THERAPEUTIC COMMUNICATION

 

Therapeutic communication

Introduction

The therapeutic relationship between nurse and client is the hallmark of psychiatric nursing. In 1952, the publication of Interpersonal Relations in Nursing, by Hildegard E. Peplau, essentially revolutionized the teaching and practice of psychiatric nursing in the United States. At a time when the introduction of psychotropic medications was changing the treatment of psychiatric illness, Peplau emphasized the interpersonal relationship of the nurse and client.

The Nurse–Client Relationship

The nurse–client relationship is the context in which the nursing process occurs and is the primary means of providing nursing care. This is true for all nursing practice, not just psychiatric nursing. Ac- cording to Peplau, nursing’s unique focus is the reactions of clients to the circumstances of their illness or health situation. Illness provides an opportunity for learning and growth. The nurse, through careful observation and thoughtfully guided communication, assists the client to identify needs and develop new intellectual and interpersonal skills. The competency of the nurse will substantially affect the quality of the client’s experience and the outcome of care. Nursing competence goes beyond the mastery and application of scientific knowledge and technical skills. The vehicle for all nursing action is the nurse–client relationship, and it is the basis for a successful and fulfilling nursing practice as well as for all nursing actions.

  Characteristics of the Therapeutic

Nurse–Client Relationship

All intentional interactions with clients that are helpful are considered therapeutic. However, not all nurse–client interactions constitute a relationship. A relationship exists between the client and the nurse only when they become significant to each other. If it is achieved, the relationship becomes therapeutic. There are several characteristics that define the therapeutic nurse–client relationship. They include the following:

◆      To be therapeutic, the nurse–client relationship must be based on mutual respect.

◆      The relationship is client focused and designed to meet the client’s needs. The emotional needs of the nurse cannot interfere with this process.  The interactions are goal oriented.

◆      Goals are mutually established by both the client and the nurse.

◆      The relationship is collaborative, with both the client and the nurse contributing to the healing, growth, and problem solving.

◆      The client and nurse engage in shared decision making.

◆      The relationship promotes the client’s independence to the maximum extent possible. The nurse works with the client and does not do for the client.

◆      The relationship promotes the expression of the client’s feelings.

 

Essential Characteristics of the Nurse in a Therapeutic Relationship

 Several qualities are recognized as significant to the development of a helping relationship.

  Respect

Psychologist Carl Rogers (1951) referred to respect as unconditional positive regard or the ability to accept another’s beliefs even if they differ from one’s own feelings and beliefs. This concept is the foundation for an accepting and nonjudgmental attitude. It communicates to clients that their personal beliefs and values are important. The nurse does not need to agree, but, at the same time, does not impose personal values on the client. Rather, the nurse attempts to understand the client’s perspective. When the client feels understood, a rapport or affinity develops between the client and the nurse. An accepting and respectful attitude is likely to promote client comfort and facilitate the client’s honest expression of symptoms, beliefs, thoughts, feelings, and concerns.

Ways to foster respect include asking clients how they prefer to be addressed, spending time with the client, being honest in all communications, providing for privacy, maintaining confidentiality, collaborating with clients on treatment planning, providing information, and answering questions.

Trust

Trust is the foundation of all interpersonal relation- ships and the first task in Erikson’s developmental hierarchy. The client’s ability to trust will be influenced by how well this developmental task was accomplished during early interactions with parents and caregivers. In describing trust, Erikson (1963) used the terms consistent, familiar, and predictable. The client needs to know that the nurse is reliable, honest, and dependable. Trust is particularly important, given the vulnerable position of clients with health- care needs. Trust does not happen immediately but evolves or, more correctly, is earned over the course of the relationship. Every interaction with the nurse will either support or shake the development of trust on the part of the client. Nurse actions that promote trust include following through on promises, showing kindness, treating the client fairly, and presenting a confident manner.

