Leadership Exam 2 Blueprint Flashcards
Ethics
system of principles that govern the actions of the nurse in relation to patients, families, other health care providers, policymakers, and society
Code of Ethics
Implicit standards and values for nursing
American Nurses Association Code of Ethics
International Council of Nurses Coder for Nurses
Bioethics
Interdisciplinary field within health care that addresses questions that arise as science and technology produce new ways of knowing
Dilemmas for health professionals examples
Life and death
Right to decide
Informed consent
Alternative tx issues
Stem cell research
Sexual reassignment
Therapeutic and reproductive cloning
In vitro fertilization; donor insemination
Surrogate motherhood
Organ transplantation
Dilemmas created by technology
Illnesses that once led to mortality are now manageable and are classified as chronic illnesses
Cost is a consequence of prolonging life with technology
Manipulation of DNA
Purpose of Ethical Principles
Establish consistent common ground for ethical discussions and decision making among all involved (nurse, patient, family, health care, society) on specific or related issues
Provides an analytical framework to evaluate moral problems
Autonomy
Principle of respect for the person: primary moral principle
People are free to form their own judgements and actions as long as they do not infringe on the autonomous actions of others
Concepts of freedom and informed consent are grounded in this principle
Beneficence
acting in the best interest of patients by promoting their well-being, preventing harm, and providing compassionate care.
Common bioethical conflict results from an imbalance bw the demands of beneficence and those of the health care delivery system
Nonmaleficence
Implies a duty not to inflict harm
removing harm to promote well being
Veracity
Principle of truth-telling to develop trust
Don’t withhold info bc you feel like it can cause harm or be uncomfortable
Justice
Nurses should treat all patients fairly and impartially, regardless of their background, race, gender, or social status
Fidelity
build trust by keeping promises, being reliable, and honoring commitments
Ethical Theory
a system of principles by which a person can determine what should and shouldnt be done
Utilitarianism
assumption that an action is right if it results in the greatest good or the least harm.
Strongest approach for bioethical decision making—Which action maximizes benefit and minimizes harm for all involved?
Deontology
Rooted in the assumption that human actions are guided by rational principles which compel people to do what is right.
Decisions should be made as if they could be universal laws
Purpose of Malpractice Insurance
to protect nurses from financial loss and legal consequences if they are accused of negligence or wrongdoing in their professional practice. It provides coverage for legal defense costs, settlements, and damages awarded in lawsuits related to patient care.
Reasons for Malpractice Insurance
More states recognize nurse malpractice claims.
RN and advanced practice roles are expanding.
Floating and cross-training mandates are increasing.
Nurses have more responsibility for supervising staff.
Some employers may fail to provide adequate defense for nurses.
Statutory Laws
Written laws that govern nursing practices and professional behavior, enacted by the federal or state legislature
Violations are criminal offenses and are punishable by fines or imprisonment
Licensing boards have the authority to hear and decide cases against nurses
Statutory Law: Penalties that may be imposed
formal reprimand
period of probation
fines
Limiting, suspending, or revoking the nurse’s license
Statutory Law: Emergency Medical Tx and Active Labor Law (EMTALA)
prohibits denying care to uninsured or poor patients in emergency departments
forbids transferring unstable patients, including women in labor, between facilities.
Applicable to nonemergency facilities (i.e. urgent care)
Statutory Law: Americans with Disabilities Act of 1990 (ADA):
ensures equal access and opportunities for individuals with disabilities by eliminating discriminatory barriers.
Statutory Law: Patient Self-Determination Act of 1990
requires healthcare providers to inform patients of their rights to make decisions about their care, including right to accept or refuse tx and advance directives for future medical preferences.
Statutory Law: Health Insurance Portability and Accountability Act of 1996 (HIPAA)
protects the privacy and security of health information, sets standards for handling personal data, and gives individuals control over their health records, including requesting corrections
Statutory Law: Patient Safety and Quality Improvement Act (PSQIA)
Promotes patient safety by encouraging error reporting without legal fear, offering federal protection for data shared with PSOs to foster a culture of safety and improvement.
Nurse/Patient ratio and mandatory overtime statues
California 1st to enact a law in Jan 1999 that mandates the establishment of minimum nurse/pt ratios in acute care facilities
Improved nurse/patient rations are associated w/ lower “failure-to-rescue” rates and lower inpatient mortality rates
Tort
A direct violation of a person’s legal rights
The plaintiff doesn’t need to prove a “special duty” or negligence, as it’s assumed nurses owe a duty of care; they only need to show the nurse’s actions fell below the standard of care.
