Professional Development
June 3, 2016 | Author: Lharra Cagulada | Category: N/A
Short Description
Professional Development...
Description
Bukidnon State University College of Nursing Malaybalay City, Bukidnon
In Partial Fulfillment of the Reuirements for the Course NCM !"#$B Nursing %eadershi& and Management
' Case Study on( PROFESSIONAL DEVELOPMENT Improper Delegation
Submitted by: 'uguis, Fe Cagulada, %harra Mae Casite, Nielmark )oydora, Ma* +usette ome-, .unfelm /omamoy, Fran0es .oy Palado, Mar0her Robosa, .oshua Santillan, Cheerille 1elin, Marvin 1ortola, 1ortola, %o2eelyn 1orayno, Imelda 3illamor, Ra0helle
Submitted to: )r* 3ioleta B* .uan
TABLE OF CONTENTS
I.
II. III.
INTRODUCTION a* 4b5e0t 4b5e0tive ives6S s6Stat tateme ement nt of of the the Prob Problem lem b* 1heoreti0al Frame2ork 0* Sign Signif ifi0 i0an0 an0ee of of the the Study Study d* )efin )efinit itio ion n of of 1e 1erms rms REVIEW OF RELATED LITERATURE CASE
IV.
PROBLEMS IDENTIFIED AND NURSING CARE PLAN
V.
SUMMARY, SUMMARY, EVA EVALUATION, LUATION, AND RECOMMENDATION RECOMMENDATION
VI.
APPENDICES
TABLE OF CONTENTS
I.
II. III.
INTRODUCTION a* 4b5e0t 4b5e0tive ives6S s6Stat tateme ement nt of of the the Prob Problem lem b* 1heoreti0al Frame2ork 0* Sign Signif ifi0 i0an0 an0ee of of the the Study Study d* )efin )efinit itio ion n of of 1e 1erms rms REVIEW OF RELATED LITERATURE CASE
IV.
PROBLEMS IDENTIFIED AND NURSING CARE PLAN
V.
SUMMARY, SUMMARY, EVA EVALUATION, LUATION, AND RECOMMENDATION RECOMMENDATION
VI.
APPENDICES
I.
INTRODUCTION
' 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 &ra0ti0e nurse 2ill need to e7tend and e7&and 8Pa7ton et al !99:;* Ne2 kno2ledge and skills 2ill be a ne0essity* In the future, one of the greatest 0hallenges to &ra0ti0e nurses 2ill be the attainment, maintenan0e and advan0ement advan0e ment of their &rofessional develo&ment* 1he 1he im&o im&ort rtan an0e 0e of 0ont 0ontin inui uing ng &rof &rofes essi siona onall devel develo&m o&ment ent 8CP) 8CP);; for for nurs nurses es has has been been 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 develo& develo&men mentt for all nurses nurses and sugges suggested ted that that it might might be hel&fu hel&full to 0onside 0onsiderr 0ontin 0ontinuin uing g &rofessional develo&ment three broad headings( in servi0e training, 0ontinuing edu0ation and s&e0ia s&e0iali list st traini training ng 8Commi 8Commissi ssion on on Nursin Nursing, g, !99;* 1here is a general 0onsensus that 0ontinuing &rofessional develo&ment for &ra0ti0e nurses should be &ur&oseful, &atient 0entered and edu0ational effe0tive 8.enkins$Clarke and Carr$/ill =""!;* Resour0e 0onstraints should not be used as an e70use for negle0ting 0ontinuing &rofessional develo&ment for this grou& of 0ommunity based nurses$ineualities bet2een &ra0ti0e nurses and other based 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 is mu0h lo2er at !> 0ases &er !",""" &o&ulation 0om&ared to the highest ever re0orded rate of :"*9 &er !"",""" in !99 is also lo2er at "*;* 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$0om&lian0e to hos&ital &roto0ol related to im&ro&er delegation* Inserting an I3 0annula is not in the 5ob des0ri&tion of a nursing attendant, therefore, the 0harge nurse, though she 2as busy 0arrying out the )o0tors 4rders, should not have delegated the task to the attendant* 4nly Registered Nurses 2ho are trained for I3F insertion 0an do the task*
(ecommendation: 's as&iring future nurse staffs and nurse managers, 2e re0ommend the follo2ing( !* 1he hos&ital must &re0isely formulate a 0om&rehensive s0o&e of &ra0ti0e for the Registered Nurse and Nursing 'ttendants, in0luding the s&e0ifi0 tasks 2hi0h are delegable* =* Registered Nurses must 0onsider the set of tasks he6she 2ould delegate, that fit 2ith the nursing assistantEs skill and are in a00ord to the hos&ital &roto0ols* >* 'dvan0e %ife Su&&ort and kno2ledge u&dates through seminars on delegation* 'lthough it is 0ostly, these a0tivities 2ill hel& not 5ust the staff nurses but also the nurse managers to enhan0e their management skills* =* Seminar on Phili&&ine Nursing '0t of =""=* Re&ubli0 '0t 9!#> en0om&asses the S0o&e of Nursing Pra0ti0e on 'rti0le 3I* It must be &resented to all the Registered Nurses as 2ell to remind them of their legal tasks, and their duty of 0ontinuing &rofessional develo&ment*
ASSESSMENT
Sub5e0tive data( Lgamayrakaayoiyanggakaihi* a 2hole day nalangiyang dia&er, gamayragyudangbasadayun nay dugoga&angga2assaiyangtudlouglagus* as verbali-ed by the mother 4b5e0tive data( 1a0hy0ardia 8PR$!J#b&m; • 1a0hy&nea 8RR$A!0&m; • /y&otension 8
NURSEING DIAGNOSIS Dfi(int f#ui2 $o#u& r-t )&orr)"g
OB?ECTIVES
INTERVENTION
Nursing 4ut0ome Classifi0ation 8?7&e0ted 4ut0omes;
In2%n2nt Nursing Intervention Classifi0ations(
-
Bedside Nurse !* 'sses initial vital signs =* Monitor vital signs every !A$>" minutes* >* Put &ressure on the bleeding areas
-
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*
-
t
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*
-
r
ASSESSMENT 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*
IV.
