Nurs Final Exam Ch 5

Chapter 5: Demonstrating Warmth Multiple Choice 1. A patient reports to the nurse, My doctor is not doing anything about my pain.= Which response by the nurse is assertive and expresses warmth? a. If I were you, I would see a different doctor.= b. What you really mean is you do not like your doctor.= c. It is wrong for you to blame your doctor.= d. You seem frustrated with your doctor.= ANS: D An assertive statement that expresses warmth (i.e., You seem frustrated with your doctor=) engages in direct, fair confrontation with clear, honest statement of feelings; when the nurse conveys warmth and is assertive, a position of < I’m OK, you’re OK= is assumed. Aggressive statements that lack expression of warmth include outright assaults or accusations (i.e., < It is wrong for you to blame your doctor=), making decisions for others (i.e., < If I were you, I would see a different doctor=), and labeling the other person (i.e., < What you really mean is you do not like your doctor=). 2. It would be most important for the nurse to temporarily withdraw expressions of warmth to which patient? a. A 20-year-old patient who is angry and throwing objects. b. A 32-year-old patient who is withdrawn and refuses nursing care. c. A 48-year-old patient who is extremely anxious about surgery. d. A 56-year-old patient who has a history of violent behavior. ANS: A When the nurse feels hurt, bitter, irritated, or enraged with a patient, trying to convey warmth would be insincere. It would be appropriate to express warmth to patients who are withdrawn and anxious. Expression of warmth is appropriate for a patient with a history of violence; the patient is not exhibiting the violent behavior at this time. 3. The nurse observes a student nurse who demonstrates nonverbal expressions that are cold and convey disinterest when caring for patients. Which statement, if made by the nurse, is best? a. < Patients will complain about you because your behaviors are unprofessional.= b. < Have you noticed that your patients do not like you very much?= c. < For the next few shifts, closely observe how I display warmth to patients.= d. < You need to change your behavior when interacting with your patients.= ANS: C The nurse should recommend an exercise that will help the student nurse identify nonverbal behaviors that convey warmth before the student nurse observes or changes his or her own behaviors. The term < unprofessional= indicates conduct, behavior, or language that is not befitting to a profession. The nurse should help the student nurse to recognize nonverbal behaviors that convey warmth instead of focusing on consequences (i.e., patient complaints) or likeability. Telling the student nurse to change behavior is not helpful; the nurse should initially focus on helping the student to identify behaviors that display warmth. 4. Which facial feature, if displayed by the nurse, best conveys warmth? a. Small pupils and a fixed gaze b. Furrowed brow and a wrinkled forehead c. Pursed lips and a forced smile d. Relaxed muscles and a concerned expression ANS: D Facial features that convey warmth include the following: (1) face moves in a relaxed, fluid way; worried, distracted, or fretful looks are absent; face shows interest and attentiveness; (2) pupils are dilated; gaze is neither fixed nor shifting and darting; (3) lips are loose and relaxed, not tight or pursed; smile is not forced, jaw is relaxed and mobile, not clenched; and (4) forehead muscles are relaxed, and forehead is smooth; there is no furrowing of the brow. 5. The nurse greets a patient who is admitted to the hospital. Which action by the nurse displays warmth and concern? a. Use a soft and relaxed tone of voice when speaking. b. Maintain a distance of 6 to 8 feet from the patient. c. Avoid attentive behaviors when interacting with the patient. d. Engage in a verbal exchange without physical contact. ANS: A A soft, modulated tone of voice conveys warmth; warmth is also conveyed with relaxed, rhythmic speech. The spatial distance between the nurse and the patient can affect the perception of warmth; a comfortable, social distance for Americans is an arm’s length to 4 feet. Touching (e.g., brief pat on the shoulder, embracing hug, or extended hand) is another way to transmit warmth. A relaxed person conveys warmth. The nurse communicates warmth when there is a genuine interest and attentiveness in the interaction with the patient. 