The investigation demonstrates the critical need for a structured and evidence-based approach to candidate preparation for the Advanced Pan-Asia Adult-Gerontology Acute Care Nursing Licensure Examination. This scenario is professionally challenging because the stakes are high for both the individual candidate and the healthcare system, which relies on competent practitioners. Inadequate preparation can lead to examination failure, delayed licensure, and potential patient safety risks if a candidate is not sufficiently prepared. Careful judgment is required to balance the candidate’s learning needs with the time constraints and the comprehensive nature of the examination. The best approach involves a personalized, multi-modal preparation strategy that integrates foundational knowledge review with targeted practice and ongoing assessment. This approach is correct because it acknowledges that adult learners benefit from diverse learning methods and that individual knowledge gaps require specific attention. Regulatory frameworks for nursing licensure, while not explicitly detailed in this prompt, universally emphasize competency and evidence of knowledge. Therefore, a preparation strategy that systematically addresses all examination domains, utilizes validated resources, and includes self-assessment aligns with the ethical imperative to ensure practitioners meet established standards. This method fosters deep understanding rather than rote memorization, which is crucial for acute care settings. An approach that relies solely on reviewing past examination papers without understanding the underlying principles is professionally unacceptable. This fails to address foundational knowledge gaps and may lead to a superficial understanding of complex clinical scenarios, potentially violating ethical obligations to provide competent care. Another unacceptable approach is to focus only on the most recent examination trends, neglecting core competencies and established best practices. This can result in a candidate being unprepared for variations in examination content and, more importantly, for the diverse patient populations encountered in acute care. Finally, an approach that prioritizes speed over thoroughness, such as cramming information in the final weeks, is ethically questionable. This method is unlikely to lead to lasting knowledge retention or the development of critical thinking skills necessary for safe and effective nursing practice, thereby failing to meet the standards expected of licensed professionals. Professionals should employ a decision-making framework that begins with a thorough self-assessment of knowledge and skills against the examination blueprint. This should be followed by the selection of reputable, evidence-based preparation resources that cover all domains. A structured timeline should be developed, incorporating regular review, practice questions, and simulated examinations. Continuous self-evaluation and adjustment of the study plan based on performance are essential. This systematic and adaptive approach ensures comprehensive preparation and aligns with the professional responsibility to maintain competence.

Scenario Analysis: This scenario is professionally challenging because it requires a nurse to navigate the specific eligibility criteria for a specialized licensure examination, balancing personal career aspirations with the regulatory requirements designed to ensure public safety and professional competence. Misinterpreting or misrepresenting eligibility can lead to significant professional consequences, including denial of licensure, disciplinary action, and damage to reputation. Careful judgment is required to accurately assess one’s qualifications against the established standards. Correct Approach Analysis: The best professional practice involves a thorough and honest self-assessment of one’s qualifications against the published eligibility requirements for the Advanced Pan-Asia Adult-Gerontology Acute Care Nursing Licensure Examination. This includes verifying that all educational prerequisites, such as the completion of an accredited advanced practice registered nursing program with a specific focus on adult-gerontology acute care, have been met. Furthermore, it necessitates confirming that the required clinical practice hours in the relevant specialty have been accrued and documented according to the examination board’s guidelines. This approach is correct because it directly aligns with the fundamental purpose of licensure examinations: to ensure that candidates possess the necessary knowledge, skills, and experience to practice safely and effectively within the defined scope of practice. Adhering strictly to the stated eligibility criteria upholds the integrity of the examination process and protects the public by ensuring only qualified individuals are granted licensure. Incorrect Approaches Analysis: One incorrect approach involves assuming eligibility based on a general advanced practice nursing license and a broad range of experience in adult care, without specifically confirming that the prior education and clinical practice directly align with the adult-gerontology acute care specialty. This fails to meet the specific requirements of the examination, which are designed to assess specialized knowledge and skills, not general competence. Ethically, this is problematic as it attempts to bypass established standards. Another incorrect approach is to rely on informal advice from colleagues or mentors regarding eligibility without independently verifying the information against the official examination board’s documentation. While well-intentioned, informal advice may be outdated, misinterpreted, or not specific enough to the exact requirements of this particular advanced examination. This approach risks misrepresenting qualifications and failing to meet the rigorous standards set by the regulatory body. A further incorrect approach is to submit an application with incomplete or inaccurate documentation of clinical hours, hoping that the examination board will overlook minor discrepancies. The purpose of detailed documentation is to provide objective evidence of the required experience. Omitting or falsifying this information undermines the integrity of the application process and demonstrates a lack of respect for the regulatory framework. This is ethically unsound and can lead to severe penalties. Professional Reasoning: Professionals should approach licensure eligibility by prioritizing official sources of information. This involves meticulously reviewing the examination board’s official handbook, website, and any published guidelines. A systematic checklist should be created based on these official requirements, and each item should be verified with supporting documentation. If any aspect of the eligibility criteria remains unclear, direct communication with the examination board’s administrative staff is the most prudent step. This methodical and transparent approach ensures that applications are accurate, complete, and compliant with all regulatory mandates, thereby safeguarding professional integrity and the public trust.

