The analysis reveals a scenario that is professionally challenging due to the inherent complexities of patient care escalation, the need for clear communication across disciplines, and the potential for patient harm if these elements are not managed effectively. The critical need for accurate and timely information exchange between nursing staff and physicians, especially when a patient’s condition is deteriorating, underscores the importance of robust leadership and delegation practices. Careful judgment is required to ensure patient safety while respecting professional roles and responsibilities. The best approach involves a nurse leader directly communicating the critical change in patient status to the attending physician, providing a concise yet comprehensive report of the patient’s condition, vital signs, and observed changes. This direct, professional communication ensures that the physician receives the most accurate and up-to-date information necessary for timely and appropriate medical intervention. This aligns with professional nursing standards and ethical obligations to advocate for patient well-being. Regulatory frameworks, such as those governing nursing practice and patient safety, emphasize the nurse’s responsibility to assess, monitor, and report changes in patient condition to the appropriate healthcare provider. Effective interprofessional communication is a cornerstone of safe patient care, preventing delays in diagnosis and treatment, and ultimately mitigating risks. An incorrect approach would be for the nurse leader to delegate the responsibility of informing the physician to a less experienced staff nurse without direct oversight or a clear communication protocol. This fails to uphold leadership responsibilities and introduces an unnecessary layer of potential miscommunication or delay. Ethically, it could be seen as an abdication of leadership duty and a failure to ensure the highest standard of care. Another incorrect approach would be to rely solely on electronic health record (EHR) documentation of the changes without direct verbal communication. While EHRs are vital, critical changes in patient status often require immediate verbal notification to ensure prompt physician awareness and action, especially in emergent situations. This approach risks the physician not seeing the update in a timely manner, leading to potential patient harm. Regulatory guidelines often stress the importance of direct communication for critical events. A further incorrect approach would be for the nurse leader to wait for the physician to initiate contact or to assume the physician is aware of the changes based on routine monitoring. This passive stance fails to proactively address a deteriorating patient condition and neglects the nurse’s role in patient advocacy and timely escalation. It represents a significant lapse in leadership and interprofessional communication, potentially violating standards of care and patient safety protocols. Professionals should employ a decision-making framework that prioritizes patient safety, clear and direct communication, and adherence to established protocols. This involves assessing the severity of the patient’s condition, identifying the most appropriate person to communicate with, and utilizing effective communication techniques (e.g., SBAR – Situation, Background, Assessment, Recommendation). Leaders must also ensure that delegation is appropriate, considering the skills and experience of the delegatee, and that clear expectations and follow-up mechanisms are in place.

Scenario Analysis: This scenario is professionally challenging because it requires an orthopaedic nurse to navigate the complex requirements and purpose of a high-stakes fellowship exit examination without direct supervision or clarification from the examination board. Misunderstanding the examination’s purpose or eligibility criteria could lead to significant professional setbacks, including wasted time, financial resources, and potential reputational damage if the nurse is deemed ineligible or unprepared. Careful judgment is required to accurately interpret the examination’s objectives and the prerequisites for participation. Correct Approach Analysis: The best professional practice involves a proactive and thorough investigation into the stated purpose and eligibility criteria of the Comprehensive North American Orthopaedic Nursing Fellowship Exit Examination. This includes consulting official documentation provided by the fellowship program or the certifying body, such as the examination handbook, website FAQs, or published guidelines. This approach ensures that the nurse bases their understanding on authoritative sources, directly addressing the examination’s intent (e.g., to assess advanced competency, facilitate professional advancement) and the specific qualifications required for candidates (e.g., years of experience, specific training, prior certifications). Adhering to official guidelines is ethically imperative, demonstrating professionalism and respect for the examination process. Incorrect Approaches Analysis: Relying solely on informal discussions with colleagues or mentors, while potentially helpful for general advice, presents a significant risk. Colleagues may have outdated or incomplete information, or their understanding might be based on personal interpretation rather than official regulations. This could lead to misinterpreting eligibility requirements or the examination’s core purpose, potentially resulting in the nurse pursuing preparation or application without meeting the necessary criteria. Similarly, inferring the examination’s purpose based on the title alone is speculative and lacks the rigor required for a formal assessment. The title may suggest advanced knowledge, but the specific scope, objectives, and eligibility are defined by the governing body, not by assumption. Attempting to bypass official channels by contacting the examination board with vague inquiries without first consulting available documentation is inefficient and may not yield precise answers, potentially reflecting poorly on the applicant’s preparedness and diligence. Professional Reasoning: Professionals facing such situations should adopt a systematic approach. First, identify the authoritative source of information for the examination. Second, meticulously review all provided documentation related to the examination’s purpose, scope, and eligibility. Third, if ambiguities persist after reviewing official materials, formulate specific, targeted questions to the examination board or program administrators, referencing the documentation reviewed. This structured process ensures that decisions are informed by accurate, official information, minimizing risk and upholding professional standards.

