# Situation: The public health nurse visits a family of six in a farming barangay. The grandmother, 74, has been bedridden since a stroke 3 months ago and has a reddened area over the sacrum that does not blanch when pressed. Her daughter-in-law, 40, cares for her while also selling goods at the market, and feeds her while she lies flat because it is easier. The family's income dropped when the eldest son lost his job. For the grandmother's skin problem, which is a correctly written OBJECTIVE of care?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=627048  
> language: ko  
> subject: Nursing Practice I — Community Health Nursing

## 문제

Situation: The public health nurse visits a family of six in a farming barangay. The grandmother, 74, has been bedridden since a stroke 3 months ago and has a reddened area over the sacrum that does not blanch when pressed. Her daughter-in-law, 40, cares for her while also selling goods at the market, and feeds her while she lies flat because it is easier. The family's income dropped when the eldest son lost his job.

For the grandmother's skin problem, which is a correctly written OBJECTIVE of care?

## 보기

1. The nurse will teach the daughter-in-law how to turn the grandmother
2. The daughter-in-law will value the need to turn the grandmother often
3. Within 1 week, the family will have her turned every 2 hours **✔ 정답**
4. The family will prevent further skin breakdown in the grandmother

**정답: 3**

## 해설

An objective of care is specific, measurable, and time-bound, and it states what the family will do. Having her turned every 2 hours within 1 week can be observed and checked, and the family decides who turns her while the daughter-in-law is at the market. A broad statement of what the family will achieve is the goal, and actions of the nurse belong in the interventions column.

## 심화 해설

Understanding the Question

This item tests your ability to distinguish between a goal, an objective, and a nursing intervention within the planning phase of the nursing process. The grandmother’s sacral area shows a non-blanchable erythema, which is a Stage 1 pressure injury. The priority is to relieve pressure through regular repositioning, but the statement of care must be written in a format that can be objectively evaluated.

Key point! An objective must be specific, measurable, and time-bound. It describes what the client or family will do, not what the nurse will do.

Analyzing Each Option

| Option | Classification | Why It Does Not Meet the Criteria for an Objective |
| --- | --- | --- |
| 1 | Nursing intervention | Begins with “The nurse will teach.” This is an action the nurse performs, which belongs in the intervention column of the care plan, not the objective column. |
| 2 | Goal (affective domain) | Uses the verb “value.” This describes a change in attitude or feeling, which is not directly observable or measurable. It is a broad, long-term goal. |
| 3 | Objective (correct answer) | Contains a time frame (“Within 1 week”), a specific action (“turned every 2 hours”), and a measurable outcome (the turning can be observed and documented). |
| 4 | Goal (broad outcome) | “Prevent further skin breakdown” is a general, long-term achievement. It lacks specificity, a measurable criterion, and a time frame. |

Why Option 3 Is the Correct Objective

The statement “Within 1 week, the family will have her turned every 2 hours” is written in the SMART format. It specifies who (the family), what (turning the grandmother), how often (every 2 hours), and when (within 1 week). The frequency of every 2 hours is a standard, evidence-based interval for pressure injury prevention in bedridden patients. Because the daughter-in-law works at the market, the objective appropriately places responsibility on the entire family, allowing them to decide who will perform the turning during her absence. This makes the objective realistic and achievable within the household’s context.

A correctly written objective focuses on observable client or family behavior, not on the nurse’s actions or on internal feelings that cannot be measured.

Clinical Link: Why Repositioning Matters for This Grandmother

The grandmother’s reddened sacral area that does not blanch indicates that capillary occlusion and tissue ischemia have already begun. In a stroke patient with immobility, sustained pressure over a bony prominence compresses capillaries, reducing blood flow and leading to tissue hypoxia. If pressure is not relieved, the injury can progress from Stage 1 to deeper tissue destruction involving subcutaneous fat, muscle, or bone.

