Part I: Post your scores and decisions on the four tasks for delegation from the power point slide patient following the instructions in the power point Include any comments as instructed. DO NOT COPY OR EMBED GRID INTO MODULE POSTING. Your mentor may ask you to send a copy of your working grid if they do not understand/agree with your decisions.
Part II: Using the short scenario below, answer the questions that follow in paragraph format. Use the readings on communication and delegation for context and citations, and the NCSBN-ANA Delegation Decision Tree as directed. Must have minimum of 2-3 in text citations that follow APA format.
A young nurse working on a med/surg unit has just received a new admission from the emergency room. The patient is a 60-year-old male with COPD just admitted with an exacerbation of COPD. The quick assessment revealed that he has a slight increase in his work of breathing and mild expiratory wheezes. He is anxious and frequently asking to be repositioned and wants the head of the bed elevated at all times. He is wet from being incontinent of urine while on the ER stretcher and needs vital signs in addition to being cleaned up.
The nurse speaks to the UAP and asks that he obtain vital signs, clean the patient, and remove the wet sheets from underneath the him. His response is “ok, no problem”. About 20 minutes later the nurse realizes that the UAP has not brought them the vital signs, but when looking at the computer, sees that they have been entered. The charted vital signs are BP 150/80, HR 120, RR 20, and PO Sat 90%. The nurse is concerned that the UAP did not report the elevated HR and decreased PO Saturation and is not convinced that the documented respiratory rate is correct.
One – Two Paragraphs:
1. Using Step two in the NCSBN-ANA Decision-Making Tree (Communication) as your guide to address below
a. Describe your perception of the effectiveness of the communication between the nurse and the UAP
b. Identify the primary limitation with the way the request was communicated (delegated) to the UAP and acknowledge (received) by the UAP
The nurse goes to the patient’s room and finds the UAP changing the sheets with the patient on their side and the head of the bed down. The patient is in moderate distress. After settling the patient and stabilizing him, the nurse needs to re-evaluate their decision to delegate this task.
2. Review the information in Step one of the Decision-Making Tree (Assessment and Planning) and using the information from that section and the textbook readings, identify and discuss the mistakes the nurse made in delegating this task to the UAP (identify and discuss at least 2 mistakes). Include specific information from the case study to support your choices.
Joint Statement on Delegation American Nurses Association (ANA) and the National Council of State Boards of Nursing (NCSBN)
Appendix B National Council of State Boards of Nursing Decision Tree for Delegation to Nursing Assistive Personnel Step One – Assessment and Planning
Do not delegate NO
Is the task within the scope of the delegating nurse?
Is the delegating nurse competent to make delegation decisions?
Has there been assessment of the client needs?
NO
NO
NO
If not in the licensed nurse’s scope of practice, then cannot delegate to the nursing assistive personnel (NAP). Authority to delegate varies; so licensed nurses must check the jurisdiction’s statutes and regulations.
Do not delegate
Assess client needs and then proceed to a consideration of delegation
Do not delegate until can provide and document additional education, then reconsider delegation; otherwise do not delegate
YES
YES
YES
NO
YES Is the task consistent with the recommended criteria for delegation to nursing assistive personnel (NAP)? Must meet all the following criteria:
Is within the NAP range of functions Frequently recurs in the daily care of a client or group of
clients; Is performed according to an established sequence of
steps; Involves little or no modification from one client-care
situation to another; May be performed with a predictable outcome; Does not inherently involve ongoing assessment,
interpretation, or decision-making which cannot be logically separated from the procedure(s) itself; and
Does not endanger a client’s life or well-being
Are there laws and rules in place that support the delegation?
Do not delegate until evidence of education and validation of competency available, then reconsider delegations; otherwise do not delegate
YES Does the nursing assistive personnel have the appropriate knowledge, skills and abilities (KSA) to accept the delegation? Does the ability of the NAP match the care needs of the client?
NO
YES
ANA • 8515 Georgia Avenue, Suite 400 • Silver Spring Maryland 20910-3492 • 301.628.6500 • Fax 301.628.5001 • www.nursingworld.org NCSBN • 111 E. Wacker Drive, Suite 2900 • Chicago, Illinois 60601-4277 • 312.525.3600 • Fax 301.279.1032 • www.ncsbn.org
Joint Statement on Delegation American Nurses Association (ANA) and the National Council of State Boards of Nursing (NCSBN)
Do not delegate NO
NO Are there agency policies, procedures and/or protocols in place for this task/activity?
Is appropriate supervision available?
Do not proceed without evaluation of need for policy, procedures and/or protocol or determination that it is in the best interest of the client to proceed to delegation. YES
Proceed with delegation*
YES
Step Two – Communication Communication must be a two-way process The nurse: Assesses the assistant’s understanding
o How the task is to be accomplished o When and what information is to be reported,
including Expected observations to report and record Specific client concerns that would require prompt reporting.
Individualizes for the nursing assistive personnel and client situation
Addresses any unique client requirements and characteristics, and clear expectations of:
Assesses the assistant’s understanding of expectations, providing clarification if needed.
Communicates his or her willingness and availability to guide and support assistant.
Assures appropriate accountability by verifying that the receiving person accepts the delegation and accompanying responsibility
The nursing assistive personnel Ask questions regarding the
delegation and seek clarification of expectations if needed
Inform the nurse if the assistant has not done a task/function/activity before, or has only done infrequently
Ask for additional training or supervision
Affirm understanding of expectations Determine the communication
method between the nurse and the assistive personnel
Determine the communication and plan of action in emergency situations.