Genuineness

The nurse’s ability to be oneself, or to be real, when interacting with clients is referred to as genuine- ness. By acting in a genuine way, the nurse helps the client to see the shared humanity between client and nurse. Genuineness implies congruence between what the nurse is feeling and the expression of that feeling. The nurse must learn appropriate use of self- disclosure. The nurse would not share all personal experiences, even if relevant, nor would the nurse express judgments that are critical of the client or the client’s values. Still, there are many ways that the nurse can show his or her humanity when interacting with the client. The nurse may laugh at a funny joke told by the client or express understanding about a difficulty the client is having, or share that the nurse finds meditation to be a helpful form of relaxation. A novice nurse may try to disguise his or her inexperience from the client out of concern that the client will think less of the nurse. In fact, clients can easily detect a lack of genuineness and are more likely to respect the nurse for honestly acknowledging limitations. The quality of genuineness, or the authentic representation of the self, will greatly enrich the nurse–client experience.

Empathy

Empathy is the ability to put oneself in another’s place and see the world as the other person does. This objective understanding of the client’s emotions allows the nurse to be sensitive to the client’s feelings without experiencing the emotions. This is in contrast to sympathy, a subjective experience, in which there is an actual sharing of experienced emotions. Sympathy can interfere with the nurse–client relationship in a couple of ways: the nurse can become overwhelmed by the emotions and be unable to help the client; the nurse who shares an experience with the client as a way of saying “I know how you feel” risks shifting the focus of the interaction away from the client. The nurse’s intention may be to support the client, but the action is not effective. Empathy promotes sensitivity to the client’s feelings and needs. The nurse must communicate this understanding to the client in a way that the client can understand. This will contribute to the client’s experience of being understood, thus building trust.

Conditions That Influence the Nurse– Client Relationship

   Client Factors

Religion and Culture

Styles of communication vary across cultures and religions. It is helpful for the nurse to be familiar with the beliefs, values, customs, and preferences of the groups most often served in the community. Even with knowledge of general beliefs and practices, the nurse should not assume that the client fits that expectation. Therefore, the nurse should clarify personal preferences with each client. Consideration should be given to the proper pronunciation of the client’s name, the need for an interpreter, the role of the family, and preferences or religious requirements regarding interaction with persons of the opposite gender. Cultural variances may include the use of eye contact, the acceptable distance between persons while communicating, posture, and other nonverbal communication. The nurse needs to be sensitive to these differences and respectful to the client.

          Age or Developmental Level

The nurse must have knowledge of the client’s developmental level and be aware of the client’s ability to communicate. This understanding will shape the way the nurse relates to the client. Communication must be appropriate to the client’s level of comprehension. The nurse will need to be aware of the client’s nonverbal communication and open to alternative ways of communicating, such as play. Children can express feelings, fears, and concerns through play.

 

Nurse Factors

Self-Awareness

Self-awareness literally means understanding the self. The nurse has a responsibility to examine personal feelings, thoughts, behaviors, attitudes, and intentions. This ongoing monitoring requires openness and an ability to be self-critical. The nurse’s emotional responses and actions have a significant impact on the client. The nurse must be sensitive to this effect. Self-awareness allows the nurse to separate personal feelings from the client’s responses. This ability to control and manage personal emotions and respond appropriately to others is called emotional competency or emotional intelligence. The personal growth that comes through self-awareness will enrich the therapeutic relationship.

Boundaries

Boundaries are limits that help establish and maintain the nurse and client roles in the relationship. To be truly helpful to clients, nurses need to under- stand the difference between professional and social relationships. Social relationships are interactions in which the needs of both persons are of equal importance. In contrast, professional relationships are those in which the needs of the client are paramount. This principle guides the nurse’s decisions on handling difficult situations with clients.

 

Self-Disclosure. 

One area of boundaries involves self-disclosure. 

Self-disclosure refers to revealing personal information about oneself, with the goal of benefiting the client and the therapeutic process.  It is not always easy to know if the information will help the client.  Self-disclosure can reverse the nurse–client dynamic and sever the client from the role of  information giver. The focus of the nurse–client relation- ship is always the client. With experience, the nurse is better able to determine what information may be shared without compromising the relationship. In the following example, the nurse balances genuineness with maintaining a professional relationship.Selfdisclosure is a controversial intervention that should only be used to benefit the client and the therapeutic process, never for selfish reasons.Example: 

Client: “I think I have to place my mother in a nursing facility. She is becoming very forgetful and needs help with her personal care. What do you think I should do?”Nurse: “That is something you will have to decide. I have an elderly parent, and I can imagine how difficult this is for you.”

