Which approach should the nurse use for this patient? a. Family as context b. Family as patient c. Family as system d. Family as caregiver
ANS: A If only one family member receives nursing care, it is realistic and practical to use the approach ―family as context.‖ Although family nursing is based on the assumption that all people regardless of age are a member of some type of family form, the patient insists that there is no family. The nurse should investigate further. However, at this time, family as patient or as system is not appropriate. Family as caregiver is not an approach but rather is a term to describe a family member caring for another family member.
A nurse is caring for a patient injured in a motor vehicle accident. Which action by the unlicensed assistive personnel will cause the nurse to intervene? a. Tells the family not to leave the bedside. b. Offers the family a sandwich. c. Gives the family a blanket. d. Sits with the family.
ANS: A The action of telling the family not to leave is inappropriate and should be corrected. Sometimes telling the family that you will stay with their loved one while they are gone is all they need to feel comfortable in leaving. Offering a sandwich, giving a blanket, and sitting with the family are appropriate and do not require the nurse to intervene. When the victim of trauma is hospitalized, take time to make sure that the family is comfortable. You can bring them something to eat or drink, give them a blanket, or encourage them to get a meal.
A nurse is assessing for factors influencing family form. Which areas will the nurse include in the assessment? (Select all that apply.) a. Homelessness b. Domestic violence c. Presence of illness d. Changing economic status e. Rise of homosexual families
ANS: A, B, C, D Families face many challenges today, including changing structures and roles related to the changing economic status of society. Some families experience challenges related to chronic illness and aging family members. Family caregiving, poverty, homelessness, and domestic violence create challenges for families. Homosexual families are not a threat facing the family; in fact, many homosexual couples now define their relationship in family terms.
In addition to providing physical care, what roles does a caregiver assure when caring for a family member? (Select all that apply.) a. Emotional supporter b. Health care decision maker c. Financial monitor d. Advocate e. Family leader
ANS: A, B, C, D Family caregivers also provide ongoing emotional support for their loved ones, making decisions about care options, being a patient advocate, and monitoring finances. The role of family leader is not necessary one that the caregiver assumes.
The nurse is providing discharge teaching for an older-adult patient who will need tube feedings at home. The spouse is the only source of care and states ―I will not be able to perform the feedings due to arthritis.‖ Which action should the nurse take? a. Obtain extra feeding supplies. b. Arrange for home care. c. Cancel the discharge. d. Teach the spouse.
ANS: B Discharge planning with a family involves an accurate assessment of what will be needed for care at the time of discharge, along with any shortcomings in the home setting. If no one can do the feedings properly, the nurse will need to arrange for a home care service referral. Extra feeding supplies will not help the situation if the spouse cannot use them. Canceling the discharge is not an option. Teaching the spouse will not be effective since the spouse is unable to perform the feeding.
A nurse is assessing the family unit to determine their ability to adapt to the change required of a member having surgery. Which area is the nurse monitoring? a. Family durability b. Family resiliency c. Family diversity d. Family forms
ANS: B Family resiliency is the ability of the family to cope with expected and unexpected stressors; it's the families' ability to adapt to changes. Family diversity is the uniqueness of each family unit. Every person within a family unit has specific needs, strengths, and important developmental considerations. Family durability is a system of support and structure within a family that extends beyond the walls of the household. Family forms are patterns of people considered by family members to be included in the family.
A nurse is using the family as context approach to provide care to a patient. What should the nurse do next? a. Assess family patterns versus individual characteristics. b. Assess how much the family provides the patient's basic needs. c. Use ―family as patient‖ and ―family as context‖ approaches simultaneously. d. Plan care to meet not only the patient's needs but also those of the family as well.
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 a specific environment (i.e., the patient's family). Although the focus is on the individual's health status, the nurse assesses how much the family provides the individual's basic needs. Family patterns are in the realm of ―family as patient‖ approach. Often, the nurse will use the two simultaneously (family as context and family as patient) with the approach of ―family as system.‖ ―Family as patient‖ involves planning to meet the needs of the patient and those of the family as well.
A nurse reviews the current trends affecting today's family. Which trend will the nurse find? a. More mothers are full time at home parents. b. Adolescent mothers usually live on their own. c. More grandparents are raising their grandchildren. d. Teenage fathers usually have stronger support systems.
ANS: C More grandparents are raising their grandchildren. The majority of women work outside the home, and about 70% of mothers with children under the age of 18 are in the workforce. The majority of adolescent mothers continue to live with their families. Teenage fathers usually have poorer support systems and fewer resources to teach them how to parent.
