Scenario Analysis: This scenario presents a common challenge in medical-surgical nursing: integrating evidence-based practice and quality improvement initiatives into daily patient care. The professional challenge lies in balancing the demands of direct patient care with the systematic requirements of simulation, quality improvement, and research translation. Nurses must demonstrate not only clinical competence but also a commitment to advancing patient outcomes through structured processes, adhering to professional standards and regulatory expectations for continuous learning and quality assurance. Careful judgment is required to identify and implement the most effective strategies that align with organizational goals and patient safety mandates. Correct Approach Analysis: The best approach involves actively participating in and contributing to the development and implementation of evidence-based practice initiatives. This includes engaging in simulation exercises designed to test and refine new protocols or skills, identifying opportunities for quality improvement based on observed patient outcomes or system inefficiencies, and critically evaluating research findings for potential translation into clinical practice. This approach is correct because it directly addresses the core expectations of medical-surgical nursing practice as outlined by professional bodies and regulatory frameworks that emphasize continuous learning, patient safety, and the application of current best evidence. It demonstrates a proactive commitment to enhancing patient care quality and safety through systematic processes. Incorrect Approaches Analysis: One incorrect approach is to solely rely on personal experience and anecdotal evidence when making clinical decisions, without actively seeking out or incorporating findings from research or formal quality improvement projects. This fails to meet the expectation of evidence-based practice, which mandates the use of the best available research to guide patient care. Another incorrect approach is to view simulation and quality improvement activities as separate from direct patient care, participating only when mandated without seeking to understand their broader impact on patient outcomes or contributing to their refinement. This neglects the interconnectedness of these initiatives with improving the quality and safety of care. Finally, an approach that prioritizes the implementation of new practices without a thorough evaluation of their evidence base or potential risks, or without adequate staff training and competency assessment, can lead to suboptimal or even harmful patient care and violates principles of responsible innovation and patient safety. Professional Reasoning: Professionals should employ a decision-making framework that prioritizes patient safety and evidence-based practice. This involves: 1) Staying current with relevant research and professional guidelines. 2) Actively participating in organizational quality improvement initiatives and simulation exercises. 3) Critically appraising evidence for applicability to their practice setting and patient population. 4) Collaborating with colleagues and leadership to advocate for and implement evidence-based changes. 5) Evaluating the impact of implemented changes and contributing to ongoing refinement. This systematic approach ensures that practice is informed, effective, and contributes to the highest standards of patient care.

Scenario Analysis: This scenario is professionally challenging because it requires a nurse to navigate the specific requirements for an “Applied Pan-Regional Medical-Surgical Nursing Practice Qualification” while ensuring their actions align with the established regulatory framework. Misinterpreting eligibility criteria or the purpose of the qualification can lead to wasted resources, professional setbacks, and potential regulatory non-compliance. Careful judgment is required to accurately assess the nurse’s current standing and the qualification’s intended outcomes. Correct Approach Analysis: The best professional approach involves a thorough review of the official documentation outlining the purpose and eligibility criteria for the Applied Pan-Regional Medical-Surgical Nursing Practice Qualification. This includes understanding the specific scope of practice the qualification aims to enhance or certify, and meticulously verifying if the nurse’s existing qualifications, experience, and current practice setting meet all stated prerequisites. This approach is correct because it directly addresses the foundational requirements of the qualification, ensuring that any pursuit of it is grounded in regulatory compliance and a clear understanding of its objectives. Adhering to these documented criteria is paramount for any professional development or certification process within a regulated field. Incorrect Approaches Analysis: Pursuing the qualification based solely on anecdotal advice from colleagues, without independent verification of the official criteria, represents a significant regulatory failure. This approach risks misinterpreting the qualification’s purpose or overlooking crucial eligibility requirements, potentially leading to an application that is rejected on technical grounds. Another incorrect approach is assuming the qualification is a universal upgrade to any nursing role, irrespective of the nurse’s current specialization or experience. This ignores the specific intent of a “Pan-Regional Medical-Surgical” qualification, which is designed to address particular competencies within that domain. Finally, focusing only on the perceived career advancement benefits without confirming eligibility and purpose is ethically questionable and professionally unsound, as it prioritizes personal gain over adherence to established professional standards and regulatory frameworks. Professional Reasoning: Professionals should adopt a systematic decision-making process when considering qualifications. This begins with identifying the specific qualification and its stated purpose. Next, they must locate and meticulously review the official regulatory documentation detailing eligibility criteria, required experience, and any prerequisite certifications. This should be followed by an honest self-assessment of their current standing against these criteria. If there are ambiguities, seeking clarification from the official awarding body or regulatory authority is essential. This structured approach ensures that professional development efforts are aligned with regulatory requirements and contribute meaningfully to their career progression and the quality of patient care.

