Scenario Analysis: This scenario is professionally challenging because it requires the Advanced Oncology Certified Clinical Nurse Specialist (AOCNS) to balance immediate patient symptom management with long-term treatment adherence and potential for severe adverse events. The patient’s reluctance to report side effects, coupled with the complexity of managing a new, potentially life-altering treatment regimen, necessitates a nuanced and patient-centered approach that prioritizes open communication and collaborative decision-making. Failure to address these issues effectively can lead to suboptimal treatment outcomes, increased toxicity, and compromised patient quality of life. Correct Approach Analysis: The best professional approach involves a comprehensive assessment of the patient’s understanding of their treatment, a thorough exploration of their experienced side effects, and a collaborative discussion about management strategies. This approach prioritizes patient education, empowers the patient to actively participate in their care, and ensures that treatment decisions are made in alignment with their values and goals. This aligns with ethical principles of autonomy and beneficence, as well as professional nursing standards that emphasize patient-centered care and effective communication. By actively listening and validating the patient’s concerns, the AOCNS builds trust and facilitates open reporting of future side effects, which is crucial for timely intervention and toxicity management. Incorrect Approaches Analysis: One incorrect approach involves solely focusing on the prescribed medication schedule and assuming the patient will report issues if they arise. This fails to acknowledge the potential for patient reluctance to report side effects due to fear, misunderstanding, or a desire to avoid perceived inconvenience. This approach neglects the professional responsibility to proactively assess and address patient concerns, potentially leading to delayed recognition and management of toxicities, thereby violating the principle of non-maleficence. Another incorrect approach is to immediately adjust the medication dosage or schedule without a thorough understanding of the patient’s experience and concerns. While dose adjustments may be necessary, doing so without a detailed assessment and patient involvement can lead to suboptimal treatment efficacy or unnecessary escalation of side effects. This bypasses the collaborative decision-making process and undermines patient autonomy. A further incorrect approach is to dismiss the patient’s reported side effects as minor or expected, without further investigation or discussion. This can invalidate the patient’s experience, erode trust, and discourage future reporting. It also fails to recognize that even seemingly minor side effects can significantly impact a patient’s quality of life and adherence to treatment, and could be early indicators of more serious toxicities. Professional Reasoning: Professionals should employ a systematic approach that begins with establishing rapport and open communication. This involves active listening, empathetic validation of the patient’s experience, and clear, understandable education about the treatment and its potential side effects. The next step is a thorough assessment of the reported side effects, including their nature, severity, and impact on the patient’s daily life. Following this, a collaborative discussion should occur with the patient to explore management options, considering both pharmacological and non-pharmacological interventions, and aligning these with the patient’s preferences and treatment goals. Regular follow-up and ongoing assessment are critical to monitor the effectiveness of interventions and to detect any new or evolving toxicities.

Scenario Analysis: This scenario presents a professional challenge due to the complex interplay of rapidly evolving genetic information, patient autonomy, and the ethical imperative to provide accurate and actionable care. The AOCNS must navigate the potential for incidental findings, the psychological impact of genetic risk disclosure, and the need for informed consent in a context where the implications of genetic mutations can be far-reaching and may extend to family members. Careful judgment is required to balance the benefits of genetic testing with the potential harms and to ensure that patient care is guided by evidence-based practice and ethical principles. Correct Approach Analysis: The best professional practice involves a comprehensive pre-test genetic counseling session. This approach entails a thorough discussion with the patient about the rationale for genetic testing, the specific genes being analyzed, the potential benefits and limitations of the test, and the implications of both positive and negative results. It includes an assessment of the patient’s understanding, their family history, and their psychosocial readiness to receive genetic information. This approach ensures that the patient can make a truly informed decision about proceeding with testing and is adequately prepared for the potential outcomes. This aligns with ethical principles of autonomy and beneficence, and regulatory guidelines that emphasize informed consent and patient-centered care in genetic testing. Incorrect Approaches Analysis: Proceeding with genetic testing solely based on a physician’s order without dedicated pre-test counseling fails to uphold the principle of patient autonomy. Patients may not fully grasp the implications of the test, leading to a lack of true informed consent. This approach risks causing undue anxiety or false reassurance if the patient misunderstands the results. Ordering genetic testing without considering the patient’s family history or psychosocial readiness overlooks crucial contextual factors. Genetic mutations often have hereditary implications, and a patient’s emotional state can significantly impact their ability to process complex genetic information. This oversight can lead to inadequate support and potentially harmful psychological distress. Disclosing genetic mutation results directly to the patient without prior counseling or a clear plan for follow-up care is ethically problematic. It bypasses the essential step of helping the patient understand the significance of the findings and how they relate to their health and potential treatment options. This can lead to confusion, fear, and a failure to implement necessary clinical interventions. Professional Reasoning: Professionals should adopt a systematic approach to genetic testing that prioritizes patient education and informed decision-making. This begins with a thorough assessment of the patient’s clinical presentation and family history to determine the appropriateness of genetic testing. Subsequently, comprehensive pre-test genetic counseling is paramount, ensuring the patient understands the test’s purpose, potential outcomes, and implications. Following testing, results should be communicated within the context of post-test counseling, which includes discussing the findings, their clinical significance, and developing a personalized care plan. This framework ensures that patient care is both scientifically sound and ethically responsible, respecting individual autonomy and promoting well-being.

