Chapter 2: Family-Centered, Community-Based Care

A nurse is providing home care to several families who live in a community with limited resources. Which of the following is an example of how the nurse can best "nurse the community"?

Organize a free flu vaccination in the community. Although all of these examples are effective means of professional self-improvement, only organizing a free flu vaccination directly benefits the community itself.

When giving family-centered care, the nurse recognizes that she needs to view which concept as the constant?

family Family-centered care recognizes the concept of the family as the constant. The health and functional abilities of the family affect the health of the patient and other members of the family.

A pregnant woman experiencing morning sickness has asked her nurse about ways to reduce or alleviate it. After receiving education and information from the nurse, which of the following statements would indicate that the client understood the information?

"I'll discuss with my doctor whether it is a good idea for me to use sea-bands." All therapies (complementary and alternative) should be discussed with the physician. Although some CAM therapies can help alleviate pain or sickness, all pregnant women should understand that these substances cross the placenta and can reach the growing embryo. In addition, many CAM therapies have not undergone scientific study and can place the woman at risk when mixed with traditional medicine.

The nurse is caring for a childbearing family of a different cultural background. In order to provide culturally appropriate and competent care, the nurse should execute which nursing action?

Ask the family for input into their care based on their cultural beliefs. Cultural beliefs vary; care should be based on the individual beliefs of each family. The imposition of personal, institutional, or others beliefs should never be done to a patient.

A client with hypertension tells her nurse that she would like to use a herbal substance (CAM) to lower her blood pressure instead of taking the antihypertensive medication. The nurse should:

Advise the client to speak with her physician about combining herbal substances with her medication. The nurse should ensure that the client speaks with her physician. Clients who are being treated with conventional medication therapy should be advised to avoid herbal substances because they may lead to unknown interaction effects.

You are preparing an hour-long prenatal seminar for a group of 27 teenage mothers. Which type of information will you gather to help ensure the success of your program?

Age, education levels, and language barriers of each of the participants. When teaching a group of patients, the group leader should seek demographic information to help develop an appropriate teaching plan for all participants in the group. This is an impersonal group, and taking the medical histories or learning their names or incomes is not appropriate.

The nurse is concluding her initial visit with a patient 28 weeks pregnant on bedrest for premature rupture of membranes. What data should the nurse consider when determining the timing of the next home visit?

Amount of supervision and health education needed by the patient The nurse should complete an assessment on the patient to include the amount of education and ability of the patient to understand the health care provider's orders. The nurse should allow the agency to work with the insurance company, and the location of the home should not influence the decision of the nurse.

A first-time mother is at home on the third day after delivery and has bleeding, painful nipples after breastfeeding. She calls the hospital to speak to her postpartum nurse. What is the best plan the nurse can implement for this patient?

Arrange for a home visit from a lactation consultant. This patient needs a skilled lactation consultant to personally assess this situation. Suggesting remedies without further assessment constitutes improper nursing care. An unskilled friend can miss signs of infection and does not have the evidence-based practice knowledge needed to best help this patient.

Advocacy for your client is an important aspect of community-based nursing. What is one way a community-based nurse can advocate for a child that is her client?

Assisting the family to apply for Medicaid or other forms of health care reimbursement. The nurse working in a community setting may often develop a long-standing relationship with childbearing and child-rearing families because of the continuous nature of client contact in an outpatient, school, or other setting. This type of relationship may allow the nurse to advocate for her client on a broader scale in health and welfare issues. Examples of interventions include helping the family apply for Medicaid or other forms of health care reimbursement. Reporting new cases of whooping cough is done to state authorities, not county authorities, and is not advocating for a client. Arranging educational events for the local hospital staff is not a community-based function. Assuring a mother that the bruises on her toddler will not be reported to social services when it is mandated that any suspected case of child abuse be reported is not advocating for the child.

Being a community-based nurse means that you have a different set of skills than those of your counterparts who work in a hospital. As a community-based nurse you also face unique issues and challenges. What is one of the unique aspects of community-based nursing?

