Family Focused Nursing Care 1st Edition Denham Eggenberger Test Bank
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Chapter 10- Family-Focused Care in Acute Settings
- Which of the following represents a barrier to the provision of family-focused nursing care in the acute care setting?
|1.||Nurse’s beliefs that family members often interfere with the ability to provide quality care to the hospitalized family member|
|2.||Family beliefs about the need to protect their hospitalized member by being involved with decisions about nursing care|
|3.||Nurse’s successful mastery of technology and electronic medical record allowing the nurse time to answer questions of family members|
|4.||Nurse’s focus on family involvement in discharge planning at the time of hospital admission|
|1||Nurses often believe that the focus of their care is on the ill individual rather than considering the family aspect; this belief can become a barrier to family-focused care. Nurses consider the acute care setting to be their domain and they are sometimes unskilled at partnering with families to provide care to the ill individual.|
|2||Vigilance and the need to protect a family member is common and should be supported in providing family-focused nursing care.|
|3||Being able to operate bedside equipment within the hospital setting and to use the electronic medical record in an efficient way allows more time for the nurse to ask important questions and share information while operating equipment.|
|4||Preparation for discharge should not take place at the time of discharge but rather begins when initially assessing the patient and family at the time of admission.|
KEY: Content Area: Family needs during acute care episodes (the acute care setting) | Integrated Process: Communication and Documentation | Client Need: Safe and Effective Care Environment | Cognitive Level: Comprehension | Question Type: Multiple Choice
- Which of the following concepts is important to the provision of family-centered nursing care in the acute care setting?
|1.||A planned hospitalization helps to clarify family roles and unifies families.|
|2.||During hospitalization, families are often challenged by the need to make adjustments in family routines.|
|3.||Deliberate adherence to typical family routines during hospitalization reduces the uncertainty experienced by family members.|
|4.||Exposure to an ill family member in the acute care setting is stressful and family time should be limited.|
|1||The hospitalization means the ill person may be absent from the roles usually assumed, and family members may take on new and unfamiliar caregiving and other roles.|
|2||Hospitalization creates the need for new skills and knowledge because the family suddenly finds themselves in a different context or situation that disrupts usual routines.|
|3||The acute care situation may create conflicts and disagreements among family members and uncertainty can result; daily routines are interrupted and families are required to adapt to the situation by changing comfortable routines.|
|4||During hospitalization families want to be near, watch over, and advocate for their family member.|
KEY: Content Area: Acute illness experience from individual and family perspectives (altered structure of family routine) | Integrated Process: Communication and Documentation | Client Need: Safe and Effective Care Environment | Cognitive Level: Comprehension | Question Type: Multiple Choice
- You are caring for an eight-year-old who is in the emergency room with need for a closed-reduction of an arm fracture. The on-call orthopedic physician will be performing the procedure using conscious sedation. You are about to move the child to a different room to start an IV when the child’s father asks you if you think that they should be seeking a second opinion. Because you know that families often feel the need to protect loved ones during hospitalization, what would your first response be to the parent?
|1.||Help the parent seek a second opinion by providing the name of another orthopedic surgeon.|
|2.||Tell the parent that a second opinion might be confusing for them and that the room is ready for them to begin the procedure.|
|3.||Review the procedure with the parent and assure them of the skill of the physician doing the procedure.|
|4.||Ask the parent what has prompted them to ask this question of you and how you can be of most help to them at this time.|
|1||The parent is not asking for the name of another surgeon at this time; this action does not address the question being asked.|
|2||This action does not answer the question being asked and it presumes the outcome of seeking a second opinion, in addition to responding to the hospital system’s needs rather than family needs.|
|3||Family members often seek control when they are in an unfamiliar environment. Educating a family member without knowing what is of concern to them does not help develop a trusting/collaborative partnership between health-care providers and family members.|
|4||Seeking clarification about the concerns behind the question establishes a trusting relationship between the nurse and parent and enables the parent to assert their need for control in the situation.|
KEY: Content Area: Family stresses in acute care settings | Integrated Process: Communication and Documentation | Client Need: Safe and Effective Care Environment | Cognitive Level: Evaluation | Question Type: Multiple Choice
- The family of an 88-year-old man with an acute exacerbation of chronic obstructive lung disease is at his bedside. He is experiencing dyspnea and placement on a ventilator is suggested. The patient is DNR and does not want extreme measures taken, but is unable to speak for himself. One daughter supports placement on a ventilator while the other believes that it will only add to his suffering. Which of the following statements by a nurse might facilitate communication between these family members?