A nurse is working with a patient. When the nurse asks about family members, the patient states that it includes my spouse, children, and aunt and uncle. How will the nurse describe this type of family? a. Nuclear b. Blended c. Extended d. Alternative
ANS: C The extended family includes relatives (aunts, uncles, grandparents, and cousins) in addition to the nuclear family. The nuclear family consists of husband and wife (and perhaps one or more children). The blended family is formed when parents bring unrelated children from prior adoptive or foster parenting relationships into a new, joint living situation. Relationships include multi-adult households, ―skip-generation‖ families (grandparents caring for grandchildren), communal groups with children, ―nonfamilies‖ (adults living alone), cohabitating partners, and homosexual couples
The nurse is interviewing a patient who is being admitted to the hospital. The patient's family went home before the nurse's interview. The nurse asks the patient, ―Who decides when to come to the hospital?‖ What is the rationale for the nurse's action? a. To assess the family form b. To assess the family function c. To assess the family structure d. To assess the family generalization
ANS: C To assess the family structure, the nurse asks questions that determine the power structure and patterning of roles and tasks (e.g., ―Who decides where to go on vacation?‖). When focusing on family form, the nurse should begin the family assessment by determining the patient's definition of family. Family function is the ability of the family to provide emotional support and to cope with health problems or situations. The question asked by the nurse will not assess that. Nurses do not assess family generalization.
The nurse is caring for an older-adult patient at home who requires teaching for dressing changes. The spouse and adult child are also involved in changing the dressing. Which statement by the nurse will most likely elicit a positive response from the patient and family? a. ―You're doing that all wrong. Let me show you how to do it.‖ b. ―I don't know who showed you how to change a dressing, but you're not doing it right. Let me show you again.‖ c. ―You're hesitant about changing the dressing like I was before I was shown an easier way; would you like to see?‖ d. ―I used to change the dressing the same way you are doing it: the wrong way. I'll show you the right way to do it.‖
ANS: C When the nurse is confident and skillful instead of coming across as an authority on the subject, the patient's/family's defenses will be down, making the patient/family more willing to listen without feeling embarrassed. Respectful communication is necessary. Saying that you're doing it wrong, you're not doing it right, or the wrong way is not respectful or necessary
The nurse, caring for a patient in hospice, notes that while the patient is getting adequate care, the caregiver is not sleeping well. The nurse also assesses the need for better family nutrition and meals assistance. The nurse discusses these needs with the patient and family and develops a plan of care with them using community resources. Which approach is the nurse using? a. Family as context b. Family as patient c. Family as system d. Family as caregiver
ANS: C When you care for the family as a system, you are caring for each family member (family as context) and the family unit (family as patient), using all available environmental, social, psychological, and community resources. In family as context, the primary focus is on the health of an individual member. In family as patient, family processes and relationships are the primary focus. Family as caregiver is not an approach to family-focused nursing but is a term used to describe a family member caring for another family member.
A nurse cares for the family's as well as the patient's needs using available resources. Which approach is the nurse using? a. Family as context b. Family as patient c. Family as system d. Family as caregivers
ANS: C When you care for the family as a system, you are caring for each family member (family as context) and the family unit (family as patient), using all available environmental, social, psychological, and community resources. When you view the family as context, the primary focus is on the health and development of an individual member existing within a specific environment (i.e., the patient's family). When you view the family as patient, the family processes and relationships (e.g., parenting or family caregiving) are the primary focuses of nursing care. There is no approach for family as caregivers; rather, it is a term to describe family members caring for other family members usually at home.
A spouse brings the children in to visit their mother in the hospital. The nurse asks how the family is doing. The husband states, ―None of her jobs are getting done, and I don't do those jobs, so the house and the kids are falling apart.‖ How will the nurse interpret this finding? a. The family structure is resilient. b. The family structure is flexible. c. The family structure is hardy. d. The family structure is rigid.
ANS: D A rigid structure specifically dictates who is able to accomplish different tasks and also limits the number of persons outside the immediate family allowed to assume these tasks. Resiliency helps to evaluate healthy responses when individuals and families are experiencing stressful events. An extremely flexible structure also presents problems for the family. There is sometimes an absence of stability that would otherwise lead to automatic action during a crisis or rapid change. Hardiness is the internal strength and durability of the family unit characterized by a sense of control over the outcome of life and an active, rather than passive, orientation in adapting to stressful events.
A nurse is caring for a patient who needs constant care in the home setting and for whom most of the care is provided by the patient's family. Which action should the nurse take to help relieve stress? a. Encourage caregiver to do as much as possible. b. Focus primarily on the patient. c. Point out weaknesses. d. Provide education
ANS: D Providing education to the family and caregiver helps relieve some of the stress of caregiving. Help the family focus on their strengths instead of on problems and weaknesses. While caregivers desire to care for the loved one, they often feel extreme pressure to do everything; therefore, encouraging the caregiver to do more will add stress. Focusing primarily on the patient will not be beneficial; the entire family is the patient