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Test Bank Maternal-Child Nursing Care Womens Health 2nd Edition Ward Hisley

Test Bank Maternal-Child Nursing Care Womens Health 2nd Edition Ward Hisley Test Bank Maternal-Child Nursing Care Womens Health 2nd Edition Ward Hisley Test Bank Maternal-Child Nursing Care Womens Health 2nd Edition Ward Hisley

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Ethnocentrism is the view that the beliefs, values, and behaviors of one culture are superior to those of other cultures. Ethnocentrism is dangerous in health care because it is blind to the possibilities of other solutions and viewpoints and alienates people in need of health care. The nurse manager would be wise to assess the clinic’s staff and procedures for ethnocentrism. Meeting with a community leader is always a good idea to learn the viewpoints of the community, but unless ethnocentric behaviors change, it is unlikely that the refugee community will increase its use of the clinic. Flyers and incentives may also be helpful in some cases, but not as helpful as reducing the barriers imposed by ethnocentrism. Cognitive Level: Application/Applying Content Area: Pediatrics/Maternity Patient Needs: Health Promotion and Maintenance Integrated Process: Caring Difficulty: Moderate PTS: 1 3. The nursing faculty explains to students that ethnopluralism is an important force shaping health care today. What concept is most important in understanding this trend? A. The decreased need for cultural competency B. The growth in one ethnic group in a single area C. The increased impact of diverse cultures on health care D. The percentage increase of the non-Caucasian population ANS: C Ethnopluralism means diverse cultures. As the population of different ethnic (non-Euro-Caucasian) groups grows, their impact on health care will increase exponentially. Ethnopluralism is not just the growth of one ethnic group in one location. It is also more than just the percentage change in the non-Euro-Caucasian population, although that is part of the phenomenon. As ethnopluralism continues to impact health care, providers will need to be more, not less, culturally competent. Cognitive Level: Knowledge/Remembering Content Area: Pediatrics/Maternity Patient Needs: Psychosocial Integrity Integrated Process: Teaching/Learning Difficulty: Moderate PTS: 1 4. A nursing faculty member is explaining recent shifts in nursing practice. What change has been important in applying the nursing process? A. A change to a spiral or circular process B. A focus on more independent nursing actions C. A return to the nurse-as-expert model of care D. An emphasis on attaining a disease-free state ANS: A
The nursing process has recently changed from a linear one to a spiral or circular process in which the patient/family is motivated toward promotion, maintenance, and restoration of health. The focus has not changed to include more independent actions, a return to the nurse-as-expert model, or an emphasis on attaining a disease-free state of being. Cognitive Level: Comprehension/Understanding Content Area: Pediatrics/Maternity Patient Needs: Health Promotion and Maintenance Integrated Process: Teaching/Learning Difficulty: Easy PTS: 1 5. A nurse is working in an urban clinic with a diverse population. What action by the nurse is most important? A. Determine patients’ definitions of health and desired outcomes of health care. B. Explain policies such as appointment cancellations to ensure compliance. C. Learn to speak one or two common languages of the patients in the clinic. D. Read about different folk remedies common among the populations seen. ANS: A Divergent populations enter the health-care system with differing beliefs about health care and wellness and differing expectations for the outcomes of such experiences. Understanding these expectations will help the nurse plan care that has a better chance of meeting these expectations. Learning languages and becoming familiar with folk remedies is helpful as well, but these two solutions are very limited in scope and a nurse cannot hope to become proficient in all the languages/behaviors of every population seen, leaving some patients with a lessened experience. Explaining policies is important too, but simply telling someone the rules does not take his or her cultural norms into account and may not be successful. Cognitive Level: Application/Applying Content Area: Pediatrics/Maternity Patient Needs: Psychosocial Integrity Integrated Process: Nursing Process: Assessment Difficulty: Moderate PTS: 1 6. A nurse is working with a minority group that has a high incidence of cardiovascular disease, including hypertension and stroke. When participating in a community health fair with this group, what action by the nurse will be most effective? A. Educate the participants about weight loss and a low-sodium, low-fat diet. B. Explain the genetic basis for the high incidence of cardiovascular disease in the group. C. Help participants make lifestyle changes that are culturally congruent. D. Present statistics on the mortality and morbidity of cardiovascular disease. ANS: C
The ever-increasing culturally diverse population interacting with the health-care system brings its own beliefs, values, and health-related practices that impact health and well-being. In order to help people make healthy lifestyle changes, the changes must be culturally congruent and acceptable. Forcing an incongruent practice makes it highly unlikely to succeed. Education is important, but it must be done in a culturally congruent way. Pathophysiology and statistical knowledge, by itself, is not likely to be beneficial. Cognitive Level: Application/Applying Content Area: Pediatrics/Maternity Patient Needs: Psychosocial Integrity Integrated Process: Teaching/Learning Difficulty: Difficult PTS: 1 7. What does the practicing nurse understand to be the most important influence on interdependent, assertive nursing practice today? A. Higher education of registered nurses B. Improved working conditions and salaries C. Increased numbers of female physicians D. Use of the nursing process for patient care ANS: D Nurses were passive, deferential, and compliant to the knowledge and orders of mostly male physicians until the late 20th century. The nursing process changed that. The nursing process is a framework for systematic problem solving and implementation of both independent and dependent nursing actions. The nursing process allows nurses to make decisions regarding patient care based on critical thinking and clinical judgment. The other options listed were not vital in creating a nursing practice that is interdependent and assertive. Cognitive Level: Analysis/Analyzing Content Area: Pediatrics/Maternity Patient Needs: Safe and Effective Care Environment: Management of Care Integrated Process: Nursing Process Difficulty: Difficult PTS: 1 8. A child who has been hospitalized for a long time is preparing to go home, where care will be continued. Which action by the nurse is most beneficial to assist the family in this transition? A. Advise the family to call the local visiting nurses association for home visits. B. Call the child’s school to inquire about requirements for returning to school. C. Consult a social worker to help evaluate insurance coverage and transportation. D. Give the family brochures for the local support group for chronically ill children. ANS: C
Preparing a family for home-based care, or other community-based care, involves ensuring that the family is able to provide the care needed by the child at home or in another setting. This can include discussing specialized equipment in the home, health insurance coverage, transportation, and/or returning to school. If the family needs or desires visiting nurses, the nursing staff or social worker at the hospital should arrange this for the family. Calling the school to get information about the child’s return to school yields helpful information, but may not be needed yet, and is too limited in scope to be the best answer. Simply giving parents brochures for support groups may or may not be helpful; the parents may not be literate or may not understand the benefit without discussion. Cognitive Level: Analysis/Analyzing Content Area: Pediatrics/Maternity Patient Needs: Health Promotion and Maintenance Integrated Process: Communication and Documentation Difficulty: Difficult PTS: 1 9. A nurse manager wants to make the pediatric clinic a more family-centered health-care setting. Which of the following actions by the nursing staff would best meet this goal? A. Encourage family members to be present in the exam room and to ask questions. B. Incorporate the use of a community health map for all new patients in the clinic. C. Recognize family members as experts on their child and incorporate them in decision making. D. Use evidence-based practice to develop policies and procedures used in the clinic. ANS: C The role of the family-centered nurse is to facilitate and assist the family in making informed choices that lead to the outcome the patient and family desire. This requires the nurse to give up the paternalistic role of authority on health care. The family knows the child best and should be assumed to make decisions that are in the best interests of both child and family. The other options are all good interventions, but are too limited in scope to be the best way to create a family-centered environment. Cognitive Level: Analysis/Analyzing Content Area: Pediatrics/Maternity Patient Needs: Psychosocial Integrity Integrated Process: Caring Difficulty: Difficult PTS: 1 10. A clinic nurse is explaining to a student nurse the function of the community health map in assessing families. Which description of this assessment tool is most accurate? A. It assesses how the family interacts with outside social systems. B. It locates health-care settings in, or close to, their neighborhood. C. It outlines family problems and social resources to help with them. D. It shows how the health of the community impacts each family. ANS: A
A community health map is an assessment tool for family structure, function, and support networks. It displays significant related data and helps the nurse focus on the family as it interacts with the social systems within and around the family. Its purpose is not to locate local health-care settings. The focus is on family health and past successes and current strengths, not on family problems. Correlations can be made between the health of the community and the health of those living in that community, but this is not the purpose of the community health map. Cognitive Level: Comprehension/Understanding Content Area: Pediatrics/Maternity Patient Needs: Health Promotion and Maintenance Integrated Process: Teaching/Learning Difficulty: Moderate PTS: 1 11. A nurse wishes to improve his or her cultural sensitivity while working with patients. Which action by the nurse would best indicate progress toward this goal? A. Demonstrate good knowledge of different cultural health beliefs B. Effectively respond to the needs of people of different cultures C. Interact respectfully with patients who have differing health beliefs D. Recognizes that he or she will never be the expert in other cultures ANS: C Cultural sensitivity is a way of approaching people who hold health beliefs different from one’s own. A nurse with this characteristic is respectful of and open to others. Cultural competence is the ability to interact effectively with people of different cultures and requires a certain level of knowledge about those cultures. Cultural humility is the recognition that one will never master all information about another culture. Cognitive Level: Analysis/Analyzing Content Area: Pediatrics/Maternity Patient Needs: Psychosocial Integrity Integrated Process: Caring Difficulty: Difficult PTS: 1 12. A nurse manager is evaluating staff members on their cultural competence. Which action best demonstrates this characteristic? A. Attends workshops on cultural diversity and health practices B. Participates in community health events with minority populations C. Plans care with the family members within their cultural beliefs D. Uses family members as interpreters to make them feel important ANS: C
The culturally sensitive nurse is able to understand and respond to the needs of individuals and families from different cultures. This nurse plans interventions with a solid knowledge of the values and practices of the members of the culture. Being open, listening to the family, and involving them in care demonstrates respect, unifies the nurse–patient relationship, and will motivate the patient (and family) to make positive health changes. Attending workshops is a good way to learn about diverse cultures and attending community events with diverse populations can increase cultural knowledge, but these actions are too limited in scope to demonstrate cultural competence. Nurses should use professional interpreters when needed. Cognitive Level: Evaluation/Evaluating Content Area: Pediatrics/Maternity Patient Needs: Psychosocial Integrity Integrated Process: Caring Difficulty: Difficult PTS: 1 13. A nurse is incorporating a cultural assessment into nursing care. Which assessment question by the nurse leads the supervisor to conclude that this nurse needs further education on cultural assessment? A. What customs and traditions are important to you? B. What kind of insurance coverage do you have? C. When you are stressed or worried, what comforts you? D. Who in your family is important for support? ANS: B Cultural influences include family support systems, religious and spiritual beliefs, customs and traditions, communication patterns, coping strategies, and problem-solving techniques. Asking about insurance coverage is not directly related to culture, although this can give information about the patient/family’s living environment and ability to access resources. Cognitive Level: Evaluation/Evaluating Content Area: Pediatrics/Maternity Patient Needs: Psychosocial Integrity Integrated Process: Communication and Documentation Difficulty: Moderate PTS: 1 14. A nurse is working with a cultural group that has many proscriptions against women seeking health care. What action by women in this community would indicate that they have successfully negotiated a new role in seeking care? A. Are able to make and keep medical appointments B. Can afford to pay for desired health-care services C. Follow their traditional roles and responsibilities D. Seek health-care advice from family members ANS: A
Cultural proscriptions are beliefs, practices, and values of a group that tell women and children what they should not do. In many traditional cultures, women do not have permission, decision-making power, or means to access the health-care system. If the women from such a culture successfully negotiate their roles regarding health care, they can access the health-care system on their own. The ability to afford services is not related, although cultural proscriptions might forbid women from making such a transaction. If they follow their traditional roles or seek health care from family members, they have not demonstrated a successful negotiation of a new role. Cognitive Level: Analysis/Analyzing Content Area: Pediatrics/Maternity Patient Needs: Health Promotion and Maintenance Integrated Process: Caring Difficulty: Difficult PTS: 1 15. A patient wishes to use complementary therapy when managing a chronic health condition. Which action by the nurse is most appropriate? A. Advise the patient that stopping medical treatment may cause it to worsen. B. Inform the patient that there are no complementary therapies for this condition. C. Investigate herbs that can be substituted for prescription drugs. D. Suggest the patient add massage therapy to the medical regimen. ANS: D Complementary therapy is nontraditional treatment that is used in addition to traditional medical care. Alternative therapies are used in place of traditional therapies. Adding massage to the medical regimen is an example of using complementary therapy. Substituting herbs for prescription medication is an example of alternative therapy. Because the patient is asking about complementary therapy, there is no need to warn him or her of the effects of stopping treatment. There are always complementary therapies that can be added to a medical regimen. Cognitive Level: Analysis/Analyzing Content Area: Pediatrics/Maternity Patient Needs: Health Promotion and Maintenance Integrated Process: Teaching/Learning Difficulty: Moderate PTS: 1 16. A nurse is working with a family that uses multiple complementary and alternative medicine (CAM) modalities. What action by the nurse is best? A. Allow the family to continue these practices as desired. B. Assess how these practices reflect religious beliefs. C. Inform the family that most of these practices do not work. D. Provide evidence-based information about the therapies. ANS: D
The nurse working with individuals or families who use CAM practices should respect the beliefs, values, and desires of the patient. The nurse should encourage families to make decisions regarding CAM practices based on evidence and research into their effects. The nurse can best assist in this by providing and discussing information. Although the nurse cannot stop the family from using CAM, he or she should not pass up the teaching opportunity. Many CAM practices have demonstrated benefit, so telling the family they don’t work is false information. A culturally competent nurse will assess how religious and spiritual beliefs affect health-care practices, but the nurse needs to advocate for the patient/family by providing solid information. Cognitive Level: Application/Applying Content Area: Pediatrics/Maternity Patient Needs: Health Promotion and Maintenance Integrated Process: Teaching/Learning Difficulty: Moderate PTS: 1 17. A nurse acting in the role of teacher is determining learning outcomes. Which action will produce the best outcomes for teaching? A. Collaborate with the discharge planner on outcomes. B. Determine the teaching priority, then establish the outcome. C. Develop outcomes mutually agreed on with the patient. D. Enlist other staff members to help prioritize outcomes. ANS: C The best nursing care (including teaching) is a collaborative effort between nurse and patient. Each participant has knowledge and shares the power of determining what is to be learned. The best outcomes result in patient cooperation, because the patient was instrumental in developing them. The other actions might be helpful in specific situations, but involving the patient (or family) is always appropriate and vital. Cognitive Level: Application/Applying Content Area: Pediatrics/Maternity Patient Needs: Health Promotion and Maintenance Integrated Process: Teaching/Learning Difficulty: Moderate PTS: 1 18. A nurse uses Nightingale’s theory of nursing to pattern care for patients. Which action by the nurse is most consistent with this theory? A. Does for the patient what he or she is unable to do for self B. Focuses patient interactions on caring, healing, and wholeness C. Keeps patient’s room clean and ensures good nutrition D. Incorporates culturally relevant actions in a caring encounter ANS: C
