Interventions in Groups

Multiple Choice

1. During a therapeutic group, which nursing action demonstrates a laissez-faire leadership style?
1. The nurse mandates that all group members reveal an embarrassing personal situation.
2. The nurse asks for a show of hands to determine group topic preference.
3. The nurse sits silently as the group members stray from the assigned topic.
4. The nurse shuffles through papers to determine the facility policy on length of group.

ANS: 3
Rationale: The nurse leader who sits silently and allows group members to stray from the assigned topic is demonstrating a laissez-faire leadership style. This style allows group members to do as they please with no direction from the leader. Group members often become frustrated and confused in reaction to a laissez-faire leadership style.

Cognitive Level: Application
Integrated Process: Implementation

2. During a community meeting, a nurse encourages clients to present unit problems and discuss possible solutions. Which type of leadership style is the nurse demonstrating?
1. Democratic
2. Autocratic
3. Laissez-faire
4. Bureaucratic

ANS: 1
Rationale: The nurse who encourages clients to present problems and discuss solutions is demonstrating a democratic leadership style. Democratic leaders share information with group members and promote decision-making by the members of the group. The leader provides guidance and expertise as needed.

Cognitive Level: Application
Integrated Process: Implementation

3. Which situation should a nurse identify as an example of an autocratic leadership style?
1. The president of Sigma Theta Tau assigns members to committees to research problems.
2. Without faculty input, the dean mandates that all course content be delivered via the Internet.
3. During a community meeting, a nurse listens as clients generate solutions.
4. The student nurses’ association advertises for candidates for president.

ANS: 2
Rationale: The nurse should identify that mandating decisions without consulting the group is considered an autocratic leadership style. Autocratic leadership increases productivity but often reduces morale and motivation owing to lack of member input and creativity.

Cognitive Level: Application
Integrated Process: Implementation

4. A single, pregnant teenager in a parenting class discloses her ambivalence toward the pregnancy and the subsequent guilt that these thoughts generate. A mother of three admits to having felt that way herself. Which of Yalom’s curative group factors does this illustrate?
1. Imparting of information
2. Instillation of hope
3. Altruism
4. Universality

ANS: 4
Rationale: The scenario is an example of the curative group factor of universality. Universality occurs when individuals realize that they are not alone in the problems, thoughts, and feelings they are experiencing. This realization reduces anxiety by the support and understanding of others.

Cognitive Level: Analysis
Integrated Process: Evaluation

5. A client diagnosed with alcohol use disorder experiences a first relapse. During an AA meeting, another group member states, “I relapsed three times, but now have been sober for 15 years.” Which of Yalom’s curative group factors does this illustrate?
1. Imparting of information
2. Instillation of hope
3. Catharsis
4. Universality

ANS: 2
Rationale: This scenario is an example of the curative group factor instillation of hope. This occurs when members observe the progress of others in the group with similar problems and begin to believe that personal problems can also be resolved.

Cognitive Level: Analysis
Integrated Process: Evaluation

6. During a group discussion, members freely interact with each other. Which member statement is an example of Yalom’s curative group factor of imparting information?
1. “I found a Web site explaining the different types of brain tumors and their treatment.”
2. “My brother also had a brain tumor and now is completely cured.”
3. “I understand your fear and will be by your side during this time.”
4. “My mother was also diagnosed with cancer of the brain.”

ANS: 1
Rationale: Yalom’s curative group factor of imparting information involves group members sharing knowledge gained through formal instruction as well as advice and suggestions.

Cognitive Level: Application
Integrated Process: Assessment

7. Prayer group members at a local Baptist church are meeting with a poor, homeless family whom they are supporting. Which member statement is an example of Yalom’s curative group factor of altruism?
1. “I’ll give you the name of a friend that rents inexpensive rooms.”
2. “The last time we helped a family, they got back on their feet and prospered.”
3. “I can give you all of my baby clothes for your little one.”
4. “I can appreciate your situation. I had to declare bankruptcy last year.”

ANS: 3
Rationale: Yalom’s curative group factor of altruism occurs when group members provide assistance and support to each other that creates a positive self-image and promotes self-growth. Individuals gain self-esteem through mutual caring and concern.