Scenario Analysis: This scenario is professionally challenging because it requires the Advanced Oncology Certified Clinical Nurse Specialist (AOCNS) to synthesize complex biological information about the tumor microenvironment with evidence-based treatment strategies, while also considering the patient’s individual circumstances and potential for treatment toxicity. The rapid advancement in understanding the tumor microenvironment necessitates continuous learning and critical appraisal of emerging research to optimize patient care. Correct Approach Analysis: The best approach involves a comprehensive review of recent peer-reviewed literature specifically investigating the role of stromal cells and extracellular matrix components in modulating response to novel immunotherapies in the context of the patient’s specific cancer type. This approach is correct because it directly addresses the core of the question by focusing on the most current and relevant scientific understanding of the tumor microenvironment’s impact on treatment efficacy. It aligns with the professional responsibility of an AOCNS to stay abreast of cutting-edge research and apply it to clinical decision-making, ensuring that treatment strategies are informed by the latest evidence regarding how the tumor’s immediate surroundings influence therapeutic outcomes. This is ethically mandated by the principle of beneficence, ensuring the patient receives the most effective care possible based on current knowledge. Incorrect Approaches Analysis: One incorrect approach is to solely rely on established treatment protocols for the patient’s cancer type without considering recent advancements in understanding the tumor microenvironment. This fails to acknowledge that the tumor microenvironment is a dynamic entity and that new research may reveal critical factors influencing treatment response that are not captured by older protocols. This approach risks suboptimal treatment selection and can be seen as a failure to uphold the duty of care to provide the most current and effective interventions. Another incorrect approach is to focus exclusively on the genetic mutations within the tumor cells themselves, neglecting the broader context of the tumor microenvironment. While tumor genetics are crucial, the microenvironment plays a significant role in immune evasion, drug resistance, and overall tumor progression. Ignoring these factors leads to an incomplete understanding of the disease and can result in treatment strategies that are less effective. This represents a failure to apply a holistic, evidence-based approach to patient care. A final incorrect approach is to prioritize patient preference for a specific investigational therapy without a thorough evaluation of its potential efficacy in relation to the patient’s tumor microenvironment characteristics. While patient autonomy is paramount, it must be balanced with the clinician’s professional responsibility to guide patients towards treatments that are supported by scientific evidence and are most likely to benefit them. This approach could lead to the selection of a therapy that is unlikely to be effective due to the specific tumor microenvironment, potentially exposing the patient to unnecessary risks and delaying more appropriate treatment. Professional Reasoning: Professionals should employ a systematic approach that begins with a thorough understanding of the patient’s specific disease context, including tumor biology and the tumor microenvironment. This should be followed by a critical appraisal of the latest evidence, considering how emerging research on the tumor microenvironment can inform treatment selection. Patient values and preferences should then be integrated into the decision-making process, ensuring shared decision-making. This framework prioritizes evidence-based practice, patient safety, and ethical considerations.

