This scenario presents a professional challenge due to the inherent variability in wound healing and the potential for complications post-debridement. The Certified Wound Specialist (CWS) must balance aggressive intervention with vigilant monitoring to ensure optimal patient outcomes while adhering to professional standards and ethical obligations. The complexity arises from individual patient factors, the nature of the wound, and the need for timely, appropriate adjustments to the care plan. Careful judgment is required to differentiate between normal healing progression and signs of adverse events, necessitating a systematic and evidence-based approach. The best professional practice involves a comprehensive post-debridement care plan that includes frequent, structured monitoring for signs of infection, delayed healing, or other complications. This approach mandates detailed documentation of wound characteristics, patient response, and any interventions. The CWS should establish a clear schedule for follow-up assessments, educate the patient and/or caregiver on warning signs, and have protocols in place for prompt escalation of care if concerns arise. This aligns with the ethical imperative to provide competent care, minimize harm, and act in the patient’s best interest. Regulatory frameworks, such as those governing healthcare practice and professional conduct, emphasize the importance of thorough assessment, individualized care planning, and diligent follow-up to ensure patient safety and quality of care. An approach that relies solely on patient self-reporting without scheduled professional reassessment is professionally unacceptable. This fails to meet the standard of care expected of a CWS, as it outsources critical clinical judgment to individuals who may lack the expertise to accurately identify subtle or early signs of complications. This can lead to delayed diagnosis and treatment, potentially resulting in increased morbidity and poorer outcomes, violating the principle of non-maleficence. Another unacceptable approach is to assume that debridement alone will resolve all issues and to schedule follow-up only at the patient’s discretion or when a significant problem is evident. This demonstrates a lack of proactive monitoring and a failure to recognize that post-debridement care is an active, ongoing process. It neglects the responsibility to systematically track healing progress and identify potential setbacks early, which is a cornerstone of effective wound management and a requirement for professional accountability. Finally, an approach that focuses exclusively on the physical appearance of the wound without considering the patient’s overall systemic status, pain levels, or functional improvement is incomplete. While visual assessment is crucial, a holistic view is necessary. Ignoring systemic indicators or patient-reported symptoms can mask underlying issues, such as developing infections or metabolic derangements that impact wound healing. This narrow focus can lead to misinterpretation of the wound’s status and inappropriate care decisions, falling short of the comprehensive assessment expected of a CWS. Professionals should employ a decision-making framework that prioritizes patient safety and evidence-based practice. This involves a systematic assessment of the wound and the patient, development of an individualized care plan with clear monitoring parameters, consistent and thorough documentation, and a commitment to ongoing evaluation and adaptation of the plan based on the patient’s response. Proactive communication with the patient and interdisciplinary team members is also essential for optimal outcomes.

The control framework reveals a common ethical dilemma in wound management, specifically concerning the selection and application of dressings and topical agents. This scenario is professionally challenging because it pits the clinician’s autonomy and clinical judgment against potential external pressures, patient preferences, and the need to adhere to evidence-based practice and institutional protocols. Careful judgment is required to balance these factors while prioritizing patient safety and optimal wound healing outcomes. The approach that represents best professional practice involves a comprehensive assessment of the wound, consideration of patient factors, and selection of a dressing and topical agent that are supported by current evidence and align with institutional guidelines. This approach prioritizes patient-centered care by involving the patient in the decision-making process after presenting them with evidence-based options and explaining the rationale behind each. It also upholds professional accountability by ensuring that the chosen intervention is appropriate, safe, and cost-effective, thereby adhering to ethical principles of beneficence, non-maleficence, and justice. This aligns with the professional obligation to provide care that is both clinically sound and ethically defensible. An approach that involves solely relying on the patient’s expressed preference for a specific product, even if it is not the most clinically indicated or evidence-based option, represents an ethical failure. While patient autonomy is crucial, it must be balanced with the clinician’s responsibility to provide safe and effective care. Uncritically accepting a patient’s preference without a thorough clinical assessment and discussion of alternatives can lead to suboptimal wound healing, increased costs, or even harm. Another professionally unacceptable approach is to exclusively use a product that is readily available or familiar to the clinician, without considering if it is the most appropriate choice for the specific wound characteristics and patient needs. This can stem from habit, convenience, or a lack of awareness of newer, more effective treatments. This approach fails to uphold the principle of providing the best possible care based on current knowledge and can be seen as a dereliction of professional duty to stay current with best practices. Furthermore, an approach that prioritizes the use of a particular dressing or topical agent solely because it is the least expensive option, without a thorough evaluation of its efficacy and potential impact on healing time and patient outcomes, is ethically problematic. While cost-effectiveness is a consideration in healthcare, it should not supersede the primary goal of achieving optimal wound healing and patient well-being. This can lead to prolonged healing, increased need for further interventions, and ultimately higher overall healthcare costs. Professional decision-making in such situations should involve a systematic process: 1) Conduct a thorough wound assessment. 2) Identify patient-specific factors (comorbidities, allergies, preferences, socioeconomic status). 3) Review current evidence-based guidelines and research for appropriate dressings and topical agents. 4) Discuss all viable options with the patient, explaining the risks, benefits, and rationale for each. 5) Collaboratively select the most appropriate intervention. 6) Document the assessment, rationale for choice, and patient involvement.