PROBLEM I&%ro%r D#g"tion
OB?ECTIVES 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*
!*
=* >*
J*
A*
ACTION 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* ?valuate their &revious &erforman0es 2hether they have 0ommitted the same a0tion on their &revious duties* )e0ide 2hether to give them a se0ond 0han0e or terminate them immediately*
-
RATIONALE 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*
ACTION
RAT
PROBLEMS IDENTIFIED AND NURSING CARE PLAN
Dfinition= *YPERT*ERMIA the body tem&erature rises above the normal range* ASSESSMENT PROBLEM OB?ECTIVES
Sub5e0tive 0ues( L/e has been feverish for
Nursing 4ut0ome *3%rt)r&i" r#"t2 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 $iru! inf(tion
8?7&e0ted 4ut0omes;
Classifi0ation(
Short term( 1hat during >"mins$ !hour of nursing interventions, &atient 2ill e7&erien0e normothermia 2ith a tem&erature of >:$ >#C*
Charge Nurse( !*Carry$out )o0torEs orders =* Make and follo2$u& laboratory results 8e*g HBC$ !A6% >*'ssess &ossible etiology of in0reased tem&erature
%ong term( 't the end of our duty, &atient 2ill be able to maintain a 0ore body Bedside Nurse( tem&erature of >:$>#C !* Provide6 en0ourage even 2ithout R1C &atient to drink anti&yreti0* &lenty of fluid as tolerated 80olostrum; =*Instru0t the signifi0ant other to let the &atient 2ear 0lothing that is thin and not the 0otton and silk ones* Medi0ation Nurse( !*Inform &atient regarding the side effe0ts of the drugs to be administered =*Considers the nursing &re0autions in drugs to be given Nursing 'ide( !*Monitor 36S every >"mins* =*Provide and in0rease air 0ir0ulation
Bedside Nurse( !*Intake and out&ut
!*1o fa0ilitat of 0are =*1o determi regimen* 1o and other m >*1o monito 0auses of the 0ondition
!*1o re&la0e eva&
=*1o &rovide 0omfort and 0lothing abs does not sti in0rease in b
!*1o edu0ate effe0ts and l
=*1o &revent u&on admini
Nursing 'id !*3ital signs determine th general 0on =* Serves as measure to l heat Bedside Nur !*)ete0ting dehydration balan0e of fl
every >hours on0e or more often* D%n2nt Nursing Interventions Classifi0ation( Nursing 'ide( !*'&&li0ation of 1e&id S&onge Bathe
Remove e70ess blankets 2hen the 0lient feels 2armD &rovide e7tra 2armth 2hen the 0lient feels 0hilled* Medi0ation Nurse( !*'dminister anti&yreti0s as ordered* Para0etamol Syru& =*Am% PRN P4
ASSESSMENT Sub5e0tive 0ues( L1here 2as blood 0oming out from his gums sin0e this morning, as verbali-ed by the &atientEs mother*
4b5e0tive 0ues( •
Bright red blood
•
on gums Pete0hiae /as no a&&etite Pale skin Pale nail beds Ca&illary refill
•
less than =se0s 36S are as
• • • •
follo2s(BP$; 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*
ele0trolytes i
!*1o enhan0 eva&oration =*Removing 0ooling mea &roviding of &romotes he
!*1o lo2er d tem&erature*
RATI
!*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$ing Perform total or &artial bed bath Perform &erineal 0are Shave Hash hair Perform mouth 0are Change linen and assist 2ith making o00u&ied bed
Nutrition Feed &atient Cal0ulate and re0ord 0alorie 0ount
S/in C"r Perform ba0k 0are Pre&are skin for &ro0edure Perform skin &re& for o&erative &ro0edure
A(ti$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$iti! C#"ning Clean eui&ment in use and stored eui&ment Clean environment, in0luding 0ounter to&s and desk to&s Clean and defrost food refrigerators Clean &atient 0are area after transfer or dis0harge Clean &atient 0are area after &ro0edures are 0om&leted ?m&ty 2aste baskets in &atient rooms and unit ?m&ty linen ham&ers Remove meal trays Clean su&&ly 0arts Clean and resto0k &ro0edure rooms Make uno00u&ied beds
Err"n2! )eliver meal trays 4btain and deliver su&&lies
4btain and deliver eui&ment 4btain and deliver blood &rodu0ts Che0k laboratory s&e0imens for a&&ro&riate labeling )eliver s&e0imens to 0lini0al laboratory
C#ri("# T"!/! Pla0e &ages Pla0e and ans2er &hone 0alls 'ssemble, disassemble, and maintain &atient 0hart 1rans0ribe &hysi0ian and nursing &atient 0are orders S0hedule diagnosti0 tests and &ro0edures 4rder ne0essary offi0e su&&lies and forms Sort and deliver mail 'ssist 2ith unit orientation for float and registry an0illary &ersonnel Pre&are 0harges for unit$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
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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
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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
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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
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&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*
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