The nurse should never reveal intimate information or answer questions that raise feelings of discomfort.

Example: Client: “May I have your phone number so I can stay in touch after I leave the hospital?”Nurse: “I cannot give my phone number. Are you concerned about who to call if you have questions or concerns after you are discharged?”In this example, the nurse appropriately refuses to give personal information and counters the client’s possible feelings of rejection by showing concern and a willingness to help. Because decisions about what information is appropriate to share with the client are difficult, the nurse should seek guidance from an experienced nurse or colleague. One piece of information important to disclose to the client to protect the client’s rights is the nurse’s name, title, and position. As mentioned earlier, students and beginning practitioners may be reluctant to divulge their novice status. Clients, however, may pick up on an interviewer’s newness. Thus, denying that you are new in the field may cause a lack of trust. Clients who seem distressed by the nurse’s lack of experience should be encouraged to discuss this with the nurse and may be referred to the nurse’s supervisor for reassurance if necessary. Psychiatric clients who have had previous experience with new nurses and students often come to expect this as the norm; certain clients actually take pride in “training” new nurses.

Touch.

The use of touch is another area that is influenced by the importance of maintaining appropriate boundaries. Touch is commonly used to convey caring, provide comfort, or offer support. Touch is essential to carry out physical care or treatments. However, touch can be interpreted differently by clients, and at times may be misinterpreted. Touch may not be welcomed based on cultural or religious preferences. Clients who are experiencing paranoia or psychoses may be threatened by touch, and clients with sexual preoccupation may misinterpret the nurse’s touch as sexual. Inpatient settings often have a general rule of no touching as a way of reducing incidents related to such misinterpretations. This rule is helpful to students and novice practitioners, since it often takes experience to recognize when touch can present serious risks. In the absence of a rule,

 

Communication Techniques

Active Listening

Active listening is an interactive process between the nurse and the client with the goal of under- standing and being understood, involving hearing the message, understanding the message, and giving feedback about what was heard.

2.Nonverbal Techniques

o   Facial Expression

o   Eye Contact

o   Posture

3.Verbal Techniques

COORDINATING CARE

 
 

TEAMWORK IN NURSING

Nurses are employed to care for sick or wounded patients. But when nurses band together for the good of their patients, their care is twice as effective.

Today's health systems are made of skilled, multigenerational, and culturally diverse work forces. And even though each specialty has a specific focus, you all share a common goal. That goal is to provide the best patient care experience in a positive work environment. The best way to accomplish that goal is with teamwork.

Teamwork requires good communication and a collaborative care strategy. All team members want to feel that their ideas and skills are valued.

Team members should be encouraged to ask questions, share ideas or concerns, and discuss potential solutions. Each person's strengths and skills must be utilized to provide the best possible patient care experience and improve job satisfaction.

According to a report by The Society for Human Resource Management, teamwork is closely associated with higher job satisfaction. And a study published in the National Library of Medicine said, Nurses who are more satisfied with their jobs provide better care.

Trustworthiness is essential for teamwork, and the best way to grow trust is to get comfortable with one another. It’s crucial to build relationships and understand how each member of the team functions.

Team members have their own individual feedback, suggestions, and questions. Therefore, active listening is an important aspect of team operations.

When many health care professionals collaborate and brainstorm about a patient's care, the workload is distributed more evenly and stress is reduced.

Educational institutions are emphasizing the importance of teamwork and communication early to build a stronger foundation for successful healthcare outcomes.

Regis college published an article that said, mutual respect is critical in health care settings, not just within the team but across collaborative departments. Team members who are not feeling respected can become defensive, foster hidden agendas, demonstrate a lack of engagement, and worse. Building mutual respect comes through a common, focused goal; an understanding that each individual’s work is valuable and an acknowledgment of the efforts of others.

Patients must be part of the communication process too. Their early and thorough involvement has been shown to minimize errors and potential adverse events, according to an article published in the National Library of Medicine.

When everyone is working together as a team to accomplish a common goal, patient care improves and job satisfaction increases. Plus, it’s a happier, more cohesive and productive work environment for everyone involved, including your patients!

