Scenario Analysis: This scenario is professionally challenging because it requires a nurse to navigate the complexities of operational readiness for board certification within a Latin American healthcare system, which often involves diverse regulatory landscapes, varying levels of institutional support, and potential resource constraints. Ensuring a candidate is fully prepared involves not only clinical knowledge but also understanding the specific administrative and procedural requirements of the certifying body, which can differ significantly across countries. Careful judgment is required to balance the candidate’s immediate needs with the broader institutional responsibilities and ethical obligations to uphold professional standards. Correct Approach Analysis: The best professional practice involves a proactive and comprehensive approach that integrates the candidate’s preparation directly into their ongoing professional development within the institution. This includes identifying specific knowledge gaps through targeted assessments, providing access to relevant study materials and mentorship, and facilitating participation in preparatory courses or workshops tailored to the Latin American board certification requirements. Crucially, this approach ensures that the candidate receives structured support that aligns with the ethical imperative of ensuring competent and qualified practitioners enter the certification process, thereby safeguarding patient care and upholding the integrity of the nursing profession within the specified regional context. This aligns with the ethical principle of beneficence, ensuring the candidate is well-equipped to succeed, and non-maleficence, by preventing unqualified individuals from proceeding. Incorrect Approaches Analysis: One incorrect approach involves solely relying on the candidate’s self-directed study without institutional oversight or support. This fails to acknowledge the potential for resource limitations, differing educational backgrounds, and the specific nuances of Latin American certification requirements that may not be readily apparent through general study. Ethically, this approach neglects the institution’s responsibility to foster professional growth and ensure its staff meet recognized standards, potentially leading to a candidate being unprepared due to lack of guidance. Another incorrect approach is to provide generic study materials that are not specific to the Latin American board certification framework or the candidate’s identified weaknesses. This is inefficient and may lead to the candidate wasting time on irrelevant information. It also fails to address the core ethical obligation to provide targeted support that maximizes the candidate’s chances of success and demonstrates a commitment to their professional development. A third incorrect approach is to prioritize administrative tasks over the candidate’s actual preparation, such as delaying the submission of necessary documentation or failing to secure adequate time for study. This demonstrates a lack of institutional commitment to the certification process and can create undue stress and anxiety for the candidate, potentially impacting their performance. It also undermines the credibility of the certification process and the institution’s role in supporting its professionals. Professional Reasoning: Professionals should adopt a systematic approach to supporting board certification readiness. This involves: 1) Initial assessment of the candidate’s current knowledge and identification of specific areas for development related to the Latin American certification standards. 2) Development of a personalized study plan that includes access to relevant resources, mentorship, and opportunities for practice assessments. 3) Regular monitoring of progress and provision of feedback to address challenges and reinforce learning. 4) Ensuring all administrative requirements are met in a timely and efficient manner. 5) Fostering a supportive environment that encourages continuous learning and professional growth.

Scenario Analysis: This scenario presents a professional challenge due to the inherent conflict between patient autonomy and the perceived best interests of the patient, complicated by the presence of a family member who may or may not accurately represent the patient’s wishes. Navigating this requires careful judgment to uphold ethical principles and legal obligations while ensuring patient-centered care. The nurse must balance the patient’s right to self-determination with the responsibility to provide safe and effective care, all within the framework of established medical-surgical nursing standards. Correct Approach Analysis: The best professional practice involves a direct, empathetic, and respectful conversation with the patient to ascertain their current wishes and understanding of their condition and treatment options. This approach prioritizes patient autonomy, a cornerstone of ethical medical practice. By engaging the patient directly, the nurse ensures that decisions are based on the patient’s informed consent and personal values, aligning with the principle of respect for persons. This also allows the nurse to assess the patient’s capacity to make decisions, which is crucial if there are doubts about their ability to understand. This direct engagement is supported by general nursing ethical codes that emphasize patient advocacy and self-determination. Incorrect Approaches Analysis: One incorrect approach involves immediately deferring to the family member’s stated wishes without independently verifying the patient’s current preferences or capacity. This fails to uphold the patient’s right to autonomy and may lead to care that is not aligned with the patient’s actual desires or best interests. It risks violating the ethical principle of respect for persons and could have legal ramifications if the patient is capable of making their own decisions. Another incorrect approach is to proceed with the family member’s suggested course of action based on past conversations, without re-evaluating the patient’s current state or wishes. Medical conditions and patient preferences can change rapidly. Relying on outdated information without current verification is a failure of due diligence and patient advocacy. It bypasses the essential step of ensuring informed consent for the current treatment plan. A third incorrect approach is to dismiss the family member’s concerns entirely and proceed solely based on the medical team’s assessment without further patient engagement. While the medical team’s expertise is vital, ignoring the family’s input, especially if they express genuine concern about the patient’s well-being or capacity, can lead to a breakdown in communication and trust. It also misses an opportunity to understand potential underlying issues or nuances that the patient might not be able to articulate themselves, even if they are deemed capable. Professional Reasoning: Professionals should employ a decision-making framework that begins with assessing the patient’s capacity to make decisions. If capacity is present, the patient’s wishes are paramount. If capacity is questionable, then the nurse should involve the patient as much as possible in the discussion, seek clarification from the family regarding advance directives or previously expressed wishes, and consult with the healthcare team, including physicians and ethics committees if necessary. The process should always prioritize open communication, respect for the patient, and adherence to ethical and legal standards of care.

