A nurse is caring for a client who has a tracheostomy and requires suctioning. Identify the sequence of steps the nurse should follow after applying sterile gloves. (Move the steps into the box on the right, placing them in the selected order of performance. Use all the steps.)

Rationale:

A. Arrange for an ethics committee meeting to address the family's concerns: An ethics committee helps resolve conflicts between families and healthcare teams while respecting patient autonomy and legal directives. This step promotes ethical decision-making and interdisciplinary collaboration.

B. Support the family's decision and initiate life-sustaining measures: Providing treatments against the client’s documented wishes violates ethical and legal standards. Advance directives must be honored, even when family members disagree.

C. Complete an incident report: An incident report is used to document errors or adverse events, not ethical conflicts. This situation requires ethical consultation and communication, not a formal incident report.

D. Encourage the family to contact an attorney: While families may seek legal counsel, it is not the nurse’s role to suggest legal action. This may escalate the conflict unnecessarily and delay proper ethical resolution.

Rationale:

A. Identify possible precipitating factors related to the infections: The first step in addressing a quality or safety concern is to assess the situation and collect data. Identifying contributing factors helps guide appropriate interventions and ensures that any subsequent actions are targeted and evidence-based.

B. Meet with providers to discuss measures to decrease the infections: Collaborating with providers is essential for implementing effective solutions, but this step should follow a thorough assessment. Without identifying root causes first, discussions may be unfocused or ineffective in reducing infection rates.

C. Schedule nursing staff training for infection control procedures: Training is a critical part of reducing catheter-associated infections, especially if staff knowledge gaps are discovered. However, education should be informed by a needs assessment and data on what factors are contributing to the infections.

D. Revise the current policy for catheter care: Policy revision may be necessary if current guidelines are outdated or inadequate. However, revising policy prematurely, without understanding the source of the problem, may lead to unnecessary or ineffective changes.