OB: Chapter 2 Family-Centered Community-Based Care

A young couple is preparing to leave the hospital and go home after the birth of their baby. While preparing their care plan, the nurse can demonstrate recognition of their cultural differences by asking:

"Do you have any treatment preferences you would like me to include in the care plan?" It is important for all nurses to incorporate the client's traditional healing and health practices with conventional medicine. Showing respect for the client's beliefs and practices will improve communication and effectiveness of the care plan. The differences and needs of the client must be considered when developing the plan. Page 45

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 statement would indicate that the client understood the information?

"I'll discuss with my primary care provider whether it is a good idea for me to use sea-bands." All therapies (complementary and alternative) should be discussed with the primary care provider. 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. Page 48

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. Page 50

What is a key element of providing family-centered care?

Communicate specific health information. Key elements in the provision of family-centered care include demonstrating interpersonal sensitivity, providing general health information and being a valuable resource, communicating specific health information, and treating people respectfully. Giving as much control as possible to the client and his or her family is essential in family-centered care. The nurse should give all the health information, both good and bad, that the client or the family requests and be culturally sensitive to the client and the family. Page 39

The nurse is asked to present an educational event to the local Junior League. While planning for the event, what is most important for 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, but 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. Page 56

The community health nurse is seeing a mother and newborn for the first home visit. Which information best indicates an understanding of visiting clients in their home?

The home visit is a way of monitoring the well-being of all family members. Home visits offer services similar to those offered at a scheduled clinic visit, but they also give the nurse an opportunity to assess the family's adaptation and dynamics and the home environment. The other statements do not indicate the best understanding of home visits. Page 53

A community-based nurse has a different set of skills than those of counterparts who work in a hospital. Community-based nurses 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 to consult with. 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. Page 58

A nurse is working in the community providing tertiary prevention. The nurse is most likely performing which activity?

counseling victims of long-term abuse who are experiencing numerous problems Tertiary prevention measures are supportive and restorative. For example, tertiary prevention efforts would focus on minimizing and managing the effects of a chronic illness such as cerebrovascular disease or the chronic effects of sexually transmitted infections (STIs), e.g., herpes, human immunodeficiency virus (HIV), and untreated syphilis. Another example would involve working with women who have suffered long-term consequences of violence. Administering immunizations and providing drug education are examples of primary prevention. Assisting with hearing evaluations is an example of secondary prevention. Page 45

During a prenatal visit, a client tells the nurse, "I just started some herbal remedies and haven't told my doctor yet." Which action by the nurse would be most appropriate?

encouraging the client to let the primary care provider know The nurse should always encourage clients to discuss the use of any unprescribed therapy with their primary care provider, as some therapies are contraindicated and may increase the risk of harm to the mother and infant. Some CAM substances are harmful during pregnancy and must be avoided. It is also important that clients research reputable sources for the information. Some substances will cross the placenta and have the potential to reach the fetus. It is extremely important that the nurse remain reflective, nonjudgmental, and open-minded about CAM. The nurse needs to do more than just document the information. Page 48

The nursing instructor is teaching a class on labor and birth. She lists the advantages of a home birth and then lists which disadvantages of home births? Select all that apply.

limited availability of pain medication danger to mother if emergency arises danger to baby if emergency arises 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. Page 52

A nurse in a woman's shelter is counseling a client who has been a victim of abuse. What type of prevention is this treatment?

tertiary Working with victims of abuse or violence is tertiary prevention. Tertiary prevention is designed to reduce or limit the progression of a disease or condition. Primary, tertiary, and secondary prevention are all examples of community-based care. Primary prevention involves preventing a disease or condition before it occurs. Secondary prevention is the early detection and treatment of adverse health conditions. Page 45

A nurse is addressing a group of women on the issue of women's health during their reproductive years. Which reason does the nurse provide regarding the need for comprehensive, community-centered care to women during this time period?

Women's health care needs change with their reproductive goals. The nurse should inform the women that comprehensive community-centered care should be given to women during their reproductive years. This is because as their reproductive goals change, as does their health care needs. A woman's immune system does not weaken immediately after birth. Similarly, women do not have more health problems specifically during their reproductive years, nor are they more susceptible to stress during their reproductive years. Page 55

Which factor 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. Page 39

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

advise the client to speak with her primary care provider about combining herbal substances with her medication. The nurse should ensure that the client speaks with her primary care provider. Clients who are being treated with conventional medication therapy should be advised to avoid herbal substances because they may lead to unknown interaction effects. Page 47

A nurse working in a clinic is following up on the primary care provider's recommendation that a client consult a nutritionist. By giving a list of referrals to this client, the nurse is engaging in:

client advocacy. Client advocacy is speaking or acting on behalf of clients to help them gain greater independence and to make the health care delivery system more responsive and relevant to their needs. Community-based nursing focuses on prevention and is directed toward persons and families within a community. Primary care is the direct action of the primary care provider. Secondary prevention involves health screening activities that aid in early diagnosis and encourage prompt treatment before long-term negative effects occur. Page 59

The nurse is conducting a postpartum home visit. Which action would not necessarily be a responsibility of a visit?

conducting a well-baby visit to start the child's immunizations Postpartum care in the home environment usually includes monitoring the physical and emotional well-being of the family members; identifying potential or developing complications for the mother and newborn; linking the family as needed to available community social services; and bridging the gap between discharge and ambulatory follow up for mothers and newborns. Page 53

A pregnant teenager is not certain that she will like home care because she is afraid she will feel lonely. The nurse should suggest that:

everyone could eat together. Helping family members adjust to home care by arranging for times for family interaction is important. Page 59

A nurse is providing care to a client who has undergone a mastectomy. The nurse provides the woman with information about where to obtain a breast prosthesis. This is an example of which type of community-based nursing intervention?

health system referral The nurse is passing along information about the location of and services offered for the client, an example of a health system referral. Health education programs assist clients in making health-related decisions about self-care and use of resources. Health screening programs focus on detecting unrecognized or preclinical illness among individuals such as mammography. Telephone consultation involves listening and providing support, information or instruction given over the phone, and documenting the interaction. Page 41

There are multiple options for clients to seek assistance at community-based settings. Which settings would clients identify as options? Select all that apply.

hospice school health home health assisted living facilities Primary health care in community-based settings is the result of changing the focus from illness-oriented care, as found in hospitals, to preventive care and health promotion as found in various community facilities. This shift in focus has opened more employment opportunities for nurses outside the hospital setting. Community-based settings include hospice, school health programs, home health, and assisted living facilties. Page 40

Nurses involved with community health nursing focus primarily on:

preventing illnesses. Community health nursing focuses on preventing illness and improving the health of populations and communities. They address current and potential health needs, promote and preserve the health of the population, and are not limited to particular age groups or diagnoses. Page 40