This scenario presents a professionally challenging situation due to the inherent complexity of managing a patient with a chronic, progressive orthopaedic condition like osteoarthritis, compounded by the emergence of acute symptoms suggestive of infection. The challenge lies in differentiating between exacerbation of the underlying chronic condition and a potentially limb-threatening acute infection, requiring a nuanced clinical judgment that integrates pathophysiological understanding with immediate patient needs and available diagnostic tools. The need for rapid, accurate diagnosis is paramount to prevent irreversible damage and systemic complications, while also avoiding unnecessary and potentially harmful interventions. The best approach involves a systematic, pathophysiology-informed assessment that prioritizes the identification of infection. This begins with a thorough clinical evaluation, including a detailed history focusing on recent changes, pain characteristics, fever, and any signs of local inflammation. This is followed by a targeted physical examination, looking for classic signs of infection such as erythema, warmth, swelling, and purulent drainage, alongside assessing joint range of motion and stability. Crucially, this approach mandates the prompt collection of appropriate diagnostic samples, such as joint fluid for cell count, Gram stain, and culture, and blood cultures, to definitively identify or rule out microbial invasion. This aligns with the ethical principle of beneficence, ensuring that interventions are guided by evidence and aimed at the most critical threat to the patient’s well-being, and the principle of non-maleficence, by avoiding premature or incorrect treatment that could harm the patient. It also adheres to professional standards of care that mandate timely and accurate diagnosis of acute conditions. An incorrect approach would be to solely attribute the new, severe pain and swelling to a flare-up of the patient’s known osteoarthritis without further investigation. This fails to acknowledge the significant pathophysiological differences between chronic degenerative joint disease and acute septic arthritis. Ethically, this constitutes a potential breach of the duty of care by neglecting to investigate a potentially life-threatening condition, thereby violating the principle of non-maleficence. It also represents a failure to adhere to professional standards that require a comprehensive differential diagnosis when new, acute symptoms arise in a patient with a complex medical history. Another incorrect approach would be to immediately initiate broad-spectrum antibiotics based solely on the patient’s report of increased pain and swelling, without obtaining diagnostic samples. While seemingly proactive, this premature administration of antibiotics can obscure the diagnosis by suppressing bacterial growth, making subsequent cultures less sensitive and potentially delaying definitive treatment if the initial antibiotic choice is not optimal. This approach risks violating the principle of beneficence by treating a presumed condition without confirmation, potentially leading to antibiotic resistance and adverse drug reactions, and failing to uphold the principle of non-maleficence by exposing the patient to unnecessary risks. A third incorrect approach would be to delay any significant intervention, including diagnostic sampling, until the patient’s osteoarthritis management plan is reviewed by the orthopaedic specialist, assuming the symptoms are a predictable consequence of the chronic condition. This passive stance ignores the acute nature of the reported symptoms and the rapid progression of septic arthritis. It represents a failure to act with appropriate urgency, potentially leading to severe joint damage, systemic sepsis, and prolonged morbidity, thereby failing to meet the ethical obligation to provide timely and effective care. Professionals should employ a structured decision-making process that begins with recognizing the potential for serious pathology when a patient’s presentation changes acutely. This involves forming a broad differential diagnosis, considering both exacerbations of chronic conditions and new, acute processes. Pathophysiological knowledge is then applied to prioritize the most urgent and potentially harmful diagnoses, such as infection. This leads to the selection of appropriate diagnostic investigations that can rapidly confirm or refute these critical diagnoses. Treatment decisions are then made based on the confirmed diagnosis, always balancing the benefits and risks of interventions, and adhering to established clinical guidelines and ethical principles.

