Delegation and Continuity of Care - Study Notes

Delegation and Continuity of Care

Overview

• Focused on the principles and practices of delegation within nursing care.

• Includes discussions on continuity of care and considerations for home care referrals.

• Source: GALEN COLLEGE OF NURSING, NUR 155/156, Unit 8.

Delegation

Definitions

• ANA Definition: The transfer of responsibility for the performance of a task from one individual to another.

• NCSBN Definition: The transfer of authority in which a nurse grants a competent individual the authority to perform a selected nursing task in a selected situation while retaining accountability for that task.

Principles of Delegation

1. Knowledge of Nurse Practice Act:
      - Nurses must possess a thorough understanding of the Nurse Practice Act in the state where they are licensed.

2. Limitations on Delegation:
      - The Registered Nurse (RN) cannot delegate:
        - Assessment
        - Planning
        - Evaluation
        - Accountability for the assigned task

3. Non-Delegability of Delegated Tasks:
      - The individual to whom the task is delegated cannot delegate that assignment to another person.

Five Rights of Safe Delegation

• To ensure safe practice, it is crucial to adhere to the following five rights:
    1. Right Task: The task must be appropriate for delegation.
    2. Right Person: The individual to whom the task is delegated must be competent to perform the task.
    3. Right Circumstance: The situation must be appropriate for delegation.
    4. Right Communication: Clear and concise information regarding the task must be shared.
    5. Right Supervision: Proper oversight must be provided to ensure task completion.

Communication of Delegation

• Essential components of delegating tasks include:
    - Specific tasks to be completed for each client.
    - Timing for each task.
    - Expected outcomes for tasks performed.
    - Identification of those who are available to assist.
    - Requirements for reporting and communication.

What Can be Delegated

• Nursing students should collaborate in groups to create a comprehensive list of tasks that can be delegated and identify the appropriate personnel for each task.

Delegation to Unlicensed Assistive Personnel (UAP)

• Typical tasks suitable for delegation to UAP include:
    - Vital signs monitoring.
    - Intake and output recording (I&O), including emptying Foley catheters, drains, and colostomies.
    - Assisting with transfers and ambulation for stable clients.
    - Providing post-mortem care.
    - Bathing and feeding patients.
    - Performing simple dressing changes.
    - Attending to patient safety, such as setting up bed alarms.
    - Weighing patients.
    - Performing CPR.

Delegation to Licensed Practical/Vocational Nurses (LPN/VN)

• Tasks that can be delegated to LPNs/VNs include:
    - Medication administration (excluding IV medications unless the LPN is IV certified).
    - Performing complex dressing changes.
    - Other basic nursing skills such as nasogastric (NG) tube insertion and Foley catheter insertion.
    - Administering enteral feedings (via G-tube or NG tube).
    - Updating care plans.
    - Plus, all tasks that are allowed for UAPs.

Delegation Decision Tree

• Group discussions are encouraged to outline a decision tree for effective delegation processes in nursing.

Continuity of Care

Definition

• Continuity of care refers to the consistent and coordinated approach to patient care over time, ensuring that patients receive comprehensive and continuous care.

Responsibilities for Continuity of Care

• Nurses must establish:
    - A thorough understanding of patient history and needs.
    - Effective communication among healthcare team members for seamless care.
    - Ongoing assessment and modification of care plans as necessary.

Home Care Referrals

• Types of clients who typically require home care referrals include:
    - Those with chronic illnesses needing ongoing management.
    - Patients recovering from surgery who require support.
    - Individuals requiring assistance with daily living activities.

Knowledge Check

• Scenario: An RN and an LPN are caring for an unstable client while a client in a different room requires assistance.
    - The RN must decide the best course of action in terms of delegation:
      - a. The RN should perform the task and not delegate.
      - b. The RN delegates the task to the LPN.
      - c. The RN delegates the task to the UAP.
      - d. The RN delegates the task to the Unit Secretary.

Task Delegation Matching Exercise

• Match the following client care tasks with the appropriate healthcare professional:
    1. Indwelling catheter insertion.
    2. Simple dressing changes.
    3. Postmortem care.
    4. Enteral feedings.
    5. Complex dressing changes.
    6. Vital signs.
    7. CPR.
    8. LPN/VN.
    9. UAP.

Fill in the Blanks Exercise

• Complete the following sentences using the provided options:
    - A nurse must have knowledge of the _____1_____ in the state where they are licensed.
    - The RN cannot delegate _____2_____, planning, evaluation, or accountability for the assigned task.
    - The person who received the assignment _____3_____ delegate that assignment to someone else.
  

Options for Fill in the Blanks

• 1. State Board of Nursing.

• 2. Nurse Practice Act.

• 3. Assessment.

• 4. Ambulation.

• 5. Can.

• 6. Cannot.