Scenario Analysis: This scenario is professionally challenging because it requires balancing the immediate needs of a critically ill patient with the ethical and legal obligations of healthcare providers to respect patient autonomy and ensure informed consent, even when the patient’s capacity is compromised. The rapid deterioration of the patient’s condition adds urgency, potentially leading to pressure to bypass standard consent procedures. Careful judgment is required to navigate these competing demands while upholding patient rights and professional standards. Correct Approach Analysis: The best professional practice involves a multi-faceted approach that prioritizes obtaining informed consent from a surrogate decision-maker when the patient lacks capacity. This approach involves first assessing the patient’s capacity to make decisions. If capacity is lacking, the nurse must identify and engage the legally authorized surrogate decision-maker, providing them with comprehensive information about the patient’s condition, the proposed treatment, alternatives, and risks and benefits. This ensures that decisions are made in accordance with the patient’s known wishes or best interests, as mandated by ethical principles of beneficence and respect for autonomy, and aligns with regulatory frameworks governing patient rights and surrogate decision-making in healthcare. Incorrect Approaches Analysis: One incorrect approach involves proceeding with the life-sustaining treatment without attempting to obtain consent from a surrogate decision-maker, relying solely on the perceived urgency of the situation. This fails to uphold the patient’s right to autonomy and the legal requirement for informed consent, even in emergencies, unless specific exceptions apply (e.g., imminent threat to life with no surrogate available). This bypasses established ethical and legal safeguards. Another incorrect approach is to unilaterally decide on the treatment plan based on the nurse’s personal judgment of what is best for the patient, without involving the patient’s family or a surrogate. This violates the principle of patient-centered care and the legal framework that designates specific individuals to make decisions on behalf of incapacitated patients. It also risks imposing the nurse’s values on the patient. A further incorrect approach is to delay necessary treatment significantly while exhaustively searching for a surrogate decision-maker, even when a clear and readily available surrogate is known to exist. While consent is crucial, an unreasonable delay in providing essential, life-sustaining care when a surrogate is available to consent can be considered a failure of the duty of care and beneficence, potentially leading to harm. Professional Reasoning: Professionals should employ a structured decision-making process. First, assess the patient’s capacity. If capacity is impaired, identify the appropriate surrogate decision-maker according to legal and institutional policies. Engage the surrogate with clear, unbiased information to facilitate informed consent. Document all discussions and decisions meticulously. If there are disputes or uncertainties regarding capacity or surrogate status, consult with the ethics committee or legal counsel to ensure adherence to all regulatory and ethical mandates.