Scenario Analysis: This scenario is professionally challenging due to the inherent complexity of assessing and monitoring orthopaedic conditions across different age groups, each presenting unique physiological, developmental, and psychosocial considerations. The nurse must integrate knowledge of age-specific anatomy and physiology, common orthopaedic pathologies, diagnostic modalities, and the impact of these conditions on functional capacity and quality of life throughout the lifespan. Furthermore, the need to tailor assessment and monitoring strategies to individual patient needs, family involvement, and potential for long-term sequelae requires nuanced clinical judgment and adherence to best practices. Correct Approach Analysis: The best professional approach involves a comprehensive, age-appropriate assessment that integrates subjective patient and family reports with objective physical examination findings and diagnostic data. This approach prioritizes understanding the patient’s current functional status, pain levels, and the impact of the orthopaedic condition on their daily life. It necessitates the systematic collection of data across the lifespan, considering developmental milestones in children, the physiological changes of adulthood, and the comorbidities and functional decline often seen in older adults. This holistic assessment forms the foundation for developing individualized, evidence-based care plans and monitoring progress effectively. Adherence to professional nursing standards and ethical principles, such as beneficence and non-maleficence, mandates this thorough and individualized approach to ensure optimal patient outcomes and safety. Incorrect Approaches Analysis: One incorrect approach would be to rely solely on generic orthopaedic assessment protocols without adapting them to the specific age and developmental stage of the patient. This fails to account for age-specific variations in presentation, pain perception, and the interpretation of diagnostic findings, potentially leading to misdiagnosis or inadequate management. Ethically, this approach breaches the principle of individualized care. Another incorrect approach would be to focus exclusively on the immediate orthopaedic pathology, neglecting the broader impact on the patient’s functional capacity, psychosocial well-being, and potential for long-term complications across their lifespan. This narrow focus overlooks the holistic nature of nursing care and the interconnectedness of physical health with overall quality of life, violating the principle of comprehensive patient care. A third incorrect approach would be to delegate critical assessment and monitoring tasks to less experienced staff without adequate supervision or to assume that diagnostic results alone are sufficient without correlating them with clinical presentation and patient-reported symptoms. This can lead to errors in interpretation, delayed interventions, and compromised patient safety, failing to uphold the professional responsibility for competent and vigilant patient care. Professional Reasoning: Professionals should employ a systematic, patient-centered decision-making process. This begins with a thorough understanding of the patient’s presenting problem and its context within their lifespan. Next, they should identify relevant age-specific assessment parameters and diagnostic tools. Crucially, they must synthesize subjective and objective data to formulate a comprehensive understanding of the patient’s condition and its impact. This understanding then guides the development of an individualized care plan, which includes ongoing monitoring strategies tailored to the patient’s needs and the expected trajectory of their orthopaedic condition. Regular re-evaluation and adaptation of the care plan based on monitoring data and patient response are essential.

Scenario Analysis: This scenario is professionally challenging because it requires the nurse to navigate the specific eligibility criteria for a specialized fellowship examination while also considering the applicant’s personal circumstances and potential impact on their career progression. Misinterpreting or misapplying the eligibility requirements can lead to significant professional consequences for both the applicant and the institution offering the fellowship. Careful judgment is required to ensure fairness, adherence to regulations, and support for professional development. Correct Approach Analysis: The best approach involves a thorough review of the official Applied Mediterranean Orthopaedic Nursing Fellowship Exit Examination eligibility criteria as outlined by the governing body. This includes verifying the applicant’s documented orthopaedic nursing experience, required certifications, and any specific educational prerequisites. The justification for this approach lies in strict adherence to the established regulatory framework for the fellowship. The examination’s purpose is to assess a defined level of specialized knowledge and skill, and eligibility is a gatekeeping mechanism to ensure candidates meet these predefined standards. By focusing solely on the documented criteria, the institution upholds the integrity and validity of the fellowship program. Incorrect Approaches Analysis: One incorrect approach is to grant eligibility based on the applicant’s expressed enthusiasm and perceived potential, without a rigorous check of their documented experience against the fellowship’s specific requirements. This fails to uphold the purpose of the examination, which is to certify a certain level of established competence, not potential. It also risks undermining the credibility of the fellowship by admitting candidates who may not possess the foundational knowledge or experience the examination is designed to assess. Another incorrect approach is to make a decision based on anecdotal evidence or informal recommendations from colleagues about the applicant’s skills, bypassing the formal documentation process. This introduces subjectivity and bias into the eligibility determination, which is contrary to the principles of fair and transparent assessment. The fellowship’s purpose is to evaluate candidates against objective, pre-defined criteria, not subjective opinions. A further incorrect approach is to consider the applicant’s personal financial situation or career urgency as a primary factor in determining eligibility. While compassionate considerations are important in healthcare, the eligibility for a professional fellowship examination is strictly defined by professional qualifications and experience. Allowing personal circumstances to override these criteria would compromise the standardized nature of the assessment and could lead to accusations of favouritism or unfairness. Professional Reasoning: Professionals should employ a systematic decision-making process that prioritizes adherence to established guidelines and regulations. This involves: 1) Clearly identifying the purpose and scope of the examination or program. 2) Thoroughly understanding and documenting all eligibility criteria. 3) Objectively assessing applicants against these criteria using verifiable evidence. 4) Maintaining a clear and documented record of the decision-making process. 5) Seeking clarification from the governing body if any ambiguity exists in the regulations. This structured approach ensures fairness, consistency, and the integrity of professional assessments.

