Bukidnon State University Bukidnon State University
College of Nursing College of Nursing Malaybalay City, Bukidnon Malaybalay City, Bukidnon
In Partial Fulfillment In Partial Fulfillment
of the Reuirements for the Course of the Reuirements for the Course
NCM !"#$B NCM !"#$B
Nursing %eadershi& and Management Nursing %eadershi& and Management
' Case Study on( ' Case Study on(
PROFESSIONAL DEVELOPMENT PROFESSIONAL DEVELOPMENT Improper Delegation Improper Delegation Submitted by: Submitted by: 'uguis, Fe 'uguis, Fe
Cagulada, %harra Mae Cagulada, %harra Mae
Casite, Nielmark Casite, Nielmark )oydora, Ma* +usette )oydora, Ma* +usette
ome-, .unfelm ome-, .unfelm /omamoy, Fran0es .oy /omamoy, Fran0es .oy
Palado, Mar0her Palado, Mar0her Robosa, .oshua Robosa, .oshua Santillan, Cheerille Santillan, Cheerille 1elin, Marvin 1elin, Marvin 1o
1ortola, rtola, %o2eelyn%o2eelyn 1orayno, Imelda 1orayno, Imelda 3illamor, Ra0helle 3illamor, Ra0helle Submitted to: Submitted to: )r* 3ioleta B* .uan )r* 3ioleta B* .uan
TABLE OF CONTENTS TABLE OF CONTENTS
II.. IINNTTRROODDUUCCTTIIOONN a*
a* 4b54b5e0te0tiveives6Ss6Stattatemeement ont of tf the Phe Probroblemlem b*
b* 1heoreti0al Frame2ork 1heoreti0al Frame2ork 0*
0* SiSigngnififi0i0an0an0e oe of tf the he StStudyudy d*
d* )ef)efininititioion on of 1f 1eermrmss II.
II. REVIEW REVIEW OF OF RELATED RELATED LITERATURELITERATURE III. CASE
III. CASE
IV.
IV. PROBLEMS PROBLEMS IDENTIFIED IDENTIFIED AND AND NURSING NURSING CARE CARE PLANPLAN
V
V. . SUMMARYSUMMARY, , EVEVAALUATLUATION, ION, AND AND RECOMMENDATRECOMMENDATIONION
VI. APPENDICES
TABLE OF CONTENTS TABLE OF CONTENTS
II.. IINNTTRROODDUUCCTTIIOONN a*
a* 4b54b5e0te0tiveives6Ss6Stattatemeement ont of tf the Phe Probroblemlem b*
b* 1heoreti0al Frame2ork 1heoreti0al Frame2ork 0*
0* SiSigngnififi0i0an0an0e oe of tf the he StStudyudy d*
d* )ef)efininititioion on of 1f 1eermrmss II.
II. REVIEW REVIEW OF OF RELATED RELATED LITERATURELITERATURE III. CASE
III. CASE
IV.
IV. PROBLEMS PROBLEMS IDENTIFIED IDENTIFIED AND AND NURSING NURSING CARE CARE PLANPLAN
V
V. . SUMMARYSUMMARY, , EVEVAALUATLUATION, ION, AND AND RECOMMENDATRECOMMENDATIONION
VI. APPENDICES
II.. IINNTTRROODDUUCCTTIIOONN
' 0hanging health 0are environment is im&a0ting on the role of &ra0ti0e nurses* 's a result of ' 0hanging health 0are environment is im&a0ting on the role of &ra0ti0e nurses* 's a result of fundamental 0hanges taking &la0e in both health 0are and nurse edu0ation, the 0lini0al role of the fundamental 0hanges taking &la0e in both health 0are and nurse edu0ation, the 0lini0al role of the &ra0ti0e
&ra0ti0e nurse nurse 2ill 2ill need need to to e7tend e7tend and and e7&and e7&and 8Pa7ton 8Pa7ton et et al al !99:;* !99:;* Ne2 Ne2 kno2ledge kno2ledge and and skillsskills 2ill be a ne0essity* In the future, one of the greatest 0hallenges to &ra0ti0e nurses 2ill be the 2ill be a ne0essity* In the future, one of the greatest 0hallenges to &ra0ti0e nurses 2ill be the attainment, maintenan0e and advan0e
attainment, maintenan0e and advan0ement of their &rofessional develo&ment*ment of their &rofessional develo&ment* 1h
1he e imim&o&ortrtanan0e 0e of of 0o0ontntininuiuing ng &r&rofofesessisionaonal l devdevelelo&mo&ment ent 8C8CP)P); ; fofor r nunursrses es hahas s beebeenn in0reasingly em&hasi-ed in the &ast fe2 years* 'n Bord 'ltranais, in its Revie2 of S0o&e of 1he in0reasingly em&hasi-ed in the &ast fe2 years* 'n Bord 'ltranais, in its Revie2 of S0o&e of 1he Commission on Nursing, sa2 the need to develo& and strengthen the availability of &rofessional Commission on Nursing, sa2 the need to develo& and strengthen the availability of &rofessional dev
develo&elo&menment t for all for all nurnurses ses and and sugsuggesgested ted thathat t it it migmight ht be be helhel&fu&ful l to to 0ons0onsideider r 0on0ontintinuinuingg &rofessional
&rofessional develo&ment develo&ment three three broad broad headings( headings( in in servi0e servi0e training, training, 0ontinuing 0ontinuing edu0ation edu0ation andand s&e
s&e0ia0ialilist st tratrainiining ng 8Co8Commimmissission on on on NurNursinsing, g, !99<!99<;*CP;*CP) ) has has beebeen n shosho2n 2n to to im&im&rovrove e 5ob5ob &erforman0e,
&erforman0e, uality uality of of 0are, 0are, organi-ational organi-ational &erforman0e &erforman0e and and servi0e servi0e delivery delivery a0rossa0ross em&loyment se0tors 2ith 0onseuential redu0tion in 0osts*
em&loyment se0tors 2ith 0onseuential redu0tion in 0osts*
Continuing Prof!!ion"# D$#o%&nt'Dfinition! Continuing Prof!!ion"# D$#o%&nt'Dfinition!