Nightingale focused on the spiritual, physical/environmental, emotional, mental, and social needs of the patient. A major area of emphasis was on improving the patient’s environment (internal and external). For this theorist, the base of nursing practice centered around observation, knowledge of sanitation, nutrition, caring, and compassion. The action most closely associated with Nightingale would be keeping the patient’s room clean and ensuring the patient gets good nutrition. A focus on caring, healing, and wholeness-centered interactions is reflective of Jean Watson’s theory. Incorporation of culture into nursing care reflects the theory of Leininger. Although not mentioned in the text, doing for others what they would do for themselves, if able, is the basis of Dorothea Orem’s self-care theory. Cognitive Level: Analysis/Analyzing Content Area: Pediatrics/Maternity Patient Needs: Psychosocial Integrity Integrated Process: Nursing Process: Implementation Difficulty: Moderate PTS: 1 19. An inpatient nursing unit uses Madeleine Leininger’s theory to organize nursing care. The manager would conclude that a new nurse has successfully integrated this theory into practice when the nurse does which of the following actions? A. Emphasizes caring over curing in nursing actions B. Establishes trusting relationships with patients C. Knows the cultural practices of many different groups D. Organizes environmental factors for the patient’s benefit ANS: B Establishing a trusting nurse–patient relationship is at the core of Leininger’s theory. In order to understand another person’s cultural beliefs, values, methods of providing or showing caring, causes of illness, and how wellness is achieved, the nurse must first establish a trusting relationship with the patient so the patient feels free to share. This is an ongoing process. The emphasis on caring over curing is part of Watson’s theory. Knowing the practices of several different cultural groups would be a valuable asset, but is not required for Leininger’s theory. Organizing the environment to benefit the patient is part of Nightingale’s theory. Cognitive Level: Evaluation/Evaluating Content Area: Pediatrics/Maternity Patient Needs: Psychosocial Integrity Integrated Process: Caring Difficulty: Difficult PTS: 1 20. A nurse uses Watson’s theory as a framework for nursing practice. Which nursing action best demonstrates the use of this theory? A. Actively clarifies the patient’s health beliefs and practices B. Allows children to visit an ill parent despite visitation restrictions C. Assesses both the physical and spiritual dimensions of the patient D. Ensures the patient is neither too warm nor too hot for comfort ANS: C
Jean Watson contends that caring as a nurse requires the nurse to pay attention to both the physical and spiritual dimensions of the patient. Clarifying health beliefs and practices is more related to Leininger’s theory. Allowing children to visit despite restrictions is a caring action, but is not tied to a specific theory. Manipulating the environment for patient comfort and well-being is a core component of Nightingale’s theory. Cognitive Level: Application/Applying Content Area: Pediatrics/Maternity Patient Needs: Psychosocial Integrity Integrated Process: Caring Difficulty: Moderate PTS: 1 21. A nursing manager wants to increase the staff’s attention to patients’ spirituality. Which action by a nurse would best demonstrate this concept? A. Asked about the patient’s religion B. Assessed the patient’s meaning of life C. Consulted a chaplain for a patient case D. Inquired about religious rituals in health ANS: B Spirituality does not necessarily equate with religion; it is more a concept related to a person’s beliefs about the meaning of life. Although all actions might be incorporated in a comprehensive discussion of spirituality, the best demonstration of attention to this characteristic is inquiring about the meaning the patient ascribes to life. Cognitive Level: Evaluation/Evaluating Content Area: Pediatrics/Maternity Patient Needs: Psychosocial Integrity Integrated Process: Caring Difficulty: Difficult PTS: 1 22. A nurse is demonstrating the professional role of provider of care to a nursing student. Which action by the nurse is most relevant to this professional role? A. Assesses the patient’s priority physical needs B. Gives the patient a bath instead of delegating it C. Supervises unlicensed assistive personnel D. Uses monitoring and IV equipment correctly ANS: D One of the major responsibilities of the nurse as provider of care is to maintain competency in using monitoring and therapeutic equipment. This is a vital safety measure for the patient. The nurse as provider of care should assess all of the patient’s physical, psychosocial, and spiritual needs, not just the priority physical needs. Supervising other personnel may or may not be part of a nurse’s job description. Choosing to delegate an activity is not a core role of the provider of care. Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity Patient Needs: Safe and Effective Care Environment: Safety and Infection Control Integrated Process: Nursing Process: Implementation Difficulty: Difficult PTS: 1 23. A nurse is caring for a patient from a culture with which the nurse is totally unfamiliar. What action by the nurse will best promote effective communication? A. Call for a professional interpreter to translate information. B. Pattern voice tone and eye contact after the patient’s behaviors. C. Talk slowly and deliberately using simple language and cues. D. Use nonverbal communication as much as possible with the patient. ANS: B In the situation where the nurse is unfamiliar with the patient’s culture, the nurse should pattern verbal and nonverbal communication after the patient’s own style. There is no indication that this patient does not speak English, so using an interpreter, talking slowly using simple language, and using mostly nonverbal communication is inappropriate. Cognitive Level: Application/Applying Content Area: Pediatrics/Maternity Patient Needs: Psychosocial Integrity Integrated Process: Communication and Documentation Difficulty: Difficult PTS: 1 24. A nurse has been teaching a patient who seems impatient and does not retain much of what is taught. What action by the nurse would be best to facilitate the patient’s learning? A. Assess for unmet personal needs such as pain or hunger. B. Determine why the patient is being uncooperative. C. Give information in writing and let the patient read it. D. Stop the teaching session and return at a later time. ANS: A Learning is not likely to be effective if the patient has unmet basic human needs such as hunger, pain, a full bladder, or fear. The nurse should assess for those needs and meet them before continuing. Labeling a patient as uncooperative is counterproductive and judgmental and does nothing to enlist the patient’s cooperation. Written information (if the patient is literate) is always a good idea, but doing nothing more than that will not improve the patient’s learning when basic needs are unmet. Returning at a later time also does not meet the patient’s needs. Cognitive Level: Applying/Application Content Area: Pediatrics/Maternity Patient Needs: Physiological Integrity: Basic Care and Comfort Integrated Process: Nursing Process: Assessment Difficulty: Moderate PTS: 1
25. A nurse manager expects all employees to be patient advocates. Which nursing action best demonstrates this nursing role? A. Arranging a family–physician conference to clarify treatment plans B. Encouraging treatment options based on personal beliefs and values C. Giving contact information for governmental assistance agencies D. Working on a political campaign to reduce poverty in the state ANS: A In the advocate role, the nurse should promote patient-/family-centered care and work to provide the patient with more control, power, and self-determination in the health-care setting. The nurse who arranges a family–physician conference to clarify treatment plans is advocating for the patient. Giving contact information for assistance agencies and working on political campaigns are also ways of demonstrating advocacy, but are too limited in scope to be the best answer. The nurse advocate must ensure he or she is speaking for the patient and the patient’s desires, not inserting personal values and beliefs into the process. Cognitive Level: Evaluation/Evaluating Content Area: Pediatrics/Maternity Patient Needs: Safe and Effective Care Environment: Management of Care Integrated Process: Caring Difficulty: Difficult PTS: 1 26. A nurse is describing the use of evidence-based practice (EBP) guidelines to a nursing student. Which explanation of EBP is most accurate? A. Includes clinical experience and patient preferences B. MEDLINE used as the primary source for EBP information C. Requires the staff to be active participants in research D. Uses research findings to plan interventions for care ANS: A EBP combines investigational guidelines and scientifically sound interventions with clinical expertise and the patient’s values and preferences. MEDLINE is one of three primary sources for EBP information; the other two are the Cochrane Database of Systematic Reviews Library and the Agency for Healthcare Research and Quality. The staff members do not have to be actively involved in research to use EBP. Using research findings to plan interventions is part, but not all, of the EBP process. Cognitive Level: Comprehension/Understanding Content Area: Pediatrics/Maternity Patient Needs: Safe and Effective Care Environment: Management of Care Integrated Process: Teaching/Learning Difficulty: Moderate PTS: 1 27. A nurse uses evidence-based practice (EBP) to plan and implement nursing care. What action by the nurse best demonstrates this process? A. Assesses, plans, implements, and evaluates nursing interventions
B. Incorporates specific research findings into the nursing care plan C. Predicts and assesses for potential problems based on research D. Uses a concept map for nursing care instead of a nursing care plan ANS: C The nurse who has incorporated EBP into nursing care is able to predict, and assess for, potential problems and complications because of knowledge of relevant research. Assessment, planning, implementation, and evaluating are steps in the traditional nursing process. Specific research findings do not need to be specifically incorporated into a nursing care plan and, in fact, without including clinical expertise and patient preferences, scientific findings are incomplete. A concept map is an alternative to the traditional nursing care plan. Cognitive Level: Analysis/Analyzing Content Area: Pediatrics/Maternity Patient Needs: Safe and Effective Care Environment: Management of Care Integrated Process: Nursing Process: Assessment Difficulty: Difficult PTS: 1 28. A patient and family have the nursing diagnosis of impaired verbal communication secondary to a language barrier. What action by the patient/family would best indicate that short-term goals for this diagnosis have been met? A. Able to communicate long-term desires for health of the patient B. Demonstrates comprehension by head nodding and saying “yes” C. States understanding of condition and treatment via an interpreter D. Understands how nonverbal communication varies between cultures ANS: C For a language barrier, using a professional interpreter is not only the best way to manage communication, it is also legally required. The best short-term goal for the patient and family is to obtain understanding of the patient’s illness and treatment and state, through the interpreter, that this is the case. Communicating long-term desires is a better long-term outcome for this diagnosis. Nodding the head and saying “yes” do not always indicate agreement, understanding, or approval. In some cultures this behavior signifies respect. Understanding the differences in nonverbal communication between cultures is not an appropriate short-term goal. Cognitive Level: Evaluation/Evaluating Content Area: Pediatrics/Maternity Patient Needs: Psychosocial Integrity Integrated Process: Communication and Documentation Difficulty: Moderate PTS: 1 MULTIPLE RESPONSE 1. The perinatal nurse is aware of changes in women’s and children’s health-care settings that affect family care. What factors do these changes include? (Select all that apply.)
A. A decreased pediatric patient population B. A redesign of policies to include families C. Development of alternative care sites D. Increased liberalization of visiting policies E. Increased patient acuity across all settings ANS: B, C, D, E Many changes have occurred across health-care settings that have affected family care. Hospitals have redesigned their policies to be family-friendly and have liberalized visiting policies to decrease stress on the family. Alternative care settings have been developed in part to combat escalating medical costs, and patients have high-acuity illnesses and needs across all of these settings. There has been no decrease in the population of pediatric patients. Cognitive Level: Knowledge/Remembering Content Area: Pediatrics/Maternity Patient Needs: Safe and Effective Care Environment: Management of Care Integrated Process: Caring Difficulty: Easy PTS: 1 2. A nurse wishes to improve critical thinking skills. Which of the following actions would be helpful for this nurse? (Select all that apply.) A. Developing checklists for care activities B. Listening intently for true understanding C. Practicing new skills D. Remaining nonobjective in patient encounters E. Searching the literature for new information ANS: B, C, D, E Critical thinking evolves from experience, seeking knowledge, practicing skills, self-reflection, open-mindedness, calculated risk-taking, and devotion to listening with a goal of true comprehension and understanding. Making checklists is not part of critical thinking. Cognitive Level: Application/Applying Content Area: Pediatrics/Maternity Patient Needs: Safe and Effective Care Environment: Management of Care Integrated Process: Caring Difficulty: Moderate PTS: 1 3. To be effective when providing information to a patient, the nurse should assess the patient for which of the following? (Select all that apply.) A. Cultural beliefs and values B. Information desired C. Preferred learning style D. Level of understanding E. Past medical history ANS: A, B, C, D
An effective teacher should assess the patient’s cultural beliefs and values, information desired, preferred learning style, and level of current understanding before planning and implementing teaching. The patient’s past medical history is not essential information for teaching. Cognitive Level: Application/Applying Content Area: Pediatrics/Maternity Patient Needs: Health Promotion and Maintenance Integrated Process: Teaching/Learning Difficulty: Moderate PTS: 1 4. The nurse listens to a mother and her 4-year-old child as they communicate with each other primarily to determine which of the following? (Select all that apply.) A. Communication styles that need improvement B. The child’s level of language development C. The family’s culture and its influences D. The family’s personal and group values E. The family’s understanding of health care ANS: B, C, D Listening to the cultural voices and experiences of family and patients affirms their value and is critically important to unifying the nurse–patient relationship. This method of interaction allows the nurse to understand family values, family developmental aspects, and the family’s cultural aspects. It also motivates patient movement toward positive health-promoting activities. It is not primarily to determine areas for improvement, although the nurse may be able to role model better communication for a patient/family. Listening to communication is also not primarily to determine the family’s understanding of health care. Cognitive Level: Application/Applying Content Area: Pediatrics/Maternity Patient Needs: Psychosocial Integrity Integrated Process: Communication and Documentation Difficulty: Moderate PTS: 1 5. The nurse mentor explains to the new nurse that multiple societal changes have given families greater power in health care. What changes have contributed to this shift? (Select all that apply.) A. Alternative community-based care sites B. Costs of obtaining health care C. Decreased health-care regulations D. Multimedia information E. Science and technology ANS: A, B, D, E
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as it went. The troll went near to him and took a look. And the fox went on watching him, for the fox watches all things. He had come back lately to those dewy fields from slinking by night along the boundary of twilight that lies between here and Elfland. He even prowls inside the very boundary, walking amongst the twilight; and it is in the mystery of that heavy twilight that lies between here and there that there clings to him some of that glamour that he brings with him to our fields. "Well, Noman's Dog," said the troll. For they know the fox in Elfland, from seeing him often go dimly along their borders; and this is the name they give him. "Well, Thing-over-the-Border," said the fox when he answered at all. For he knew troll-talk. "Are the haunts of men near here?" said the troll. The fox moved his whiskers by slightly wrinkling his lip. Like all liars he reflected before he spoke, and sometimes even let wise silences do better than speech. "Men live here and men live there," said the fox. "I want their haunts," said the troll. "What for?" said the fox. "I have a message from the King of Elfland." The fox showed no respect or fear at the mention of that dread name, but slightly moved his head and eyes to conceal the awe that he felt. "If it is a message," he said, "their haunts are over there." And he pointed with his long thin nose towards Erl. "How shall I know when I get there?" said the troll. "By the smell," said the fox. "It is a big haunt of men, and the smell is dreadful."
"Thanks, Noman's Dog," said the troll. And he seldom thanked anyone. "I should never go near them," said the fox, "but for ..." And he paused and reflected silently. "But for what?" said the troll. "But for their poultry." And he fell into a grave silence. "Good-bye, Noman's Dog," said the troll and turned head-over- heels, and was off on his way to Erl. Passing over the buttercups all through the dewy morning the troll was far on his way by the afternoon, and saw before evening the smoke and the towers of Erl. It was all sunk in a hollow; and gables and chimneys and towers peered over the lip of the valley, and smoke hung over them on the dreamy air. "The haunts of men," said the troll. Then he sat down amongst the grasses and looked at it. Presently he went nearer and looked at it again. He did not like the look of the smoke and that crowd of gables: certainly it smelt dreadfully. There had been some legend in Elfland of the wisdom of Man; and whatever respect that legend had gained for us in the light mind of the troll now all blew lightly away as he looked at the crowded houses. And as he looked at them there passed a child of four, a small girl on a footpath over the fields, going home in the evening to Erl. They looked at each other with round eyes. "Hullo," said the child. "Hullo, Child of Men," said the troll. He was not speaking troll-talk now, but the language of Elfland, that grander tongue that he had had to speak when he was before the King: for he knew the language of Elfland although it was never used in the homes of the trolls, who preferred troll-talk. This language was spoken in those days also by men, for there were fewer languages then, and the elves and the people of Erl both used the same.
"What are you?" said the child. "A troll of Elfland," answered the troll. "So I thought," said the child. "Where are you going, child of men?" the troll asked. "To the houses," the child replied. "We don't want to go there," said the troll. "N-no," said the child. "Come to Elfland," the troll said. The child thought for awhile. Other children had gone, and the elves always sent a changeling in their place, so that nobody quite missed them and nobody really knew. She thought awhile of the wonder and wildness of Elfland, and then of her own home. "N-no," said the child. "Why not?" said the troll. "Mother made a jam roll this morning," said the child. And she walked on gravely home. Had it not been for that chance jam roll she had gone to Elfland. "Jam!" said the troll contemptuously and thought of the tarns of Elfland, the great lily-leaves lying flat upon their solemn waters, the huge blue lilies towering into the elf-light above the green deep tarns: for jam this child had forsaken them! Then he thought of his duty again, the roll of parchment and the Elf King's rune for his daughter. He had carried the parchment in his left hand when he ran, in his mouth when he somersaulted over the buttercups. Was the Princess here he thought? Or were there other haunts of men? As evening drew in he crept nearer and nearer the homes, to hear without being seen.
