Which of the following clients would most likely be selected for case management?

Correct Answer: C

Rationale: The correct answer is C because an elderly client awaiting a hip replacement typically requires ongoing support and coordination of services, making them a good candidate for case management. This client would benefit from assistance with navigating the healthcare system, coordinating appointments, and ensuring continuity of care post-surgery. Choice A is incorrect as the adolescent with a gunshot wound in the ER is likely to be in need of immediate medical intervention rather than case management. Choice B is incorrect as a young adult with a fractured pelvis may require medical treatment but may not necessarily need the level of ongoing support that case management provides. Choice D is incorrect as a 41-year-old client admitted for an outpatient tonsillectomy is a relatively straightforward procedure that may not require extensive case management services.

Correct Answer: A

Rationale: The correct answer is A: Moving. In Havelock's model of change, the Moving stage involves implementing the chosen change after considering alternatives. In this scenario, the nursing staff accepted a new procedure, indicating they are moving forward with the change. This stage focuses on putting the change into action. Summary of other choices: B: Self-renewal - This choice is not applicable as self-renewal refers to personal growth and development, not organizational change stages. C: Refreezing - This choice is incorrect as refreezing involves stabilizing the change and ensuring it becomes the new norm, which comes after the Moving stage. D: Unfreezing - This choice is incorrect as unfreezing refers to preparing for change by overcoming resistance and creating readiness, which precedes the Moving stage.

Correct Answer: D

Rationale: The correct answer is D: Patient-focused. Developing a patient-focused atmosphere is crucial to reduce potential risks in healthcare. Patients should be at the center of care, with their needs, preferences, and safety prioritized. In a patient-focused atmosphere, communication is enhanced, leading to better understanding and adherence to treatment plans, reducing errors and adverse events. Nurses, physicians, and families play important roles in patient care, but ultimately, the patient should be the primary focus. Incorrect choices: A: Nurse-focused - Focusing solely on nurses may neglect the holistic approach to patient care and fail to address the patient's needs directly. B: Physician-focused - Similarly, focusing only on physicians may lead to a lack of patient involvement in decision-making and may not address the emotional and psychological aspects of care. C: Family-focused - While involving families in care is important, solely focusing on them may not always align with the patient's best interests and may not address the patient's autonomy and individual needs.

Correct Answer: C

Rationale: The correct answer is C: Continual monitoring. Quality improvement programs require ongoing monitoring to assess progress, identify areas for improvement, and make data-driven decisions. Continual monitoring allows for timely adjustments to processes and interventions to ensure sustained quality improvement. Blame and punishment (A) are counterproductive in a QI program as they can create a culture of fear and hinder open communication. Employee satisfaction (B) is important but not necessarily an essential element of a QI program. Strict adherence to policies (D) is important but alone may not lead to continuous improvement without the feedback loop provided by continual monitoring.

Correct Answer: C

Rationale: The correct answer is C: Shared decision making. Shared governance involves collaborative decision-making among healthcare professionals, including nurses, to improve patient care and organizational outcomes. This approach empowers frontline staff to have a voice in decisions that affect their work environment and patient care. Nurse-led committees (option B) may be a part of shared governance but do not fully encompass the concept. Top-down management (option A) and hierarchical structure (option D) are opposite to the principles of shared governance as they involve centralized decision-making and lack of employee involvement in decision-making processes.