caring
Universal phenomenon influencing the ways in which people think, feel, and behave in relation to one another.
presence
person-to-person encounter conveying a closeness and sense of caring.
A nurse hears a colleague tell a nursing student that she never touches a patient unless she is performing a procedure or doing an assessment. The nurse tells the student that from a caring perspective:
A. She does not touch the patients either.
B. Touch is a type of verbal communication.
C. There is never a problem with using touch.
D. Touch forms a connection between nurse and patient.
D. Touch forms a connection between nurse and patient.
Touch is relational and leads to a connection between nurse and patient. It involves contact and noncontact touch. Contact touch involves obvious skin-to-skin contact, whereas noncontact touch refers to eye contact.
Of the five caring processes described by Swanson, which describes "knowing the patient"?
A. Anticipating the patient's cultural preferences.
B. Determining the patient's physician preference.
C. Establishing an understanding of a specific patient.
D. Gathering task-oriented information during assessment.
C. Establishing an understanding of a specific patient.
Knowing the context of a patient's illness helps you choose and individualize interventions that will actually help him or her. Strive to understand an event as it has meaning in the life of the other. Knowing the patient is essential when providing patient-centered care. Two elements that facilitate knowing are continuity of care and clinical expertise.
A Muslim woman enters the clinic to have a woman's health examination for the first time. Which nursing behavior applies Swanson's caring process of "knowing the patient?"
A. Sharing feelings about the importance of having regular woman's health examinations.
B. Gaining and understanding of what a woman's health examination means to the patient.
C. Recognizing that the patient is modest; obtaining gender-congruent caregiver.
D. Explaining the risk factors for cervical cancer.
B. Gaining and understanding of what a woman's health examination means to the patient.
You should strive to understand an event as it has meaning in the life of the other. Knowing the patient is essential when providing patient-centered care.
Helping a new mother through the birthing experience demonstrates which of the Swanson's five caring processes?
A. Knowing.
B. Enabling.
C. Doing for.
D. Being
with.
B. Enabling.
The caring behavior of enabling facilitates the other's passage through life transitions (e.g., birth, death) and unfamiliar events. When a nurse practices enabling, the patient and nurse work together to identify alternatives and resources.
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. The patient's nurse replies:
A. "Spiritual care should be left to a professional."
B. "You are correct, religion is a personal decision."
C. "Nurses should not force their religious beliefs on patients."
D. Spiritual, mind, and body connections can affect health."
D. Spiritual, mind, and body connections can affect health."
Spirituality offers a sense of connectedness, intrapersonally (connected with oneself), interpersonally (connected with others and the environment), and transpersonally (connected with the unseen, God, or a higher power). In a caring relationship the patient and nurse come to know one another so both move toward a healing relationship.
Which of the following is a strategy for creating work environments that enable nurses to demonstrate more caring behaviors?
A. Increasing the working hours of the staff.
B. Increasing salary benefits of the staff.
C. Creating a setting that allows flexibility and autonomy for staff.
D. Encouraging increased input concerning nursing functions from physicians.
C. Creating a setting that allows flexibility and autonomy for staff.
These factors all affect nursing satisfaction. When nurses' job satisfaction is high, they have a greater connectedness with their patients and believe that caring practices are part of the nursing culture.
When a nurse helps a patient find the meaning of cancer by supporting beliefs about life, this is an example of:
A. Instilling hope and faith.
B. Forming a human-altruistic value system.
C. Cultural caring.
D. Being with.
A. Instilling hope and faith.
Instilling hope and faith helps to increase an individual's capacity to get through an event or transition and face the future with meaning.
An example of a nurse caring behavior that families of acutely ill patients perceive as important to patients' well-being is:
A. Making health care decisions for patients.
B. Having family members provide a patient's total personal hygiene.
C. Injecting the nurse's perceptions about the level of care provided.
D. Asking permission before performing a
procedure on the patient.
D. Asking permission before performing a procedure on the patient.
Caring for the family takes into consideration the context of the patient's illness and the stress it imposes on all members.
A nurse demonstrates caring by helping family members:
A. Become active participants in care.
B. Provide activities of daily living (ADLs).
C. Remove themselves from personal
care.
D. Make health care decisions for the patient.
A. Become active participants in care.
Caring for the family takes into consideration the context of the patient's illness and the stress it imposes on all members.
Listening is not only "taking in" what a patient says; it also includes:
A. Incorporating the views of the physician.
B. Correcting any errors in the patient's
understanding.