Autonomous Community-based nursing practice is autonomous. There are often no other members of the health care team to consult, or no members within the area when you need to consult with them. Team work is important in community-based nursing, but it is not a unique aspect of this type of nursing. Disease orientation is the medical model of health care. Community-based nursing takes in all aspects of the client, including community aspects such as education—not just the disease process. Therefore, it is more holistic rather than less holistic.

A 40-year-old pregnant client tells her nurse that she would like to give birth in a birthing center because she wants several friends and family members to be there and will have more freedom at the center. What would be the most important factor for the nurse to point out when discussing this option with the client?

Birthing centers do not always have pediatricians on staff if the newborn has special needs. With this particular client, the nurse should point out that many birthing centers do not have pediatricians on site. The nurse should include all information related to birthing centers, such as the freedom to eat, move around, and give birth in any position so that the client can make the best decision. Birthing centers do not limit the number of friends and family who can attend the birth.

The nurse is caring for a pregnant woman and her family who are immigrants. Which intervention would be the priority for helping to achieve a successful outcome?

Communicating using understandable terms Communicating using understandable terms, whether that means using an interpreter or speaking slowly and using simple terms, will greatly affect the success of the care provided. Inquiring about their financial situation, assessing transportation issues, and helping them access aid programs are secondary to the need for effective communication.

How can the home health nurse assist with achieving National Health Goals when caring for a woman with placental previa at 28 weeks' gestation who is on bed rest?

Educate the patient on the benefits of bed rest for the pregnancy and access community resources to assist her with compliance. National Health Goals are concerned with reducing complications of pregnancy, both by better monitoring and preventing complications during pregnancy. Nurses can help the nation achieve these goals by helping women better accept and adhere to home care if it is advised during pregnancy.

An ill child will be cared for at home by the parents. What resources will be most advantageous for this family?

Effective support people from the family or community to offer help. Home care is most successful effective support people from the family or community offer help. Otherwise, parents and children can experience loneliness and low self-esteem that interfere with their ability to remain on continuous bed rest or continue with a medical regimen.

A client at 28 weeks' gestation is required to maintain bed rest for the duration of the pregnancy because she has placenta previa. What suggestions can the nurse make for the client to help her cope with the experience?

Encourage the client to learn a new skill while confined to bed. Most women can name activities they would like to do but have never had time to begin. One solution to help women cope with the stress of bed rest is for them to keep busy or use their time to learn a new skill.

A nursing student states, "When communicating with an interpreter I should speak directly to the interpreter." This statement is which of the following?

False When using an interpreter, talk directly to the family, not to the interpreter.

A family with limited income must make the entrance to their house wheelchair accessible for their 11-year-old son, who is now receiving home care. Which of the following would be the most appropriate recommendation for the nurse to make?

Have local carpenter build a ramp across the front steps to the house the client will use a wheelchair to ambulate, family members need to consider if adaptations of their home will be necessary. A local carpenter can build a ramp across the house steps or a split-level elevation to allow wheelchair access. Wheelchair lifts or elevators can be purchased and mounted alongside house steps, but they are more expensive. Placing furniture along the walls and providing tongs do not pertain to making the entrance to the house wheelchair accessible.

Which of the following is NOT an advantage of home care?

It can increase self-confidence because it allows sick people to rest while others take care of them. Home care can increase a woman's or child's self-confidence because it allows for more self-care and often more control of circumstances. The other statements are true.

The nurse is informing a young pregnant patient of the many different maternal community health services that are available. She tells the patient about the group that provides mother-to-mother support for breast-feeding, nutrition, and infant care problem-solving strategies. This group is known as which of the following?

La Leche League La Leche League provides mother-to-mother support for breast feeding, nutrition, and infant care. WIC is a federally funded program that provides food, nutrition, and other services for low income women, infants and children. AFDC stands for Aid to Families with Dependent Children. There are no groups known as the Breastfeeding Club.

Community-based nursing focuses on prevention. As a school nurse in a community you send home information to let the parents know that during the following week you will be screening for lice infestations in all the first-grade classrooms. What type of prevention is this an example of?