This scenario is professionally challenging because it requires the candidate to navigate the delicate balance between upholding the integrity of the examination process and demonstrating empathy towards a candidate facing personal difficulties. The decision-making process must prioritize fairness, consistency, and adherence to established policies while acknowledging individual circumstances. The best approach involves a thorough review of the examination’s blueprint weighting, scoring, and retake policies, coupled with a clear and documented communication of these policies to the candidate. This ensures that the candidate understands the established framework governing their performance and any subsequent actions. Adhering strictly to the published policies demonstrates fairness and impartiality, which are cornerstones of professional examination administration. It also provides a transparent and objective basis for any decisions made, minimizing the risk of perceived bias. This aligns with the ethical obligation to maintain the credibility and validity of the fellowship examination. An incorrect approach would be to immediately grant a retake without a formal review of the established policies. This bypasses the established procedures and could set a precedent for inconsistent application of rules, undermining the fairness of the examination process for all candidates. It also fails to address the specific requirements of the blueprint weighting and scoring, which are crucial for assessing competency. Another incorrect approach is to dismiss the candidate’s request outright without any consideration or explanation. While adherence to policy is important, a complete lack of empathy or communication can be detrimental to the candidate’s experience and the overall perception of the fellowship program. This approach lacks professionalism and fails to uphold the supportive aspect of professional development. Finally, an incorrect approach would be to offer a modified retake that deviates from the established policy without proper authorization or justification. This introduces subjectivity and inconsistency into the examination process, potentially compromising its validity and fairness. It also fails to provide the candidate with a clear understanding of the standard pathway for addressing performance issues. Professionals should employ a decision-making framework that begins with understanding and applying established policies. This involves consulting the examination blueprint, scoring rubrics, and retake policies. Next, they should engage in clear and empathetic communication with the candidate, explaining the relevant policies and options. Finally, decisions should be documented thoroughly, ensuring transparency and accountability throughout the process.

This scenario presents a professional challenge due to the critical need to balance patient safety, adherence to established protocols, and effective communication within a multidisciplinary team. The monitoring system’s alert signifies a potential deviation from the expected post-operative recovery trajectory, requiring immediate and informed action. Careful judgment is essential to avoid unnecessary alarm while ensuring timely intervention if a genuine complication arises. The best professional approach involves a systematic and evidence-based response. This begins with a thorough assessment of the patient’s current clinical status, correlating the monitoring system’s alert with objective signs and symptoms. This assessment should then be immediately communicated to the responsible orthopaedic surgeon or their designated deputy, providing a clear, concise, and factual report of the findings. This approach is correct because it prioritizes patient safety by directly addressing the potential issue, adheres to established clinical pathways for post-operative monitoring, and upholds the professional responsibility to inform the medical team of significant changes in a patient’s condition. It aligns with ethical principles of beneficence and non-maleficence, ensuring the patient receives appropriate care without delay. Failing to conduct a thorough patient assessment before escalating the alert is an unacceptable approach. This bypasses crucial clinical evaluation, potentially leading to unnecessary anxiety for the patient and the medical team, and misallocation of resources. It neglects the professional duty to gather comprehensive data before initiating further action. Another unacceptable approach is to ignore the monitoring system’s alert, assuming it is a false positive without any verification. This demonstrates a disregard for established safety protocols and could lead to a delayed diagnosis and treatment of a serious complication, directly violating the principle of non-maleficence and potentially causing harm to the patient. Finally, communicating the alert to colleagues without first assessing the patient or informing the responsible surgeon is professionally unsound. While teamwork is vital, the initial responsibility for interpreting and acting upon critical monitoring data lies with the nurse. This approach undermines the chain of command and the structured communication necessary for effective patient care, potentially leading to confusion and fragmented decision-making. Professionals should employ a decision-making framework that begins with recognizing and validating critical alerts. This involves immediate patient assessment, followed by clear and concise communication to the appropriate medical personnel, and then collaborative decision-making regarding further management. This structured approach ensures patient safety, efficient resource utilization, and adherence to professional standards.