CHAPTER VIII The Arrival of the Rune On a sunny May morning in Erl the witch Ziroonderel sat in the castle nursery by the fire, cooking a meal for the baby. The boy was now three years old, and still Lirazel had not named him; for she feared lest some jealous spirit of Earth or air should hear the name, and if so she would not say what she feared then. And Alveric had said he must be named. And the boy could bowl a hoop; for the witch had gone one misty night to her hill and had brought him a moon-halo which she got by enchantment at moonrise, and had hammered it into a hoop, and had made him a little rod of thunderbolt-iron with which to beat it along. And now the boy was waiting for his breakfast; and there was a spell across the threshold to keep the nursery snug, which Ziroonderel had put there with a wave of her ebon stick, and it kept out rats and mice and dogs, nor could bats sail across it, and the watchful nursery cat it kept at home: no lock that blacksmiths made was any stronger. Suddenly over the threshold and over the spell the troll jumped somersaulting through the air and came down sitting. The crude wooden nursery-clock hanging over the fire stopped its loud tick as he came; for he bore with him a little charm against time, with strange grass round one of his fingers, that he might not be withered away in the fields we know. For well the Elf King knew the flight of our hours: four years had swept over these fields of ours while he had boomed down his brazen steps and sent for his troll and given him that spell to bind round one of his fingers. "What's this?" said Ziroonderel.
That troll knew well when to be impudent, but looking in the witch's eyes saw something to be afraid of; and well he might, for those eyes had looked in the Elf King's own. Therefore he played, as we say in these fields, his best card, and answered: "A message from the King of Elfland." "Is that so?" said the old witch. "Yes, yes," she added more lowly to herself, "that would be for my lady. Yes, that would come." The troll sat still on the floor fingering the roll of parchment inside of which was written the rune of the King of Elfland. Then over the end of his bed, as he waited for breakfast, the baby saw the troll, and asked him who he was and where he came from and what he was able to do. When the baby asked him what he was able to do the troll jumped up and skipped about the room like a moth on a lamp-lit ceiling. From floor to shelves and back and up again he went with leaps like flying; the baby clapped his hands, the cat was furious; the witch raised her ebon stick and made a charm against leaping, but it could not hold the troll. He leaped and bounced and bounded, while the cat hissed all the curses that the feline language knows, and Ziroonderel was wrath not only because her magic was thwarted, but because with mere human alarm she feared for her cups and saucers; and the baby shouted all the while for more. And all at once the troll remembered his errand and the dread parchment he bore. "Where is the Princess Lirazel?" he said to the witch. And the witch pointed the way to the princess's tower; for she knew that there were no means nor power she had by which to hinder a rune from the King of Elfland. And as the troll turned to go Lirazel entered the room. He bowed all low before this great lady of Elfland and, with all his impudence in a moment lost, kneeled on one knee before the blaze of her beauty and presented the Elf King's rune. The boy was shouting to his mother to demand more leaps from the troll, as she took the scroll in her hand; the cat with her back to a box was watching alertly; Ziroonderel was all silent.
And then the troll thought of the weed-green tarns of Elfland in the woods that the trolls knew; he thought of the wonder of the unwithering flowers that time has never touched; the deep, deep colour and the perpetual calm: his errand was over and he was weary of Earth. For a moment nothing moved there but the baby, shouting for new troll antics and waving his arms: Lirazel stood with the elfin scroll in her hand, the troll knelt before her, the witch never stirred, the cat stood watching fiercely, even the clock was still. Then the Princess moved and the troll rose to his feet, the witch sighed and the cat gave up her watchfulness as the troll scampered away. And though the baby shouted for the troll to return it never heeded, but twisted down the long spiral stairs, and slipping out through a door was off towards Elfland. As the troll passed over the threshold the wooden clock ticked again. Lirazel looked at the scroll and looked at her boy, and did not unroll the parchment, but turned and carried it away, and came to her chamber and locked the scroll in a casket, and left it there unread. For her fears told her well the most potent rune of her father, that she had dreaded so much as she fled from his silver tower and heard his feet go booming up the brass, had crossed the frontier of twilight written upon the scroll, and would meet her eyes the moment she unrolled it and waft her thence. When the rune was safe in the casket she went to Alveric to tell him of the peril that had come near her. But Alveric was troubled because she would not name the baby, and asked her at once about this. And so she suggested a name at last to him; and it was one that no one in these fields could pronounce, an elvish name full of wonder, and made of syllables like birds' cries at night: Alveric would have none of it. And her whim in this came, as all the whims she had, from no customary thing of these fields of ours, but sheer over the border from Elfland, sheer over the border with all wild fancies that rarely visit our fields. And Alveric was vexed with these whims, for there had been none like them of old in the Castle of Erl: none
could interpret them to him and none advise him. He looked for her to be guided by old customs; she looked only for some wild fancy to come from the south-east. He reasoned with her with the human reason that folk set much store by here, but she did not want reason. And so when they parted she had not after all told anything of the peril that had sought her from Elfland, which she had come to Alveric to tell. She went instead to her tower and looked at the casket, shining there in the low late light; and turned from it and often looked again; while the light went under the fields and the gloaming came, and all glimmered away. She sat then by the casement open towards eastern hills, above whose darkening curves she watched the stars. She watched so long that she saw them change their places. For more than all things else that she had seen since she came to these fields of ours she had wondered at the stars. She loved their gentle beauty; and yet she was sad as she looked wistfully to them, for Alveric had said that she must not worship them. How if she might not worship them could she give them their due, could she thank them for their beauty, could she praise their joyful calm? And then she thought of her baby: then she saw Orion: then she defied all jealous spirits of air, and, looking toward Orion, whom she must never worship, she offered her baby's days to that belted hunter, naming her baby after those splendid stars. And when Alveric came to the tower she told him of her wish, and he was willing the boy should be named Orion, for all in that valley set much store by hunting. And the hope came back to Alveric, which he would not put away, that being reasonable at last in this, she would now be reasonable in all other things, and be guided by custom, and do what others did, and forsake wild whims and fancies that came over the border from Elfland. And he asked her to worship the holy things of the Freer. For never had she given any of these things their due, and knew not which was the holier, his candlestick or his bell, and never would learn for ought that Alveric told her.
And now she answered him pleasantly and her husband thought all was well, but her thoughts were far with Orion; nor did they ever tarry with grave things long, nor could tarry longer amongst them than butterflies do in the shade. All that night the casket was locked on the rune of the King of Elfland. And next morning Lirazel gave little thought to the rune, for they went with the boy to the holy place of the Freer; and Ziroonderel came with them but waited without. And the folk of Erl came too, as many as could leave the affairs of man with the fields; and all were there of those that had made the parliament, when they went to Alveric's sire in the long red room. And all of these were glad when they saw the boy and marked his strength and growth; and, muttering low together as they stood in the holy place, they foretold how all should be as they had planned. And the Freer came forth and, standing amongst his holy things, he gave to the boy before him the name of Orion, though he sooner had given some name of those that he knew to be blessed. And he rejoiced to see the boy and to name him there; for by the family that dwelt in the Castle of Erl all these folk marked the generations, and watched the ages pass, as sometimes we watch the seasons go over some old known tree. And he bowed himself before Alveric, and was full courteous to Lirazel, yet his courtesy to the princess came not from his heart, for in his heart he held her in no more reverence than he held a mermaid that had forsaken the sea. And the boy came even so by the name of Orion. And all the folk rejoiced as he came out with his parents and rejoined Ziroonderel at the edge of the holy garden. And Alveric, Lirazel, Ziroonderel and Orion all walked back to the castle. And all that day Lirazel did nothing that caused anybody to wonder, but let herself be governed by custom and the ways of the fields we know. Only, when the stars came out and Orion shone, she knew that their splendour had not received its due, and her gratitude to Orion yearned to be said. She was grateful for his bright
beauty that cheered our fields, and grateful for his protection, of which she felt sure for her boy, against jealous spirits of air. And all her unsaid thanks so burned in her heart that all of a sudden she rose and left her tower and went out to the open starlight, and lifted her face to the stars and the place of Orion, and stood all dumb though her thanks were trembling upon her lips; for Alveric had told her one must not pray to the stars. With face upturned to all that wandering host she stood long silent, obedient to Alveric: then she lowered her eyes, and there was a small pool glimmering in the night, in which all the faces of the stars were shining. "To pray to the stars," she said to herself in the night, "is surely wrong. These images in the water are not the stars. I will pray to their images, and the stars will know." And on her knees amongst the iris leaves she prayed at the edge of the pool, and gave thanks to the images of the stars for the joy she had had of the night, when the constellations shone in their myriad majesty, and moved like an army dressed in silver mail, marching from unknown victories to conquer in distant wars. She blessed and thanked and praised those bright reflections shimmering down in the pool, and bade them tell her thanks and her praise to Orion, to whom she might not pray. It was thus that Alveric found her, kneeling, bent down in the dark, and reproached her bitterly. She was worshipping the stars, he said, which were there for no such purpose. And she said she was only supplicating their images. We may understand his feelings easily: the strangeness of her, her unexpected acts, her contrariness to all established things, her scorn for custom, her wayward ignorance, jarred on some treasured tradition every day. The more romantic she had been far away over the frontier, as told of by legend and song, the more difficult it was for her to fill any place once held by the ladies of that castle who were versed in all the lore of the fields we know. And Alveric looked for her to fulfil duties and follow customs which were all as new to her as the twinkling stars.
But Lirazel felt only that the stars had not their due, and that custom or reason or whatever men set store by should demand that thanks be given them for their beauty; and she had not thanked them even, but had supplicated only their images in the pool. That night she thought of Elfland, where all things were matched with her beauty, where nothing changed and there were no strange customs, and no strange magnificences like these stars of ours to whom none gave their due. She thought of the elfin lawns and the towering banks of the flowers, and the palace that may not be told of but only in song. Still locked in the dark of the casket the rune bided its time.
CHAPTER IX Lirazel Blows Away And the days went by, the Summer passed over Erl, the sun that had travelled northward fared South again, it was near to the time when the swallows left those eaves, and Lirazel had not learnt anything. She had not prayed to the stars again, or supplicated their images, but she had learned no human customs, and could not see why her love and gratitude must remain unexpressed to the stars. And Alveric did not know that the time must come when some simple trivial thing would divide them utterly. And then one day, hoping still, he took her with him to the house of the Freer to teach her how to worship his holy things. And gladly the good man brought his candle and bell, and the eagle of brass that held up his book when he read, and a little symbolic bowl that had scented water, and the silver snuffers that put his candle out. And he told her clearly and simply, as he had told her before, the origin, meaning and mystery of all these things, and why the bowl was of brass and the snuffer of silver, and what the symbols were that were carved on the bowl. With fitting courtesy he told her these things, even with kindness; and yet there was something in his voice as he told, a little distant from her; and she knew that he spoke as one that walked safe on shore calling far to a mermaid amid dangerous seas. As they came back to the castle the swallows were grouped to go, sitting in lines along the battlements. And Lirazel had promised to worship the holy things of the Freer, like the simple bell-fearing folk of the valley of Erl: and a late hope was shining in Alveric's mind that even yet all was well. And for many days she remembered all that the Freer had told her.
And one day walking late from the nursery, past tall windows to her tower, and looking out on the evening, remembering that she must not worship the stars, she called to mind the holy things of the Freer, and tried to remember all she was told of them. It seemed so hard to worship them just as she should. She knew that before many hours the swallows would all be gone; and often when they left her her mood would change; and she feared that she might forget, and never remember more, how she ought to worship the holy things of the Freer. So she went out into the night again over the grasses to where a thin brook ran, and drew out some great flat pebbles that she knew where to find, turning her face away from the images of the stars. By day the stones shone beautifully in the water, all ruddy and mauve; now they were all dark. She drew them out and laid them in the meadow: she loved these smooth flat stones, for somehow they made her remember the rocks of Elfland. She laid them all in a row, this for the candlestick, this for the bell, that for the holy bowl. "If I can worship these lovely stones as things ought to be worshipped," she said, "I can worship the things of the Freer." Then she kneeled down before the big flat stones and prayed to them as though they were Christom things. And Alveric seeking her in the wide night, wondering what wild fancy had carried her whither, heard her voice in the meadow, crooning such prayers as are offered to holy things. When he saw the four flat stones to which she prayed, bowed down before them in the grass, he said that no worse than this were the darkest ways of the heathen. And she said "I am learning to worship the holy things of the Freer." "It is the art of the heathen," he said. Now of all things that men feared in the valley of Erl they feared most the arts of the heathen, of whom they knew nothing but that their ways were dark. And he spoke with the anger which men
always used when they spoke there of the heathen. And his anger went to her heart, for she was but learning to worship his holy things to please him, and yet he had spoken like this. And Alveric would not speak the words that should have been said, to turn aside anger and soothe her; for no man, he foolishly thought, should compromise in matters touching on heathenesse. So Lirazel went alone all sadly back to her tower. And Alveric stayed to cast the four flat stones afar. And the swallows left, and unhappy days went by. And one day Alveric bade her worship the holy things of the Freer, and she had quite forgotten how. And he spoke again of the arts of heathenesse. The day was shining and the poplars golden and all the aspens red. Then Lirazel went to her tower and opened the casket, that shone in the morning with the clear autumnal light, and took in her hand the rune of the King of Elfland, and carried it with her across the high vaulted hall, and came to another tower and climbed its steps to the nursery. And there all day she stayed and played with her child, with the scroll still tight in her hand: and, merrily though she played at whiles, yet there were strange calms in her eyes, which Ziroonderel watched while she wondered. And when the sun was low and she had put the child to bed she sat beside him all solemn as she told him childish tales. And Ziroonderel, the wise witch, watched; and for all her wisdom only guessed how it would be, and knew not how to make it otherwise. And before sunset Lirazel kissed the boy and unrolled the Elf King's scroll. It was but a petulance that had made her take it from the coffer in which it lay, and the petulance might have passed and she might not have unrolled the scroll, only that it was there in her hand. Partly petulance, partly wonder, partly whims too idle to name, drew her eyes to the Elf King's words in their coal-black curious characters.
And whatever magic there was in the rune of which I cannot tell (and dreadful magic there was), the rune was written with love that was stronger than magic, till those mystical characters glowed with the love that the Elf King had for his daughter, and there were blended in that mighty rune two powers, magic and love, the greatest power there is beyond the boundary of twilight with the greatest power there is in the fields we know. And if Alveric's love could have held her he should have trusted alone to that love, for the Elf King's rune was mightier than the holy things of the Freer. No sooner had Lirazel read the rune on the scroll than fancies from Elfland began to pour over the border. Some came that would make a clerk in the City to-day leave his desk at once to dance on the sea-shore; and some would have driven all the men in a bank to leave doors and coffers open and wander away till they came to green open land and the heathery hills; and some would have made a poet of a man, all of a sudden as he sat at his business. They were mighty fancies that the Elf King summoned by the force of his magical rune. And Lirazel sat there with the rune in her hand, helpless amongst this mass of tumultuous fancies from Elfland. And as the fancies raged and sang and called, more and more over the border, all crowding on one poor mind, her body grew lighter and lighter. Her feet half rested half floated, upon the floor; Earth scarcely held her down, so fast was she becoming a thing of dreams. No love of hers for Earth, or of the children of Earth for her, had any longer power to hold her there. And now came memories of her ageless childhood beside the tarns of Elfland, by the deep forest's border, by those delirious lawns, or in the palace that may not be told of except only in song. She saw those things as clearly as we see small shells in water, looking through clear ice down to the floor of some sleeping lake, a little dimmed in that other region across the barrier of ice; so too her memories shone a little dimly from across the frontier of Elfland. Little queer sounds of elfin creatures came to her, scents swam from those miraculous flowers that glowed by the lawns she knew, faint sounds of enchanted songs blew over the border and reached her
seated there, voices and melodies and memories came floating through the twilight, all Elfland was calling. Then measured and resonant, and strangely near, she heard her father's voice. She rose at once, and now Earth had lost on her the grip that it only has on material things, and a thing of dreams and fancy and fable and phantasy she drifted from the room; and Ziroonderel had no power to hold her with any spell, nor had she herself the power even to turn, even to look at her boy as she drifted away. And at that moment a wind came out of the north-west, and entered the woods and bared the golden branches, and danced on over the downs, and led a company of scarlet and golden leaves, that had dreaded this day but danced now it had come; and away with a riot of dancing and glory of colour, high in the light of the sun that had set from the sight of the fields, went wind and leaves together. With them went Lirazel.
