Exam 3: Chapter 22 Flashcards
The chief nursing officer decides to establish a client advocacy position in an oncology unit. Advocacy is best represented by:
a. establishing private and professional networking systems.
b. asking social services to handle clients’ concerns.
c. identifying community support groups.
d. empowering others by promoting self-determination.
ANS: D
Advocacy involves empowering and promoting self-determination in others.
As part of performance appraisal, the nurse manager designs strategies to acknowledge staff members. What practices by the nurse
manager best acknowledge staff accountability and contribution?
a. Providing new and varied learning experiences for staff members
b. Fostering group cohesiveness through standardization of unit activities
c. Allowing professionals greater influence over their practices
d. Giving recognition for success and support for failure to staff members
ANS: C
The nurse manager on a pediatric intensive care unit wants to evaluate patient satisfaction. The nurse manager understands that
ultimately, positive relationships with consumers of care are evaluated by the:
a. cultural sensitivity of staff.
b. cost-effectiveness of care delivery.
c. economic value of service.
d. outcomes for clients and their perceptions of care.
ANS: D
Trend-setting organizations such as Magnet® organizations need to demonstrate excellence in outcome data such as patient satisfaction. Patient satisfaction and perception of the quality of care are affected by the quality of the nurse-patient relationship.
Valid measurement of patient satisfaction is an evolving science; nurses do not always accurately gauge what factors are most
important to patients. Satisfaction measures are often skewed in a positive direction with scores clustered at the top of the scale.
The nurse manager must develop a patient satisfaction survey. What is one of the critical elements in selecting a patient satisfaction instrument?
a. Being able to use the same instrument for all clinical units
b. Including items that are important from the patient’s perspective
c. Being able to administer the instrument before a patient’s discharge from the
hospital
d. Being sure that the reading level is no higher than third grade
ANS: B
Because satisfaction is a measure of service and service is a measure of perception of what matters to the patient, to measure
satisfaction, surveys must include items that reflect the perspective of the patient. The quality of human contacts becomes the
measure by which the consumer forms perceptions and judgments about nursing and the health agency. Consumers may not be able to evaluate the quality of interventions, but they always can evaluate the quality of the relationship with the person delivering the
service.
In writing the patient satisfaction survey, the nurse manager is aware of the education levels of the families. What is the most
critical element in the concept of health literacy?
a. Providing instructional materials at appropriate reading levels
b. Facilitating access to translators for persons with language barriers
c. Obtaining, processing, and understanding basic health information so appropriate
decisions can be made
d. Knowing that most people have limited health literacy skills
ANS: C
The definition of health literacy used by the federal government is “the degree to which individuals have the capacity to obtain,
process, and understand basic health information and services needed to make appropriate health decisions” (U.S. Department of
Health and Human Services, 2010).
The nurse manager analyzes the data from the patient satisfaction surveys. What can a nurse manager do to strengthen service
recovery and improve consumer relationships?
a. Post comparisons of patient satisfaction scores with those of other units monthly.
b. Involve the staff in resolving consumer issues quickly and effectively.
c. Ensure that staff members apologize to patients when they complain about
services.
d. Ask that patients with complaints about services place them in a written format.
ANS: B
Consumers need to be treated with fairness, given explanation, and provided with information about how errors will be prevented
in the future. Staff can be assisted to respond to patient concerns through scripting, support, and an atmosphere that places an
emphasis on learning and solutions rather than on blaming.
Based on data from the patient satisfaction survey, the nurse manager decides that a change should be made in communication with
family members. What would be important for a nurse manager to consider when instituting a change to improve customer service?
a. Assess the perceptions of the nursing staff regarding the specific service problem.
b. Include community representatives on a planning committee to address the
change.
c. Involve physicians, other healthcare professionals, and ancillary staff.
d. Review all patient complaints with the nursing staff.
ANS: A
Nurses are the healthcare providers who spend the most time with the consumer and are in an opportune position to understand the
issues, structures, and processes that affect patients. The nurse acts as the primary person to be alert to circumstances that may
prevent a successful outcome for the patient and to intervene on the patient’s behalf. As a nurse manager, it is important to support
staff in their use of power to be in control and to make decisions at the consumer-staff level of interaction.
The chief nursing officer is pleased with the nurse manager’s strategy of improving patient satisfaction in the pediatric intensive
care unit. She decides to implement these changes throughout the hospital. What would be important to consider in implementing a
new program focused on improving relationships with consumers?
a. Recognition of the nursing staff for excellence in promoting consumer
relationships
b. Holding the staff accountable for resolving patient complaints
c. Selecting a staff nurse leader to implement the program
d. Identifying key staff members who have already demonstrated excellence in
consumer relationships
ANS: A
The nurse leader should allow professionals more influence over their practice; give staff opportunities to learn new and varied skills; give recognition and reward for success and support and consolation for lack of success; and foster motivation and belief in
the importance of each individual and the value of his or her contribution.