Scenario Analysis: This scenario presents a professional challenge rooted in balancing patient autonomy with the imperative of ensuring safe and effective care within a regulated healthcare environment. The nurse must navigate the complex interplay between a patient’s expressed wishes, their perceived capacity to make informed decisions, and the professional and legal obligations to provide appropriate medical-surgical interventions. Misjudging the patient’s capacity or failing to adhere to established protocols for assessing and managing such situations can lead to significant ethical breaches and regulatory non-compliance. Correct Approach Analysis: The best professional approach involves a systematic and documented assessment of the patient’s capacity to understand the proposed treatment, appreciate the consequences of their decision, and communicate their choice. This assessment should be conducted by the registered nurse, and if any doubt exists regarding capacity, a formal capacity assessment by a qualified clinician (e.g., physician, senior nurse practitioner) should be initiated. The nurse must then clearly document the assessment findings and the rationale for any decision made regarding treatment. This approach aligns with the fundamental ethical principles of respect for autonomy and beneficence, and it adheres to regulatory frameworks that mandate patient-centered care and the protection of vulnerable individuals. It ensures that decisions about medical-surgical interventions are made by individuals who are capable of understanding and consenting to them, or that appropriate safeguards are in place if capacity is compromised. Incorrect Approaches Analysis: Proceeding with the patient’s stated preference without a formal capacity assessment, despite the nurse’s concerns about the patient’s understanding of the risks and benefits, represents a failure to uphold the duty of care. This approach risks administering a treatment that the patient may not truly consent to, thereby violating the principle of informed consent and potentially leading to harm. It also disregards the regulatory requirement to ensure patient understanding before proceeding with interventions. Involving the patient’s family in the decision-making process without first establishing the patient’s capacity to make their own decisions is also professionally unacceptable. While family involvement can be supportive, it should not supersede the patient’s right to self-determination if they possess the capacity to exercise it. This approach can undermine patient autonomy and may lead to decisions that do not reflect the patient’s true wishes or best interests, and it bypasses the necessary regulatory steps for capacity assessment. Delaying the medical-surgical intervention indefinitely due to the nurse’s personal discomfort with the patient’s expressed wishes, without initiating a formal capacity assessment or seeking further clinical guidance, is also inappropriate. While professional judgment is crucial, it must be exercised within established protocols. This approach fails to address the underlying issue of potential capacity concerns and can lead to a deterioration in the patient’s condition, violating the principle of beneficence and potentially contravening regulatory expectations for timely and appropriate care. Professional Reasoning: Professionals should employ a decision-making framework that prioritizes patient safety and rights. This involves: 1) Recognizing and acknowledging any concerns about a patient’s capacity to make informed decisions. 2) Initiating a structured assessment of capacity, following established institutional policies and professional guidelines. 3) Collaborating with other healthcare professionals when capacity is in doubt or complex. 4) Documenting all assessments, discussions, and decisions thoroughly. 5) Upholding patient autonomy while ensuring beneficence and non-maleficence.