Why Teamwork and Communication Are Critical in Nursing

 

In contemporary healthcare settings, it is rare for patients to be under the care of only one provider. Instead, an interdisciplinary team of healthcare professionals delivers patient care, and nurses must have the necessary preparation and skills to work as part of a team.

 

Patient care today is more complicated than ever due to an increasingly large aging population that has one or more chronic conditions such as diabetes, cancer, arthritis, Alzheimer's or kidney disease. Because these illnesses are complex, there is a need for specialized care, which has resulted in a multidisciplinary approach to treating patients.

With teams made up of different nurses, physicians and other healthcare professionals, it is important that they clearly and effectively communicate with one another to build strong work relationships, share resources and solve problems. Healthcare team members focus on patient-centered care by doing the following:

 

   ·         Cooperating with one another

·         Exchanging information

·         Integrating electronic medical records

·         Providing timely informed consent

 

How Does Teamwork Help Patients?

When teams coordinate care, they decrease the level of stress patients may experience and positively affect outcomes. In addition, teamwork may reduce the number of issues related to burnout in nurses. As team members, nurses are not the sole providers of care so they do not carry the entire responsibility for a patient's health. They have the support of their teammates to help them make decisions.

According to the study "Multidisciplinary In-Hospital Teams Improve Patient Outcomes: A Review," teams that consist of nurses, physicians and other staff can reduce morbidity rates while increasing patient and healthcare worker satisfaction. By working cohesively in an effective manner, healthcare teams can accomplish the following goals:

·         Enhance patient safety.

·         Improve clinical performance.

·         Cut down on medical errors.

·         Ease patient concerns about treatments and procedures.

·         Raise efficiency and lower healthcare costs.

What Listening Skills Help Nurses with Patient Assessments?

The healthcare team relies on solid patient assessment for planning a course of action. For nurses to gather the necessary patient information, they have to be good listeners. To properly assess patients, skilled nurses use the following listening skills:

·         Stay relaxed.

·         Make eye contact.

·         Smile.

·         Sit at the bedside facing the patient.

·         Refrain from making judgements or criticizing the patient.

·         Keep from interrupting patients while they are talking, and wait for pauses to ask questions.

·         Repeat back to patients what they have said.

What Communication Skills Do Nurses Need?

It is imperative that nurses competently communicate with team members. Great communication skills include:

·         Active listening

·         Awareness of nonverbal cues

·         Confidence

·         Flexibility

·         Constructive feedback

·         Honesty and courtesy

·         Empathy

·         Verbal clarity

 

 

 

 

 

Leadership in nursing

 

 Leadership has been illustrated in the nursing literature as a difficult and multifaceted process. It includes providing direction and support, motivating, coordinating, collaboration, effective communication, and advocating for patients to achieve optimal patient outcomes. In nursing, leadership is showing the followers how things are done, guiding their way, and the course of actions.

Additionally, nurses as part of the health intra disciplinary team must be capable of leading in this era of high patient acuity, fast paced, and highly complex environment. The Institute of medicine(IOM) states that nurses must be able to lead inter professional teams and healthcare systems. Furthermore, studies conducted on nursing leadership have shown the effectiveness of leadership in a nursing role on patient outcomes such as patient safety. According to O’Connor “effective communication is central to leadership in clinical settings” . Nursing leadership has been defined as influencing others to improve the quality of care along with the direct participation in clinical care .

Leadership in nursing involves an environment that has a clear vision, and where staff are motivated and empowered. Nursing leaders are agents who have followers in the healthcare team. According to Cook and Holt, nursing leadership is about having a vision and empowering staff. They also added that nurse leaders must have skills, such as self-confidence, valuing others, and being able to build teams effectively. Similarly, Lett defined nursing leadership as providing followers with a vision and empowering others. Leadership is contained in the professional nursing role and practice, as all nurses’ roles are leadership roles. However, most often nursing leadership is linked to nurse executives and is less often connected to bedside nursing practice.

