Chapter 10 Caring for Families

1. The family is a central institution in American society; however, the concept, structure, and functioning of the family unit continue to change over time. The uniqueness of each family is referred to as family

a.
Durability.
b.
Resiliency.
c.
Diversity.
d.
Forms.

ANS: C

Family diversity is the uniqueness of each family unit. Family durability is the term for the intrafamilial system of support and structure that extends beyond the walls of the household. Family resiliency is the ability of the family to cope with expected and unexpected stressors. Family forms are patterns of people considered by family members to be included in the family.

DIF: Remember REF: 116

OBJ: Discuss how the term family reflects family diversity. TOP: Assessment

MSC: Nursing Process

2. Balancing employment and family life creates a variety of challenges in terms of child care and household work for both parents. This has major implications in health care because

a.
Maternal employment has been demonstrated to be harmful for children.
b.
Maternal employment has shifted the majority of household tasks to the male.
c.
Fathers now participate more fully in day-to-day parenting responsibilities.
d.
The number of single-parent families has decreased since 1970.

ANS: C

There is no proof that maternal employment is damaging for children. However, finding quality child care is a major issue. Managing household tasks is another challenge. Although equal division of labor receives verbal approval, most household tasks remain “women’s work.” Evidence suggests that the fathering role is changing. Fathers now participate more fully in day-to-day parenting responsibilities. The number of single-parent families, which doubled from the 1940s to the 1990s, seems to be stabilizing.

DIF: Understand REF: 117

OBJ: Explain how the relationships between family structure and patterns of functioning affect the health of individuals within the family and the family as a whole.

TOP: Diagnosis MSC: Nursing Process

3. A husband brings his children in to visit their mother in the hospital. The nurse asks how the family is getting along at home without their mom around. The husband states, “None of her jobs are getting done, and I don’t do those jobs, so the house and the kids are falling apart.” The nurse suspects that this family structure is

a.
Very flexible.
b.
Quite rigid.
c.
Extremely open.
d.
Hardy.

ANS: B

A rigid structure specifically dictates who is able to accomplish a task and may limit the number of people outside the immediate family who assume these tasks. An extremely open or very flexible structure also presents problems for the family in that consistent patterns of behavior do not exist, and enactment of roles is overly flexible. Hardiness is the internal strength and durability of the family unit characterized by a sense of control over the outcome of life and an active rather than passive orientation in adapting to stressful events.

DIF: Apply REF: 121-122

OBJ: Explain how the relationships between family structure and patterns of functioning affect the health of individuals within the family and the family as a whole.

TOP: Implementation MSC: Nursing Process

4. It is essential for family members to realize that a family’s beliefs, values, and practices strongly influence the health-promoting behaviors of its members, and to understand that

a.
American families are part of the same culture with the same values and beliefs.
b.
Economic status has little effect on a family’s ability to access adequate health care.
c.
Family environment in early life has a strong influence on later health practices.
d.
All families place a high value on good health and health practices.

ANS: C

Family environment is crucial because health behavior reinforced early in life has a strong influence on later health practices. Although American families exist within the same culture, they live in very different ways as a result of race, values, social class, and ethnicity. Economic stability increases a family’s access to adequate health care. Some families do not place a high value on good health. In fact, some families accept harmful practices.

DIF: Understand REF: 121

OBJ: Discuss the way family members influence one another’s health.

TOP: Assessment MSC: Nursing Process

5. Different approaches may be taken to family nursing practice. When the nurse is caring for a patient who needs constant care in the home setting and for whom most of the care is provided by the patient’s family, what is the best approach for the nurse to take?

a.
Family as context
b.
Family as patient
c.
Family as system
d.
Patient as individual

ANS: C

The newest model, called family as system includes both relational and transactional concepts. If only one family member receives nursing care, it is realistic and practical to view the family as context. When all family members are involved in the daily care of one another, the family as patient is the best approach. Although theoretical and practical distinctions have been noted between family as context and family as patient, they are not necessarily mutually exclusive. Often, the nurse will use the two simultaneously, such as with the perspective of the family as system. Family nursing is based on the assumption that all people are members of some type of family form.

DIF: Evaluate REF: 121-122

OBJ: Discuss the way family members influence one another’s health.

TOP: Evaluation MSC: Nursing Process

6. The nurse is caring for a male patient newly diagnosed with type 1 diabetes mellitus. The patient is not adjusting well to the diagnosis and is refusing to learn how to self-inject insulin. The patient’s wife is critical of the patient’s refusal to learn; a small argument ensues, and the wife leaves, stating, “I’ll be back later when I cool off.” What should the nurse do?

a.
Ask the patient if he would like his wife excluded at visiting time.
b.
Tell the wife in the hall that her behavior is unacceptable and cannot be tolerated.
c.
Realize that the wife will be an important part of therapy.
d.
Tell the patient that he needs to listen to his wife more.

