Management of Care - Part 2

Overview

Welcome back, everyone! In this session, we’ll break down critical nursing concepts relevant to the NCLEX-RN’s Management of Care section. We’ll explore best practices for documentation, ethical decision-making, prioritization, confidentiality, and performance improvement—all essential for safe, legal, and ethical nursing practice. By the end, you’ll be equipped to reason through complex situations, apply ethical frameworks, and confidently tackle documentation and prioritization questions.

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Concept-by-Concept Deep Dive

Confidentiality and Mandatory Reporting

What it is:
Confidentiality means safeguarding patient information and only disclosing it to those directly involved in care. However, there are exceptions—mandatory reporting laws require nurses to report certain issues (like abuse or communicable diseases) to authorities.

Components:

• HIPAA and Privacy: Know what constitutes protected health information (PHI) and how to avoid inadvertent breaches (e.g., hallway conversations).
• Mandatory Reporting: Understand scenarios where nurses must report information, such as suspected abuse, threats of harm, or specific public health risks.

Reasoning Steps:

1. Assess who is requesting information and their need to know.
2. Distinguish between routine sharing (permitted) versus breaches (not permitted).
3. Identify cases where the law requires breaking confidentiality.
4. Always act according to policies and notify appropriate supervisors if unsure.

Common Misconceptions:

• Thinking that family members are always entitled to information.
• Believing that confidentiality can only be breached with consent—sometimes law overrides consent.
• Discussing patient information in public or semi-public areas.

Fix: Always verify legal and institutional policies before sharing information; when in doubt, err on the side of confidentiality unless a mandatory report is required.

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Prioritization of Care

What it is:
Prioritization involves determining which patient requires immediate attention based on acuity and risk, ensuring the most critical needs are met first.

Components:

• ABC Framework: Airway, Breathing, Circulation—always consider these first.
• Maslow’s Hierarchy: Address physiological needs before psychosocial ones.
• Acute vs. Chronic: Acute, unstable, or new conditions take precedence over stable, chronic issues.
• Assessment vs. Intervention: Sometimes, rapid assessment precedes action.

Step-by-Step Reasoning:

1. Scan all patient scenarios for life-threatening conditions.
2. Identify signs of deterioration or new, severe symptoms.
3. Use ABCs and Maslow to rank needs.
4. Factor in time-sensitivity and risk of harm.

Common Misconceptions:

• Prioritizing based on room order or personal comfort with certain patients.
• Overlooking subtle signs of instability.
• Assuming chronic conditions always need more urgent attention.

Fix: Practice applying ABC and Maslow in every scenario; focus on instability and risk, not convenience.

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Documentation and Approved Terminology

What it is:
Accurate, objective documentation using standardized terms is essential for communication, legal protection, and patient safety.

Components:

• Objective Language: Record only what you observe, not your interpretations.
• Approved Terminology: Use medical terms recognized by your institution—avoid slang or ambiguous phrases.
• Refusals and Incidents: Clearly document patient refusals, actions taken, and any follow-up.

Recipe for Documentation:

1. Write what you see, hear, or measure (e.g., “Patient stated...”, “Vital signs: ...”).
2. Use exact terms for symptoms and conditions.
3. Avoid judgmental, vague, or subjective language.
4. If a patient refuses care, document the refusal, your education about the consequences, and any actions taken.

Common Misconceptions:

• Charting “noncompliant” without context.
• Using nonstandard abbreviations or terms.
• Failing to record patient statements verbatim.

Fix: Stick to facts, approved abbreviations, and direct quotations when relevant.

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Ethical Principles in Nursing

What it is:
Nursing practice is guided by a code of ethics, including principles like autonomy, beneficence, nonmaleficence, justice, and fidelity.

Key Principles:

• Autonomy: Respecting the patient’s right to make decisions.
• Beneficence: Doing good—acting in the patient’s best interest.
• Nonmaleficence: “Do no harm”—avoiding unnecessary harm to patients.
• Justice: Fair and equal treatment for all patients.
• Fidelity: Keeping promises and maintaining trust.

Applying Principles:

1. Identify the ethical dilemma or conflict.
2. Weigh the competing ethical principles.
3. Involve patients and families in decision-making when appropriate.