In nursing literature, until recently, the leadership phenomenon has reflected the general leadership. That is leadership is defined in terms of an interactive process where followers are motivated and empowered to accomplish specific goals. Nevertheless, leadership is not merely linked to top management levels, but it can be developed and implemented at bedside for nurses. Thus, acquiring clinical leadership skills is crucial for nurses who provide direct patient care. This allows nurses to direct and support patients and healthcare teams when providing care 

 Nursing clinical leadership

Nursing clinical leadership skills focus on clients and healthcare teams such as those advocating for patients, communicating with the healthcare team, patients, and their families; compared to individuals reporting to and working with a nurse in a formal leadership position. In fact, the nursing profession is very autonomous where it requires nurses to make decisions and take responsibility for their actions. Nurses are at the first level of decision-making, and granting them independence in this area will help them to form the foundations of leadership in the nursing role.

Nursing leadership at the patient bedside is a new area of research. The IOM report discussion increased the interest in clinical leadership at clinical settings due to the emphasis on a nurse’s fundamental role in maintaining patients’ safety. Additionally, this report stated that nurses are instrumental in providing effective communication between various healthcare disciplines and assuring patient care continuity. Clinical leadership skills focus on patients and healthcare teams rather than formal leadership positions.

According to Patrick et al.  clinical leadership is defined as “staff nurse behaviors that provide direction and support to clients and the healthcare team in the delivery of patient care. A clinical leader is a registered nurse who influences and coordinates patients, families and health care teams for the purpose of integrating the care they provide to achieve positive patient outcomes” . Based on this definition, all registered nurses are clinical leaders, particularly nurses at the bedside. However, in nursing literature, the concept of nursing clinical leadership is usually associated with nurse executives and formal leadership roles. In fact, nursing leadership is rarely linked to bedside nursing practice leaders. Cook defined a clinical leader as “a nurse directly involved in providing clinical care that continuously improves care through influencing others” . According to Harper, a clinical leader is “one who possesses clinical expertise in a specialty practice area and who uses interpersonal skills to enable nurses and other health care providers to deliver quality patient care” . According to Patrick et al., five characteristics define clinical leadership skill as follows: clinical expertise, effective communication, collaboration, coordination, and interpersonal understanding. Clinical leaders are experts in their field, effective communicators, empowered decision makers, clinically knowledgeable and competent, provide a vision, support others, provide guidance to patients and their families, and drive change by providing high-quality care.

Furthermore, Stanley defined a clinical leader as “a clinician who is an expert in [her or his] field, and who, because they are approachable, effective communicators and empowered, are able to act as a role model, motivating others by matching their values and beliefs about nursing and care to their practice” . All of these definitions demonstrate that clinical leadership can be at the bedside and clearly does not need to be linked or limited to management or senior levels.

Thus, the concept of nursing clinical leadership relates to nursing professional activities, which provide direct care at bedside, which differs from the traditional nursing leadership notion. Clinical leadership is illustrated by the nurse leader’s actions at the bedside through professional nursing practice utilizing their clinical skills and also by demonstrating therapeutic relationship between the nurse and patients and the healthcare practitioners. Nurses are accountable for their patients, so it is crucial for nurses to provide constant observation and assessment of patients, to set priorities, work effectively, and efficiently to recognize critical situations, which may necessitate the nurse to monitor the patient closely. Nurses must also make clinical decisions about a required intervention; or, if needed, communicate with other healthcare team members for assistance, support, or guidance; or call the primary healthcare provider. Hence, it is essential that bedside nurses acquire leadership skills to improve patient outcomes and safety through the care provided.

Nurses are considered leaders in providing patient care, as leadership is a key part of effective nursing care. Nurses are the frontline of healthcare delivery, thus, they are pivotal to providing safe, high-quality care, and assuring positive patient outcomes. Nurses direct, support, and coordinate healthcare teams, families, and patients to maintain patients’ health. In fact, nurses are required to be resilient and acquire effective communication skills, such as the capability of influencing others to achieve a shared objective and working toward change.

Nursing clinical leadership includes critical thinking, decision making, action, and advocacy. Nurses in their role at the bedside demonstrate clinical leadership skills by providing, facilitating, and promoting the best possible care for their patients. In addition, nurses at the clinical practice when providing direct client care are expected to show leadership skills when collaborating with healthcare teams. Therefore, there is need for functional nursing clinical leadership at all levels and domains of nursing practice to assure effective collaboration of group to ensure highest quality of care provided.