Consequences include fines, punitive damages, or criminal acts
Torts include:
Assault and Battery
Defamation of character; libel/slander
False imprisonment; restraints
Intentional Infliction of emotional distress
Invasion of Privacy
Incident Reporting
The process of documenting and reporting any unusual events that occur during patient care, which may affect patient safety, quality of care, or the healthcare environment. This could include errors, accidents, injuries, near-misses, or adverse events.
Purpose of Incidence Reporting
helps prevent future occurrences and improves care quality.
uncovers patterns or systemic issues in care, equipment, or communication.
protects providers from liability by showing transparency and a commitment to improvement.
encourages open communication about mistakes without fear of punishment, fostering learning and safety.
Mandated reporting
Laws that mandate reporting of specific health problems and suspected or confirmed abuse
Most laws grant immunity from suit within the context of the mandatory reporting statue
Mandated circumstances that must be reported
Health Professionals must report the following under penalty of fine or imprisonment for failing to do so:
Infant and child abuse (Child Abuse Prevention and Treatment Act)
Dependent elder abuse
Specified communicable diseases
Ethical Decision Making: Answering Difficult Questions
What is safe care?
When staffing is inadequate, what care should be accepted or refused?
What does it mean to be ill or well?
What is the proper balance bw science/technology and the good of humans?
Where do we find balance when science will allow us to experiment with the basic origins of life?
What happens when tension exists bw personal beliefs and values and institutional policy or patient desires?
Ethical Decision-Making Model
- Situation assessment procedure
- Identify the ethical issues and problems
- Identify and analyze available alternatives for action
- Select one alternative
- Justify the selection
Situational Assessment Procedure: Usefulness & Application
Patient Provider Relationship
—Privacy, paternalism, fidelity. veracity
Encompassing questions for group (i.e. Institutional Ethics Committee)
—Provide ethics education, assistance with ethical policy development, and serve as consultative body to guide resolving ethical dilemmas
Policy making right and wrong choice that affect society
Daily practice of ethical decision-making
Bioethical Dilemmas
Dilemmas that involve choosing between confusing options in the delivery of healthcare due to unclear right or wrong answers.
Bioethical Dilemma: Life
abortion issue
When does life begin?
Reproduction issue: influenced by genetic screening, genetic engineering, and cloning
90% of the human genome identified in 2003 by Human genome Project
Bioethical Dilemma: Death
Quality of life and definition of death issues: w/ advances in health care, what is usual and what is heroic care has become unclear
Euthanasia and assisted suicide present new ethical questions
Bioethical Dilemma: Right to Healthcare
Health Care system more selective in the amount and type of tx offered as a result of managed care
Is each person entitled to the same health care package?
Does ability to pay affect a specific level of entitlement?
How ethical is gatekeeping in the new managed care system?
Access to health care and respect for human dignity are at the core of nursing practice
Bioethical Dilemma: Allocation of Scarce Resources
Should the recipient of scarce resources be selected on the basis of quality of life? Ability to pay? Best prognosis? First-come, first-served?
Moral development for a professional nurse
Moving toward moral maturity
The quality of healthcare decisions depends on the moral development of the nurse making them
Values essential for the professional nurse
altruism, autonomy, human dignity, social justice
Nurse value: Altruism
concern for the welfare of others
Nurse value: Autonomy
right to self-determination
Nurse value: Human Dignity
respect for inherent worth and uniqueness of individuals and populations
Nurse value: Social Justice
acting in accordance with fair tx regardless of background
Ethics acculturation
adopting the cultural norms and values of the healthcare environment they work in.
Values: Integrity, personal growth, practical wisdom, and effective problem solving
Rights of conscience:
the right to practice according to your ethical convictions (what you feel is right or wrong)
ex:debates over abortion and euthanasia, as part of civil rights in the U.S.
Ethical theory and ethical principles can provide a basis for
moving forward as a morally mature professional adult
Negligence
failure to act in a reasonable and prudent manner
Malpractice:
special type of negligence; the failure of a trained professional, to act in a reasonable and prudent manner
Elements essential to prove negligence or malpractice
A nurse owes a duty of care once a nurse-patient relationship is formed.
