Chapter 2: Values, Beliefs, and Caring
While doing her morning assessment, the nurse shares with her patients the tests and procedures they have scheduled for that day as well as when she expects to return to deliver their medications or do their treatments. Even though the hospital is a hectic and difficult environment to predict, the nurse regards this information session with her patients as an important way to demonstrate she cares. The rationale behind her action is a. to increase the patients' sense of security by making the environment more predictable for the patients. b. to ease her patients' fears since they may worry that she'll forget to give them their medications. c. to point out to her patients that the care they are receiving is consistent and delivered on time so they will rate her care higher when they leave the hospital. d. to allow the patients some flexibility in when they want to take their medications or have their tests and procedures done.
ANS: A The nurse is informing the patients about the day's schedule so they will know what to expect. The idea is to increase the predictability of an otherwise hectic and unpredictable environment. "To ease her patients' fears since they may worry that she'll forget to give them their medications" is incorrect since there's nothing in the stem of the question that indicates the patients are afraid she'll forget. "To point out to her patients that the care they are receiving is consistent and delivered on time so they will rate her care higher when they leave the hospital" is incorrect since the nurse's intention is to show the patients that she cares; this is not a patient-centered rationale but is intended to boost the nurse's satisfaction ratings. "To allow the patients some flexibility in when they want to take their medications or have their tests and procedures done" is incorrect since the patients are not being given options about when things will happen but are only being told in advance what will happen and when.
A nurse is gathering an admission assessment on a patient who recently emigrated from Japan and is a Buddhist. The man told the nurse that he normally meditates daily and lives almost exactly the way he did in Japan. However, he has not been able to walk for the past weeks. Based on the assessment findings, which questions would be important for the nurse to ask before implementing his nursing care? (Select all that apply.) a. What have you done to cope with your health problem? b. What do you call your health problem? What do you think is wrong? c. What concerns you most about the recommended treatment plan? d. What do you think caused your health problem?
ANS: A, B, C, D All assessment questions fit the scenario and are questions the nurse should explore with a patient who describes himself as someone from a very different culture and religion than the dominant health care culture. The patient should be given the opportunity to describe what he thinks is wrong and what he expects in terms of treatment. The nurse also needs to collect data on what health remedies the patient has tried to cope with the problem and anything that might concern him about the plan of care the nurse has developed.
The nurse recognizes the importance of a patient's beliefs in influencing the patient's behaviors and responses to health care problems. Which of the following are examples of a patient's beliefs? (Select all that apply.) a. A patient explains that the medication he is taking is helping him overcome his anxiety. b. A patient reflects on her values and uses them to help her make a decision about whether or not to have breast reconstruction surgery. c. A patient expresses a feeling of dread about the future to his nurse. d. A 78-year-old man signs a "Do Not Resuscitate Order" when he learns he's had a massive heart attack because, he explains, "he can hardly wait to go and be with his wife in heaven."
ANS: A, D "A patient explains that the medication he is taking is helping him overcome his anxiety" is correct because it describes a man who believes in the effectiveness of using medications that have been scientifically tested to help alleviate health problems such as anxiety. "A 78-year-old man signs a 'Do Not Resuscitate Order' when he learns he's had a massive heart attack because, he explains, 'he can hardly wait to go and be with his wife in heaven'" is correct because it describes a man whose religious beliefs helped him decide against undergoing life prolonging treatments because he says he believes in an afterlife in "heaven." "A patient reflects on her values and uses them to help her make a decision about whether or not to have breast reconstruction surgery" is incorrect because it describes a woman who used "values clarification" to help make a decision about her health care. "A patient expresses a feeling of dread about the future to his nurse" is incorrect because a feeling of dread is "anxiety" and is not a belief.
A nurse recognizes the importance of active listening as a way to show the nurse cares. Which of the following actions by the nurse describes active listening? (Select all that apply.) a. Sitting at the patient's bedside and listening to the patient talk while inserting an IV b. Sitting in a chair facing a patient and making a mental note of the major points of the conversation c. Listening to what the patient says and what he means while she conducts her early morning assessment d. Engaging both the patient and the family members while taking careful notes of the conversation
ANS: B Active listening means doing nothing else but listening to the patient. It's about being attentive and engaged. "Sitting at the patient's bedside and listening to the patient talk while inserting an IV" is incorrect because the nurse is doing something else while the patient talks. "Listening to what the patient says and what he means while she conducts her early morning assessment" is also incorrect because the nurse is also conducting an early morning assessment while listening. "Engaging both the patient and the family members while taking careful notes of the conversation" is incorrect because the nurse is attending to note taking instead of only listening.
