During an initial visit, a home health nurse is assessing a client who has cultural beliefs different than their own. Which of the following questions should the nurse ask to determine the client's beliefs about environmental control?

Near miss:

• Incident Report 1: The nurse identified the client's allergy before administering azithromycin, preventing an adverse reaction. Holding the medication and notifying the provider ensured patient safety, making this a near miss rather than an adverse event.

Adverse Event:

• Incident Report 2: The client did not receive prescribed prophylactic antibiotics during labor, leading to neonatal sepsis. The lack of antibiotic administration increased the risk of serious complications, making this an adverse event with potential long-term consequences.

• Incident Report 3: A tenfold dosing error led to the administration of 60 units instead of 6 units of insulin, resulting in severe hypoglycemia and unresponsiveness. This critical medication error placed the client at significant risk for neurological damage or death, classifying it as an adverse event.

• Incident Report 4: A critically low platelet value was reported but not communicated to the provider, delaying intervention and leading to a coma. The failure to act on critical lab results contributed to a preventable deterioration in the client’s condition, making this an adverse event.

• Incident Report 5: Despite being identified as a fall risk, the client sustained a fall due to a malfunctioning call bell, leading to an injury. The failure to address the defective equipment compromised patient safety, making this an adverse event that could have been prevented.

A. The advice of an expert nephrology nurse. While experienced nurses provide valuable clinical insights, their knowledge may be based on personal experience rather than the latest evidence-based research. Best practices should be supported by scientific studies rather than anecdotal expertise.

B. Retrospective chart reviews. Chart reviews can offer useful data on past interventions and outcomes, but they do not always reflect the most current evidence-based practices. Additionally, they may contain inconsistencies or lack standardized guidelines necessary for broad application.

C. Facility critical pathway. Critical pathways are developed based on evidence-based guidelines, but they may not always reflect the most up-to-date research. These protocols are useful for standardizing care within a specific institution but should be supplemented with current peer-reviewed research to ensure best practices.

D. A recent peer-reviewed nursing research article. Peer-reviewed nursing research articles provide the most current and scientifically validated evidence. These sources undergo rigorous evaluation before publication, ensuring that recommendations are based on high-quality research rather than opinion or outdated protocols.