6. A nurse preceptor is assigned to help several graduate nurses assess their ability to convey warmth to patients. Which activity, if selected by the nurse preceptor, is best? a. Set up sessions for the graduate nurses to practice various nonverbal gestures. b. Ask the graduate nurses to record the behaviors of experienced nurses on the unit. c. Provide the graduate nurses with a list of nonverbal behaviors that convey warmth. d. Have the graduate nurses evaluate each other during simulated patient interviews. ANS: D A simulated patient interview that is evaluated would provide the best opportunity for the graduate nurses to develop skills to assess warmth and to receive feedback on personal warmth skills. A list of nonverbal behaviors does not foster active learning. Nonverbal gesture practice does not help graduate nurses learn how to assess warmth skills with a patient. Recording nonverbal behaviors is observation and does not give the graduate nurses a specific experience in assessment of warmth skills. 7. The nurse cares for a patient who has metastatic cancer. Which action(s) by the nurse conveys warmth? (Select all that apply) a. Avoid distracting actions such as hand gestures. b. Show interest by occasional head nodding. c. Lean forward toward the patient at a 45-degree angle. d. Place arms across the chest to prevent fidgeting. e. Sit or stand to keep eyes level with the patient’s eyes. ANS: B, E The nurse displays warmth by certain body postures. Body postures that convey warmth include the following: (1) the nurse’s head should be kept at the same level as the client’s head; (2) hand gestures should be natural, with no clenching or grasping of objects and avoiding distracting mannerisms; (3) arms are kept loose and able to move smoothly, rather than held stiffly; (4) periodic nodding shows interest and attentiveness; and (5) the chest should be kept open with slight forward leaning to show interest. 8. According to Kimble and Bamford-Wade, what distinguishes the behavior of one caring and competent nurse from another nurse who is simply competent but not engaged with the patient? a. Immediacy, the availability of the nurse b. Warmth, the hallmark of compassion c. Attention, the focus of the nurse d. Communication, the instructional side of the nurse ANS: B Healy, a nurse patient, recounts a long wait before surgery, ponders what it was that distinguished the behavior of one caring nurse, and identifies warmth as the hallmark of compassion, also a quality of compassionate listening (Kimble and BamfordWade, 2013). 9. A nurse manager asks a colleague for advice on strategies to improve communication with staff nurses. Which response by the nurse manager’s colleague is best? a. Be sensitive, show respect, and be genuine.= b. < You need to be consistently nice to the staff nurses.= c. < Work as a staff nurse every month to develop empathy.= d. < Staff nurses need a leader who is not emotional.= ANS: A Improved communication with colleagues can be enhanced by expression of warmth. Warmth enhances closeness, creates a better work environment, and makes a colleague more approachable. A nurse manager needs to avoid insensitivity to co-workers and demonstrating aloofness and arrogance. Warmth, respect, genuineness, and empathy are needed to improve communication with colleagues. Being nice is not equivalent to expressing warmth. Empathy is not learned by performing the job of a colleague. Expression of warmth is an emotion. 10. A patient is irritable and complains to the nurse about difficulty sleeping last night. Which response by the nurse is most appropriate? a. < I know you will sleep better tonight.= b. < Tell me more about what happened last night.= c. < Did you drink too much caffeine yesterday?= d. < No one sleeps well in the hospital.= ANS: B Kindness and warmth in healthcaring relationships are important to customer service. Responses that demonstrate warmth (i.e., < Tell me about your concerns=) are important when a patient makes a complaint. Nontherapeutic responses that do not convey warmth include reassurance (i.e., < I know you will sleep better tonight=); failure to probe (i.e., < Did you drink too much caffeine yesterday?=); and making stereotyped responses (i.e., < No one sleeps well in the hospital=). 11. The nurse has implemented a plan to improve expression of warmth to other nurses. It is most important for the nurse to include which evaluation method? a. Self-monitor interactions with colleagues for feelings of relaxation and caring. b. Ask patients for their perception of the interactions that occur among nurses. c. Invite a supervisor to evaluate interactions and provide suggestions for improvement. d. Seek nominations for an award at the organizational level or from an association. ANS: A One of the most important measures of warmth is the individual’s inner feelings; the nurse should monitor for more relaxed, caring feelings toward others and for free-flowing affection and engagement with others. The patients would not be able to reliably evaluate interactions between nurses or other healthcare professionals. Specific feedback about warmth ability can be obtained by asking a colleague (or supervisor) to evaluate the interactions with colleagues and to let them provide constructive feedback. An award nomination is not a suggested evaluation method to measure warmth.