A co-worker is an excellent nurse but often assumes responsibility for other people's irresponsible behaviors. Her nurse manager notices that in the past several months she has become overly sensitive with her patients and that she complains of feeling stressed and worn out because she has taken on too much. She admits to having a family background that makes her suspect she has some co-dependent traits. How should her nurse manager proceed if the nurse's work continues to suffer? a. The manager should offer her emotional support for as long as she needs it. b. Help her recognize that she may be co-dependent and needs to get professional help. c. Take her to the next scheduled group therapy session in the mental health ward. d. Confront her about her inappropriate behavior and threaten to fire her if her work doesn't improve.
ANS: B From the scenario, the nurse needs help to recognize that she may be co-dependent and that it is impacting her work performance and the way she's treating her patients. She needs to seek out professional counseling. "The manager should offer her emotional support for as long as she needs it" is incorrect because the nurse manager needs to refer her for treatment and not drag out the situation indefinitely, which is implied in the answer. "Take her to the next scheduled group therapy session in the mental health ward" is incorrect since the nurse manager should not take responsibility away from the nurse but encourage the nurse to take responsibility for herself, which is the best way she can learn to help others. "Confront her about her inappropriate behavior and threaten to fire her if her work doesn't improve" is incorrect since it is not supportive but aggressive and confrontational in nature. The manager wants to help the nurse return to being an excellent nurse again and that would not happen if the manager fires her.
A nursing student walks into the patient's room and is unsure about when it is appropriate to use caring touch in a nurse-patient care situation. What should the student do? a. Leave the room and ask her clinical instructor when and where she should touch her patient. b. Ask the patient for permission to touch her before proceeding. c. Disregard the use of touch since she is unsure of how to maintain professional boundary when it comes to touching a patient. d. Assume all patients want to be touched and that they see it as an act of caring.
ANS: B Whenever a nurse is unsure about the use of touch, it's always best to ask the patient's permission. "Leave the room and ask her clinical instructor when and where she should touch her patient" is incorrect since the nursing instructor is not there and would not know the patient any better than the student. "Disregard the use of touch since she is unsure of how to maintain professional boundary when it comes to touching a patient" is incorrect since "caring touch" is an important way nurses convey they care. To disregard it is to ignore an important means of communication. It is better that the student keep practicing and gaining experience in using touch in order to learn how and when to use it to let her patients know she cares. "Assume all patients want to be touched and that they see it as an act of caring" is incorrect since not all patients want to be touched. The nurse should develop the skills of being able to read the patient's body language and when unsure, to ask permission.
Which of the following actions by the nurse demonstrates "doing for" as described in Swanson's theory? a. Going the extra mile b. Thoroughly assessing in order to know what the patient thinks c. Seeking cues and expertise from colleagues about the patient's condition d. Preserving the patient's dignity and performing competently
ANS: D The "doing for" process of Swanson's theory includes preserving the patient's dignity and performing competently. The other answers are either part of the caring process or are part of the practice of knowing the patient.
The best approach for a nurse who is performing an assessment on a patient from an ethnic group the nurse knows nothing about is to a. use the information the nurse already knows about the other ethnic groups that may be similar to the patient's group to come up with assessment questions. b. ask the same questions the nurse typically asks of all patients and not deviate from the questions on the assessment form. c. ask the patient to explain what he or she believes his or her health problem is and what he or she thinks caused it. d. ask the patient to help the nurse understand anything about the patient's ethnic group that may have a bearing on the patient's health care needs.
ANS: D The best strategy by the nurse is to approach the situation with humility and admit he knows nothing about the patient's ethnic group but would like to learn about anything that would be significant to the patient's care. "Use the information the nurse already knows about the other ethnic groups that may be similar to the patient's group to come up with assessment questions" is incorrect because it amounts to guessing or pretending rather than just admitting he doesn't know what he needs to in order to provide ethnically appropriate care. The result could mean the nurse would miss something important to the patient. "To ask the same questions the nurse typically asks of all patients and not deviate from the questions on the assessment form" is incorrect since it would completely ignore the patient's ethnic differences and would end in something important being missed. "Ask the patient to explain what he or she believes his or her health problem is and what he or she thinks caused it" is incorrect because it addresses the patient's health problem but doesn't include other ethnic-specific information that would be important in providing care for this patient.