The impact of nursing clinical leadership

Nursing clinical leadership is crucial for various reasons. First, clinical nurse leaders play a critical role in sustaining the efficiency, production, and cost-effectiveness of nursing services. Effective clinical leadership skills empower nurses while providing care with the abilities to direct and support patients and healthcare teams. It also improves the care delivered to patients, which in turn improves patient outcomes. In addition, clinical nursing leadership impacts the safety and quality of care provided. It is indeed vital to highlight the influence that nursing clinical leadership has on patient outcomes. Nurse leaders consider patients’ safety as a priority while performing nursing care such as medication management, wound care, infection control, and patient education to achieve optimal patient outcomes.

In their systematic review, Wong et al.  found a relationship between nursing leadership practices and patient outcomes. Their findings indicated that effective leadership has been associated to reduced length of stay, lowering rates of medication errors, patient falls, urinary tract infections, and pneumonia. Additionally, the nursing literature proposes that clinical leadership improves the quality of care provided, patient outcomes, and lower patient mortality. Nurses who possess clinical leadership skills influence the clinical setting and improve patient safety. Thus, it can be said that clinical leadership serves to achieve safe care and optimal patient outcomes, which emphasizes its importance.

 Characteristics of effective nurse clinical leaders

 

A successful nurse clinical leader is one who is a critical thinker, lifelong learner, and open to new ideas. The nurse clinical leader must be knowledgeable, maintain professional growth, and stay current in the profession. In fact, they should be clinically competent and clinically knowledgeable. In addition, leaders must have a vision, the art of knowing how to elect the best from others. In short, thriving leaders make others do their best to accomplish the intended outcome. An effective leader demonstrates confidence, as it is a key leadership skill. Knowing what needs to be done, being proactive and approaching every patient with a confident and competent attitude to improve patient outcomes.

Furthermore, motivating people toward goal-directed behavior, which in turn contributes to the interest of the organization is of crucial importance. The leader should be able to communicate clearly and effectively. Being a good listener is a valuable attribute, as patients and colleagues may talk to the nurse and ask for guidance. Effective leaders use problem-solving processes by being solution-focused to improve a situation. The nurse clinical leaders should be empowered decision makers utilizing evidence-based research to make clinical decisions. Additionally, the effective nurse clinical leader must be authentic by recognizing the strengths and weakness of self and others. This will allow clinical nurse leaders to demonstrate integrity while delivering care through making sound decisions that will create added value to the healthcare team.

An effective nurse clinical leader possesses self-awareness, which means knowing how to read one’s own feelings and how they can affect others. For example, if a nurse is taking care of a patient in a pediatric unit and the mother expresses her concerns that her child did not receive a standard treatment when the nurse had already provided the treatment. The nurse may have mixed emotions such as irritation or anger. In this situation, it is crucial that the nurse identifies these emotions and considers how expressing them would influence the situation. The nurse can recognize her/his feelings by keeping a journal, meditating, or exercising. Additionally, the nurse clinical leader should be accountable, as it will result in better performances.

Time management is also an important skill that the nurse clinical leader should possess in order to organize, plan, and prioritize daily tasks and responsibilities that need to be accomplished for patients. They are also dynamic, empathic, caring, and passionate about their patients’ needs and values. In addition, effective nurse clinical leaders have the ability to nurture, inspire others, seek maximum standards, and maintain high-quality benchmarks. An effective nurse clinical leaders’ performance positively influences the outcomes of the healthcare organization. It also improves the quality of care provided to the patient, which in turn affect quality outcomes.

Successful nurse clinical leaders are highly motivated, committed to organizational vision, mission, and goals, and thus deliver patient care with greater effectiveness.

 A clinical nurse leader must be highly committed and focused on teamwork in order to accomplish a common goal. She/he should start with a clear understanding of the destination that the team wants to achieve. An effective nurse clinical leader must develop skills of collaboration, delegation, and conflict resolution that will facilitate her/his work within teams. Successful nurse clinical leaders are honest, trust worthy, and respectful.

