HESI Delegation test with verified solutions 2024

When Delegating Consider... 1. Potential for harm 2. Complexity of task 3. Problem solving and innovation required 4. Unpredictability of the outcome 5. Level of patient interaction nursing judgment about which tasks are to be delegated requires consideration of the client's needs at that particular time. Need to be considered in delegating care activities The client or family members' preferences for treatment/care The ultimate responsibility and accountability rests with Delegator because the delegator is accountable to his or her own superiors for fulfilling the responsibility to get the job done right and on time. RN must determine the degree of supervision that may be required Is it the first time a staff member performed the task? Does the client present a complicating factor whereby the RN's assistance is necessary? Does the staff member have prior experience with a particular type of client in addition to having received training on skill performance? The RN's final responsibility is to Evaluate whether assistive personnel performed a task properly and whether desired outcomes were realized. Assess the knowledge and skills of the delegate: Determine what assistive personnel know and what they can do by asking open-ended questions that will elicit conversation and details on what the person knows; for example, "How do you usually put the cuff on when you measure a blood pressure?" or "Tell me how you prepare the tubing before you give an enema." Match tasks to the delegate's skills: Know what skills are included in the training program for assistive personnel at your facility. Determine if personnel have learned critical thinking skills, such as knowing when a client may be in harm or knowing the difference between normal clinical findings and changes to report. Communicate clearly: Always provide unambiguous and clear directions by describing a task, the desired outcome, and the time period within which the task should be completed. Never give instructions through another staff member. Make the person feel as though he or she is part of the team. Example, "I'd like you to help me by getting Mr. Floyd up to ambulate before lunch. Be sure to check his blood pressure before he stands and write your finding on the graphic sheet. OK?" Listen attentively: Listen to the response of assistive personnel after you provide directions. Do they feel comfortable in asking questions or requesting clarification? If you encourage a response, listen to what the person has to say. Be especially attentive if the staff member has been given a deadline to meet by another nurse. Help sort out priorities. Provide feedback: Always give assistive personnel feedback regarding performance, regardless of outcome. Let them know of a job well done. If an outcome is undesirable, find a private place to discuss what occurred, any miscommunication, and how to achieve a better outcome in the future. Who Has Accountability? Delegator Own acts Acts of delegation Acts of supervision Assessment of the situation Follow-up Intervention Corrective active Delegatee Own acts Accepting the delegation Appropriate notification and reporting Accomplishing the task Therefore accountability is shared by both the delegator and delegatee. The nurse is accountable for supervision, follow-up, intervention, and corrective action in the event of an error. What to Delegate Assessment, evaluation, and nursing judgment should not be delegated; Tasks and procedures may be delegated. The legal issues associated with delegation include the following: RN remains legally responsible for activities delegated. RN is accountable for appropriateness of delegated task and its accurate completion. Organization for which the RN, UAP, and LPN/LVN work for is liable for their negligence or malpractice. No Nos UAP cannot supervise other UAP. UAP cannot redelegate to another UAP or nursing student. UAP cannot complete a pain assessment. LPN/LVN cannot complete discharge teaching. Client care assistant (nurse's aide, unlicensed assistive personnel, certified nursing assistant): Assign activities that have very specific guidelines: bed making, bathing, feeding, ambulating, general activities of daily living. A licensed practical nurse (LPN) or licensed vocational nurse (LVN): Performs nursing actions (e.g., suctioning, catheterization) requiring knowledge of sterile technique, medication administration; implements basic nursing process after RN has evaluated client and determined plan of care. RN: Uses nursing judgment (required for unstable clients), develops nursing care plan, implements teaching plan, and plans for client discharge. Initial client assessment, d/c planning, and planning for client ed responsibilities of RN. RN cont... Performs the initial assessment on admission and after surgery or treatment. Analyzes assessment data and determines appropriate nursing diagnoses and nursing actions. Assigns most ill or unstable client to person most qualified to care for him or her; should be an RN. Responsible for making decisions regarding client care.