The efficiency study reveals a critical juncture in the implementation of a new pan-regional medical-surgical nursing practice qualification. The challenge lies in ensuring that the proposed efficiency gains do not inadvertently compromise patient safety or the quality of care, which are paramount under the UK’s regulatory framework for healthcare professionals, including guidelines from the Nursing and Midwifery Council (NMC) and the Care Quality Commission (CQC). Professionals must navigate the tension between optimizing resource allocation and upholding their fundamental duty of care. The best approach involves a comprehensive review of the proposed changes by a multidisciplinary team, including experienced nurses, patient safety officers, and clinical governance leads. This team should meticulously assess the impact of each efficiency measure on patient outcomes, staff workload, and the adherence to established clinical protocols and best practices. Their evaluation must be grounded in evidence and align with the NMC’s Code, which emphasizes providing high-quality care, working within scope of practice, and maintaining patient safety. This approach ensures that any efficiency improvements are sustainable, evidence-based, and do not create new risks or negatively affect patient experience, thereby upholding the professional and ethical obligations of nurses. An incorrect approach would be to implement efficiency measures solely based on cost-saving projections without a thorough clinical impact assessment. This fails to acknowledge the CQC’s fundamental standards of quality and safety, which require services to be effective, caring, responsive, well-led, and safe. Such an approach risks compromising patient care by potentially reducing necessary staffing levels, shortening consultation times, or limiting access to essential resources, all of which could lead to adverse patient events and breaches of regulatory requirements. Another unacceptable approach is to prioritize speed of implementation over thoroughness, by rolling out changes without adequate staff training or consultation. This disregards the NMC’s requirement for nurses to maintain their competence and to work collaboratively. Inadequate training can lead to errors in practice, while a lack of consultation can foster resistance and undermine the effective integration of new practices, ultimately jeopardizing patient safety and the integrity of the qualification. Furthermore, an approach that relies on anecdotal evidence or the opinions of a limited group of stakeholders, without engaging a broader range of clinical expertise and patient perspectives, is also professionally unsound. This overlooks the importance of a holistic and evidence-based decision-making process, which is crucial for ensuring that changes are beneficial and ethically defensible, aligning with the principles of good governance and professional accountability. Professionals should employ a decision-making framework that prioritizes patient safety and quality of care above all else. This involves a systematic process of risk assessment, evidence appraisal, stakeholder consultation, and continuous monitoring. When considering changes that impact practice, professionals must ask: Does this change enhance patient safety? Does it improve the quality of care? Is it ethically justifiable? Does it comply with all relevant professional and regulatory standards? This critical self-reflection and adherence to established protocols are essential for maintaining public trust and delivering effective, safe nursing care.

Scenario Analysis: This scenario is professionally challenging because it requires balancing the need for consistent and fair assessment with the practicalities of a high-stakes qualification. Misinterpreting or misapplying the blueprint weighting, scoring, and retake policies can lead to unfair outcomes for candidates, damage the reputation of the qualification, and potentially lead to regulatory scrutiny. Careful judgment is required to ensure adherence to established policies while addressing individual candidate circumstances appropriately. Correct Approach Analysis: The best professional practice involves a thorough review of the official qualification blueprint and associated policies. This approach ensures that all assessment decisions are grounded in the established framework for weighting, scoring, and retake eligibility. Specifically, understanding the precise percentage allocated to each domain within the blueprint dictates the relative importance of different sections, and adherence to the defined scoring rubric ensures objective evaluation. Similarly, a clear understanding of the retake policy, including any conditions or limitations, is crucial for fair application. This approach is correct because it directly aligns with the principles of fairness, transparency, and standardization mandated by professional assessment bodies and regulatory guidelines for qualifications. It upholds the integrity of the assessment process by ensuring that all candidates are evaluated against the same, pre-defined criteria. Incorrect Approaches Analysis: One incorrect approach involves making subjective adjustments to scoring based on perceived candidate effort or improvement without explicit policy allowance. This fails to adhere to the standardized scoring rubric and can introduce bias, violating the principle of equitable assessment. It also undermines the validity of the blueprint weighting, as subjective adjustments can disproportionately impact the overall score. Another incorrect approach is to grant retakes based on anecdotal evidence or personal sympathy, bypassing the defined retake policy. This is ethically unsound as it creates an uneven playing field for candidates who have followed the established procedures. It also disregards the rationale behind the retake policy, which is often designed to ensure a certain level of competency is demonstrated before re-assessment. A further incorrect approach is to interpret the blueprint weighting loosely, allowing for significant deviation in the emphasis placed on certain domains during assessment. This compromises the representational validity of the assessment, meaning it may not accurately reflect the candidate’s proficiency across the entire scope of the qualification as intended by the blueprint. It also fails to uphold the transparency expected in qualification frameworks. Professional Reasoning: Professionals involved in administering and scoring assessments should adopt a systematic decision-making process. This begins with a comprehensive understanding of all relevant policies and the qualification blueprint. When faced with a candidate situation, the first step is to identify which specific policy or blueprint component is relevant. Then, compare the situation directly against the established criteria. If the situation falls clearly within the policy, apply it directly. If there is ambiguity, consult official documentation or designated policy experts. Avoid making ad hoc decisions or relying on personal judgment that deviates from established guidelines. The overarching principle is to maintain the integrity, fairness, and validity of the assessment process at all times.

