Professional Practice, Ethics, Safety and Quality Improvement
Core concepts
Ethical principles: autonomy, beneficence, nonmaleficence, justice, veracity, and fidelity. Apply informed consent, confidentiality, capacity assessment, and conflict-of-interest awareness. Safety includes hazardous drug handling, closed-system transfer devices, personal protective equipment, spill management, safe disposal, and error reporting. Quality improvement uses plan-do-study-act cycles, root cause analysis, and metrics such as central line infection rates and medication errors.
Traps in questions
- Capacity versus competence: capacity is a clinical determination; competence is legal.
- Consent requires understanding: a signed form is not consent if the patient does not understand.
- Error reporting is nonpunitive: the goal is system learning, not blame.
- Hazardous drug exposure: nurses handling chemotherapy need appropriate PPE and should not be pregnant or trying to conceive only if policy restricts - know your institutional policy rather than assuming.
- Just culture: distinguish human error, at-risk behavior, and reckless behavior.
Rule of thumb
Patient first, then system, then self. In ethical dilemmas, determine the patient's wishes and capacity before acting; in safety events, report and analyze before assigning blame.
Worked example
A nurse notices a colleague skipping a double-check before chemotherapy. The correct action is to intervene in the moment to protect the patient, then report through the appropriate safety channel so the system can be improved - not to ignore it or to publicly shame the colleague.
Patient Education, Shared Decision-Making and Self-Management Support
Core concepts
Use teach-back to confirm understanding, plain language, and culturally appropriate materials. Assess health literacy, language, sensory, and cognitive needs. Shared decision-making involves presenting options, benefits, harms, and uncertainty, exploring values, and reaching a decision together. Self-management support builds skills: symptom monitoring, medication adherence, when to call, nutrition, activity, and managing uncertainty.
Traps in questions
- Teach-back is not repetition: the patient explains in their own words; the nurse does not simply restate.
- Information alone is not shared decision-making: values and preferences must be elicited.
- Health literacy is not intelligence: high-functioning people can have low health literacy.
- Written materials alone are insufficient for low-literacy or non-native-language patients.
- Self-management is not abandonment: the team remains available and provides escalation criteria.
Rule of thumb
Ask, tell, ask. Ask what the patient knows, tell them the key message plainly, then ask them to teach it back.
Worked example
A patient starting oral chemotherapy says, "I'll take it whenever I remember." The nurse uses teach-back to confirm understanding of timing, missed-dose rules, and when to call, and documents the education and the patient's demonstrated understanding.