The control framework reveals a common ethical dilemma in wound care, where a clinician’s personal beliefs or external pressures might conflict with evidence-based practice and patient autonomy. This scenario is professionally challenging because it requires the clinician to navigate the complex interplay between established wound healing phases, patient preferences, and the ethical obligation to provide optimal care. Careful judgment is required to ensure that the patient’s well-being and the integrity of the healing process are prioritized above all else. The best professional approach involves a comprehensive assessment of the wound’s current phase of healing and the implementation of interventions tailored to that specific phase, while also respecting the patient’s informed consent and preferences. This aligns with the ethical principles of beneficence (acting in the patient’s best interest) and autonomy (respecting the patient’s right to make decisions about their care). Specifically, if a wound is in the inflammatory phase, the focus should be on managing inflammation, preventing infection, and preparing the wound bed for healing. This might involve debridement, appropriate dressings, and antimicrobial therapy if indicated. The clinician must clearly communicate the rationale for these interventions to the patient, ensuring they understand the connection between the chosen treatment and the expected progression through the healing phases. An approach that prioritizes a novel, unproven treatment over established protocols for the inflammatory phase is professionally unacceptable. This fails to adhere to the principle of beneficence, as it exposes the patient to potential harm from an untested therapy without clear evidence of benefit, and it neglects the established understanding of wound healing. Furthermore, it undermines the ethical obligation to provide care based on scientific evidence and best practices. Another professionally unacceptable approach is to discontinue all active treatment simply because the patient expresses frustration with the slow pace of healing. This neglects the clinician’s duty of care and the understanding that wound healing is a dynamic process that requires ongoing management. It fails to acknowledge that the inflammatory phase, while sometimes prolonged, is a necessary step in preparing the wound for subsequent phases. This approach could lead to complications such as infection or delayed healing. Finally, an approach that focuses solely on the proliferation phase without adequately addressing the preceding inflammatory phase is also flawed. While proliferation is crucial for tissue regeneration, it cannot occur effectively if inflammation is not controlled and the wound bed is not properly prepared. This oversight demonstrates a lack of understanding of the sequential nature of wound healing and could result in suboptimal outcomes or a return to earlier, problematic phases. The professional reasoning process for such situations should involve: 1) A thorough assessment of the wound, identifying its current phase of healing and any contributing factors. 2) Reviewing evidence-based guidelines and best practices for managing wounds in that specific phase. 3) Engaging in open and honest communication with the patient, explaining the healing process, the rationale for proposed treatments, and addressing their concerns. 4) Obtaining informed consent for the chosen treatment plan. 5) Continuously monitoring the wound’s progress and adjusting the plan as needed, always prioritizing patient safety and optimal healing outcomes.