This scenario presents a professional challenge due to the inherent complexity of assessing and monitoring adult-gerontology patients across diverse acute care settings, requiring a nuanced understanding of their evolving physiological, psychological, and social needs. The critical need for accurate diagnostics and effective monitoring is amplified by the potential for rapid deterioration and the ethical imperative to provide patient-centered, evidence-based care. Professionals must navigate the delicate balance between timely intervention and respecting patient autonomy, all while adhering to stringent regulatory standards for patient safety and quality of care. The best approach involves a systematic, holistic, and evidence-based assessment that integrates objective data with subjective patient and family reports. This approach prioritizes the identification of subtle changes indicative of potential complications, utilizing validated diagnostic tools and continuous monitoring strategies tailored to the individual’s condition and risk factors. It emphasizes interdisciplinary collaboration, ensuring that all members of the healthcare team contribute their expertise to inform diagnostic reasoning and treatment planning. This aligns with ethical principles of beneficence and non-maleficence, as well as regulatory requirements for comprehensive patient care and accurate documentation. An incorrect approach would be to rely solely on routine, standardized assessments without adapting them to the specific clinical presentation and individual patient history. This failure to individualize care can lead to missed early warning signs and delayed interventions, potentially compromising patient outcomes. Ethically, it falls short of the duty to provide individualized care. Another incorrect approach is to prioritize diagnostic testing over thorough clinical assessment and patient history. While diagnostics are crucial, they should complement, not replace, the foundational understanding gained from a comprehensive assessment. Over-reliance on tests without clinical correlation can lead to misinterpretation, unnecessary procedures, and increased healthcare costs, violating principles of prudent resource utilization and patient safety. A further incorrect approach is to delegate critical assessment and monitoring tasks to unlicensed personnel without adequate supervision or validation of their competency. This poses a significant risk to patient safety, as unlicensed staff may lack the knowledge and skills to recognize critical changes or respond appropriately. It also represents a failure to adhere to professional scope of practice guidelines and regulatory mandates for qualified personnel. Professionals should employ a decision-making framework that begins with a thorough understanding of the patient’s baseline status and risk factors. This is followed by a systematic assessment, incorporating both subjective and objective data. Diagnostic reasoning should be guided by the assessment findings, leading to the selection of appropriate diagnostic tests. Monitoring strategies should be continuously evaluated and adjusted based on the patient’s response to treatment and evolving clinical picture. Throughout this process, open communication with the patient, family, and interdisciplinary team is paramount, ensuring shared decision-making and optimal care delivery within the established regulatory and ethical boundaries.

The assessment process reveals a complex clinical scenario involving an elderly patient with multiple comorbidities presenting with acute respiratory distress. This situation is professionally challenging due to the inherent complexity of geriatric acute care, where subtle signs and symptoms can indicate significant underlying pathophysiology, and the potential for rapid deterioration. Differentiating between exacerbations of chronic conditions and new acute processes requires a high degree of clinical acumen and a systematic, pathophysiology-informed approach. Careful judgment is required to prioritize interventions, avoid iatrogenic harm, and ensure patient safety and optimal outcomes within the framework of advanced nursing practice. The best approach involves a comprehensive, pathophysiology-informed assessment that integrates the patient’s history, physical examination findings, and diagnostic data to formulate a differential diagnosis. This approach prioritizes understanding the underlying disease processes contributing to the patient’s current presentation. For example, recognizing the signs of pulmonary edema versus pneumonia requires knowledge of the distinct pathophysiological mechanisms and their clinical manifestations. This systematic evaluation allows for the development of a targeted and evidence-based management plan, aligning with the ethical principles of beneficence and non-maleficence, and the professional standards of advanced practice nursing which mandate evidence-based decision-making. An incorrect approach would be to solely rely on a single diagnostic test result without considering the broader clinical picture and underlying pathophysiology. For instance, treating a positive sputum culture without assessing for signs of active infection or considering alternative explanations for the findings could lead to unnecessary antibiotic use and potential adverse effects, violating the principle of non-maleficence. Another incorrect approach is to manage symptoms in isolation without identifying and addressing the root cause. This could involve administering bronchodilators for dyspnea without investigating for a potential cardiac etiology, which would be a failure to provide comprehensive and effective care. Finally, deferring all critical decisions to the physician without utilizing advanced practice nursing scope of practice and clinical judgment represents a failure to act autonomously and competently within the established professional role. Professionals should employ a structured decision-making framework that begins with a thorough assessment, followed by the generation of differential diagnoses based on pathophysiological understanding. This should be followed by the selection of appropriate diagnostic investigations to confirm or refute these diagnoses, and then the development and implementation of a patient-centered, evidence-based treatment plan. Ongoing reassessment and evaluation of the patient’s response to treatment are crucial for adjusting the plan as needed.