|1.||“Can you tell me if he has ever been on a ventilator before, and how he responded to it then?”|
|2.||“Given this confusion, maybe we should discuss his DNR status; I can go get the information we have on file.”|
|3.||“I know that this is a difficult situation—perhaps you would like to talk with a clergy person to help in making the decision.”|
|4.||“I’m sure that it is difficult seeing your father like this, can we spend a few minutes talking about your concerns at this time?”|
|1||Asking this question might prompt conversation, but it focuses more on patient response than on the daughters’ opposing opinions.|
|2||A therapeutic conversation is intended to address concerns in the attempt to alleviate suffering; resorting to the DNR status request is something that best comes later in the conversation when the father’s wishes are addressed.|
|3||Nurses are capable of dealing with family interaction and conflict because of their family-focused communication skills; a response like this might send the message that the nurse does not want to deal with the issue.|
|4||An open ended statement such as “tell me your concerns about this illness and hospitalization” can allow the family to share their illness story.|
KEY: Content Area: Acute illness experience from family perspective (family communication in the acute care setting) | Integrated Process: Communication and Documentation | Client Need: Physiological Integrity | Cognitive Level: Application | Question Type: Multiple Choice
- Aiza is the wife of 52-year-old Hasan, who has been hospitalized for pneumonia. Aiza has spent the day by her husband’s bedside and decides to leave his side to have dinner in the hospital cafeteria. When she returns to his room she finds Hasan is having difficulty breathing and notices that his oxygen saturation monitor is beeping and that the monitor is displaying 88% rather than the 94% it has been during the day. Aiza runs to get Hasan’s nurse who is at a nearby computer charting. Which of the following statements made by Aiza best reflects the uncertainty of family illness?
|1.||“Please, you need to come to my husband’s room—I’m afraid that he is dying.”|
|2.||“You need to come right now, I think that my husband needs some oxygen.”|
|3.||“This happened last time he was in the hospital for the flu—I think you need to check on him right away.”|
|4.||“I know I shouldn’t have left for dinner—he gets so upset when I’m not at his side—he is probably having a hard time breathing because he is upset.”|
|1||Uncertainty can be defined as the inability to identify the meaning of illness-related events. Families are often in a foreign territory when a member is hospitalized and they don’t have the skill or ability to accurately understand or interpret situations and often expect the worst.|
|2||Aiza has accurately diagnosed her husband’s physiological need with certainty.|
|3||Prior experience is reducing the level of uncertainty in this situation.|
|4||Although taking on responsibility for a problem that may not have been caused by her absence, this potential explanation is based on accurate prior history rather than uncertainty about the situation.|
KEY: Content Area: Family uncertainty | Integrated Process: Communication and Documentation | Client Need: Safe and Effective Care Environment | Cognitive Level: Analysis | Question Type: Multiple Choice
- Which of the following statements made by a nursing student indicates the need for further education about family-focused nursing?
|1.||“When family members are not well-supported during hospitalization, patients are often readmitted.”|
|2.||“Families that are well-supported by nurses during hospitalization are more satisfied with their care.”|
|3.||“While the individual patient is the focus during early hospitalization, the family should be included when things stabilize.”|
|4.||“When nurses exclude family members from patient care, suffering may be magnified.”|
|1||Patient readmissions are often a result of the perceptions of lack of support from health-care providers by family members.|
|2||Families that are supported during hospitalization of a family member are more satisfied with their care.|
|3||Families should be included as partners in care from the beginning of hospitalization.|
|4||Not being able to be a collaborative partner in care often causes family members to think that information is being withheld and fears about the unknown can increase emotional tension and magnify suffering.|
KEY: Content Area: Acute illness experience from individual and family perspective (family suffering in acute care settings) | Integrated Process: Nursing Process | Client Need: Safe and Effective Care Environment | Cognitive Level: Evaluation | Question Type: Multiple Choice
- Which of the following statements is the best rationale for allowing a family member to be present during cardiopulmonary resuscitation of another family member?