This scenario is professionally challenging due to the inherent vulnerability of the pediatric patient and the potential for delayed diagnosis or misinterpretation of subtle signs, which can have significant long-term consequences for musculoskeletal development and function. The nurse must integrate knowledge of age-specific developmental milestones, common orthopaedic conditions in children, and effective risk assessment strategies to ensure timely and appropriate intervention. The ethical imperative to act in the best interest of the child, coupled with the professional responsibility to maintain competence and provide evidence-based care, necessitates a rigorous and systematic approach to assessment and monitoring. The best approach involves a comprehensive, multi-faceted risk assessment that prioritizes objective data collection and considers the child’s developmental stage and family context. This includes a thorough physical examination, detailed history from the caregiver, and observation of the child’s functional abilities and pain behaviors. This approach is correct because it aligns with established nursing standards of practice and ethical guidelines that mandate a holistic and individualized assessment. Specifically, the American Nurses Association (ANA) Code of Ethics emphasizes the nurse’s responsibility to advocate for patients and provide competent, compassionate care, which includes thorough assessment and monitoring. Furthermore, best practice guidelines for pediatric orthopaedic nursing stress the importance of early identification of potential issues through systematic assessment and ongoing monitoring, recognizing that children may not always articulate their symptoms clearly. An approach that relies solely on the caregiver’s subjective report without independent objective assessment is professionally unacceptable. This fails to meet the standard of care because it overlooks the possibility of caregiver bias, lack of awareness, or misinterpretation of symptoms, potentially leading to missed diagnoses. Ethically, it compromises the nurse’s duty to independently verify information and ensure the child’s well-being. An approach that focuses only on the most common orthopaedic conditions without considering less frequent but potentially serious presentations is also professionally unacceptable. This narrow focus can lead to diagnostic errors and delays in treatment for atypical conditions. It violates the principle of comprehensive assessment, which requires considering a broad differential diagnosis based on the presenting signs and symptoms. An approach that delays further investigation or referral until the child exhibits severe, overt signs of distress is professionally unacceptable. This reactive approach ignores the proactive nature of risk assessment and early intervention, which is crucial in pediatric orthopaedics. It risks allowing conditions to progress to a point where treatment is more complex and outcomes are less favorable, violating the ethical principle of beneficence and the professional responsibility to prevent harm. Professionals should employ a decision-making framework that begins with a broad assessment of potential risks, followed by targeted data collection based on initial findings. This involves critically evaluating all available information, considering the child’s age and developmental stage, and consulting with other healthcare professionals when necessary. The process should be iterative, with ongoing monitoring and reassessment to detect changes and ensure the effectiveness of interventions.

