Homework Lance
1. Caring is central to nursing practice, but technological advances for rapid diagnosis and treatment should lead the nurse to realize that
a.
Technology has replaced caring as nurses’ primary focus.
b.
Technology and caring cannot coexist when related to patient care.
c.
Technology becomes a powerful tool when it works with caring.
d.
Caring is the essence of nursing and is isolated from technology.
ANS: C
Technological advances become dangerous without a context of skillful and compassionate care. It is time to value and embrace caring practices and expert knowledge (technology), which are the heart of competent nursing practice. Neither technology nor caring can stand alone. They must coexist to provide ultimate patient care.
DIF: Remember REF: 79
OBJ: Discuss the role that caring plays in building a nurse-patient relationship.
TOP: Evaluation MSC: Nursing Process
2. Caring is a universal phenomenon that involves
a.
Being disconnected.
b.
Excluding outside phenomena in favor of family relationships.
c.
Focusing only on human relationships with one another.
d.
What matters to a person.
ANS: D
Caring determines what matters to a person. It underlies a wide range of interactions, from parental love to friendship, from caring for one’s work to caring for one’s pet to caring for and about one’s patients. Caring means that people, events, projects, and things matter to a person. It is a word for being connected.
DIF: Remember REF: 80 OBJ: Compare and contrast theories on caring.
TOP: Assessment MSC: Nursing Process
3. With respect to the concept of caring, most nursing theories
a.
Embrace the disease orientation to health care as Watson does.
b.
Recognize Leininger’s theory and reject culture as a caring force.
c.
Identify caring as highly relational involving patient and nurse.
d.
Stress the universality of the expression of caring.
ANS: C
Nursing caring theories have common themes. Caring is highly relational. Caregiving relationships open up possibilities or close them down. Watson’s transpersonal caring theory rejects the disease orientation to health care and places care before cure. Leininger stresses the importance of nurses’ understanding of cultural caring behaviors. Caring is very personal, thus expression of caring differs for each patient.
DIF: Understand REF: 80-82 OBJ: Compare and contrast theories on caring.
TOP: Evaluation MSC: Nursing Process
4. The patient has had a colostomy placed but has not yet been able to look at it. The nurse is given the task of teaching the patient how to care for it. The nurse sits with the patient, and together they form a plan on how to approach dealing with colostomy care. Which caring process is the nurse performing?
a.
Knowing
b.
Doing for
c.
Enabling
d.
Maintaining belief
ANS: C
Enabling is facilitating another’s passage through a life transition and unfamiliar events. Working with the patient to find alternate ways to help him face his fears and perform the task is doing just that. Knowing is striving to understand an event because it has meaning in the life of another. This must be done before enabling can occur. Doing for is doing for the other as he or she would do for self if it were at all possible. The nurse here is not doing for the patient but is helping him find a way that he can do it. Maintaining belief is sustaining faith in the other’s capacity to get through an event or transition and face a future with meaning. This may be an underlying theme to the process but is not what the nurse is actually doing.
DIF: Apply REF: 82 OBJ: Compare and contrast theories on caring.
TOP: Implementation MSC: Caring
5. In trying to determine patients’ perception of caring, several studies have suggested that
a.
The nurse’s effectiveness in performing tasks defines her profession.
b.
The affective dimension of nursing care is of primary importance.
c.
All patients have the same needs and similar personalities.
d.
Patients value both task performance and the affective dimension of nursing.
ANS: D
Patients continue to value nurses’ effectiveness in performing tasks, but clearly patients value the affective dimension of nursing care. All patients are unique; however, understanding common behaviors that patients associate with caring helps the nurse learn to express caring in practice.
DIF: Understand REF: 83
OBJ: Discuss the evidence that exists about patients’ perceptions of caring.
TOP: Assessment MSC: Caring
6. The nurse is admitting a patient who will be having elective surgery. The nurse spends over an hour asking the patient questions as part of the admission process. What is the nurse’s primary reason for doing this?
a.
It is hospital protocol and part of the admission process.
b.
The nurse is trying to make the patient more comfortable.
c.
This will help the nurse provide better care for the patient.
d.
The nurse needs the time to give a detailed description of what to expect.
ANS: C
Focusing on building a relationship that allows the nurse to learn what is important to the patient helps the nurse to identify a patient’s unique perceptions and expectations. Knowing who patients are helps the nurse select caring approaches that are most appropriate to patients’ needs. Learning what is important to patients may determine how much description is needed.
DIF: Apply REF: 83
OBJ: Discuss the evidence that exists about patients’ perceptions of caring.