Cognitive Level: Application
Integrated Process: Assessment

8. During an inpatient educational group, a client shouts out, “This information is worthless. Nothing you have said can help me.” These statements indicate to a nurse leader that the client is assuming which group role?
1. The group role of aggressor
2. The group role of initiator
3. The group role of gatekeeper
4. The group role of blocker

ANS: 1
Rationale: The nurse should identify that the client is assuming the group role of the aggressor. The aggressor expresses negativism and hostility toward others in the group or to the group leader and may use sarcasm in an effort to degrade the status of others.

Cognitive Level: Application
Integrated Process: Assessment

9. During a group session, which client statement demonstrates that the group has progressed to the middle, or working, phase of group development?
1. “It’s hard for me to tell my story when I’m not sure about the reactions of others.”
2. “I think Joe’s Antabuse suggestion is a good one and might work for me.”
3. “My situation is very complex, and I need professional, not peer, advice.”
4. “I am really upset that you expect me to solve my own problems.”

ANS: 2
Rationale: The nurse should recognize that group members have progressed to the working phase of group development when members begin to look to each other instead of to the leader for guidance. Group members in the working phase begin to accept criticism from each other and use it constructively to create change.

Cognitive Level: Application
Integrated Process: Evaluation

10. Which group leader activity should a nurse identify as being most effective in the final, or termination, phase of group development?
1. The group leader establishes the rules that will govern the group after discharge.
2. The group leader encourages members to rely on each other for problem solving.
3. The group leader presents and discusses the concept of group termination.
4. The group leader helps the members to process feelings of loss.

ANS: 4
Rationale: The most effective intervention in the final, or termination, phase of group development would be for the group leader to help the members to process feelings of loss. The leader should encourage the members to review the goals and discuss outcomes, reminisce about what has occurred, and encourage members to provide feedback to each other about progress.

Cognitive Level: Application
Integrated Process: Assessment

11. A nursing instructor is teaching students about self-help groups like Alcoholics Anonymous (AA). Which student statement indicates that learning has occurred?
1. “There is little research to support AA’s effectiveness.”
2. “Self-help groups used to be the treatment of choice, but their popularity is waning.”
3. “These groups have no external regulation, so clients need to be cautious.”
4. “Members themselves run the group, with leadership usually rotating among the members.”

ANS: 4
Rationale: The student indicates an understanding of self-help groups when stating, “Members themselves run the group, with leadership usually rotating among the members.” Nurses may or may not be involved in self-help groups. These groups allow members to talk about feelings and reduce feelings of isolation, while receiving support from others undergoing similar experiences.

Cognitive Level: Application
Integrated Process: Evaluation

12. When planning group therapy, a nurse should identify which configuration as most optimal for a therapeutic group?
1. Open-ended membership; circle of chairs; group size of 5 to 10 members
2. Open-ended membership; chairs around a table; group size of 10 to 15 members
3. Closed membership; circle of chairs; group size of 5 to 10 members
4. Closed membership; chairs around a table; group size of 10 to 15 members

ANS: 3
Rationale: The nurse should identify that the most optimal conditions for a therapeutic group is one in which the membership is closed and in which the group size is between 5 and 10 members, who are arranged in a circle of chairs. The focus of therapeutic groups is directed to relations within the group and the interactions among group members.

Cognitive Level: Application
Integrated Process: Planning

13. During the sixth week of a 10-week parenting skills group, a nurse observes as several members get into a heated dispute about spanking. As a group, they decide to create a pros-and-cons poster on the use of physical discipline. At this time, what is the role of the group leader?
1. The leader should referee the debate.
2. The leader should adamantly oppose physical disciplining measures.
3. The leader should redirect the group to a less-controversial topic.
4. The leader should encourage the group to solve the problem collectively.

ANS: 4
Rationale: The role of the group leader is to encourage the group to solve the problem collectively. A democratic leadership style supports members in their participation and problem-solving. Members are encouraged to solve issues that relate to the group cooperatively.

Cognitive Level: Application
Integrated Process: Implementation

14. A 10-week, prenuptial counseling group composed of five couples is terminating. At the last group meeting, a nurse notices that the two most faithful and participative couples are absent. When considering concepts of group development, what might explain this behavior?
1. They are experiencing problems with termination, leading to feelings of abandonment.
2. They did not think any new material would be covered at the last session.
3. They were angry with the leader for not extending the length of the group.
4. They were bored with the material covered in the group.