ANS: C

Although relationships are strained when confronted with illness, research indicates that family members have the potential to be a primary force for coping. Excluding the wife would limit that potential. The “unacceptable behavior,” in this situation, may be the way this individual expresses concern and frustration. The nurse may want to speak with the wife to allow her to vent those concerns and frustrations. Telling the patient that he needs to listen to his wife would set up an adversarial situation that should be avoided.

DIF: Apply REF: 122

OBJ: Discuss the way family members influence one another’s health.

TOP: Implementation MSC: Nursing Process

7. When initiating the care of families, one factor that helps organize the family approach to the nursing process is that the nurse

a.
Views all patients as unique individuals.
b.
Realizes that families have little impact on individuals.
c.
Understands that individuals have little impact on families.
d.
Realizes that individuals have an impact on families.

ANS: D

When initiating the care of families, three factors organize the family approach to the nursing process: (1) that the nurse views all individuals within their family context, (2) that families have an impact on individuals, and (3) that individuals have an impact on families.

DIF: Understand REF: 123

OBJ: Discuss the role of families and family members as caregivers.

TOP: Assessment MSC: Nursing Process

8. The nurse is interviewing a patient who is being admitted to the hospital. The patient’s family went home before the nurse’s interview. The nurse asks the patient, “Who decides where to go on vacation?” In asking this, what is the nurse trying to do?

a.
Assess the family structure.
b.
Assess the family form.
c.
Assess the family function.
d.
Make a categorical generalization.

ANS: A

To assess the family structure, the nurse asks questions that determine the power structure and patterning of roles and tasks (e.g., “Who decides where to go on vacation?”). When focusing on family form, the nurse should begin the family assessment by determining the patient’s definition of family. Family function is the ability of the family to provide emotional support and to cope with health problems or situations. The question asked above will not assess that. It is imperative to remember that categorical generalizations are misleading and should be avoided.

DIF: Apply REF: 124

OBJ: Discuss the role of families and family members as caregivers.

TOP: Implementation MSC: Teaching/Learning

9. When focusing on older adults, the nurse must be aware that

a.
Elder abuse happens in lower socioeconomic classes only.
b.
Elders have the same social networks as younger people.
c.
Caregivers may be spouses or middle-age children.
d.
Caregiver stress is minimal when caring for a parent.

ANS: C

Caregivers are typically spouses, who may be older adults with declining physical stamina, or middle-age children, who often have other responsibilities. Abuse of older adults in families occurs across all social classes. Later-life families have a different social network than younger families because friends and same-generation family members often have died or have been ill themselves. The nurse should assess for caregiver stress such as tension in relationships between family and care recipient, changes in level of health, changes in mood, and anxiety and depression.

DIF: Remember REF: 118

OBJ: Discuss factors that promote or impede family health. TOP: Assessment

MSC: Caring

10. When the nurse views the family as context, the primary focus is on the health and development of an individual member existing within a specific environment (i.e., the patient’s family). Although the focus is on the individual’s health status, the nurse should

a.
Assess how much the family provides the patient’s basic needs.
b.
Assess family patterns versus individual characteristics.
c.
Maintain distinctions between “family as patient” and “family as context.”
d.
Plan care to meet not only the patient’s needs, but those of his family as well.

ANS: A

When the nurse views the family as context, the primary focus is on the health and development of an individual member existing within a specific environment (i.e., the patient’s family). Although the focus is on the individual’s health status, the nurse assesses how much the family provides the individual’s basic needs. Family patterns are in the realm of “family as patient.” It is important to understand that although the nurse is able to make theoretical and practical distinctions between “family as context” and “family as patient,” they are not necessarily mutually exclusive. Often, the nurse will use the two simultaneously, as with the perspective of “family as system.” “Family as patient” involves planning to meet the needs of the patient and those of his family as well.

DIF: Understand REF: 121-122

OBJ: Compare family as context to family as patient and explain the way these perspectives influence nursing practice. TOP: Assessment MSC: Caring

11. The nurse is caring for a patient in hospice. As she observes the family dynamics, she notes that the patient is getting adequate care, but the wife is not sleeping well and needs rest. The nurse also assesses the need for better family nutrition and meals assistance. The nurse discusses these assessments with the patient and his family and formulates a plan of care with them to address these issues. The nurse is utilizing which approach to family nursing practice?

a.
Family as context
b.
Family as patient
c.
Family as system
d.
Autocratic determination

ANS: C

In “family as context,” the primary focus is on the health of an individual member. In “family as patient,” family processes and relationships are the primary focus. Often, the nurse will use the two simultaneously, as with the perspective of “family as system.” Because the plan of care was developed with family input, autocratic determination was not used.

