The control framework reveals a critical juncture in patient care where a nurse must integrate evidence-based practice with a patient’s unique needs and risk factors to develop an effective infection prevention care plan. This scenario is professionally challenging because it requires the nurse to move beyond simply applying general guidelines to actively assessing individual patient vulnerabilities and tailoring interventions accordingly. The pressure to act swiftly while ensuring the plan is both evidence-based and personalized necessitates careful judgment. The best approach involves a comprehensive risk assessment that systematically identifies potential sources of infection specific to the patient’s condition, environment, and treatment regimen. This includes evaluating factors such as immunocompromise, presence of invasive devices, mobility status, and potential for pathogen transmission within the healthcare setting. By prioritizing interventions based on the identified risks and the strength of evidence supporting their efficacy, the nurse ensures that resources are allocated most effectively to prevent infection. This aligns with the ethical imperative to provide competent and individualized care, as well as regulatory expectations that healthcare providers utilize best practices to safeguard patient well-being and prevent healthcare-associated infections. An approach that relies solely on generalized infection prevention protocols without a specific patient risk assessment fails to address the unique vulnerabilities of the individual. This can lead to the omission of critical, targeted interventions or the implementation of unnecessary measures, thus not optimizing patient safety and potentially violating the principle of providing care that is both effective and appropriate to the patient’s circumstances. Another unacceptable approach is to prioritize interventions based on anecdotal experience or tradition rather than current evidence. While experience is valuable, it must be grounded in scientific findings. Relying on outdated or unproven methods can expose patients to preventable infections and contravenes the core tenets of evidence-based practice, which mandates the use of the most reliable and up-to-date knowledge. Furthermore, an approach that neglects to involve the patient or their family in the care planning process, where appropriate, is ethically deficient. Patient-centered care requires collaboration and shared decision-making, ensuring that the plan is not only clinically sound but also acceptable and feasible for the patient to adhere to. The professional reasoning process for such situations should begin with a thorough understanding of the patient’s clinical presentation and history. This is followed by a systematic review of evidence-based guidelines relevant to the patient’s condition and potential infection risks. The nurse then conducts a personalized risk assessment, integrating the general evidence with the patient’s specific factors. Based on this comprehensive evaluation, the nurse develops a prioritized, individualized care plan, which is then communicated and, where appropriate, collaboratively refined with the patient and their healthcare team.

Scenario Analysis: This scenario is professionally challenging because it requires the nurse to balance the immediate need for infection control with the ethical and legal obligations to respect patient autonomy and privacy, particularly when dealing with vulnerable populations like children. The nurse must navigate potential conflicts between parental consent, the child’s evolving capacity for assent, and the public health imperative to prevent infectious disease spread. Accurate and timely diagnostic assessment is crucial for effective intervention, but the methods employed must be both clinically sound and ethically defensible. Correct Approach Analysis: The best professional practice involves a comprehensive assessment that integrates clinical findings with an understanding of the patient’s developmental stage and capacity for assent. This approach prioritizes obtaining informed consent from the parent or legal guardian while simultaneously engaging the child in an age-appropriate manner to explain procedures and seek their agreement. This respects both legal requirements for consent and the ethical principle of beneficence by ensuring the child’s well-being and understanding. It aligns with nursing standards of care that emphasize patient-centered care and the importance of shared decision-making across the lifespan. Regulatory frameworks governing pediatric care and infection control mandate that interventions are performed with appropriate consent and consideration for the patient’s developmental level. Incorrect Approaches Analysis: One incorrect approach involves proceeding with diagnostic testing solely based on parental consent without any attempt to involve the child, even if they are of an age where they can comprehend the situation. This fails to acknowledge the evolving autonomy of children and can undermine trust and cooperation, potentially leading to resistance and distress. Ethically, it neglects the principle of respect for persons, which extends to children’s right to be informed and have their assent considered. Another incorrect approach is to delay necessary diagnostic testing due to an overly rigid interpretation of parental consent, especially in situations where there is a clear and present risk of infectious disease transmission. This could jeopardize the health of the child and others, violating the nurse’s duty to protect public health and act in the best interest of the patient. It prioritizes a procedural aspect of consent over the critical need for timely intervention. A third incorrect approach is to proceed with diagnostic testing without obtaining any consent, relying solely on the perceived urgency of the situation. This is a significant ethical and legal violation, infringing upon the patient’s right to bodily integrity and autonomy. It bypasses established legal requirements for consent for medical procedures and exposes the healthcare provider and institution to legal repercussions. Professional Reasoning: Professionals should employ a decision-making framework that begins with a thorough risk assessment for the patient and the community. This assessment should then inform the approach to consent, considering the patient’s age, developmental stage, and capacity. The nurse should always strive for shared decision-making, involving parents or guardians and, where appropriate, the patient themselves. When faced with potential conflicts, the nurse should consult with colleagues, supervisors, or ethics committees to ensure adherence to best practices and legal requirements. Documentation of the assessment, consent process, and rationale for decisions is paramount.