Scenario Analysis: This scenario is professionally challenging because it involves navigating the complex and often stressful process of licensure examination retakes, balancing the candidate’s desire to practice with the regulatory body’s mandate to ensure public safety. The candidate’s emotional state and potential financial strain add layers of complexity, requiring a nuanced and ethically grounded approach from the regulatory body. Careful judgment is required to uphold examination integrity while providing a fair and transparent process for candidates. Correct Approach Analysis: The best professional practice involves clearly communicating the established blueprint weighting, scoring, and retake policies to the candidate. This approach is correct because it adheres to principles of transparency and fairness inherent in regulatory frameworks. Specific guidelines for licensure examinations, such as those often outlined by professional nursing boards or examination bodies, typically mandate that all candidates be informed of the examination structure, passing criteria, and the procedures for retaking the exam. This ensures that candidates understand the requirements and the consequences of not meeting them, fostering an environment of informed consent and equitable treatment. Adherence to these policies protects the integrity of the examination process and upholds the regulatory body’s responsibility to ensure competent practitioners. Incorrect Approaches Analysis: One incorrect approach involves waiving the standard retake policy due to the candidate’s expressed distress and financial hardship. This is professionally unacceptable because it undermines the established regulatory framework. Licensure examinations are designed with specific criteria to ensure a minimum standard of competency. Deviating from these policies, even with good intentions, compromises the validity and reliability of the examination process and could potentially allow an unqualified individual to practice, jeopardizing public safety. It also creates an unfair precedent for other candidates who have adhered to the established policies. Another incorrect approach is to offer a modified or less rigorous retake examination without explicit regulatory approval. This is ethically and regulatorily unsound. Modifying examination procedures on a case-by-case basis, outside of established protocols, erodes public trust in the licensing process and violates the principle of equal treatment for all candidates. The examination blueprint and retake policies are carefully constructed to assess specific competencies; altering them for an individual candidate bypasses these critical safeguards. A further incorrect approach is to delay the decision on the retake policy indefinitely while the candidate seeks further preparation, without a defined timeline or clear communication of expectations. This is professionally problematic as it creates uncertainty for the candidate and potentially delays their ability to practice if they were to pass a subsequent examination. It also represents a failure to adhere to the established procedural fairness expected of regulatory bodies, which should operate with efficiency and clarity in their decision-making processes regarding licensure. Professional Reasoning: Professionals in regulatory roles should employ a decision-making framework that prioritizes adherence to established policies and regulations. This involves: 1) Understanding and clearly communicating the existing rules and guidelines (blueprint weighting, scoring, retake policies). 2) Applying these rules consistently and equitably to all candidates. 3) Recognizing the importance of transparency and providing clear information to candidates regarding their examination status and options. 4) Seeking guidance or formal approval from higher authorities or the governing board when faced with exceptional circumstances that might warrant policy review, rather than making ad-hoc decisions. 5) Balancing the need for fairness to the candidate with the paramount responsibility to protect public safety by ensuring only qualified individuals are licensed.

Scenario Analysis: This scenario presents a professional challenge due to the inherent conflict between a patient’s expressed wishes and the perceived best interests of their family, complicated by the patient’s diminished capacity. Navigating this requires a delicate balance of respecting patient autonomy, upholding ethical principles of beneficence and non-maleficence, and adhering to legal frameworks governing patient care and decision-making, particularly in the context of acute care where rapid decisions may be necessary. The nurse must act as a patient advocate while also facilitating communication and understanding among all involved parties. Correct Approach Analysis: The best professional approach involves prioritizing direct communication with the patient, even with their cognitive impairment, to ascertain their current wishes and understanding of their condition and treatment options. This approach respects the patient’s fundamental right to self-determination, even when that autonomy is compromised. It involves employing communication strategies tailored to the patient’s cognitive state, such as using simple language, providing information in manageable chunks, and allowing ample time for responses. This aligns with ethical principles of autonomy and beneficence, as it seeks to act in accordance with the patient’s values and well-being as they define it. Regulatory frameworks, such as those governing patient rights and informed consent, emphasize the importance of involving the patient in their care decisions to the greatest extent possible, even when capacity is fluctuating. Incorrect Approaches Analysis: One incorrect approach involves solely relying on the family’s interpretation of the patient’s wishes and making decisions based on their input without sufficient direct engagement with the patient. This fails to uphold the principle of patient autonomy and risks imposing decisions that may not align with the patient’s actual desires or values, potentially leading to ethical distress and legal challenges related to patient rights. Another incorrect approach is to proceed with a treatment plan that the patient has previously expressed a desire to avoid, based on the family’s insistence that it is for the patient’s own good. While beneficence is a key ethical principle, it must be balanced with autonomy. Acting solely on the family’s perception of “best interest” without a thorough assessment of the patient’s current wishes and capacity can be paternalistic and violate the patient’s right to refuse treatment, even if that refusal seems detrimental to external observers. A further incorrect approach involves unilaterally making a decision about the patient’s care without adequate consultation with either the patient or the family, or without involving the interdisciplinary team. This bypasses essential communication and collaborative decision-making processes, potentially leading to suboptimal care, increased family conflict, and a failure to meet the patient’s holistic needs. It also neglects the importance of a multidisciplinary approach to complex patient care decisions. Professional Reasoning: Professionals should employ a decision-making framework that begins with a thorough assessment of the patient’s current condition, including their cognitive status and capacity to make decisions. This should be followed by direct, empathetic communication with the patient, using appropriate strategies to facilitate understanding. Simultaneously, open and respectful communication with the family is crucial to gather their perspectives and concerns, while clearly articulating the patient’s rights and the nurse’s professional obligations. When capacity is questionable or fluctuating, the interdisciplinary team, including physicians, social workers, and ethics consultants if available, should be involved to ensure a comprehensive and ethically sound plan of care that respects the patient’s autonomy to the greatest extent possible.