Scenario Analysis: This scenario is professionally challenging because it requires the candidate to balance the need for thorough preparation with the practical constraints of time and available resources, all while adhering to the professional standards expected within the Applied Pan-Regional Medical-Surgical Nursing Practice Qualification framework. Misjudging the preparation timeline or relying on inadequate resources can lead to a failure to meet the qualification’s standards, potentially impacting patient care and professional standing. The pressure to perform well on a high-stakes qualification necessitates a strategic and informed approach to preparation. Correct Approach Analysis: The best approach involves a structured, phased preparation plan that begins with a comprehensive review of the qualification’s learning outcomes and assessment criteria. This should be followed by an honest self-assessment of knowledge gaps, leading to the targeted selection of high-quality, officially recommended or endorsed resources. A realistic timeline should then be established, incorporating regular review sessions, practice assessments, and opportunities for feedback, with flexibility built in for unforeseen circumstances. This approach is correct because it aligns with the principles of adult learning, ensuring that preparation is efficient, effective, and directly addresses the requirements of the qualification. It prioritizes understanding and application over rote memorization, which is crucial for medical-surgical nursing practice. Adhering to officially recommended resources ensures alignment with the qualification’s intended scope and depth, minimizing the risk of preparing with irrelevant or outdated material. Incorrect Approaches Analysis: Relying solely on informal study groups without consulting official guidance or recommended resources is professionally unacceptable. This approach risks encountering misinformation, focusing on non-essential topics, or missing critical areas mandated by the qualification. It fails to demonstrate due diligence in resource selection and can lead to a superficial understanding of the subject matter, which is ethically problematic in a healthcare context. Beginning preparation only a few weeks before the assessment without a structured plan is also professionally unsound. This rushed approach often leads to superficial learning, increased stress, and a higher likelihood of overlooking crucial information, thereby failing to meet the expected standard of competence. It does not allow for adequate consolidation of knowledge or practice of assessment techniques. Focusing exclusively on memorizing past examination questions without understanding the underlying principles is another professionally deficient approach. This method does not foster the critical thinking and application skills necessary for competent medical-surgical nursing practice, and it is ethically questionable as it prioritizes passing an exam over genuine professional development and patient safety. Professional Reasoning: Professionals preparing for high-stakes qualifications should adopt a proactive and systematic approach. This involves understanding the qualification’s objectives, identifying personal learning needs, and strategically utilizing validated resources. A realistic timeline, incorporating regular self-assessment and practice, is essential. Professionals should prioritize depth of understanding and application of knowledge over superficial memorization. When in doubt about resources or preparation strategies, consulting official qualification guidelines or experienced mentors is advisable.

This scenario is professionally challenging due to the inherent risks associated with medication management, particularly when supporting a prescriber who may be experiencing cognitive impairment. The nurse’s responsibility extends beyond simple task completion to ensuring patient safety and upholding professional standards of care. The potential for medication errors, adverse drug events, and compromised patient outcomes necessitates a rigorous and ethically sound approach. The best professional practice involves a direct, clear, and documented communication with the prescribing clinician, escalating concerns through appropriate channels if immediate resolution is not achieved. This approach prioritizes patient safety by addressing the potential impairment directly and seeking a resolution that ensures safe prescribing. Regulatory frameworks, such as those governing nursing practice and medication administration, mandate that nurses act in the best interest of the patient and report concerns about a colleague’s fitness to practice. The Nursing and Midwifery Council (NMC) Code, for instance, emphasizes the importance of raising concerns and acting to protect patients. Ethically, this aligns with the principle of non-maleficence (do no harm) and beneficence (act in the patient’s best interest). An incorrect approach would be to proceed with the prescription without addressing the observed signs of impairment. This fails to uphold the nurse’s duty of care and could lead to significant patient harm, violating regulatory expectations for safe practice. It also neglects the ethical obligation to advocate for the patient. Another incorrect approach would be to discuss the prescriber’s condition with other colleagues without directly addressing the issue with the prescriber or escalating it through formal channels. While collegial support is important, gossip or informal discussions do not constitute a professional resolution and can breach confidentiality and professional boundaries, failing to protect the patient. Finally, an incorrect approach would be to ignore the signs and assume the prescriber is capable, hoping the situation resolves itself. This passive stance abdicates professional responsibility and places patients at undue risk, directly contravening the proactive and vigilant approach required in medication safety and professional conduct. Professionals should employ a decision-making framework that begins with observation and assessment of potential risks. This is followed by direct, respectful communication with the individual involved. If the concern persists or is not adequately addressed, the framework dictates escalation through established organizational policies and regulatory reporting mechanisms, always prioritizing patient safety and adhering to professional codes of conduct.