Scenario Analysis: This scenario is professionally challenging because it requires a nurse to navigate the complex requirements for professional licensure and global recognition of their qualifications. Misunderstanding the purpose and eligibility criteria for an examination like the Applied Global Infection Prevention Nursing Licensure Examination can lead to wasted resources, professional delays, and potentially practicing without appropriate authorization, which carries significant ethical and legal ramifications. Careful judgment is required to ensure alignment with the examination’s stated objectives and the applicant’s professional standing. Correct Approach Analysis: The approach that represents best professional practice involves thoroughly researching the official documentation and stated purpose of the Applied Global Infection Prevention Nursing Licensure Examination. This includes identifying the target audience, the specific competencies it aims to assess, and the defined eligibility pathways. For a nurse seeking to demonstrate their expertise in infection prevention on a global scale, understanding that this examination is designed to validate a standardized level of knowledge and skill for international practice is paramount. Adhering to the stated eligibility criteria, which are established to ensure candidates possess the foundational nursing education and relevant experience necessary to undertake advanced infection prevention practice, is the only ethically and legally sound path. This approach directly aligns with the examination’s purpose of promoting consistent, high-quality infection prevention practices worldwide. Incorrect Approaches Analysis: Pursuing the examination solely based on a colleague’s recommendation without verifying the official eligibility requirements is professionally unacceptable. This approach bypasses the crucial step of confirming personal suitability according to the examination’s governing body, potentially leading to an application being rejected or, worse, practicing with an invalid credential. It fails to acknowledge the formal, regulated nature of licensure. Assuming that any nursing license automatically qualifies an individual for a specialized global examination is also professionally unsound. Licensure requirements vary significantly by jurisdiction and specialty. Global examinations often have specific prerequisites related to education, experience, and sometimes even prior certifications that a general nursing license may not fulfill. This approach ignores the distinct purpose of specialized global assessments. Focusing only on the perceived prestige or career advancement opportunities associated with the examination, without first confirming eligibility, demonstrates a disregard for the foundational requirements of professional licensure. While career advancement is a valid motivation, it cannot supersede the necessity of meeting the established criteria for taking the examination. This approach prioritizes personal ambition over regulatory compliance and ethical practice. Professional Reasoning: Professionals should adopt a systematic approach when considering specialized licensure examinations. This involves: 1. Identifying the examination’s official governing body and its stated purpose. 2. Thoroughly reviewing all published eligibility criteria, including educational prerequisites, required experience, and any necessary documentation. 3. Self-assessing against these criteria to determine suitability. 4. Consulting official resources or examination administrators for clarification if any aspect of the requirements is unclear. 5. Proceeding with the application process only after confirming that all eligibility requirements are met. This structured approach ensures adherence to regulatory frameworks and ethical standards, safeguarding both the individual professional and the public.