The nurse failed to meet that duty.
The patient experienced harm or damage.
The nurse’s actions directly caused the patient’s injury.
Most frequent allegations of nursing negligence
Failure to ensure patient safety.
Improper or negligent treatment
Failure to monitor and report key findings.
Medication errors.
Not following agency policies and procedures
Negligence and the doctrine of res ipsa loquitur
- Applies when the negligent act is obvious and within common knowledge to determine the standard of care—”the thing that speaks for itself.”
- An expert nurse witness is not needed to establish the standard of care.
- Example: Studies show about 5,000 foreign bodies (like instruments or sponges) are left inside patients after surgery each year.
Gross negligence
Reckless act that reflects a conscious disregard for the patient’s welfare
Court may award special damages meant to punish the nurse for the outrageous conduct; these are referred to as punitive damages
Criminal negligence
Constitutes a crime—the act is deemed so reckless that it results in serious injury or death to the patient
Malpractice insurance may not cover costs in all cases
98,000 patients die each year as a result of negligence and malpractice of health care providers
Consequences in addition to criminal negligence charges include
Loss of job and livelihood
Suspension or revocation of license
Out-of-pocket fines levied by the nursing board
Significant attorney’s fees
What can nurses not use as a defense against claims of negligence?
In no case may a nurse use the defense “following physician’s orders”
Defenses against claims of negligence
- Emergency situations: Care in life-threatening emergencies may not meet the usual standard of care.
- Governmental immunity: Healthcare workers in federal or state facilities are protected from personal responsibility in malpractice cases.
3 - Good Samaritan immunity: Nurses are shielded from malpractice when providing emergency help outside their job setting.
ANA Code of Ethics and American Medical Association’s Code of Medical Ethics:
the central role of nurses is to prevent patient harm
The law and patient rights
Advance directives
The right to refuse treatment
Leaving against medical advice (AMA)
The use of physical restraints
Advance Directives
Statutes grant adults the right to refuse extraordinary medical tx when no hope of recovery
Patient’s wishes are made known through execution of a living will
Medical and physician directives
Document that lists desires of patient in a particular scenario
If properly executed, physical restraints provides physician with
immunity from claims of negligence in the patient’s death
Do not resuscitate orders
Written by a physician based on directives by the patient
Nurses have absolute duty to respect patient’s DNR orders
Durable power of attorney for health care:
document that authorizes patient to name the person who will make the day-to-day and end-of-life decisions when he or she becomes decisionally incompetent
Informed Consent
Physician or NP has duty to disclose information so patient can make choices
Mandated by federal statute and state law
Provider cannot delegate this to RN
If nurse has reason to believe that pt has no given informed consent, the provider should be immediately notified
Information that must be disclosed to patients
Nature of the therapy or procedure
Expected benefits and outcomes
Potential risks
Alternative therapies
Risks of not having the procedure
Value
personal belief about worth that acts as a guide to behavior
Value System
entire framework on which actions are based
Diane Ustal
first nurse leader to describe the role of values clarification
Ethics acculturations
a process of adapting one’s personal ethical values to the ethical standards and procedures of a professional organization
Values Formation and Moral Development: Worldview
Provides a cohesive model for life
Encourages personal responsibility for living life
Prepares one for making ethical choices
Learning Right and Wrong: Infants
Begin with no concept of right or wrong
If the need for basic trust is met, infants will develop the foundation for secure moral thought
Learning Right and Wrong: Toddlers
Learn that good behavior is rewarded, and bad behavior is punished
Begin to make choices that are based on an understanding of good and bad
Learning Right and Wrong: Adolescent
Questions existing moral values and his or her relevance to society
Becomes more aware of contradictions in adults’ value systems
Learning Right and Wrong: Adult
Strives to make sense of the contradictions and learns to develop own set of morals and values
Begins to make choices that are based on an internalized set of principles
Values clarification:
A process where people reflect on their values and how they fit into the bigger picture.
Moral development
Developing a worldview and value system through an ongoing, evolving process.
RNs cannot delegate:
- Initial and ongoing assessments requiring nursing knowledge and skill.
- Determining nursing diagnoses.
- Setting nursing care goals.
- Creating a nursing care plan.
- Evaluating patient progress.