Scenario Analysis: This scenario is professionally challenging because it requires the nurse to balance the immediate needs of a patient with the imperative to adhere to established evidence-based practices and institutional protocols. The pressure to provide rapid care can sometimes lead to deviations from best practice, necessitating a strong understanding of the underlying rationale for interventions and the regulatory framework governing nursing practice. Ensuring patient safety and optimal outcomes while respecting professional accountability is paramount. Correct Approach Analysis: The best professional approach involves critically evaluating the patient’s current presentation against the established evidence-based care plan. This means reviewing the existing plan, identifying any discrepancies or unmet needs, and then consulting relevant, up-to-date clinical guidelines and research to inform any necessary modifications. This approach is correct because it prioritizes patient safety and quality of care by ensuring interventions are grounded in current scientific knowledge and best practices, as mandated by professional nursing standards and regulatory bodies that expect nurses to practice competently and ethically. Adherence to evidence-based practice is a cornerstone of professional accountability. Incorrect Approaches Analysis: One incorrect approach involves proceeding with interventions that, while familiar, are not explicitly supported by current evidence or are contrary to the patient’s established care plan without a thorough re-evaluation. This risks providing suboptimal or even harmful care, violating the professional duty to practice evidence-based nursing and potentially contravening regulatory requirements for competent care. Another incorrect approach is to solely rely on the patient’s or family’s expressed preferences without critically assessing their alignment with evidence-based recommendations and the patient’s clinical status. While patient-centered care is vital, it must be integrated with professional judgment and evidence, not supersede it, to ensure safe and effective treatment, as per ethical and regulatory guidelines. A further incorrect approach is to implement interventions based on anecdotal experience or the practices of colleagues without verifying their current evidence base or appropriateness for the specific patient. This bypasses the essential process of evidence appraisal and can lead to the perpetuation of outdated or ineffective practices, which is a failure of professional responsibility and regulatory compliance. Professional Reasoning: Professionals should employ a systematic decision-making process that begins with a thorough assessment of the patient’s current condition. This assessment should then be compared against the existing evidence-based care plan. If deviations or new needs are identified, the nurse must consult current, reputable evidence (e.g., peer-reviewed journals, established clinical guidelines) to inform any proposed changes to the care plan. Collaboration with the interdisciplinary team, including physicians and other healthcare professionals, is crucial for validating and implementing evidence-based modifications. Documentation of the assessment, rationale for changes, and the implemented interventions is essential for accountability and continuity of care, aligning with professional standards and regulatory expectations.