Scenario Analysis: This scenario is professionally challenging because it requires the Advanced Oncology Certified Clinical Nurse Specialist (AOCNS) to balance the immediate need for patient care with the complex ethical and regulatory considerations surrounding experimental treatments. The rapid progression of the patient’s disease necessitates swift action, but the experimental nature of the drug introduces significant unknowns regarding efficacy, side effects, and long-term outcomes. The AOCNS must navigate patient autonomy, informed consent, institutional review board (IRB) protocols, and the overarching duty to provide safe and effective care within the established legal and ethical frameworks governing clinical trials and advanced practice nursing. Careful judgment is required to ensure the patient’s best interests are served while adhering to all applicable regulations and ethical principles. Correct Approach Analysis: The best professional practice involves a comprehensive and collaborative approach that prioritizes patient safety and informed decision-making. This includes thoroughly reviewing the investigational drug’s protocol, understanding its mechanism of action in relation to the patient’s specific cancer type and stage, and assessing the patient’s overall health status and suitability for the trial. Crucially, this approach mandates a detailed discussion with the patient and their family about the potential benefits, risks, uncertainties, and alternatives to participation, ensuring truly informed consent. Collaboration with the principal investigator, the oncology team, and the IRB is essential to confirm eligibility, address any emergent concerns, and ensure compliance with all study requirements and institutional policies. This approach aligns with ethical principles of beneficence, non-maleficence, and respect for autonomy, as well as regulatory requirements for clinical trial participation and advanced practice nursing. Incorrect Approaches Analysis: Initiating the investigational drug without a thorough review of the protocol and a comprehensive discussion with the patient and the research team would be a significant ethical and regulatory failure. This bypasses the essential informed consent process, potentially exposing the patient to unknown risks without their full understanding or agreement. It also disregards the established procedures for investigational new drug (IND) administration and clinical trial oversight, which are designed to protect participants. Proceeding with the treatment based solely on the patient’s expressed desire and the oncologist’s recommendation, without engaging the IRB or ensuring all protocol requirements are met, is also professionally unacceptable. While patient autonomy is paramount, it must be exercised within a framework of safety and regulatory compliance. The IRB’s role is to protect human subjects in research, and their approval is a critical safeguard. Relying on anecdotal evidence or the experiences of other institutions without verifying the specific protocol and its applicability to the current patient’s situation is a dangerous practice. Clinical trial protocols are highly specific, and deviations can compromise the integrity of the research and the safety of the participant. This approach lacks the rigorous evidence-based foundation required for advanced oncology nursing practice and research participation. Professional Reasoning: Professionals should employ a systematic decision-making process that begins with a thorough assessment of the clinical situation and the patient’s needs. This is followed by an evaluation of available treatment options, including standard therapies and investigational approaches. For investigational treatments, the process must include a detailed review of the research protocol, consultation with the research team and relevant committees (e.g., IRB), and a comprehensive discussion with the patient and their family to ensure informed consent. Adherence to institutional policies and regulatory guidelines is non-negotiable. When faced with complex ethical dilemmas, seeking guidance from ethics committees or senior colleagues is also a crucial step in ensuring the best and most ethical course of action.

This scenario is professionally challenging because it requires balancing a patient’s expressed wishes with the nurse’s ethical and professional obligations to ensure informed consent and patient safety, particularly when a patient’s understanding may be compromised. The nurse must navigate potential communication barriers and advocate for the patient’s best interests while respecting their autonomy. The best approach involves a multi-faceted strategy focused on clear, accessible communication and collaborative decision-making. This includes utilizing trained interpreters or communication aids to bridge language barriers, employing teach-back methods to confirm understanding of complex medical information, and actively involving the patient’s designated support persons in discussions, with the patient’s explicit consent. This approach is correct because it directly addresses the core principles of patient advocacy and education by ensuring the patient can make an informed decision. It aligns with ethical guidelines that mandate clear communication and respect for patient autonomy, and regulatory frameworks that emphasize the patient’s right to understand their treatment options and participate in their care decisions. By actively seeking to understand and address the patient’s concerns and ensuring comprehension, the nurse upholds their professional duty to provide high-quality, patient-centered care. An approach that relies solely on a family member to translate and explain complex treatment options without verifying the patient’s understanding is professionally unacceptable. This fails to meet the regulatory requirement for informed consent, as the patient may not be receiving accurate or complete information. Ethically, it bypasses the nurse’s direct responsibility to educate the patient and can lead to a violation of the patient’s autonomy if decisions are made based on misinterpretations or the family’s agenda rather than the patient’s true wishes. Another unacceptable approach is to proceed with treatment based on the family’s assurance that the patient understands, without independently assessing the patient’s comprehension. This demonstrates a failure in professional diligence and advocacy. It neglects the nurse’s ethical obligation to ensure the patient is a fully informed participant in their care and can lead to significant legal and ethical repercussions if the patient later expresses a lack of understanding or disagreement with the treatment. Finally, an approach that involves presenting simplified information without acknowledging or addressing the language barrier and the patient’s potential confusion is also professionally flawed. While simplification can be a tool, ignoring the fundamental communication gap prevents true understanding and informed consent. It is ethically problematic as it does not adequately support the patient’s right to receive information in a manner they can comprehend, thereby undermining their autonomy. Professionals should employ a decision-making framework that prioritizes patient-centered communication. This involves assessing the patient’s current understanding, identifying any barriers to comprehension (such as language, cognitive status, or emotional distress), and implementing strategies to overcome these barriers. Collaboration with the interdisciplinary team, including physicians and language services, is crucial. The process should always loop back to confirming the patient’s understanding and ensuring their active participation in decision-making, respecting their values and preferences.