Scenario Analysis: This scenario is professionally challenging because it requires the nurse to balance immediate patient needs with the broader mandate of infection prevention within a healthcare setting. The pressure to provide care can sometimes conflict with the systematic implementation of infection control protocols, especially when resources are strained or when staff are fatigued. Careful judgment is required to ensure that individual patient care does not inadvertently compromise the safety of other patients or staff. Correct Approach Analysis: The best professional practice involves a systematic, evidence-based approach to risk assessment that prioritizes the identification and mitigation of potential infection transmission pathways. This approach involves a comprehensive review of the patient’s condition, potential sources of infection, the environment, and the practices of healthcare personnel. It aligns with core principles of infection prevention and control, which emphasize proactive identification of risks and the implementation of targeted interventions to break the chain of infection. Regulatory frameworks and professional guidelines consistently advocate for such a structured and proactive methodology to safeguard patient and staff safety. Incorrect Approaches Analysis: One incorrect approach involves solely focusing on the immediate symptoms of the patient without considering the broader context of potential transmission. This failure to conduct a comprehensive risk assessment overlooks potential environmental or staff-related factors that could contribute to infection spread, violating the principle of holistic patient and population safety. Another unacceptable approach is to rely solely on anecdotal evidence or past experiences without consulting current evidence-based guidelines or conducting a formal risk assessment. This can lead to outdated or ineffective interventions, potentially increasing the risk of transmission and failing to meet professional standards of care. A further incorrect approach is to delegate the entire risk assessment process to junior staff without adequate supervision or validation. While delegation is a part of nursing practice, the ultimate responsibility for ensuring a thorough and accurate risk assessment rests with the licensed professional, and failing to oversee this critical process can lead to significant oversights and breaches of professional duty. Professional Reasoning: Professionals should employ a decision-making framework that begins with a thorough understanding of the patient’s clinical presentation and history. This should be followed by a systematic risk assessment that considers all potential sources of infection, transmission routes, and contributing factors within the healthcare environment. Evidence-based guidelines and institutional protocols should then inform the selection and implementation of appropriate infection prevention and control measures. Regular re-evaluation of the risk assessment and interventions is crucial, especially when patient conditions change or new information becomes available.

Performance analysis shows a candidate has failed the Applied Global Infection Prevention Nursing Licensure Examination twice. This scenario is professionally challenging because it requires a delicate balance between upholding licensure standards, ensuring public safety, and providing compassionate support to the candidate. The examination’s blueprint weighting, scoring, and retake policies are designed to ensure competency, but repeated failure necessitates a deeper investigation beyond simply retesting. Careful judgment is required to determine the most appropriate next steps, considering both the candidate’s potential and the integrity of the profession. The best professional approach involves a comprehensive review of the candidate’s performance data in conjunction with an exploration of available remediation resources. This approach acknowledges that repeated failure may stem from various factors beyond a lack of knowledge, such as test anxiety, learning style mismatches, or gaps in practical application. By analyzing the specific areas of weakness identified in the blueprint weighting and scoring, and then recommending targeted educational interventions or mentorship, the candidate is given a structured pathway to address their deficiencies. This aligns with the ethical principle of beneficence, aiming to help the candidate succeed while maintaining professional standards. Furthermore, it respects the established retake policies by ensuring that any subsequent attempts are made with improved preparedness. An incorrect approach would be to immediately deny further examination attempts without a thorough review. This fails to consider the possibility of underlying issues that could be addressed through remediation and may be perceived as punitive rather than supportive. It also overlooks the ethical obligation to assist individuals in achieving professional competence when feasible. Another incorrect approach is to allow immediate retesting without any form of intervention or analysis of previous performance. This disregards the purpose of the retake policy, which is to allow for improvement after identifying and addressing weaknesses. It risks the candidate repeatedly failing without gaining the necessary skills or knowledge, potentially compromising patient safety if they were to be licensed without adequate preparation. Finally, an incorrect approach would be to suggest that the candidate pursue an entirely different career path solely based on two failed attempts, without exploring any supportive or remedial options. This is premature and lacks the ethical consideration of providing opportunities for growth and development within the profession. It fails to acknowledge that licensure examinations are designed to be challenging and that support systems are often in place to help candidates overcome obstacles. The professional decision-making process for similar situations should involve a systematic evaluation of the candidate’s performance data, consultation with examination board guidelines, and consideration of ethical principles. This includes understanding the specific weighting of different content areas within the blueprint, how scoring reflects mastery, and the established retake policies. When a candidate struggles, the focus should shift from mere assessment to a supportive intervention strategy that aims to enhance their competence and readiness for licensure.

