Which of the following should be included in a discussion of advance directives with new nurse graduates?

Correct Answer: D

Rationale: Option D is correct because it accurately describes the primary purpose of an advance directive in a healthcare context. An advance directive is a legal document that allows individuals to specify their preferences for medical treatment and appoint a healthcare surrogate (also called a healthcare proxy or agent) to make decisions on their behalf if they become incapacitated. This surrogate is responsible for communicating and enforcing the patient’s documented wishes, ensuring autonomy is preserved even when the patient cannot speak for themselves. This aligns with ethical principles of patient-centered care and respects the individual’s right to self-determination in medical decisions. Option A is incorrect because it misrepresents the role of nurses under the Patient Self-Determination Act (PSDA). While the PSDA mandates that healthcare institutions (such as hospitals) inform patients of their right to create an advance directive upon admission, it does not place this responsibility solely on nurses. Nurses may facilitate these discussions, but the legal obligation lies with the institution. Additionally, the PSDA does not require nurses to directly educate clients about advance directives—it ensures that institutions provide written information, not individual providers. Option B is incorrect because it conflates advance directives with financial decision-making authority. Advance directives pertain exclusively to healthcare decisions, not financial or legal matters. Financial decisions for an incapacitated individual are typically handled through separate legal instruments, such as a durable power of attorney for finances or a conservatorship. Including this in a discussion with nurse graduates would create confusion about the scope of advance directives, which are strictly healthcare-related. Option C is incorrect because it inaccurately describes the function of a living will. A living will is a type of advance directive that outlines an individual’s preferences for specific medical treatments (e.g., life support, artificial nutrition) but does not designate a decision-maker. The confusion arises from mixing the concepts of a living will (which states wishes) and a healthcare surrogate designation (which appoints a person to make decisions). A living will is static, while a surrogate can adapt decisions to unanticipated circumstances, making this distinction critical for nurse graduates to understand. Clarity on these distinctions is essential for nurses, as they often serve as advocates and educators for patients navigating advance care planning. Misinformation could lead to legal or ethical breaches, such as failing to honor a patient’s true wishes or improperly guiding families during crises. The correct answer (D) emphasizes the surrogate’s role, which is central to the practical application of advance directives in clinical settings.

Correct Answer: D

Rationale: In today's healthcare environment, professionals require a diverse skill set to effectively navigate the complexities of patient care. Communication is fundamental for effective patient interactions, teamwork, and collaboration. Supervision and management skills are crucial for overseeing patient care and ensuring operational efficiency. Delegation is important for distributing tasks appropriately among team members. Therefore, all the skills mentioned (communication, supervision, management, and delegation) are essential for healthcare professionals in today's healthcare environment. The correct answer is 'All of the above' because all the skills listed are crucial and interlinked in providing high-quality patient care in the current healthcare setting. Choices A, B, and C are incorrect because each skill plays a vital role in the multifaceted responsibilities of healthcare professionals, and focusing on only one aspect would be limiting in today's dynamic healthcare landscape.

Correct Answer: B

Rationale: The correct answer is 'Functional.' In a functional structure, organizations group employees into departments based on specialty, where similar tasks are performed by the same group. In this scenario, the hospital organizing its departments by specialty such as nursing, dietary, and pharmacy aligns with the characteristics of a functional structure. Choice A, 'Parallel,' does not fit the scenario described; parallel structures involve separate, independent units operating in parallel with little interaction. Choice C, 'Service-integrated,' does not align with the scenario either as it involves integrating services across departments. Choice D, 'Matrix,' is not the correct answer as it involves a complex organizational structure where employees report to multiple managers simultaneously, which is not the case in the scenario provided.

Correct Answer: B

Rationale: A critical pathway should be revised when variances in the patient's progress indicate a new trend or deviation from the expected course of treatment. This allows healthcare providers to adjust the pathway to ensure optimal patient care and outcomes. Changes in the critical pathway are not typically driven by its length or external factors like team member retirements or client discharges. Therefore, the correct answer is B. Choice A is incorrect because the length of the critical pathway alone does not determine the need for revision. Choices C and D are irrelevant to the patient's progress and treatment plan, making them incorrect.

Correct Answer: B

Rationale: The correct answer is B: Being a change agent. The manager is demonstrating the quality of being a change agent by implementing an initiative aimed at improving the unit's operations. A change agent initiates and drives changes to enhance effectiveness and efficiency within the unit. Choice A is incorrect because the manager's actions are not described as unrealistic but rather proactive. Choice C, being democratic, is incorrect as it does not relate to the manager's initiative to improve unit operations. Choice D, being authoritarian, is also incorrect as the manager is not described as enforcing changes through strict control and power.