CHAPTER X The Ebbing of Elfland Next morning Alveric came up the tower to the witch Ziroonderel, weary and frantic from searching all night long in strange places for Lirazel. All night he had tried to guess what fancy had beckoned her out and whither it might have led her; he had searched by the stream by which she had prayed to the stones, and the pool where she prayed to the stars; he had called her name up every tower, and had called it wide in the dark, and had had no answer but echo; and so he had come at last to the witch Ziroonderel. "Whither?" he said, saying no more than that, that the boy might not know his fears. Yet Orion knew. And Ziroonderel all mournfully shook her head. "The way of the leaves," she said. "The way of all beauty." But Alveric did not stay to hear her say more than her first five words; for he went with the restlessness with which he had come, straight from the room and hastily down the stair, and out at once into the windy morning, to see which way those glorious leaves were gone. And a few leaves that had clung to cold branches longer, when the gay company of their comrades had gone, were now too on the air, going lonely and last: and Alveric saw they were going south- east towards Elfland. Hurriedly then he donned his magical sword in its wide scabbard of leather; and with scanty provisions hastened over the fields, after the last of the leaves, whose autumnal glory led him, as many a cause in its latter days, all splendid and fallen, leads all manner of men.
And so he came to the upland fields with their grass all grey with dew; and the air was all sparkling with sunlight, and gay with the last of the leaves, but a melancholy seemed to dwell with the sound of the lowing of cattle. In the calm bright morning with the north-west wind roaming through it Alveric came by no calm, and never gave up the haste of one who has lost something suddenly: he had the swift movements of such, and the frantic air. He watched all day over clear wide horizons, south-east where the leaves were leading; and at evening he looked to see the Elfin Mountains, severe and changeless, unlit by any light we know, the colour of pale forget-me-nots. He held on restlessly to see their summits, but never they came to view. And then he saw the house of the old leather-worker who had made the scabbard for his sword; and the sight of it brought back to him the years that were gone since the evening when first he had seen it, although he never knew how many they were, and could not know, for no one has ever devised any exact calculation whereby to estimate the action of time in Elfland. Then he looked once more for the pale-blue Elfin Mountains, remembering well where they lay, in their long grave row past a point of one of the leather-worker's gables, but he saw never a line of them. Then he entered the house and the old man still was there. The leather-worker was wonderfully aged; even the table on which he worked was much older. He greeted Alveric, remembering who he was, and Alveric enquired for the old man's wife. "She died long ago," he said. And again Alveric felt the baffling flight of those years, which added a fear to Elfland whither he went, yet he neither thought to turn back nor reined for a moment his impatient haste. He said a few formal things of the old man's loss that had happened so long ago. Then "Where are the Elfin Mountains," he asked, "the pale-blue peaks?" A look came slowly over the old man's face as though he had never seen them, as though Alveric being learned spoke of something that the old leather-worker could not know. No, he did
not know, he said. And Alveric found that to-day as all those years ago, this old man still refused to speak of Elfland. Well, the boundary was only a few yards away; he would cross it and ask the way of elfin creatures, if he could not see the mountains to guide him then. The old man offered him food, and he had not eaten all day; but Alveric in his haste only asked him once more of Elfland, and the old man humbly said that of such things he knew nothing. Then Alveric strode away and came to the field he knew, which he remembered to be divided by the nebulous border of twilight. And indeed he had no sooner come to the field than he saw all the toadstools leaning over one way, and that the way he was going; for just as thorn trees all lean away from the sea, so toadstools and every plant that has any touch of mystery, such as foxgloves, mulleins and certain kinds of orchis, when growing anywhere near it, all lean towards Elfland. By this one may know before one has heard a murmur of waves, or before one has guessed an influence of magical things, that one comes, as the case may be, to the sea or the border of Elfland. And in the air above him Alveric saw golden birds, and guessed that there had been a storm in Elfland blowing them over the border from the south-east, though a north-west wind blew over the fields we know. And he went on but the boundary was not there, and he crossed the field as any field we know, and still he had not come to the fells of Elfland. Then Alveric pressed on with a new impatience, with the north- west wind behind him. And the Earth began to grow bare and shingly and dull, without flowers, without shade, without colour, with none of those things that there are in remembered lands, by which we build pictures of them when we are there no more; it was all disenchanted now. Alveric saw a golden bird high up, rushing away to the south-east; and he followed his flight hoping soon to see the mountains of Elfland, which he supposed to be merely concealed by some magical mist. But still the autumnal sky was bright and clear, and all the horizon plain, and still there came never a gleam of the Elfin Mountains. And not from this did he learn that Elfland had ebbed.
But when he saw on that desolate shingly plain, untorn by the north- west wind but blooming fair in the Autumn, a may tree that he remembered a long while since, all white with blossom that once rejoiced a Spring day far in his childhood, then he knew that Elfland had been there and must have receded, although he knew not how far. For it is true, and Alveric knew, that just as the glamour that brightens much of our lives, especially in early years, comes from rumours that reach us from Elfland by various messengers (on whom be blessings and peace), so there returns from our fields to Elfland again, to become a part of its mystery, all manner of little memories that we have lost and little devoted toys that were treasured once. And this is part of the law of ebb and flow that science may trace in all things; thus light grew the forest of coal, and the coal gives back light; thus rivers fill the sea, and the sea sends back to the rivers; thus all things give that receive; even Death. Next Alveric saw lying there on the flat dry ground a toy that he yet remembered, which years and years ago (how could he say how many?) had been a childish joy to him, crudely carved out of wood; and one unlucky day it had been broken, and one unhappy day it had been thrown away. And now he saw it lying there not merely new and unbroken, but with a wonder about it, a splendour and a romance, the radiant transfigured thing that his young fancy had known. It lay there forsaken of Elfland as wonderful things of the sea lie sometimes desolate on wastes of sand, when the sea is a far blue bulk with a border of foam. Dreary with lost romance was the plain from which Elfland had gone, though here and there Alveric saw again and again those little forsaken things that had been lost from his childhood, dropping through time to the ageless and hourless region of Elfland to be a part of its glory, and now left forlorn by this immense withdrawal. Old tunes, old songs, old voices, hummed there too, growing fainter and fainter, as though they could not live long in the fields we know.
And, when the sun set, a mauve-rose glow in the East, that Alveric fancied a little too gorgeous for Earth, led him onward still; for he deemed it to be the reflection cast on the sky by the glow of the splendour of Elfland. So he went on hoping to find it, horizon after horizon; and night came on with all Earth's comrade stars. And only then Alveric put aside at last that frantic restlessness that had driven him since the morning; and, wrapping himself in a loose cloak that he wore, ate such food as he had in a satchel, and slept a troubled sleep alone with other forsaken things. At the earliest moment of dawn his impatience awoke him, although one of October's mists hid all glimpses of light. He ate the last of his food and then pushed on through the greyness. No sound from the things of our fields came to him now; for men never went that way when Elfland was there, and none but Alveric went now to that desolate plain. He had travelled beyond the sound of cock-crow from the comfortable houses of men and was now marching through a curious silence, broken only now and then by the small dim cries of the lost songs that had been left by the ebb of Elfland and were fainter now than they had been the day before. And when dawn shone Alveric saw again so great a splendour in the sky, glowing all green low down in the south-east, that he thought once more he saw a reflection from Elfland, and pressed on hoping to find it over the next horizon. And he passed the next horizon; and still that shingly plain, and never a peak of the pale-blue Elfin Mountains. Whether Elfland always lay over the next horizon, brightening the clouds with its glow, and moved away just as he came, or whether it had gone days or years before, he did not know but still kept on and on. And he came at last to a dry and grassless ridge on which his eyes and his hopes had been set for long, and from it he looked far over the desolate flatness that stretched to the rim of the sky, and saw never a sign of Elfland, never a slope of the mountains: even the little treasures of memory that had been left behind by the ebb were withering into things of our every day. Then Alveric drew his
magical sword from its sheath. But though that sword had power against enchantment it had not been given the power to bring again an enchantment that was gone; and the desolate land remained the same, for all that he waved his sword, stony, deserted, unromantic and wide. For a little while he went on; but in that flat land the horizon moved imperceptibly with him, and never a peak appeared of the Elfin Mountains; and on that dreary plain he soon discovered, as sooner or later many a man must, that he had lost Elfland.
CHAPTER XI The Deep of the Woods In those days Ziroonderel would amuse the boy by charms and by little wonders, and he was content for a while. And then he began to guess for himself, all in silence, where his mother was. He listened to all things said, and thought long about them. And days passed thus and he only knew she had gone, and still he said never a word of the thing with which his thoughts were busy. And then he came to know from things said or unsaid, or from looks or glances or wagging of heads, that there was a wonder about his mother's going. But what the wonder was he could not find, for all the marvels that crossed his mind when he guessed. And at last one day he asked Ziroonderel. And stored though her old mind was with ages and ages of wisdom, and though she had feared this question, yet she did not know it had dwelt in his mind for days, and could find no better answer out of her wisdom than that his mother had gone to the woods. When the boy heard this he determined to go to the woods to find her. Now in his walks abroad with Ziroonderel through the little hamlet of Erl, Orion would see the villagers walking by and the smith at his open forge, and folk in their doorways, and men that came in to the market from distant fields; and he knew them all. And most of all he knew Threl with his quiet feet, and Oth with his lithe limbs; for both of these would tell him tales when they met of the uplands, and the deep woods over the hill; and Orion on little journeys with his nurse loved to hear tales of far places. There was an ancient myrtle tree by a well, where Ziroonderel would sit in the Summer evenings while Orion played on the grass;
and Oth would cross the grass with his curious bow, going out in the evening, and sometimes Threl would come; and every time that one of them came Orion would stop him and ask for a tale of the woods. And if it were Oth he would bow to Ziroonderel with a look of awe as he bowed, and would tell some tale of what the deer did, and Orion would ask him why. Then a look would come over Oth's face as though he were carefully remembering things that had happened very long ago, and after some moments of silence he would give the ancient cause of whatever the deer did, which explained how they came by the custom. If it were Threl that came across the grass he would appear not to see Ziroonderel and would tell his tale of the woods more hastily in a low voice and pass on, leaving the evening, as Orion felt, full of mystery behind him. He would tell tales of all manner of creatures; and the tales were so strange that he told them only to young Orion, because, as he explained, there were many folk that were unable to believe the truth, and he did not wish his tales to come to the ears of such. Once Orion had gone to his house, a dark hut full of skins: all kinds of skins hung on the wall, foxes, badgers, and martens; and there were smaller ones in heaps in the corners. To Orion Threl's dark hut was more full of wonder than any other house he had ever seen. But now it was Autumn and the boy and his nurse saw Oth and Threl more seldom; for in the misty evenings with the threat of frost in the air they sat no longer by the myrtle tree. Yet Orion watched on their short walks; and one day he saw Threl going away from the village with his face to the uplands. And he called to Threl, and Threl stood still with a certain air of confusion, for he deemed himself of too little account to be clearly seen and noticed by the nurse at the castle, be she witch or woman. And Orion ran up to him and said "Show me the woods." And Ziroonderel perceived that the time had come when his thoughts were roaming beyond the lip of the valley, and knew that no spell of hers would hold him long from following after them. And Threl said, "No, my Master," and looked uneasily at
Ziroonderel, who came after the boy and led him away from Threl. And Threl went on alone to his work in the deep of the woods. And it was not otherwise than the witch had foreseen. For first Orion wept, and then he dreamed of the woods, and next day he slipped away alone to the house of Oth and asked him to take him with him when he went to hunt the deer. And Oth, standing on a wide deer-skin in front of blazing logs, spoke much of the woods, but did not take him then. Instead he brought Orion back to the Castle. And Ziroonderel regretted too late that she had idly said his mother was gone to the woods, for those words of hers had called up too soon that spirit of roving which was bound to come to him, and she saw that her spells could bring content no more. So in the end she let him go to the woods. But not until by lifting of wand and saying of incantation she had called the glamour of the woods down to the nursery hearth, and had made it haunt the shadows that went from the fire and creep with them all about the room, till the nursery was all as mysterious as the forest. When this spell would not soothe him and keep his longing at home she let him go to the woods. He stole away once more to the house of Oth, over crisp grass one morning; and the old witch knew he had gone but did not call him back, for she had no spell to curb the love of roving in man, whether it came early or late. And she would not hold back his limbs when his heart was gone to the woods, for it is ever the way of witches with any two things to care for the more mysterious of the two. So the boy came alone to the house of Oth, through his garden where dead flowers hung on brown stalks, and the petals turned to slime if he fingered them, for November was come and the frosts were abroad all night. And this time Orion just met with a mood in Oth, which in less than an hour would have gone, that was favourable to the boy's longing. Oth was taking down his bow from the wall as Orion went in, and Oth's heart was gone to the woods; and when the boy came yearning to go to the woods too the hunter in that mood could not refuse him.
So Oth took Orion on his shoulder and went up out of the valley. Folk saw them go thus, Oth with his bow and his soft noiseless sandals, and his brown garments of leather, Orion on his shoulder, wrapped in the skin of a fawn which Oth had thrown round him. And as the village fell behind them Orion rejoiced to see the houses further and further away, for he had never been so far from them before. And when the uplands opened their distances to his eyes he felt that he was now upon no mere walk, but a journey. And then he saw the solemn gloom of the wintry woods far off, and that filled him at once with a delighted awe. To their darkness, their mystery and their shelter Oth brought him. So softly Oth entered the wood that the blackbirds that guarded it, sitting watchful on branches, did not flee at his coming, but only uttered slowly their warning notes, and listened suspiciously till he passed, and were never sure if a man had broken the charm of the wood. Into that charm and the gloom and the deep silence Oth moved gravely; and a solemness came on his face as he entered the wood; for to go on quiet feet through the wood was the work of his life, and he came to it as men come to their heart's desire. And soon he put the boy down on the brown bracken and went on for a while alone. Orion watched him go with his bow in his left hand, till he disappeared in the wood, like a shadow going to a gathering of shadows and merging amongst its fellows. And although Orion might not go with him now, he had great joy from this, for he knew by the way Oth went and the air he had that this was serious hunting and no mere amusement made to please a child; and it pleased him more than all the toys he had had. And quiet and lonely the great wood loomed round him while he waited for Oth to return. And after a long while he heard a sound, all in the wonder of the wood, that was less loud than the sound that a blackbird made scattering dead leaves to find insects, and Oth had come back again. He had not found a deer; and for a while he sat by Orion and shot arrows into a tree; but soon he gathered his arrows and took the boy on his shoulder again and turned homewards. And there
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  • 5.