A 57-year-old male patient who was hospitalized with an admitting blood pressure of 240/120 asked the nurse if his family could bring in some meat and vegetable dishes from home. He explained that he cannot eat the foods on the hospital menu because it is summer and the hospital is only offering chicken and fish, which in his culture are "hot" foods that will interfere with his healing. Which response by the nurse would best demonstrate an application of Leininger's theory? a. Discourage the family from bringing in food, explaining that the idea of "hot" and "cold" foods is a superstition without scientific basis. b. Negotiate home-prepared food options with the patient and his family to ensure that treatment for the patient's blood pressure is supported. c. Explain that the patient will need to have home-prepared foods evaluated by the dietary staff to ensure that they are acceptable options. d. Tell the family to bring in any foods they want, to help preserve the patient's cultural practices and dietary preferences.
Answer: b According to Leininger's theory, negotiation and adaptation are part of what nurses do to accommodate the patient's cultural ways of life. As long as the foods from home have low concentrations of sodium or other ingredients that are known to affect blood pressure, the nurse can accommodate the patient's beliefs and cultural dietary practices as well as the medical plan of care. Rejecting the patient's cultural traditions and/or accepting them without regard for the well-being of the patient are unacceptable actions. Food given to patients from family members does not need to be evaluated by the dietary staff before consumption.
Nurses need to understand how beliefs and values are different. A nurse begins to offer information to a patient and the patient says, "I've already heard all of that before and I don't agree with any of it." How should the nurse proceed? a. Ask the patient to explain his values. b. Ask the patient to explain what he believes. c. Ask the patient about his prejudicial attitude. d. Confront the patient about the values conflict he's experiencing.
Answer: b The purpose of the question is contained in the stem, to determine whether the student can distinguish between a belief and a value. By asking the patient to explain what he or she believes, the nurse is asking an open-ended question to find out what part of what the nurse is saying the patient believes and what part he or she does not believe. Asking the patient to explain his or her values is incorrect because there is no mention in the stem about the patient saying his or her values are different from what the nurse is trying to say. Asking the patient about his or her prejudicial attitude is incorrect because there is nothing in the stem that indicates a prejudicial attitude. Confronting the patient about the values conflict he or she is experiencing is incorrect because there is nothing in the stem that indicates the patient is experiencing a values conflict. He or she simply does not believe the same thing the nurse believes.
The nurse in the emergency department is caring for an 8-year-old who has had a serious asthma attack. When the nurse attempts to explain the problem to the child's mother, she smells cigarette smoke on the mother's breath. The nurse asks the mother if she has been smoking and the mother responds, "Yes, and I know they've told me before I can't smoke around him." What should the nurse do next? a. Ask the patient's mother what she values more, her child or her habit. b. Ask the patient's mother to explain what she believes about smoking and asthma. c. Ask the patient's mother about her prejudicial attitude toward smoking. d. Confront the patient's mother about the values conflict she's experiencing.
Answer: b The nurse should begin by asking the mother what she believes because the nurse does not know at this point. When working with a patient who has an addiction, the nurse should begin at the assessment phase of the nursing process and attempt to build a trusting relationship with the patient. Asking the mother what she values more, her child or her habit, is incorrect because the issue is not about the mother's values but about what she knows and what she believes. Asking the mother about her prejudicial attitude toward smoking is incorrect because there is nothing in the stem to indicate the mother is prejudiced toward or against smoking. Confronting the mother about the values conflict she is experiencing is incorrect because there is nothing in the question to indicate the mother is having a values conflict. She may not believe what the health care professionals are telling her or she may not believe that she can quit smoking. She may need to be convinced that she can do it, and the best way to make that happen is to build a trusting relationship with her rather than alienate her with accusatory remarks.
As the nurse explained the preoperative instructions to the patient, the patient's older brother suddenly stepped into the doorway and yelled, "People who go under the knife always die. Don't do it! They're going to kill you." What type of higher-order belief is the patient's older brother displaying? a. Distress b. Stereotype c. Prejudice d. Denial
Answer: b The patient's brother is making a generalization that is a stereotype, which is a belief about a person, group, or an event that is thought to be typical of all others in that group. Although it is true that people occasionally die during surgery, it does not always happen as the brother fears. Distress is incorrect; the male is distressed, but distress is not a higher-order belief. Prejudice is incorrect because a prejudicial belief is a preformed opinion, usually an unfavorable one, about an entire group of people based on insufficient knowledge. Denial is wrong because he is not in denial, which is defined as a behavior of refusing to admit something is true.
Which statement best describes for new parents how and when children develop first-order beliefs? a. During infancy, and once developed, such beliefs seldom change b. From life experiences during the toddler and preschool years c. Throughout life from first-hand experiences and information provided by authority figures d. From teen and young-adult peer interaction and mentorship of professional role models
Answer: c Individuals develop first-order beliefs beginning in childhood and continue to acquire them throughout life from first-hand experiences and what they are told by various authority figures. Therefore, first-order beliefs are acquired throughout life and not just in infancy, the first years of life, or adolescence. They form as the result of life experiences and from information provided by people perceived as having authority.