Scenario Analysis: This scenario is professionally challenging because it involves a patient with a complex medical history and potential for significant harm if their pain is inadequately managed. The nurse must balance the patient’s immediate need for pain relief with the regulatory and ethical obligations to ensure safe and appropriate medication administration, particularly concerning controlled substances. Accurate risk assessment is paramount to prevent diversion, misuse, and adverse drug events, while also upholding the patient’s right to effective pain management. Correct Approach Analysis: The best professional practice involves a comprehensive, multi-faceted risk assessment that integrates the patient’s clinical presentation, medication history, and psychosocial factors. This approach directly addresses the core principles of safe medication management and patient advocacy. It aligns with the ethical imperative to provide competent care and the regulatory requirement to administer medications judiciously, especially controlled substances. By systematically evaluating all relevant factors, the nurse can identify potential risks and implement appropriate safeguards, ensuring both patient safety and adherence to legal and professional standards. This proactive and thorough method is the most effective in mitigating risks associated with opioid administration. Incorrect Approaches Analysis: One incorrect approach involves solely relying on the patient’s self-report of pain without further objective assessment or consideration of contributing factors. This fails to meet the regulatory expectation for thorough patient evaluation and can lead to inappropriate prescribing or administration of analgesics, potentially masking underlying issues or contributing to medication misuse. Ethically, it neglects the nurse’s responsibility to advocate for the patient’s holistic well-being. Another incorrect approach is to administer the prescribed opioid dose without verifying the patient’s previous response to similar medications or assessing for contraindications. This bypasses crucial safety checks mandated by regulatory bodies and professional guidelines, increasing the risk of adverse drug reactions, respiratory depression, or dependence. It demonstrates a failure to exercise due diligence in medication administration. A third incorrect approach is to delay or withhold pain medication based on a generalized fear of addiction without a specific, evidence-based assessment of the patient’s individual risk factors for opioid misuse. While vigilance regarding addiction is important, an unsubstantiated delay can lead to unnecessary suffering for the patient and violates the ethical principle of beneficence. Regulatory frameworks emphasize individualized care and evidence-based practice, not blanket assumptions. Professional Reasoning: Professionals should employ a systematic risk assessment framework that begins with understanding the patient’s current clinical status and pain complaint. This should be followed by a review of their medical history, including previous pain management strategies and responses, as well as any history of substance use or mental health conditions. Next, an assessment of the immediate clinical context, including the type of surgery or condition, is crucial. Finally, consideration of psychosocial factors that might influence pain perception or adherence to treatment is essential. This comprehensive evaluation allows for the identification of specific risks and the development of a tailored pain management plan that prioritizes safety, efficacy, and adherence to all applicable regulations and ethical standards.

Scenario Analysis: This scenario is professionally challenging because it requires the nurse to balance the immediate need for patient comfort and safety with the imperative to adhere to established protocols and ensure accurate data collection for ongoing care and research. The pressure to provide immediate relief can sometimes conflict with the systematic approach necessary for comprehensive assessment and documentation, potentially leading to rushed or incomplete evaluations. Correct Approach Analysis: The best professional practice involves a systematic, multi-faceted approach that prioritizes patient safety and comfort while ensuring data integrity. This begins with a rapid, focused assessment to identify immediate threats to stability and pain levels. Following this, a more thorough, systematic assessment of the surgical site, vital signs, and neurological status is conducted. Crucially, this approach emphasizes clear, concise, and accurate documentation in real-time or immediately post-assessment, adhering to institutional policies and the ethical obligation to maintain accurate patient records. This aligns with professional nursing standards that mandate comprehensive assessment, timely intervention, and meticulous record-keeping to ensure continuity of care and legal defensibility. Incorrect Approaches Analysis: One incorrect approach involves solely focusing on pain management without a concurrent, systematic assessment of the surgical site and overall patient status. This fails to address potential complications like bleeding or infection that might be indicated by other signs and symptoms, violating the principle of holistic patient care and potentially delaying critical interventions. It also compromises the accuracy of the patient’s overall clinical picture. Another incorrect approach is to delay all assessment and documentation until the patient is fully settled and comfortable, potentially hours later. This significantly deviates from best practices for post-operative care, where timely assessment is crucial for early detection of adverse events. It also risks memory recall errors, leading to inaccurate or incomplete documentation, which is a breach of professional responsibility and can have legal ramifications. A third incorrect approach is to rely on assumptions about the patient’s condition based on previous shifts or similar cases without conducting a current, individualized assessment. This overlooks the unique physiological responses of each patient and can lead to missed critical changes, compromising patient safety and violating the ethical duty to provide individualized care. It also undermines the scientific basis of nursing practice, which relies on objective data. Professional Reasoning: Professionals should employ a structured decision-making process that begins with recognizing the immediate needs of the patient, followed by a systematic assessment that integrates all relevant data points. This process should be guided by established protocols, ethical principles of patient advocacy and beneficence, and a commitment to accurate and timely documentation. When faced with competing demands, prioritizing patient safety and then ensuring comprehensive data collection are paramount. This involves a continuous cycle of assessment, intervention, and evaluation, all meticulously recorded.