Secondary prevention Primary prevention is health-promoting activities that help prevent the development of illness or injury. Secondary prevention is health-screening activities that aid in early diagnosis and encourage prompt treatment before long-term negative effects arise. Tertiary prevention is health-promoting activities that focus on rehabilitation and teaching to prevent further injury or illness, occurs in special settings. Screening is a preventative measure, so the last answer is incorrect.

A nurse is assigned to perform a blood pressure evaluation on a pregnant patient. This type of care is referred to as

Secondary prevention Secondary prevention refers to teaching and screening performed to assist early diagnosis and treatment of an existing or potential problem to avoid long-term negative effects.

A nurse has moved into a new community and will begin practicing at the local health department. Why is it important for this nurse to become familiar with the community where he or she will work?

The health of a community influences the health of its individuals. Because the health of a community influences the health of its individuals, it is important for the nurse to become acquainted with the community in which he or she practices. Community assessment can reveal aspects of a community that may have contributed to an illness and help determine whether a person will be able to return to the community without extra help and counseling after recovering from an illness.

A young woman is seen in the physician's office for her yearly check-up and annual Pap smear. This is an example of which type of prevention?

secondary Secondary prevention is the early detection and treatment of adverse health conditions. A Pap smear is one example of this level. Such an intervention will not prevent a health problem, but is intended for early detection and prompt treatment to prevent complications.

All women during pregnancy should drink six to eight full glasses of fluid a day to obtain adequate fluid for effective kidney function and placental exchange.

true

As part of an education program for pregnant women and their partners, the nurse describes the various settings available for childbirth. The nurse determines that the program was successful when the group relates which of the following about home births?

"Women giving birth at home have control over every part of labor." Home births permit the woman to maintain control over every aspect affecting the woman's labor, such as positioning, attire, and support persons present. A home birth involves the least amount of cost. Home births are recommended for pregnant women considered to be at low risk for complications. Some birthing centers may have very rigid screening criteria. The availability for pain medication is limited for home births.

You evaluate a family to see if they are a good candidate for home care. Which of the following factors would be most important to see in their home or family?

A dedicated home-care provider Home care is only successful if there is a family member able to assume primary care of the child.

Which of the following should a nurse do to avoid disrupting a family routine when visiting to provide home care?

Avoid coming during mealtimes To avoid disrupting family routines, try not to visit at prayer times or mealtimes unless observing family interaction or what a client is eating for a typical meal is necessary for assessment. The other answers, although they are valid guidelines for home visits, would not help the nurse avoid disrupting a family routine

A couple has recently been divorced. The couple has joint custody of their 15-year-old daughter. The nurse recognizes that the daughter is now at a 50% greater risk for which of the following?

Beginning smoking or drinking alcohol Findings have revealed that adolescents living in shared physical custody had higher rates of health risk behaviors such as beginning smoking or drinking alcohol compared with adolescents from two-parent families (60% and 50% higher). Children with parents who are both employed would be more likely to be exposed to violence on television if they are at home alone or to experience upper respiratory infections if in daycare. Although incidence of child maltreatment remains high, there is no correlation between joint custody and a 50% increase in risk for abuse.

A woman with a high-risk pregnancy is on bed rest and is receiving home care from a nurse. The mother expresses anxiety over the possibility of losing the baby, as she has lost a previous pregnancy. She says that receiving visits from her friends and family while at home reduce her anxiety. Which of the following would be the most appropriate outcome criterion pertaining to the home care of this patient?

Client is able to receive frequent visits from friends and family The most appropriate outcome criterion for this patient pertaining to home care is that she is able to receive frequent visits from friends and family and thereby reduce her anxiety levels. Maintaining an appropriate weight could be an appropriate goal pertaining to home care, but it does not address the client's expressed need. Being able to manage pain effectively during labor at the hospital and traveling safely to the hospital do not primarily pertain to home care.

Which of the following is most critical to effective home care?

Commitment to home care from family and other essential people. Home care works best when a family is strongly committed to home care and well prepared to cooperate with health care providers.

