A nurse manager is on a quality improvement committee to develop a new policy for client care. Which of the following actions should the nurse include first?

Communicate information about the new policy to nursing staff.

Create options for implementing the new policy.

Research the requirements of accrediting agencies that are related to the new policy.

Review feedback from nursing staff to determine the effectiveness of the new policy.

Answer and Explanation

The Correct Answer is C

Rationale:

A. Communicate information about the new policy to nursing staff: This occurs after the policy is developed and approved. It is important for implementation but is not the first step in policy development.

B. Create options for implementing the new policy: This step follows initial research and policy design. It cannot be done until there is a clear understanding of requirements and goals.

C. Research the requirements of accrediting agencies that are related to the new policy: This is the first step to ensure the policy aligns with regulatory standards and evidence-based practices. It provides a foundation for developing relevant and compliant guidelines.

D. Review feedback from nursing staff to determine the effectiveness of the new policy: This is part of the evaluation phase, which happens after the policy has been implemented and trialed.

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Correct Answer is C

Explanation

Rationale:

A. Number of staffing personnel on a shift: While staffing can sometimes be adjusted based on patient census, minimum staffing levels are often mandated by policy, union agreements, or patient safety standards, making this a semi-controllable or fixed cost in many cases.

B. Overtime acquired due to an emergency: Overtime in response to unplanned events like emergencies is generally unpredictable and difficult to control in the moment. It is considered a variable but less controllable expense in budgeting.

C. Wound care supplies used for a client: Supplies like dressings and topical treatments are directly influenced by nursing choices and adherence to clinical protocols. Standardizing and monitoring supply usage can reduce waste, making this a controllable expense in the budget.

D. Depreciation of equipment value: Depreciation is a non-controllable, fixed expense calculated over time based on accounting rules. It reflects asset wear and tear and cannot be changed through day-to-day management practices.

A. Cuts an opening in the skin barrier 0.32 cm (0.125 in) larger than the stoma B. Applies a piece of gauze over the stoma after removing the old appliance C. Cleanses the client's skin around the stoma with deodorant soap D. Uses toilet tissue to remove stool from the client's skin around the stoma

Correct Answer is C

Explanation

Rationale:

A. Cuts an opening in the skin barrier 0.32 cm (0.125 in) larger than the stoma: This is appropriate technique. Leaving a small gap allows the barrier to fit snugly without constricting the stoma, while preventing skin irritation or breakdown from contact with stoma output.

B. Applies a piece of gauze over the stoma after removing the old appliance: This is a good practice. Covering the stoma temporarily helps absorb any stool during the cleaning and preparation process, maintaining cleanliness and preventing soiling.

C. Cleanses the client's skin around the stoma with deodorant soap: Deodorant or antibacterial soaps can contain harsh chemicals and fragrances that irritate the skin or interfere with barrier adhesion. The skin should be cleaned with warm water or a mild, fragrance-free soap.

D. Uses toilet tissue to remove stool from the client's skin around the stoma: Using toilet tissue to wipe away stool is acceptable for initial cleaning. It can help remove bulk waste before using a washcloth or gauze for a more thorough cleansing.

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