TOP: Implementation MSC: Caring
7. The term “ethics” refers to the ideals of right and wrong behavior. As such, the “ethics of care” creates a professional relationship in which the nurse
a.
Must make decisions for the patient solely using intellectual principles.
b.
Must become the patient’s advocate based on the patient’s wishes.
c.
Uses only analytical principles to determine what is best for the patient.
d.
Must ignore unequal family relationships because they are personal.
ANS: B
An ethic of care places the nurse as the patient’s advocate, solving ethical dilemmas by attending to relationships and by giving priority to each patient’s unique personhood. An ethic of care is unique so that professional nurses do not make professional decisions based solely on intellectual or analytical principles. Instead, an ethic of care places “caring” at the center of decision making. Nurses who function from an ethic of care are sensitive to unequal relationships that lead to abuse of one person’s power over another—intentional or otherwise.
DIF: Understand REF: 83
OBJ: Explain how an ethic of care influences nurses’ decision making.
TOP: Evaluation MSC: Caring
8. Providing “presence” involves “being there” and “being with.” What does this involve?
a.
Closeness and a sense of caring
b.
Focusing on the task that needs to be done
c.
Jumping in to provide patient comfort
d.
Being there without an identified goal
ANS: A
Providing presence is a person-to-person encounter conveying closeness and a sense of caring. “Being there” seems to depend on the fact that a nurse is attentive to the patient more than the task. “Being with” means being available and at the patient’s disposal. If the patient accepts the nurse, the nurse will be invited to see, share, and touch the patient’s vulnerability and suffering. Jumping in may not be welcomed. Being there is something the nurse offers to the patient with the purpose of achieving some goal, such as support, comfort, or encouragement.
DIF: Understand REF: 83-84
OBJ: Describe ways to express caring through presence and touch.
TOP: Evaluation MSC: Caring
9. The patient is to have thoracentesis at the bedside but tells the nurse that he is afraid and would like to cancel. The nurse sits with the patient and asks him to describe his fears. She then explains the procedure and assures the patient that she will be with him during the procedure. The patient agrees to have the procedure, and during the procedure, the nurse stays with the patient, explaining each step and providing encouragement. How has the nurse helped this patient?
a.
Providing a presence
b.
Listening
c.
Providing touch
d.
Providing family care
ANS: A
The nurse’s presence helps to calm anxiety and fear related to stressful situations. Giving reassurance and thorough explanations about a procedure, remaining at the patient’s side, and coaching the patient through the experience all convey a presence that is invaluable to the patient’s well-being. Listening and touch can be part of the “presence” but are not its entirety. No family was involved in this scenario.
DIF: Apply REF: 84
OBJ: Describe ways to express caring through presence and touch.
TOP: Implementation MSC: Caring
10. The nurse has cared for a patient for several days. The patient is terminal and is very near death. The nurse notices the heart rate on the monitor decreasing and then the absence of a pattern. The family is standing at the patient’s bed, and when the nurse checks the patient and finds no pulse or blood pressure, the family begins sobbing and hugging each other. Some hold the patient’s hand. The nurse is overwhelmed by the presence of grief and leaves the room to cry in the nurses’ lounge. What is the nurse demonstrating?
a.
Task-oriented touch
b.
Caring touch
c.
Protective touch
d.
None of the above
ANS: C
When a nurse withdraws or distances herself or himself from a patient when the nurse is unable to tolerate suffering or needs to escape from a situation that is causing tension, the nurse is practicing a form of protective touch that is used to protect the nurse emotionally. Task-oriented touch is done when performing a task or procedure. Caring touch is a form of nonverbal communication that influences a patient’s comfort and security, enhances self-esteem, and improves reality orientation.
DIF: Apply REF: 84
OBJ: Describe ways to express caring through presence and touch.
TOP: Implementation MSC: Caring
11. When dealing with the concept of “touch,” the nurse realizes what with regard to contact touch?
a.
Involves only skin-to-skin contact
b.
Involves eye contact
c.
Occurs only when tasks are being performed
d.
Is used only to protect the patient
ANS: A
Contact touch involves obvious skin-to-skin contact, whereas noncontact touch refers to eye contact. It is difficult to separate the two. Touch that occurs when tasks are being performed is known as “task-oriented touch.” Touch used to protect the patient or nurse is known as “protective touch.” Although contact touch does include task-oriented and protective touch, these are not the only forms of touch.
DIF: Understand REF: 84
OBJ: Describe ways to express caring through presence and touch.
TOP: Evaluation MSC: Caring
12. The nurse is caring for a patient who has been sullen and quiet for the past three days. Suddenly, he says, “I’m really nervous about surgery tomorrow, but I’m more worried about how it will affect my family.” What should the nurse do?
a.