This scenario is professionally challenging because it requires the candidate to balance the need for comprehensive preparation with the practical constraints of time and available resources, all while adhering to the standards expected for licensure. The pressure to pass the Applied Global Infection Prevention Nursing Licensure Examination necessitates a strategic approach to studying that is both effective and efficient. Careful judgment is required to select preparation methods that are evidence-based and aligned with the examination’s scope and objectives, rather than relying on anecdotal advice or less structured methods. The best approach involves a structured, multi-modal preparation strategy that prioritizes official examination blueprints and reputable, evidence-based resources. This includes dedicating specific time blocks for reviewing core infection prevention principles, practicing with sample questions that mirror the examination’s format and difficulty, and engaging in active recall techniques. This approach is correct because it directly addresses the examination’s stated requirements and is supported by best practices in adult learning and professional development. It ensures that the candidate is not only familiar with the content but also with the application of that knowledge in a testing environment, aligning with the ethical obligation to be competent and prepared for professional practice. Relying solely on informal study groups without verifying the accuracy or relevance of the information shared is professionally unacceptable. This approach risks exposure to outdated or incorrect information, which could lead to a failure to meet the examination’s standards and potentially compromise patient safety upon licensure. It also bypasses the critical step of independently validating knowledge against authoritative sources. Focusing exclusively on memorizing facts without understanding the underlying principles or their application in clinical scenarios is also professionally unsound. Licensure examinations typically assess the ability to apply knowledge, not just recall it. This method fails to develop the critical thinking skills necessary for effective infection prevention in real-world settings and neglects the ethical imperative to practice with a deep understanding of the subject matter. Waiting until the last few weeks before the examination to begin intensive study is a high-risk strategy that is professionally inadvisable. This approach does not allow for adequate assimilation of complex information, reinforcement of learning through spaced repetition, or sufficient practice with examination-style questions. It creates undue stress and increases the likelihood of superficial learning, which is ethically problematic as it suggests a lack of commitment to thorough preparation for a role that impacts public health. Professionals should approach licensure preparation by first thoroughly reviewing the official examination blueprint and any provided study guides. They should then create a realistic study schedule that incorporates a variety of learning methods, such as reading authoritative texts, reviewing guidelines from recognized infection prevention organizations, utilizing practice question banks, and engaging in self-testing and concept mapping. Regular self-assessment of knowledge gaps and adjustment of the study plan are crucial. This systematic and evidence-informed process ensures comprehensive preparation and upholds the professional responsibility to be competent and ready to practice.

Scenario Analysis: This scenario is professionally challenging because it requires the nurse to balance immediate patient needs with the potential for widespread transmission of a highly contagious pathogen. The decision-making process must be informed by an understanding of the pathophysiology of the infection, the patient’s clinical presentation, and the established protocols for infection prevention, all while considering the ethical imperative to protect both the individual patient and the wider community. Failure to accurately assess the risk and implement appropriate measures can have severe consequences, including patient harm and outbreaks. Correct Approach Analysis: The best professional practice involves a systematic, pathophysiology-informed risk assessment that prioritizes immediate patient safety and containment. This approach begins with recognizing the signs and symptoms suggestive of a highly transmissible infection, understanding the likely routes of transmission based on the pathogen’s characteristics (e.g., airborne, droplet, contact), and immediately implementing appropriate personal protective equipment (PPE) and isolation precautions. This aligns with fundamental principles of infection control and public health mandates to prevent the spread of communicable diseases, ensuring that patient care is delivered in a manner that minimizes risk to healthcare workers and other patients. The ethical duty of beneficence (acting in the patient’s best interest) and non-maleficence (avoiding harm) are directly addressed by prompt and accurate risk assessment and intervention. Incorrect Approaches Analysis: Implementing standard precautions only, without considering the specific signs and symptoms that suggest a higher risk of transmission, is a significant ethical and regulatory failure. Standard precautions are a baseline, but when clinical indicators point towards a potentially more virulent or transmissible pathogen, they are insufficient. This approach neglects the pathophysiology-informed aspect of risk assessment, potentially leading to inadequate containment and transmission to others. Delaying isolation and PPE until a definitive diagnosis is confirmed, while understandable from a resource management perspective, poses a grave risk. The pathophysiology of many highly infectious agents means that transmission can occur before definitive diagnostic results are available. This delay violates the principle of acting proactively to prevent harm and can lead to breaches in infection control, which are subject to regulatory scrutiny and ethical condemnation for failing to protect vulnerable populations. Focusing solely on the patient’s comfort without adequately assessing and mitigating the infectious risk is a failure of professional duty. While patient comfort is important, it cannot supersede the responsibility to prevent the spread of potentially dangerous pathogens. This approach demonstrates a lack of understanding of the broader implications of infectious disease management within a healthcare setting and disregards the ethical obligation to protect the community. Professional Reasoning: Professionals should employ a tiered approach to risk assessment. First, recognize clinical cues that deviate from the norm and suggest a potential infectious etiology. Second, consider the likely pathophysiology and transmission routes of suspected pathogens. Third, consult established infection prevention guidelines and institutional protocols. Fourth, implement the most stringent precautions indicated by the initial assessment, erring on the side of caution, and then de-escalate as diagnostic information becomes available and confirms a lower risk. This systematic process ensures that patient care is both effective and safe for all involved.