The monitoring system demonstrates a candidate for the Applied Mediterranean Orthopaedic Nursing Fellowship Exit Examination exhibiting significant anxiety regarding their preparation resources and timeline. This scenario is professionally challenging because it requires the supervising educator to balance the candidate’s immediate distress with the long-term need for effective, compliant preparation, ensuring the candidate meets the rigorous standards of the fellowship without compromising ethical or regulatory guidelines. The educator must guide the candidate towards a structured and evidence-based approach to preparation, rather than succumbing to panic or relying on unverified methods. The best approach involves a structured review of the candidate’s current preparation, identifying specific knowledge gaps and resource deficiencies, and collaboratively developing a realistic, phased study plan. This plan should prioritize core curriculum areas, incorporate diverse learning modalities (e.g., case studies, simulation, peer review), and allocate dedicated time for revision and practice assessments. This aligns with the ethical imperative to provide adequate support and supervision, ensuring the candidate is prepared to a professional standard. It also implicitly adheres to any implied regulatory framework that mandates competency-based assessment and professional development for advanced nursing roles, ensuring patient safety and quality of care. An incorrect approach would be to immediately recommend a vast array of unvetted online resources or intensive, unstructured cramming sessions. This fails to address the root cause of the anxiety, which may stem from a lack of foundational understanding or poor study habits. It also risks overwhelming the candidate further and could lead to the acquisition of inaccurate or outdated information, potentially violating standards of professional practice that require evidence-based knowledge. Another incorrect approach would be to dismiss the candidate’s concerns as mere nervousness and suggest they simply “study harder” without providing concrete guidance or resources. This demonstrates a lack of empathy and professional responsibility, failing to offer the necessary support for a candidate facing a high-stakes examination. It neglects the educator’s role in facilitating learning and professional growth, potentially leading to burnout or a compromised examination outcome due to inadequate preparation. Finally, suggesting the candidate focus solely on memorizing past examination questions without understanding the underlying principles is also professionally unacceptable. While practice questions are valuable, an over-reliance on rote memorization without conceptual understanding can lead to superficial knowledge. This approach does not foster the deep analytical and critical thinking skills expected of a fellowship graduate and could result in an inability to apply knowledge to novel clinical situations, thereby failing to meet the expected standards of advanced nursing practice. The professional reasoning process for this situation should involve active listening to the candidate’s concerns, followed by an objective assessment of their current preparation level. Based on this assessment, the educator should collaboratively develop a personalized, structured, and evidence-informed preparation plan that addresses identified weaknesses and leverages the candidate’s strengths. This plan should be regularly reviewed and adjusted as needed, fostering a supportive and goal-oriented learning environment.

Scenario Analysis: This scenario is professionally challenging because it involves a potential medication error impacting a vulnerable patient. The nurse must balance the immediate need to address the patient’s pain with the imperative to ensure medication safety and adhere to prescribing protocols. The complexity arises from the discrepancy between the prescribed medication and the patient’s known allergies, requiring prompt and accurate intervention to prevent harm. Correct Approach Analysis: The best professional practice involves immediately verifying the prescription with the prescribing clinician and documenting the interaction. This approach is correct because it directly addresses the potential safety issue by engaging the prescriber, who has the ultimate authority and knowledge regarding the medication order. This aligns with fundamental principles of patient safety, professional accountability, and the legal and ethical duty to prevent harm. Specifically, it upholds the nurse’s role in the medication safety chain, which includes questioning and clarifying potentially unsafe orders. This proactive communication prevents the administration of a medication that could cause an allergic reaction, thereby safeguarding the patient. Incorrect Approaches Analysis: Administering the medication as prescribed without further inquiry is professionally unacceptable because it directly violates the nurse’s duty of care and the principle of “do no harm.” It ignores the critical information about the patient’s allergy, creating a high risk of a severe adverse reaction. This failure to question a potentially unsafe order is a significant breach of professional responsibility and could have legal and ethical ramifications. Contacting the pharmacy for clarification before speaking with the prescriber is professionally unacceptable. While the pharmacy plays a role in medication dispensing, they are not the ultimate authority on the clinical appropriateness of a prescription for a specific patient. The prescriber is responsible for the decision to order the medication and must be the primary point of contact for resolving discrepancies related to patient-specific factors like allergies. Relying solely on the pharmacy bypasses the essential clinical judgment required in this situation. Documenting the allergy in the patient’s chart and proceeding with the administration is professionally unacceptable. While accurate documentation is crucial, it does not negate the immediate risk posed by administering a medication to which the patient is known to be allergic. The allergy information should have triggered a halt to administration and a direct inquiry with the prescriber prior to any further action. Professional Reasoning: Professionals should employ a systematic approach to medication safety. This involves: 1. Recognizing a potential safety concern (e.g., allergy alert). 2. Halting the medication administration process. 3. Verifying the information and the order with the most appropriate authority (the prescriber). 4. Documenting the concern, the interaction, and the resolution. 5. Ensuring patient safety is paramount throughout the process.

