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 the baby food orally. The nurse recognizes a high risk of aspiration and an already compromised respiratory status. The most appropriate nursing action is to:

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 the potential options can be explored. Refusing to feed him orally does not determine why the parents wish the oral feedings to begin and does not involve them in the problem solving. The decision to begin or not to change feedings should be a collaborative one,made in consultation with the family,nurse,and appropriate member of the health care team.

Question 2

When communicating with other professionals,it is important for home care nurses to:&#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. The nurse should share only clinically relevant information with other involved health professionals. The nurse must assure families that they have a right to expect confidentiality in regard to the data collected.

Question 3

One of the supervisors for a home health agency asks the nurse to give the family a survey evaluating the nurses and other service providers. The nurse should recognize this as:&#10;A)Inappropriate unless nurses are able to evaluate family.&#10;B)Appropriate to improve quality of care.&#10;C)Inappropriate unless nurses and other providers agree to participate.&#10;D)Inappropriate because family lacks knowledge necessary to evaluate professionals.

Accepted Answer

Quality-assessment and quality-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 the individual home care nurses,the home care agency,and other service providers periodically. The nurse is the care provider. The evaluation is of the provision of care to the patient and family. The role of the nurse is not to evaluate the family. Quality-monitoring activities are required by virtually all health care agencies. During the evaluation process the family is requested to provide their perceptions of care.

Question 4

The home health nurse is caring for a child who requires complex care. The family expresses frustration related to obtaining accurate information about their child's illness and its management. The best action for the nurse is to:

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

Accepted Answer

The philosophic basis for family-centered 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. Questions about what they need and want to know concerning their child's care should be addressed.

Question 5

Home care is being considered for a young child who is ventilator dependent. Which factor is most important in deciding 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 family&#10;D)Family's ability to assume all health care costs

Accepted Answer

One of the essential elements is the training and preparation of the family. The family 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 the important issue. The determinant 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 6

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. The initial action of the nurse is to:

A)Refer mother for counseling.
B)Listen and reflect mother's feelings.
C)Ask 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 issues such as an additional home health aid 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. It is a judgment beyond the role of the nurse and can help undermine the family relationship. Counseling 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 responsibilities for the loss of their normal child and new parenting responsibilities.

Question 7

What are likely to be the most effective options for case management? Choose all that apply.&#10;A)One nursing case manager&#10;B)The insurance company&#10;C)A panel of experts&#10;D)A multidisciplinary team&#10;E)Primary care provider

Accepted Answer

Nursing case managers are ideally suited to provide the care coordination necessary. Care coordination is most effective if a single person works with the family to accomplish the many tasks and responsibilities that are necessary. The family retains the role as 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 8

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. The family priorities should guide the planning process. 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.

Deck 43: Family-Centered Home Care