The audit findings indicate a potential gap in the facility’s infection prevention protocols, specifically concerning the systematic identification and mitigation of risks associated with patient care. This scenario is professionally challenging because it requires the nurse to move beyond routine tasks and engage in proactive, evidence-based risk assessment to ensure patient safety and compliance with established standards. A failure to adequately assess and address risks can lead to preventable healthcare-associated infections (HAIs), patient harm, and regulatory non-compliance. The best approach involves a comprehensive, multi-faceted risk assessment that systematically evaluates potential hazards, their likelihood, and their impact within the specific context of the facility’s operations and patient population. This includes reviewing existing data, identifying high-risk procedures or patient groups, and considering environmental factors. This approach is correct because it aligns with the fundamental principles of infection prevention and control, which mandate a proactive and systematic process for identifying and managing risks. Regulatory frameworks, such as those promoted by the Centers for Disease Control and Prevention (CDC) and professional nursing organizations, emphasize the importance of risk assessment as a cornerstone of effective infection prevention programs. Ethically, nurses have a duty to protect patients from harm, and a thorough risk assessment is a critical component of fulfilling this obligation. An approach that focuses solely on addressing immediate, reported incidents without a broader risk assessment framework is incorrect. This reactive strategy fails to identify underlying systemic issues or potential future risks, leading to a cycle of addressing problems after they have occurred rather than preventing them. This is a regulatory failure as it does not demonstrate a commitment to a comprehensive infection prevention program as often required by accrediting bodies and public health agencies. Another incorrect approach is to rely exclusively on anecdotal evidence or the opinions of a few staff members without systematic data collection or analysis. While staff experience is valuable, it is not a substitute for a structured risk assessment process that considers objective data, epidemiological trends, and established best practices. This approach risks overlooking significant risks that may not be immediately apparent through informal observation and can lead to biased decision-making, which is ethically problematic as it may not serve the best interests of all patients. Finally, an approach that prioritizes cost-saving measures over robust infection prevention measures, even if seemingly efficient, is fundamentally flawed. While resource management is important, compromising on infection prevention can lead to increased costs associated with treating HAIs, extended hospital stays, and potential legal liabilities. This is a significant ethical and regulatory failure, as patient safety must always be the paramount concern, and cost-cutting should never come at the expense of effective infection control. Professionals should employ a decision-making framework that begins with understanding the regulatory and ethical imperatives of infection prevention. This involves actively seeking out and understanding relevant guidelines and standards. Next, they should adopt a systematic approach to data gathering and analysis, utilizing both quantitative and qualitative information. This framework encourages a proactive mindset, emphasizing the identification and mitigation of risks before they manifest as patient harm. Regular review and re-evaluation of risk assessments are also crucial to adapt to changing circumstances and emerging threats.