Scenario Analysis: This scenario is professionally challenging because it requires the nurse to balance immediate patient care needs with the stringent requirements of clinical documentation and regulatory compliance. The pressure to provide timely care can sometimes lead to shortcuts in documentation, which can have serious legal and ethical repercussions. Ensuring accuracy, completeness, and timeliness in electronic health records (EHRs) is paramount for patient safety, continuity of care, and adherence to healthcare regulations. Correct Approach Analysis: The best professional practice involves meticulously documenting all aspects of the patient’s care in the EHR immediately after the intervention or assessment. This includes the administration of medications, vital signs, patient responses, and any communication with the medical team. This approach ensures that the record is an accurate and contemporaneous reflection of the patient’s status and the care provided. Adherence to the principles of good clinical documentation, which emphasize accuracy, completeness, legibility, timeliness, and relevance, is a fundamental ethical and regulatory requirement. In the context of the UK, this aligns with the Nursing and Midwifery Council (NMC) Code, which mandates that nurses maintain accurate and comprehensive records. Furthermore, the Health and Social Care Act 2012 and associated regulations emphasize the importance of robust information governance and data protection, which are directly supported by diligent EHR practices. Incorrect Approaches Analysis: Failing to document the medication administration and the patient’s subsequent reaction immediately, and instead relying on memory to complete the entry later, introduces a significant risk of error. Memory can be fallible, especially under pressure, leading to omissions or inaccuracies in the record. This violates the principle of contemporaneous documentation and can compromise patient safety if the information is critical for subsequent care decisions. It also creates a gap in the legal record, potentially exposing the nurse and the healthcare institution to liability. This approach fails to meet the standards expected by the NMC and the requirements for accurate record-keeping under UK healthcare legislation. Documenting the medication administration as “as per protocol” without specifying the actual medication, dose, route, and time, is insufficient. While protocols guide practice, the EHR must reflect the specific actions taken for the individual patient. This vague entry lacks the necessary detail for continuity of care, auditing, or legal purposes. It does not provide a clear audit trail of what was administered to whom and when, which is a core requirement for regulatory compliance and patient safety. This falls short of the detailed and specific documentation expected by regulatory bodies. Delaying the documentation of the patient’s adverse reaction until the end of the shift, or relying on a verbal handover without a written record, is unacceptable. Adverse events require immediate attention and documentation to ensure prompt medical intervention and to inform future care. A verbal handover is a supplement, not a substitute, for accurate written records. This delay can lead to a failure to adequately manage the patient’s condition and breaches the duty of care. It also fails to meet the regulatory expectation for timely reporting and documentation of significant patient events. Professional Reasoning: Professionals should prioritize accurate and timely documentation as an integral part of patient care, not an afterthought. When faced with competing demands, it is essential to allocate sufficient time for documentation immediately after patient interactions. If immediate documentation is impossible due to an emergency, a clear plan should be in place to complete the record as soon as the emergency is resolved, noting the circumstances of the delay. Professionals should be familiar with their organization’s policies on EHR use and documentation standards, as well as relevant professional and legal requirements. Regular review of documentation practices and seeking feedback can help maintain high standards.