    Ethnocentrism is theview that the beliefs, values, and behaviors of one culture are superior to those of other cultures. Ethnocentrism is dangerous in health care because it is blind to the possibilities of other solutions and viewpoints and alienates people in need of health care. The nurse manager would be wise to assess the clinic’s staff and procedures for ethnocentrism. Meeting with a community leader is always a good idea to learn the viewpoints of the community, but unless ethnocentric behaviors change, it is unlikely that the refugee community will increase its use of the clinic. Flyers and incentives may also be helpful in some cases, but not as helpful as reducing the barriers imposed by ethnocentrism. Cognitive Level: Application/Applying Content Area: Pediatrics/Maternity Patient Needs: Health Promotion and Maintenance Integrated Process: Caring Difficulty: Moderate PTS: 1 3. The nursing faculty explains to students that ethnopluralism is an important force shaping health care today. What concept is most important in understanding this trend? A. The decreased need for cultural competency B. The growth in one ethnic group in a single area C. The increased impact of diverse cultures on health care D. The percentage increase of the non-Caucasian population ANS: C Ethnopluralism means diverse cultures. As the population of different ethnic (non-Euro-Caucasian) groups grows, their impact on health care will increase exponentially. Ethnopluralism is not just the growth of one ethnic group in one location. It is also more than just the percentage change in the non-Euro-Caucasian population, although that is part of the phenomenon. As ethnopluralism continues to impact health care, providers will need to be more, not less, culturally competent. Cognitive Level: Knowledge/Remembering Content Area: Pediatrics/Maternity Patient Needs: Psychosocial Integrity Integrated Process: Teaching/Learning Difficulty: Moderate PTS: 1 4. A nursing faculty member is explaining recent shifts in nursing practice. What change has been important in applying the nursing process? A. A change to a spiral or circular process B. A focus on more independent nursing actions C. A return to the nurse-as-expert model of care D. An emphasis on attaining a disease-free state ANS: A
  • 6.
    The nursing processhas recently changed from a linear one to a spiral or circular process in which the patient/family is motivated toward promotion, maintenance, and restoration of health. The focus has not changed to include more independent actions, a return to the nurse-as-expert model, or an emphasis on attaining a disease-free state of being. Cognitive Level: Comprehension/Understanding Content Area: Pediatrics/Maternity Patient Needs: Health Promotion and Maintenance Integrated Process: Teaching/Learning Difficulty: Easy PTS: 1 5. A nurse is working in an urban clinic with a diverse population. What action by the nurse is most important? A. Determine patients’ definitions of health and desired outcomes of health care. B. Explain policies such as appointment cancellations to ensure compliance. C. Learn to speak one or two common languages of the patients in the clinic. D. Read about different folk remedies common among the populations seen. ANS: A Divergent populations enter the health-care system with differing beliefs about health care and wellness and differing expectations for the outcomes of such experiences. Understanding these expectations will help the nurse plan care that has a better chance of meeting these expectations. Learning languages and becoming familiar with folk remedies is helpful as well, but these two solutions are very limited in scope and a nurse cannot hope to become proficient in all the languages/behaviors of every population seen, leaving some patients with a lessened experience. Explaining policies is important too, but simply telling someone the rules does not take his or her cultural norms into account and may not be successful. Cognitive Level: Application/Applying Content Area: Pediatrics/Maternity Patient Needs: Psychosocial Integrity Integrated Process: Nursing Process: Assessment Difficulty: Moderate PTS: 1 6. A nurse is working with a minority group that has a high incidence of cardiovascular disease, including hypertension and stroke. When participating in a community health fair with this group, what action by the nurse will be most effective? A. Educate the participants about weight loss and a low-sodium, low-fat diet. B. Explain the genetic basis for the high incidence of cardiovascular disease in the group. C. Help participants make lifestyle changes that are culturally congruent. D. Present statistics on the mortality and morbidity of cardiovascular disease. ANS: C
  • 7.
    The ever-increasing culturallydiverse population interacting with the health-care system brings its own beliefs, values, and health-related practices that impact health and well-being. In order to help people make healthy lifestyle changes, the changes must be culturally congruent and acceptable. Forcing an incongruent practice makes it highly unlikely to succeed. Education is important, but it must be done in a culturally congruent way. Pathophysiology and statistical knowledge, by itself, is not likely to be beneficial. Cognitive Level: Application/Applying Content Area: Pediatrics/Maternity Patient Needs: Psychosocial Integrity Integrated Process: Teaching/Learning Difficulty: Difficult PTS: 1 7. What does the practicing nurse understand to be the most important influence on interdependent, assertive nursing practice today? A. Higher education of registered nurses B. Improved working conditions and salaries C. Increased numbers of female physicians D. Use of the nursing process for patient care ANS: D Nurses were passive, deferential, and compliant to the knowledge and orders of mostly male physicians until the late 20th century. The nursing process changed that. The nursing process is a framework for systematic problem solving and implementation of both independent and dependent nursing actions. The nursing process allows nurses to make decisions regarding patient care based on critical thinking and clinical judgment. The other options listed were not vital in creating a nursing practice that is interdependent and assertive. Cognitive Level: Analysis/Analyzing Content Area: Pediatrics/Maternity Patient Needs: Safe and Effective Care Environment: Management of Care Integrated Process: Nursing Process Difficulty: Difficult PTS: 1 8. A child who has been hospitalized for a long time is preparing to go home, where care will be continued. Which action by the nurse is most beneficial to assist the family in this transition? A. Advise the family to call the local visiting nurses association for home visits. B. Call the child’s school to inquire about requirements for returning to school. C. Consult a social worker to help evaluate insurance coverage and transportation. D. Give the family brochures for the local support group for chronically ill children. ANS: C
  • 8.
    Preparing a familyfor home-based care, or other community-based care, involves ensuring that the family is able to provide the care needed by the child at home or in another setting. This can include discussing specialized equipment in the home, health insurance coverage, transportation, and/or returning to school. If the family needs or desires visiting nurses, the nursing staff or social worker at the hospital should arrange this for the family. Calling the school to get information about the child’s return to school yields helpful information, but may not be needed yet, and is too limited in scope to be the best answer. Simply giving parents brochures for support groups may or may not be helpful; the parents may not be literate or may not understand the benefit without discussion. Cognitive Level: Analysis/Analyzing Content Area: Pediatrics/Maternity Patient Needs: Health Promotion and Maintenance Integrated Process: Communication and Documentation Difficulty: Difficult PTS: 1 9. A nurse manager wants to make the pediatric clinic a more family-centered health-care setting. Which of the following actions by the nursing staff would best meet this goal? A. Encourage family members to be present in the exam room and to ask questions. B. Incorporate the use of a community health map for all new patients in the clinic. C. Recognize family members as experts on their child and incorporate them in decision making. D. Use evidence-based practice to develop policies and procedures used in the clinic. ANS: C The role of the family-centered nurse is to facilitate and assist the family in making informed choices that lead to the outcome the patient and family desire. This requires the nurse to give up the paternalistic role of authority on health care. The family knows the child best and should be assumed to make decisions that are in the best interests of both child and family. The other options are all good interventions, but are too limited in scope to be the best way to create a family-centered environment. Cognitive Level: Analysis/Analyzing Content Area: Pediatrics/Maternity Patient Needs: Psychosocial Integrity Integrated Process: Caring Difficulty: Difficult PTS: 1 10. A clinic nurse is explaining to a student nurse the function of the community health map in assessing families. Which description of this assessment tool is most accurate? A. It assesses how the family interacts with outside social systems. B. It locates health-care settings in, or close to, their neighborhood. C. It outlines family problems and social resources to help with them. D. It shows how the health of the community impacts each family. ANS: A
  • 9.
    A community healthmap is an assessment tool for family structure, function, and support networks. It displays significant related data and helps the nurse focus on the family as it interacts with the social systems within and around the family. Its purpose is not to locate local health-care settings. The focus is on family health and past successes and current strengths, not on family problems. Correlations can be made between the health of the community and the health of those living in that community, but this is not the purpose of the community health map. Cognitive Level: Comprehension/Understanding Content Area: Pediatrics/Maternity Patient Needs: Health Promotion and Maintenance Integrated Process: Teaching/Learning Difficulty: Moderate PTS: 1 11. A nurse wishes to improve his or her cultural sensitivity while working with patients. Which action by the nurse would best indicate progress toward this goal? A. Demonstrate good knowledge of different cultural health beliefs B. Effectively respond to the needs of people of different cultures C. Interact respectfully with patients who have differing health beliefs D. Recognizes that he or she will never be the expert in other cultures ANS: C Cultural sensitivity is a way of approaching people who hold health beliefs different from one’s own. A nurse with this characteristic is respectful of and open to others. Cultural competence is the ability to interact effectively with people of different cultures and requires a certain level of knowledge about those cultures. Cultural humility is the recognition that one will never master all information about another culture. Cognitive Level: Analysis/Analyzing Content Area: Pediatrics/Maternity Patient Needs: Psychosocial Integrity Integrated Process: Caring Difficulty: Difficult PTS: 1 12. A nurse manager is evaluating staff members on their cultural competence. Which action best demonstrates this characteristic? A. Attends workshops on cultural diversity and health practices B. Participates in community health events with minority populations C. Plans care with the family members within their cultural beliefs D. Uses family members as interpreters to make them feel important ANS: C
  • 10.
    The culturally sensitivenurse is able to understand and respond to the needs of individuals and families from different cultures. This nurse plans interventions with a solid knowledge of the values and practices of the members of the culture. Being open, listening to the family, and involving them in care demonstrates respect, unifies the nurse–patient relationship, and will motivate the patient (and family) to make positive health changes. Attending workshops is a good way to learn about diverse cultures and attending community events with diverse populations can increase cultural knowledge, but these actions are too limited in scope to demonstrate cultural competence. Nurses should use professional interpreters when needed. Cognitive Level: Evaluation/Evaluating Content Area: Pediatrics/Maternity Patient Needs: Psychosocial Integrity Integrated Process: Caring Difficulty: Difficult PTS: 1 13. A nurse is incorporating a cultural assessment into nursing care. Which assessment question by the nurse leads the supervisor to conclude that this nurse needs further education on cultural assessment? A. What customs and traditions are important to you? B. What kind of insurance coverage do you have? C. When you are stressed or worried, what comforts you? D. Who in your family is important for support? ANS: B Cultural influences include family support systems, religious and spiritual beliefs, customs and traditions, communication patterns, coping strategies, and problem-solving techniques. Asking about insurance coverage is not directly related to culture, although this can give information about the patient/family’s living environment and ability to access resources. Cognitive Level: Evaluation/Evaluating Content Area: Pediatrics/Maternity Patient Needs: Psychosocial Integrity Integrated Process: Communication and Documentation Difficulty: Moderate PTS: 1 14. A nurse is working with a cultural group that has many proscriptions against women seeking health care. What action by women in this community would indicate that they have successfully negotiated a new role in seeking care? A. Are able to make and keep medical appointments B. Can afford to pay for desired health-care services C. Follow their traditional roles and responsibilities D. Seek health-care advice from family members ANS: A
  • 11.
    Cultural proscriptions arebeliefs, practices, and values of a group that tell women and children what they should not do. In many traditional cultures, women do not have permission, decision-making power, or means to access the health-care system. If the women from such a culture successfully negotiate their roles regarding health care, they can access the health-care system on their own. The ability to afford services is not related, although cultural proscriptions might forbid women from making such a transaction. If they follow their traditional roles or seek health care from family members, they have not demonstrated a successful negotiation of a new role. Cognitive Level: Analysis/Analyzing Content Area: Pediatrics/Maternity Patient Needs: Health Promotion and Maintenance Integrated Process: Caring Difficulty: Difficult PTS: 1 15. A patient wishes to use complementary therapy when managing a chronic health condition. Which action by the nurse is most appropriate? A. Advise the patient that stopping medical treatment may cause it to worsen. B. Inform the patient that there are no complementary therapies for this condition. C. Investigate herbs that can be substituted for prescription drugs. D. Suggest the patient add massage therapy to the medical regimen. ANS: D Complementary therapy is nontraditional treatment that is used in addition to traditional medical care. Alternative therapies are used in place of traditional therapies. Adding massage to the medical regimen is an example of using complementary therapy. Substituting herbs for prescription medication is an example of alternative therapy. Because the patient is asking about complementary therapy, there is no need to warn him or her of the effects of stopping treatment. There are always complementary therapies that can be added to a medical regimen. Cognitive Level: Analysis/Analyzing Content Area: Pediatrics/Maternity Patient Needs: Health Promotion and Maintenance Integrated Process: Teaching/Learning Difficulty: Moderate PTS: 1 16. A nurse is working with a family that uses multiple complementary and alternative medicine (CAM) modalities. What action by the nurse is best? A. Allow the family to continue these practices as desired. B. Assess how these practices reflect religious beliefs. C. Inform the family that most of these practices do not work. D. Provide evidence-based information about the therapies. ANS: D
  • 12.
    The nurse workingwith individuals or families who use CAM practices should respect the beliefs, values, and desires of the patient. The nurse should encourage families to make decisions regarding CAM practices based on evidence and research into their effects. The nurse can best assist in this by providing and discussing information. Although the nurse cannot stop the family from using CAM, he or she should not pass up the teaching opportunity. Many CAM practices have demonstrated benefit, so telling the family they don’t work is false information. A culturally competent nurse will assess how religious and spiritual beliefs affect health-care practices, but the nurse needs to advocate for the patient/family by providing solid information. Cognitive Level: Application/Applying Content Area: Pediatrics/Maternity Patient Needs: Health Promotion and Maintenance Integrated Process: Teaching/Learning Difficulty: Moderate PTS: 1 17. A nurse acting in the role of teacher is determining learning outcomes. Which action will produce the best outcomes for teaching? A. Collaborate with the discharge planner on outcomes. B. Determine the teaching priority, then establish the outcome. C. Develop outcomes mutually agreed on with the patient. D. Enlist other staff members to help prioritize outcomes. ANS: C The best nursing care (including teaching) is a collaborative effort between nurse and patient. Each participant has knowledge and shares the power of determining what is to be learned. The best outcomes result in patient cooperation, because the patient was instrumental in developing them. The other actions might be helpful in specific situations, but involving the patient (or family) is always appropriate and vital. Cognitive Level: Application/Applying Content Area: Pediatrics/Maternity Patient Needs: Health Promotion and Maintenance Integrated Process: Teaching/Learning Difficulty: Moderate PTS: 1 18. A nurse uses Nightingale’s theory of nursing to pattern care for patients. Which action by the nurse is most consistent with this theory? A. Does for the patient what he or she is unable to do for self B. Focuses patient interactions on caring, healing, and wholeness C. Keeps patient’s room clean and ensures good nutrition D. Incorporates culturally relevant actions in a caring encounter ANS: C
  • 13.
    Nightingale focused onthe spiritual, physical/environmental, emotional, mental, and social needs of the patient. A major area of emphasis was on improving the patient’s environment (internal and external). For this theorist, the base of nursing practice centered around observation, knowledge of sanitation, nutrition, caring, and compassion. The action most closely associated with Nightingale would be keeping the patient’s room clean and ensuring the patient gets good nutrition. A focus on caring, healing, and wholeness-centered interactions is reflective of Jean Watson’s theory. Incorporation of culture into nursing care reflects the theory of Leininger. Although not mentioned in the text, doing for others what they would do for themselves, if able, is the basis of Dorothea Orem’s self-care theory. Cognitive Level: Analysis/Analyzing Content Area: Pediatrics/Maternity Patient Needs: Psychosocial Integrity Integrated Process: Nursing Process: Implementation Difficulty: Moderate PTS: 1 19. An inpatient nursing unit uses Madeleine Leininger’s theory to organize nursing care. The manager would conclude that a new nurse has successfully integrated this theory into practice when the nurse does which of the following actions? A. Emphasizes caring over curing in nursing actions B. Establishes trusting relationships with patients C. Knows the cultural practices of many different groups D. Organizes environmental factors for the patient’s benefit ANS: B Establishing a trusting nurse–patient relationship is at the core of Leininger’s theory. In order to understand another person’s cultural beliefs, values, methods of providing or showing caring, causes of illness, and how wellness is achieved, the nurse must first establish a trusting relationship with the patient so the patient feels free to share. This is an ongoing process. The emphasis on caring over curing is part of Watson’s theory. Knowing the practices of several different cultural groups would be a valuable asset, but is not required for Leininger’s theory. Organizing the environment to benefit the patient is part of Nightingale’s theory. Cognitive Level: Evaluation/Evaluating Content Area: Pediatrics/Maternity Patient Needs: Psychosocial Integrity Integrated Process: Caring Difficulty: Difficult PTS: 1 20. A nurse uses Watson’s theory as a framework for nursing practice. Which nursing action best demonstrates the use of this theory? A. Actively clarifies the patient’s health beliefs and practices B. Allows children to visit an ill parent despite visitation restrictions C. Assesses both the physical and spiritual dimensions of the patient D. Ensures the patient is neither too warm nor too hot for comfort ANS: C
  • 14.