This scenario is professionally challenging due to the inherent complexity of assessing and monitoring a patient with a chronic, progressive condition across different developmental stages. The nurse must integrate knowledge of the disease process, age-specific physiological and psychosocial needs, and the evolving diagnostic and monitoring technologies. Ethical considerations include ensuring patient autonomy, maintaining confidentiality, and providing culturally sensitive care, all within the framework of established nursing practice standards and relevant Latin American healthcare regulations. The best professional approach involves a comprehensive, holistic assessment that integrates objective data (diagnostic results, vital signs) with subjective patient and family reports, considering the patient’s developmental stage and psychosocial context. This approach aligns with ethical principles of beneficence and non-maleficence by ensuring that interventions are tailored to the individual’s needs and that monitoring is proactive and responsive. It also adheres to professional nursing standards that mandate thorough patient evaluation and ongoing reassessment. An approach that relies solely on outdated diagnostic criteria without considering current clinical presentation or patient-reported symptoms is professionally unacceptable. This failure to adapt assessment to the individual’s current state and developmental stage can lead to misdiagnosis, delayed or inappropriate treatment, and ultimately, compromised patient outcomes. It violates the ethical duty to provide competent and individualized care. Another professionally unacceptable approach is to focus exclusively on the physical manifestations of the condition while neglecting the psychosocial impact on the patient and their family. This oversight can lead to unmet needs, reduced quality of life, and a breakdown in the therapeutic relationship. It fails to uphold the holistic nursing perspective and the ethical imperative to address the patient’s overall well-being. Furthermore, an approach that prioritizes the convenience of the healthcare provider over the patient’s comfort and accessibility to monitoring, particularly for a child or elderly individual, is ethically flawed. This disregards the principles of patient-centered care and can create barriers to consistent and effective monitoring, potentially leading to adverse events. The professional reasoning process for similar situations should involve a systematic approach: first, gathering all available data (historical, diagnostic, subjective reports); second, analyzing this data through the lens of the patient’s age, developmental stage, and psychosocial context; third, identifying potential deviations from normal or expected findings; fourth, formulating a differential diagnosis or identifying areas requiring further investigation; and fifth, developing and implementing a tailored monitoring and intervention plan, with continuous reassessment and adaptation. This iterative process ensures that care remains dynamic, responsive, and ethically sound.