Documentation: Timely, complete and accurate documentation of provided care Facilitates
communication with other members of the healthcare team
Records the nursing care provided.
ANA • 8515 Georgia Avenue, Suite 400 • Silver Spring Maryland 20910-3492 • 301.628.6500 • Fax 301.628.5001 • www.nursingworld.org NCSBN • 111 E. Wacker Drive, Suite 2900 • Chicago, Illinois 60601-4277 • 312.525.3600 • Fax 301.279.1032 • www.ncsbn.org
Joint Statement on Delegation American Nurses Association (ANA) and the National Council of State Boards of Nursing (NCSBN)
Step Three – Surveillance and Supervision The purpose of surveillance and monitoring is related to nurse’s responsibility for client care within the context of a client population. The nurse supervises the delegation by monitoring the performance of the task or function and assures compliance with standards of practice, policies and procedures. Frequency, level and nature of monitoring vary with needs of client and experience of assistant. The nurse considers the: Client’s health care status
and stability of condition Predictability of
responses and risks Setting where care occurs Availability of resources
and support infrastructure. Complexity of the task
being performed.
The nurse determines: The frequency of onsite
supervision and assessment based on: o Needs of the client o Complexity of the
delegated function/task/activity
o Proximity of nurse’s location
The nurse is responsible for: Timely intervening and follow-up on problems and
concerns. Examples of the need for intervening include: Alertness to subtle signs and symptoms (which allows
nurse and assistant to be proactive, before a client’s condition deteriorates significantly).
Awareness of assistant’s difficulties in completing delegated activities.
Providing adequate follow-up to problems and/or changing situations is a critical aspect of delegation.
Step Four – Evaluation and Feedback
Evaluation is often the forgotten step in delegation. In considering the effectiveness of delegation, the nurse addresses the following questions: Was the delegation successful?
o Was the task/function/activity performed correctly? o Was the client’s desired and/or expected outcome achieved? o Was the outcome optimal, satisfactory or unsatisfactory? o Was communication timely and effective? o What went well; what was challenging? o Were there any problems or concerns; if so, how were they addressed?
Is there a better way to meet the client need? Is there a need to adjust the overall plan of care, or should this approach be continued? Were there any “learning moments” for the assistant and/or the nurse? Was appropriate feedback provided to the assistant regarding the performance of the delegation? Was the assistant acknowledged for accomplishing the task/activity/function?
ANA • 8515 Georgia Avenue, Suite 400 • Silver Spring Maryland 20910-3492 • 301.628.6500 • Fax 301.628.5001 • www.nursingworld.org NCSBN • 111 E. Wacker Drive, Suite 2900 • Chicago, Illinois 60601-4277 • 312.525.3600 • Fax 301.279.1032 • www.ncsbn.org
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Delegation Decision-making Grid
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Described activity/task: |
Task 1 AM Vital signs |
Task 2 AM Care |
Task 3 OOB to chair |
Task 4 FS BS |
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Level of Client Stability |
Score the client’s level of stability: 0. client condition is chronic/stable/predictable 1. client condition has minimal potential for change 2. client condition has moderate potential for change 3. client condition is unstable/acute/strong potential for change |
2 |
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Level of UAP Competence |
Score the UAP competence in completing delegated nursing care activities in the defined client population: 0. UAP – expert in activities to be delegated, in defined population 1. UAP – experienced in activities to be delegated, in defined population 2. UAP – experienced in activities but not in defined population 3. UAP – novice in performing activities and in defined population |
0 |
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Level of Licensed Nurse Competence |
Score the licensed nurse’s competence in relation to both knowledge of providing nursing care to a defined population and competence in implementation of the delegation process: 0. Expert in the knowledge of nursing needs/activities of defined client population and expert in the delegation process 1. Either expert in knowledge of needs/activities of defined client population and competent in delegation or experienced in the needs/activities of defined client population and expert in the delegation process 2. Experienced in the knowledge of needs/activities of defined client population and competent in the delegation process 3. Either experienced in the knowledge of needs/activities of defined client population or competent in the delegation process 4. Experienced in knowledge of defined population but novice in delegation 5. Novice in the knowledge of defined population and novice in delegation |
4 |
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Potential for Harm |
Score the potential level of risk the nursing care activity has for the client ( risk is probability of suffering harm): 0. None 1. Low 2. Medium 3. High |
1 |
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Frequency |
Score based on how often the UAP has performed the specific nursing care activity: 0. Performed at least daily 1. Performed at least weekly 2. Performed at least monthly 3. Performed less then monthly 4. Never performed |
0 |
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Level of Decision-making |
Score the decision-making needed, related to the specific nursing care activity, client (both cognitive and physical status) and client situation: 0. Does not require decision making 1. Minimal level of decision making 2. Moderate level of decision making 3. High level of decision making |
1 |
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Ability for Self-Care |
Score the client’s level of assistance needed for self-care activities: 0. No assistance 1. Limited assistance 2. Extensive assistance 3. Total care or constant attendance |
0 |
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TOTAL |
8 |
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Decision to delegate: Yes or No |
Yes |
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Task 1: VS |
Total score is 8 (slightly high score is due to nurse being a novice in delegation. Decision: will delegate this task to UAP, but will provide direction that UAP should notify RN immediately if any vital signs are abnormal, specifically BP less than 100 systolic or HR greater than 90 |
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Task 2: AM care |
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Task 3: OOB to chair |
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Task 4: FS BS |