Chapter 07: Caring in Nursing Practice // Potter: Fundamentals of Nursing, 11th Edition

A nurse is caring for a patient in pain. Which nursing approach is priority?

a. Patient-centered

b. Technology-centered

c. High tech-centered

d. Family-centered

ANS: A

It is important to preserve a patient-centered approach to patient care for all aspects of nursing, whether the care focuses on pain management, teaching self-care, or basic hygiene measures. While technology, high tech, and family are important, they are not the priority.

A nurse is providing pain medication to patients after surgery. Which component is key for the nurse's personal philosophy of nursing?

a. Caring

b. Technology

c. Informatics

d. Therapeutics

ANS: A

The American Organization of Nurse Executives describes caring and knowledge as the core of nursing, with caring being a key component of what a nurse brings to a patient experience. While technology, informatics, and therapeutics are important, they are not the key components of nursing.

A nurse attends a seminar on nursing theories for caring. Which information from the nurse indicates a correct understanding of these theories?

a. Benner identifies caring as highly connected involving patient and nurse.

b. Swanson develops four caring processes to convey caring in nursing.

c. Watson's transcultural caring views inclusion of culture as caring.

d. Leininger's theory places care before cure and is transformative.

ANS: A

Benner believes caring is highly connected involving each nurse-patient encounter. Swanson developed five caring processes, not four. Watson's theory places care before cure and is transformative, whereas Leininger's transcultural caring views inclusion of culture as caring.

The patient has a colostomy but has not yet been able to look at it. The nurse teaches the patient how to care for the colostomy. 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 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 in this situation is not doing for the patient but is teaching/informing on how to care for the colostomy. 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.

A nurse is using Watson's model to provide care to patients. Which carative factor will the nurse use?

a. Maintaining belief

b. Instilling faith-hope

c. Maintaining ethics

d. Instilling values

ANS: B

Watson has 10 carative factors, one of which is instilling faith-hope. Maintaining belief is a caring process of Swanson's theory. Ethics and values are important in caring but they are not examples of Watson's carative factors.

A nurse provides care that is receptive to patients' and families' perceptions of caring. Which action will the nurse take?

a. Provides clear, accurate information.

b. Just performs nursing tasks competently.

c. Does as much for the patient as possible.

d. Focuses solely on the patient's diagnosis.

ANS: A

Research indicates caring behaviors of nurses from the patient's/families' perspective include the following: (1) providing honest, clear, and accurate information; (2) asking permission before doing something to a patient; (3) helping patients do as much for themselves as possible; and (4) teaching the family how to keep the relative physically comfortable. Patients continue to value nurses' effectiveness in performing tasks, but clearly patients value the affective dimension of nursing care.

A nurse follows the ―ethics of care‖ when working with patients. Which action will the nurse take?

a. Becomes the patient's advocate based on the patient's wishes.

b. Makes decisions for the patient solely using analytical principles.

c. Uses only intellectual principles to determine what is best for the patient.

d. Ignores unequal family relationships since that is a personal matter for the family.

ANS: A

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.

A nurse is providing presence to a patient and the family. Which nursing action does this involve?

a. Focusing on the task that needs to be done

b. Providing closeness and a sense of caring

c. Jumping in to provide patient comfort

d. Being there without an identified goal

ANS: B

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 patient care goal.

The patient is afraid to have a thoracentesis at the bedside. The nurse sits with the patient and asks about the fears. During the procedure, the nurse stays with the patient, explaining each step and providing encouragement. What is the nurse displaying?

a. Providing touch

b. Providing a presence

c. Providing family care

d. Providing a listening ear

ANS: B

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.

The patient has a terminal diagnosis and is very near death. When the nurse assesses the patient and finds no pulse or blood pressure, the family begins sobbing and hugging each other. Some family members hold the patient's hand. The nurse is overwhelmed by the presence of grief and leaves the room. What is the nurse demonstrating?

a. Caring touch

b. Protective touch

c. Therapeutic touch

d. Task-oriented touch

ANS: B

Protective touch is also a kind of touch that protects the nurse emotionally. A nurse withdraws or distances herself or himself from a patient when he or she is unable to tolerate suffering or needs to escape from a situation that is causing tension. Caring touch is a form of nonverbal communication that influences a patient's comfort and security, enhances self-esteem, and improves mental well-being. Therapeutic touch is a type of alternative therapy for healing. Task-oriented touch is done when performing a task or procedure.