This scenario presents a professional challenge due to the inherent complexity of managing a patient with a chronic, progressive neurological condition like Multiple Sclerosis (MS) who is experiencing an acute exacerbation. The nurse must balance immediate symptom management with long-term disease progression and the patient’s overall well-being, all while navigating the ethical imperative of patient autonomy and informed consent. Careful judgment is required to differentiate between a typical exacerbation and a potential complication, and to tailor interventions to the individual’s specific needs and preferences. The approach that represents best professional practice involves a comprehensive assessment that integrates the patient’s reported symptoms with objective clinical findings and an understanding of MS pathophysiology. This includes evaluating the neurological deficits, assessing vital signs, and considering potential triggers for the exacerbation. Crucially, this approach prioritizes open communication with the patient to understand their lived experience, their concerns, and their goals of care. By correlating the patient’s subjective report with objective data and pathophysiological knowledge, the nurse can make informed decisions about the most appropriate immediate interventions, such as medication adjustments, symptom management strategies, and the need for further diagnostic investigations or specialist consultation. This aligns with ethical principles of beneficence and non-maleficence, ensuring that care is evidence-based and patient-centered. An incorrect approach would be to solely rely on the patient’s self-reported symptoms without objective verification or consideration of underlying pathophysiology. This could lead to misinterpretation of the severity or nature of the exacerbation, potentially delaying necessary interventions or leading to inappropriate treatment. Such an approach fails to uphold the professional responsibility to provide evidence-based care and could compromise patient safety. Another incorrect approach would be to focus exclusively on objective clinical findings and disregard the patient’s subjective experience. While objective data is vital, the patient’s perception of their symptoms is a critical component of understanding their condition and its impact on their quality of life. Ignoring their input can lead to a disconnect in care and a failure to address their most pressing concerns, potentially eroding trust and hindering adherence to treatment. A further incorrect approach would be to immediately escalate care to a higher level of acuity without a thorough initial assessment. While prompt action is sometimes necessary, a hasty escalation without a clear pathophysiological rationale or comprehensive evaluation can lead to unnecessary anxiety for the patient, increased healthcare costs, and potentially divert resources from patients who genuinely require more intensive care. The professional decision-making process for similar situations should involve a systematic approach: first, gather subjective data from the patient; second, obtain objective clinical data; third, integrate this information with knowledge of the underlying pathophysiology; fourth, consider the patient’s values and preferences; and finally, formulate a plan of care that is both clinically sound and ethically appropriate, involving shared decision-making with the patient.

Scenario Analysis: This scenario is professionally challenging because it requires the nurse to navigate the complex interplay between personal circumstances, professional development, and the formal requirements of maintaining board certification. The pressure to advance one’s career and the desire to avoid the financial and time commitment of retaking an exam can lead to ethically compromised decisions. Careful judgment is required to ensure that professional integrity and adherence to certification standards are prioritized over expediency. Correct Approach Analysis: The best professional approach involves proactively understanding and adhering to the stated retake policies of the Comprehensive Latin American Medical-Surgical Nursing Board Certification. This means reviewing the official documentation regarding eligibility for retakes, any time limits for reapplication after a failed attempt, and the specific requirements for submitting documentation or fees. This approach is correct because it demonstrates a commitment to professional standards, respects the integrity of the certification process, and avoids potential ethical breaches by operating within the established rules. It ensures that the nurse’s actions are transparent and compliant with the governing body’s regulations. Incorrect Approaches Analysis: One incorrect approach is to assume that a personal hardship exemption from the standard retake policy can be granted without explicit confirmation from the certifying body. This is ethically flawed because it bypasses established procedures and relies on an assumption rather than verified information. It could lead to the nurse being ineligible for retake or facing disciplinary action for non-compliance. Another incorrect approach is to delay addressing the failed exam and the retake policy until the last possible moment, hoping for a change in personal circumstances or a more lenient interpretation of the rules. This is professionally irresponsible as it demonstrates a lack of proactive engagement with professional development requirements and can result in missed deadlines for reapplication, effectively forfeiting the opportunity to retake the exam within a reasonable timeframe. A further incorrect approach is to seek informal advice from colleagues or mentors about circumventing the official retake policy without consulting the official documentation or contacting the certifying board directly. While well-intentioned, this can lead to misinformation and a misunderstanding of the precise requirements, potentially resulting in actions that violate the board’s regulations. Professional accountability demands direct engagement with the official source of information. Professional Reasoning: Professionals facing situations involving certification requirements should always prioritize direct consultation with the certifying body’s official guidelines and policies. When in doubt, direct communication with the board is essential. This ensures that decisions are based on accurate information and align with ethical and regulatory standards. A proactive and transparent approach to professional development, including understanding and adhering to examination and certification policies, is paramount.