Furthermore, nurse clinical leaders are an advocate for patients by providing and promoting the best possible available care. The effective nurse clinical leader will act as a liaison between patients and healthcare teams in advocating for the rights and welfare of patients and by emphasizing the importance of a safe health setting for providing care. The nurse clinical leader will also challenge poor practices and assist patients’ access to appropriate healthcare information and allow them to be engaged in decision making of their care. These characteristics are critical for nurse clinical leaders to have, as it will help them to be successful and provide high quality care. Nurses must apply these characteristics to their profession to gain trust and respect of healthcare members and patients, which will in turn direct the development of nursing clinical practice.

DELEGATION

Definition

 Delegation generally involves assignment of the performance of activities or tasks related to patient care to unlicensed assistive personnel while retaining accountability for the outcome. The registered nurse cannot delegate responsibilities related to making nursing judgments. Examples of nursing activities that cannot be delegated to unlicensed assistive personnel include assessment and evaluation of the impact of interventions on care provided to the patient. Delegation involves “the transfer of responsibility for the performance of a task from one individual to another while retaining accountability for the outcome. Example: the RN, in delegating a task to an assistive individual, transfers the responsibility for the performance of the task but retains professional accountability for the overall care”

 

Principles for Delegation

•     The following principles provide guidance and inform the registered nurse’s decision-making about delegation:
• ·         The nursing profession determines the scope and standards of nursing practice. The RN takes responsibility and accountability for the provision of nursing practice.
• ·         The RN directs care and determines the appropriate utilization of resources when providing care.
• ·         The RN may delegate tasks or elements of care but does not delegate the nursing process itself. The RN considers facility/agency policies and procedures and the knowledge and skills, training, diversity awareness, and experience of any individual to whom the RN may delegate elements of care.
• ·         The decision to delegate is based upon the RN’s judgment concerning the care complexity of the patient, the availability and competence of the individual accepting the delegation, and the type and intensity of supervision required.
• ·         The RN acknowledges that delegation involves the relational concept of mutual respect. Nurse leaders are accountable for establishing systems to assess, monitor, verify, and communicate ongoing competence requirements in areas related to delegation.
• ·         The organization/agency is accountable to provide sufficient resources to enable appropriate delegation.
• ·         The organization/agency is accountable for ensuring that the RN has access to documented competency information for staff to whom the RN is delegating tasks. Organizational/agency policies on delegation are developed with the active participation of registered nurses

 

Care Provision

 To determine if delegation is appropriate, the registered nurse will

               1.    Perform an assessment of the healthcare consumer’s:

 ·         Care needs and determine if any cultural modifications are required

  ·         Condition to determine if it is stable and predictable c. Environment where care will be provide.

2.    Develop a plan of care with the healthcare consumer and his/her family, identifying the delegable task and intended outcome as part of the overall plan of care. Involving and educating healthcare consumers and their families about appropriate expectations of the roles of care providers promotes a safer environment and improved patient outcomes.

 The plan of care should include:

 

·         Baseline status of the healthcare consumer

·         Specific unchanging task performance steps

·         When and to whom the UAP need to report if the baseline status is changed

·         Documentation of expectations as appropriate

 

           3. Analyze the following:

·         Is the task within the delegating RN’s scope of practice?

·         Are there federal or state laws, rules, or regulations that support the delegation?

·          Does the employing organization/agency of the delegating RN and the UAP permit the delegation?

·         Is the delegating RN competent to make the delegation decision?

·         Is the UAP competent to perform the delegated task?

·         Is RN supervision of the UAP available?

 

3.    Monitor implementation of the delegated task as appropriate to the overall plan of care.

 

·         Evaluate overall condition of the healthcare consumer and the consumer’s response to the delegated task.

 

REFERENCE

 

·         American Nurses Association. (2001). Code of Ethics for Nurses with interpretive statements. Washington, DC: American Nurses Publishing. American Nurses Association. (2005).

·         Principles for delegation. Silver Spring, MD: Nursesbooks.org. American Nurses Association. (2010a). Nursing: Scope and standards of practice, 2nd ed. Silver Spring, MD: Nursesbooks.org.

·         https://www.intechopen.com/books/contemporary-leadership-challenges/leadership-in-nursing

·         http://blog.diversitynursing.com/blog/teamwork-in-nursing