Which action indicates a nurse is using caring touch with a patient?

a. Inserts a catheter.

b. Rubs a patient's back.

c. Prevents a patient from falling.

d. Administers an injection.

ANS: B

Caring touch is the way a nurse holds a patient's hand, gives a back massage, or gently positions a patient. Touch that occurs when tasks are being performed, such as insertion of a catheter or administering an injection, is known as ―task-oriented touch.‖ Touch used to protect the patient (holding and bracing a patient to avoid a fall) or nurse (withdraws from tension-filled situations) is known as ―protective touch.‖

The nurse is caring for a patient who has been sullen and quiet for the past 3 days. Suddenly, the patient 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 first?

a. Assure the patient that everything will be all right.

b. Tell the patient that there is no need to worry.

c. Listen to the patient's concerns and fears.

d. Inform the patient a social worker is available.

ANS: C

Listening to the meaning of what a patient says helps create a mutual relationship. Assuring and telling a patient not to worry are not truly listening; these do not convey listening. Although contacting a social worker could be an appropriate measure for this patient, the nurse should first listen to what the patient is saying.

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 and stops to listen. Which response by the nurse may be most beneficial?

a. ―I had a similar procedure and I can tell you what I went through if you want.‖

b. ―I think you'll be all right, but, of course, there are no sure guarantees.‖

c. ―I don't think you have anything to worry about. They do lots of these.‖

d. ―I can call the doctor and cancel the procedure, if you are really concerned.‖

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 false reassurances and cliches, telling not to worry, or offering to cancel the procedure does not open up that relationship and dismisses the patient's concerns.

In making rounds, the nurse meets a patient for the first time. The nurse asks the patient when they usually take their morning medications. What does knowing the patient allow the nurse to do?

a. Choose the most appropriate time to give the medication.

b. Know what information to put on the medication error report form.

c. Explain to the patient that the medication will not be given at the usual time.

d. Evaluate whether or not the patient is taking the 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 the medication will allow the nurse to keep the patient on as near normal a schedule as possible. Nothing in this question infers that the patient will not get the medications on time or that a medication error report will need to be completed. Although the nurse can evaluate whether or not the patient is taking the medication correctly at home, the main purpose, within this scenario, is to determine the most appropriate time to administer the medication.

A nurse cares for patients. Which areas does caring influence? (Select all that apply.)

a. The way in which patients feel.

b. The way in which patients learn.

c. The way in which patients think.

d. The way in which patients study.

e. The way in which patients behave.

ANS: A, C, 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 study involves other concepts such as teaching/learning.

Which actions by the nurse should be done in order to get to know the patient? (Select all that apply.)

a. Avoid assumptions.

b. Focus on the patient.

c. Engage in a caring relationship.

d. Form the relationship very quickly.

e. Not address spiritual or higher needs.

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.

Which actions by the nurse indicate compassion and caring to patients? (Select all that apply.)

a. Saying ―I'm here‖

b. Including the family in care

c. Staying with the patient during a bedside test

d. Relying on monitors and technology

e. Refining work processes on the unit

ANS: A, B, C

Our patients tell us that a simple touch, a simple phrase, ―I'm here,‖ or a promise to remain at the bedside represent caring and compassion. Caring for an individual cannot occur in isolation from that person's family. As a nurse it is important to know the family almost as thoroughly as you know a patient. A reliance on technology and cost-effective health care strategies and efforts to standardize and refine work processes all undermine the nature of caring.