1he
1he NatNationional al CounCoun0il 0il for for the the ProProfesfessiosional nal )ev)eveloelo&me&ment nt of of NurNursinsing g and and MidMid2if2iferyery 8="">; defines CP) as( a lifelong &ro0ess, 2hi0h in0ludes both stru0tured and informal a0tivities 8="">; defines CP) as( a lifelong &ro0ess, 2hi0h in0ludes both stru0tured and informal a0tivities that may in0lude formal edu0ational &rogrammes* 1his definition is in kee&ing 2ith an earlier that may in0lude formal edu0ational &rogrammes* 1his definition is in kee&ing 2ith an earlier one
one &ro&rovidvided ed by by the the ?ngl?nglish ish NatNationional al BoarBoard d 8!98!99"; 9"; 2hi2hi0h 0h stastates tes 0ont0ontinuinuing ing &ro&rofesfessiosionalnal edu
edu0at0ation ion is is any any &os&ost$bt$basiasi0&r0&rofeofessissional onal edu0edu0atiation on 2hi2hi0h 0h is is dirdire0te0ted ed at at maimaintantainiining ng andand im&roving the uality of 0are &rovided to the &ubli0 8?NB !99" &* >;* 1here is a general im&roving the uality of 0are &rovided to the &ubli0 8?NB !99" &* >;* 1here is a general 0onsensus that 0ontinuing &rofessional develo&ment for &ra0ti0e nurses should be &ur&oseful, 0onsensus that 0ontinuing &rofessional develo&ment for &ra0ti0e nurses should be &ur&oseful, &atient
&atient 0entered 0entered and and edu0ational edu0ational effe0tive effe0tive 8.enkins$Clarke 8.enkins$Clarke and and Carr$/ill Carr$/ill =""!;* =""!;* Resour0eResour0e 0onstraints should not be used as an e70use for negle0ting 0ontinuing &rofessional develo&ment 0onstraints should not be used as an e70use for negle0ting 0ontinuing &rofessional develo&ment for this grou& of 0ommunity based nurses$ineualities bet2een &ra0ti0e nurses and other based for this grou& of 0ommunity based nurses$ineualities bet2een &ra0ti0e nurses and other based 0ommunity nurses should go and &arti0i&ation should be both en0ouraged and integrated*
Continuing Prof!!ion"# D$#o%&nt in Pr"(ti(
Nursing uality 0are reuires 0onsiderable kno2ledge and skills from its &ra0titioners* 1hrough time, 0hallenges in the health field 2ill 0ontinue to o00ur* 1he kno2ledge and skills needed by &ra0ti0e nurses 2ill also need to 0hange to meet the 0hallenges &osed by this 0hanging health 0are environment*
Continuing Prof!!ion"# D$#o%&nt (r"ting t) rig)t n$iron&nt
@em& 8="">; believes that &rofessional develo&ment o00urs 2here &rofessionals see their task in a ne2 light, 2ith the aim of maintaining or im&roving the uality of &rofessional &erforman0e* 1he vast ma5ority of &ra0ti0e nurses are 0ons0ientious about the art and s0ien0e of
nursing Ma0kereth 8!99A;, and have al2ays re0ogni-ed the im&ortan0e of CP) for the maintenan0e of u&$to$date &ra0ti0e, 2hile others may be less enthusiasti0*
Dngu *&orr)"gi( F$r
)engue hemorrhagi0 fever is a severe and sometimes fatal infe0tion that o00urs tro&i0al regions* It is most 0ommon in Southeast 'sia and the 2estern Pa0ifi0 islands* 1he dengue virus is transmitted by mosuitoes* ' more severe version of the infe0tion 0alled dengue hemorrhagi0 fever 0an involve signifi0ant bleeding and a dro& in blood &ressure that 0an 0ause sho0k and death* 1his 0ondition is sometimes kno2n as dengue sho0k syndrome*
)engue hemorrhagi0 fever 0an o00ur 2hen a &erson is bitten by a mosuito and e7&osed to blood infe0ted 2ith the dengue virus* 1hose 2ho are re&eatedly e7&osed to the dengue virus often e7&erien0e more a0ute sym&toms and are at risk for dengue hemorrhagi0 fever*
Peo&le at risk of 0ontra0ting the dengue virus in0lude &eo&le living in or traveling to Southeast 'sia, South and Central 'meri0a, Sub$Saharan 'fri0a, and &arts of the Caribbean* 1hese &atients are also at higher risk(infants and small 0hildren, the elderly, and those 2ith 0om&romised immune systems*
1he sym&toms of the dengue virus generally in0lude mild, moderate, or high fever, heada0hes, nausea, vomiting, &ain in the mus0les, bones, or 5oints, and rashes on the skin* In the 0ase of dengue hemorrhagi0 fever, other disturbing sym&toms 0an develo&* 1hese may in0lude(restlessness, a0ute fever, bleeding or bruising under the skin, and 0old or 0 lammy skin*
Phili&&ine /emorrhagi0 Fever 2as first re&orted in !9A>* In !9A<, hemorrhagi0 fever be0ame a notifiable disease in the 0ountry and 2as later re0lassified as )engue /emorrhagi0
Fever* 1he morbidity rate of dengue fever in =""> is mu0h lo2er at !> 0ases &er !",""" &o&ulation 0om&ared to the highest ever re0orded rate of :"*9 &er !"",""" in !99<* 1he 0ase fatality ratio for dengue fever and dengue hemorrhagi0 fever in =""> is also lo2er at "*< 0om&ared to the highest re0orded ratio of =*: in !99<*
' )engue /emorrhagi0 Fever &atient, having a lethal disease must be stri0tly 2at0hed for the signs and sym&toms as this 0ould turn to life$threatening situation*
1he &resenters being student nurses sought to kno2 and understand delegation, tasks that are not to be delegated, la2s relating to im&ro&er delegation in relation to the 0ase identified, and &rofessional develo&ment a0tivities to im&rove kno2ledge on delegation*
A. O+(ti$!- St"t&nt of t) Pro+#& General Objectives:
't the end of = hours of dis0ussion, the fa0ilitators 2ill be able to im&art kno2ledge to the &arti0i&ants that they 2ill be able to understand &ro&er delegation and a&&ly the nurse managers a0tions6interventions in their &rofessional develo&ment 2hen they be0ome future nurse staffs and nurse managers*
Specific Objectives:
't the end of = hours of dis0ussion,
1he fa0ilitators 2ill be able to dis0uss briefly delegation, tasks that are not to be delegated, and la2s relating to im&ro&er delegationD
1he fa0ilitators 2ill be able to dis0uss the 5ob des0ri&tions of the nurse staff, nurse manager, and nursing attendantD
1he fa0ilitators 2ill be able to &resent a 0ase study based on the fa0ilitators hos&ital e7&erien0e regarding delegationD
1he fa0ilitators 2ill be able to &resent a 0on0e&tual frame2ork based on the theory of @no2lesD
1he fa0ilitators 2ill be able to &resent a Nursing Care Plan for a 0riti0al &atient in the 0ase studyD
1he fa0ilitators 2ill be able to determine the Nurse Managers a0tions to be done 2ith the staff nurse 2ho im&ro&erly delegated the taskD
1he &arti0i&ants 2ill be able to understand and relate their o2n e7&erien0es to the 0ase studyD
1he Clini0al Instru0tors 2ill be able to &rovide additional information on delegation and &rofessional develo&ment*
B. T)orti("# Fr"&or/
0no#!1 A2u#t L"rning T)or3
@no2lesE 8!9#<; 'dult %earning 1heory 0laims
that adults learn differently from 0hildren* 1his differen0e
should be identified and addressed in &rofessional
develo&ment for health 0are 2orkers* @no2lesE 'dult
%earning 1heory is a&&li0able to the develo&ment
of learning o&&ortunities for registered nurses* @no2les labeled the differen0es in adult learning andragogy* 'ndragogy deals 2ith ho2 s0ien0e and art assist adult learners in a s&e0ial 2ay* 1he goal of edu0ators should be to guide adult learners to meeting their learning needs and rea0hing their goals*
1here are si7 basi0 assum&tions of andragogy 8@no2les, !9#<;* 1he first assum&tion is 0alled self$0on0e&t* 1his means that adults need to be self$dire0ted* 1he se0ond assum&tion addresses the issue of e7&erien0e* 'dults bring their &ast e7&erien0es to the learning environment* 1he third assum&tion is readiness to learn* 'dults are ready to learn 2hen they feel that they need to kno2 the information or 2hen they feel the in0rease in kno2ledge 2ill hel& them a00om&lish a task more effe0tively* 1he fourth assum&tion is orientation to learning* 's adults mature, they a&&ly kno2ledge learned immediately* 'dults learn based on an immediate &roblem or task, and this is related to the fifth assum&tionmotivation* 's adults mature, the motivation to learn be0omes intrinsi0* 1he si7th assum&tion is the need to learn* 1o be motivated, adults must kno2 the reason 2hy they should learn something* 1hese si7 assum&tions are essential to the 0reation of the milestone &ath2ay tool* 1hey drive the 0reation of the tool that hel&s fa0ilitate forming &rofessional develo&ment goals that are signifi0ant to the individual and s&e0ifi0 to the nursing unit* 1he tool en0ourages self$dire0tion and takes into a00ount e7&erien0e level* Understanding the assum&tions allo2s 0reation of a tool that is a&&ro&riate for adult learners*
T) fir!t "!!u&%tion i! ("##2 !#f'(on(%t. 1his means that adults need to be self$ dire0ted* 's a Registered nurse you need to think first the 2elfare of others before yourself* 1o gro2 &rofessionally this kind of attitude must be 2ithin you*
T) !(on2 "!!u&%tion "22r!!! t) i!!u of 4%rin(* 'dults bring their &ast e7&erien0es to the learning environment* If you are an e7&erien0ed nurse you already kno2 if ho2 to assess your &atients thoroughly* Gou kno2 2hat are the task need to done and need to be delegated* 's a RN you learn based on an immediate &roblem or task and you 2ill kno2 2hat to do* Gou already kno2 ho2 to 2eigh the situation to 2hat 2ill be &rioriti-e*
T) t)ir2 "!!u&%tion i! r"2in!! to #"rn. 'dults are ready to learn 2hen they feel that they need to kno2 the information or 2hen they feel the in0rease in kno2ledge 2ill hel&
PROFESSIONAL DEVELOPMENT 0NOWLES ADULT LEARNING T*EORY
5. S#f'
(on(%t
6. I!!u of
4%rin(
7. R"2in!!
8.