In orienting new staff nurses to a pediatric intensive care unit, the nurse manager asks the staff nurses to answer the following
question: “What is an important consideration in providing information to parents of a critically ill child?”
a. Making sure that they receive complete information during each encounter with a
member of the nursing staff
b. Assessing parents’ preferences regarding the amount of information provided
c. Allowing parents to observe key aspects of their child’s nursing care
d. Making sure that patient education brochures explaining ICU protocols are
readily available
ANS: B
Consultation with the parents regarding the amount of information that they desire reflects a service orientation, in which preferences and needs of the consumer are placed first. The other answers reflect nurse-directed decisions in which the nurse
decides what information and how much information is needed and how it is to be delivered.
In designing a program for young adults regarding safe sexual practices, which of the following might reach the greatest number in the target group? a. Web-based applications b. Print-based media such as newspapers c. Television advertisements d. Brochures in kiosks in malls
ANS: A
Mobile technology is changing the digital divide, with young adults, minorities, those with no college experience, and those with
lower household incomes being more likely to indicate that phones are their main source of Internet access.
A nurse is admitted to a psychiatric unit. The staff expresses frustration with her because they have explained her medication
regimen several times, and yet, when she leaves the unit with a pass, she fails to follow it. The staff believe that, as a nurse, she
should be able to understand what is expected. The nurse’s failure to follow the regimen indicates:
a. early cognitive impairment.
b. lack of motivation.
c. lack of health literacy.
d. worsening health state.
ANS: C
What is evident from the response is that she lacks health literacy or the capacity to obtain, process, and understand basic health
information and services. Using a Health Literate Care Model involves weaving health literacy strategies into care by assuming that
patients do not understand their health conditions or what to do about them, and then, subsequently assessing patients’
understanding. For example, a nurse who is an expert clinician in a specialty practice area, when diagnosed with a serious chronic
illness, may not have the appropriate background to make informed healthcare decisions.
John is an older adult patient who comes regularly to the multigroup practice in which you are a nurse practitioner. He says that he
doesn’t understand what he is supposed to be doing about his medications, because every time he comes to the clinic, he sees a different provider. John’s experience represents what aspect of the current consumer experience?
a. Nurses are well-trusted members of the healthcare team.
b. Fragmentation of care results in lack of respect and trust.
c. Care providers often have conflicting ideas about care.
d. The public does not trust care providers other than nurses.
ANS: B
When consumers visit a multigroup practice, they do not have the option of selecting a specific healthcare provider, and thus, there
is less opportunity to build a trusting relationship with a provider.
The complexity of the healthcare environment for consumers is increased by:
a. falling levels of education among the public.
b. increased levels of poverty.
c. complex compensatory systems and a variety of delivery systems.
d. increased numbers of uninsured or underinsured.
ANS: C
The complexity of options in health care and the processes and policies involved in funding health services for patients, as well as fragmented relationships with a growing variety of healthcare providers, contribute to the complexity of the system for patients,
especially for those who might need it most, such as the poor, uninsured or underinsured, and homeless.
Corrine, a student nurse, often hears that nurses are gatekeepers and wonders what that term means. As a nurse leader, you explain
that this is a reference to the:
a. assessment and admission of patients into care.
b. orientation of patients to services once they are admitted.
c. function of controlling which patients see the physician and which do not.
d. coordination of care, services, advocacy, and access for patients within the
healthcare system.
ANS: D
As gatekeepers to the system, nurses advocate for and coordinate care, services, and access for patients across all providers,
settings, and levels of care.
A 27-year-old woman is admitted to your ICU in a coma, following an accident. The family of the patient, who is a Native
American, places a medicine pouch in the bed with the young woman. As the nurse in this situation, it is important to:
a. explain to the family that the medicine pouch may contain herbs that may bother
other patients.
b. ask the family about the significance of the medicine pouch for them.
c. remove the pouch when the family is not present.
d. put the medicine pouch on the shelf beside the bed.
ANS: B
Diversity encompasses more than differences in nationality or ethnicity and may include a variety of ways that patients are different from their healthcare providers. Nurses need to recognize the culture of their work setting, realizing that it may differ markedly
from the culture of the consumer, and move beyond ethnocentrism to provide culturally competent care. This competence includes
cultural knowledge, which involves actively learning about a community; cultural sensitivity, which entails valuing and respecting
beliefs, norms, and practices of the people being served; and collaboration within a community. In this instance, it is important to
understand the meaning of the pouch for the family; removal from the bed without discussion does not demonstrate respect for the
values and beliefs of this family.
