A charge nurse on a mental health unit is receiving change of shift report for a group of clients. The charge nurse is working with an RN, an LPN, and assistive personnel (AP) from 0700 to 1900 and is reviewing client care assignments. Complete the following sentence by using the lists of options.

The charge nurse should first assess the client who has a 7-year history of major depressive disorder, whose friend reports the client has stopped taking their medication, and who is flat, withdrawn, cries all the time, sleeps all the time, and has extremely slowed movements, due to the risk of Select.

Choice A reason: Changing the facility's vendor for central line products is not a quality improvement strategy. The vendor is not the cause of the infections, but the process of insertion, maintenance, and removal of the central line. The nurse manager should focus on improving the quality of care rather than the quality of products.

Choice B reason: Using resources that identify benchmarks of best practices is a quality improvement strategy. The nurse manager should compare the facility's performance with the standards and guidelines of evidence-based practice, such as the Centers for Disease Control and Prevention (CDC) or the Institute for Healthcare Improvement (IHI). The nurse manager should also implement interventions to reduce the infection rate, such as staff education, audits, and feedback.

Choice C reason: Identifying the staff caring for clients who acquire an infection is not a quality improvement strategy. The nurse manager should not single out or blame the staff for the infections, but rather involve them in the quality improvement process. The nurse manager should foster a culture of safety and teamwork, and encourage the staff to report and prevent errors.

Choice D reason: Reporting the incidence of infection to the health department is not a quality improvement strategy. The nurse manager should report the infection rate as required by law, but this does not improve the quality of care. The nurse manager should use the data to identify the gaps and areas of improvement, and monitor the outcomes of the quality improvement plan.

Choice A reason: A nurse refusing to actively participate during an elective abortion procedure scheduled for their client is not a behavior that indicates a need for further education. The nurse has the right to conscientious objection, which means they can decline to perform or assist in a procedure that violates their moral or religious beliefs. The nurse should inform the charge nurse of their objection and request to be reassigned to another client.

Choice B reason: A nurse explaining to a client's family that a DNR order includes withholding comfort measures is a behavior that indicates a need for further education. The nurse is providing false and misleading information that can cause harm and distress to the client and the family. A DNR order only means that no cardiopulmonary resuscitation (CPR) or advanced cardiac life support (ACLS) will be initiated in the event of a cardiac or respiratory arrest. A DNR order does not affect the provision of other treatments, such as pain management, hydration, nutrition, oxygen, or emotional support.

Choice C reason: A nurse informing a confused client who wants to go home that they are going to stay at the facility until they are better is not a behavior that indicates a need for further education. The nurse is using therapeutic communication and providing reassurance to the client. The nurse is also respecting the client's autonomy and right to refuse treatment, as long as the client is competent and informed. The nurse should assess the client's mental status and decision-making capacity, and involve the client's family or surrogate decision-maker if needed.

Choice D reason: A nurse giving prescribed opioids to a client who has a terminal illness and respirations of 8/min is not a behavior that indicates a need for further education. The nurse is following the principle of beneficence, which means doing good and preventing harm to the client. The nurse is also following the principle of double effect, which means that an action that has both a good and a bad effect is morally permissible if the good effect outweighs the bad effect. The nurse is providing adequate pain relief to the client, even if it may hasten their death. The nurse should monitor the client's vital signs and level of consciousness, and adjust the opioid dose as prescribed.