|1.||The inclusion of the family will improve the public image of nurses.|
|2.||Inclusion of family members reduces the need for the nurse to constantly update them on patient progress.|
|3.||The inclusion of family members reduces both patient and family distress.|
|4.||The inclusion of family will improve the overall efficiency of the healthcare team.|
|1||Improving the public image of nursing is not the intended benefit of family presence during resuscitation.|
|2||Although the family member will be able to see the progress of resuscitation efforts, this is not the intended purpose of family presence during resuscitation.|
|3||Family members benefit from feeling connected; fear and anxiety are reduced because they know what is happening rather than doubting that “everything possible” is being done.|
|4||Additional non-provider family members will not improve efficiency of the health-care team.|
KEY: Content Area: Stress and uncertainty during acute illness and hospitalization | Integrated Process: Nursing Process | Client Need: Safe and Effective Care Environment | Cognitive Level: Evaluation | Question Type: Multiple Choice
- You are caring for a 58-year-old woman who had a bilateral mastectomy 48 hours ago. When you meet the patient she tells you that her husband will not attend the discharge teaching meeting as planned. She also mentions that he has not been to the hospital since the surgery. Which of the following responses by the nurse practicing family-focused care is most appropriate?
|1.||“Can you tell me more about your family and how your hospitalization has affected them?”|
|2.||“We may be able to reschedule the meeting—I’ll check with the discharge planner.”|
|3.||“Did the admitting nurse create a genogram of your family?—it might help if I took a look at it.”|
|4.||“Will you be able to manage your care alone at home, or is there someone else I should call?”|
|1||Therapeutic questions with the family are critical to family-focused nursing. Open-ended questions facilitate explanation of data including facts, thoughts, or emotions.|
|2||This statement fails to recognize the wife’s potential concern about her absent spouse.|
|3||Closed-ended questions shut down nurse-family communication.|
|4||Closed-ended questions shut down nurse-family communication.|
KEY: Content Area: Nursing actions that support family | Integrated Process: Communication and Documentation | Client Need: Physiological Integrity | Cognitive Level: Application | Question Type: Multiple Choice
- Kathy is the parent of 13-year-old Meg, who has cerebral palsy. In the medical record, it is noted that in a previous hospitalization Kathy complained that Meg was forced to wear an oxygenation saturation monitor although the physician had said it was not needed. After you introduce yourself as the nurse, which of the following statements might best help build a positive nurse-family partnership?
|1.||“I understand that you were upset about the monitor during the last hospitalization, but every patient has to wear it.”|
|2.||“I know that you were upset during the last hospitalization. We will not use the monitor if the physician does not believe it is needed.”|
|3.||“Is there some way we can help Meg better comply with wearing the monitor during this hospitalization?”|
|4.||“Parents are often upset during hospitalizations. Fatigue reduces your patience for hospital routine.”|
|1||Rigid adherence to hospital policy places the nurse in position of directing the care of the hospitalized individual rather than sharing responsibility with the family or considering their expertise in the care of their child.|
|2||Nurses who acknowledge prior experiences of a family might establish a foundation on which to build a positive relationship. This comment supports the family in partnering for mutually positive outcomes.|
|3||This comment suggests that the nurse is intent on following procedure and focusing on the ill individual rather than considering the family as mutual partners in care.|
|4||This judgmental comment makes the assumption that fatigue is responsible for unwillingness to adhere to hospital routine.|
KEY: Content Area: Nursing actions that support family | Integrated Process: Communication and Documentation | Client Need: Safe and Effective Care Environment | Cognitive Level: Evaluation | Question Type: Multiple Choice
- You are a nurse caring for a patient who is having a GI bleed. You say to his wife: “It is so fortunate that you brought him to the emergency room. You were right in thinking that he needed immediate medical attention.” This is a therapeutic statement for which of the following reasons?
|1.||It is an open-ended question that encourages conversation.|
|2.||It is circular questioning that focuses on relationships.|
|3.||It commends the family member and empowers them in the situation.|
|4.||It makes the family member feel that she has been heard.|
|1||This is not an open-ended question—it is a statement of commendation.|
|2||This is not a circular question—it is a statement of commendation.|
|3||Commendations, or statements of praise, empower family members and enhance the ability of the nurse to form a collaborative relationship. Praise often helps family members better endure the strain of the illness experience.|
|4||This response is only partially correct. The family member is not only heard but her actions are praised which in itself is a nursing intervention.|
KEY: Content Area: Nursing actions that support family | Integrated Process: Communication and Documentation | Client Need: Physiological Integrity | Cognitive Level: Analysis | Question Type: Multiple Choice
- Which of the following is an accurate statement about circular questions?