DIF: Apply REF: 121-122

OBJ: Compare family as context to family as patient and explain the way these perspectives influence nursing practice. TOP: Implementation

MSC: Caring

12. The nurse is caring for an elderly patient who has no apparent family. When questioned about his family and his definition of family, the patient states, “I have no family. They’re all gone.” When asked, “Who prepares your meals?” he states, “I do, or I go out.” Given the three different approaches to family nursing practice, which would be most appropriate for this patient?

a.
Family as context
b.
Family as patient
c.
Family as system
d.
Combination of “family as context” and “family as patient”

ANS: A

If only one family member receives nursing care, it is realistic and practical to view the “family as context.” Although family nursing is based on the assumption that all people regardless of age are a member of some type of family form, the patient insists that he has no family. The nurse should investigate further. However, at this time, family as patient, as system, or in a combination is not appropriate.

DIF: Analyze REF: 121-122

OBJ: Compare family as context to family as patient and explain the way these perspectives influence nursing practice. TOP: Evaluation MSC: Caring

13. The nurse is caring for an elderly woman and notices that she is not using her cane properly. Which of the following statements by the nurse would most likely elicit a positive response from the patient?

a.
“You’re doing that all wrong. Let me show you how to do it.”
b.
“I don’t know who showed how to use the cane like that, but you’re not doing it right. Let me show you again.”
c.
“You use the cane the way I did before I was shown a way to keep from tripping over it; do you mind if I show you?”
d.
“I used to use the cane the same way you are using it: the wrong way. I’ll show you the right way to do it.”

ANS: C

When the nurse is confident and skillful instead of coming across as an authority on the subject, the patient’s defenses will be down, making the patient more willing to listen without feeling embarrassed. Respectful communication is necessary.

DIF: Understand REF: 125

OBJ: Use the nursing process to provide for the health care needs of the family.

TOP: Implementation MSC: Caring

14. The nurse is providing discharge teaching for an older adult woman who will need dressing changes at home. Her husband, who is also elderly, is her only source of care. The husband states that he will not be able to perform the dressing changes. What does the nurse need to arrange for?

a.
Home care service referrals
b.
Extra dressing supplies
c.
Cancellation of the discharge
d.
An order for antibiotics

ANS: A

Discharge planning with a family involves an accurate assessment of what will be needed for care at the time of discharge, along with any shortcomings in the home setting. If no one can do the dressings properly, the nurse will need to arrange for a home care service referral. Extra dressing supplies will not help the situation if the husband is afraid to use them. Only under extreme situations or in an unsafe situation will the discharge be canceled. An order for antibiotics is not a replacement for good dressing change technique.

DIF: Apply REF: 125

OBJ: Use the nursing process to provide for the health care needs of the family.

TOP: Implementation MSC: Caring

MULTIPLE RESPONSE

1. Social scientists have identified four threats facing the family in today’s American society. Of the choices below, what are the four threats? (Select all that apply.)

a.
Changing economic status
b.
Homelessness
c.
Family violence
d.
Rise of homosexual families
e.
Presence of illness

ANS: A, B, C, E

Social scientists have identified four trends as threats facing the family. These include (1) changing economic status, (2) homelessness, (3) family violence, and (4) the presence of acute or chronic illness. Many homosexual couples define their relationship in family terms, but homosexual families are not listed as a threat facing the family.

DIF: Understand REF: 118-119

OBJ: Explain how the relationships between family structure and patterns of functioning affect the health of individuals within the family and the family as a whole.

TOP: Diagnosis MSC: Nursing Process

2. Although the family as a whole differs from individual members, the measure of family health is more than a summary of the health of all members. Of the following, what areas are unique to family assessment? (Select all that apply.)

a.
Family form
b.
Family structure
c.
Family function
d.
Family health
e.
Individual health

ANS: A, B, C, D

Although the family as a whole differs from individual members, the measure of family health is more than a summary of the health of all members. The form, structure, function, and health of the family are areas unique to family assessment. Although individual health is important, it varies from the family focus.

DIF: Remember REF: 119| 121

OBJ: Discuss the role of families and family members as caregivers.

TOP: Assessment MSC: Nursing Process