Orint"tion
to #"rning
9. Moti$"tion
them a00om&lish a task more effe0tively* For &rofessional develo&ment, nurses need to have 0ontinuing edu0ation to be u&dated and has an attitude to learn and a00e&t o&inions from others*
T) fourt) "!!u&%tion i! orint"tion to #"rning* 's adults mature, they a&&ly kno2ledge learned immediately* Hhen you are in this stage you 2ill a&&ly all your learningsfrom the ne2 u&dates that you learned*
T) fift) "!!u&%tion i! &oti$"tion. 's adults mature, the motivation to learn be0omes intrinsi0* Registered nurses must have the motivation for 0ontinuing &rofessional develo&ment as this 2ill hel& them enhan0e their kno2ledge, skills, and attitude to2ards nursing*
T) !i4t) "!!u&%tion i! t) n2 to #"rn. 1o be motivated, adults must kno2 the reason 2hy they should learn something* 1
1hese si7 assum&tions are essential to the 0reation of the milestone &ath2ay tool* 1hey drive the 0reation of the tool that hel&s fa0ilitate forming &rofessional develo&ment goals that are signifi0ant to the individual and s&e0ifi0 to the nursing unit* 1he tool en0ourages self$dire0tion and takes into a00ount e7&erien0e level* In order for you to be a 0om&etent nurse and to gro2 &rofessionally you should not sto& learning* Gou should have 0ontinuing edu0ation* 1o be more
effi0ient and effe0tive nurse, you should be u&dated to the ne2 trends and develo&ment in nursing &rofession so that you 0an &rovide uality 0are to your 0lients*
C. Signifi("n( of t) Stu23
1his study is signifi0ant to the follo2ing(
• St"ff Nur!! "n2 Nur!ing Attn2"nt!. 1he staff nurses and nursing attendants
2ill be &resented and u&dated regarding their roles and res&onsibilities as a nurse6nurse attendant, the tasks that are not to be delegated, and la2s relating to im&ro&er delegationD
• C)if Nur!!. 1he study 2ill &resent the Chief Nurse the a0tual s0enarios
observed by student nurses in the hos&ital, and 2ill be able to further 0ondu0t 0ontinuing &rofessional develo&ment a0tivities for the nurses and nurse attendants*
• D"n of Co##g of Nur!ing of Bu/i2non St"t Uni$r!it3. 1his study 0an be
used as a basis for &roviding training &rograms, 2orksho&s, and 0onferen0es regarding &rofessional develo&ment*
• Stu2nt Nur!! of Bu/i2non St"t Uni$r!it3' the students 2ill be able to kno2
2hat delegation is, the tasks that are not to be delegated, la2s relating to im&ro&er delegationD and also 2ill serve as a sour0e for further studiesD
• R!"r()r!. 1his study 2ill serve as a related literature to future resear0hers 2ho
2ould like to &ursue a similar study.
D. Dfinition of Tr&!
• D#g"tion is the assignment of res&onsibility or authority to another &erson to 0arry
out s&e0ifi0 a0tivities**
• I&%ro%r D#g"tionis the im&ro&er assignment of res&onsibility to another &erson
to 0arry out s&e0ifi0 a0tivities*
• Pri&"r3 ("r is the day$to$day health 0are given by a health 0are &rovider* 1y&i0ally
this &rovider a0ts as the first 0onta0t and &rin0i&al &oint of 0ontinuing 0are for &atients 2ithin a health 0are system, and 0oordinates other s&e0ialist 0are that the &atient may need*
• Nur!ing %ro(!! is a modified s0ientifi0 method* 1he nursing &ro0ess uses 0lini0al
5udgement to strike a balan0e of e&istemology bet2een &ersonal inter&retation and resear0h eviden0e in 2hi0h 0riti0al thinking may &lay a &art to 0ategori-e the 0lients issue and 0ourse of a0tion* Nursing offers diverse &atterns of kno2ing*
• *"2 nur!!0an 2ork in any variety of medi0al fa0ilities su0h as hos&itals, treatment
0enters or nursing homes* In general, they 2ork in larger fa0ilities 2here 0oordination of nursing teams is needed* /ead nurses 0arry out the same fun0tions as any other nurse, but they are in a managerial &osition and often are res&onsible for 2hole se0tions of fa0ilities as 2ell as 0ommuni0ation 2ith u&&er management and do0tors*
• St"ff Nur! evaluates assigned &atients and &lans, im&lements and do0uments
nursing 0are* 'ssists &hysi0ians during e7aminations and &ro0edures*
• Nur! %r"(titionr ;NP< is an advan0ed &ra0ti0e registered nurse 8'PRN; 2ho has
0om&leted advan0ed 0ourse2ork and 0lini0al edu0ation beyond that reuired of the generalist registered nurse 8RN; role*
• Nur!ing "i2sometimes 0alled a nursing assistant, assists medi0al staff in &roviding
0are for residents of long$term 0are fa0ilities, su0h as nursing homes, as 2ell as for short$term hos&ital &atients*
• An2r"gog3a s&e0ifi0 theoreti0al and &ra0ti0al a&&roa0h, based on a humanisti0
0on0e&tion of self$dire0ted and autonomous learners and tea0hers as fa0ilitators of learning*
• N2 to /no( 'dults need to kno2 the reason for learning something*
• Foun2"tion( ?7&erien0e 8in0luding error; &rovides the basis for learning a0tivities* • S#f'(on(%t= 'dults need to be res&onsible for their de0isions on edu0ationD
involvement in the &lanning and evaluation of their instru0tion*
• R"2in!!( 'dults are most interested in learning sub5e0ts having immediate
relevan0e to their 2ork and6or &ersonal lives*
• Orint"tion= 'dult learning is &roblem$0entered rather than 0ontent$oriented* • Moti$"tion= 'dults res&ond better to internal versus e7ternal motivators* • Err"n2 is an oral message entrusted to a &erson*
II. REVIEW OF RELATED LITERATURE
Nurses have authority to assign sele0ted a0tivities of 0are to other ualified and 0om&etent hel&ers 2hile &rote0ting the health, safety, and 2elfare of every &atient* Registered Nurses 8RNs; determine the tasks that 0an be delegatedD they rely on other assistive 0aregivers as a ne0essary 0om&onent of safe staffing* 4rgani-ations rely on assistive 2orkers to &rovide a 0ost$effe0tive skill mi7* 1hreats of nursing shortages, mandates for re&ortable uality out0omes, and data su&&orting greater RN &resen0e as im&roving nurse$sensitive measures have in0reased the urgen0y to ensure a&&ro&riate RN staffing in0lusive of effe0tive delegation*
)elegation unburdens the RN from unne0essary 2ork others 0an do, 2hile the RN retains a00ountability for 0are and out0omes* Hith in0reased 0om&le7ity of &atients, nurses in0reasingly must use 0riti0al thinking skills to evaluate the ty&e of 0are, 0ir0umstan0es, and 0om&eten0e of assistive 0aregivers &rior to delegation* )elegation remains an underdevelo&ed skill among nurses, and one that is diffi0ult to measure* It relies on &ersonality, 0ommuni0ation style, and 0oo&eration* 1he su00ess or failure of delegation de&ends on a &ositive t2o$2ay relationshi& of mutual res&e0t and trust bet2een the RN and the hel&er 2ho assumes res&onsibility for s&e0ifi0 tasks* 1his dynami0 e70hange bet2een the RN and the hel&er reuires 0onstant evaluation, feedba0k, and modifi0ation to a0hieve the results needed to meet &atient 0are goals*