|1.||Circular questions often focus on family beliefs about acute illness.|
|2.||Circular questions are primarily intended to commend family actions.|
|3.||Circular questions may be open ended or yes-or-no questions.|
|4.||The same circular questions should be used daily to ensure a consistent result.|
|1||The Calgary Family Intervention Model includes a circular questioning process in which explanations, facts, thoughts, and emotions of family members can be used to gather information.|
|2||Commendation, or praise, may be used within a circular question, but it is not the sole intention of the circular questioning approach.|
|3||Circular questions are not closed, yes-or-no questions.|
|4||A circular question evokes a response that generates a new, different question to be asked, eliciting further information to be gathered or allowing a cycle of dialogue to occur.|
KEY: Content Area: Nursing actions that support family | Integrated Process: Communication and Documentation | Client Need: Nursing Process | Cognitive Level: Comprehension | Question Type: Multiple Choice
- When nurses are trying to determine whether patients and families need more information, they often ask, “Do you have any questions?” Which of the following statements best explains why this approach is flawed?
|1.||Patients and families will ask questions without being invited, and this approach is too direct.|
|2.||This approach presumes that the family and patient are not on the healthcare team and may be condescending.|
|3.||The question asks patients to share private information, which is a violation of HIPPA guidelines.|
|4.||Patients and families often don’t know enough about a situation to know what questions to ask.|
|1||Families of hospitalized individuals are often too intimidated by the setting and the bureaucratic culture within acute care settings to ask questions—they need to be invited.|
|2||The question as worded does not begin with an inviting tone, such as, “We consider your opinion to be very important; do you have any questions at this point?”|
|3||Exchanging information with a patient/family member is not a violation of HIPPA guidelines unless the family member does not want information shared.|
|4||At times, families do not know what questions to ask because the situation is new or foreign to them and the language of providers can be difficult to understand. A nurse may begin with the assumption that most families have questions.|
KEY: Content Area: Nursing actions that support family (nursing actions in the acute care setting, p. 45) | Integrated Process: Teaching/Learning | Client Need: Safe and Effective Care Environment | Cognitive Level: Analysis | Question Type: Multiple Choice
- Which of the following statements about the value of nurse-family meetings in the acute care setting is inaccurate?
|1.||Regular nurse-family meetings usually increase conflict between staff and family.|
|2.||Regular family meetings help to improve care processes in the hospital.|
|3.||Regular nurse-family meetings may enhance family decision-making.|
|4.||Regular nurse-family meetings allow acknowledgement of family suffering.|
|1||Meetings most often decrease conflict between staff and family because opinions and beliefs are openly shared in a collaborative manner.|
|2||Regularly scheduled nurse family meetings may decrease family uncertainty and help families face the struggles and stresses of family decision-making.|
|3||Regularly scheduled nurse-family meetings may help families with decision-making.|
|4||Regular nurse-family meetings provides opportunity for family members to discuss how another member’s hospitalization is affecting them emotionally or spiritually.|
KEY: Content Area: Nursing actions that support family | Integrated Process: Communication and Documentation | Client Need: Safe and Effective Care Environment | Cognitive Level: Comprehension | Question Type: Multiple Choice
- Juanita was brought to the hospital by her daughter-in-law, Alejandra, who lives within a few miles of her in a remote area of the state. Juanita will be kept in a semi-private room for overnight observation and Alejandra plans to stay at Juanita’s bedside for a couple of hours so she can find out what is going on before she leaves to check into a motel for the night. Juanita’s nurse checks in on her patient and asks Alejandra what her relationship is to Juanita. Upon learning this information, what is the best response by the nurse?