    Jean Watson contendsthat caring as a nurse requires the nurse to pay attention to both the physical and spiritual dimensions of the patient. Clarifying health beliefs and practices is more related to Leininger’s theory. Allowing children to visit despite restrictions is a caring action, but is not tied to a specific theory. Manipulating the environment for patient comfort and well-being is a core component of Nightingale’s theory. Cognitive Level: Application/Applying Content Area: Pediatrics/Maternity Patient Needs: Psychosocial Integrity Integrated Process: Caring Difficulty: Moderate PTS: 1 21. A nursing manager wants to increase the staff’s attention to patients’ spirituality. Which action by a nurse would best demonstrate this concept? A. Asked about the patient’s religion B. Assessed the patient’s meaning of life C. Consulted a chaplain for a patient case D. Inquired about religious rituals in health ANS: B Spirituality does not necessarily equate with religion; it is more a concept related to a person’s beliefs about the meaning of life. Although all actions might be incorporated in a comprehensive discussion of spirituality, the best demonstration of attention to this characteristic is inquiring about the meaning the patient ascribes to life. Cognitive Level: Evaluation/Evaluating Content Area: Pediatrics/Maternity Patient Needs: Psychosocial Integrity Integrated Process: Caring Difficulty: Difficult PTS: 1 22. A nurse is demonstrating the professional role of provider of care to a nursing student. Which action by the nurse is most relevant to this professional role? A. Assesses the patient’s priority physical needs B. Gives the patient a bath instead of delegating it C. Supervises unlicensed assistive personnel D. Uses monitoring and IV equipment correctly ANS: D One of the major responsibilities of the nurse as provider of care is to maintain competency in using monitoring and therapeutic equipment. This is a vital safety measure for the patient. The nurse as provider of care should assess all of the patient’s physical, psychosocial, and spiritual needs, not just the priority physical needs. Supervising other personnel may or may not be part of a nurse’s job description. Choosing to delegate an activity is not a core role of the provider of care. Cognitive Level: Application/Applying
  • 15.
    Content Area: Pediatrics/Maternity PatientNeeds: Safe and Effective Care Environment: Safety and Infection Control Integrated Process: Nursing Process: Implementation Difficulty: Difficult PTS: 1 23. A nurse is caring for a patient from a culture with which the nurse is totally unfamiliar. What action by the nurse will best promote effective communication? A. Call for a professional interpreter to translate information. B. Pattern voice tone and eye contact after the patient’s behaviors. C. Talk slowly and deliberately using simple language and cues. D. Use nonverbal communication as much as possible with the patient. ANS: B In the situation where the nurse is unfamiliar with the patient’s culture, the nurse should pattern verbal and nonverbal communication after the patient’s own style. There is no indication that this patient does not speak English, so using an interpreter, talking slowly using simple language, and using mostly nonverbal communication is inappropriate. Cognitive Level: Application/Applying Content Area: Pediatrics/Maternity Patient Needs: Psychosocial Integrity Integrated Process: Communication and Documentation Difficulty: Difficult PTS: 1 24. A nurse has been teaching a patient who seems impatient and does not retain much of what is taught. What action by the nurse would be best to facilitate the patient’s learning? A. Assess for unmet personal needs such as pain or hunger. B. Determine why the patient is being uncooperative. C. Give information in writing and let the patient read it. D. Stop the teaching session and return at a later time. ANS: A Learning is not likely to be effective if the patient has unmet basic human needs such as hunger, pain, a full bladder, or fear. The nurse should assess for those needs and meet them before continuing. Labeling a patient as uncooperative is counterproductive and judgmental and does nothing to enlist the patient’s cooperation. Written information (if the patient is literate) is always a good idea, but doing nothing more than that will not improve the patient’s learning when basic needs are unmet. Returning at a later time also does not meet the patient’s needs. Cognitive Level: Applying/Application Content Area: Pediatrics/Maternity Patient Needs: Physiological Integrity: Basic Care and Comfort Integrated Process: Nursing Process: Assessment Difficulty: Moderate PTS: 1
  • 16.
    25. A nursemanager expects all employees to be patient advocates. Which nursing action best demonstrates this nursing role? A. Arranging a family–physician conference to clarify treatment plans B. Encouraging treatment options based on personal beliefs and values C. Giving contact information for governmental assistance agencies D. Working on a political campaign to reduce poverty in the state ANS: A In the advocate role, the nurse should promote patient-/family-centered care and work to provide the patient with more control, power, and self-determination in the health-care setting. The nurse who arranges a family–physician conference to clarify treatment plans is advocating for the patient. Giving contact information for assistance agencies and working on political campaigns are also ways of demonstrating advocacy, but are too limited in scope to be the best answer. The nurse advocate must ensure he or she is speaking for the patient and the patient’s desires, not inserting personal values and beliefs into the process. Cognitive Level: Evaluation/Evaluating Content Area: Pediatrics/Maternity Patient Needs: Safe and Effective Care Environment: Management of Care Integrated Process: Caring Difficulty: Difficult PTS: 1 26. A nurse is describing the use of evidence-based practice (EBP) guidelines to a nursing student. Which explanation of EBP is most accurate? A. Includes clinical experience and patient preferences B. MEDLINE used as the primary source for EBP information C. Requires the staff to be active participants in research D. Uses research findings to plan interventions for care ANS: A EBP combines investigational guidelines and scientifically sound interventions with clinical expertise and the patient’s values and preferences. MEDLINE is one of three primary sources for EBP information; the other two are the Cochrane Database of Systematic Reviews Library and the Agency for Healthcare Research and Quality. The staff members do not have to be actively involved in research to use EBP. Using research findings to plan interventions is part, but not all, of the EBP process. Cognitive Level: Comprehension/Understanding Content Area: Pediatrics/Maternity Patient Needs: Safe and Effective Care Environment: Management of Care Integrated Process: Teaching/Learning Difficulty: Moderate PTS: 1 27. A nurse uses evidence-based practice (EBP) to plan and implement nursing care. What action by the nurse best demonstrates this process? A. Assesses, plans, implements, and evaluates nursing interventions
  • 17.
    B. Incorporates specificresearch findings into the nursing care plan C. Predicts and assesses for potential problems based on research D. Uses a concept map for nursing care instead of a nursing care plan ANS: C The nurse who has incorporated EBP into nursing care is able to predict, and assess for, potential problems and complications because of knowledge of relevant research. Assessment, planning, implementation, and evaluating are steps in the traditional nursing process. Specific research findings do not need to be specifically incorporated into a nursing care plan and, in fact, without including clinical expertise and patient preferences, scientific findings are incomplete. A concept map is an alternative to the traditional nursing care plan. Cognitive Level: Analysis/Analyzing Content Area: Pediatrics/Maternity Patient Needs: Safe and Effective Care Environment: Management of Care Integrated Process: Nursing Process: Assessment Difficulty: Difficult PTS: 1 28. A patient and family have the nursing diagnosis of impaired verbal communication secondary to a language barrier. What action by the patient/family would best indicate that short-term goals for this diagnosis have been met? A. Able to communicate long-term desires for health of the patient B. Demonstrates comprehension by head nodding and saying “yes” C. States understanding of condition and treatment via an interpreter D. Understands how nonverbal communication varies between cultures ANS: C For a language barrier, using a professional interpreter is not only the best way to manage communication, it is also legally required. The best short-term goal for the patient and family is to obtain understanding of the patient’s illness and treatment and state, through the interpreter, that this is the case. Communicating long-term desires is a better long-term outcome for this diagnosis. Nodding the head and saying “yes” do not always indicate agreement, understanding, or approval. In some cultures this behavior signifies respect. Understanding the differences in nonverbal communication between cultures is not an appropriate short-term goal. Cognitive Level: Evaluation/Evaluating Content Area: Pediatrics/Maternity Patient Needs: Psychosocial Integrity Integrated Process: Communication and Documentation Difficulty: Moderate PTS: 1 MULTIPLE RESPONSE 1. The perinatal nurse is aware of changes in women’s and children’s health-care settings that affect family care. What factors do these changes include? (Select all that apply.)
  • 18.
    A. A decreasedpediatric patient population B. A redesign of policies to include families C. Development of alternative care sites D. Increased liberalization of visiting policies E. Increased patient acuity across all settings ANS: B, C, D, E Many changes have occurred across health-care settings that have affected family care. Hospitals have redesigned their policies to be family-friendly and have liberalized visiting policies to decrease stress on the family. Alternative care settings have been developed in part to combat escalating medical costs, and patients have high-acuity illnesses and needs across all of these settings. There has been no decrease in the population of pediatric patients. Cognitive Level: Knowledge/Remembering Content Area: Pediatrics/Maternity Patient Needs: Safe and Effective Care Environment: Management of Care Integrated Process: Caring Difficulty: Easy PTS: 1 2. A nurse wishes to improve critical thinking skills. Which of the following actions would be helpful for this nurse? (Select all that apply.) A. Developing checklists for care activities B. Listening intently for true understanding C. Practicing new skills D. Remaining nonobjective in patient encounters E. Searching the literature for new information ANS: B, C, D, E Critical thinking evolves from experience, seeking knowledge, practicing skills, self-reflection, open-mindedness, calculated risk-taking, and devotion to listening with a goal of true comprehension and understanding. Making checklists is not part of critical thinking. Cognitive Level: Application/Applying Content Area: Pediatrics/Maternity Patient Needs: Safe and Effective Care Environment: Management of Care Integrated Process: Caring Difficulty: Moderate PTS: 1 3. To be effective when providing information to a patient, the nurse should assess the patient for which of the following? (Select all that apply.) A. Cultural beliefs and values B. Information desired C. Preferred learning style D. Level of understanding E. Past medical history ANS: A, B, C, D
  • 19.
    An effective teachershould assess the patient’s cultural beliefs and values, information desired, preferred learning style, and level of current understanding before planning and implementing teaching. The patient’s past medical history is not essential information for teaching. Cognitive Level: Application/Applying Content Area: Pediatrics/Maternity Patient Needs: Health Promotion and Maintenance Integrated Process: Teaching/Learning Difficulty: Moderate PTS: 1 4. The nurse listens to a mother and her 4-year-old child as they communicate with each other primarily to determine which of the following? (Select all that apply.) A. Communication styles that need improvement B. The child’s level of language development C. The family’s culture and its influences D. The family’s personal and group values E. The family’s understanding of health care ANS: B, C, D Listening to the cultural voices and experiences of family and patients affirms their value and is critically important to unifying the nurse–patient relationship. This method of interaction allows the nurse to understand family values, family developmental aspects, and the family’s cultural aspects. It also motivates patient movement toward positive health-promoting activities. It is not primarily to determine areas for improvement, although the nurse may be able to role model better communication for a patient/family. Listening to communication is also not primarily to determine the family’s understanding of health care. Cognitive Level: Application/Applying Content Area: Pediatrics/Maternity Patient Needs: Psychosocial Integrity Integrated Process: Communication and Documentation Difficulty: Moderate PTS: 1 5. The nurse mentor explains to the new nurse that multiple societal changes have given families greater power in health care. What changes have contributed to this shift? (Select all that apply.) A. Alternative community-based care sites B. Costs of obtaining health care C. Decreased health-care regulations D. Multimedia information E. Science and technology ANS: A, B, D, E
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  • 21.
    as it went.The troll went near to him and took a look. And the fox went on watching him, for the fox watches all things. He had come back lately to those dewy fields from slinking by night along the boundary of twilight that lies between here and Elfland. He even prowls inside the very boundary, walking amongst the twilight; and it is in the mystery of that heavy twilight that lies between here and there that there clings to him some of that glamour that he brings with him to our fields. "Well, Noman's Dog," said the troll. For they know the fox in Elfland, from seeing him often go dimly along their borders; and this is the name they give him. "Well, Thing-over-the-Border," said the fox when he answered at all. For he knew troll-talk. "Are the haunts of men near here?" said the troll. The fox moved his whiskers by slightly wrinkling his lip. Like all liars he reflected before he spoke, and sometimes even let wise silences do better than speech. "Men live here and men live there," said the fox. "I want their haunts," said the troll. "What for?" said the fox. "I have a message from the King of Elfland." The fox showed no respect or fear at the mention of that dread name, but slightly moved his head and eyes to conceal the awe that he felt. "If it is a message," he said, "their haunts are over there." And he pointed with his long thin nose towards Erl. "How shall I know when I get there?" said the troll. "By the smell," said the fox. "It is a big haunt of men, and the smell is dreadful."
  • 22.
    "Thanks, Noman's Dog,"said the troll. And he seldom thanked anyone. "I should never go near them," said the fox, "but for ..." And he paused and reflected silently. "But for what?" said the troll. "But for their poultry." And he fell into a grave silence. "Good-bye, Noman's Dog," said the troll and turned head-over- heels, and was off on his way to Erl. Passing over the buttercups all through the dewy morning the troll was far on his way by the afternoon, and saw before evening the smoke and the towers of Erl. It was all sunk in a hollow; and gables and chimneys and towers peered over the lip of the valley, and smoke hung over them on the dreamy air. "The haunts of men," said the troll. Then he sat down amongst the grasses and looked at it. Presently he went nearer and looked at it again. He did not like the look of the smoke and that crowd of gables: certainly it smelt dreadfully. There had been some legend in Elfland of the wisdom of Man; and whatever respect that legend had gained for us in the light mind of the troll now all blew lightly away as he looked at the crowded houses. And as he looked at them there passed a child of four, a small girl on a footpath over the fields, going home in the evening to Erl. They looked at each other with round eyes. "Hullo," said the child. "Hullo, Child of Men," said the troll. He was not speaking troll-talk now, but the language of Elfland, that grander tongue that he had had to speak when he was before the King: for he knew the language of Elfland although it was never used in the homes of the trolls, who preferred troll-talk. This language was spoken in those days also by men, for there were fewer languages then, and the elves and the people of Erl both used the same.
  • 23.
    "What are you?"said the child. "A troll of Elfland," answered the troll. "So I thought," said the child. "Where are you going, child of men?" the troll asked. "To the houses," the child replied. "We don't want to go there," said the troll. "N-no," said the child. "Come to Elfland," the troll said. The child thought for awhile. Other children had gone, and the elves always sent a changeling in their place, so that nobody quite missed them and nobody really knew. She thought awhile of the wonder and wildness of Elfland, and then of her own home. "N-no," said the child. "Why not?" said the troll. "Mother made a jam roll this morning," said the child. And she walked on gravely home. Had it not been for that chance jam roll she had gone to Elfland. "Jam!" said the troll contemptuously and thought of the tarns of Elfland, the great lily-leaves lying flat upon their solemn waters, the huge blue lilies towering into the elf-light above the green deep tarns: for jam this child had forsaken them! Then he thought of his duty again, the roll of parchment and the Elf King's rune for his daughter. He had carried the parchment in his left hand when he ran, in his mouth when he somersaulted over the buttercups. Was the Princess here he thought? Or were there other haunts of men? As evening drew in he crept nearer and nearer the homes, to hear without being seen.