Scenario Analysis: This scenario presents a professional challenge due to the inherent conflict between a patient’s expressed wishes and the clinician’s professional judgment regarding the optimal treatment for a complex wound. The clinician must navigate the ethical principles of patient autonomy and beneficence, while also considering the evidence-based best practices for wound management. The complexity arises from the potential for a patient’s misunderstanding of their condition or treatment options to lead to suboptimal outcomes, necessitating careful communication and shared decision-making. Correct Approach Analysis: The best professional approach involves engaging in a thorough and empathetic discussion with the patient to understand the root of their preference for a less evidence-based treatment. This includes clearly explaining the rationale behind the recommended treatment, which leverages the synergistic roles of fibroblasts in collagen synthesis and extracellular matrix deposition, keratinocytes in re-epithelialization and barrier formation, and endothelial cells in angiogenesis and nutrient supply, all critical for effective wound closure. The clinician should patiently address the patient’s concerns, fears, and misconceptions, providing clear, understandable information about the risks and benefits of both the recommended and the patient’s preferred approach. This collaborative dialogue aims to achieve informed consent, respecting the patient’s autonomy while upholding the clinician’s duty of beneficence by guiding them towards the most effective care. This aligns with ethical guidelines emphasizing patient-centered care and shared decision-making, ensuring the patient feels heard and empowered in their treatment choices. Incorrect Approaches Analysis: Proceeding with the patient’s preferred treatment without a comprehensive discussion and clear understanding of their reasoning would be ethically problematic. It risks undermining the principle of beneficence by potentially offering a less effective treatment, thereby prolonging healing or increasing the risk of complications. This approach fails to adequately explore the patient’s autonomy, as their consent may not be fully informed if their concerns are not addressed. Directly overriding the patient’s wishes and insisting on the clinician’s preferred treatment, even if evidence-based, would violate the principle of patient autonomy. While the clinician’s intention might be to provide the best care, disregarding the patient’s right to make decisions about their own body is ethically unacceptable and can erode trust in the therapeutic relationship. Dismissing the patient’s concerns as uninformed or irrational without attempting to understand their perspective is also professionally unsound. This approach fails to acknowledge the patient’s lived experience and can lead to a breakdown in communication and a refusal of care, ultimately hindering the healing process. Professional Reasoning: Professionals facing such dilemmas should employ a structured decision-making process. This begins with active listening to fully comprehend the patient’s perspective and the underlying reasons for their preferences. Next, the clinician must clearly and empathetically articulate the evidence-based rationale for their recommended treatment, explaining the cellular mechanisms involved in wound healing in a patient-friendly manner. This should be followed by a transparent discussion of the potential risks and benefits of all viable options. The goal is to facilitate shared decision-making, where the patient, armed with accurate information and feeling respected, can make an informed choice that aligns with their values and the clinician’s professional judgment. Documentation of this process is crucial.

Scenario Analysis: This scenario presents a professional challenge due to the inherent conflict between a patient’s expressed preference for a specific advanced wound care product and the clinician’s professional judgment regarding its suitability and cost-effectiveness. The clinician must navigate the ethical imperative to respect patient autonomy while upholding their responsibility to provide evidence-based, safe, and fiscally responsible care. The availability of a potentially superior, yet more expensive, alternative further complicates the decision-making process, requiring a careful balance of patient wishes, clinical efficacy, and resource allocation. Correct Approach Analysis: The best professional practice involves a thorough, patient-centered discussion that educates the patient about all available, clinically appropriate advanced wound care products. This approach prioritizes informed consent and shared decision-making. It requires the clinician to explain the rationale behind recommending a particular product, detailing its benefits, potential drawbacks, and the evidence supporting its use for the patient’s specific wound type and stage. Crucially, it involves transparently discussing the cost implications of different options and exploring potential avenues for coverage or alternative, equally effective, lower-cost products if the preferred option is not financially viable. This aligns with ethical principles of beneficence (acting in the patient’s best interest), non-maleficence (avoiding harm, including financial burden), and respect for autonomy. Regulatory frameworks often emphasize patient education and the right to make informed choices about their care. Incorrect Approaches Analysis: One incorrect approach involves immediately acquiescing to the patient’s demand for the specific product without a comprehensive discussion. This fails to uphold the clinician’s professional responsibility to ensure the chosen product is the most appropriate and cost-effective for the patient’s clinical needs. It bypasses the opportunity for shared decision-making and may lead to the use of a product that is not clinically superior or is unnecessarily expensive, potentially causing financial strain for the patient or the healthcare system. This approach neglects the principle of prudence in resource utilization. Another incorrect approach is to dismiss the patient’s preference outright and unilaterally decide on a different product without adequate explanation or consideration of the patient’s wishes. This undermines patient autonomy and can erode trust in the clinician-patient relationship. While the clinician may have valid clinical reasons, failing to engage the patient in the decision-making process is ethically problematic and may lead to patient non-adherence. A third incorrect approach is to recommend the more expensive product solely because it is what the patient requested, without a thorough clinical assessment of its superiority over other options or a discussion of cost-effectiveness. This prioritizes patient preference over clinical evidence and responsible resource management, potentially leading to suboptimal care or unnecessary expenditure. Professional Reasoning: Professionals should employ a decision-making framework that begins with a comprehensive assessment of the patient’s wound and overall health status. This is followed by an open and honest dialogue with the patient, exploring their preferences, understanding their concerns, and educating them about all clinically appropriate treatment options, including their respective benefits, risks, and costs. The clinician should then collaboratively determine the best course of action, ensuring the patient feels heard, respected, and empowered in their treatment decisions, while also adhering to professional standards of care and fiscal responsibility.