1he si7 initial arti0les in this to&i0 address a variety of 0onsiderations that are im&ortant in su00essful delegation* 1hese 0onsiderations in0lude traditional and emerging thought about the 0ommon skills ne0essary for delegation and the uniue 0hallenges a0ross &ra0ti0e settings* ' number of 0ommon themes emerge in this to&i0* First is the im&ortan0e of understanding the legal authority to delegate to other ualified individuals* In the United States 8US; ea0h state issues its o2n definitions and regulations regarding delegation, 2hereas there is no legal definition of nursing in the United @ingdom 8U@;, making delegation even more 0hallenging* 'dditionally, in any &ra0ti0e setting, develo&ing trust is a fundamental reuirement for su00essful delegation* NursesE delegation skills develo& over time, building on 0riti0al thinking, and gro2ing from being un0omfortable delegating to others to being 0onfident in this delegation &ro0ess* Com&eten0e in delegation is as im&ortant for the nurse as are other 0ognitive or &sy0homotor skills* 1his 0om&eten0e reuires ongoing edu0ation and develo&ment* 1he
influen0e of delegation on uality and safety out0omes should not be underestimated* ro2ing so&histi0ation in our ability to measure nurse$sensitive out0omes 0reates an im&erative to assess the 0ontributions of all 2ho 0ontribute to 0are under the dire0tion of the RN*
Building delegation skills starts 2ith all nurses understanding the &rovisions of their nurse &ra0ti0e a0ts, and also understanding of the 0on0e&ts of res&onsibility, a00ountability, and
authority* In )evelo&ing )elegation Skills, Heydt 2alks the reader through the fundamental five rights of delegation as arti0ulated by the National Coun0il of State Boards of Nursing 8NCSBN;* 1hese in0lude the right taskD 0ir0umstan0eD &ersonD dire0tion and 0ommuni0ationD and su&ervision and evaluation* She &oints out t2o ma5or 2ays delegation o00urs, by sim&le task assignment based on 5ob des0ri&tions or mat0hing a staff memberEs e7&ertise to a &atientEs needs* Heydt stresses the need for( 8a; 0larity in delegation, 8b; ongoing develo&ment of delegation skills, 80; assuring that the &erson to 2hom a task is delegated is ualified to &erform the task, and 8d; assuring the RN retains final a00ountability*
'nthony and 3idal des0ribe ho2 the right 0ommuni0ation, one of the five rights of )elegation, influen0es effe0tive delegation* In Mindful Communication: A Novel Approach to Improving elegation and Increasing !atient Safety " they e7&lore mindfulE 0ommuni0ation 2hi0h reuires individuals to re0ogni-e the signifi0an0e of fa0ts and ho2 the fa0ts relate to a 0urrent &atient 0ondition or situation* S0enarios am&lify the relationshi& of delegation to safety and uality out0omes* Some of the tasks ty&i0ally delegated, for e7am&le turning, ambulating, &roviding &ersonal 0are, and6or glu0ose 0he0king, are dire0tly asso0iated 2ith nurse$sensitive
out0omes, su0h as &reventing 0om&li0ations and maintaining &hysiologi0 balan0e* 1he right 0ommuni0ation transmitted via timely and 0lear messages makes 0ommuni0ation meaningful* Refle0ting on the 0ommuni0ation 0on0e&ts of information de0ayE and information salien0y,E RNs must em&hasi-e to the assisting 0aregiver 2hat information is im&ortant and 0larify any information that 0an be inter&reted in more than one 2ay* .ust as 0ommuni0ation breakdo2n is res&onsible for sentinel events, it also has a signifi0ant effe0t on effe0tive delegation in our daily &ra0ti0e*
In elegation in the School Setting: Is it a Safe !ractice#, Resha &oints out that s0hool nurses are &roviding more 0are than ever before, 2ith limited numbers of &roviders* In many lo0ations the ratio of RN to students is five times the re0ommended ! to #A" 2ell students* Nurses are 0alled u&on to &erform health s0reenings, immuni-ations and re&orting, health
tea0hing, 0ase management, and management of medi0ally fragile 0hildren 2ith 0om&le7 needs, in0luding ventilators, &a0emakers, and insulin &um&s* Safe delegation 0an o00ur for some of these a0tivities if there is adeuate training of assistive &ersonnel and 0lose su&ervision* /o2ever, for s0hool nurses assigned to multi&le buildings and lo0ations, 0lose su&ervision is a myth* In some s0hools there is no su&&ort for a nurse hel&er* Hhen the RN is not &resent, other substitutes, for e7am&le administrators, tea0hers, and6or &arents, may ste& in to &rovide 0areD this &resents a risk to safe &atient 0are as 2ell as to the s0hool nurse* S0hool nursing &ra0ti0e in0ludes
&laying a role in develo&ment of s0hool &oli0ies, being 0om&etent in the five rights of delegation, edu0ating assistive &ersonnel, and building relationshi&s to ensure &ro&er delegation*
)elegation is a universal nursing skill* Hith the looming 2orld$2ide nursing shortage, any 0hange in skill mi7 2ill undoubtedly lead to an in0rease in the amount of delegation of 0ertain as&e0ts of 0are* In the U@ delegation is re0ogni-ed as an im&ortant skill at all levels of &ra0ti0e* illen and raffin des0ribe the authority, a00ountability, and res&onsibility for delegation in the U@, along 2ith fa0ilitators and barriers in their arti0le elegation in Nursing in the $nited %ingdom* Hith no legal definition of a nurse in the U@ it is im&erative that there be 0larity in &ro0edures for delegation as 2ell as 0larity bet2een the RN and /ealth Care 'ssistant* Many
delegation similarities e7ist bet2een the U@ and the US* In both 0ountries the RN retains a00ountability and res&onsibility for 0are, but the &erson 2ho a00e&ts the assigned 2ork also a00e&ts res&onsibility for &erforming the 2ork* '&&ro&riate delegation assumes that &rior to assignment of tasks, the RN uses 5udgment and demonstrates 0riti0al thinking to assess the skill, 0om&eten0e, attitude, and e7&erien0e of the hel&er, as 2ell as the &atient reuirements and nature of the 0ir0umstan0es* Building of trust, effe0tive 0ommuni0ation, and mutual su&&ort 0ontribute to su00ess in the US and the U@, and around the 2orld* 8)elegation )ilemmas( Standards and Skills for Pra0ti0e by( P"&#" F. Ci%ri"no, P)D, RN, NEA'BC, FAAND Retrieved February =J, ="!A;
1he .oint Commission on '00reditation of /ealth0are 4rgani-ations 8.C'/4; defines negligence as a Kfailure to use su0h 0are as a reasonably &rudent and 0areful &erson 2ould use under similar 0ir0umstan0es*K .C'/4 defines malpractice as Kim&ro&er or unethi0al 0ondu0t or unreasonable la0k of skill by a holder of a &rofessional or offi0ial &ositionD often a&&lied to &hysi0ians, dentists, la2yers, and &ubli0 offi0ers to denote negligent or unskillful &erforman0e of
duties 2hen &rofessional skills are obligatory* Mal&ra0ti0e is a 0ause of a0tion for 2hi0h damages are allo2ed*K Mal&ra0ti0e is defined variously under state nurse &ra0ti0e a0ts, institutional &oli0ies, and federal guidelines su0h as .C'/4 standards, all of 2hi0h ma y be taken into 0onsideration in 0ourt*
Several fa0tors have 0ontributed to the in0rease in the number of mal&ra0ti0e 0ases against nurses(
• D#g"tion. 's a result of 0ost$0ontainment efforts in hos&itals and /M4s, nurses are
delegating more of their tasks to unli0ensed assistive &ersonnel* )elegation of some of these tasks may be 0onsidered negligen0e a00ording to a given fa0ilitys standards of 0are or a states nurse &ra0ti0e a0t*