Which nursing theory of care describes how the nurse's presence in the nurse-patient relationship transcends the physical and material world, facilitating the development of a higher sense of self by the patient? a. Swanson's Theory of Caring Processes b. Madeline Leininger's Cultural Care Theory c. Watson's Theory of Human Science and Human Care d. Travelbee's Human-to-Human Relationship Model
Answer: c One of the major concepts of Watson's Theory of Human Caring is described in the stem of the question. Watson's theory is based on a holistic paradigm in which both the nurse and the patient transcend time and the physical and material world. Swanson's theory focuses on practical ways the nurse can help the patient through the use of the five caring processes. Leininger's theory focuses on maintaining and preserving the patient's cultural practices and ways of living but never mentions transcending beyond the physical world. Travelbee's theory focuses on the nurse and the patient creating a relationship bond, but the only mention of transcendence is that the nurse and the patient must transcend the roles that each has assumed.
After admitting a homeless patient to the floor, the nurse tells a colleague that "homeless people are too dumb to understand instructions." What action should the colleague take first? a. Ignore the nurse's prejudicial comment without responding b. Offer to trade assignments and care for the homeless patient c. Ask the nurse about the patient's personal history assessment data d. Challenge the nurse's thinking, pointing out the ability of all people
Answer: c The colleague should first ask the nurse to share information about the patient's background. This should encourage the nurse to consider the feelings and values of the patient and hopefully help the nurse to view the patient as a total individual. Ignoring the statement, offering to change assignments, or challenging the nurse's statement does not promote an enhanced nurse-patient relationship and may prevent the nurse from professional growth or make the nurse defensive.
In Swanson's Caring Theory, the nurse demonstrates caring using several techniques. Which of the following is (are) included in the five caring processes? (Select all that apply.) a. Call patients by their first name to demonstrate a caring attitude. b. Sit at the bedside for at least 5 minutes each hour. c. Use touch based on the nurse's judgment of what is appropriate. d. Ask the patient to identify the most important thing to accomplish during the nurse's shift.
Answer: d The answer is based on the idea that the patient should always, whenever possible, be included in developing the plan of care and especially in setting his or her own goals. The other three answers are close, but something is wrong with each one. Calling patients by their first name to demonstrate a caring attitude is incorrect because the nurse should call each patient by his or her preferred name. Sitting at the bedside for at least 5 minutes each hour is incorrect because the nurse should sit at the bedside for 5 minutes each shift rather than each hour. Using touch based on the nurse's judgment is wrong because the nurse should allow the patient to decide how much touch is appropriate.
A nurse is working with a 35-year-old patient who needs to decide whether to donate a kidney to his brother who has been in renal failure for 5 years. The patient shares with the nurse that the decision is especially difficult because he would not be able to continue to work in his current profession and would be unable to support his three small children if he ever needed dialysis. Which intervention(s) would be most appropriate for the nurse to implement in this situation? (Select all that apply.) a. Explain that it is unlikely that he will ever need dialysis even if he has only one kidney. b. Guide the patient through a values clarification process to help him make a decision based on his values. c. Provide information the patient needs to help him make an informed decision. d. Ask for his permission to contact the kidney donation team to answer any questions he may have.
Answers: b, c, d Encouraging the patient to make a decision based on his personal values, providing necessary information, and offering consultation with individuals most familiar with the kidney donation process are all excellent interventions. It would be impossible to predict whether a patient will need dialysis in the future, making this type of statement misleading.
A new nurse is about to insert a nasogastric tube for the first time but is not sure what equipment to gather or how to begin the procedure. The patient is an 80-year-old woman who is frightened and slightly confused. Which actions by the nurse would best demonstrate caring? (Select all that apply.) a. Offer the patient pain medication to help her calm down. b. Hold the patient's hand while inserting the nasogastric tube. c. Speak calmly while explaining the procedure to the patient beforehand. d. Ask another, more experienced nurse for assistance before initiating care.
Answers: c, d Using a calm voice and seeking help from an experienced nurse exhibit caring for the patient and will help to allay patient anxiety. Medicating a patient for pain before the experience will not automatically alleviate patient anxiety and may cause the patient to experience greater confusion. The nurse will need to use both hands to safely insert the nasogastric tube and promote a positive patient outcome, so the nurse is unable to hold the patient's hand during the procedure.