Scenario Analysis: This scenario presents a professional challenge due to the conflict between a patient’s expressed wishes and the clinician’s assessment of the patient’s best interest, particularly when those wishes might lead to suboptimal wound healing outcomes. The clinician must navigate the ethical principles of patient autonomy and beneficence, while also considering the practical implications of treatment choices on skin integrity and the patient’s overall health. The complexity arises from the need to respect the patient’s right to self-determination without compromising the quality of care or potentially causing harm through ineffective or inappropriate treatment. Correct Approach Analysis: The best professional practice involves a thorough and empathetic discussion with the patient to understand the rationale behind their preference for a specific dressing. This approach prioritizes patient education and shared decision-making. By explaining the physiological benefits of the recommended dressing in promoting optimal wound healing and maintaining skin integrity, and by addressing the patient’s concerns or misconceptions about the alternative, the clinician empowers the patient to make an informed choice. This aligns with the ethical principle of autonomy, ensuring the patient’s values and preferences are respected, while also upholding the principle of beneficence by striving for the best possible outcome through informed consent. The Certified Wound Specialist (CWS) Code of Ethics emphasizes patient-centered care and the importance of informed consent, which necessitates clear communication and addressing patient concerns. Incorrect Approaches Analysis: Choosing the patient’s preferred dressing without further discussion or education fails to uphold the principle of beneficence. While respecting autonomy, it neglects the professional responsibility to guide the patient towards the most effective treatment for their wound, potentially leading to delayed healing or complications. This approach bypasses the educational role of the clinician and could be seen as a failure to provide optimal care. Insisting on the clinician’s preferred dressing without fully exploring the patient’s reasoning or attempting to find a compromise disregards the principle of autonomy. This paternalistic approach can erode patient trust and lead to non-adherence, ultimately hindering the healing process. It fails to acknowledge the patient’s right to participate in their own care decisions. Documenting the patient’s refusal of the recommended dressing and proceeding with the patient’s choice without any attempt at further discussion or education is a minimal compliance approach. While it acknowledges the patient’s decision, it misses the opportunity to educate, build rapport, and potentially achieve a mutually agreed-upon, optimal treatment plan. This approach prioritizes documentation over active patient engagement and professional guidance. Professional Reasoning: Professionals should employ a shared decision-making model. This involves: 1) assessing the patient’s understanding of their condition and treatment options; 2) exploring the patient’s values, preferences, and goals; 3) providing clear, unbiased information about the risks and benefits of each option; 4) discussing the rationale for the clinician’s recommendation; and 5) collaboratively agreeing on a treatment plan. When a patient expresses a preference that differs from the clinician’s recommendation, the professional’s duty is to understand the patient’s perspective, educate them on the implications of their choice, and work towards a consensus that respects both autonomy and beneficence.

This scenario presents a professional challenge due to the conflict between a patient’s expressed wishes and the clinician’s assessment of the most effective treatment based on current understanding of wound healing. The clinician must navigate patient autonomy, the principle of beneficence, and the ethical obligation to provide evidence-based care, all while considering the specific properties of extracellular matrix (ECM) components. Careful judgment is required to balance these competing ethical considerations. The best professional approach involves a thorough discussion with the patient about the rationale behind the proposed treatment, emphasizing how the specific ECM components in the recommended dressing are known to support cellular migration, proliferation, and tissue regeneration, thereby promoting optimal wound healing. This approach respects patient autonomy by providing comprehensive information for informed consent, while also upholding the clinician’s duty of care by advocating for a treatment grounded in scientific understanding of ECM function. This aligns with ethical principles of patient-centered care and evidence-based practice, ensuring the patient can make an informed decision based on accurate information about how the ECM facilitates wound repair. An incorrect approach would be to dismiss the patient’s preference outright and insist on the recommended treatment without further explanation. This fails to acknowledge the patient’s right to participate in their care decisions and can erode trust. It also overlooks the potential for alternative approaches, even if less optimal, to achieve a satisfactory outcome, and it does not engage the patient in understanding the biological mechanisms at play. Another incorrect approach would be to agree to the patient’s preferred treatment without adequately explaining the potential drawbacks or the scientific basis for the clinician’s initial recommendation. This prioritizes patient satisfaction over optimal clinical outcomes and may lead to suboptimal healing, increased risk of complications, and a failure to educate the patient about the role of ECM in their wound’s recovery. Finally, an incorrect approach would be to proceed with the patient’s preferred treatment while secretly believing it is detrimental, without any attempt to re-educate or find common ground. This is a breach of professional integrity and the duty to provide competent care, as it involves withholding potentially superior treatment options and acting against one’s professional judgment without transparent communication. Professional reasoning in such situations requires a systematic approach: first, actively listen to and understand the patient’s concerns and preferences. Second, clearly and empathetically explain the scientific rationale for the recommended treatment, focusing on how the ECM’s composition and function directly influence healing processes. Third, explore the patient’s reasoning for their preference and address any misconceptions. Fourth, collaboratively develop a treatment plan that, where possible, incorporates the patient’s wishes while remaining within the bounds of safe and effective care, always prioritizing the patient’s well-being and informed consent.