The nurse is providing a secondary prevention activity when

Conducting a skin cancer screening fair Secondary prevention measures are those taken to screen for diseases, delayed development according to criteria, or use of medication.

A pregnant woman with a premature ruptured membrane is trying to decide whether home care might be the best option for her. Which of the following is an advantage the nurse should mention to her that is most pertinent to her condition?

Decreased exposure to infection There may be an advantage of placing women with premature ruptured membranes on home care rather than hospital care because of the decreased exposure to infection in their own homes compared to hospitals. Although prevention of disruption to the family and lower cost for the health care delivery system may be advantages, they are not the most pertinent to the patient's condition. Home care would be more likely to cause social isolation than prevent it.

An elderly woman brings her 10-year-old granddaughter to the doctor's office for a vaccination. The nurse learns that the elderly woman lives with her daughter, son-in-law, and three grandchildren. What type of family is this?

Extended family An extended, or multigenerational, family is one that includes not only a nuclear family but also other family members, such as grandmothers, grandfathers, aunts, uncles, cousins, and grandchildren. The family in the scenario fits this description. The family is not a blended family, as the children all have the same parents. It is not an adoptive family, as the children were born into the family, not adopted.

A genogram is a diagram of family and community relationships.

False An ecomap, not a genogram, is a diagram of family and community relationships and is used to document the fit of a family into their community. A genogram is a diagram that details family structure and provides information about the family's health history and the roles of various family members across several generations. It can provide a basis for discussion and analysis of family interaction at health care visits.

The role of a home care assistant includes not only recording a blood pressure reading but evaluating the reading and explaining its significance to the patient.

False When making assignments for home care assistants, be certain they understand that making an assessment (such as recording a blood pressure) is not the same as evaluating the meaning of the assessment. That requires professional expertise.

A female community health nurse is to be accompanied by a male student nurse for the day. The female nurse asks parents who are scheduled for an upcoming home visit if the student nurse can observe the breastfeeding assessment to be conducted for the new mother and baby. The couple decline. What is the nurse's most appropriate next action?

Honor the couple's preference. When providing services in the homes of clients, nurses need to respect the family's values and cultural preferences related to the provision of services. The other responses negate the couple's wishes and could be seen as confrontational and not client centered.

Communicating using understandable terms, whether that means using an interpreter or speaking slowly and using simple terms, will greatly affect the success of the care provided. Inquiring about their financial situation, assessing transportation issues, and helping them access aid programs are secondary to the need for effective communication.

It is increasing because new technology makes so many procedures available in the home. Home care is expanding because it can offer advantages to both caregivers and consumers. New technology makes it successful.

As a community health nurse you are asked to present an educational event to the local Junior League. While planning for the event, what is most important for you, the nurse, to do?

Know the needs of the audience To teach a group successfully, it is important to know the needs of the target population and to have the appropriate teaching skills, strategies, and resources. Asking questions about the histories of those who will be attending the event comes under asking about the targeted group's demographics. While it is important to have these facts it is not most important for the nurse to know. Using posters that everyone can read is part of the presentation strategy of the nurse. Again it is not most important. Telling those present at the event a brief synopsis of the nurses' background is usually done by whomever introduces the nurse as the speaker. It is not usually an activity the nurse does himself or herself.

A nurse is assisting a young woman who has recently moved to the United States from Saudi Arabia. She is frustrated because she continually experiences conflict with her husband's older wife regarding childrearing. Which type of family is this woman a part of?

Polygamous family polygamous family is one that includes multiple wives or husbands or both, which describes this family. This family is not a dyad family (which would be only two members), extended family (which would include family beyond the nuclear family), or cohabitation family (which would involve unmarried partners).

A nurse in the community is working on primary prevention of illness by

Teaching how to properly apply sunscreen Primary prevention consists of interventions taken to prevent an illness or promote a healthful behavior. It takes place before a problem exists.

An example of an intervention taken on the tertiary prevention level of care is

Teaching signs and symptoms of infection to a postoperative patient. A tertiary level intervention is one taken to prevent further illness or injury associated with an existing problem.