Assure the patient that everything will be all right and continue what she/he is doing.
b.
Tell the patient that whatever happens is out of his control, so he shouldn’t worry.
c.
Stop what he/she is doing (if possible) and ask the patient to expand on his statement.
d.
Contact hospital clergy to come and talk with the patient.
ANS: C
A nurse needs to be able to give patients full, focused attention as they tell their stories. It is easy to become distracted by tasks at hand, colleagues shouting instructions, or other patients waiting to have their needs met. However, the time taken to listen effectively is worthwhile both in the information gained and in strengthening of the nurse-patient relationship. Although contacting clergy could be an appropriate measure for this patient, the nurse should first listen to what the patient is saying. By observing expressions and body language of the patient, the nurse will find cues to assist the patient in exploring ways to achieve greater peace.
DIF: Apply REF: 85
OBJ: Describe the therapeutic benefit of listening to patients. TOP: Implementation
MSC: Caring
13. The patient is about to undergo a certain procedure and has voiced concern about outcomes and prognosis. The nurse caring for the patient underwent a similar procedure a few years earlier and stops to listen to the patient’s concerns. Which of the following responses by the nurse may be most beneficial?
a.
“I had a similar procedure last year and I can tell you what I went through.”
b.
“I don’t think you have anything to worry about. They do lots of these.”
c.
“If you’re really concerned, I can call the doctor and cancel the procedure.”
d.
“Of course there are no guarantees, but I think you’ll be all right.”
ANS: A
When an ill person chooses to tell his story, it involves reaching out to another human being. Telling the story implies a relationship that develops only if the clinician exchanges his or her stories as well. Professionals do not routinely take seriously their own need to be known as part of a clinical relationship. Yet, unless the professional acknowledges this need, there is no reciprocal relationship, only an interaction. Offering reassurances or offering to cancel the procedure does not open up that relationship. B, C, and D all dismiss the patient’s concerns.
DIF: Evaluate REF: 84
OBJ: Describe the therapeutic benefit of listening to patients. TOP: Evaluation
MSC: Caring
14. The nurse is making her first set of rounds in the morning. In doing so, she meets a patient whom she has never worked with before. She introduces herself and explains the plan of the day. She also asks the patient how he normally takes his morning medications, such as before breakfast, after breakfast, or during breakfast. She does this because most of the morning medications in that institution are scheduled by pharmacy for 0900. Getting to know her patient will allow her to
a.
Choose the most appropriate time to give the medication.
b.
Explain to the patient that he will not get his medication at his usual time.
c.
Know what information to put on the medication error report form.
d.
Evaluate whether or not the patient is taking his medication correctly at home.
ANS: A
“Knowing the patient” is at the core of the process nurses use to make clinical decisions. Knowing when the patient normally takes his medication will allow the nurse to keep him on as near normal a schedule as possible. Nothing in this question infers that the patient will not get his medications on time, or that a medication error report will need to be completed. Although the nurse can be using this opportunity to evaluate whether or not the patient is taking the medication correctly at home, the main purpose, within this context, is to determine the most appropriate time to administer the medication.
DIF: Apply REF: 86
OBJ: Explain the relationship between knowing a patient and clinical decision making.
TOP: Implementation MSC: Nursing Process
MULTIPLE RESPONSE
1. Caring is a universal phenomenon that influences the ways in which people (Select all that apply.)
a.
Learn.
b.
Think.
c.
Believe.
d.
Feel.
e.
Behave.
ANS: B, D, E
Caring is a universal phenomenon that influences the ways in which people think, feel, and behave in relation to one another. How people learn and what they believe involve other concepts such as teaching/learning and ethics.
DIF: Understand REF: 80
OBJ: Discuss the role that caring plays in building a nurse-patient relationship.
TOP: Evaluation MSC: Nursing Process
2. The concept of “knowing” the patient comprises both the nurse’s understanding of a specific patient and the nurse’s subsequent selection of interventions. To know a patient means that the nurse (Select all that apply.)
a.
Avoids assumptions.
b.
Focuses on the patient.
c.
Engages in a caring relationship.
d.
Forms the relationship quickly.
ANS: A, B, C
To know a patient means that the nurse avoids assumptions, focuses on the patient, and engages in a caring relationship with the patient that reveals information and cues that facilitate critical thinking and clinical judgments. Knowing develops over time as a nurse learns the clinical conditions within a specialty and the behaviors and physiological responses of patients.
DIF: Understand REF: 85
OBJ: Explain the relationship between knowing a patient and clinical decision making.
TOP: Assessment MSC: Nursing Process
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