Scenario Analysis: This scenario is professionally challenging because it requires balancing the ethical imperative to advance rehabilitation nursing practice through innovation with the regulatory and ethical obligations to ensure patient safety and data integrity. The rapid pace of technological advancement in rehabilitation, coupled with the need for robust evidence, creates a complex decision-making environment. Professionals must navigate the potential benefits of novel approaches against the risks of unproven methods and the responsible stewardship of patient data collected through registries. Careful judgment is required to ensure that innovation serves, rather than compromises, patient well-being and the credibility of the profession. Correct Approach Analysis: The best professional approach involves a systematic and evidence-based integration of translational research findings into practice, supported by well-designed patient registries and a commitment to ethical innovation. This approach prioritizes the rigorous evaluation of new interventions and technologies, ensuring they are safe and effective before widespread adoption. Patient registries are crucial for collecting real-world data, monitoring outcomes, identifying trends, and informing further research and quality improvement initiatives. Ethical innovation means that new methods are developed and implemented with transparency, patient consent, and a clear understanding of potential risks and benefits, all within the established regulatory framework for research and healthcare data. This aligns with the core principles of evidence-based practice and patient-centered care, ensuring that advancements are grounded in scientific validity and ethical considerations. Incorrect Approaches Analysis: One incorrect approach involves prematurely adopting innovative technologies or interventions based solely on anecdotal evidence or marketing claims, without sufficient translational research or registry data to support their efficacy and safety. This bypasses the critical step of evidence generation and validation, potentially exposing patients to unproven or even harmful practices and undermining the credibility of rehabilitation nursing. Another incorrect approach is to neglect the establishment and maintenance of comprehensive patient registries when implementing innovative practices. Without robust data collection, it becomes impossible to track the long-term impact of innovations, identify adverse events, or generate the evidence needed for future improvements and regulatory compliance. This leads to a lack of accountability and hinders the scientific advancement of the field. A further incorrect approach is to pursue innovation in isolation, without engaging with relevant professional bodies, regulatory agencies, or ethical review boards. This can lead to practices that are not aligned with current standards, may violate patient privacy regulations, or fail to meet ethical guidelines for research and clinical practice, ultimately jeopardizing patient trust and professional integrity. Professional Reasoning: Professionals should employ a decision-making framework that begins with identifying a clinical need or opportunity for improvement. This should be followed by a thorough literature review to understand existing translational research. If innovation is considered, a plan for rigorous evaluation, including the potential use of patient registries for data collection and outcome monitoring, must be developed. This plan should be reviewed against ethical guidelines and relevant regulations. Collaboration with peers, researchers, and regulatory experts is essential throughout the process. The decision to implement an innovation should be based on a clear demonstration of benefit, safety, and alignment with professional standards and patient values.

This scenario presents a professional challenge because the rehabilitation nursing consultant must navigate the complex interplay between patient autonomy, family involvement, and the ethical imperative to provide the highest standard of care within the established rehabilitation plan. The consultant’s decision-making process is critical, as it directly impacts the patient’s well-being, recovery trajectory, and the trust established with the patient and their family. The core knowledge domains of rehabilitation nursing, particularly those related to patient-centered care, communication, and ethical practice, are central to resolving this dilemma. The best approach involves a structured, patient-centered communication strategy that respects the patient’s expressed wishes while also ensuring the family is informed and involved appropriately. This begins with a direct, empathetic conversation with the patient to understand the root of their resistance to the prescribed exercises. The consultant should then facilitate a joint discussion with the patient and their family, clearly explaining the rationale behind the rehabilitation plan, the potential benefits of adherence, and the risks associated with non-compliance, all while actively listening to and validating the concerns of both the patient and the family. This collaborative approach aligns with ethical principles of informed consent and beneficence, ensuring the patient’s right to self-determination is honored while also promoting their optimal recovery. It also adheres to professional guidelines that emphasize open communication and shared decision-making in healthcare. An incorrect approach would be to unilaterally override the patient’s expressed reluctance and insist on the exercises without further exploration of their concerns. This fails to acknowledge the patient’s autonomy and can erode trust, potentially leading to increased resistance and a negative impact on their engagement with the rehabilitation process. It also neglects the importance of understanding the underlying reasons for the patient’s feelings, which could be related to pain, fear, or misunderstanding. Another incorrect approach would be to solely defer to the family’s wishes without adequately engaging the patient in the decision-making process. While family support is valuable, the patient is the primary recipient of care and their voice must be central. Ignoring the patient’s expressed feelings or concerns in favor of family directives violates their right to self-determination and can lead to resentment and disengagement. Finally, an incorrect approach would be to avoid the difficult conversation altogether and simply document the patient’s resistance without attempting to resolve it. This passive stance fails to uphold the consultant’s professional responsibility to advocate for the patient’s best interests and to actively work towards overcoming barriers to their recovery. It represents a failure to apply core rehabilitation nursing knowledge in a proactive and ethical manner. Professionals should employ a decision-making framework that prioritizes patient-centered communication, ethical principles, and evidence-based practice. This involves actively listening, empathizing, educating, and collaborating with the patient and their support system to reach shared decisions that respect individual autonomy and promote optimal outcomes.