Match the examples to the areas the nurse will promote connectedness for patient's spirituality needs.

a. Connection with others

b. Connection with higher power

c. Connection with oneself

1. Intrapersonally

2. Interpersonally

3. Transpersonally

1. ANS: C

2. ANS: A

3. ANS: B

A nurse encounters the patient's wife, who is tearful and worried Her husband was just transferred from his room to the operating room for a complex cardiovascular surgery. The nurse brings the wife a glass of water and encourages her to talk about her fears. The nurse remains in the room quietly listening. What caring behaviors is the nurse demonstrating? (Select all that apply)

1. Touching

2. Listening

3. Knowing

4. Presence

5. Spiritual care

ANS: 2, 4

A nurse needs to use clinical judgment before planning and implementing any touch interventions. What does the nurse need to understand about the use of touch? (Select all that apply)

1. Some cultures may have specific restrictions about non-skill-based touch

2. Touch is a form of nonverbal communication

3. Touch reduces only physical pain

4. Touch can successfully influence a patient's level of comfort

5. There is never a problem with using touch at any time

ANS: 1, 2, 4

A young woman comes to a clinic for the first time for a gynecological examination. She asks about the procedure, who will be in the room with her, and does she have to remove all her clothes. Which nursing behavior applies Swanson's caring process of "knowing" the patient?

1. Sharing feelings about the importance of having regular gynecological examinations

2. Explaining risk factors for cervical cancer

3. Recognizing that the patient is modest and maintaining her privacy during the examination

4. Asking the patient what it means to have a vaginal examination

ANS: 3

A patient is fearful of upcoming surgery and a possible cancer diagnosis. He discusses his love for the Bible with his nurse, who recommends a favorite Bible verse. Another nurse tells the patient's nurse that there is no place in nursing for spiritual caring. What is the best response by the patient's nurse?

1. "You're correct; spiritual care should be left to a pastoral care professional."

2. "You're correct; religion is a personal decision."

3. "Nurses should explain their own religious beliefs to patients."

4. "Spiritual, mind, and body connections can affect health."

ANS: 4

Which of the following are strategies for creating work environments that support nurse caring interventions? (Select all that apply)

1. Increasing technological support

2. Improving flexibility for scheduling

3. Providing opportunities to discuss care practices

4. Promoting autonomy of practice

5. Encouraging increased input concerning nursing functions from health care providers

ANS: 2, 3, 4

A nurse is caring for a patient newly diagnosed with testicular cancer. He asked the nurse to help him find the meaning of cancer by supporting beliefs about life. This is an example of:

1. Instilling hope and faith

2. Forming a human-altruistic value system

3. Cultural caring

4. Being with

ANS: 1

An example of a nurse caring behavior that families of patients who are acutely ill perceive as important to patients' well-being is:

1. Making health care decisions for patients

2. Having family members provide a patient's total personal hygiene

3. Injecting the nurse's perceptions about the level of care provided

4. Asking permission before performing a procedure on a patient

ANS: 4

A nurse is caring for a patient who has just transferred from an intensive care unit and still has a long hospitalization ahead. Because of the complexity of care and the number of caregivers for this patient, the family members feel disconnected from their loved one and not part of the care team. Which interventions would demonstrate care by helping family members? (Select all that apply)

1. Helping family become active participants in care

2. Removing family members from assisting with the patient's personal care

3. Allowing the family to offer opinions on health care decisions for the patient

4. Providing the family opportunities to discuss their concerns with the health care team

5. Planning uninterrupted time for the family and patient to be together

ANS: 1, 4, 5

A hospice nurse sits at the bedside of a male patient in the final stages of cancer. He and his parents made the decision that he would move home and they would help him in the final stages of his disease. The family participates in his care, but lately the nurse has increased the amount of time spent with the family. Whenever the nurse enters the room or approaches the patient to give care, the nurse touches his shoulder and states, "I am your nurse, and I am here for you." This is an example of what type of touch?

1. Caring touch

2. Protective touch

3. Task-oriented touch

4. Interpersonal touch

ANS: 1

Match the following caring behaviors with a nursing action.

1. Knowing

2. Being with

3. Doing for

4. Maintaining belief

a. Encouraging a patient or family to use resources and trust previous decisions that have helped to resolve issues

b. Asking a patient to talk about what the loss of a loved one means for the patient and the family

c. Telling a family that you understand their anger about the side effects of chemotherapy

d. Providing an opportunity for a patient's specific religious practice as the patient would do it

ANS:

1. B

2. C

3. D

4. A