The scenario presents a common challenge in oncology nursing: balancing the need for efficient patient care with the imperative of maintaining high-quality, individualized treatment. The professional challenge lies in optimizing processes without compromising patient safety, dignity, or the nurse’s ethical obligations. This requires a nuanced understanding of workflow, patient needs, and regulatory expectations. The best approach involves a systematic, data-driven evaluation of current workflows to identify bottlenecks and areas for improvement, followed by the implementation of evidence-based interventions with a focus on patient outcomes and safety. This process typically includes interdisciplinary collaboration, staff education, and continuous monitoring. This approach is correct because it aligns with the principles of quality improvement mandated by healthcare regulatory bodies, which emphasize patient-centered care, safety, and efficiency. Ethically, it upholds the nurse’s duty to provide competent and compassionate care by proactively seeking to enhance the delivery of services. This method ensures that any changes are well-researched, validated, and implemented with patient well-being as the primary consideration, thereby adhering to professional standards of practice and ethical codes that prioritize patient welfare and continuous improvement. An approach that focuses solely on reducing staff workload without a thorough assessment of patient impact is professionally unacceptable. This overlooks the fundamental ethical obligation to prioritize patient safety and quality of care. Regulatory frameworks consistently emphasize that efficiency gains should not come at the expense of patient well-being or the integrity of treatment protocols. Implementing changes based on anecdotal evidence or personal preference, without objective data or interdisciplinary input, is also professionally unsound. This bypasses the rigorous evaluation required by quality improvement standards and risks introducing unintended negative consequences for patients. It fails to meet the ethical standard of evidence-based practice and can lead to deviations from established best practices, potentially compromising patient outcomes. Furthermore, an approach that involves bypassing established communication channels or failing to involve the entire care team in process changes is problematic. This can lead to fragmentation of care, miscommunication, and a lack of buy-in from essential stakeholders, ultimately undermining the effectiveness of any optimization efforts and potentially jeopardizing patient safety. It violates ethical principles of collaboration and transparency within the healthcare team. Professionals should employ a structured decision-making process that begins with identifying the problem and its impact. This should be followed by gathering data, involving the interdisciplinary team, exploring potential solutions, implementing the chosen solution with careful monitoring, and evaluating its effectiveness. This cyclical process, often referred to as Plan-Do-Study-Act (PDSA), ensures that improvements are evidence-based, patient-centered, and sustainable.

The review process indicates a need to optimize the management of nausea and vomiting in advanced oncology patients. This scenario is professionally challenging because nausea and vomiting are common, distressing side effects of cancer treatment that significantly impact a patient’s quality of life, adherence to therapy, and nutritional status. Effective management requires a multi-faceted approach that considers the patient’s individual needs, the underlying cause of the symptoms, and adherence to evidence-based guidelines. Careful judgment is required to balance pharmacological interventions with non-pharmacological strategies and to adapt the plan as the patient’s condition evolves. The best approach involves a comprehensive, individualized assessment followed by a tailored, multi-modal management plan. This includes identifying potential triggers (e.g., chemotherapy type, radiation site, concurrent medications, psychological factors), implementing preemptive antiemetic regimens based on emetogenic risk, and providing patient education on symptom management and reporting. This approach aligns with ethical principles of beneficence and non-maleficence, aiming to alleviate suffering and promote well-being. It also adheres to professional nursing standards that mandate patient-centered care and the application of evidence-based practice to optimize outcomes. An approach that relies solely on as-needed (PRN) antiemetics without a proactive, preemptive strategy fails to adequately address the high emetogenic potential of many oncology treatments. This can lead to breakthrough nausea and vomiting, increased patient distress, and potential treatment delays or dose reductions, which is ethically problematic as it may not optimize patient outcomes. Another incorrect approach is to focus exclusively on pharmacological interventions without considering non-pharmacological supportive measures. While medications are crucial, strategies such as dietary modifications, relaxation techniques, and environmental adjustments can significantly enhance symptom control and patient comfort. Neglecting these aspects represents a failure to provide holistic, patient-centered care. Furthermore, an approach that does not involve ongoing patient assessment and adjustment of the management plan is inadequate. Nausea and vomiting can fluctuate, and the effectiveness of interventions may change over time. Failing to reassess and modify the plan based on the patient’s response and evolving clinical status can lead to suboptimal symptom control and prolonged suffering. Professionals should employ a systematic decision-making process that begins with a thorough assessment of the patient’s symptoms, treatment regimen, and individual risk factors. This should be followed by the development of a personalized, evidence-based management plan that integrates pharmacological and non-pharmacological interventions. Continuous monitoring of the patient’s response, prompt reassessment, and timely adjustments to the plan are essential to ensure optimal symptom management and support the patient’s quality of life throughout their cancer journey.