This scenario is professionally challenging because it requires a nuanced understanding of the purpose and eligibility criteria for a specialized credentialing program, the Elite Latin American Rehabilitation Nursing Consultant Credentialing. The challenge lies in discerning which applicant’s profile most accurately aligns with the program’s stated objectives and requirements, necessitating careful evaluation beyond superficial similarities. Misinterpreting these criteria could lead to either the exclusion of a deserving candidate or the acceptance of an unqualified one, both of which undermine the integrity and purpose of the credentialing body. The correct approach involves a thorough review of the applicant’s professional background, educational achievements, and demonstrated commitment to rehabilitation nursing within the Latin American context, directly correlating these with the stated purpose of the credentialing program. This program is designed to recognize and elevate consultants who possess a deep understanding of rehabilitation needs and practices specific to Latin America, including cultural competencies and experience with regional healthcare systems. Eligibility is predicated on a combination of advanced practice experience, specialized training in rehabilitation, and a proven track record of contributing to the field within the specified geographic region. This approach ensures that only those who truly embody the spirit and meet the rigorous standards of the Elite Latin American Rehabilitation Nursing Consultant Credentialing are recognized, thereby upholding the credential’s value and its intended impact on rehabilitation care in the region. An incorrect approach would be to prioritize an applicant solely based on extensive general nursing experience, even if it includes some rehabilitation exposure, without a clear focus on the Latin American context or the specific advanced competencies the credential seeks to validate. This fails to acknowledge the specialized nature of the credential and its regional focus, potentially overlooking candidates with more relevant expertise. Another incorrect approach would be to accept an applicant based on a broad interpretation of “consultant” without verifying if their experience directly relates to rehabilitation nursing and if they have actively engaged in consulting roles that align with the program’s objectives. This dilutes the credential’s specificity and purpose. Finally, an approach that overlooks the requirement for demonstrated contributions to the rehabilitation nursing field within Latin America, focusing instead on international experience that may not be transferable or relevant to the region’s unique challenges, would also be a failure. This neglects a core eligibility criterion designed to ensure practical, regional impact. Professionals should employ a decision-making framework that begins with a clear understanding of the credentialing body’s mission and the specific objectives of the Elite Latin American Rehabilitation Nursing Consultant Credentialing. This involves meticulously dissecting the eligibility criteria and comparing them against each applicant’s documented qualifications. A structured evaluation process, perhaps using a scoring rubric based on the stated criteria, can help ensure objectivity. Furthermore, seeking clarification from the credentialing body on any ambiguous aspects of an application or the criteria themselves is a crucial step in maintaining professional integrity and making informed decisions.