Scenario Analysis: This scenario presents a professional challenge rooted in the ethical obligation to provide evidence-based care while navigating the complexities of emerging therapies and patient autonomy. The Certified Wound Specialist (CWS) must balance the potential benefits of a novel treatment with the established standards of care and the patient’s right to informed consent. The pressure to adopt new technologies, coupled with the inherent uncertainties of investigational treatments, requires careful ethical deliberation and adherence to professional guidelines. Correct Approach Analysis: The best professional approach involves a thorough, evidence-based assessment of the investigational growth factor therapy’s safety and efficacy in the context of the patient’s specific wound. This includes consulting peer-reviewed literature, understanding the mechanism of action of the specific growth factor and its relevant cytokines, and evaluating its potential benefits against known risks and standard treatment outcomes. Crucially, this approach mandates comprehensive informed consent, ensuring the patient fully understands the investigational nature of the therapy, potential benefits, risks, alternatives, and the right to withdraw. This aligns with ethical principles of beneficence, non-maleficence, and patient autonomy, and adheres to professional standards that require practitioners to stay abreast of scientific advancements while prioritizing patient well-being and informed decision-making. Incorrect Approaches Analysis: One incorrect approach involves immediately adopting the investigational growth factor therapy based solely on the manufacturer’s claims and the desire to offer a “cutting-edge” solution. This fails to uphold the principle of evidence-based practice, as it bypasses the critical step of independent scientific validation and risk-benefit analysis. It also risks violating the ethical duty to avoid harm by potentially exposing the patient to an unproven or even detrimental treatment without adequate justification. Another incorrect approach is to dismiss the investigational therapy outright without a comprehensive review of available evidence, simply because it is not yet a widely established standard of care. While caution is warranted with new treatments, a blanket refusal to consider potentially beneficial therapies, without due diligence, could be seen as a failure to act in the patient’s best interest and a missed opportunity to advance wound care through responsible innovation. This approach may also disregard the patient’s right to explore all reasonable treatment options. A third incorrect approach is to proceed with the investigational therapy without obtaining truly informed consent, perhaps by downplaying the risks or overstating the potential benefits. This is a direct violation of patient autonomy and a serious ethical breach. It undermines the patient’s right to make an informed decision about their own healthcare and can lead to mistrust and potential harm if the treatment does not yield the promised results or causes adverse effects. Professional Reasoning: Professionals facing such dilemmas should employ a structured decision-making process. This begins with a thorough understanding of the patient’s condition and needs. Next, they must critically evaluate any proposed treatment, especially investigational ones, by seeking out robust scientific evidence and understanding the underlying biological mechanisms. Ethical principles, including beneficence, non-maleficence, autonomy, and justice, should guide every decision. Transparency and open communication with the patient are paramount, ensuring they are fully informed and empowered to participate in treatment decisions. Finally, adherence to professional codes of conduct and regulatory guidelines is essential to maintain ethical practice and patient safety.