ANS: 1
Rationale: The nurse should determine that the clients’ absence from the final group meeting may indicate that they are experiencing problems with termination. The termination phase of group development may elicit feelings of abandonment and anger. Successful termination may help members develop skills to cope with future unrelated losses.

Cognitive Level: Application
Integrated Process: Evaluation

15. An experienced psychiatric registered nurse has taken a new position leading groups in a day treatment program. Which group is this nurse most qualified to lead?
1. A psychodrama group
2. A psychotherapy group
3. A parenting group
4. A family therapy group

ANS: 3
Rationale: A psychiatric registered nurse is qualified to lead a parenting group. A parenting group can be classified as either a teaching group or therapeutic group. Psychodrama, psychotherapy, and family therapy are forms of group therapy and must be lead by qualified leaders who generally have advanced degrees in psychology, social work, nursing, or medicine.

Cognitive Level: Application
Integrated Process: Implementation

16. A nursing instructor is teaching about psychodrama, a specialized type of therapeutic group. Which student statement indicates that further teaching is necessary?
1. “Psychodrama provides a safe setting in which to discuss painful issues.”
2. “In psychodrama, the client is the protagonist.”
3. “In psychodrama, the client observes actor interactions from the audience.”
4. “Psychodrama facilitates resolution of interpersonal conflicts.”

ANS: 2
Rationale: The nurse should educate the student that in psychodrama the client plays the role of him or herself in a life-situation scenario and is called the protagonist. During psychodrama, the client does not observe interactions from the audience. Other group members perform the role of the audience and discuss the situation they have observed, offer feedback, and express their feelings. Leaders of psychodrama must have specialized training to become a psychodramatist.

Cognitive Level: Application
Integrated Process: Evaluation

Multiple Response

17. Which of the following behavioral skills should a nurse implement when leading a group that is functioning in the orientation phase of group development? (Select all that apply.)
1. Encourage members to provide feedback to each other about individual progress.
2. Ensure that group rules do not interfere with goal fulfillment.
3. Work with group members to establish rules that will govern the group.
4. Emphasize the need for and importance of confidentiality within the group.
5. Help the leader to resolve conflicts and foster cohesiveness within the group.

ANS: 2, 3, 4
Rationale: During the orientation phase of group development, the nurse leader should work together with members to establish rules that will govern the group. The leader should ensure that group rules do not interfere with goal fulfillment and establish the need for and importance of confidentiality within the group. Members need to establish trust and cohesion in order to move into the working phase.

Cognitive Level: Application
Integrated Process: Implementation

Ordered Response

18. Order the following leadership expectations that occur in the three phases of the group development process.
_____The leader encourages members to provide feedback to each other about individual progress and to review goals and discuss outcomes.
_____The leader promotes an environment of trust and ensures that rules established by the group do not interfere with fulfillment of the goals.
_____The leader helps to resolve conflict and fosters cohesiveness, while ensuring that members do not deviate from the intended task.

ANS: The correct order is 3, 1, 2
Rationale:
1. In the Initial, or Orientation, phase, the leader is expected to orient members to specific group processes, encourage members to participate without disclosing too much too soon, promote an environment of trust, and ensure that rules established by the group do not interfere with fulfillment of the goals.
2. In the Middle, or Working, phase, the role of leader diminishes and becomes more one of facilitator. Some leadership functions are shared by certain members of the group as they progress toward resolution. The leader helps to resolve conflicts and continues to foster cohesiveness among the members, while ensuring that they do not deviate from the intended task or purpose for which the group was organized.
3. In the Final, or Termination, phase, the leader encourages the group members to reminisce about what has occurred within the group, to review the goals and discuss the actual outcomes, and to encourage members to provide feedback to each other about individual progress within the group. The leader encourages members to discuss feelings of loss associated with termination of the group.

Cognitive Level: Analysis
Integrated Process: Implementation

Fill-in-the-Blank

19. A ______________________ is a collection of individuals whose association is founded on shared commonalities of interest, values, norms, or purpose.

ANS: group
Rationale: A group is a collection of individuals whose association is founded on shared commonalities of interest, values, norms, or purpose. Membership in a group is generally by chance (born into the group), by choice (voluntary affiliation), or by circumstance (the result of life-cycle events over which an individual may or may not have control).

Cognitive Level: Application
Integrated Process: Assessment