Question 1

As a head nurse,you are concerned about the service orientation on your unit.Which of the following findings and approaches might provide useful information for you?
A) Patients find nurses friendly and accessible; data are aggregated for the institution as a whole.
B) Data indicate that nurses are responsive to requests for assistance; data are available for the unit and the institution.
C) Specific questions related to management of comfort are included for the institution as a whole.
D) The survey asks for a range of responses for the unit and the organization, with a focus on facilities, such as cleanliness and responsiveness of administrative services.

Accepted Answer

The National Database of Nursing Quality Indicators (NDNQI)is a national repository for unit-based quality data that can be used by organizations to benchmark the outcomes of care against those of other institutions (ANA,n.d.).Unit-based quality indicators,including satisfaction with nursing care,are a key feature of the NDNQI.In addition to hospitals being provided with their own and comparison data,researchers are able to access de-identified data in order to answer important questions about nursing care quality.Pain management,the discharge process,and post-discharge patient callbacks are specific areas where nurses can make significant improvement in patient satisfaction.Because patients and nurses may differ in what they see as factors that produce satisfaction,total reliance on nursing perceptions of patient satisfaction may not provide a complete picture.

Question 2

Which of the following exemplifies a service orientation for a facility?
A) Staff members on the unit are encouraged to chart details about family support networks.
B) Chart audit reveals that details related to assessment of family history are missing.
C) The palliative care unit organizes a "tree of light" fundraiser each year to highlight the importance of palliative care.
D) A children's preoperative holding area is implemented in response to requests from families and staff nurses for development of an area.

Accepted Answer

A service orientation needs to translate caring into appropriate,timely action that meets the needs of patients.Activities such as documentation of details or promotion of services may remain at the technical or conceptual level without a commitment to caring interactions.The institution of a holding area where families can be with children represents a caring action that arises out of interactions and knowledge of patient needs and thus,is service oriented.

Question 3

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.

Accepted Answer

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.

Question 4

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

Accepted Answer

Facilitating greater control over practices implies trust and acknowledges expertise and performance.

Question 5

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.

Accepted Answer

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.

Question 6

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

Accepted Answer

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.

Question 7

Technology is integral to a cardiac ICU.Sue,the nurse manager,implements a patient-centered approach that focuses on the meaning of the experience for the patient and family,primary nursing,and a health literacy approach.Sue is:
A) using high-tech-low-touch approaches.
B) using high-tech-high-touch approaches.
C) providing products.
D) providing tangible products of satisfaction.

Accepted Answer

The provision of humanistic care within a high-tech environment is characteristic of high tech-high-touch approaches and reflects the idea that the more that high-tech is used,the more patients also desire high-touch.

Question 8

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

Accepted Answer

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.

Question 9

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.

Accepted Answer

As gatekeepers to the system,nurses advocate for and coordinate care,services,and access for patients across all providers,settings,and levels of care.

Question 10

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.

Accepted Answer

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.

Question 11

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.

Accepted Answer

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.

Question 12

As a nurse manager,you see an opportunity for patients to be well serviced through the medical home concept.You recognize that the concept of medical homes:
A) currently does not include nurses in its vision of multifaceted primary care.
B) includes nurses as part of an interdisciplinary and multidisciplinary team.
C) restricts nurses to services related to direct care and procedures.
D) cannot encompass nurses within this framework.

Accepted Answer

The concept of medical homes encompasses the idea of multifaceted medical homes that provide a usual source of health care.Current discussions have focused on physician-directed care even though nurses in advanced practice are well suited to lead teams in this model.

Question 13

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.

Accepted Answer

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.

Question 14

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.

Accepted Answer

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.

Question 15

You are involved in designing a clinic for women in an inner-city neighborhood.A goal of this clinic might be:
A) development of services that are identified in various studies as important for this target group.
B) partnership with area city councilors and health professionals to provide services that are consistent with their vision and funding sources.
C) provision of immunization and addictions services and health screening services for women in the area.
D) development of services that have been identified by the women and neighborhood advocates as necessary for their health care.

Accepted Answer

Involvement of persons in their own health care is a cornerstone of healthcare reform and is important for improving health outcomes and patient experiences.While studies and partnership with key informants are important sources of information in the design of services,engagement of the women through their neighborhood advocates may increase activation and resulting behavior.Patient activation refers to patients' willingness and ability to take independent actions to manage their health and care.

Question 16

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.

Accepted Answer

Advocacy involves empowering and promoting self-determination in others.

Question 17

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.

Accepted Answer

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.

Question 18

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

Accepted Answer

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).

Question 19

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

Accepted Answer

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.

Question 20

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

Accepted Answer

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.

Quiz 22: Person-Centered Care

As a head nurse,you are concerned about the service orientation on your unit.Which of the following findings and approaches might provide useful information for you?

Which of the following exemplifies a service orientation for a facility?

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?

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?

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?

In designing a program for young adults regarding safe sexual practices,which of the following might reach the greatest number in the target group?

Technology is integral to a cardiac ICU.Sue,the nurse manager,implements a patient-centered approach that focuses on the meaning of the experience for the patient and family,primary nursing,and a health literacy approach.Sue is:

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?"

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:

The complexity of the healthcare environment for consumers is increased by:

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:

As a nurse manager,you see an opportunity for patients to be well serviced through the medical home concept.You recognize that the concept of medical homes:

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:

You are involved in designing a clinic for women in an inner-city neighborhood.A goal of this clinic might be:

The chief nursing officer decides to establish a client advocacy position in an oncology unit.Advocacy is best represented by:

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?

The nurse manager must develop a patient satisfaction survey.What is one of the critical elements in selecting a patient satisfaction instrument?