This scenario is professionally challenging due to the inherent conflict between a patient’s expressed wishes and the perceived best interests of their recovery, complicated by the need to adhere to established nursing standards and ethical principles within the Latin American rehabilitation nursing context. The consultant must navigate cultural nuances, family dynamics, and the patient’s autonomy while ensuring evidence-based care and maintaining professional boundaries. Careful judgment is required to balance these competing factors without compromising patient safety or dignity. The best approach involves a comprehensive assessment of the patient’s capacity to make decisions, followed by open and empathetic communication with the patient and their family. This includes clearly explaining the rationale behind the recommended rehabilitation plan, addressing any concerns or misunderstandings, and collaboratively developing a care plan that respects the patient’s values and preferences while aligning with professional standards for rehabilitation. This approach is correct because it prioritizes patient autonomy and informed consent, which are fundamental ethical principles in nursing. It also aligns with the principles of patient-centered care, ensuring that the rehabilitation plan is tailored to the individual’s needs and goals. Furthermore, it fosters trust and collaboration, which are essential for successful rehabilitation outcomes. An approach that involves overriding the patient’s stated preferences without a thorough assessment of their decision-making capacity is professionally unacceptable. This fails to respect patient autonomy and can lead to a breakdown in trust and adherence to the care plan. Similarly, an approach that solely focuses on the family’s wishes without adequately engaging the patient or ensuring their understanding and consent is ethically flawed. This can lead to coercion and a care plan that does not truly serve the patient’s best interests. Finally, an approach that neglects to document the decision-making process and the rationale behind the chosen rehabilitation plan is a failure of professional accountability and can leave the consultant vulnerable to ethical and legal challenges. Professionals should employ a decision-making framework that begins with a thorough assessment of the patient’s current condition, cognitive status, and decision-making capacity. This should be followed by active listening and empathetic communication to understand the patient’s perspective, values, and goals. Open dialogue with the patient and their family, involving shared decision-making, is crucial. The professional must then weigh the evidence-based recommendations against the patient’s expressed wishes and cultural context, seeking to find a mutually agreeable path forward. Documentation of all assessments, communications, and decisions is paramount for accountability and continuity of care.

This scenario presents a professional challenge because the credentialing body for Elite Latin American Rehabilitation Nursing Consultants has established specific policies regarding blueprint weighting, scoring, and retake opportunities. Adhering to these policies is crucial for maintaining the integrity and fairness of the credentialing process. A consultant’s understanding and application of these policies directly impact their ability to achieve or maintain their credential, and also reflect their commitment to professional standards. The best approach involves a thorough review of the official credentialing handbook and direct communication with the credentialing body to clarify any ambiguities regarding the blueprint weighting, scoring methodology, and the conditions under which a retake examination is permitted. This approach is correct because it prioritizes accurate information and adherence to established procedures. The credentialing body’s policies are the definitive source for understanding the examination’s structure, evaluation, and retake rules. Seeking clarification ensures that the consultant’s actions are aligned with the regulatory framework governing the credential, thereby upholding ethical standards of transparency and compliance. An incorrect approach would be to rely on informal discussions or anecdotal evidence from colleagues about the examination’s weighting or scoring. This is professionally unacceptable because it bypasses the official, authoritative source of information. Such reliance can lead to misinterpretations of the blueprint, inaccurate self-assessment of performance, and potentially missed opportunities or incorrect assumptions about retake eligibility, all of which violate the principle of adhering to established regulatory guidelines. Another incorrect approach is to assume that the retake policy is universally applied without considering specific conditions or limitations outlined by the credentialing body. For instance, assuming an immediate retake is always possible without understanding potential waiting periods, additional fees, or requirements for further professional development might lead to a flawed plan. This failure to consult the specific policy can result in a violation of the credentialing body’s rules, undermining the fairness of the process. Finally, an incorrect approach would be to interpret the blueprint weighting and scoring in a way that seems subjectively “fair” or “logical” without consulting the official documentation. The credentialing body’s established weighting and scoring are based on their defined competencies and learning objectives. Deviating from this established framework based on personal interpretation risks misaligning one’s preparation and understanding of their performance with the actual assessment criteria, thereby failing to meet the credentialing requirements. Professionals should employ a decision-making framework that begins with identifying the governing regulatory body and its official documentation. This should be followed by a diligent review of all relevant policies, including those pertaining to examination structure, scoring, and retakes. When ambiguities arise, direct, documented communication with the credentialing body is paramount. This systematic approach ensures that decisions are informed, compliant, and ethically sound, fostering trust and integrity in the professional credentialing process.