• E"r#3 2i!()"rg. Patients are being dis0harged from hos&itals at earlier stages of
re0overy and 2ith 0onditions reuiring more a0ute and intensive nursing 0are*Nurses may be sued for not &roviding 0are or not making referrals a&&ro&riate to the &atients 0ondition*
• T) nur!ing !)ort"g "n2 )o!%it"# 2on!i>ing have 0ontributed to greater
2orkloads for nurses, in0reasing the likelihood of error*
• A2$"n(! in t()no#og3 reuire nurses to have kno2ledge of a variety of
te0hnologies 0a&abilities, limitations, and safety features*
• In(r"!2 "utono&3 "n2 r!%on!i+i#it3 of )o!%it"# nur!! in the e7er0ise of
advan0ed nursing skills have also brought about greater risk of error and liability*
• Bttr'infor&2 (on!u&r! are more likely to be a2are of mal&ra0ti0e issues and to
re0ogni-e insuffi0ient or ina&&ro&riate 0are*
• E4%"n22 #g"# 2finition! of #i"+i#it3 have held all &rofessionals to higher
standards of a00ountability* For e7am&le, be0ause of the e7&anded s0o&e of &ra0ti0e of advan0ed &ra0ti0e nurses, 0ourts have held them to a medi0al standard of 0are*
Re&ubli0 '0t 9!#>, also kno2n as the Phili&&ine Nursing '0t of =""= states in 'rti0le :, Se0tion =< that it shall be the duty of the nurse to Lunderta&e nursing and health human resource development training and research" 'hich shall include" but not limited to" the development of advance nursing practice* Nurses really must 0ontinue &rofessional develo&ment in a00ord to the la2, in order to &rovide the best &ossible 0are to &atients*
IIII. CASE
Nurse + has been 2orking at Bukidnon /os&ital 2ith 0om&etitive servi0e of 0aring and love for &atients for almost five years* /e is 0urrently assigned as a 0harge nurse at the Pediatri0 Hard, su&ervising three nurses under his shift* 4ne fine day in the hos&ital, the ?R staff 2as e7tremely busy 0aring for urgent &atients arriving* ' male infant named B'BG 2as brought to the ?R by his mother 2ho is !J months old 2ith a high fever of J"*!C, and red &at0h rashes all over the body* 1he mother said that it 2as the :th day of his fever, he does not drink his milk, has
been having diarrhea, bleeding on gums, vomiting, e&ista7is, s2elling around the eyes, irritable 2ith a blood &ressure of <"6:" mm/g, &ulse &ressure of =" mm/g, PR$!J#b&m, RR$A!0&m*
Hhile in the ?R, after the admitting &hysi0ian e7amined the 0hild, he diagnosed him of having a )engue /emorrhagi0 Fever )egree III, the 0harge nurse 0arried out the order and asked the nursing attendant LCould you &lease start I3F on &t* B'BGO IEm very busy 0arrying out orders here* 1he nursing attendant did insert the I3 0annula but the first attem&t 2as unsu00essful* 'fter several times of reinsertion of the I3 0annula to the same vein, she finally 2as able to insert it* She left the 0hild and attended to ne7t &atients 2ithout informing the 0harge nurse regarding the several attem&ts of I3 0annula insertion* 'fter a 2hile, the mother 0om&lained to the nurses and said,( L/ey my babyEs hand is starting to s2ell and blood is 0oming out from his nails, but the nurses did not &ay mu0h attention not until the mother s0reamed for hel&* Suddenly, all staff gave their attention and transferred the &atient to the Pediatri0 Hard* 1he &atientEs mother told Nurse + about the situation that have ha&&ened at the ?R that her babyEs I3F 2as not infusing 2ell and that the site has be0ome s2ollen* 'fter a fe2 hours, lab results 2ere in and the CBC sho2ed thrombo0yto&enia 89","""mm>;* Nurse + kne2 that the &atient must be stri0tly 2at0hed for 0om&li0ations of )engue /emorrhagi0 Fever su0h as e7tensive bleeding, %4C and &leural effusion* /o2ever, the bedside nurse delegated the task to the nursing
attendant to dis0ontinue and reinsert a ne2 I3 0annula to another site be0ause she 2as busy attending other &atients and 0arrying out do0torEs orders*
V. SUMMARY, EVALUATION, AND RECOMMENDATION
't the ?mergen0y Hard, the nursing attendant inserted the I3 0annula but the first attem&t 2as unsu00essful* 'fter several times of reinsertion of the I3 0annula to the same vein, she finally 2as able to insert it* She left the 0hild and attended to ne7t &atients 2ithout informing the 0harge nurse regarding the several attem&ts of I3 0annula insertion* 't the Pediatri0 Hard, Nurse + kne2 that the &atient must be stri0tly 2at0hed for 0om&li0ations of )engue
/emorrhagi0 Fever su0h as e7tensive bleeding, %4C and &leural effusion* /o2ever, the nurse delegated the task to the nursing attendant to dis0ontinue and reinsert a ne2 I3 0annula to another site be0ause she 2as busy attending other &atients and 0arrying out do0torEs orders* 1he identified &roblem from the 0ase 2as( Non$0om&lian0e to hos&ital &roto0ol related to im&ro&er delegation* Inserting an I3 0annula is not in the 5ob des0ri&tion of a nursing attendant, therefore, the 0harge nurse, though she 2as busy 0arrying out the )o0tors 4rders, should not have delegated the task to the attendant* 4nly Registered Nurses 2ho are trained for I3F insertion 0an do the task*
(ecommendation:
's as&iring future nurse staffs and nurse managers, 2e re0ommend the follo2ing(
!* 1he hos&ital must &re0isely formulate a 0om&rehensive s0o&e of &ra0ti0e for the Registered Nurse and Nursing 'ttendants, in0luding the s&e0ifi0 tasks 2hi0h are delegable*
=* Registered Nurses must 0onsider the set of tasks he6she 2ould delegate, that fit 2ith the nursing assistantEs skill and are in a00ord to the hos&ital &roto0ols*
>* 'dvan0e %ife Su&&ort and kno2ledge u&dates through seminars on delegation*
'lthough it is 0ostly, these a0tivities 2ill hel& not 5ust the staff nurses but also the nurse managers to enhan0e their management skills*
=* Seminar on Phili&&ine Nursing '0t of =""=*
Re&ubli0 '0t 9!#> en0om&asses the S0o&e of Nursing Pra0ti0e on 'rti0le 3I* It must be &resented to all the Registered Nurses as 2ell to remind them of their legal tasks, and
ASSESSMENT NURSEING DIAGNOSIS
OB?ECTIVES INTERVENTION
Sub5e0tive data(
Lgamayrakaayoiyanggakaihi* a 2hole day nalangiyang dia&er,
gamayragyudangbasadayun nay
dugoga&angga2assaiyangtudlouglagus* as verbali-ed by the mother
4b5e0tive data(
• 1a0hy0ardia 8PR$!J#b&m; • 1a0hy&nea 8RR$A!0&m; • /y&otension 8<"6:" mm/g; • )e0reased urine out&ut • Bleeding on gums • )elayed 0lotting time
• 1hrombo0yto&enia Platelet 0ount Q
9","""mm> Dfi(int f#ui2 $o#u& r-t )&orr)"g Nursing 4ut0ome Classifi0ation 8?7&e0ted 4ut0omes; Short term( 't the end of >" minutes of several interventions, the &atientEs vital signs
2ill be stable and bleeding 2ill be
minimal*
%ong term(
't the end of fe2 hours of
interventions, the &atientEs &latelet
0ount 2ill im&rove*
In2%n2nt Nursing Intervention
Classifi0ations(
Bedside Nurse
!* 'sses initial vital signs
=* Monitor vital signs every !A$>"
minutes*
>* Put &ressure on the bleeding areas D%n2nt Nursing Intervention Classifi0ations( Medi0ation Nurse J* Start I3F PNSS ! % u&on do0torEs order* A* Blood transfusion 8&latelet; Charge Nurse :* Monitor &latelet 0ount together 2ith the med te0h* #* Refer the &t* to the