  • 24.
    CHAPTER VIII The Arrivalof the Rune On a sunny May morning in Erl the witch Ziroonderel sat in the castle nursery by the fire, cooking a meal for the baby. The boy was now three years old, and still Lirazel had not named him; for she feared lest some jealous spirit of Earth or air should hear the name, and if so she would not say what she feared then. And Alveric had said he must be named. And the boy could bowl a hoop; for the witch had gone one misty night to her hill and had brought him a moon-halo which she got by enchantment at moonrise, and had hammered it into a hoop, and had made him a little rod of thunderbolt-iron with which to beat it along. And now the boy was waiting for his breakfast; and there was a spell across the threshold to keep the nursery snug, which Ziroonderel had put there with a wave of her ebon stick, and it kept out rats and mice and dogs, nor could bats sail across it, and the watchful nursery cat it kept at home: no lock that blacksmiths made was any stronger. Suddenly over the threshold and over the spell the troll jumped somersaulting through the air and came down sitting. The crude wooden nursery-clock hanging over the fire stopped its loud tick as he came; for he bore with him a little charm against time, with strange grass round one of his fingers, that he might not be withered away in the fields we know. For well the Elf King knew the flight of our hours: four years had swept over these fields of ours while he had boomed down his brazen steps and sent for his troll and given him that spell to bind round one of his fingers. "What's this?" said Ziroonderel.
  • 25.
    That troll knewwell when to be impudent, but looking in the witch's eyes saw something to be afraid of; and well he might, for those eyes had looked in the Elf King's own. Therefore he played, as we say in these fields, his best card, and answered: "A message from the King of Elfland." "Is that so?" said the old witch. "Yes, yes," she added more lowly to herself, "that would be for my lady. Yes, that would come." The troll sat still on the floor fingering the roll of parchment inside of which was written the rune of the King of Elfland. Then over the end of his bed, as he waited for breakfast, the baby saw the troll, and asked him who he was and where he came from and what he was able to do. When the baby asked him what he was able to do the troll jumped up and skipped about the room like a moth on a lamp-lit ceiling. From floor to shelves and back and up again he went with leaps like flying; the baby clapped his hands, the cat was furious; the witch raised her ebon stick and made a charm against leaping, but it could not hold the troll. He leaped and bounced and bounded, while the cat hissed all the curses that the feline language knows, and Ziroonderel was wrath not only because her magic was thwarted, but because with mere human alarm she feared for her cups and saucers; and the baby shouted all the while for more. And all at once the troll remembered his errand and the dread parchment he bore. "Where is the Princess Lirazel?" he said to the witch. And the witch pointed the way to the princess's tower; for she knew that there were no means nor power she had by which to hinder a rune from the King of Elfland. And as the troll turned to go Lirazel entered the room. He bowed all low before this great lady of Elfland and, with all his impudence in a moment lost, kneeled on one knee before the blaze of her beauty and presented the Elf King's rune. The boy was shouting to his mother to demand more leaps from the troll, as she took the scroll in her hand; the cat with her back to a box was watching alertly; Ziroonderel was all silent.
  • 26.
    And then thetroll thought of the weed-green tarns of Elfland in the woods that the trolls knew; he thought of the wonder of the unwithering flowers that time has never touched; the deep, deep colour and the perpetual calm: his errand was over and he was weary of Earth. For a moment nothing moved there but the baby, shouting for new troll antics and waving his arms: Lirazel stood with the elfin scroll in her hand, the troll knelt before her, the witch never stirred, the cat stood watching fiercely, even the clock was still. Then the Princess moved and the troll rose to his feet, the witch sighed and the cat gave up her watchfulness as the troll scampered away. And though the baby shouted for the troll to return it never heeded, but twisted down the long spiral stairs, and slipping out through a door was off towards Elfland. As the troll passed over the threshold the wooden clock ticked again. Lirazel looked at the scroll and looked at her boy, and did not unroll the parchment, but turned and carried it away, and came to her chamber and locked the scroll in a casket, and left it there unread. For her fears told her well the most potent rune of her father, that she had dreaded so much as she fled from his silver tower and heard his feet go booming up the brass, had crossed the frontier of twilight written upon the scroll, and would meet her eyes the moment she unrolled it and waft her thence. When the rune was safe in the casket she went to Alveric to tell him of the peril that had come near her. But Alveric was troubled because she would not name the baby, and asked her at once about this. And so she suggested a name at last to him; and it was one that no one in these fields could pronounce, an elvish name full of wonder, and made of syllables like birds' cries at night: Alveric would have none of it. And her whim in this came, as all the whims she had, from no customary thing of these fields of ours, but sheer over the border from Elfland, sheer over the border with all wild fancies that rarely visit our fields. And Alveric was vexed with these whims, for there had been none like them of old in the Castle of Erl: none
  • 27.
    could interpret themto him and none advise him. He looked for her to be guided by old customs; she looked only for some wild fancy to come from the south-east. He reasoned with her with the human reason that folk set much store by here, but she did not want reason. And so when they parted she had not after all told anything of the peril that had sought her from Elfland, which she had come to Alveric to tell. She went instead to her tower and looked at the casket, shining there in the low late light; and turned from it and often looked again; while the light went under the fields and the gloaming came, and all glimmered away. She sat then by the casement open towards eastern hills, above whose darkening curves she watched the stars. She watched so long that she saw them change their places. For more than all things else that she had seen since she came to these fields of ours she had wondered at the stars. She loved their gentle beauty; and yet she was sad as she looked wistfully to them, for Alveric had said that she must not worship them. How if she might not worship them could she give them their due, could she thank them for their beauty, could she praise their joyful calm? And then she thought of her baby: then she saw Orion: then she defied all jealous spirits of air, and, looking toward Orion, whom she must never worship, she offered her baby's days to that belted hunter, naming her baby after those splendid stars. And when Alveric came to the tower she told him of her wish, and he was willing the boy should be named Orion, for all in that valley set much store by hunting. And the hope came back to Alveric, which he would not put away, that being reasonable at last in this, she would now be reasonable in all other things, and be guided by custom, and do what others did, and forsake wild whims and fancies that came over the border from Elfland. And he asked her to worship the holy things of the Freer. For never had she given any of these things their due, and knew not which was the holier, his candlestick or his bell, and never would learn for ought that Alveric told her.
  • 28.
    And now sheanswered him pleasantly and her husband thought all was well, but her thoughts were far with Orion; nor did they ever tarry with grave things long, nor could tarry longer amongst them than butterflies do in the shade. All that night the casket was locked on the rune of the King of Elfland. And next morning Lirazel gave little thought to the rune, for they went with the boy to the holy place of the Freer; and Ziroonderel came with them but waited without. And the folk of Erl came too, as many as could leave the affairs of man with the fields; and all were there of those that had made the parliament, when they went to Alveric's sire in the long red room. And all of these were glad when they saw the boy and marked his strength and growth; and, muttering low together as they stood in the holy place, they foretold how all should be as they had planned. And the Freer came forth and, standing amongst his holy things, he gave to the boy before him the name of Orion, though he sooner had given some name of those that he knew to be blessed. And he rejoiced to see the boy and to name him there; for by the family that dwelt in the Castle of Erl all these folk marked the generations, and watched the ages pass, as sometimes we watch the seasons go over some old known tree. And he bowed himself before Alveric, and was full courteous to Lirazel, yet his courtesy to the princess came not from his heart, for in his heart he held her in no more reverence than he held a mermaid that had forsaken the sea. And the boy came even so by the name of Orion. And all the folk rejoiced as he came out with his parents and rejoined Ziroonderel at the edge of the holy garden. And Alveric, Lirazel, Ziroonderel and Orion all walked back to the castle. And all that day Lirazel did nothing that caused anybody to wonder, but let herself be governed by custom and the ways of the fields we know. Only, when the stars came out and Orion shone, she knew that their splendour had not received its due, and her gratitude to Orion yearned to be said. She was grateful for his bright
  • 29.
    beauty that cheeredour fields, and grateful for his protection, of which she felt sure for her boy, against jealous spirits of air. And all her unsaid thanks so burned in her heart that all of a sudden she rose and left her tower and went out to the open starlight, and lifted her face to the stars and the place of Orion, and stood all dumb though her thanks were trembling upon her lips; for Alveric had told her one must not pray to the stars. With face upturned to all that wandering host she stood long silent, obedient to Alveric: then she lowered her eyes, and there was a small pool glimmering in the night, in which all the faces of the stars were shining. "To pray to the stars," she said to herself in the night, "is surely wrong. These images in the water are not the stars. I will pray to their images, and the stars will know." And on her knees amongst the iris leaves she prayed at the edge of the pool, and gave thanks to the images of the stars for the joy she had had of the night, when the constellations shone in their myriad majesty, and moved like an army dressed in silver mail, marching from unknown victories to conquer in distant wars. She blessed and thanked and praised those bright reflections shimmering down in the pool, and bade them tell her thanks and her praise to Orion, to whom she might not pray. It was thus that Alveric found her, kneeling, bent down in the dark, and reproached her bitterly. She was worshipping the stars, he said, which were there for no such purpose. And she said she was only supplicating their images. We may understand his feelings easily: the strangeness of her, her unexpected acts, her contrariness to all established things, her scorn for custom, her wayward ignorance, jarred on some treasured tradition every day. The more romantic she had been far away over the frontier, as told of by legend and song, the more difficult it was for her to fill any place once held by the ladies of that castle who were versed in all the lore of the fields we know. And Alveric looked for her to fulfil duties and follow customs which were all as new to her as the twinkling stars.
  • 30.
    But Lirazel feltonly that the stars had not their due, and that custom or reason or whatever men set store by should demand that thanks be given them for their beauty; and she had not thanked them even, but had supplicated only their images in the pool. That night she thought of Elfland, where all things were matched with her beauty, where nothing changed and there were no strange customs, and no strange magnificences like these stars of ours to whom none gave their due. She thought of the elfin lawns and the towering banks of the flowers, and the palace that may not be told of but only in song. Still locked in the dark of the casket the rune bided its time.
  • 31.
    CHAPTER IX Lirazel BlowsAway And the days went by, the Summer passed over Erl, the sun that had travelled northward fared South again, it was near to the time when the swallows left those eaves, and Lirazel had not learnt anything. She had not prayed to the stars again, or supplicated their images, but she had learned no human customs, and could not see why her love and gratitude must remain unexpressed to the stars. And Alveric did not know that the time must come when some simple trivial thing would divide them utterly. And then one day, hoping still, he took her with him to the house of the Freer to teach her how to worship his holy things. And gladly the good man brought his candle and bell, and the eagle of brass that held up his book when he read, and a little symbolic bowl that had scented water, and the silver snuffers that put his candle out. And he told her clearly and simply, as he had told her before, the origin, meaning and mystery of all these things, and why the bowl was of brass and the snuffer of silver, and what the symbols were that were carved on the bowl. With fitting courtesy he told her these things, even with kindness; and yet there was something in his voice as he told, a little distant from her; and she knew that he spoke as one that walked safe on shore calling far to a mermaid amid dangerous seas. As they came back to the castle the swallows were grouped to go, sitting in lines along the battlements. And Lirazel had promised to worship the holy things of the Freer, like the simple bell-fearing folk of the valley of Erl: and a late hope was shining in Alveric's mind that even yet all was well. And for many days she remembered all that the Freer had told her.
  • 32.
    And one daywalking late from the nursery, past tall windows to her tower, and looking out on the evening, remembering that she must not worship the stars, she called to mind the holy things of the Freer, and tried to remember all she was told of them. It seemed so hard to worship them just as she should. She knew that before many hours the swallows would all be gone; and often when they left her her mood would change; and she feared that she might forget, and never remember more, how she ought to worship the holy things of the Freer. So she went out into the night again over the grasses to where a thin brook ran, and drew out some great flat pebbles that she knew where to find, turning her face away from the images of the stars. By day the stones shone beautifully in the water, all ruddy and mauve; now they were all dark. She drew them out and laid them in the meadow: she loved these smooth flat stones, for somehow they made her remember the rocks of Elfland. She laid them all in a row, this for the candlestick, this for the bell, that for the holy bowl. "If I can worship these lovely stones as things ought to be worshipped," she said, "I can worship the things of the Freer." Then she kneeled down before the big flat stones and prayed to them as though they were Christom things. And Alveric seeking her in the wide night, wondering what wild fancy had carried her whither, heard her voice in the meadow, crooning such prayers as are offered to holy things. When he saw the four flat stones to which she prayed, bowed down before them in the grass, he said that no worse than this were the darkest ways of the heathen. And she said "I am learning to worship the holy things of the Freer." "It is the art of the heathen," he said. Now of all things that men feared in the valley of Erl they feared most the arts of the heathen, of whom they knew nothing but that their ways were dark. And he spoke with the anger which men
  • 33.
    always used whenthey spoke there of the heathen. And his anger went to her heart, for she was but learning to worship his holy things to please him, and yet he had spoken like this. And Alveric would not speak the words that should have been said, to turn aside anger and soothe her; for no man, he foolishly thought, should compromise in matters touching on heathenesse. So Lirazel went alone all sadly back to her tower. And Alveric stayed to cast the four flat stones afar. And the swallows left, and unhappy days went by. And one day Alveric bade her worship the holy things of the Freer, and she had quite forgotten how. And he spoke again of the arts of heathenesse. The day was shining and the poplars golden and all the aspens red. Then Lirazel went to her tower and opened the casket, that shone in the morning with the clear autumnal light, and took in her hand the rune of the King of Elfland, and carried it with her across the high vaulted hall, and came to another tower and climbed its steps to the nursery. And there all day she stayed and played with her child, with the scroll still tight in her hand: and, merrily though she played at whiles, yet there were strange calms in her eyes, which Ziroonderel watched while she wondered. And when the sun was low and she had put the child to bed she sat beside him all solemn as she told him childish tales. And Ziroonderel, the wise witch, watched; and for all her wisdom only guessed how it would be, and knew not how to make it otherwise. And before sunset Lirazel kissed the boy and unrolled the Elf King's scroll. It was but a petulance that had made her take it from the coffer in which it lay, and the petulance might have passed and she might not have unrolled the scroll, only that it was there in her hand. Partly petulance, partly wonder, partly whims too idle to name, drew her eyes to the Elf King's words in their coal-black curious characters.
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    And whatever magicthere was in the rune of which I cannot tell (and dreadful magic there was), the rune was written with love that was stronger than magic, till those mystical characters glowed with the love that the Elf King had for his daughter, and there were blended in that mighty rune two powers, magic and love, the greatest power there is beyond the boundary of twilight with the greatest power there is in the fields we know. And if Alveric's love could have held her he should have trusted alone to that love, for the Elf King's rune was mightier than the holy things of the Freer. No sooner had Lirazel read the rune on the scroll than fancies from Elfland began to pour over the border. Some came that would make a clerk in the City to-day leave his desk at once to dance on the sea-shore; and some would have driven all the men in a bank to leave doors and coffers open and wander away till they came to green open land and the heathery hills; and some would have made a poet of a man, all of a sudden as he sat at his business. They were mighty fancies that the Elf King summoned by the force of his magical rune. And Lirazel sat there with the rune in her hand, helpless amongst this mass of tumultuous fancies from Elfland. And as the fancies raged and sang and called, more and more over the border, all crowding on one poor mind, her body grew lighter and lighter. Her feet half rested half floated, upon the floor; Earth scarcely held her down, so fast was she becoming a thing of dreams. No love of hers for Earth, or of the children of Earth for her, had any longer power to hold her there. And now came memories of her ageless childhood beside the tarns of Elfland, by the deep forest's border, by those delirious lawns, or in the palace that may not be told of except only in song. She saw those things as clearly as we see small shells in water, looking through clear ice down to the floor of some sleeping lake, a little dimmed in that other region across the barrier of ice; so too her memories shone a little dimly from across the frontier of Elfland. Little queer sounds of elfin creatures came to her, scents swam from those miraculous flowers that glowed by the lawns she knew, faint sounds of enchanted songs blew over the border and reached her
  • 35.
    seated there, voicesand melodies and memories came floating through the twilight, all Elfland was calling. Then measured and resonant, and strangely near, she heard her father's voice. She rose at once, and now Earth had lost on her the grip that it only has on material things, and a thing of dreams and fancy and fable and phantasy she drifted from the room; and Ziroonderel had no power to hold her with any spell, nor had she herself the power even to turn, even to look at her boy as she drifted away. And at that moment a wind came out of the north-west, and entered the woods and bared the golden branches, and danced on over the downs, and led a company of scarlet and golden leaves, that had dreaded this day but danced now it had come; and away with a riot of dancing and glory of colour, high in the light of the sun that had set from the sight of the fields, went wind and leaves together. With them went Lirazel.
