So as new nursing students we keep getting told time and again, "Dont read into the question."
Ok fine.
We had a question recently:
"A Native American patient has been refusing to take their medication or attend treatment, which of the following would be a proper nursing response?"
A. Something outrageously not right
B. Something also clearly not right
C. Enlist the help of a family member, to discover if their are traditional healing practices the patient may be more receptive too.
D. Recommend to the provider that the patient be referred for a consult with a social worker.
To me C was clearly not right because, discussing the patient's diagnosis and health status without permission to a 3rd party (even if its family) is a clear violation of HIPAA. While we should respect the patient's culture and beliefs, discussing his diagnosis with an outside party is still a violation.
In D we are bringing the patient's lack of compliance to the provider's attention and using a collaborative team effort (social worker) to help address and overcome the patient's concerns with both the medication and treatment.
So I answered D.
We were told the answer is C. I questioned, "How is this not a clear HIPAA violation? We were told not to read into the questions. The question doesnt state, s/he gave you written permission to discuss their care with a 3rd party."
Response: "It doesnt state you werent given permission either."
Oh so Im supposed to be able to guess when they do and dont want me to read into questions, and in which way Im supposed to be able to read into the question.
While it is true you should avoid reading into a question, there are a couple of other important things to consider when answering questions for nursing/NCLEX.
1. You always have an order or approval for the options listed unless stated otherwise. They are not trying to trick you into violating scope of practice or HIPPA. There's only so much you can say in a question so a good ground rule is that they are trying to test you choice of the available options.
2. A nursing action is nearly always preferable to passing the buck. While collaboration is an important part of heathcare, they are testing you on nursing care and not if your can identify they appropriate person to pass the situation off on (e.g. social work). This does not apply when there is a clear indication that you need to contact the physician/provider to report something, request or clarify an order.
3. You always have everything you need to preform the actions. They are not testing you on te availability of resources. If something is an answer choice, assume you have the equipment/supplies available unless stated otherwise.
4. Imagine you can only conplete the action in question and then your shift is over. Don't assume an answer is correct because you could justify it by doing x, y, and z later. Obviously you wouldn't abound the pt but the best choice won't require subsequent actions that aren't listed and shouldn't need to be justified. This will help a lot with prioritization questions when you get those.
While some of these might sound like reading into the question, they are better thought of as the way a nurse reads a question. They don't always match up with the real world but they line up with the way your instructors are thinking when writing questions.
I was going to type out a response, but this is almost exactly what I was going to say!
I did well in nursing school, but I would have done even better if I had known these things at the beginning of the program, instead of learning them after graduation when I was studying for NCLEX.
Lots of people have given good feedback but, I just want to add, that answer D is not correct. A competent adult has the right to refuse medication and treatment and refusing recommended care doesn't automatically mean that one needs a social work consult. You would first need to explore why the patient is refusing his medication and not attending his treatments. If it's because he doesn't want the treatment, that's not a social work issue. If it's because he cannot afford the medication and doesn't have a ride to treatment, that IS a social work issue. As the nurse, you need to further assess the patient. The only correct answer is C.
It's not a HIPAA violation to ask the family if the patient follows any traditional/healing practices. You can ask the family "are there any traditional or healing practices your father follows?" without saying "your father isn't taking his BP meds and isn't going to dialysis" (or whatever the situation may be).
I think in some instances, yes, cultural competency is the initial purpose and clear objective of the question, however, the questions often utilize scenarios that are deeply stereotypical or suggestive of incorrect correlations between race and behavoir. Maybe thats what they meant?
It's not a HIPAA violation to ask the family if the patient follows any traditional/healing practices. You can ask the family "are there any traditional or healing practices your father follows?" without saying "your father isn't taking his BP meds and isn't going to dialysis" (or whatever the situation may be).
NCLEX questions aside. Im fairly confident, even as a student, that if the adult under your care is:
1. Fully competent
2. Not a danger to themselves or others
3. Not involved in an emergent/traumatic situation
4. Has not given you permission to contact family and has not involved family in their care thus far.
And you decide to call a family member using a phone number from their emergency contact card, identify yourself as a nurse in their care (oncology for example), thus revealing a possible diagnosis to their family...
These arent isolated incidents. Our current textbook has similar examples that are extremely derogatory to minorities and shows a profound amount of ignorance to any culture outside of the United States.
LOL. I was a passionate question arguer in my 1st semester. That was because the instructor did not have the best grasp of the language and some of the words she used changed the meaning of the question but she did not care about that. It was totally frustrating. She's no longer an instructor there. My opinion is ALL exams should be reviewed by peers for accuracy and clarity. Many students failed their first semester because of her lame question writing ability and that is shame.
Yes, they are stereotypical. For example a correct answer to a question was "ask the patient if they would be more comfortable with a same sex provider." The rationale was that because the patient was muslim, this is common practice in their culture. I feel that asking the question is an insult because I would be making an assumption that this person devoutly follows their religion. If they want a same sex provider...they will ask for one. Ugh
NCLEX questions aside. Im fairly confident, even as a student, that if the adult under your care is:
1. Fully competent
2. Not a danger to themselves or others
3. Not involved in an emergent/traumatic situation
4. Has not given you permission to contact family and has not involved family in their care thus far.
And you decide to call a family member using a phone number from their emergency contact card, identify yourself as a nurse in their care (oncology for example), thus revealing a possible diagnosis to their family...
that you will very shortly be looking for a job.
You need to remind yourself what you said in the first line of your OP:
So as new nursing students we keep getting told time and again, "Dont read into the question."
I said nothing in the post you are responding to about searching for the patient's emergency contact information in the chart nor identifying yourself as an oncology or nephrology (or whatever it may be) nurse involved in his care nor the family not being involved in the care in the first place. I said it's not a HIPAA violation to ask the family "are there traditional healing practices your father/grandfather/whoever practices?" Period. That's all your test question asked too.
And, once again, the answer you chose is also not correct. There's nothing in the question that would give you any reason to think a social work consult is indicated. You need to figure out why the patient is refusing his medications and treatment and the only answer that comes close to doing that is the one about asking the family about traditional healing practices.
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NurseJamillah, MSN, NP
82 Posts
I was going to type out a response, but this is almost exactly what I was going to say!
I did well in nursing school, but I would have done even better if I had known these things at the beginning of the program, instead of learning them after graduation when I was studying for NCLEX.