&hysi0ian* -t -r
ASSESSMENT PROBLEM OB?ECTIVES ACTION RATIONALE Sub5e0tive 0ues(
LCould you &lease start I3F on &t*
B'BGO IEm very busy 0arrying out orders here* 's verbali-ed by the 0harge nurse to
the nursing attendant*
4b5e0tive 0ues( 1he nursing attendant inserted the I3
0annula but the first attem&t 2as
unsu00essful* 'fter several times of reinsertion of the I3 0annula to the same vein, she finally 2as able to insert it* She left the 0hild and attended to ne7t &atients 2ithout
informing the 0harge nurse regarding the several attem&ts of I3 0annula insertion* I&%ro%r D#g"tion Nursing 4ut0ome Classifi0ations 8?7&e0ted 4ut0omes;
't the end of nurse managerEs a0tion, the staff nurse and
nursing attendant 2ill 0om&ly 2ith hos&ital &roto0ols*
!* Call the attention of the staffs on duty and the nursing attendant on that shift* =* /ave them make
in0ident re&ort* >* Revie2 to them the 0onseuen0es and san0tions of their a0tion* J* ?valuate their &revious &erforman0es 2hether they have 0ommitted the same a0tion on their &revious duties* A* )e0ide 2hether to give them a se0ond 0han0e or terminate them immediately* - 1o have them
e7&lain their side of the issue* - For do0umentation - 1o remind them of the hos&ital &roto0ols*
- So that the nurse
manager 2ill have her basis on her de0ision*
- 1o redu0e the risk
dragging the /os&italEs name on the 2rongful a0tions that the staff nurses 0ommits*
IV. PROBLEMS IDENTIFIED AND NURSING CARE PLAN
Dfinition= *YPERT*ERMIAthe body tem&erature rises above the normal range*
ASSESSMENT PROBLEM OB?ECTIVES ACTION RAT
Sub5e0tive 0ues(
L/e has been feverish for *3%rt)r&i" r#"t2
Nursing 4ut0ome Classifi0ations(
In2%n2nt Nursing Interventions
the &ast days* /e 0ries a lot, too as verbali-ed by the &atientEs mother*
4b5e0tive 0ues(
• /igh fever 81em&*
Q J"*!C; • Irritable • Cries a lot • /as no a&&etite • 1a0hy&nea • 1a0hy0ardia • Harm skin • Skin redness to t) %ro(!! of 2ngu $iru! inf(tion
8?7&e0ted 4ut0omes;
Short term(
1hat during >"mins$ !hour of nursing interventions, &atient 2ill e7&erien0e normothermia 2ith a tem&erature of >:$ >#C* %ong term(
't the end of our duty, &atient 2ill be able to
maintain a 0ore body tem&erature of >:$>#C even 2ithout R1C anti&yreti0* Classifi0ation( Charge Nurse( !*Carry$out )o0torEs orders
=* Make and follo2$u& laboratory results 8e*g HBC$ !A6% >*'ssess &ossible etiology of in0reased tem&erature Bedside Nurse( !* Provide6 en0ourage &atient to drink &lenty of fluid as tolerated 80olostrum; =*Instru0t the signifi0ant
other to let the &atient 2ear
0lothing that is thin and not the 0otton and silk ones*
Medi0ation Nurse( !*Inform &atient regarding the side effe0ts of the drugs to be administered
=*Considers the nursing &re0autions in drugs to be given
Nursing 'ide(
!*Monitor 36S every >"mins*
=*Provide and in0rease air 0ir0ulation
Bedside Nurse( !*Intake and out&ut
!*1o fa0ilitat of 0are =*1o determi regimen* 1o and other m >*1o monito 0auses of the 0ondition !*1o re&la0e eva& =*1o &rovide 0omfort and 0lothing abs does not sti in0rease in b !*1o edu0ate effe0ts and l =*1o &revent u&on admini Nursing 'id !*3ital signs determine th general 0on =* Serves as measure to l heat Bedside Nur !*)ete0ting dehydration balan0e of fl
every >hours on0e or more often* D%n2nt Nursing Interventions Classifi0ation( Nursing 'ide( !*'&&li0ation of 1e&id S&onge Bathe Remove e70ess
blankets 2hen the 0lient feels 2armD &rovide e7tra 2armth 2hen the 0lient feels 0hilled*
Medi0ation Nurse( !*'dminister anti&yreti0s as ordered* Para0etamol Syru& =*Am% PRN P4 ele0trolytes i !*1o enhan0 eva&oration =*Removing 0ooling mea &roviding of &romotes he !*1o lo2er d tem&erature*
ASSESSMENT PROBLEM OB?ECTIVES ACTION RATI
Sub5e0tive 0ues(
L1here 2as blood 0oming out from his gums sin0e this morning, as
verbali-ed by the &atientEs mother*
4b5e0tive 0ues(
• Bright red blood
on gums
• Pete0hiae • /as no a&&etite • Pale skin
• Pale nail beds • Ca&illary refill
less than =se0s
• 36S are as follo2s(BP$<"6:" Ri!/ for )&orr)"g r#"t2 to "#tr2 (#otting f"(tor Nursing 4ut0ome Classifi0ation( 'fter > hours of nursing interventions, the 0lient 2ill be able to demonstrate behaviors 2hi0h
redu0e the risk of bleeding*
In2%n2nt NIC(
Charge Nurse(
!*Carry$out )o0torEs orders =* Make and follo2$u&
laboratory results 8e*g Platelet Ct( 9","""mm>;
Bedside Nurse(
!* 'ssess the signs and sym&toms of I bleeding* Che0k for se0retions* 4bserve 0olor and 0onsisten0y of stools or vomitus*
=* 4bserve for &resen0e of &ete0hiae, e00hymosis, bleeding from one more
sites*
!*1o fa0ilitate 0 0are
=*1o determine regimen
!* !*1he I tra0t i sour0e of blee mu0osal fragil =*Sub$a0ute dis intravas0ular 0 develo& se0ond 0lotting fa0tor*
mm/g, &ulse &ressure of =" mm/g, PR$ !J#b&m, RR$ A!0&m Nursing 'ides(
>* Monitor vital signs hourly or more often*
Medi0ation Nurse(
J* Use small needles for in5e0tions* '&&ly &ressure to veni&un0ture sites for longer than usual*
Collaborative(
!* 'dministration of PNSS !% A"006hr as &er Physi0ianEs order
>*'n in0rease i de0rease BP 0a of 0ir0ulating b
J* Minimi-e da redu0e risk for hematoma*
!* 1o re&l 0an go transfu isotoni
VI. APPENDICES
Duti! "n2 R!%on!i+i#iti! of " *"2 Nur!=
/ead nurses 0an 2ork in any variety of medi0al fa0ilities su0h as hos&itals, treatment 0enters or nursing homes* In general, they 2ork in larger fa0ilities 2here 0oordination of nursing teams is needed* /ead nurses 0arry out the same fun0tions as any other nurse, but they are in a managerial &osition and often are res&onsible for 2hole se0tions of
fa0ilities as 2ell as 0ommuni0ation 2ith u&&er management and do0tors*
a* /ead nurses manage all the administrative duties of the de&artments 2hi0h theyare assigned to 2ork in
b* 1hey s0hedule shifts for the nurses and assign duties to them*
0* 1hey 0olle0t 2ork re&orts from all the nurses regarding their day$to$day a0tivitiesand maintain a re0ord of them*
d* 1hey &resent the re0ords 0olle0ted from all the nurses to the res&e0tive do0tors2ho are handling 0ases of those &atients*
e* 1hey assist and 0ondu0t training &rograms for the nurses 2ho are ne2 and need hel&* f* 1hey also solve any issues related to the &atients*
g* /ead nurses also 0ome in dire0t 0onta0t 2ith the &atients and diagnose their health &roblems
h* Inventory management is also one of the res&onsibilities of the head nurses*
i* /ead nurses revie2 and su&ervise the &re$o&erative settings made by the nurses in the o&erating room and make sure that they have &rovided reuired eui&mentEs to the do0tors*
5* /ead nurses often a00om&any the do0tors 2hen they go on their rounds to 0he0kthe &atients 2here they &resent the re&orts 0olle0ted by them*
k* 1hey &rovide ne0essary hel& to the do0tors su0h as 0arrying diagnosti0 eui&mentEs, et0*, to the do0tors 2hile they are on round for 0he0k$u&*