  • 36.
    CHAPTER X The Ebbingof Elfland Next morning Alveric came up the tower to the witch Ziroonderel, weary and frantic from searching all night long in strange places for Lirazel. All night he had tried to guess what fancy had beckoned her out and whither it might have led her; he had searched by the stream by which she had prayed to the stones, and the pool where she prayed to the stars; he had called her name up every tower, and had called it wide in the dark, and had had no answer but echo; and so he had come at last to the witch Ziroonderel. "Whither?" he said, saying no more than that, that the boy might not know his fears. Yet Orion knew. And Ziroonderel all mournfully shook her head. "The way of the leaves," she said. "The way of all beauty." But Alveric did not stay to hear her say more than her first five words; for he went with the restlessness with which he had come, straight from the room and hastily down the stair, and out at once into the windy morning, to see which way those glorious leaves were gone. And a few leaves that had clung to cold branches longer, when the gay company of their comrades had gone, were now too on the air, going lonely and last: and Alveric saw they were going south- east towards Elfland. Hurriedly then he donned his magical sword in its wide scabbard of leather; and with scanty provisions hastened over the fields, after the last of the leaves, whose autumnal glory led him, as many a cause in its latter days, all splendid and fallen, leads all manner of men.
  • 37.
    And so hecame to the upland fields with their grass all grey with dew; and the air was all sparkling with sunlight, and gay with the last of the leaves, but a melancholy seemed to dwell with the sound of the lowing of cattle. In the calm bright morning with the north-west wind roaming through it Alveric came by no calm, and never gave up the haste of one who has lost something suddenly: he had the swift movements of such, and the frantic air. He watched all day over clear wide horizons, south-east where the leaves were leading; and at evening he looked to see the Elfin Mountains, severe and changeless, unlit by any light we know, the colour of pale forget-me-nots. He held on restlessly to see their summits, but never they came to view. And then he saw the house of the old leather-worker who had made the scabbard for his sword; and the sight of it brought back to him the years that were gone since the evening when first he had seen it, although he never knew how many they were, and could not know, for no one has ever devised any exact calculation whereby to estimate the action of time in Elfland. Then he looked once more for the pale-blue Elfin Mountains, remembering well where they lay, in their long grave row past a point of one of the leather-worker's gables, but he saw never a line of them. Then he entered the house and the old man still was there. The leather-worker was wonderfully aged; even the table on which he worked was much older. He greeted Alveric, remembering who he was, and Alveric enquired for the old man's wife. "She died long ago," he said. And again Alveric felt the baffling flight of those years, which added a fear to Elfland whither he went, yet he neither thought to turn back nor reined for a moment his impatient haste. He said a few formal things of the old man's loss that had happened so long ago. Then "Where are the Elfin Mountains," he asked, "the pale-blue peaks?" A look came slowly over the old man's face as though he had never seen them, as though Alveric being learned spoke of something that the old leather-worker could not know. No, he did
  • 38.
    not know, hesaid. And Alveric found that to-day as all those years ago, this old man still refused to speak of Elfland. Well, the boundary was only a few yards away; he would cross it and ask the way of elfin creatures, if he could not see the mountains to guide him then. The old man offered him food, and he had not eaten all day; but Alveric in his haste only asked him once more of Elfland, and the old man humbly said that of such things he knew nothing. Then Alveric strode away and came to the field he knew, which he remembered to be divided by the nebulous border of twilight. And indeed he had no sooner come to the field than he saw all the toadstools leaning over one way, and that the way he was going; for just as thorn trees all lean away from the sea, so toadstools and every plant that has any touch of mystery, such as foxgloves, mulleins and certain kinds of orchis, when growing anywhere near it, all lean towards Elfland. By this one may know before one has heard a murmur of waves, or before one has guessed an influence of magical things, that one comes, as the case may be, to the sea or the border of Elfland. And in the air above him Alveric saw golden birds, and guessed that there had been a storm in Elfland blowing them over the border from the south-east, though a north-west wind blew over the fields we know. And he went on but the boundary was not there, and he crossed the field as any field we know, and still he had not come to the fells of Elfland. Then Alveric pressed on with a new impatience, with the north- west wind behind him. And the Earth began to grow bare and shingly and dull, without flowers, without shade, without colour, with none of those things that there are in remembered lands, by which we build pictures of them when we are there no more; it was all disenchanted now. Alveric saw a golden bird high up, rushing away to the south-east; and he followed his flight hoping soon to see the mountains of Elfland, which he supposed to be merely concealed by some magical mist. But still the autumnal sky was bright and clear, and all the horizon plain, and still there came never a gleam of the Elfin Mountains. And not from this did he learn that Elfland had ebbed.
  • 39.
    But when hesaw on that desolate shingly plain, untorn by the north- west wind but blooming fair in the Autumn, a may tree that he remembered a long while since, all white with blossom that once rejoiced a Spring day far in his childhood, then he knew that Elfland had been there and must have receded, although he knew not how far. For it is true, and Alveric knew, that just as the glamour that brightens much of our lives, especially in early years, comes from rumours that reach us from Elfland by various messengers (on whom be blessings and peace), so there returns from our fields to Elfland again, to become a part of its mystery, all manner of little memories that we have lost and little devoted toys that were treasured once. And this is part of the law of ebb and flow that science may trace in all things; thus light grew the forest of coal, and the coal gives back light; thus rivers fill the sea, and the sea sends back to the rivers; thus all things give that receive; even Death. Next Alveric saw lying there on the flat dry ground a toy that he yet remembered, which years and years ago (how could he say how many?) had been a childish joy to him, crudely carved out of wood; and one unlucky day it had been broken, and one unhappy day it had been thrown away. And now he saw it lying there not merely new and unbroken, but with a wonder about it, a splendour and a romance, the radiant transfigured thing that his young fancy had known. It lay there forsaken of Elfland as wonderful things of the sea lie sometimes desolate on wastes of sand, when the sea is a far blue bulk with a border of foam. Dreary with lost romance was the plain from which Elfland had gone, though here and there Alveric saw again and again those little forsaken things that had been lost from his childhood, dropping through time to the ageless and hourless region of Elfland to be a part of its glory, and now left forlorn by this immense withdrawal. Old tunes, old songs, old voices, hummed there too, growing fainter and fainter, as though they could not live long in the fields we know.
  • 40.
    And, when thesun set, a mauve-rose glow in the East, that Alveric fancied a little too gorgeous for Earth, led him onward still; for he deemed it to be the reflection cast on the sky by the glow of the splendour of Elfland. So he went on hoping to find it, horizon after horizon; and night came on with all Earth's comrade stars. And only then Alveric put aside at last that frantic restlessness that had driven him since the morning; and, wrapping himself in a loose cloak that he wore, ate such food as he had in a satchel, and slept a troubled sleep alone with other forsaken things. At the earliest moment of dawn his impatience awoke him, although one of October's mists hid all glimpses of light. He ate the last of his food and then pushed on through the greyness. No sound from the things of our fields came to him now; for men never went that way when Elfland was there, and none but Alveric went now to that desolate plain. He had travelled beyond the sound of cock-crow from the comfortable houses of men and was now marching through a curious silence, broken only now and then by the small dim cries of the lost songs that had been left by the ebb of Elfland and were fainter now than they had been the day before. And when dawn shone Alveric saw again so great a splendour in the sky, glowing all green low down in the south-east, that he thought once more he saw a reflection from Elfland, and pressed on hoping to find it over the next horizon. And he passed the next horizon; and still that shingly plain, and never a peak of the pale-blue Elfin Mountains. Whether Elfland always lay over the next horizon, brightening the clouds with its glow, and moved away just as he came, or whether it had gone days or years before, he did not know but still kept on and on. And he came at last to a dry and grassless ridge on which his eyes and his hopes had been set for long, and from it he looked far over the desolate flatness that stretched to the rim of the sky, and saw never a sign of Elfland, never a slope of the mountains: even the little treasures of memory that had been left behind by the ebb were withering into things of our every day. Then Alveric drew his
  • 41.
    magical sword fromits sheath. But though that sword had power against enchantment it had not been given the power to bring again an enchantment that was gone; and the desolate land remained the same, for all that he waved his sword, stony, deserted, unromantic and wide. For a little while he went on; but in that flat land the horizon moved imperceptibly with him, and never a peak appeared of the Elfin Mountains; and on that dreary plain he soon discovered, as sooner or later many a man must, that he had lost Elfland.
  • 42.
    CHAPTER XI The Deepof the Woods In those days Ziroonderel would amuse the boy by charms and by little wonders, and he was content for a while. And then he began to guess for himself, all in silence, where his mother was. He listened to all things said, and thought long about them. And days passed thus and he only knew she had gone, and still he said never a word of the thing with which his thoughts were busy. And then he came to know from things said or unsaid, or from looks or glances or wagging of heads, that there was a wonder about his mother's going. But what the wonder was he could not find, for all the marvels that crossed his mind when he guessed. And at last one day he asked Ziroonderel. And stored though her old mind was with ages and ages of wisdom, and though she had feared this question, yet she did not know it had dwelt in his mind for days, and could find no better answer out of her wisdom than that his mother had gone to the woods. When the boy heard this he determined to go to the woods to find her. Now in his walks abroad with Ziroonderel through the little hamlet of Erl, Orion would see the villagers walking by and the smith at his open forge, and folk in their doorways, and men that came in to the market from distant fields; and he knew them all. And most of all he knew Threl with his quiet feet, and Oth with his lithe limbs; for both of these would tell him tales when they met of the uplands, and the deep woods over the hill; and Orion on little journeys with his nurse loved to hear tales of far places. There was an ancient myrtle tree by a well, where Ziroonderel would sit in the Summer evenings while Orion played on the grass;
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    and Oth wouldcross the grass with his curious bow, going out in the evening, and sometimes Threl would come; and every time that one of them came Orion would stop him and ask for a tale of the woods. And if it were Oth he would bow to Ziroonderel with a look of awe as he bowed, and would tell some tale of what the deer did, and Orion would ask him why. Then a look would come over Oth's face as though he were carefully remembering things that had happened very long ago, and after some moments of silence he would give the ancient cause of whatever the deer did, which explained how they came by the custom. If it were Threl that came across the grass he would appear not to see Ziroonderel and would tell his tale of the woods more hastily in a low voice and pass on, leaving the evening, as Orion felt, full of mystery behind him. He would tell tales of all manner of creatures; and the tales were so strange that he told them only to young Orion, because, as he explained, there were many folk that were unable to believe the truth, and he did not wish his tales to come to the ears of such. Once Orion had gone to his house, a dark hut full of skins: all kinds of skins hung on the wall, foxes, badgers, and martens; and there were smaller ones in heaps in the corners. To Orion Threl's dark hut was more full of wonder than any other house he had ever seen. But now it was Autumn and the boy and his nurse saw Oth and Threl more seldom; for in the misty evenings with the threat of frost in the air they sat no longer by the myrtle tree. Yet Orion watched on their short walks; and one day he saw Threl going away from the village with his face to the uplands. And he called to Threl, and Threl stood still with a certain air of confusion, for he deemed himself of too little account to be clearly seen and noticed by the nurse at the castle, be she witch or woman. And Orion ran up to him and said "Show me the woods." And Ziroonderel perceived that the time had come when his thoughts were roaming beyond the lip of the valley, and knew that no spell of hers would hold him long from following after them. And Threl said, "No, my Master," and looked uneasily at
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    Ziroonderel, who cameafter the boy and led him away from Threl. And Threl went on alone to his work in the deep of the woods. And it was not otherwise than the witch had foreseen. For first Orion wept, and then he dreamed of the woods, and next day he slipped away alone to the house of Oth and asked him to take him with him when he went to hunt the deer. And Oth, standing on a wide deer-skin in front of blazing logs, spoke much of the woods, but did not take him then. Instead he brought Orion back to the Castle. And Ziroonderel regretted too late that she had idly said his mother was gone to the woods, for those words of hers had called up too soon that spirit of roving which was bound to come to him, and she saw that her spells could bring content no more. So in the end she let him go to the woods. But not until by lifting of wand and saying of incantation she had called the glamour of the woods down to the nursery hearth, and had made it haunt the shadows that went from the fire and creep with them all about the room, till the nursery was all as mysterious as the forest. When this spell would not soothe him and keep his longing at home she let him go to the woods. He stole away once more to the house of Oth, over crisp grass one morning; and the old witch knew he had gone but did not call him back, for she had no spell to curb the love of roving in man, whether it came early or late. And she would not hold back his limbs when his heart was gone to the woods, for it is ever the way of witches with any two things to care for the more mysterious of the two. So the boy came alone to the house of Oth, through his garden where dead flowers hung on brown stalks, and the petals turned to slime if he fingered them, for November was come and the frosts were abroad all night. And this time Orion just met with a mood in Oth, which in less than an hour would have gone, that was favourable to the boy's longing. Oth was taking down his bow from the wall as Orion went in, and Oth's heart was gone to the woods; and when the boy came yearning to go to the woods too the hunter in that mood could not refuse him.
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    So Oth tookOrion on his shoulder and went up out of the valley. Folk saw them go thus, Oth with his bow and his soft noiseless sandals, and his brown garments of leather, Orion on his shoulder, wrapped in the skin of a fawn which Oth had thrown round him. And as the village fell behind them Orion rejoiced to see the houses further and further away, for he had never been so far from them before. And when the uplands opened their distances to his eyes he felt that he was now upon no mere walk, but a journey. And then he saw the solemn gloom of the wintry woods far off, and that filled him at once with a delighted awe. To their darkness, their mystery and their shelter Oth brought him. So softly Oth entered the wood that the blackbirds that guarded it, sitting watchful on branches, did not flee at his coming, but only uttered slowly their warning notes, and listened suspiciously till he passed, and were never sure if a man had broken the charm of the wood. Into that charm and the gloom and the deep silence Oth moved gravely; and a solemness came on his face as he entered the wood; for to go on quiet feet through the wood was the work of his life, and he came to it as men come to their heart's desire. And soon he put the boy down on the brown bracken and went on for a while alone. Orion watched him go with his bow in his left hand, till he disappeared in the wood, like a shadow going to a gathering of shadows and merging amongst its fellows. And although Orion might not go with him now, he had great joy from this, for he knew by the way Oth went and the air he had that this was serious hunting and no mere amusement made to please a child; and it pleased him more than all the toys he had had. And quiet and lonely the great wood loomed round him while he waited for Oth to return. And after a long while he heard a sound, all in the wonder of the wood, that was less loud than the sound that a blackbird made scattering dead leaves to find insects, and Oth had come back again. He had not found a deer; and for a while he sat by Orion and shot arrows into a tree; but soon he gathered his arrows and took the boy on his shoulder again and turned homewards. And there
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