Scenario Analysis: This scenario is professionally challenging because it requires a nurse to balance the immediate need for information with the ethical and regulatory obligations to protect patient privacy and ensure data integrity. The pressure to provide comprehensive data for a certification exam, coupled with the potential for incomplete or inaccurate records, necessitates careful judgment. Misinterpreting or misusing patient information can lead to serious ethical breaches and regulatory violations, impacting both the patient and the nurse’s professional standing. Correct Approach Analysis: The best professional practice involves a multi-faceted approach that prioritizes ethical conduct and regulatory compliance while still aiming for thorough preparation. This approach involves diligently reviewing personal study notes, utilizing official study guides provided by the certifying body, and engaging in practice questions that simulate the exam format. This method ensures that the information being reviewed is accurate, relevant to the exam’s scope, and obtained through legitimate channels. It respects patient confidentiality by not requiring access to live patient data for study purposes and adheres to the principles of professional development by relying on established educational resources. The ethical justification lies in upholding patient privacy and data security, as mandated by healthcare regulations and professional codes of conduct. Incorrect Approaches Analysis: One incorrect approach involves attempting to access and review actual patient electronic health records (EHRs) from past clinical rotations or current practice to familiarize oneself with common case presentations and documentation styles. This is ethically and regulatorily unacceptable because it constitutes a breach of patient confidentiality and privacy. Accessing patient data without a direct clinical need for patient care, especially for personal study, violates data protection laws and professional ethical standards, potentially leading to severe disciplinary action. Another incorrect approach is relying solely on anecdotal information or informal study groups that may share unofficial or outdated study materials. While informal learning can be supplementary, it lacks the rigor and accuracy required for board certification preparation. This approach risks exposure to misinformation, incomplete coverage of essential topics, and potentially unethical sharing of information that might inadvertently compromise patient privacy if real patient scenarios are discussed without proper anonymization. It fails to meet the standard of diligent preparation expected for professional certification. A further incorrect approach is to postpone preparation until the last few weeks before the exam, then attempting to cram by quickly skimming through vast amounts of material without deep understanding or practice. This is professionally unsound as it does not allow for adequate knowledge assimilation and retention, increasing the likelihood of superficial learning and poor exam performance. While not directly a privacy violation, it demonstrates a lack of professional commitment to thorough preparation and competence, which is an ethical failing in itself when seeking to be certified as a medical-surgical nurse. Professional Reasoning: Professionals should adopt a structured and ethical approach to exam preparation. This involves creating a realistic study timeline that allocates sufficient time for each topic, identifying and utilizing official, reputable study resources, and engaging in practice assessments that mirror the exam’s format and difficulty. When faced with the temptation to use patient data for study, professionals must always remember their primary obligation to patient confidentiality and data security. If unsure about the appropriateness of a resource or method, consulting with supervisors, mentors, or the certifying body’s guidelines is a crucial step in professional decision-making.

This scenario is professionally challenging due to the inherent conflict between patient autonomy, the legal requirements for informed consent, and the potential for a patient’s condition to impair their decision-making capacity. Navigating this requires a delicate balance of respecting the patient’s wishes while ensuring their safety and adherence to legal and ethical standards. Careful judgment is required to assess the patient’s capacity without being overly paternalistic or dismissive of their expressed desires. The best professional approach involves a thorough assessment of the patient’s capacity to understand the proposed surgical procedure, its risks, benefits, and alternatives, and to communicate their decision. This assessment should be conducted by the nursing professional in collaboration with the medical team, and if capacity is questionable, a formal capacity assessment by a qualified physician or psychiatrist should be sought. This approach is correct because it upholds the fundamental ethical principle of patient autonomy while adhering to legal mandates for informed consent. Latin American medical-surgical nursing practice is guided by principles of patient-centered care and respect for human dignity, which necessitate ensuring that patients are capable of making informed decisions about their healthcare. Regulatory frameworks in most Latin American countries emphasize the patient’s right to self-determination, contingent upon their capacity to understand and consent. An incorrect approach would be to proceed with the surgery based solely on the family’s insistence, overriding the patient’s expressed desire to refuse. This fails to respect patient autonomy and violates the principle of informed consent, as the patient, despite their current distress, has the right to make decisions about their own body, provided they have the capacity to do so. Ethically and legally, consent must be given by the individual receiving the treatment. Another incorrect approach is to dismiss the patient’s refusal outright due to their emotional state without a formal assessment of their decision-making capacity. While emotional distress can affect a patient’s presentation, it does not automatically equate to a lack of capacity. This approach risks violating the patient’s rights by assuming incapacity without due process. Finally, an incorrect approach would be to delay the surgery indefinitely without further assessment or consultation, simply because the patient is expressing reluctance due to fear. While fear is a valid emotion, it should be addressed through education, reassurance, and exploration of concerns, rather than being a sole reason to halt necessary medical intervention without a comprehensive evaluation of the patient’s understanding and decision-making ability. The professional reasoning process for similar situations should involve a systematic approach: first, actively listen to and acknowledge the patient’s concerns and expressed wishes. Second, assess the patient’s understanding of their condition, the proposed treatment, and its implications. Third, evaluate their capacity to make a decision, considering their ability to comprehend information, appreciate the situation and its consequences, reason through options, and communicate a choice. Fourth, if capacity is uncertain, involve the medical team and seek expert consultation for a formal capacity assessment. Fifth, document all assessments, discussions, and decisions meticulously.

