Chapter 22: Consumer Relationships


Chapter 22: Consumer Relationships
Yoder-Wise: Leading and Managing in Nursing, 6th Edition


1. 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.
Advocacy involves empowering and promoting self-determination in others.

REF: Page 420
TOP: AONE competency: Professionalism| AONE competency: Knowledge of the Health Care Environment

2. 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
Facilitating greater control over practices implies trust and acknowledges expertise and performance.

REF: Page 425 | Page 426 TOP: AONE competency: Professionalism

3. The nurse manager understands that the three Ps associated with client education are philosophy, priority, and performance. Effective client education programs start with a shared philosophy that such programs are worth the investment. Evidence of a philosophic commitment to client teaching is best represented by:
a. Investing time and energy in teaching clients.
b. Developing teaching skills among the nursing staff.
c. Assuming that clients lack the knowledge they need.
d. Having a teaching checklist on clients’ charts.
A philosophy that patient education is an investment with a significant positive return is one of the three Ps of a successful consumer education focus. Money invested in teaching is money well spent.

REF: Page 420 TOP: AONE competency: Communication and Relationship-Building

4. 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.
Trend-setting organizations such as MagnetTM 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.

REF: Page 416 | Page 417 TOP: AONE competency: Professionalism

5. The nurse manager has to 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
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.

REF: Page 417 TOP: AONE competency: Professionalism

6. 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
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).

REF: Page 412 TOP: AONE competency: Communication and Relationship-Building

7. 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 on a monthly basis.
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.
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.

REF: Page 415 | Page 418
TOP: AONE competency: Communication and Relationship-Building

8. 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 particular 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.
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.

REF: Page 410 | Page 424
TOP: AONE competency: Communication and Relationship-Building

9. 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
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.

REF: Page 425 TOP: AONE competency: Communication and Relationship-Building

10. 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 for the amount of information desired
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
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.

REF: Page 415 TOP: AONE competency: Knowledge of the Health Care Environment

11. In designing a program for young adults regarding safe sexual practices, which of the following might reach the greatest number in your target group?
a. Web-based applications
b. Print-based media such as newspapers
c. Television advertisements
d. Brochures in kiosks in malls
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 (Zickuhr & Smith).

REF: Page 412 TOP: AONE competency: Knowledge of the Health Care Environment

12. A nurse is admitted to a psychiatric unit. The staff expresses frustration with her because they have explained several times her medication regimen, and yet, when she goes on passes, 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.
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 (Koh, Brach, Harris, & Parchman, 2013). 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.

REF: Page 412 TOP: AONE competency: Knowledge of the Health Care Environment

13. 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 someone else who has different ideas. 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.
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.

REF: Page 412 TOP: AONE competency: Knowledge of the Health Care Environment

14. 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.
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.

REF: Page 443 | Page 444
TOP: AONE competency: Knowledge of the Health Care Environment

15. 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.
As gatekeepers to the system, nurses advocate for and coordinate care, services, and access for patients across all providers, settings, and levels of care.

REF: Page 414 TOP: AONE competency: Professionalism

16. 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.
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 (Flaskerud, 2007). 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.

REF: Page 420 | Page 421
TOP: AONE competency: Communication and Relationship-Building

17. 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.
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.

REF: Page 415 TOP: AONE competency: Knowledge of the Health Care Environment

18. Which of the following exemplifies a service orientation?
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 initiated in response to requests from families and nurses who care for them..
A service orntation 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.

REF: Page 415 TOP: AONE competency: Communication and Relationship-Building

19. 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.
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.

REF: Page 417 TOP: AONE competency: Knowledge of the Health Care Environment

20. 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.
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.

REF: Page 414 | Page 415
TOP: AONE competency: Knowledge of the Health Care Environment

21. 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.
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.

REF: Page 417 TOP: AONE competency: Knowledge of the Health Care Environment

22. Which of the following actions best exemplifies advocacy?
a. Developing a list of agencies that will provide free services for the homeless
b. Working in a needle exchange program for individuals in an inner-city environment
c. Acting on behalf of a patient to promote end-of-life wishes to an ethics committee
d. Working in a free clinic for immigrant workers
Advocacy means making known and defending and protecting the rights and interests of others, as well as ensuring the dignity and respect due to others. Simply being employed in an environment where this might be a focus of practice does not necessarily ensure that advocacy is actually occurring.

REF: Page 420 TOP: AONE competency: Professionalism

23. During review of a patient’s progress, the healthcare team determines that a patient requires treatment that is generally accepted at that time in the usual illness trajectory of a patient. The patient is unable to pay. As the head nurse, you persist in ensuring that this patient receives the treatment. You are:
a. Empowering the patient.
b. Avoiding litigation.
c. Advocating for the patient.
d. Supporting the clinical pathway.
Advocacy means defending the rights and interests of others and, in this situation, the right of a patient to receive care, as determined by standards utilized in a critical pathway.

REF: Page 420 TOP: AONE competency: Professionalism

24. A nurse makes a medication error that is not serious and does not cause harm to the patient. As the head nurse, your best action would be to:
a. Call attention to it by posting the critical incidents report at the nursing station.
b. Include the mistake on the nurse’s performance appraisal.
c. Apologize to the patient for the error, and indicate that discipline has occurred.
d. Educate the nurse on how to provide an apology to the patient.
Service recovery ensures responsiveness to the patient, and as part of service recovery, it is important to address an error in the most productive way, which also includes the nurse who made the error offering an apology to the patient.

REF: Page 419 | Page 420
TOP: AONE competency: Communication and Relationship-Building

25. An example of a factor that would impede a patient’s learning is:
a. Poverty.
b. Limited health insurance.
c. Being an older adult.
d. Heavy sedation.
Nurses need to be sensitive to the teaching needs of those at risk for disparities in health care: persons of a different race or ethnic group, women, children, older adults, rural residents, and those with limited or no health insurance, low health literacy, and/or low socioeconomic status. It is important that lower expectations for persons who are disadvantaged, have a low literacy level, or have limited English proficiency are not unintentionally communicated.

REF: Page 423 TOP: AONE competency: Knowledge of the Health Care Environment


1. Which of the following activities would represent a customer-friendly approach in a healthcare setting? (Select all that apply.)
a. Using a local anesthetic before inserting a needle into a child’s arm
b. Repeating patient history information to the admitting clerk, the admitting nurse, and the ultrasound technician
c. Ensuring that birthing preferences are on file and available when a laboring mother comes in
d. Providing support to families when a family member is brought into trauma
ANS: A, C, D
A service orientation means delivering services in a manner that is least disruptive. When possible, services should come to the patient and should be as easy, comfortable, pleasant, and effective as possible. Meeting the emotional, psychosocial, and spiritual needs of the patient is important.

REF: Page 415 | Page 416
TOP: AONE competency: Communication and Relationship-Building