The assessment process reveals a candidate’s performance on the Comprehensive North American Orthopaedic Nursing Fellowship Exit Examination. This scenario is professionally challenging because it involves interpreting and applying the fellowship’s established blueprint weighting, scoring, and retake policies, which are designed to ensure consistent and fair evaluation of candidates. Careful judgment is required to avoid bias and uphold the integrity of the certification process. The best professional approach involves a thorough review of the candidate’s performance against the established blueprint weighting and scoring criteria, followed by a direct application of the fellowship’s stated retake policy. This approach is correct because it adheres strictly to the pre-defined, objective standards set by the fellowship. The blueprint weighting ensures that different domains of knowledge and skill are assessed proportionally to their importance in orthopaedic nursing practice. The scoring criteria provide a standardized method for evaluating performance within each domain. The retake policy, when clearly defined and consistently applied, offers a transparent pathway for candidates who do not initially meet the passing standard, promoting fairness and opportunity. This aligns with ethical principles of fairness, transparency, and accountability in professional assessment. An incorrect approach would be to deviate from the established blueprint weighting based on a subjective perception of the candidate’s overall clinical experience. This is professionally unacceptable because it undermines the validity and reliability of the examination. The blueprint is developed by subject matter experts to reflect the essential competencies, and altering its weighting introduces bias and compromises the standardized nature of the assessment. Another incorrect approach would be to modify the scoring criteria to accommodate a candidate who narrowly misses the passing score, perhaps due to a perceived “good effort.” This is professionally unacceptable as it violates the principle of objective evaluation. Scoring criteria are established to define what constitutes acceptable performance, and altering them post-hoc creates an unfair advantage and erodes the credibility of the examination. A further incorrect approach would be to offer an immediate, informal retake opportunity outside of the fellowship’s formal retake policy, without considering the implications for other candidates or the program’s standards. This is professionally unacceptable because it bypasses the established governance and procedural fairness of the fellowship. Formal policies are in place to ensure that all candidates are treated equitably and that the assessment process is administered consistently. The professional reasoning process for similar situations should involve a commitment to upholding the integrity of the assessment process. This includes: 1) clearly understanding and internalizing the fellowship’s blueprint, scoring, and retake policies; 2) applying these policies objectively and consistently to all candidates; 3) documenting all assessment decisions and rationale; and 4) seeking clarification from fellowship leadership if any ambiguity arises regarding policy application. The focus must always be on fair, valid, and reliable evaluation based on pre-established standards.

Scenario Analysis: This scenario presents a professional challenge due to the inherent variability in patient responses to surgical interventions and the critical need for individualized care planning. Orthopaedic patients often have complex comorbidities, varying levels of mobility, and diverse psychosocial factors that influence their recovery. Nurses must navigate these complexities while adhering to evidence-based practices and ensuring patient safety and optimal outcomes. The challenge lies in translating broad evidence into specific, actionable interventions tailored to each patient’s unique risk profile and care trajectory. Correct Approach Analysis: The best professional practice involves a comprehensive, individualized risk assessment that integrates patient-specific data with evidence-based guidelines. This approach begins with a thorough evaluation of the patient’s pre-operative status, including medical history, functional level, nutritional status, and psychosocial factors. It then systematically identifies potential risks for complications such as infection, deep vein thrombosis, impaired wound healing, and functional decline. Based on this individualized risk profile, the nurse collaborates with the interdisciplinary team to develop a care plan that prioritizes evidence-based interventions directly addressing identified risks. This approach aligns with ethical principles of beneficence and non-maleficence, ensuring that care is both effective and safe, and with regulatory requirements for individualized patient care and quality improvement. Incorrect Approaches Analysis: One incorrect approach involves relying solely on generalized post-operative protocols without a specific patient risk assessment. This fails to account for individual patient vulnerabilities and can lead to under- or over-treatment, potentially increasing the risk of complications or delaying recovery. It neglects the professional responsibility to personalize care and may violate standards of practice that mandate individualized care planning. Another incorrect approach is to focus exclusively on the surgical procedure itself, neglecting the patient’s overall health status and recovery potential. This narrow focus can lead to overlooking critical factors that influence healing and functional outcomes, such as pain management, mobility, and psychological well-being. Such an approach is ethically deficient as it fails to consider the holistic needs of the patient and may not meet regulatory expectations for comprehensive patient care. A further incorrect approach is to delegate the primary responsibility for risk assessment and care planning to less experienced staff without adequate oversight or validation. While teamwork is essential, the registered nurse retains ultimate accountability for the quality and appropriateness of the care plan. This delegation without proper supervision can lead to errors in judgment and potentially compromise patient safety, violating professional standards and regulatory mandates for competent nursing practice. Professional Reasoning: Professionals should employ a systematic, evidence-based decision-making process that begins with a comprehensive patient assessment. This assessment should identify patient-specific risks and needs. Next, nurses should consult current, high-quality evidence and clinical guidelines relevant to the patient’s condition and planned interventions. They must then critically analyze this evidence in the context of the individual patient’s unique circumstances, including their values, preferences, and social support. Finally, the nurse collaborates with the patient and interdisciplinary team to develop and implement a personalized, evidence-based care plan, continuously evaluating its effectiveness and making necessary adjustments.