|1.||“I’m afraid that, due to HIPPA regulations, we have a hospital policy that we can only share information about the patient with Juanita’s extended family such as her husband or children.”|
|2.||“I’ll need you to step out in the hallway so that I can talk to you about Juanita’s medical status; it’s an issue of confidentiality and we need to protect personal health information.”|
|3.||“I’ll need to check with Juanita to make sure it’s okay if I discuss her medical status with you.”|
|4.||“I’m sorry, but due to HIPPA regulations, we can’t have visitors stay at the bedside when the patient is not in a private room.”|
|1||A nurse may discuss individual health status with family members if the individual does not object.|
|2||This is not an accurate interpretation of the HIPPA guideline regulations; the nurse must obtain Juanita’s permission before sharing her information.|
|3||A hospitalized individual can give permission for information sharing with another family member or whomever the hospitalized person wants to have this information.|
|4||This is not an accurate interpretation of the HIPPA guideline regulations; these regulations do not stipulate hospital visitation policy.|
KEY: Content Area: Environmental factors that support and challenge family-focused care | Integrated Process: Communication and Documentation | Client Need: Safe and Effective Care Environment | Cognitive Level: Application | Question Type: Multiple Choice
- Based on current research, which of the following statements about family presence in the acute care setting is accurate?
|1.||Visitation by family members should be unlimited in the acute care setting with the exception of the ICU.|
|2.||Inclusion of family members in bedside rounds may cause miscommunication and family stress.|
|3.||Inclusion of family members in bedside rounds improves patient/family satisfaction.|
|4.||The inclusion of family members during resuscitation and invasive procedures is appropriate.|
ANS: 3, 4
Unrestricted family visitation increases patient comfort and patient and family satisfaction with care, including in the ICU. Research supports inclusion of family members in bedside rounds because it improves communication and patient/family satisfaction. There is a growing movement to support the presence of family during resuscitation and invasive procedures when guidelines are followed to support the family during the experience.
KEY: Content Area: Evidence that supports family presence | Integrated Process: Communication and Documentation | Client Need: Safe and Effective Care Environment | Cognitive Level: Comprehension | Question Type: Multiple Response
- Often, the admission of a family member to the hospital creates conflict and stress for family members. This is the case for the White family, who ask the nurse caring for an elderly family member multiple questions and for explanations about their father’s recent admission to the hospital for pancreatitis. Which of the following environmental factors is supportive of family-focused nursing care?
|1.||Prior family priorities and routines assist the health-care team to concentrate on the family’s perceptions of priorities of care.|
|2.||Multiple questions suggest that family members are not absorbing the information that is being provided to them; they need to be provided with more online resources to use at times that are convenient for them.|
|3.||The family is likely to be disagreeing with one another about what should be happening with the care of their father; the nurse should seek out a key family member to discuss concerns rather than meeting with the entire family.|
|4.||Information needs to be given in understandable language, with the use of pictures drawn to illustrate concepts starting at the time of admission to the hospital.|
ANS: 1, 4
Family priorities for care may be different from those of the health-care team; being able to share these is supportive of family-focused nursing care. Online resources are helpful to augment information being provided by nurses and other health-care team members, however it may not be at the reading level of the family member or directly address the questions in understandable language for the family. Hospitalization of a family member is a family experience and, as such, all of those affected by the hospitalization should be included in discussions about care, rather than connecting with one member of the family. Beliefs about which family members should be present during decision-making are to be respected by health-care providers. The information provided to families by nurses needs to be tailored to the family’s health literacy level and be consistent among members of the health-care team. Diagrams can be very helpful to facilitate family understanding of an illness condition.
KEY: Content Area: Environmental factors in acute care settings | Integrated Process: Communication and Documentation | Client Need: Safe and Effective Care Environment | Cognitive Level: Comprehension | Question Type: Multiple Response
- Family members of critically ill hospitalized adults often have a well-defined, predictable set of needs. Which of the following are accurate representations of these needs?
|1.||Being able to take breaks in order to return home for rest and healthy meals|
|2.||Remaining near to the patient in order to maintain the familial relationship|
|3.||Being kept informed about decisions being made for the family by the health-care team|
|4.||Being given time to make decisions|
ANS: 2, 4
Family members need to be able to care for themselves during critical care hospitalization of an adult family member, but they prefer to remain close by and not leave the setting. Consequently, hospitals are creating patient rooms that allow families to stay close and either receive meals or prepare them in “within hospital” kitchenette suites. Family presence and maintaining family relationships are important and benefit both the patient and the family. Families would prefer that health-care decisions not be made for them but rather with them as partners in care planning. Families find decision making during a critical care admission to be very challenging and they need health care providers to give them time to make decisions.
KEY: Content Area: Examine family needs during acute care episodes | Integrated Process: Communication and Documentation | Client Need: Safe and Effective Care Environment | Cognitive Level: Comprehension | Question Type: Multiple Response