This scenario presents a professional challenge due to the critical nature of medication administration and the potential for severe patient harm if errors occur. The nurse must navigate complex patient information, potential drug interactions, and the need for clear communication with the prescribing physician, all within a framework that prioritizes patient safety and adherence to established protocols. Careful judgment is required to ensure the correct medication is administered at the correct dose, via the correct route, to the correct patient, at the correct time, and for the correct reason. The best approach involves a systematic verification process that prioritizes patient safety and adheres to established medication administration protocols. This includes confirming the patient’s identity using at least two identifiers, reviewing the medication order against the patient’s chart and medication administration record (MAR), assessing for allergies, and performing a thorough check of the medication itself (drug name, dose, expiry date, appearance). Crucially, this approach mandates direct communication with the prescribing physician if any discrepancies or concerns arise regarding the order, such as potential interactions or contraindications based on the patient’s current condition or other medications. This aligns with ethical principles of beneficence and non-maleficence, as well as regulatory guidelines that emphasize the nurse’s responsibility in safe medication practice and the importance of closed-loop communication to prevent errors. An incorrect approach would be to administer the medication based solely on the written order without independently verifying the patient’s identity or checking for allergies, especially if the patient appears familiar or the nurse has administered the medication to this patient before. This bypasses essential safety checks and violates the fundamental principles of medication administration, increasing the risk of administering medication to the wrong patient or causing an adverse reaction due to an unaddressed allergy. Another incorrect approach is to assume the physician’s order is correct and proceed with administration without addressing the potential interaction with the patient’s newly prescribed anticoagulant. This demonstrates a failure to critically assess the medication order in the context of the patient’s complete medication profile and current health status. It neglects the nurse’s professional responsibility to identify and report potential drug-drug interactions, which could lead to serious bleeding complications. Finally, an incorrect approach would be to delegate the verification of the medication order and patient assessment to an unlicensed assistive personnel without direct supervision or independent verification by a licensed nurse. While unlicensed personnel can assist with certain tasks, the ultimate responsibility for safe medication administration, including critical assessment and verification, rests with the licensed nurse. This delegation would be a violation of professional scope of practice and regulatory requirements for medication safety. Professionals should employ a decision-making framework that begins with a thorough understanding of the “five rights” (or more) of medication administration. This framework necessitates a proactive approach to patient safety, involving critical thinking, vigilant observation, and clear, assertive communication with the healthcare team. When faced with any ambiguity or potential risk, the professional should pause, gather all necessary information, consult relevant resources (e.g., drug references, institutional policies), and communicate concerns to the prescriber before proceeding.