This scenario presents a professional challenge due to the critical need for accurate, timely, and compliant clinical documentation in an acute care setting. The integration of informatics systems introduces potential for both efficiency and error, necessitating a robust understanding of regulatory requirements to safeguard patient privacy, ensure continuity of care, and avoid legal repercussions. The complexity arises from balancing technological capabilities with the fundamental ethical and legal obligations of healthcare providers. The best approach involves a proactive and systematic review of all electronic health record (EHR) entries for completeness, accuracy, and adherence to established documentation standards and relevant Pan-Asian healthcare regulations. This includes verifying that all entries are timely, legible, objective, and contain all necessary patient information, including dates, times, and the identity of the recorder. This approach is correct because it directly addresses the core principles of good clinical documentation, which are foundational to patient safety and regulatory compliance. Adherence to these principles, as often mandated by national healthcare bodies and professional nursing standards across Pan-Asia, ensures that patient records are reliable legal documents and facilitate effective interdisciplinary communication. An incorrect approach would be to rely solely on the EHR system’s automated prompts without independent verification. This is professionally unacceptable because automated prompts may not capture nuanced clinical details or account for specific patient circumstances that require narrative elaboration. Regulatory frameworks often emphasize the clinician’s responsibility for the accuracy and completeness of their entries, not just system-generated data. Another incorrect approach is to delegate the final review of documentation to unlicensed assistive personnel without direct clinical oversight. This is ethically and regulatorily problematic as it bypasses the licensed nurse’s ultimate accountability for the patient’s record. Pan-Asian nursing practice acts and professional guidelines typically stipulate that licensed nurses are responsible for documenting their assessments, interventions, and patient responses. Finally, an incorrect approach is to prioritize speed of documentation over thoroughness, leading to the omission of critical details or the use of vague terminology. This failure to document comprehensively can compromise patient care continuity and create significant legal vulnerabilities, as incomplete records can be interpreted as evidence of substandard care. Regulatory bodies consistently emphasize the importance of detailed and specific documentation to support clinical decision-making and demonstrate adherence to standards of care. Professionals should employ a decision-making framework that begins with understanding the specific documentation requirements of their institution and the prevailing national healthcare regulations. This involves regular training on EHR functionalities and documentation best practices, coupled with a critical self-assessment of each entry before it is finalized. A commitment to ongoing professional development in clinical informatics and regulatory compliance is essential for navigating the complexities of modern healthcare documentation.

