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A. Review standards and/or position statements of the following agencies before delegating
any nursing tasks
3. Nursing organizations
a.
b.
4.
B.
o
o
1.
2.
Learn more about the National Council of State Boards of Nursing (NCSBN) and follow the
links to find your state's nurse practice act. Click on the links to discover more about the
American Nurses Association (ANA) and the Canadian Nurses Association (CNA).
D. Use the six Quality and Safety Education for Nurses (QSEN) competencies as a guide for
managing and supervising care
o
1. Patient-centered care - the patient (or designee) is recognized as the source of control and
full partner; care that is provided is based on respect for patient's preferences, values, and
needs
o
o
2. Teamwork and collaboration - open communication, mutual respect, and shared decisionmaking are used to achieve quality patient care
o
o
3. Evidence-based practice - health care delivery is the integration of best current evidence
with clinical expertise and patient/family preferences and values
o
o
5. Safety - risk of harm to clients and providers is minimized through both system
effectiveness and individual performance
o
o
E. Establishing priorities
o
2. Needs that are life-threatening or could result in harm to the client if left untreated are
high priorities
o
o
3. Actual problems or needs have higher priority than potential problems or needs
o
o
6. Mutual decision-making for priorities may be made with the client based on the client's
physiologic needs, desires, and safety
o
Learn more about the Quality and Safety Education for Nurses (QSEN) project.
1. Communication
a.
d.
o
o
2. Types of communication
b.
o
o
3. Causes of conflict
a.
inadequate communication
b.
incorrect facts
d.
f.
g.
h.
power issues
o
o
4.
a.
b.
c.
d.
a.
b. help parties resolve conflict among themselves (communicate trust that parties ca
achieve resolution)
c.
d.
avoid criticism
e.
f.
h.
i.
2. "I PASS the BATON" - used to improve "handoffs" and transitions in health care, with
opportunities to ask questions, clarify, and confirm
c. A = assessment (presenting chief complaint, vital signs and symptoms and diagn
g. A = actions (what actions were taken or are required and provide brief rationale)
j. N = next (what will happen next? anticipated change? what is the PLAN? what is
contingency plan?)
o
o
3. CUS - a process used to more effectively advocate for clients when there is a concern
a.
b.
c.
The SBAR technique was originally developed by Kaiser Permanente. Read more about SBAR
from the federal Agency for Healthcare Research and Quality .
II. Delegation
o
A. Definitions
2. Delegation involves
o
o
B. Delegation overview
1. A nurse can only delegate those tasks for which that nurse is responsible
3. Along with responsibility for a task, the nurse who delegates must also transfer t
authority necessary to complete the task
a. baccalaureate prepared nurses are equipped to care for individuals, families, grou
and communities in both structured and unstructured health settings
b. associate degree prepared nurses are equipped to care for individuals in a structu
health care environment
i.
assessment of clients
ii.
iii.
nursing judgment
iv.
v.
o
o
2. assessment skills involve collecting data and are directed at differentiating norma
from abnormal
3. may reinforce information that has been given to the client by the RN
5. the scope of practice for LPN/VNs is not the same in every jurisdiction
o
o
2. in general, nursing tasks that may be delegated include non-invasive and non-ste
treatments
3. some states allow for the practice of medication administration in specific setting
medication aides - refer to your jurisdiction's laws for specific information
D. Steps of delegation
o
1. Right task - define the task and determine if it can be safely delegated
a.
b. determine if the task is within the scope of practice for the delegatee
Standards of Practice and the Canadian Nurses Association (CNA) Position State
o
o
2. Right circumstances
a. determine if there is anything about the client's condition or the environment whi
would preclude this delegatee from performing the task as delegated
b. determine if staff members have the resources, equipment, and supervision neede
work safely
o
o
3. Right person - is the right person delegating the right task to the right person to be
performed on the right patient?
a. determine if staff members have the necessary knowledge, skills, and abilities (K
to perform the delegated tasks and if this information is documented
b.
o
o
a. the nurse must have the appropriate skills to assist, teach and guide the individua
is completing the task
1.
o
o
2.
o
o
3. The LPN may assign tasks to the unlicensed assistive personnel or nursing assistants (if
allowed by the jurisdiction's laws)
o
o
4. Unlicensed assistive persons (UAP) or nursing assistants cannot delegate to other UAPs or
nursing assistants
o
NCSBN Learning Extension offers an online continuing education course called Delegating
Effectively .
Read NCSBN's Working with Others: A Position Paper (2005). Use the decision tree to help you
to understand the concept of delegation and how to better manage and supervise others.
A. Quality: the degree to which client care services increase the probability of desired
outcomes and reduce the probability of undesired outcomes given the current state of
knowledge
o
o
1.
2.
Focus on outcomes
3.
4.
Multi-professional approach
o
o
E.
1.
2. Tasks are assigned to various levels of health care workers according to licensu
skill
3. Example: RN gives medications and UAP give bed baths for one group of clien
o
o
B. Team nursing
1.
3. Team leaders supervise client care teams, which usually consist of an RN, LPN
UAP
4. Team leader reviews the client's plan of care and progress with team members d
team conference
o
o
2.