A nurse is providing home care to a pregnant woman who is on bed rest. The woman has two other children. During her assessment, the nurse asks the woman how she occupies her time. What is the best rationale for asking this question?

To ensure that the woman is not engaging in activities that would disrupt her rest If bed rest is required, ask how the client occupies his or her time. A woman is not really resting if she is concerned about her family or finances, is caring for older children, or is so bored, she is frequently turning or sitting up. The other answers are legitimate reasons for asking the question but are not the best rationale for it.

The first phase of divorce is marked by quarreling, hurt feelings, and whispered conversations, as the parents realize they are no longer compatible.

True The first phase is apt to be an antagonistic time as parents realize they are no longer compatible and is marked by quarreling, hurt feelings, and whispered conversations. This phase can be particularly upsetting for children because they usually haven't been told what is happening as yet. They may assume the quarreling is their fault (if they had behaved better, this wouldn't be happening). The second phase is the actual separation stage. The third phase involves reshaping lives.

The nurse is instructing a young woman who wants to get pregnant on the use of folic acid supplement three months before and three months after conception. This is an example of which level of prevention?

primary Taking folic acid is an example of primary prevention. Taking it three months before and at least three months after conception will help prevent neural tube defects such as anencephaly and spinal bifida.

The nuring instructor is teaching students about the importance of active listening when communicating with patients. She informs them that which of the following might happen if the nurse does not listen?

Critical information may be missed. Active listening is critical to the communication process. Listening may uncover fears or concerns that the nurse may not have discovered through questioning. By not listening, critical information may be missed.

The nurse is participating in a poisoning prevention program. This activity is an example of which type of community-based nursing intervention?

Health education program Health screening interventions include activities such as mammograms, Pap smears, and well child hearing and vision checks. Health system referral interventions include activities such as referring a woman for a breast prosthesis after a mastectomy or arranging for home tutoring for a child with a long-term illness. Nutritional counseling interventions include activities such as Women, Infants, and Children (WIC) programs, counselor interview of a pregnant woman or child and parents with anemia, and eating disorders programs. Health education program interventions include activities such as poisoning prevention programs, childbirth education or breast self-examination classes, child safety programs, and youth drug awareness programs.

As part of your role as a school nurse, you are conducting a drug education program in a fourth-grade class. This is an example of nursing in

Primary prevention Primary prevention is promotion of heath positive activities and includes teaching regarding safety, diet, rest, exercise, and disease prevention. Secondary prevention focuses on health screening activities that aid in early diagnosis and encourage prompt treatment. Tertiary prevention focuses on rehabilitation and instruction on ways to prevent further injury or illness. Home health care refers to practices done in the home by the patient.

Community care settings for the pediatric client are as varied in their settings as they are in their functions. Much of the care of the pediatric client has been shifted from the hospital setting to a community setting suitable for the care being provided. Which community care setting is appropriate for assessing vision and hearing in children?

Schools Assessing the vision and hearing of a child is a function of the school nurse who makes these assessments several times during the course of a child's school career. Vision and hearing centers, while in the community, are not settings to provide routine pediatric screenings for vision and hearing problems. Pediatric rehabilitation centers are not settings for vision and hearing screenings. Pediatric acute care clinics are for treating acute injuries and illnesses. They are not appropriate settings for routine screenings of a child.

A physician writes an order for home visits daily for a postpartum woman. The nurse is to perform dressing changes on an infected cesarean section incision and administer Rocephin 1 GM IV. What type of care will the nurse be providing in the home?

Skilled home nursing care Home nursing care is considered skilled if it includes physician-prescribed procedures such as dressing changes, medication administration, health teaching, or observation of a woman or child's progress or status through such activities as monitoring vital signs or fetal heart rate.

The father of a child who requires home care following open heart surgery has changed his work schedule to work the night shift so that he can take care of the child during the day. The father is obese, and his work requires strenuous manual labor. He takes insulin for his type 2 diabetes. He complains of being constantly fatigued and irritable, making it difficult to care for his child. Which of the following nursing diagnoses pertaining to home care would best explain the father's fatigue and irritability?

