Question 1

A family wants to begin oral feeding of their 4-year-old son,who is ventilator dependent and currently tube fed.They ask the home health nurse to feed him baby food orally.The nurse recognizes a high risk of aspiration and an already compromised respiratory status.What is the most appropriate nursing action?

A) Refuse to feed him orally because the risk is too high.
B) Explain the risks involved and let the family decide what should be done.
C) Feed him orally because the family has the right to make this decision for their child.
D) Acknowledge their request, explain the risks, and explore with the family the available options.

Accepted Answer

Parents want to be included in the decision-making for their child's care.The nurse should discuss the request with the family to ensure that this is the issue of concern,and then explore potential options.Refusing to feed him orally does not determine why the parents wish for oral feedings to begin and does not involve them in the problem-solving process.The decision to begin or not to change feedings should be a collaborative one,made in consultation with the family,nurse,and appropriate members of the health care team.

Question 2

Home care is being considered for a young child who is ventilator dependent.Which factor is most important in determining whether home care is appropriate?&#10;A) Level of parents' education&#10;B) Presence of two parents in the home&#10;C) Preparation and training of the family&#10;D) Family's ability to assume all health care costs

Accepted Answer

The essential element is the training and preparation of the family,who must be able to demonstrate all aspects of care for the child.In many areas it cannot be guaranteed that nursing care will be available on a continual basis,and the family will have to care for the child.The amount of formal education reached by the parents is not important,it is the family's ability to care adequately for the child in the home.At least two family members should learn and demonstrate all aspects of the child's care in the hospital,but it does not have to be two parents.Few families can assume all health care costs.Financial planning,including negotiating arrangements with the insurance company and/or public programs,may be required.

Question 3

The home health nurse outlines short- and long-term goals for a 10-year-old child with many complex health problems.Who should agree on these goals?&#10;A) Family and nurse&#10;B) Child, family, and nurse&#10;C) All professionals involved&#10;D) Child, family, and all professionals involved

Accepted Answer

In the home,the family is a partner in each step of the nursing process,so family priorities should guide planning.Both short- and long-term goals should be outlined and agreed on by the child,family,and professionals involved.Involvement of the individuals who are essential to the child's care is necessary during this very important stage.The elimination of any one of these groups can potentially create a plan of care that does not meet the needs of the child and family.

Question 4

What is likely to be the most effective option for case management?&#10;A) One nursing case manager&#10;B) The insurance company&#10;C) A panel of experts&#10;D) A multidisciplinary team

Accepted Answer

Nursing case managers are ideally suited to provide the necessary coordination of care.Care coordination is most effective if a single person works with the family to accomplish the many tasks and take on responsibilities.The family retains the role of primary decision-maker.Most likely the insurance company will have a case manager focusing on the financial aspects of care.This does not include coordination of care to assist the family.The primary care provider will work closely with the home care agency to provide orders for necessary medication and durable medication equipment; however,they are not suited to coordinate this task.

Question 5

The home health nurse is looking after a child who requires complex care.The family expresses frustration over obtaining accurate information concerning their child's illness and its management.What is the best action for the nurse to take?

A) Determine why the family is frustrated.
B) Refer the family to the child's primary care practitioner.
C) Clarify the family's request and provide the information they want.
D) Answer only questions that are essential to the family knowledge base.

Accepted Answer

The philosophical basis of family-centred practice is the recognition that the family is the constant in the child's life.It is essential and appropriate that the family have complete and accurate information about their child's illness and management.The nurse may first have to clarify what information the family feels has not been communicated.The family's frustration arises from their perception that they are not receiving information pertinent to their child's care.Referring the family to the child's PCP does not help the family.The home health nurse should have access to the necessary information.

Question 6

One of the supervisors for a home health agency asks the nurse to give the family a survey to evaluate the nurses and other service providers.The nurse should recognize this request as which one of the following?

A) Inappropriate, unless nurses are able to evaluate family
B) Appropriate to improve the quality of care
C) Inappropriate, unless nurses and other providers agree to participate
D) Inappropriate, because the family lacks the knowledge necessary to evaluate professionals

Accepted Answer

Quality assessment and improvement activities are essential for virtually all organizations.Family involvement is essential in evaluating a home care plan and can occur on several levels.The nurse can ask the family open-ended questions at regular intervals to assess their opinion of the effectiveness of care.Families should also be given an opportunity to evaluate individual home care nurses,the home care agency,and other service providers periodically.The nurse is the care provider.The evaluation concerns the provision of care to the patient and family.The role of the nurse is not to evaluate the family.

Question 7

The home care nurse has been visiting an adolescent with recently acquired quadriplegia.The teen's mother tells the nurse,"I'm sick of providing all the care while my husband does whatever he wants,whenever he wants to do it." What is the best initial action for the nurse to take?

A) Refer the mother for counselling.
B) Listen to and reflect mother's feelings.
C) Ask the father in private why he does not help.
D) Suggest ways the mother can get her husband to help.

Accepted Answer

It is appropriate for the nurse to reflect with the mother about her feelings,exploring possible solutions such as an additional home health aide to help care for the child and provide respite for the mother.It is inappropriate for the nurse to agree with the mother that her husband is not helping enough,because this is a judgement beyond the nurse's role and can undermine the family relationship.Counselling is not necessary at this time.A support group for caregivers may be indicated.Privately asking the father why he doesn't help and suggesting ways the mother can get him to help are interventions based on the mother's assumption of the father's minimal contribution to the care of the child.The father may have a full-time job and other commitments.The parents need to have an involved third person help them through the negotiation of new parenting responsibilities resulting from their child's injury.

Question 8

What is one important thing home care nurses should do when communicating with other professionals?&#10;A) Ask others what they want to know.&#10;B) Share everything known about the family.&#10;C) Restrict communication to clinically relevant information.&#10;D) Recognize that confidentiality is not possible.

Accepted Answer

Through both oral and written communication,the nurse will need to share clinically relevant information with other involved health professionals,but this is all that should be shared.The nurse must assure families that they have a right to expect confidentiality in regard to the data collected.

Deck 43: Family-Centred Home Care