This scenario is professionally challenging because it requires balancing the imperative of early cancer detection with the ethical considerations of patient autonomy, informed consent, and resource allocation within a specific healthcare system. The Advanced Oncology Certified Clinical Nurse Specialist (AOCNS) must navigate these complexities to optimize screening processes effectively and ethically. The approach that represents best professional practice involves implementing a multi-modal, evidence-based screening strategy that is tailored to population-specific risk factors and leverages accessible technologies, while simultaneously prioritizing patient education and shared decision-making. This approach is correct because it aligns with the principles of public health, preventive medicine, and patient-centered care. Regulatory frameworks and professional guidelines emphasize the importance of evidence-based practice, ensuring that screening recommendations are supported by robust data on efficacy and safety. Furthermore, ethical mandates require that patients are fully informed about the benefits, risks, and limitations of any screening test, enabling them to make autonomous decisions. This also involves considering the accessibility and equity of screening services, ensuring that all eligible individuals have the opportunity to participate, regardless of socioeconomic status or geographic location. An approach that focuses solely on the most technologically advanced screening methods without considering cost-effectiveness or patient accessibility would be ethically problematic. It could lead to disparities in care, where only a subset of the population can benefit from these advanced tools, potentially violating principles of justice and equity. An approach that relies exclusively on patient self-referral for screening, without proactive outreach or educational campaigns, would be insufficient. This fails to address potential barriers to access, such as lack of awareness, fear, or logistical challenges, and could result in missed opportunities for early detection, particularly among vulnerable populations. An approach that prioritizes screening for rare cancers over more prevalent ones, based on anecdotal evidence or personal interest rather than epidemiological data, would be professionally unsound. This misallocates resources and deviates from evidence-based public health strategies, failing to maximize the impact on overall cancer morbidity and mortality. Professionals should employ a decision-making framework that begins with a thorough understanding of the epidemiological landscape of cancer within the target population. This involves reviewing current evidence-based guidelines and research on screening efficacy, sensitivity, and specificity. Subsequently, the framework should incorporate an assessment of available resources, technological capabilities, and patient demographics to identify potential barriers to access and adherence. Ethical considerations, including informed consent, patient autonomy, and the principle of beneficence, must be integrated at every stage. Finally, a process for continuous evaluation and quality improvement should be established to ensure the screening program remains effective, efficient, and equitable.

