NCLEX®: Understanding the Management of Care Category

October 1

Debra S. McDonough

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The content of the NCLEX®-RN Test Plan is organized into four major client needs categories. Two categories are divided into subcategories. So you basically have eight client needs categories. Based on a practice analysis process, NCSBN develops the percentage range that each category will appear on your NCLEX® exam. Then related content is provided.

But NOTE: NCSBN says “Related content includes but is not limited to…

Safe and Effective Care Environment

Management of Care: 17-23% Safety and Infection Control: 9-15%

Health Promotion and Maintenance: 6-12%

Psychosocial Integrity: 6-12%

Physiological Integrity

Basic Care and Comfort: 6-12% Pharmacological and Parenteral Therapies: 12-18% Reduction of Risk Potential: 9-15% Physiological Adaptation:11-17%

NCSBN (2015, p. 3).

Did you notice that the management of care subcategory has the highest percentage range for NCLEX® test questions to be served upon your exam? So what exactly is the management of care? NCSBN defines the management of care as “providing and directing nursing care that enhances the care delivery setting to protect clients and health care personnel” (NCSBN, 2013, p. 10). The primary nursing responsibilities covered under the management of care include:

  • Advance Directives
  • Advocacy
  • Assignment, Delegation, and Supervision
  • Case Management
  • Client Rights
  • Collaboration with Interdisciplinary Team
  • Concepts of Management
  • Confidentiality
  • Continuity of Care
  • Establishing Priorities
  • Ethical Practices
  • Informed Consent
  • Information Technology
  • Legal Rights & Responsibilities
  • Performance Improvement
  • Referrals

How can you make certain you know this information without a doubt and without hesitation? First, download the NCLEX®-RN Detailed Test Plan - Candidate Version. Then look at the related content for the management of care subcategory. Write them down in a notebook and then look up the correct answers. You might want to make flashcards. Use this as a study guide throughout nursing school and when preparing for your NCLEX® exam.

Example

Advance Directives. Here are the statements included under the advance directives content:

  1. Assess client and/or staff member knowledge of advance directives (e.g., living will, health care proxy, Durable Power of Attorney for Health Care [DPAHC]).
  2. Integrate advance directives into the client plan of care.
  3. Provide clients with information about advance directives (NCSBN, 2013, p. 11).

Look at the first statement. What do we know about advance directives?

  1. Assess client and/or staff member knowledge of advance directives (e.g., living will, health care proxy, Durable Power of Attorney for Health Care [DPAHC]).

A living will – Also called a directive to physicians or advance directive, is a document that lets people state their wishes for end-of-life medical care, in case they become unable to communicate their decisions. It has no power after death (Randolph, 2015).

Health care proxy – Sometimes called a "health care surrogate" or "durable medical power of attorney," is a durable power of attorney specifically designed to cover medical treatment. The client appoints a person and grants the authority to make medical decisions in the event the client is unable to express preferences about medical treatment. Most commonly, this situation occurs either because the client is unconscious or because the client’s mental state is such that the client does not have the legal capacity to make decisions (American Bar Association, 2015).

Durable Power of Attorney for Health Care – Active when the person granting the authority becomes unable to make decisions or becomes incompetent. This document allows a person to appoint an agent to make health care decisions when the person becomes unable to do so. A person must be at least 18 years old and must know what the durable health care power of attorney is, what directives are in the power of attorney, and what it does, in order to create one (American Bar Association, 2015). How can you assess a client’s knowledge of advance directives?

Start by asking the client if an advance directive has been made out. If the answer is no, then ask the client what he or she knows about advance directives. Based on what the client already knows will determine what the nurse will teach the client. Explain the definition of each term that is part of advance directives. Discuss the purpose and advantages of having an advance directive. Provide written information that further explains advance directives (after making sure of reading ability and reading level). Allow time for the client to ask questions. Provide referral for clients who are interested in having an advance directive.

Have a community educational session on advance directives. This will provide a time and location for those interested in knowing more about this topic to attend. Time could be allotted for completing advance directive forms as well.

How can you assess a staff member’s knowledge of advance directives?

Ask staff to discuss their understanding of advance directives. Provide an in-service or continuing education session. Evaluate knowledge with a pre and post-test. Nurse Managers can audit charts for advance directives or nursing notes acknowledging a discussion of advance directives.

Conclusion

By following this process throughout your nursing program, you will be focusing on key areas that NCSBN sees as important areas for the brand new nurse to have knowledge and competence. Now you are ready to go through each of the other areas of the management of care category.

References

American Bar Association (2015). Living Wills, Health Care Proxies, & Advance Health Care Directives. Retrieved from http://www.americanbar.org/groups/real_property_trust_estate/resources/estate_planning/living_wills_health_care_proxies_advance_health_care_directives.html

National Council of State Boards of Nursing, Inc. (2013). 2013 NCLEX-RN® Detailed Test Plan - Candidate Version. Chicago: Author.

Randolph, M. (2015). What is a living will? Retrieved from http://www.alllaw.com/articles/wills_and_trusts/article7.asp

December 21

Debra S. McDonough, RN, MSN, EdD