- Education
- Activities needing specialized nursing knowledge and skill.
UAP capabilities
no activity that requires nursing judgement. (i.e. assessing, teaching, evaluation, or administering meds)
Can collect, report, and document simple data
Can do simple, repeitive tasks (i.e. ADL’s, hygiene, feeding, and ambulation)
Can collect I/Os, specimen collection, & vital signs on stable patients
LPN capabilities
Cannot initially assess, initially teach, or evaluate any client
Cannot delegate the care of an unstable client
Can reinforce client teaching
Can give some but not all medications
Can do Trach care, suctioning, insert urinary catheters, and administration of enteral feedings
LPN can
data collect, monitor, observe
administer IVPB medication
Monitor transfusion of blood products
Administer topical, PO, or IM pain medications
Administer meds and nutrition via NG tube, G-tube or button, J-tube
Insert, maintain, & remove NG tubes and urinary catheters
Maintain & remove peripheral IV catheters
Calculate and monitor IV flow rate
LPNs cant:
Administer IV push medication
Initiate transfusion of blood products
Administer IVP pain medications
Administer meds & nutrition via central line (no TPN)
Safe delegation practices
Develop a foundation of knowledge (i.e., nurse practice act, policies, standards of care, competencies, etc…)
Know the patient
Know the staff member and his/her skills & competencies
Know the task
Explain tasks and expected outcomes
Expect responsible action
Assess and supervise
Evaluate and follow-up
5 Rights of Delegation
- Right task: delegated tasks must conform to established guidelines
- Right circumstances: delegated tasks do not require independent nursing judgment
- Right person: one who is qualified and competent
- Right direction and communication: clear explanation about the task and outcomes and when the delegatee should report back to the RN
- Right supervision and evaluation: feedback to assess and improve the process; evaluate patient outcomes
Assignment Considerations
Assigning groups of clients to various care providers, including AP and LPNs/LVNs is not appropriate
AP assignments include functions and tasks
LPNs/LVNs may be assigned specific clients for which to perform care, but RNs remain responsible for all nursing practice activities
RN responsible for assignments made to nursing personnel should consider:
patient’s physiologic status and complexity of care
infection control or cross-contamination issues
level of supervision required
staff development opportunities such as assigning a less experienced nurse to a more complex patient with an increased level of supervision
Nurse Practice Act
Will provide guidance for legal delegation
State board of nursing may offer guidance
RN should understand the legal scope of practice for an LPN/LVN
Practice by AP is generally governed by the health care organization’s standards
Supervision
the active process of directing, guiding, and influencing the outcome of a worker’s performance
On-site supervision
the nurse is physically present or is immediately available while the activity is being performed
Off-site supervision
the nurse has the ability to provide direction through written, verbal, and electronic communication
What situations can be unsupervised?
One RN works with another RN in a collegial relationship
Neither RN is in the position of supervising the other
Initial direction/periodic inspection
RN is supervising a licensed or unlicensed caregiver
Knows the individual’s training and competencies
Has developed a working relationship with the individual
Continuous supervision
RN has determined that the delegatee will need very frequent to continual support and assistance
Examples of Stable Clients
Post-op client being discharged with no family
Client with COPD, stable vitals, and uses O2
Diabetic with a wound, stable blood sugar, taking medications as ordered
Client with neurological problems, stable vital signs, no change in LOC/neuro checks
Client with dehydration, stable electrolytes, appropriate urine output, and improving hydration status
Client with chronic hypertension, history of angina controlled with meds & lives alone
Client with HIV+, medication compliance and works full time
Client with history of cancer in remission and young children in home
Client with history of stroke, paresthesias, and rehab equipment
Examples of Unstable Clients
New admission
Neuro checks suddenly change
Diabetic with low blood sugar
Client returning from an invasive procedure
Client with acid-base imbalance and respiratory distress with unstable vital signs
Client with syncope and chest pain
Client with recent 2nd & 3rd degree burns
Client with infectious diseases - new onset
Client with multiple IV fluids & meds, plus lab & vital sign changes
Prioritization Factors
Acute vs Chronic
ABC’s
Maslow’s Hierarchy of Needs
Urgent vs Nonurgent
Survival Potential
Maslow’s Hierarchy of Needs
1.Physiological Needs: air, water, food, shelter, clothing, etc.