This scenario presents a professional challenge due to the inherent conflict between a patient’s expressed wishes and the clinician’s assessment of their best interests, particularly when those wishes might lead to suboptimal wound healing outcomes. Navigating this requires a delicate balance of patient autonomy, beneficence, and professional integrity, all within the ethical framework governing wound care specialists. The correct approach involves a thorough, patient-centered discussion that prioritizes informed consent and shared decision-making. This entails clearly explaining the rationale behind the recommended treatment plan, detailing the potential benefits and risks of both the preferred and the patient-chosen interventions, and actively listening to and addressing the patient’s concerns, values, and beliefs. The specialist must ensure the patient possesses the capacity to make such decisions and that their choices are not influenced by coercion or misinformation. This aligns with the ethical principle of patient autonomy, which mandates respecting an individual’s right to self-determination in their healthcare, provided they have the capacity to do so. It also upholds the principle of beneficence by ensuring the patient is fully informed to make a choice that, while potentially not the clinician’s first choice, is one they understand and consent to, thereby fostering trust and adherence. An incorrect approach would be to unilaterally override the patient’s wishes based solely on the specialist’s clinical judgment, without engaging in a comprehensive discussion about the patient’s rationale or exploring alternative solutions that might align better with their preferences while still promoting healing. This disregards the ethical imperative of patient autonomy and can lead to a breakdown in the therapeutic relationship, potentially resulting in non-adherence and poorer outcomes. Another incorrect approach would be to proceed with the patient’s preferred but suboptimal treatment without adequately educating them on the potential consequences for wound healing. This fails to uphold the principle of beneficence, as the specialist is not acting in the patient’s best interest by allowing them to make an uninformed choice that could compromise their health. It also neglects the ethical duty to provide clear and understandable information to facilitate informed consent. Finally, an incorrect approach would be to dismiss the patient’s concerns as irrelevant or uninformed without attempting to understand their perspective. This demonstrates a lack of empathy and respect for the patient’s lived experience and values, which are crucial components of effective wound care. It undermines the collaborative nature of healthcare and can alienate the patient, making them less likely to engage in their treatment plan. Professionals should approach such situations by first assessing the patient’s decision-making capacity. If capacity is present, the next step is to engage in open, honest, and empathetic communication. This involves active listening, validating the patient’s feelings and concerns, and clearly articulating the clinical rationale for recommended treatments. The goal is to reach a shared understanding and a mutually agreed-upon plan, even if it requires compromise or exploring alternative strategies that respect the patient’s values while still aiming for optimal wound healing.

Scenario Analysis: This scenario presents a professional challenge due to the inherent conflict between a patient’s expressed wishes and the clinical team’s assessment of their best interests, particularly concerning the prevention and management of pressure ulcers. The ethical imperative to respect patient autonomy must be balanced with the duty of care to prevent harm and promote well-being. The complexity arises from the patient’s cognitive state, which may impair their ability to fully comprehend the risks and benefits of their decisions, necessitating careful consideration of capacity and the role of surrogate decision-makers. Correct Approach Analysis: The best professional practice involves a comprehensive assessment of the patient’s capacity to make decisions regarding their care plan, specifically concerning pressure ulcer prevention strategies. If capacity is deemed present, the patient’s informed wishes, even if they deviate from the team’s preferred approach, must be respected, provided they do not pose an immediate and severe threat to life that overrides autonomy. If capacity is impaired, the process shifts to involving the designated surrogate decision-maker, ensuring they are fully informed about the risks, benefits, and alternatives, and guiding them to make decisions in the patient’s best interest, or according to the patient’s known prior wishes. This approach upholds the principles of autonomy and beneficence while adhering to ethical guidelines for patient care and decision-making. Incorrect Approaches Analysis: One incorrect approach would be to unilaterally implement a strict pressure ulcer prevention protocol without adequately assessing the patient’s capacity or engaging with their surrogate decision-maker, overriding their stated preferences. This fails to respect patient autonomy and can lead to a breakdown in trust and patient-provider relationships. It also neglects the ethical requirement to involve individuals with decision-making authority when a patient’s capacity is questionable. Another incorrect approach would be to dismiss the patient’s preferences entirely due to their expressed desire to avoid repositioning, without a thorough assessment of their capacity or exploring the underlying reasons for their resistance. This demonstrates a lack of empathy and a failure to explore less restrictive means of achieving pressure ulcer prevention. It also bypasses the crucial step of understanding the patient’s perspective and potential barriers to adherence. A third incorrect approach would be to proceed with the most aggressive treatment plan without ensuring the patient or their surrogate fully understands the rationale, risks, and benefits of each intervention. This constitutes a failure in the informed consent process, even if the chosen interventions are clinically sound. Ethical practice demands clear communication and shared decision-making, not just the application of best clinical practice in isolation. Professional Reasoning: Professionals should employ a structured decision-making process that begins with a thorough assessment of the patient’s condition and their capacity to make informed decisions. This involves open communication, active listening, and a collaborative approach with the patient and their family or surrogate. When capacity is uncertain, formal capacity assessments should be conducted. Ethical principles of autonomy, beneficence, non-maleficence, and justice should guide all decisions. Documentation of the assessment, discussions, and decisions is paramount.