l* 1hey maintain a log of the entries of the &atients in their 2ards and their health re&orts* m* /ead nurses also look for the hygiene in the hos&ital and in the rooms and makesure that
the &atients are &rovided 2ith enough fa0ilities and entertain all ty&esof 0om&laints from the &atients*
Skills Reuired in a /ead Nurse(
a* ' head nurse should have e7&ert management, administration and &lanning skills*
b* 'bility to assist the nurses and manage the team &ro&erly by motivating theem&loyees to 2ork*
0* Should have good 0ommuni0ation skills to understand the &roblems and resolve them* d* In$de&th kno2ledge of all the &ro0edures used in the management of the hos&ital* e* Sound kno2ledge of the eui&mentEs used in the surgi0al &ro0ess*
f* 'bility to use various diagnosti0 methods in diagnosis and &rovide &rimarytreatment to the &atients in emergen0y*
g* ood &resentation skills to 0ondu0t training &rograms* h* ?nthusiasti0, enduring, and 2illing to 2ork for e7tra hours* i* Should be fo0used and 2illing to hel& the &atients*
5* Profound 2ritten skills and should have &rofi0ien0y in handling basi0 0om&uter&rograms used in hos&ital management*
?du0ational ualifi0ations Reuired in /ead Nurse(
". 1o be0ome a nurse one has to &urse a J year degree &rogram in nursing and should undergo training &rograms in the same*
+. 1here are various nursing &rograms that offer li0ensure for the nurses* Certified and li0ensed nurses are in great demand these days* /ead nurses should also have servi0ed as nurses for more than J$A years*
DUTIES @ RESPONSIBILITIES OF STAFF NURSE=
1he Staff Nurse is the first level &rofessional Nurse in the hos&ital set u&* 1herefore by a&&earan0e and by 2ord she 2ill be &rofessional at all time*
She 2ill be skilled nurse, giving e7&ert bed side 0are to &atient and e7e0uting s&e0ial te0hni0al duties in the s&e0ial areas like o&eration theatres, intensive 0are unit, highly de&endent unit et0* She also a0ts as de fa0toE sister as and 2hen situation arises in the 2ard or de&artment*
DUTIES @ RESPONSIBILITIES IN RELATION TO PATIENT CARE
a* She 2ill assess the needs of the &atients in the 2ard and make nursing 0are &lan for all &atients 0onsulting 2ith 2ard sister*
b* She 2ill give dire0t &atient 0are 8bed making, 0hanging of bed sheets, mouth 0are, ba0k 0are, bed bathing, hair 2ash, 0hanging of &osition et0*; and allotted 0are to her by the 2ard sister*
0* She 2ill fulfill all basi0 needs 8hygieni0 need, nutritional need et0*; of the &atients* d* She 2ill &rovide 0omfort to the &atient and maintain safety of the &atient*
e* She 2ill take over the 0harge from duty nurse of &revious shift, regarding &atients 8bed to bed;, instrument su&&lies, drugs et0* and handed over the same to the ne7t shift*
R?SP4NSIBI%I1G IN R?%'1I4N 14 H'R) ')MINIS1R'1I4N a* She 2ill ensure to make the 2ard 0lean and tidy in0luding bed*
b* She 2ill kee& all arti0les 2ell$arranged and maintain the inventory*
0* She 2ill take the re&ort, make bed to bed round at the time of 0hanging of the shift of the unit*
d* She 2ill orient the ne2 &atient 2ith 2ard*
e* She 2ill hel& the 2ard sister for su&ervision of 2ork of rou& ) allotted in the 2ard for maintenan0e of 0leanliness and sanitation*
f* She 2ill make list of &atients belongings and kee& in safe 0ustody, a00ording to laid do2n &oli0y of the hos&ital*
g* She 2ill kee& a sub sto0k of drugs, linen and other su&&lies for 2ard maintenan0e* h* She 2ill maintain &oisonous drugs registered*
i* She 2ill sterili-e all arti0lesD maintain all eui&mentEs, gadgets, ele0tri0al 0onne0tions Sight, fan et0*
5* She 2ill indent drugs, diet, and other su&&lies if ne0essary*
k* She 2ill vigilant to &rote0t the &atient from in5ury or a00ident by &roviding side rail* l* She 2ill 2rite re&ort of ea0h shift and sign the re&ort after 0he0king &ro&erly*
m* She 2ill assist the 2ard sister in orientation &rogramme of ne2 staff and students* n* She 2ill make round 2ith do0tors and senior nursing offi0ers*
o* She 2ill hel& 2ard sister in indenting and 0he0king of drugs, su&&lies and maintaining inventories*
&* She 2ill be de&uted for the 2ard sister during her absent*
* She 2ill kee& herself u& to date 2ith nursing kno2ledge by taking &art in $servi0e edu0ation &rogramme*
Duti! "n2 R!%on!i+i#iti! of " NURSING ATTENDANT=
' nursing aide, sometimes 0alled a nursing assistant, assists medi0al staff in &roviding 0are for residents of long$term 0are fa0ilities, su0h as nursing homes, as 2ell as for short$ term hos&ital &atients* )uring a ty&i0al 2orkday, they &erform a 2ide variety of non$ medi0al duties* Be0ause nursing aides s&end a large &art of ea0h day intera0ting 2ith &atients, many of 2hom may not be able to &rovide for themselves, it is im&ortant that
nursing aides be 0aring, 0om&assionate and &atient individuals* Basi0 Needs
a* Nursing aides 2ork 2ith &atients 2ho reuire assistan0e to &erform even the most basi0 tasks* 1hey are often 0alled u&on to feed, bathe or move &atients*
b* Nursing aides hel& re&osition bedridden &atients so they do not develo& bedsores*
0* 1hey hel& &atients 2ho need assistan0e going to the bathroom* Be0ause freuent lifting of &atients is reuired in this 5ob, the Bureau of %abor Statisti0s re&orts that 2ork&la0e in5uries are more 0ommon among nursing aides than among most other ty&es of 2orkers*
Medi0al )uties
In addition to hel&ing &atients 0are for themselves, nursing aides &rovide very basi0 medi0al 0are*
a* 1hey monitor vital signs, su0h as blood &ressure, &ulse and tem&erature* Nursing aides re&ort any irregularities in vital signs or health 0on0erns e7&ressed by &atients to su&ervising nurses or do0tors*
b* In some states, nursing aides 2ho have been s&e0ially trained and 0ertified are res&onsible for administering medi0ation to &atients and residents*
Cleaning Res&onsibilities
a* Hhile hos&itals and nursing homes almost al2ays em&loy a 0ustodial staff for the big 5obs, nursing aides are e7&e0ted to maintain 0leanliness to a 0ertain e7tent 2hile on the 5ob*
b* For instan0e, it is often the res&onsibility of the nursing aide to 0lear the dishes and silver2are of residents after meals*
0* Nursing aides also may remove soiled bed&ansD s2ee& and 2i&e do2n furnitureD and 0hange bedding*
A(ti$iti! T)"t M"3 + D#g"t2
1he nursing &ro0ess 0an be utili-ed as a frame2ork to su&&ort the RN in delegating &atient 0are a0tivities to su&&ort and assistive &ersonnel* Prior to delegating, the RN assuming 0are of the &atient is res&onsible for 0om&leting an assessment of the &atient as 2ell as revie2ing the &atientEs individuali-ed &lan of 0are* 1he RN should also verify &ro&er training and 0om&eten0y evaluation of U'P before a task is delegated* Regardless of ho2 sim&le the delegated task may seem, the RN is res&onsible for &atient out0omes* Institutional &oli0y and regulations from state boards of nursing and state de&artments of health may govern the a0tivities of su&&ort &ersonnel*
8'&&endi7 '; 1he follo2ing lists are e7am&les of &atient 0are a0tivities that might be delegated Dir(t P"tint C"r A(ti$iti!
