Chapter 10 Family-Focused Care in Acute Settings

Chapter 10  Family-Focused Care in Acute Settings

Complete Chapter Questions And Answers
 

Sample Questions

MULTIPLE CHOICE

1. 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

ANS: 1

Feedback
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.

PTS: 1
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

2. 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.

ANS: 2

Feedback
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.

PTS: 1
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

3. 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.

ANS: 4

Feedback
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.

PTS: 1
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

4. 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?”

ANS: 4

Feedback
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.

PTS: 1
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