....................14. Managing Client Care: Utilizing the Five Rights of Delegation
Right task
A. Identify what tasks are appropriate to delegate for
... [Show More] each specific client.
B. Delegate to appropriate team members (AP, LPN)
o RIGHT TASK: Delegate an AP to assist a client who has pneumonia to use a bedpan.
o WRONG TASK: Delegate an AP to administer a nebulizer treatment to a client who has pneumonia
Right circumstance
A. RIGHT CIRCUMSTANCE: Delegate an AP to measure the vital signs of a client who is postoperative and stable.
B. WRONG CIRCUMSTANCE: Delegate an AP to measure the vital signs of a client who is postoperative and
received naloxone to reverse respiratory depression.
Right person
A. The task must be within the team member’s scope of practice.
B. The team member must have the necessary competence/training.
C. Continually review the performance of the team member
o RIGHT PERSON: Delegate an PN to administer enteral feedings to a client who has a head injury.
o WRONG PERSON: Delegate an AP to administer enteral feedings to a client who has a head injury.
Right direction/communication
A. Communicate either in writing or orally.
B. Data that needs to be collected
C. Method and timeline for reporting, including when to report concerns/findings
D. Specific task(s) to be performed; client-specific instructions
E. Expected results, timelines, and expectations for follow-up communication
o RIGHT DIRECTION AND COMMUNICATION: Delegate an AP to assist Mr. Martin in room 312 with a shower
before 0900.
o WRONG DIRECTION AND COMMUNICATION: Delegate an AP to assist Mr. Martin in room 312 with
morning hygiene.
Right supervision/evaluation
A. The delegating nurse must:
o Provide supervision, either directly or indirectly (assigning supervision to another licensed nurse).
o Provide clear directions and expectations of the task to be performed (time frames, what to report).
o Monitor performance.
o Provide feedback.
o Intervene if necessary (unsafe clinical practice).
o Evaluate the client and determine if client outcomes were met.
o Evaluate client care tasks and identify needs for quality improvement activities and/or additional
resources.
§ RIGHT SUPERVISION: Delegate the ambulation of a client to an AP. Observe the AP to ensure safe ambulation of
the client, and provide positive feedback to the AP after completion of the task.
§ WRONG SUPERVISION: Delegate the ambulation of a client to an AP without supervision to determine the need
for intervention and failing to provide feedback to the AP.
15. Managing Client Care: Providing Cost-Effective Care
Cost - effective
A. Strategies that achieve optimal results in relation to the money spent to achieve those results. In other
words, cost-effective means “getting your money’s worth.”
o Example: Spending increased money on staff training for transmission-based precautions resulting in the
increased and effective use of PPE for client care. These actions have the result of a decrease in infection
transmission and an overall savings in the cost of caring for clients who would have acquired these infections.
COST - EFFECTIVE CARE STRATEGIES
A. Providing clients with needed education to decrease or eliminate future medical costs associated with future
complications.
o Example: Teaching a client who has a new diagnosis of diabetes mellitus how to adjust the dosage of
insulin depending on activity level reducing the risk of hypoglycemia resulting in the need for medical care.
B. Promoting the use of evidence-based care resulting in improved client care outcomes.
o Example: Implementing the use of evidence-based techniques to care for clients who have indwelling
catheters resulting in a decreased incidence of catheter-acquired urinary tract infections.
C. Promoting cost-effective resource management.
o Example: Using all levels of personnel to their fullest when making assignments. Delegating effectively to
members of the nursing care team.
o Example: Providing necessary equipment and properly charging clients.
o Example: Returning uncontaminated, unused equipment to the appropriate department for credit.
o Example: Using equipment properly to prevent wastage.
o Example: Providing training to staff unfamiliar with equipment.
o Example: Returning equipment (IV pumps) to the proper department (central service, central distribution)
as soon as it is no longer needed. This action will prevent further cost to clients.