Scenario Analysis: This scenario is professionally challenging due to the inherent conflict between patient autonomy, the legal framework governing informed consent, and the potential for perceived benefit by the healthcare team. Navigating these competing interests requires a nuanced understanding of ethical principles and legal mandates to ensure patient rights are upheld while providing appropriate care. The pressure to act in what is believed to be the patient’s best interest, especially when the patient’s capacity is in question, can lead to ethical dilemmas that demand careful judgment. Correct Approach Analysis: The best professional practice involves a systematic assessment of the patient’s capacity to make decisions regarding their treatment. This approach prioritizes respecting the patient’s autonomy by first determining if they possess the cognitive ability to understand their condition, the proposed treatment, its risks and benefits, and alternatives. If capacity is confirmed, their informed decision, even if it differs from the healthcare team’s recommendation, must be respected. If capacity is found to be lacking, then the legal and ethical framework for decision-making by a surrogate or through established legal processes for incapacitated individuals must be followed. This aligns with fundamental ethical principles of autonomy and beneficence, as well as legal requirements for informed consent, ensuring that any intervention is both ethically sound and legally permissible. Incorrect Approaches Analysis: One incorrect approach involves proceeding with the surgery based solely on the perceived benefit to the patient, without a formal assessment of their decision-making capacity. This disregards the legal and ethical imperative of informed consent and infringes upon the patient’s right to self-determination. It assumes the healthcare team’s judgment of benefit supersedes the patient’s right to choose, which is a violation of autonomy. Another incorrect approach is to immediately seek a surrogate decision-maker without first attempting to assess the patient’s capacity. While involving a surrogate is necessary when a patient lacks capacity, bypassing the assessment phase is premature and potentially disrespectful to the patient’s existing autonomy. It can also lead to unnecessary involvement of others if the patient is, in fact, capable of making their own decisions. A further incorrect approach is to delay the necessary surgical intervention indefinitely due to uncertainty about the patient’s capacity, without initiating the appropriate steps to clarify their decision-making ability. While caution is warranted, prolonged delay can lead to deterioration of the patient’s condition, potentially causing greater harm and violating the principle of beneficence. This approach fails to proactively address the ethical and legal challenges. Professional Reasoning: Professionals should employ a decision-making framework that begins with assessing the patient’s capacity to consent. This involves evaluating their ability to understand information, appreciate the situation and its consequences, reason through options, and communicate a choice. If capacity is present, informed consent is obtained. If capacity is lacking, the process shifts to identifying and involving the legally authorized surrogate decision-maker, adhering to established protocols for substituted judgment or best interests. Throughout this process, clear documentation of assessments, discussions, and decisions is crucial.

Scenario Analysis: This scenario is professionally challenging due to the inherent conflict between a nurse’s duty to provide safe patient care and the pressures of resource limitations and team dynamics. The nurse leader must balance the immediate needs of critically ill patients with the professional development and well-being of the nursing staff. Effective delegation and interprofessional communication are paramount to ensuring patient safety and maintaining a functional, supportive work environment. Misjudgment in delegation or communication can lead to compromised care, staff burnout, and ethical breaches. Correct Approach Analysis: The best professional practice involves a direct, respectful, and collaborative approach. This entails the nurse leader initiating a private conversation with the experienced nurse to understand their concerns and perspective regarding the delegation. The leader should clearly articulate the rationale behind the delegation, emphasizing patient needs and the developmental goals for the less experienced nurse, while also acknowledging the experienced nurse’s workload and expertise. This approach fosters open communication, builds trust, and allows for a mutually agreeable solution that prioritizes patient safety and staff development. It aligns with ethical principles of respect for autonomy and beneficence, and professional guidelines that advocate for clear communication and supportive leadership in healthcare settings. Incorrect Approaches Analysis: One incorrect approach involves ignoring the experienced nurse’s concerns and proceeding with the delegation as initially planned without further discussion. This demonstrates a failure in empathetic leadership and effective communication. It disregards the potential for burnout or resentment in experienced staff, which can negatively impact team morale and patient care indirectly. Ethically, it fails to respect the experienced nurse’s professional judgment and concerns, potentially leading to a breakdown in trust. Another incorrect approach is to immediately reassign the task to another nurse without addressing the underlying issue with the original delegate. This avoids conflict but does not resolve the problem of appropriate task distribution or staff development. It may create a perception of favoritism or an unwillingness to address challenges directly, undermining the leader’s authority and the fairness of the delegation process. It also misses an opportunity to mentor and support the less experienced nurse. A third incorrect approach is to publicly reprimand the experienced nurse for expressing reluctance. This is unprofessional, creates a hostile work environment, and is a significant breach of ethical conduct. It discourages open communication and can lead to fear and anxiety among the entire team, severely damaging morale and trust. Such an action is contrary to principles of supportive leadership and professional respect. Professional Reasoning: Professionals should employ a decision-making framework that prioritizes open communication, ethical considerations, and patient safety. When faced with delegation challenges, the process should involve: 1) Active listening to understand all perspectives. 2) Clear articulation of the rationale and expectations. 3) Collaborative problem-solving to find the most effective and ethical solution. 4) Consideration of the impact on patient care, staff well-being, and professional development. 5) Adherence to institutional policies and professional ethical codes.