Scenario Analysis: This scenario is professionally challenging because it involves a critical juncture where a nurse must balance immediate patient care needs with the stringent requirements of clinical documentation and regulatory compliance. The potential for incomplete or inaccurate documentation can have significant repercussions, including compromised patient safety, legal liabilities, and regulatory sanctions. The pressure to provide timely care can sometimes lead to shortcuts in documentation, making a robust risk assessment essential. Correct Approach Analysis: The best professional practice involves a systematic approach to risk assessment that prioritizes patient safety and regulatory adherence. This means proactively identifying potential documentation gaps or inaccuracies that could impact patient care or lead to non-compliance. It involves reviewing the patient’s chart, consulting with the care team, and verifying that all necessary information is accurately and completely recorded according to established protocols and relevant healthcare regulations (e.g., HIPAA in the US for patient privacy and data security, and professional nursing standards of practice). This approach ensures that documentation is not an afterthought but an integral part of the care process, mitigating risks before they manifest. Incorrect Approaches Analysis: Failing to document a critical intervention due to time constraints is professionally unacceptable. This directly violates professional nursing standards of practice and can lead to a lack of continuity of care, potential medical errors if another provider is unaware of the intervention, and significant legal and regulatory repercussions. It undermines the legal and ethical obligation to maintain accurate patient records. Relying solely on verbal communication with colleagues to supplement missing documentation is also professionally unacceptable. While verbal communication is important, it does not replace the legal and regulatory requirement for written or electronic documentation. Verbal information is ephemeral and prone to misinterpretation or forgetting, leaving no auditable record. This creates a significant compliance risk and can be detrimental to patient safety if critical details are lost. Assuming that a colleague will document the intervention later is professionally unacceptable. This demonstrates a lack of personal accountability for one’s actions and documentation responsibilities. It shifts the burden of compliance to another individual and creates a significant risk of the documentation being forgotten, incomplete, or inaccurate, leading to the same negative consequences as failing to document in the first place. Professional Reasoning: Professionals should employ a decision-making framework that integrates patient care needs with regulatory and ethical obligations. This involves a proactive mindset, where documentation is considered a concurrent activity with patient care, not a post-hoc task. When faced with time pressures, nurses should assess the criticality of the information and the potential impact of delayed documentation on patient safety and regulatory compliance. If immediate documentation is not feasible, a plan for timely and accurate recording must be established and executed, with a clear understanding of the risks associated with any delay. Adherence to organizational policies and relevant healthcare laws (such as HIPAA) should guide all documentation practices.