Scenario Analysis: This scenario is professionally challenging because it involves a vulnerable patient with potential cognitive impairment, requiring a nuanced approach to medication safety. The nurse must balance the patient’s right to autonomy with the imperative to prevent harm, especially when a significant medication error has occurred. The potential for adverse drug events, patient distress, and erosion of trust necessitates careful, evidence-based, and ethically sound decision-making. Correct Approach Analysis: The best professional practice involves a comprehensive, patient-centered risk assessment that prioritizes immediate patient safety and then systematically addresses the medication error. This approach begins with a thorough evaluation of the patient’s current condition, including vital signs, level of consciousness, and any immediate signs of adverse effects from the incorrect medication. Simultaneously, the nurse must gather all relevant information about the medication error itself – the drug administered, the dose, the route, the time, and the intended drug and dose. This information is crucial for informing subsequent interventions, such as contacting the prescriber for revised orders, administering antidotes if necessary, and initiating monitoring protocols. This approach aligns with the fundamental ethical principles of beneficence (acting in the patient’s best interest) and non-maleficence (avoiding harm). It also adheres to professional nursing standards that mandate accurate medication administration, vigilant monitoring, and prompt reporting of errors to ensure patient well-being and facilitate system improvements. Incorrect Approaches Analysis: One incorrect approach involves immediately documenting the error and awaiting further instructions without assessing the patient’s immediate clinical status. This fails to uphold the principle of beneficence, as it delays potentially life-saving interventions and neglects the immediate need to ascertain and mitigate harm. It also falls short of professional accountability, which requires proactive patient care. Another incorrect approach is to administer the correct medication as prescribed without first assessing the patient for any adverse effects from the incorrect medication and without informing the prescriber of the error. This approach risks masking or exacerbating existing problems and bypasses essential communication channels designed to ensure patient safety and appropriate clinical management. It violates the principle of non-maleficence by potentially allowing harm to continue unaddressed. A third incorrect approach is to focus solely on reporting the error to the pharmacy and administration without directly assessing the patient or communicating with the prescriber. While reporting is important for quality improvement, it is insufficient as a primary response when a patient’s immediate safety is at risk. This approach prioritizes administrative processes over direct patient care and fails to fulfill the nurse’s primary responsibility to the patient. Professional Reasoning: Professionals should employ a systematic decision-making process that begins with a rapid assessment of the patient’s immediate safety and clinical status. This should be followed by a thorough investigation of the error, clear communication with the prescriber and other relevant healthcare professionals, and implementation of appropriate interventions. Documentation and reporting are critical but should follow the immediate stabilization and assessment of the patient. This framework ensures that patient well-being remains the paramount concern throughout the management of a medication error.

Scenario Analysis: This scenario is professionally challenging because it involves a critical patient safety issue stemming from a potential breakdown in interprofessional communication and delegation. The nurse manager must balance the immediate need to address the patient’s deteriorating condition with the established protocols for reporting and escalation, while also considering the impact on team dynamics and patient outcomes. Failure to act decisively and appropriately could have severe consequences for the patient and expose the healthcare facility to regulatory scrutiny. Correct Approach Analysis: The best professional approach involves the nurse manager immediately initiating a direct, respectful, and assertive conversation with the physician to clarify the order and express concerns about the patient’s status. This approach is correct because it prioritizes patient safety by directly addressing the potential medication error and its implications. It aligns with ethical principles of beneficence and non-maleficence, ensuring the patient receives appropriate care and is protected from harm. Furthermore, it upholds professional standards of interprofessional communication, which emphasize clear, timely, and collaborative dialogue to resolve patient care issues. This direct communication also respects the physician’s role while ensuring the nurse’s professional responsibility to advocate for the patient is met. Incorrect Approaches Analysis: One incorrect approach involves the nurse manager immediately contacting the hospital’s risk management department without first attempting to clarify the order with the physician. This fails to address the immediate patient safety concern in a timely manner and bypasses the established chain of command for resolving clinical discrepancies. It can lead to delays in appropriate patient care and may be perceived as undermining the physician-physician relationship without attempting collaborative problem-solving. Another incorrect approach is for the nurse manager to instruct the charge nurse to administer the medication as ordered, assuming the physician knows best. This is professionally unacceptable as it abdicates the nurse manager’s responsibility for patient safety and oversight of nursing practice. It ignores the nurse’s professional judgment and the potential for a serious medication error, violating the ethical duty to advocate for the patient and adhere to safe medication administration practices. A further incorrect approach involves the nurse manager documenting the concern in the patient’s chart and waiting for the physician to review it during rounds. While documentation is important, this approach is insufficient when a patient’s condition is actively deteriorating and a potentially harmful medication order is in question. It creates an unacceptable delay in addressing a critical safety issue and fails to demonstrate proactive leadership in ensuring immediate patient well-being. Professional Reasoning: Professionals should employ a structured decision-making process that prioritizes patient safety. This involves: 1. Recognizing and assessing the potential risk (e.g., medication error, patient deterioration). 2. Utilizing established communication channels and protocols for escalation and clarification. 3. Engaging in direct, assertive, and respectful interprofessional communication to resolve the issue collaboratively. 4. Documenting all actions and communications accurately. 5. If the issue remains unresolved or poses an immediate threat, escalating to the next level of authority or appropriate support services (e.g., supervisor, risk management, ethics committee) as per organizational policy.