Turning every 2 hours redistributes pressure and allows reperfusion of ischemic tissue, which is the single most effective non-pharmacologic intervention for preventing pressure injury progression.

The evidence base supports this approach. A scoping review on rehabilitation interventions for pressure ulcer prevention identifies repositioning and mobility promotion as core components of preventive care for people with impaired mobility and reduced self-care capacity, such as this post-stroke grandmother [3]. Similarly, research on pressure injury prevention in stroke populations emphasizes the importance of early, consistent tissue-risk detection and preventive repositioning to interrupt the ischemic cascade [2]. The development of standardized prevention protocols, such as the Belgian BEPU2025 project, also highlights that timely identification of at-risk patients must be followed by prompt, structured preventive actions—of which regular turning is a cornerstone [1].

Watch out! Do not confuse the goal (broad, long-term, e.g., “prevent skin breakdown”) with the objective (specific, measurable, time-bound, e.g., “turn every 2 hours within 1 week”). On licensure exams, the correct answer is almost always the option that includes a number and a time frame.

Applying This to the Nursing Process

In the planning phase, the care plan has three distinct columns: goal/objective, interventions, and evaluation. The objective states the expected client or family outcome. The interventions are the nurse’s actions to help achieve that objective. For this family, an appropriate intervention would be: “The nurse will demonstrate proper turning technique using pillows for positioning and teach the family to inspect the sacral skin at each turn.” The evaluation would then check: “After 1 week, the family has turned the grandmother every 2 hours as documented on a turning schedule.”

The objective is the bridge between assessment and intervention—it tells you exactly what change you expect to see and by when.

In community health nursing, objectives must also be culturally and economically feasible. The family’s reduced income and the daughter-in-law’s work schedule are real constraints. The objective “Within 1 week, the family will have her turned every 2 hours” respects these constraints by involving the whole family rather than placing the burden solely on one caregiver. This aligns with the principle that preventive care for pressure injuries in home settings requires shared responsibility and practical, low-cost strategies [3].References (research sources)

- [1]From risk scores to prevention action: the development of BEPU2025 to standardise and optimise pressure ulcer risk assessment and prevention in Belgium.Research articleSmet S, Nys M, de Graaf A, Cortebeeck K, Ruysch K, van Roy W, Beeckman D. (2026) · DOI: 10.12968/jowc.2026.0325

- [2]Digital and Smart Technologies for Early Pressure Injury Detection and Prevention in Stroke and Mobility-Impaired Patients: A Scoping Review.Research articleAbu M, Latif AI, Saranga JL, Zakariyati, Kusmayanti E, Halimah N, Ali DB, Ruqaiyah. (2026) · DOI: 10.1155/nrp/6992856

- [3]Rehabilitation Workforce Interventions for Pressure Ulcer Prevention: A Scoping Review.Research articleVeríssimo JJ, Fernandes JB. (2026) · DOI: 10.3390/nursrep16090339

## 임상 시나리오

Writing Measurable Family ObjectivesPressure Injury Prevention in Home Care
A well-written objective of care must be specific, measurable, and time-bound. It states what the family or client will do, not what the nurse will do.

For a Stage 1 pressure injury on the sacrum, the priority is regular repositioning. The objective should specify the action (turned every 2 hours) and the time frame (within 1 week).

CautionDo not confuse objectives with nursing interventions (nurse actions) or broad goals (general outcomes like "prevent breakdown"). The objective must be observable and checkable.

## 핵심 개념

- **Objective of Care** — A specific, measurable, time-bound statement of what the client or family will do to achieve a goal.
- **Nursing Intervention** — A specific action performed by the nurse to help the client achieve expected outcomes.
- **Goal of Care** — A broad, general statement of the desired long-term outcome of nursing care.
- **Stage 1 Pressure Injury** — Non-blanchable erythema of intact skin, indicating localized damage from pressure.
- **Repositioning** — Changing a patient's body position to relieve pressure on bony prominences and prevent tissue injury.

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