Scenario Analysis: This scenario is professionally challenging because it requires the orthopaedic nurse to balance the immediate need for pain management with the critical requirement of obtaining informed consent, especially when the patient is experiencing significant distress. The nurse must navigate ethical obligations to alleviate suffering while upholding the patient’s autonomy and right to make informed decisions about their care. Failure to do so can lead to patient harm, legal repercussions, and breaches of professional conduct. Correct Approach Analysis: The best professional practice involves a multi-faceted approach that prioritizes patient comfort while ensuring informed consent is obtained ethically and legally. This includes assessing the patient’s capacity to consent, providing clear and understandable information about the pain management options, including potential benefits, risks, and alternatives, and allowing the patient sufficient time to ask questions and make a decision. If the patient’s pain is so severe that it impairs their capacity to understand the information, the nurse should explore less invasive pain relief measures that do not preclude future informed consent for more definitive treatments, while simultaneously working to improve the patient’s pain control to a level where they can engage in the consent process. This aligns with ethical principles of beneficence (acting in the patient’s best interest), non-maleficence (avoiding harm), and respect for autonomy. Regulatory frameworks, such as those governing patient rights and informed consent in healthcare settings, mandate that patients have the right to be informed and to consent to or refuse treatment, even in emergency or high-pain situations, unless specific exceptions apply (e.g., immediate life-saving intervention where consent is impossible). Incorrect Approaches Analysis: One incorrect approach involves administering strong analgesia without a thorough assessment of the patient’s capacity to consent or providing adequate information about the proposed treatment. This bypasses the patient’s right to autonomy and can lead to the patient receiving a treatment they may not have agreed to if they were able to fully comprehend the implications. This violates the fundamental ethical and regulatory requirement for informed consent. Another incorrect approach is to delay necessary pain management significantly while attempting to obtain consent for a procedure that the patient is currently too distressed to consider. While informed consent is paramount, prolonged severe pain can itself be harmful and can further impair a patient’s ability to engage in decision-making. This approach fails to adequately address the principle of beneficence by prolonging suffering unnecessarily. A third incorrect approach is to assume that because the patient is in pain, they automatically consent to any pain relief offered. This paternalistic approach disregards the patient’s right to refuse treatment and their right to understand what is being administered. It fails to recognize that even in distress, patients retain the right to make choices about their bodies and medical care. Professional Reasoning: Professionals should employ a decision-making framework that prioritizes patient safety and well-being while upholding ethical and legal standards. This involves a continuous assessment of the patient’s condition, including their pain level and capacity for decision-making. When faced with a conflict between immediate symptom relief and the need for informed consent, professionals should seek to address both concurrently. This might involve administering basic comfort measures that do not impede future consent, while simultaneously working to improve the patient’s pain to a level where they can participate in informed decision-making. Open communication with the patient, their family (if appropriate and with patient consent), and the interdisciplinary team is crucial. Documentation of all assessments, discussions, and interventions is essential for accountability and continuity of care.

This scenario is professionally challenging due to the inherent complexity of orthopaedic trauma, where subtle pathophysiological changes can rapidly escalate, impacting patient outcomes and requiring timely, evidence-based interventions. The nurse must balance immediate clinical needs with long-term functional recovery, all while navigating the ethical imperative to provide patient-centered care and adhere to professional standards. Careful judgment is required to differentiate between expected post-operative discomfort and signs of serious complications, necessitating a robust risk assessment process. The best professional approach involves a systematic, multi-faceted risk assessment that integrates the patient’s baseline health status, the specific surgical intervention, immediate post-operative physiological responses, and potential for complications. This approach prioritizes early identification of deviations from expected recovery trajectories by considering factors such as pain levels, vital signs, wound integrity, neurological status, and mobility. It aligns with the ethical principles of beneficence and non-maleficence by proactively seeking to prevent harm and promote well-being. Furthermore, it is supported by professional nursing standards that mandate continuous patient assessment and the application of critical thinking skills to anticipate and manage potential adverse events. This comprehensive strategy ensures that clinical decisions are informed by a deep understanding of the patient’s evolving pathophysiological state. An approach that relies solely on the patient’s subjective report of pain without objective physiological assessment is professionally unacceptable. This failure neglects the potential for stoicism or altered pain perception due to medication or underlying conditions, leading to delayed recognition of serious issues like compartment syndrome or infection. Ethically, it breaches the duty of care by not adequately monitoring the patient’s condition. Another professionally unacceptable approach is to attribute all post-operative symptoms solely to the expected effects of surgery without considering alternative or superimposed pathologies. This can lead to a false sense of security and a failure to investigate concerning signs, potentially resulting in significant patient harm and violating the principle of vigilance in nursing practice. Finally, an approach that prioritizes administrative efficiency over thorough clinical assessment, such as limiting assessment frequency based on non-clinical factors, is ethically and professionally flawed. This disregards the dynamic nature of post-operative recovery and the potential for rapid deterioration, undermining the nurse’s responsibility to advocate for the patient’s immediate safety and well-being. The professional decision-making process for similar situations should involve a continuous cycle of assessment, diagnosis, planning, implementation, and evaluation. This process should be guided by a strong understanding of orthopaedic pathophysiology, evidence-based practice guidelines, and a commitment to patient advocacy. Risk assessment should be an integral part of every assessment, utilizing a combination of subjective and objective data to identify potential threats to the patient’s recovery.