The control framework reveals that preparing for the Elite Latin American Rehabilitation Nursing Consultant Credentialing requires a structured and informed approach to candidate resources and timeline recommendations. This scenario is professionally challenging because rehabilitation nursing is a dynamic field, and the credentialing process itself demands a thorough understanding of specific competencies and best practices relevant to the Latin American context. Misjudging the necessary preparation resources or setting an unrealistic timeline can lead to candidate frustration, potential failure in the credentialing process, and ultimately, a delay in qualified professionals contributing to patient care. Careful judgment is required to balance the depth of preparation with the practicalities of a candidate’s existing workload and learning style. The best approach involves a comprehensive assessment of the candidate’s current knowledge base and practical experience against the credentialing body’s stated requirements. This includes identifying specific gaps in understanding or skill application that the credentialing exam will likely probe. Based on this assessment, a tailored study plan should be developed, recommending a blend of theoretical review (e.g., relevant rehabilitation nursing literature, ethical guidelines for patient care in Latin America), practical skill reinforcement (e.g., case study analysis, simulation exercises), and familiarization with the credentialing exam format and typical question types. The timeline should be realistic, allowing for dedicated study periods, practice assessments, and time for reflection and consolidation of learning, while also considering the candidate’s professional commitments. This approach aligns with the ethical principle of competence, ensuring that candidates are adequately prepared to demonstrate the required knowledge and skills, thereby upholding the standards of the profession and protecting patient welfare. It also respects the candidate’s investment of time and resources by providing a clear, actionable, and achievable path to credentialing. An approach that focuses solely on reviewing general rehabilitation nursing textbooks without considering the specific competencies outlined by the credentialing body or the unique healthcare context of Latin America is insufficient. This fails to address the precise requirements of the credentialing exam, leading to inefficient study and a higher risk of not meeting the specific standards. Ethically, this could be seen as a disservice to the candidate by not providing targeted guidance. Another inadequate approach is to recommend an overly aggressive timeline that does not account for the candidate’s existing professional responsibilities or learning pace. This can lead to burnout, superficial learning, and increased anxiety, potentially compromising the quality of preparation and the candidate’s well-being. It neglects the practical realities of adult learning and professional development. Finally, an approach that relies exclusively on practice exams without a foundational review of core concepts and ethical considerations is also flawed. While practice exams are valuable for familiarization, they are not a substitute for a deep understanding of the underlying principles of rehabilitation nursing and the ethical frameworks governing practice in Latin America. This can lead to rote memorization without true comprehension, which is unlikely to result in sustained competence or the ability to apply knowledge in complex clinical situations. Professionals should employ a decision-making framework that begins with a thorough understanding of the credentialing body’s requirements and the specific context of practice. This should be followed by a diagnostic assessment of the candidate’s strengths and weaknesses. Based on this, a personalized and phased preparation plan should be co-created with the candidate, incorporating diverse learning resources and a realistic timeline. Regular check-ins and opportunities for feedback are crucial to adapt the plan as needed and ensure the candidate’s progress and confidence.

Scenario Analysis: This scenario is professionally challenging because it involves a patient with complex needs, potential for polypharmacy, and the critical need for accurate medication reconciliation to prevent adverse drug events. The rehabilitation nursing consultant must navigate patient autonomy, the limitations of their role, and the responsibility to ensure safe and effective medication management within the established healthcare system. The potential for miscommunication or incomplete information between healthcare providers poses a significant risk. Correct Approach Analysis: The best professional approach involves initiating a comprehensive medication reconciliation process. This entails systematically reviewing the patient’s current medication list against newly prescribed medications, identifying any discrepancies, and proactively communicating these findings to the prescribing physician for clarification and resolution. This approach is correct because it directly addresses the core principles of medication safety, which mandate accurate and up-to-date medication information for all patients. It aligns with ethical obligations to advocate for patient well-being and prevent harm, and it adheres to best practices in interprofessional collaboration, ensuring that all members of the care team are informed and involved in medication decisions. This proactive stance minimizes the risk of drug interactions, duplications, or omissions. Incorrect Approaches Analysis: One incorrect approach involves accepting the new prescription without further inquiry, assuming the prescribing physician has accounted for all existing medications. This fails to uphold the nursing consultant’s responsibility in medication safety and could lead to dangerous drug interactions or therapeutic duplication, violating ethical duties to prevent harm. Another incorrect approach is to inform the patient that medication changes are solely the physician’s responsibility and to advise them to follow the physician’s orders without any nursing intervention. This abdicates the nursing consultant’s role in patient advocacy and medication safety oversight, potentially leaving the patient vulnerable to medication errors. Finally, a flawed approach would be to unilaterally alter the patient’s medication regimen based on the consultant’s own judgment without consulting the prescribing physician. This oversteps professional boundaries, undermines the physician’s authority, and introduces a significant risk of inappropriate medication management, potentially causing harm. Professional Reasoning: Professionals should employ a structured decision-making framework when faced with medication management challenges. This framework begins with a thorough assessment of the patient’s current medication regimen and the proposed changes. Next, it involves identifying potential risks and benefits, considering patient factors, and consulting relevant resources. Crucially, it emphasizes clear and timely communication with the prescribing physician and other members of the healthcare team. The professional should always prioritize patient safety and advocate for the most appropriate and safest course of action, adhering to established protocols and ethical guidelines.

