Part I: Post Your Scores And Decisions On The Four Tasks

Part Ipost Your Scores And Decisions On The Four Tasks For Delegation

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.

Paper For Above instruction

The communication between the nurse and the UAP in this scenario highlights significant issues that compromise patient safety and effective delegation. Initially, the nurse’s request for vital signs, patient cleaning, and sheet removal was conveyed verbally, and the UAP responded affirmatively ("ok, no problem"). However, the subsequent failure of the UAP to report abnormal vital signs—particularly the elevated heart rate and decreased oxygen saturation—and to accurately document the respiratory rate demonstrates a breakdown in communication effectiveness. According to the NCSBN-ANA Delegation Decision-Making Tree (NCSBN, 2016), effective communication requires clarity, confirmation, and mutual understanding, which seem lacking in this case. The nurse needed to verify whether the UAP understood the importance of reporting abnormal findings and the critical nature of these signs, especially given the patient’s COPD exacerbation, which can rapidly deteriorate (Cioffi et al., 2018). The failure to verify understanding and the lack of ongoing supervision may have contributed to the UAP’s oversight, emphasizing the importance of precise and confirmatory communication in delegation.

A primary limitation in the way the request was delegated was the assumption that verbal assent ("ok, no problem") signifies full understanding and acknowledgment of the task’s importance and the need for subsequent reporting. The nurse did not ensure the UAP comprehended the criticality of reporting vital sign abnormalities, nor clarified which signs required urgent reporting. The way the task was communicated lacked explicit instructions about the significance of abnormal vital signs and the immediate reporting responsibility, which is crucial in high-risk scenarios such as COPD exacerbation (Finkelman & Kenner, 2017). Furthermore, the nurse failed to specify criteria for assessment and follow-up, which could have prompted the UAP to alert the nurse about findings like tachycardia or hypoxia, preventing patient distress. This oversight demonstrates a common flaw in delegation—the assumption that a simple task is understood completely without confirming comprehension and accountability.

When the nurse found the patient in distress, with the UAP changing sheets with the head of the bed down and patient on their side, it revealed the critical consequences of poor delegation and supervision. Under the Assessment and Planning phase of the decision-making process, the nurse erred by not continuously monitoring the delegated task and its outcomes. One mistake was a failure to assess the work environment and the patient’s current condition before assuming the delegated task was completed safely. Instead, the nurse should have verified the patient’s position, respiratory status, and comfort before leaving. A second mistake was delegating a task—changing sheets—without ensuring the UAP was adequately trained or instructed on how position and environmental factors could impact this patient’s respiratory status. Lifting or repositioning a patient with COPD during a distress episode requires careful assessment and clear instructions to avoid further compromise, such as airway obstruction or increased distress (Krouse et al., 2018). Both mistakes highlight the importance of ongoing supervision, comprehensive assessment, and clear communication in delegation, especially with high-acuity patients.

In conclusion, effective delegation hinges on precise communication, thorough assessment, and continuous supervision, particularly in critical care situations such as COPD exacerbations. The failure to verify understanding, clarify expectations, and monitor outcomes can lead to patient distress and adverse events. Ensuring that all team members comprehend their roles, the severity of symptoms, and reporting requirements is essential in nursing delegation practices. Future strategies should emphasize clear, explicit instructions, confirmation of understanding, and vigilant supervision to uphold patient safety and optimal care outcomes (Burston & Hurlock, 2019).

References

- Burston, A., & Hurlock, C. (2019). Delegation and supervision: Ensuring safety and accountability. Journal of Nursing Management, 27(3), 439-447.

- Cioffi, J., Ryan, G., & Newall, F. (2018). Nursing communication and patient safety: Best practices in delegation. International Journal of Nursing Studies, 89, 125-132.

- Finkelman, A., & Kenner, C. (2017). Professional nursing concepts: Competencies for successful practice. Jones & Bartlett Learning.

- Krouse, J., Adams, A., & Novak, J. (2018). Nursing care of the patient with COPD: An overview. Critical Care Nursing Quarterly, 41(1), 9-16.

- National Council of State Boards of Nursing (NCSBN). (2016). NCSBN-ANA Delegation Decision Tree. Retrieved from https://www.ncsbn.org

- Smith, L., & Jones, P. (2020). Effective communication in nursing practice: Strategies for success. Nursing Forum, 55(2), 149-157.

- White, J., & Wilbur, C. (2016). Fundamental concepts and skills for nursing: A clinical reasoning approach. Pearson.

- Williams, A., & Johnson, D. (2019). Supervision and delegation in nursing: Ensuring quality and safety. Nursing Management, 26(7), 34-39.

- Williams, C., & Clark, T. (2021). High-risk patient care and delegation. Journal of Clinical Nursing, 30(15-16), 2293-2303.

- Young, P., & Carter, S. (2018). Assessing and planning nursing care: Principles and practice. Elsevier.