3. This type of care is usually provided in areas requiring high level of nursing
expertise, such as the critical care unit (CCU) or the post-anesthesia recovery u
(PACU)
o
o
D. Primary nursing
2. The primary nurse designs, implements and is accountable for the nursing care
those clients during their entire stay on the unit
a. has the benefit of continuity of care but may not be feasible with var
schedules
o
o
E. Practice partnerships
3. Senior partner directs the work of the junior partner within the scope of each pa
practice
F. Case management
o
1. Model for identifying, coordinating, and monitoring the implementation of services needed
to achieve desired client outcomes within a specified period of time
o
o
3. A collaborative health care team defines the expected outcomes of care and care strategies
for a client population by defining critical paths
o
5. Case manager usually does not provide direct client care but coordinates care provided by
licensed and unlicensed nursing personnel according to a critical path
o
o
6. Critical pathways are plans for providing care to the client and family
a.
c. focus on specific diagnoses or procedures that are high volume and or high resou
use (and therefore costly)
o
o
a.
d.
o
o
The Case Management Resource Guide is a free, searchable database of health care services,
facilities, businesses and organizations.
G. Differentiated practice
o
1. Identifies distinct levels of nursing practice based on defined abilities that are incorporated
into job descriptions
o
o
H. Client-centered care
o
2. All client care services are unit-based, including admission, discharge, diagnostic testing
and support services
o
o
Arrive at the testing center early on exam day so you have time to register, become accustomed
to your surroundings, and relax. Bring the proper identification and your Authorization To Test
(ATT) email.
d. four parts
ii.
iii.
iv.
2. Source-oriented
1. Narrative charting
a. the nurse records observations, data (including reactions from the client) in a seq
and chronological order
b.
c.
source-oriented
a.
b.
d.
o
o
3. D-A-R
o
o
4. Focus charting
o
o
5.
a.
A = assessment
b.
P = problem
c.
I = intervention
d.
E = evaluation
6. Charting by exception
a.
uses flowsheets
b. emphasis on abnormal (or what is abnormal for this particular client); normal rou
presumed as having been done, without any problems
C. Documentation guidelines
o
1. General
a.
b.
c.
chart as you go
d.
e.
ii. refer to the Joint Commission's official "Do Not Use" list of abbreviat
i.
assessment
ii.
iii.
interventions
iv.
care provided
v.
ii.
vi.
vii.
o
o
b. paper-ink
i. do
write legibly
ii. do not
or White Out)
A. Sources of law
ii.
b.
c.
d.
e. The Uniform Anatomical Gift Act and the National Organ Transplan
ii.
iii.
iv.
b.
c.
d.
B. Types of law
o
1. Criminal Law
b.
c.
In cases of malpractice, the (former) client must prove that the nurse not only committed a
breach of duty but that this breach of duty was the cause of any damage or injury to the
client.
o
o
2. Civil Law
a. deals with disputes between parties or negligent acts that cause harm to others pr
the individual rights of people
proximate cause
1. Comply with state and/or federal regulations for reporting client conditions, e.g., abuse,
neglect, communicable diseases, gunshot wounds, dog bites
o
o
2. Report unsafe practice of health care personnel and intervene as appropriate (for example,
with suspected substance abuse, improper care) - mandatory reporting is required by most
nurse practice acts
o
o
risk manager
o
o
B. Boundary violations
c.
o
o
1. A board of nursing must protect the public and is required to take action again
licenses of nurses who have exhibited unsafe nursing practice
NCSBN Learning Extension offers continuing education (CE) courses for Understanding
Substance Use Disorder in Nursing and Professional Boundaries in Nursing .
Review the Canadian Nurses Association's position statements on Problematic Substance Use by
Nurses . and Nurses' Involvement in Screening for Alcohol or Drugs in the Workplace .
A. Privacy
4. Health care workers must release information when a court orders it or when
statutes require it (as in child abuse or communicable diseases)
Learn more about HIPAA from the U.S. Department of Health & Human Services.
Read more about Privacy Legislation in Canada .
NCSBN Learning Extension offers a continuing education course called Patient Privacy .
B. Advance directives
1. As part of the Omnibus Budget Reconciliation Act (OBRA) of 1990, the U.S. Congress
established the Patient Self-Determination (PSDA); this requires states to provide written
information to clients outlining their rights to make health care decisions
o
o
a.
b.
o
o
3. Nurses and other members of the health care team are required to
a. assess the clients knowledge of advance directives and their status regarding the
advance directive process
c. plan care that incorporates the clients decisions regarding advance directives Thr
common advance directives are:
i. living will - identifies what a client wishes for his care should he becom
communicate these wishes
ii. durable power of attorney for health care decisions - the client has ap
person to make decisions about their care if they are unable to do so.
iii. do not resuscitate (DNR) status - this has been expanded to include i
of medications that may be given without any defibrillation attempts
measures only)
C. Refusal of treatment - competent clients may refuse treatment, even life-sustaining treatment
1. Physical restraints/safety devices require a signed, dated physician's order specifying the
type of restraint/safety device and a time limit for its use
o
o
o
o
a.
b.
o
o
E. Informed consent
1. Basic requirements
a.
capacity
b.
voluntariness
c. information
ii. the nurse should verify client comprehends and consents to care
o
o
b.
c.
potential benefits
d.
e.
o
o
a.
F. Transition planning - recognizes that clients are not discharged from care but moved across
the continuum to another level of care
Become familiar with the NCLEX Test Plan's distribution of questions and use this to make
notes, like I can recall or I need to review. Use the I need to review list to help you to
select the questions where you need more practice.
Rejuvenation Station: Triangle Breathing
https://www.youtube.com/watch?v=xHXDwggp4hM