D. Patient should not be compromised quality of care ****
16. Managing Client Care: Delegating to an Assistive Personnel
17. Managing Client Care: Delegating Tasks to an Assistive Personnel
18. Managing Client Care: Delegating a Task to a Float Nurse
A. Make sure nurse has the knowledge/skill to complete task
B. Negotiate new assignment w/ charge nurse
19. Managing Client Care: Steps of the Delegation Process
20. Managing Client Care: Tasks to delegate to an Assistive Personnel
21. Managing Client Care: Delegating care to an Assistive Personnel
22. Cultural and Spiritual Nursing Care: Working with an Interpreter
23. Infection Control: Caring for a Client Who Has Clostridium Difficile
A. Contract precautions
B. Wash hands with soap and warm water, don’t use gel
C. Clean equipment with bleach
D. Water soluble, yellow bag for disposing
24. Care of Specific Populations: Priority Action for Family in Grieving
A. Assess risk for suicide
B. Stay with family
C. Allow to express feeling/ allow time to grief
D. Provide extra hard (resources – therapy)
E. Assess coping mechanism/social support
F. GRIEF COUNSELING
25. Managing Client Care: Strategies for Conflict Resolution
CONFLICT RESOLUTION STRATEGIES PROBLEM-SOLVING
Actions nurses can take to promote open communication and de - escalate conflicts
A. Use “I” statements, and remember to focus on the problem, not on personal differences.
B. Move a conflict that is escalating to a private location or postpone the discussion until a later time to give
everyone a chance to regain control of their emotions.
NEGOTIATION
· Each party agrees to give up something
Example
· One nurse offers to care for Client A today if the other will care for Client B tomorrow.
Strategy: Avoiding/Withdrawing
· Both parties know there is a conflict, but they refuse to face it or work toward a resolution.
· Can be appropriate for minor conflicts or when one party holds more power than the other party or if the
issue can work itself out over time.
Strategy: Smoothing
· One party attempts to “smooth” another party by trying to satisfy the other party.
· Often used to preserve or maintain a peaceful work environment.
Strategy: Competing/Coercing = throwing people under the bus
· One party pursues a desired solution at the expense of others.
· Managers can use this when a quick or unpopular decision must be made.
· The party who loses something can experience anger, aggravation, and a desire for retribution.
Strategy: Cooperating/ Accommodating
· One party sacrifices something, allowing the other party to get what it wants. This is the opposite of
competing.
· The original problem might not actually be resolved.
· Can contribute to future conflict.
Strategy: Compromising/Negotiating
· Each party gives up something.
· To consider this a win/lose-win/lose solution, both parties must give up something equally important. If one
party gives up more than the other, it can become a win-lose solution.
Strategy: Collaborating
· Both parties set aside their original individual goals work together to achieve a new common goal.
· Requires mutual respect, positive communication, and shared decision-making between parties.
26. Coordinating Client Care: Information to Include in Change-of-shift Report
A. Code status
B. Allergies
C. Current medications
o When the next ones are due
o Are they on pain medication?
D. Pertinent labs
E. Current condition/status of patient
F. IV fluids/rate
G. Any change in care needed
H. Any wounds/dressings
I. Previous assessment
J. Abnormal findings
K. If they are going to surgery or a procedure
L. If they need blood sugar checked
M. Diet (NPO?)
N. Activity level
O. Plan of care
P. BLOOD LOSS*
27. Gastrointestinal Therapeutic Procedures: Priority Findings Following a Colostomy
A. If the stoma appears black or purple in color , this indicates a serious impairment of blood flow and requires
immediate interventionà EMERGENCY
NURSING ACTIONS
· Assess the type and fit of the ostomy appliance. Monitor for leakage (risk to skin integrity).
· Assess peristomal skin integrity and appearance of the stoma. The stoma should appear pink and moist.
· Evaluate stoma output. Output should be more liquid and more acidic the closer the ostomy is to the
proximal small intestine.
· Empty the ostomy bag when it is ¼ to ½ f full of drainage.
· Assess for fluid and electrolyte imbalances, particularly with a new ileostomy.
· Evaluate ability of the client or support person to perform ostomy care.
Stomal ischemia/necrosis
· Stomal appearance should normally be pink or red and moist.
· Signs of stomal ischemia are pale pink or bluish purple color and dry appearance. [Show Less]