This scenario presents a professional challenge due to the inherent conflict between patient autonomy and the perceived need for immediate intervention to prevent harm, particularly in the context of a fellowship exit examination where performance is being evaluated. The pressure of the examination setting can exacerbate the difficulty in making sound clinical and ethical judgments. Careful consideration of established protocols, ethical principles, and the specific regulatory framework governing nursing practice is paramount. The correct approach involves a systematic and documented process of assessment, communication, and escalation. This begins with a thorough, objective assessment of the patient’s condition, including vital signs, neurological status, and any observable signs of distress or deterioration. Following this, a clear and concise communication with the supervising consultant is essential, presenting the objective findings and the rationale for concern. This communication should be documented in the patient’s record. The consultant’s guidance should then be followed, with further documentation of the plan of care and its execution. This approach aligns with the fundamental principles of patient care, emphasizing evidence-based practice, clear communication channels, and adherence to the established hierarchy of medical responsibility within the healthcare setting. It respects the patient’s right to be involved in their care where possible, while ensuring appropriate medical oversight. An incorrect approach would be to administer medication without explicit consultation and order from the supervising consultant. This bypasses the established chain of command and the requirement for physician oversight in prescribing and administering potent medications, potentially leading to medication errors, adverse drug reactions, and a breach of professional accountability. It undermines the principle of safe patient care by acting unilaterally without the necessary authorization. Another incorrect approach would be to delay reporting the patient’s change in condition to the supervising consultant, opting instead to wait and observe for a longer period. This failure to promptly communicate critical changes can lead to significant patient harm if the condition deteriorates rapidly. It violates the ethical and professional obligation to act in the patient’s best interest and to escalate concerns in a timely manner, especially when dealing with a potentially unstable patient. Finally, an incorrect approach would be to document the patient’s condition as stable and not report any concerns, despite personal unease. This constitutes falsification of records and a serious breach of professional integrity and ethical duty. It prioritizes the perceived need to appear competent in the examination over the patient’s safety and well-being, and it fails to uphold the trust placed in healthcare professionals. Professionals should employ a decision-making framework that prioritizes patient safety, adheres to established protocols and regulatory requirements, and emphasizes clear, timely, and accurate communication. This involves a continuous cycle of assessment, critical thinking, communication, and documentation, always seeking guidance from senior colleagues when uncertainty exists or when patient condition warrants it.

Scenario Analysis: This scenario is professionally challenging due to the inherent conflict between patient autonomy, the legal framework surrounding consent for medical procedures, and the potential for harm if a patient’s wishes are overridden without due process. The nurse must navigate the complexities of assessing a patient’s capacity to make decisions, understanding the legal implications of consent, and acting in the patient’s best interest while respecting their rights. The urgency of the situation, coupled with the patient’s distress and potential for deterioration, adds significant pressure to the decision-making process. Correct Approach Analysis: The best professional practice involves a thorough assessment of the patient’s capacity to consent to the proposed surgical intervention. This includes evaluating their ability to understand the nature, purpose, benefits, risks, and alternatives of the surgery, as well as the consequences of refusing it. If the patient is deemed to have capacity, their informed refusal must be respected, and the nurse should explore alternative management strategies with the medical team and the patient. This approach is ethically grounded in the principle of patient autonomy and legally supported by the requirement for informed consent for medical treatment. Respecting a competent patient’s decision, even if it appears contrary to their best medical interests, is a cornerstone of ethical nursing practice. Incorrect Approaches Analysis: Proceeding with the surgery without a formal capacity assessment and assuming the patient’s refusal is due to confusion or distress, without further investigation, would be a significant ethical and legal failure. This disregards the principle of patient autonomy and could constitute battery. Administering sedation to facilitate the surgery against the patient’s explicit verbal refusal, even if the medical team believes it is in their best interest, bypasses the legal requirement for consent and violates the patient’s right to bodily integrity. Documenting the patient’s refusal but then proceeding with the surgery based on the medical team’s directive, without a clear legal or ethical justification for overriding the refusal (such as a court order or established lack of capacity), would also be professionally unacceptable. This action demonstrates a failure to advocate for the patient’s rights and a potential abdication of professional responsibility. Professional Reasoning: Professionals should employ a structured decision-making process that prioritizes patient rights and legal requirements. This involves: 1) Actively listening to and understanding the patient’s concerns and wishes. 2) Assessing the patient’s capacity to make informed decisions, utilizing established frameworks and seeking assistance from senior colleagues or the medical team if capacity is questionable. 3) If capacity is present, respecting the patient’s autonomous decision, even if it differs from medical recommendations. 4) If capacity is lacking, acting in the patient’s best interest, which may involve seeking legal or ethical consultation to determine the appropriate course of action. 5) Thoroughly documenting all assessments, discussions, and decisions made.