This scenario is professionally challenging because it requires the Advanced Oncology Certified Clinical Nurse Specialist (AOCNS) to navigate complex systemic issues that contribute to disparities in cancer care, rather than focusing solely on individual patient treatment. The AOCNS must balance immediate patient needs with the broader responsibility of advocating for equitable access and quality of care across diverse populations. Careful judgment is required to identify root causes of disparities and implement sustainable solutions that align with ethical principles and professional standards. The best approach involves a comprehensive, multi-faceted strategy that directly addresses the identified barriers to equitable cancer care. This includes conducting a thorough needs assessment within the specific patient population to understand the unique social determinants of health impacting their cancer journey. Based on this assessment, the AOCNS should then develop and implement targeted interventions, such as patient navigation programs, culturally sensitive educational materials, and partnerships with community resources to address issues like transportation, financial toxicity, and health literacy. This approach is correct because it is evidence-based, patient-centered, and aligns with ethical obligations to promote justice and beneficence in healthcare. It directly tackles the systemic factors contributing to disparities, aiming for long-term improvement in outcomes for underserved populations, which is a core responsibility of an AOCNS. An approach that focuses solely on optimizing individual treatment plans without considering the broader systemic barriers faced by certain patient groups is professionally unacceptable. While excellent clinical care is essential, it fails to address the root causes of disparities. This approach neglects the ethical imperative to promote justice by ensuring equitable access to care and may inadvertently perpetuate existing inequities if patients cannot access or adhere to recommended treatments due to external factors. Another professionally unacceptable approach is to rely solely on existing hospital policies and procedures without actively seeking to identify and address their limitations in serving diverse populations. Hospital policies may not adequately account for the specific needs of marginalized groups, and a passive approach fails to fulfill the AOCNS’s role as an advocate for vulnerable patients. This overlooks the ethical responsibility to ensure that care is not only clinically sound but also accessible and culturally appropriate for all patients. Furthermore, an approach that prioritizes research and data collection on disparities without concurrently implementing actionable interventions is insufficient. While data is crucial for understanding the problem, it does not, in itself, alleviate the suffering or improve the outcomes of patients experiencing disparities. This approach fails to translate knowledge into practice and neglects the ethical duty to act in the best interests of patients by actively working to mitigate inequities. The professional decision-making process for similar situations should involve a systematic evaluation of the problem, considering both clinical and systemic factors. This includes engaging with patients and communities to understand their lived experiences, consulting relevant literature and best practices, and collaborating with interdisciplinary teams and community stakeholders. The AOCNS should then prioritize interventions that are evidence-based, culturally sensitive, and sustainable, with a clear plan for implementation, evaluation, and continuous improvement, always guided by principles of justice, beneficence, non-maleficence, and autonomy.

Scenario Analysis: This scenario is professionally challenging because it requires the Advanced Oncology Certified Clinical Nurse Specialist (AOCNS) to balance the patient’s immediate need for surgical intervention with the complex ethical and regulatory considerations surrounding informed consent, particularly when a patient’s capacity to consent is in question. The AOCNS must navigate potential conflicts between the patient’s perceived best interests, the family’s input, and the legal and ethical requirements for valid consent, all while ensuring the patient’s autonomy is respected to the greatest extent possible. The urgency of the oncological condition adds further pressure, demanding swift yet thorough decision-making. Correct Approach Analysis: The best professional practice involves a multi-faceted approach that prioritizes assessing and supporting the patient’s decision-making capacity. This includes a comprehensive evaluation by the AOCNS and the medical team to determine the extent of the patient’s understanding of their condition, the proposed surgical intervention, its risks and benefits, and alternative options. If the patient demonstrates capacity, their informed consent is paramount. If capacity is impaired, the AOCNS must follow established legal and ethical protocols for surrogate decision-making, which typically involves identifying a legally authorized surrogate decision-maker (e.g., healthcare power of attorney, next of kin) and ensuring they are provided with all necessary information to make decisions in the patient’s best interest or according to the patient’s known wishes. This approach aligns with the fundamental ethical principles of autonomy and beneficence, and adheres to regulatory frameworks that mandate informed consent and protect vulnerable patients. Incorrect Approaches Analysis: Proceeding with surgery based solely on the family’s insistence, without a thorough assessment of the patient’s capacity and obtaining their consent if capable, violates the principle of patient autonomy and potentially legal requirements for informed consent. This approach disregards the patient’s right to self-determination. Delaying surgery indefinitely due to the family’s expressed concerns about the patient’s capacity, without a formal assessment and exploration of alternatives or support for the patient’s decision-making, could be detrimental to the patient’s health and contravenes the principle of beneficence. It also fails to actively address the capacity issue. Obtaining consent from a surrogate decision-maker without first conducting a diligent assessment of the patient’s own capacity, or without ensuring the surrogate has the most up-to-date and complete information, is ethically and legally problematic. This bypasses the primary right of the patient to consent if they are able. Professional Reasoning: Professionals should employ a structured decision-making process that begins with a thorough assessment of the patient’s clinical status and their capacity to make informed decisions. This involves open communication with the patient, family, and the multidisciplinary team. When capacity is questionable, a formal assessment should be conducted. The legal and ethical framework for informed consent and surrogate decision-making must be strictly followed. Documentation of all assessments, discussions, and decisions is crucial. The AOCNS should advocate for the patient’s rights and ensure that care aligns with both ethical principles and regulatory mandates.