C. Injecting the nurse's personal views and statements.
D. Interpreting and understanding what the patient means.
D. Interpreting and understanding what the patient means.
Listening is powerful. It conveys the nurse's full attention and interest. A true caring presence involves listening. Listen to what is important to another person and the meaning of a situation to that person.
A nurse is caring for an older adult who needs to enter an assisted-living facility following discharge from the hospital. Which of the following is an example of listening that displays caring?
A. The nurse encourages the patient to talk about his concerns while reviewing the computer screen in the room.
B. The nurse sits at the patient's bedside, listens as he relays his fear of never seeing his home again, and then asks if he wants anything to eat.
C. The nurse listens to the patient's
story while sitting on the side of the bed then summarizes the story.
D. The nurse listens to the patient talk about his fears of not returning home and then tells him to think positively.
C. The nurse listens to the patient's story while sitting on the side of the bed then summarizes the story.
Attentive listening lets the nurse hear the patient's story and then correctly summarize it. It does not occur when the nurse is distracted by equipment or other personnel. The importance of listening is not to distract the patient or solve the problem, but rather to hear what the patient has to say and understand what the situation means to him.
Presence involves a person-to-person encounter that:
A. Enables patients to care for self.
B. Provides personal care to a patient.
C. Conveys a closeness and a sense of caring.
D. Describes being in close contact with a patient.
C. Conveys a closeness and a sense of caring.
Providing presence is a person-to-person encounter conveying closeness and a sense of caring. It involves "being there" and "being with." "Being there" is not only a physical presence but also includes communication and understanding. Presence is an interpersonal process that is characterized by sensitivity, holism, intimacy, vulnerability, and adaptation to unique circumstances.
A nurse enters a patient's room, arranges the supplies for a Foley catheter insertion, and explains the procedure to the patient. She tells the patient what to expect; just before inserting the catheter, she tells the patient to relax and that, once the catheter is in place, she will not feel the bladder pressure. The nurse then proceeds to skillfully insert the Foley catheter. This is an example of what type of touch?
A. Caring touch.
B. Protective touch.
C. Task-oriented
touch.
D. Interpersonal touch.
C. Task-oriented touch.
Nurses use task-oriented touch when performing a task or procedure. An expert nurse learns that any procedure is more effective when administered carefully and in consideration of any patient concern.
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 she spends with the family. Whenever she enters the room or approaches the patient to give care, she touches his shoulder and tells him that she is present. This is an example of what type of touch?
A. Caring touch.
B. Protective touch.
C. Task-oriented touch.
D. Interpersonal touch.
A. Caring touch.
Caring touch is a form of nonverbal communication. You express this in the way you hold a patient's hand, give a back massage, gently position a patient, or participate in a conversation. When using a caring touch, you connect with the patient physically and emotionally.
Match the following caring behaviors with their definitions.
1. Knowing.
2. Being with.
3. Doing for.
4. Maintaining belief.
a. Sustaining faith in
one's capacity to get through a situation.
b. Striving to understand an event meaning for another person.
c. Being emotionally there for another person.
d. Providing for another as he or she would do for themselves.
1. b. Striving to understand an event meaning for another person.
2. c. Being emotionally there for another person.
3. d. Providing for another as he or she would do for themselves.
4. a. Sustaining faith in one's capacity to
get through a situation.
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.
C. Technology becomes a powerful tool when it works with caring.
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.
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.
D. What matters to a person.
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.
With respect to the concept of caring, most nursing theories:
A. Embrace the disease oriented 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 express of caring.
C. Identify caring as highly relational involving patient and nurse.
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.
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.
C. Enabling.
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.
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.
D. Patients value both task performance and the affective dimension of nursing.
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.
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.
C. This will help the nurse provide better care for the patient.
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.
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.
B. Must become the patient's advocate based on the patient's wishes.
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.
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.
A. Closeness and a sense of caring.
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.
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.
A. Providing a presence.
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 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.
C. Protective touch.
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.
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.
A. Involves only skin-to-skin contact.
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.
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 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.
C. Stop what he/she is doing (if possible) and ask the patient to expand on his statement.
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.
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."
A. "I had a similar procedure last year and I can tell you what I went through."
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.
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.
A. Choose the most appropriate time to give the medication.
"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.
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.
B. Think.
D. Feel.
E. Behave.
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.
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.
A. Avoids assumptions.
B. Focuses on the patient.
C. Engages in a caring relationship.
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.