Which statement(s) if made by the nurse manager demonstrates effective change management? Select all that apply.

Therapeutic communication in nursing is based on patient-centered interviewing, active listening, verbal facilitation techniques, and information exploration strategies, which promote accurate data collection, patient trust, and comprehensive understanding of symptoms such as vertigo, which may have vestibular, neurological, or cardiovascular origins.

Rationale:

A. Sending a PCA to assess dizziness is inappropriate because it bypasses the nurse–patient therapeutic relationship and delegates assessment communication in a non-therapeutic and clinically unsound manner. It also risks inaccurate symptom interpretation without nursing assessment.

B. Writing notes while avoiding eye contact and giving reassurance without assessment limits therapeutic engagement. This behavior reflects non-therapeutic communication, reduces patient trust, and prevents exploration of symptom characteristics necessary for clinical evaluation of vertigo.

C. Using open-ended questions is the most therapeutic approach because it encourages detailed patient responses, promotes elaboration of symptom characteristics such as onset, duration, triggers, and associated symptoms, and enhances accurate clinical data collection during nursing assessment.

D. Turning away from the patient demonstrates non-verbal disengagement and lack of active listening. This behavior decreases rapport, limits patient disclosure, and interferes with effective therapeutic communication needed to assess complex symptoms like vertigo.

Chronic disease management involves long term coordination, multidisciplinary care, resource utilization, and functional decline prevention in conditions requiring continuous monitoring, complex therapy adjustment, and frequent healthcare system interactions support services.

Rationale:

A. This client has Type 2 diabetes mellitus with A1C 4.8 indicating excellent glycemic control. Case management is not required due to stable metabolic status. No complications or frequent healthcare utilization present. Therefore not suitable candidate for case management services.

B. This client has atrial fibrillation since 2022 indicating chronic arrhythmia condition. However case management eligibility depends on symptom burden and case management eligibility depends on symptom burden and complications. No evidence of high utilization or decompensation provided. Bare condition does not clearly require coordinated case management services.

C. This client presents with influenza infection in elderly individual. Condition is typically acute self-limiting and managed outpatient. No chronic complexity or long term coordination needs identified. C case management not indicated given short duration and low complexity care requirement.

D. This client has congestive heart failure with ejection fraction 35 to 40 percent. Condition reflects chronic systolic dysfunction requiring long term management. High risk of hospitalization and disease exacerbations present. Therefore appropriate candidate for case management services coordination care.