This scenario is professionally challenging because it requires the rehabilitation nursing consultant to navigate complex ethical considerations and potential conflicts of interest while upholding the highest standards of patient care and professional integrity. The consultant must balance the immediate needs of the patient with the long-term implications of their recommendations, ensuring that all decisions are grounded in evidence-based practice and adhere to the ethical codes governing their profession. The best approach involves a systematic, evidence-based, and patient-centered decision-making process. This begins with a thorough assessment of the patient’s current condition, needs, and goals, followed by a comprehensive review of relevant literature and best practices in rehabilitation nursing. The consultant must then consider the available resources, potential barriers to care, and the patient’s preferences and values. Finally, recommendations should be clearly articulated, justified by evidence, and communicated transparently to the patient, their family, and the interdisciplinary team. This approach ensures that decisions are objective, ethically sound, and aligned with the principles of patient autonomy and beneficence. An approach that prioritizes immediate financial gain over comprehensive patient assessment and evidence-based recommendations is ethically unacceptable. This could lead to suboptimal care, patient harm, and a breach of professional duty. Similarly, an approach that relies solely on anecdotal evidence or personal experience without consulting current research or established guidelines fails to meet professional standards and risks providing outdated or ineffective interventions. Furthermore, an approach that neglects to involve the patient and their family in the decision-making process, or fails to consider their values and preferences, violates the principle of patient autonomy and can lead to dissatisfaction and non-adherence to care plans. Professionals should employ a decision-making framework that includes: 1) Information Gathering: Collect all relevant data about the patient, their condition, and the context of care. 2) Ethical Analysis: Identify ethical principles at play and potential conflicts. 3) Evidence Review: Consult current research and best practice guidelines. 4) Stakeholder Consultation: Engage with the patient, family, and interdisciplinary team. 5) Option Generation and Evaluation: Develop and assess potential courses of action based on evidence and ethical considerations. 6) Decision and Implementation: Select the best course of action and implement it. 7) Evaluation and Reflection: Monitor outcomes and reflect on the decision-making process for future improvement.

Scenario Analysis: This scenario is professionally challenging because it requires balancing the immediate need for patient care with the stringent requirements of clinical documentation and regulatory compliance within the Latin American rehabilitation nursing context. Misinterpreting or neglecting regulatory mandates can lead to significant legal and ethical repercussions, impacting patient safety, data integrity, and the reputation of the healthcare facility. The consultant must navigate potential ambiguities in documentation standards and ensure adherence to local health authority regulations. Correct Approach Analysis: The best professional practice involves meticulously documenting all aspects of patient care, including assessments, interventions, and outcomes, in a clear, accurate, and timely manner, ensuring that all entries comply with the specific regulatory framework governing clinical documentation in the relevant Latin American country. This approach is correct because it directly addresses the core requirements of regulatory compliance, which mandates comprehensive and accurate record-keeping for patient safety, continuity of care, and legal accountability. Adherence to these standards prevents data loss, facilitates audits, and supports evidence-based practice, all critical elements in rehabilitation nursing. Incorrect Approaches Analysis: Failing to document specific details of the patient’s response to a new therapeutic exercise, even if the patient verbally reports improvement, is an ethical and regulatory failure. Clinical documentation must be objective and verifiable; subjective patient reports, while important, require objective nursing observation and recording to be considered complete clinical data. This omission compromises the ability to track progress accurately, assess the effectiveness of interventions, and could lead to inappropriate treatment adjustments if future care providers rely solely on incomplete records. Prioritizing the completion of administrative tasks over the immediate documentation of a critical patient assessment, even with the intention to document later, is a regulatory and ethical lapse. While administrative duties are necessary, patient care documentation is a primary legal and ethical obligation. Delaying documentation of a critical assessment increases the risk of memory distortion, potential errors, and can hinder timely intervention if a change in patient condition is not immediately recorded and communicated. This also violates regulations that often stipulate prompt documentation of significant clinical events. Relying solely on informal verbal communication with colleagues to convey crucial patient status updates without contemporaneous written documentation is a significant regulatory and ethical breach. Verbal communication is transient and prone to misinterpretation or omission. Regulatory frameworks typically require that all significant patient information, including changes in condition and care plans, be formally recorded in the patient’s chart to ensure a permanent, accessible, and auditable record. This practice undermines data integrity and patient safety. Professional Reasoning: Professionals should employ a decision-making framework that prioritizes patient safety and regulatory adherence. This involves: 1) Understanding and internalizing the specific regulatory requirements for clinical documentation in their jurisdiction. 2) Implementing a systematic approach to documentation that integrates it into the workflow, rather than treating it as an afterthought. 3) Regularly reviewing and updating documentation practices to align with evolving regulations and best practices. 4) Recognizing that documentation is an integral part of patient care, not a separate administrative burden. When faced with competing demands, the consultant should always assess which action has the most direct and immediate impact on patient safety and legal/regulatory compliance, prioritizing those actions accordingly.