Sleep deprivation due to working the night shift and caring for the child Although all of these could be valid reasons for the father to be fatigued and irritable, only the lack of sleep due to working the night shift and caring for the child pertain to the home care.

Client and family education is a priority and is addressed in Healthy People 2010. This statement is which of the following?

True This is a true statement. "To cope effectively with illness, to understand and participate in decisions about treatment plans, and to maintain and improve health after treatment, clients and their families must have knowledge and skills relevant to their conditions" (JCAHO, 2008)

A pregnant woman who appears to be having contractions comes to the emergency room accompanied by her 10 year-old son. The mother speaks no English, but the son is fluent in both English and Spanish. The nurse knows she must use an interpreter to fully assess this patient? Which of the following would be the best interpreter?

a nurse on the medical-surgical floor who is fluent in both English and Spanish You should not use children as interpreters because by doing so you can affect family relationships, proper understanding, and compliance with health care issues. Also, just because someone speaks the language doesn't mean he will make a good interpreter, especially if they have no medical background. The nurse who speaks both languages would be a good choice. In this case an interpreter is definitely needed.

The nursing instructor is teaching students about the benefits of CAM. Which of the following are examples of CAM? (check all that apply)

• aromatherapy • guided imagery • therapeutic touch • acupressure CAM is the use of complementary and alternative medicine. It is used widely by people in all areas of the community and is used more often by women than men. Some examples include aromatherapy, homeopathy, acupressure, feng shui, guided imagery, reflexology, therapeutic touch, herbal medicine and spiritual healing.

A pregnant teenager is not certain that she will like home care because she is afraid she will feel lonely. You suggest that

everyone could eat together. Helping family members adjust to home care by arranging for times for family interaction is important.

A physician orders a pregnant woman with slightly elevated blood pressure to return home on bed rest until her next scheduled check-up. This is an example of which type of care?

home care This is an example of home care, or care of persons in their own home. Hospice care relates to end-of-life care and care of those with chronic illnesses who are not expected to get any better. Skilled care requires treatments such as administering IV medications, enteral feedings, and dressing changes. Community care relates to care of individuals and/or groups of people living in a specific geographical area.

When performing an initial home care assessment, the nurse evaluates material resources (eg, hospital beds, oxygen, fetal home monitors) as well as which of the following?

if the family can deal with the stress of home care. On the first home care visit, the nurse must perform a thorough history and physical examination of the patient as well as assess resources of the family and whether they will be able to care for the patient at home. Resources include not only material objects such as hospital beds, oxygen, and fetal monitors but also whether the family can deal with the chronic stress of home care.

The community health nurse understands that epidemiology plays a role in caring for and planning health services for patients in a community. She knows that epidemiology refers to which of the following?

the study of the causes, distribution, and control of disease in populations. Pathophysiology is the study of the changes of normal mechanical, physiological, and biochemical functions. Psychiatry is the study and treatment of mental disorders while epidemiology is the study of the causes, distribution, and control of disease in populations. Etymology is the study of the history of words and their meanings.

The nursing students are learning about using a family-centered approach to achieve positive outcomes. This family-centered care refers to which of the following?

• It refers to the collaborative partnership among the individual, family, and caregivers to determine goals, share information, offer support and formulate plans for health care. Family-centered care refers to the collaborative partnership among the individual, family, and caregivers to determine goals, share information, offer support and formulate plans for health care. Commnunity health nursing focuses on preventing illness and improving the health of populations and communities. In community-based care the community is the unit of service and the providers are concerned for the patients who seek service, but also with the larger population of potential or at-risk patients.

The nurse is assessing a pregnant woman's health literacy during a prenatal visit. Which of the following would the nurse identify as impacting the woman's health literacy? Select all that apply.

• Lack of familiarity with the information • Complexity of information • Woman's level of emotional distress Health literacy refers to the ability to read, understand, and use health care information. When new or unfamiliar information is presented or when emotional distress is present, reading ability and understanding are reduced. The last grade completed in school does not equate with reading ability. In addition, appearance, verbal ability, employment status, and educational level cannot reveal persons who do not read well.