Vit"# Sign!
1ake and re0ord blood &ressure, res&irations, tem&erature, and &ulse rate 4btain daily 2eight
'&&ly leads and 0onne0t to 0ardia0 monitor 4btain !=$lead ?C
Perform 0hest 0om&ressions in life su&&ort situations Int"/ "n2 Out%ut
Measure and re0ord intake and out&ut Colle0t s&e0imens
A(ti$iti! of D"i#3 Li$ing
Perform total or &artial bed bath Perform &erineal 0are
Shave Hash hair
Perform mouth 0are
Change linen and assist 2ith making o00u&ied bed Nutrition
Feed &atient
Cal0ulate and re0ord 0alorie 0ount S/in C"r
Perform ba0k 0are
Pre&are skin for &ro0edure
A(ti$it3 "n2 Mo+i#it3
'ssist in ambulating &atient
Perform &assive and a0tive range of motion Position
1urn and re&osition &atient 'ssist 2ith transfers
R!%ir"tor3 Su%%ort Set u& o7ygen
'ssist &atient 2ith using an in0entive s&irometer
'ssist &atient 2ith 0oughing and dee& breathing e7er0ises Perform oral su0tioning using an oral su0tion devi0e
Pro(2ur!
Set u& &atient room 8su0tion 0anisters, 0ables for 0ontinuous 0ardia0 monitoring, tubing for 0hest tubes;
4rient &atient to room environment
Set u& and 0alibrate hemodynami0 monitoring eui&ment 4btain ne0essary su&&lies for sterile &ro0edure
)is0ontinue &eri&heral intravenous 0atheter Perform &ostmortem 0are
In2ir(t P"tint C"r A(ti$iti! C#"ning
Clean eui&ment in use and stored eui&ment
Clean environment, in0luding 0ounter to&s and desk to&s Clean and defrost food refrigerators
Clean &atient 0are area after transfer or dis0harge Clean &atient 0are area after &ro0edures are 0om&leted ?m&ty 2aste baskets in &atient rooms and unit
?m&ty linen ham&ers Remove meal trays Clean su&&ly 0arts
Clean and resto0k &ro0edure rooms Make uno00u&ied beds
Err"n2!
)eliver meal trays
4btain and deliver eui&ment 4btain and deliver blood &rodu0ts
Che0k laboratory s&e0imens for a&&ro&riate labeling )eliver s&e0imens to 0lini0al laboratory
C#ri("# T"!/! Pla0e &ages
Pla0e and ans2er &hone 0alls
'ssemble, disassemble, and maintain &atient 0hart 1rans0ribe &hysi0ian and nursing &atient 0are orders S0hedule diagnosti0 tests and &ro0edures
4rder ne0essary offi0e su&&lies and forms Sort and deliver mail
'ssist 2ith unit orientation for float and registry an0illary &ersonnel Pre&are 0harges for unit$based billing
Problem solve and lo0ate lost 0harges
@ee& unit log books u& to date 2ith &atient admissions, transfers, and dis0harges Maintain a2areness of nursing bed assignments
U&date and retrieve information systems data Sto(/ing "n2 M"intn"n(
Sto0k &atient bedside su&&lies Sto0k unit su&&lies
Sto0k utility rooms
Sto0k treatment, e7amination, and &ro0edure rooms Sto0k nourishments and kit0hen su&&lies
Che0k ele0tri0al eui&ment for ins&e0tions due dates Sto0k linen 0art
A(ti$iti! T)"t M"3 Not B D#g"t2
Nur!ing "(ti$iti! t)"t &"3 not + 2#g"t2 in(#u2=
Performing an initial &atient assessment and subseuent assessments or nursing interventions that reuire s&e0iali-ed nursing kno2ledge, 5udgment, and6or skill
Formulating a nursing diagnosis
Identifying nursing 0are goals and develo&ing the nursing &lan of 0are in 0on5un0tion 2ith the &atient and6or family
U&dating the &atientEs &lan of 0are
Providing &atient edu0ation to &atient and6or family
?valuating a &atientEs &rogress, or la0k thereof, to2ard a0hieving desired goals and out0omes
)is0ussing &atient issues 2ith &hysi0ian
Communi0ating 2ith &hysi0ians or im&lementing orders from &hysi0ian
)o0umenting the &atientEs assessment, res&onse to thera&euti0 interventions, in the &atientEs &lan of 0are
'dministering medi0ations Providing dire0t nursing 0are
Gui2#in!-Situ"tion for D#g"tion
• )elegable task* 1he nurse first should determine if the task is &ro&erly delegable* For
e7am&le, giving medi0ations or inter&reting 0lini0al data 0annot be delegated be0ause these are li0ensed fun0tions* /o2ever, it is generally agreed that routine tasks 8e*g**, taking vital signs; or &ersonal 0are a0tivities 8e*g**, bathing; for stable &atients 2ith &redi0table out0omes 0an be assigned to U'P
• PatientEs needs* 1he nurse is res&onsible for individual &atient assessment and
determination of nursing 0are needs* 1herefore, even though an intervention su0h as giving a bath may be a routine, the nurse may need to 0om&lete this task for 0ertain &atientEs if further assessment or health tea0hing is needed* 1he nurse should refuse to
delegate any task that 2ould 5eo&ardi-e &atient safety*
• Com&eten0y of U'P* .ob des0ri&tion for U'P should have 0learly s&e0ify their
res&onsibilities* U'P should have a re0ord of do0umented 0om&eten0ies to &erform tasks and should have &arti0i&ated in a formali-ed edu0ational &rogram that &rovided instru0tion* /o2ever, it is the duty of the nurse to ensure that U'P are 0om&etent in &arti0ular situations 8e*g**, they may not be able to measure blood &ressure &ro&erly even though there is do0umentation that they 0an;* It is the nurseEs res&onsibility to determine ability and &rovide &ro&er instru0tion for U'P or 0om&lete the task himself or herself* 1he nurse must &rovide su&ervision for U'P and serve as a resour0e* 1he sole 0riterion for determining 2ho should 0om&lete a task in a &arti0ular situation in &atient safety, as determined by the nurse*
• Communi0ation* Clear dire0tions must be given to U'P so that the task 0an be 0om&leted
&ro&erly* For e7am&le, the nurse should say, L I need a finger sti0k done on Mr* .ones* ' better instru0tion 2ould indi0ate the immediate need for blood glu0ose measure and to re&ort the value to the nurse immediately, 2ho 2ill determine if insulin is needed* It is suggested that the nurse obtain Lminire&orts throughout the shift, to 0larify data obtained and to &rovide any su&ervision ne0essary for U'P*
• ?valuation* 's &art of the nurseEs duty to su&ervise U'P, the nurse is res&onsible for
evaluating their &erforman0e* 1his is an o&&ortunity to &rovide &ositive and negative feedba0k as 2ell as su&ervised &ra0ti0e of a skill if needed* 1he ability to set &riorities for 0om&letion of task is an essential skill needed by U'P and often reuires guidan0e by the nurse*