Scenario Analysis: This scenario is professionally challenging because it involves a critical patient situation requiring immediate and coordinated action, balancing the need for rapid intervention with the principles of safe delegation and effective interprofessional collaboration. The nurse consultant must assess the situation, determine the appropriate level of intervention, and communicate effectively with the team to ensure patient safety and optimal care outcomes. Misjudgment in delegation or communication can lead to delayed treatment, errors, or patient harm, undermining the trust and effectiveness of the interprofessional team. Correct Approach Analysis: The best professional practice involves the nurse consultant directly assessing the patient’s immediate needs to determine the most appropriate course of action. This includes evaluating the urgency of the situation, identifying necessary interventions, and then delegating specific tasks to the appropriate team members based on their scope of practice and competency. This approach ensures that the most critical aspects of care are addressed by the most qualified individuals, while also fostering a collaborative environment where all team members contribute effectively. This aligns with ethical principles of beneficence and non-maleficence, ensuring patient well-being and avoiding harm through careful assessment and appropriate delegation. It also upholds professional standards of leadership and accountability in rehabilitation nursing. Incorrect Approaches Analysis: One incorrect approach involves immediately delegating the task of administering the new medication without a direct assessment of the patient’s current status. This bypasses the crucial step of the consultant’s professional judgment regarding the medication’s appropriateness and potential immediate side effects in the context of the patient’s current condition. This failure to assess directly before delegating can lead to medication errors or adverse events, violating the principle of non-maleficence and demonstrating a lack of leadership accountability. Another incorrect approach is to assume the junior nurse has the necessary expertise and experience to manage the situation independently without further guidance or assessment from the consultant. While delegation is important, it must be accompanied by clear instructions and a mechanism for oversight, especially in complex or critical situations. This approach risks overburdening the junior nurse and potentially compromising patient care due to a lack of direct supervision or a thorough understanding of the patient’s specific needs. It fails to uphold the consultant’s responsibility for ensuring competent care delivery. A third incorrect approach is to escalate the situation to the physician without first attempting to assess the patient and delegate appropriate tasks within the nursing scope of practice. While physician involvement is sometimes necessary, a rehabilitation nurse consultant’s role includes independent assessment and delegation of nursing interventions. Premature escalation can undermine the nursing team’s autonomy and efficiency, and may not be the most timely or appropriate first step for a situation that could be managed effectively by experienced nursing staff. Professional Reasoning: Professionals should employ a decision-making framework that prioritizes patient safety and evidence-based practice. This involves a systematic approach: first, conduct a thorough assessment of the patient’s immediate needs and the situation’s urgency. Second, identify the necessary interventions and determine which can be safely and effectively delegated to other team members based on their scope of practice, competency, and the complexity of the task. Third, communicate clearly and concisely with the delegated individuals, providing specific instructions and expected outcomes. Fourth, establish a plan for monitoring and follow-up to ensure the delegated tasks are completed correctly and the patient’s condition is stable. Finally, document all actions and communications accurately. This structured approach ensures accountability, promotes effective teamwork, and upholds the highest standards of patient care.