The community nurse who is working with women, children, and families knows the importance of using good communication, both verbal and nonverbal. Some examples of nonverbal communication include which of the following? (Check all that apply.)

• active listening • attending to others • nodding Verbal communication is the spoken word and it includes singing. Nodding, attending to others, and active listening are forms of nonverbal communication.

The nurse takes on many roles, especially in the community setting. One important role of the nurse in the community is educator. Patient and family education allows for which of the following? (Check all that apply.)

• allows for questions to be answered • promotes recognition of problem situations and their appropriate responses • allows for families and patients to make informed decisions • ensures the presence of basic health care skills Overall, patient and family education allows patients and families to make informed decisions, ensures the presence of basic health care skills, promotes recognition of problem situations, promotes appropriate responses to problems, and allows for questions to be answered. Through patient education patients can overcome feelings of helplessness and powerlessness and gain the confidence to be active members in their plan of care.

The nurses who works in the community understands the importance of becoming culturally competent. Steps to gain cultural competence include which of the following? (Check all that apply.)

• cultural self-awareness • cultural skills • cultural encounters • cultural knowledge Nurses working in the community need to develop cultural competence. Steps to gaining cultural competence include cultural self-awareness, cultural knowledge, cultural skills, and cultural encounters. Cultural competence does not mean replacing one's own cultural identity with another, ignoring the variability within cultural groups, or even appreciating the cultures being served. Instead, nurses skilled at cultural competence show a respect for difference, an eagerness to learn, and a willingness to accept multiple views of the world.

The nursing instructor is teaching a class on labor and delivery. She lists the advantages of a home birth and then lists which of the following to be disadvantages of home births? (Check all that apply.)

• danger to baby if emergency arises • danger to mother if emergency arises • limited availability of pain medication Home birth is advantageous for many different reasons, including permitting the woman to maintain control as well as allowing for labor to progress normally without any interferences and unnecessary interventions. Disadvatanges include the limited availability of pain medication and danger to the mother and baby if an emergency arises.

The experienced nurse has seen many changes in health care throughout the last few decades. One such change has been to move from acute care settings out into the community with an emphasis on which of the following? (Check all that apply.)

• health promotion • illness prevention Health care delivery has moved from the acute care settings out into the community. It now has a focus on health promotion and illness prevention. It wants to prevent acute and chronic illnesses so that they are not a focus of health care delivery but instead and outcomes if the goal of prevention is not achieved.

The nurse reinforces to the patient that prenatal care is associated with improved pregnancy outcomes. She lists the basic components of good prenatal care to be which of the following? (Check all that apply.)

• health promotion • medical and psychosocial interventions • early and continuing risk assessment • follow-up Early prenatal care can improve pregnancy outcomes. Basic components of prenatal care are early and continuing risk assessment, health promotion, medical and psychosocial interventions and follow-up. Not working while pregnant does not necessarily help. Keeping active usually provides a healthier lifestyle and in turn a better outcome.

The nursing student demonstrates an understanding of what is included in postpartum home visits when she correctly lists which of the following? (Check all that apply.)

• monitoring the physical and emotional well-being of the family members • bridging the gap between discharge and ambulatory follow-up for mothers and their newborns • identifying potential or developing complications for the mother and newborn Home visits give the nurse an opportunity to assess the family's adaptation and dynamics and the home enviornment. Postpartum care includes monitoring the physical and emotional well-being of the family members, identifying potential or developing complications for the mother and newborn, and bridging the gap between discharge and ambulatory follow-up for mothers and their newborns. Administering all of the newborn vaccinations is not feassible as they are numerous and are scheduled at differnent intervals and are not given in the home but instead in a physician's office or clinic. The nurse does not perform any home cleaning for the family.

The nurse identifies which of the following to be techniques to use when teaching patients who have poor health literacy skills? (Check all that apply.)

• pictures • videos • audio tapes • color coding the patient has poor health literacy skills, learning can be fostered by the use of audio tapes, videos, pictures, and color coding (such as medication bottles or steps of a procedure). Written handouts would not be beneficial for someone who has a literacy problem.