- Safety Needs: personal security, employment, resources, health, property
- Love and Belonging: friendship, intimacy, family, sense of connection
- Esteem: respect, self-esteem, status, recognition, strength, freedom
- Self actualization: desire to become the most that one can be; achieving one’s full potential including creative activites
Triage Class: Emergent/ Immediate
Red; Highest priority is given to clients who have life-threatening injuries but also have a high possibility of survival once they are stabilized; tx w/in 1 hr
Triage Class: Urgent/ Delayed
Yellow; Second highest priority is given to clients who have major injuries that are not yet life-threatening and can usually wait 30 minutes to 2 hours for tx
Triage Class: Nonurgent/ Minimal
Green; 3rd priority is given to clients who have minor injuries that are not life-threatening and do not need immediate attention
Triage Class: Expectant
Black; The lowest priority is given to clients who are not expected to live and are allowed to die naturally. Comfort measures can be provided, but restorative care is not
Prioritizing Questions
Is the situation life-threatening or life-altering? If yes, this client is the highest priority.
*Is the situation unexpected for the disease process? If yes, then this client may be priority.
*Is the data presented abnormal? If yes, then this client may be priority?
*Is the situation expected for the disease process and not life threatening? If yes, then this client may be but probably is not priority.
*Is the situation/data normal? If yes, this client can be seen last
Federal Policies That Shaped Nursing Practice
Nurse practice acts and registration of nurses (implemented in most states by 1910)
Sheppard-Towner Act (1921)
Hill-Burton Act (1950)
Medicare program (1965)
Renal disease program (1972)
Diagnosis-related groups (DRGs) (1983)
Patient Protection and Affordable Care Act (2010
Nurse Practice Acts and Registration of Nurses
State laws regulate nursing practice, define its scope, set education and licensure requirements, and ensure nurses meet care standards, protecting the public by ensuring only qualified individuals practice.
Sheppard-Towner Act (1921)
Federal law providing funds for maternal and infant health services to reduce mortality rates.
Hill-Burton Act (1950)
Provided federal funding for hospital construction and modernization particularly in underserved areas and required free or reduced-cost care for the uninsured.
Medicare program (1965)
A federal health insurance program for individuals aged 65 and older and disabled populations
provides funding for hospital care (Part A), medical services (Part B), and prescription drug coverage (Part D)
Renal disease program (1972)
Medicare coverage for individuals with end-stage renal disease, including dialysis and transplants. .
Diagnosis-related groups (DRGs) (1983)
Medicare system categorizing hospital cases to control costs by providing fixed payments per diagnosis.
Patient Protection and Affordable Care Act (2010
Healthcare reform law expanding access, reducing costs, and improving care quality, with a focus on insurance coverage and preventive services.
Examples of Local Health Policy
Free or reduced-rate immunizations
Tobacco-free public buildings
Safe drinking water
Provision of an emergency medical system
Examples of State Health Policy
Governs nursing through nurse practice act
Ensures safe food storage and preparation in restaurants
Regulates healthcare facilities
Pays for healthcare services through Medicaid
Examples of Federal Health Policy
Funds health-related research
Funds education for health professionals, including nurses and physicians
Pays for health care through Medicare, Medicaid, SCHIP, and the Veterans Administration health care system
Plays a monumental role in shaping nursing practice
Passage of the Patient Protection and Affordable Care Act (PPACA) (2010)
Health Policy Purpose?
Set course of action taken by governments or health care organizations to obtain desired health outcome
Private Health Policy
made by health care organizations such as hospitals and managed care organizations
Public Health Policy
Refers to laws, regulations, and court rulings that govern healthcare practices at local, state, and federal levels.
Health Policy Development; Who does it include?
Enactment of legislation and accompanying rules and regulations that carry the weight of law
Administrative decisions made by various governmental agencies
Judicial decisions that interpret the law
Involves numerous individuals and groups:
Elected officials & governmental agency officials
Experts in the related area
Stakeholders such as corporate representatives
Representatives from special interest groups
Other affected citizens
Involves all three branches of government
Care Delivery Models
Describes how tasks, responsibilities, and authority are assigned to ensure effective patient care, matching caregiver roles to patient needs in a cost-effective way.