The assessment process reveals a complex clinical scenario where a patient’s physiological presentation contradicts their stated wishes regarding end-of-life care. This situation is professionally challenging because it pits the nurse’s duty to preserve life and alleviate suffering against the patient’s fundamental right to autonomy and self-determination. Navigating this requires a delicate balance, informed by a deep understanding of the pathophysiology of the patient’s condition and the ethical and legal frameworks governing patient care. The best professional approach involves a multi-faceted strategy that prioritizes open communication, thorough assessment, and collaborative decision-making. This approach begins with acknowledging the patient’s current physiological state and its implications, while simultaneously respecting their previously expressed wishes. It necessitates engaging in a sensitive and empathetic conversation with the patient, if they are capable, to understand any changes in their perspective or understanding of their condition. If the patient lacks capacity, the focus shifts to consulting with their designated substitute decision-maker, armed with a comprehensive understanding of the patient’s values, beliefs, and previously documented wishes. This approach is correct because it upholds the principles of patient autonomy, beneficence, and non-maleficence. It aligns with professional nursing standards that mandate respecting patient wishes, advocating for their best interests, and ensuring informed consent or substitute consent processes are followed diligently. The pathophysiology of the patient’s condition informs the assessment of their current state and prognosis, which is crucial information to share with the patient or their substitute decision-maker to facilitate informed choices. An incorrect approach would be to unilaterally override the patient’s previously expressed wishes based solely on the current physiological findings, without further exploration or consultation. This fails to respect patient autonomy and could lead to a violation of their right to self-determination, potentially causing significant distress and undermining the therapeutic relationship. Another incorrect approach would be to proceed with interventions that are contrary to the patient’s stated wishes, even if they are physiologically indicated, without a thorough re-evaluation of their capacity and a discussion with the substitute decision-maker. This disregards the ethical imperative to act in accordance with the patient’s values and preferences. Finally, abandoning the patient or withdrawing care prematurely without proper consultation and adherence to established protocols, even if the patient’s condition appears dire, would be professionally unacceptable and ethically unsound. The professional decision-making process in such situations should follow a structured framework. This includes: 1) Comprehensive Assessment: Thoroughly evaluate the patient’s current physiological status, understanding the pathophysiology and its implications. 2) Capacity Assessment: Determine the patient’s ability to understand their condition, treatment options, and consequences. 3) Communication: Engage in open, honest, and empathetic dialogue with the patient (if capable) or their substitute decision-maker. 4) Ethical and Legal Review: Consult relevant ethical guidelines, professional standards, and legal requirements regarding patient autonomy, advance directives, and end-of-life care. 5) Collaborative Decision-Making: Work with the patient, family, and healthcare team to reach a decision that aligns with the patient’s values and best interests. 6) Documentation: Meticulously document all assessments, communications, decisions, and interventions.

This scenario presents a professional challenge due to the inherent conflict between respecting patient autonomy and the nurse’s duty of care, particularly when a patient’s decision-making capacity is in question. The need for comprehensive assessment, diagnostics, and monitoring across the lifespan is paramount, but its application here is complicated by the ethical imperative to uphold individual rights. Careful judgment is required to balance these competing principles. The best professional approach involves a systematic, evidence-based assessment of the patient’s capacity to make decisions regarding their treatment. This includes a thorough evaluation of their understanding of their condition, the proposed treatment options, the risks and benefits, and the consequences of refusal. This approach is correct because it aligns with fundamental ethical principles of autonomy and beneficence, as well as professional nursing standards that mandate respecting patient self-determination while ensuring their well-being. Regulatory frameworks, such as those governing patient rights and informed consent, underscore the necessity of this capacity assessment before overriding a patient’s expressed wishes. It prioritizes a patient-centered care model, ensuring that any intervention is either consented to or, if capacity is lacking, is in the patient’s best interest as determined through established legal and ethical protocols. An incorrect approach would be to immediately proceed with the prescribed treatment without further assessment, based solely on the physician’s directive or the assumption that the patient’s refusal is irrational. This fails to acknowledge the patient’s right to self-determination and could constitute a breach of professional duty and patient rights. It bypasses the crucial step of assessing decision-making capacity, which is a cornerstone of ethical medical practice. Another incorrect approach would be to dismiss the patient’s concerns and refuse to engage in further discussion, assuming the patient is being difficult or non-compliant. This demonstrates a lack of empathy and a failure to uphold the nurse’s role in advocating for the patient. It neglects the opportunity to explore the underlying reasons for the patient’s refusal, which may stem from fear, misunderstanding, or other valid concerns that could be addressed through effective communication and education. Finally, an incorrect approach would be to involve family members to coerce the patient into accepting treatment without a formal assessment of the patient’s own capacity. While family involvement can be supportive, it should not supersede the patient’s rights or be used as a substitute for a professional capacity assessment. This approach risks violating the patient’s privacy and autonomy, and could lead to legal and ethical repercussions. The professional decision-making process for similar situations should involve a structured approach: first, gather all relevant clinical information about the patient’s condition and the proposed treatment. Second, assess the patient’s decision-making capacity using established tools and professional judgment, documenting the findings meticulously. Third, if capacity is present, engage in shared decision-making, addressing the patient’s concerns and providing clear, understandable information. If capacity is impaired, follow established protocols for surrogate decision-making, always prioritizing the patient’s best interests and known wishes. Throughout this process, maintain open communication with the patient, the healthcare team, and, where appropriate, the patient’s family.