This scenario presents a professional challenge due to the critical nature of medication management in acute care settings, particularly for vulnerable adult and gerontology populations. Ensuring patient safety requires a meticulous approach to prescribing support and medication administration, balancing therapeutic efficacy with the prevention of adverse drug events. The complexity arises from the need to integrate evidence-based practice with individual patient needs, potential drug interactions, and the legal and ethical responsibilities of the advanced practice nurse. Careful judgment is paramount to avoid errors that could lead to significant patient harm. The best approach involves a comprehensive review of the patient’s current medication regimen, including over-the-counter drugs and supplements, in conjunction with a thorough assessment of their physiological status, comorbidities, and potential for drug interactions. This includes consulting available drug interaction databases and relevant clinical guidelines. The advanced practice nurse should then collaborate with the prescribing physician to discuss any identified concerns or potential adjustments, providing clear, evidence-based rationale for proposed changes. This collaborative, evidence-informed strategy aligns with ethical principles of patient advocacy and beneficence, and regulatory expectations for safe prescribing and medication management, emphasizing a proactive and patient-centered approach to prevent medication errors and optimize therapeutic outcomes. An incorrect approach would be to assume the existing prescription is optimal without independent verification, especially if the patient presents with new or worsening symptoms. This failure to critically evaluate the medication regimen, despite potential indicators of adverse effects or suboptimal therapy, neglects the advanced practice nurse’s responsibility to ensure patient safety and can lead to delayed diagnosis of medication-related problems or continued exposure to harmful drugs. Another incorrect approach would be to unilaterally alter the medication regimen based on personal preference or incomplete information, without consulting the prescribing physician or thoroughly reviewing the patient’s clinical data. This bypasses essential collaborative practice protocols and undermines the established physician-nurse relationship, potentially leading to conflicting treatment plans and patient confusion or harm. It also disregards the legal and ethical framework that governs prescribing authority and collaborative practice. A further incorrect approach would be to rely solely on the patient’s self-report of medication adherence without objective verification or consideration of potential cognitive impairments that might affect recall. While patient input is valuable, it must be corroborated with clinical assessment and medication reconciliation to ensure accuracy and identify potential barriers to effective treatment. This oversight can mask underlying issues contributing to treatment failure or adverse events. Professionals should employ a systematic decision-making process that begins with a thorough patient assessment, followed by critical evaluation of all prescribed and self-administered medications. This includes utilizing available resources for drug information and interaction checking. Any identified discrepancies or concerns should be addressed through collaborative discussion with the prescribing physician, supported by evidence-based rationale. Documentation of all assessments, consultations, and decisions is crucial for accountability and continuity of care.

Scenario Analysis: This scenario is professionally challenging because it involves a critical patient situation requiring immediate and coordinated action, while simultaneously navigating the complexities of delegation and interprofessional communication within a busy acute care setting. The nurse leader must balance patient safety, efficient resource allocation, and the professional boundaries of various team members. Careful judgment is required to ensure that tasks are assigned appropriately, that communication is clear and effective, and that the entire team is aligned towards the patient’s best interest. Correct Approach Analysis: The best professional practice involves the nurse leader directly assessing the patient’s stability and then initiating a clear, concise communication with the attending physician to discuss the observed changes and propose a management plan. This approach prioritizes direct patient assessment by the leader, ensuring an accurate understanding of the situation before involving other team members or making delegation decisions. It also establishes a direct line of communication with the physician, which is crucial for timely medical intervention and collaborative decision-making, aligning with principles of patient advocacy and safe practice. This aligns with the ethical imperative to provide competent care and the professional responsibility to communicate effectively with the medical team. Incorrect Approaches Analysis: One incorrect approach involves immediately delegating the task of reassessing the patient to a junior nurse without first performing a direct assessment. This fails to uphold the nurse leader’s responsibility for direct patient care oversight and could lead to delayed or inaccurate assessment if the junior nurse lacks the experience or is overwhelmed. It bypasses the leader’s critical role in initial evaluation and potentially compromises patient safety. Another incorrect approach is to wait for the attending physician to make rounds and observe the patient’s changes. This passive approach delays necessary intervention and communication, potentially exacerbating the patient’s condition. It neglects the nurse leader’s proactive role in identifying and escalating critical patient changes, which is a fundamental aspect of acute care nursing leadership. A further incorrect approach is to delegate the task of contacting the physician to a unit secretary. This is inappropriate as it removes the clinical judgment and direct communication from a qualified nursing professional. The unit secretary is not equipped to convey the nuances of the patient’s condition or to participate in the clinical decision-making process with the physician, thereby creating a communication breakdown and potential patient harm. Professional Reasoning: Professionals should employ a structured decision-making process that begins with patient assessment, followed by a clear understanding of the situation. This understanding then informs appropriate delegation based on skill mix and scope of practice, and facilitates effective interprofessional communication. Prioritizing patient safety, adhering to professional standards, and utilizing clear, direct communication channels are paramount in acute care settings.