Total Patient Care
Nurse is responsible for planning, organizing, and performing all patient care during the assigned shift
1.Background
2.. Oldest method of organizing patient care, sometimes referred to as case nursing
- Nursing student typically performs total patient care for assigned patients
Functional Nursing
Staff members are assigned to complete certain tasks for a group of patients rather than care for specific patients
Functional Nursing: Lines of Responsibility and Accountability
1.RN nurse manager assigns responsibility for completion of tasks to a group of health care workers
2.RN is responsible for planning care and supervising workers
3.RN retains accountability for the patient care provided
Team Nursing
RN functions as a team leader and coordinates care for a small group of patients
Team Nursing: Lines of Responsibility and Accountability
RN team leader is responsible for the following:
1.Planning care
2.Assigning duties
3.Directing, supervising, and assisting team members
4.Giving direct care
5.RN retains accountability for all patient care
6.RN team leader is responsible for encouraging a cooperative environment and maintaining clear communication
Primary Nursing
RN “primary” nurse assumes 24-hour responsibility for planning, directing, and evaluating the patient’s care from admission through discharge
Provides total patient care while on duty
While off duty, care is provided by an associate nurse, who follows the care plan established by the primary nurse
Modular Nursing
Modification of team nursing
1.Patient unit divided into modules; same team of caregivers assigned consistently to same geographic location
2.Each location or module has RN as team leader
3.Goal is to increase the involvement of the RN in planning and coordinating care
4.Designated modules should contain all the supplies needed by the staff to maximize efficiency
Partnership Model (Co-primary nursing)
RN is partnered with an LPN/LVN or a nursing assistant; pair work together consistently
1.Modification of primary nursing designed to ensure more efficient use of RN
2.Lines of responsibility and accountability
3.RN responsible for planning care, assigning duties, coordinating care, and supervising the partner
4.RN is accountable for patient care for all assigned patients
Purpose of Case Management
Collaborative approach to:
1.provide and coordinate health care services
2.identify and facilitate options and services for meeting health needs
3.decrease fragmentation and duplication of care
4.enhance quality, cost-effective clinical outcomes
5.Nurse case manager “manages” a “case load” of patients from preadmission (onset of illness) to discharge (resolution of illness)
Case Management & Other Nursing Care Delivery Models
Supplemental form of nursing care that does not replace the nursing care delivery model already in place to provide direct patient care
RN case manager assumes a planning and evaluative role and usually is not responsible for direct care duties
Case management is generally reserved for the chronically ill; the seriously ill or injured; and long-term, high-cost cases
Newer Models of Case Management
Newer models are emerging because of health care reform and the need to move patients to less costly home and community care settings
-Patient Navigators
-Transitional Care RN
Patient Navigators
help people “navigate” the complex health care system (physicians, clinics, hospitals, outpatient centers, insurance and payment systems, patient-support organizations, etc.)
Transitional Care RN
facilitate effective transitions for chronically ill patients to ensure good communication across settings and providers, appropriate follow-up, clear understanding of prescribed medications, assistance with referrals, and encouraging patients and families to take an active role in their health care
Patient-Centered Care
Definition by IOM (2001) “Providing care that is respectful of & responsive to individual patient preferences, needs, and values and ensuring that patient values guide all clinical decisions”
health professionals ensure that health care decisions respect patients’ wants, needs, and preferences
Not a nursing care delivery model but a philosophy of care that is an essential component of any nursing care delivery model
Methods to Engage patients, families, and significant others as partners in care
Include them in developing care plans and discharge plans
Include them in change-of-shift or handoff reports
Provide them with the information and education needed to make informed decisions
Establish “family advisory councils” to engage patients and families in decision making
Patient Acuity
Indication of the severity of the patient’s illness and the amount and complexity of nursing care required; high acuity indicates a need for more intense, complex nursing care, and lower acuity indicates a need for moderate, less complex nursing care.
Clinical Pathways
Delineates a predetermined written plan of care for a particular health problem
Specifies desired outcomes and the interdisciplinary intervention required within a specified period for a particular diagnosis or health problem
Written to address common medical diagnoses such as heart failure and pneumonia, common nursing care needs such as immobility, and medical complications such as weaning from mechanical ventilation
Essential Components of Clinical Pathways
Physical assessment guidelines
Laboratory and diagnostic tests
Medications and procedures
Safety and self-care activities
Nutrition
Patient and family education needs
Discharge planning
May address triggers—potential or actual variations in the patient’s response to the planned interventions
