Home Uncategorized Discussion Topic-Ch 6,7

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Discussion Topic-Ch 6,7

Read Chapter 6 & 7. Answer each question one by one.

1. Discuss the importance of effective communication in the personal relationship, the therapeutic relationship, and the relationship within the interprofessional health-care team.

2. What similarities and differences can you identify among the above interactions?

3. Explain the concept of congruence between verbal and nonverbal communication.

4. There are many pitfalls to electronic communication. Identify a situation in which an electronic form of communication may result in miscommunication. What other methods of communication would have been more effective?

5. How have you seen ISBAR used during your clinical experiences?

6- Develop a hand-off report for yourself. Include items that you believe are pertinent for safe and effective nursing care. Refer to the information in the chapter for creating this report form. Using the information from the chapter, determine the effectiveness of the system currently in use on your unit for communicating shift-to-shift reports.

7-Dr. Roberts comes into the nurses’ station demanding, “Where are Mr. Adams’s lab reports? I ordered these stat, and they’re not here! Who’s responsible for this patient?” How would you, as the nurse, respond?

8-Explain the concept of accountability in the delegation. What are the legal ramifications of accountability in the delegation?

9. Dennie and Elias arrive in the unit for the 7:00 p.m. to 7:00 a.m. shift. Both nurses completed orientation 4 weeks ago. They find that they will be the only two RNs on the floor that night. There is a census of 48 clients. The remaining staff consists of two NAPs/UAPs and one LPN. What are the responsibilities of the RN, NAP/UAP, and LPN? Can Dennie and Elias effectively delegate client care tasks and care safely for all 48 clients? Use the Delegation Tree to make your decisions.

10. Discuss the differences between direct delegation and indirect delegation.

1. You have to observe delegation procedures in your assigned unit:

A-What considerations does the RN take into account when delegating patient care?

2-You have to look at the unit census and prioritize patient care:

A- Give the rationale for your choices.

3.Answer the following questions during your clinical experiences:

a. What specific tasks did your patients require that you might have been able to delegate?

b. How effective was your nurse/preceptor in delegating tasks to others?

c. How did your nurse/preceptor ensure that the tasks were completed safely and appropriately?

Communicating With Others and Working With the Interprofessional Team
Chapter 6

Communication
Giving information is only a small part of communication.
Occurs on several levels
Involves different factors
Requires active listening skills

Factors Affecting Communication
Emotional state of individuals
Outside distractions
Cultural background
Superficial listening
Individual attitudes regarding the content of the communication

Assertiveness in Communication
Allows people to stand up for themselves
Respects the rights of others
Clearly states an individual’s position
Uses “I” statements
Assumes a greater importance in the interprofessional environment

Interpersonal Communication
Most daily communication falls into this category.
Interactions that occur on a personal level
Process that gives individuals the opportunity to construct personal knowledge
Used to establish relationships
Differs from general communication

Interpersonal Communication (cont’d)
Occurs on a more intimate level
Systematic process
Individuals hold a specific role within the communication
Dynamic and ongoing process

Transactional Models of Communication
Differ from earlier linear models
Consider all individuals communicators
Allow that communication among and between individuals occurs simultaneously
Acknowledge that “noise” occurs in all interactions
Include the concept of time

Barriers to Communication Among Health-Care Providers and Health-Care Recipients

Challenges
Low health literacy
Cultural diversity
Cultural competence of health-care providers
Lack of interprofessional communication education among providers

Electronic Forms of Communication

Information Systems
Communication through the use of health documents
The Health Information Technology for Economic and Clinical Health (HITECH)
Electronic Medical Records (EMRs)
Electronic Health Records (EHRs)

Advantages of EMR
Track data over time
Identify which patients need preventive screenings or checkups
Monitor patient status
Evaluate and improve overall quality

Advantages of EHR
Documents are shared among varying institutions/individuals
Focus on the total health of a patient
Provide a more inclusive view of a patient’s care over time
Designed to share information with other health-care providers
Assist in maintaining patient confidentiality

E-mail
Used both within and outside of organizations
Same communication principles that apply to traditional letter writing apply to e-mail
Requires good writing skills
Rules in the workplace different from personal e-mail

Text Messaging
Evolved as a quick method of communication
Brief informal method
No “texting rules”
Business consultants predict that this communication method will evolve
Important to follow the same rules that apply to e-mail

Reporting Patient Information

Hand Off Communications
Previously referred to as “change of shift” report in nursing
Move toward an interprofessional team philosophy has changed the way reports are given
Ensures continuity of care from one area to another
Part of the TJC “National Patient Safety Goals”

Communicating With the Health-Care Provider
Communicate changes in patients’ conditions.
Share pertinent information.
Discuss modifications in the treatment plan.
Clarify orders.

Before Calling the Health-Care Provider
Have all the information available.
Be prepared to provide general assessment information.
Pertinent information
Most recent vital signs and trends
Laboratory values
Medications and times the patient received the most recent dose

After Calling the Health-Care
Provider
Document time of the call in the patient record.
If the health-care provider needed to return the call, document the time the call was returned in a health-care provider call log.
Follow the chain of command if a call is not returned within an appropriate amount of time.

ISBARR
Introduction
Situation
Background
Assessment
Recommendation
Read-back

Health-Care Provider Orders
Written
Telephone
Fax
EMR orders

Teams

Purpose
Bring professionals together
Common goal: quality patient care
Collaborative focus

Teamwork
QSEN definition
The ability to “perform effectively within nursing and interprofessional teams, fostering open communication, mutual respect, and shared decision making to achieve quality patient care.”

(http://qsen.org)

Learning to Become a Team Player
Recognize that every member brings value to the team.
Treat each team member with dignity and respect.
Understand the role of each team member.
Support each other in achieving the team’s goals.

Building a Working Team
Identify the team players.
Make sure the team members understand the goals and are committed to achieving the outcomes.
Act as a role model and exhibit expected behaviors.

Interprofessional Collaboration and the Interprofessional Team

Interprofessional Collaboration
“Occurs when multiple health workers from different professional backgrounds work together with patients, families, caregivers, and communities to deliver the highest quality care.”
(WHO, 2010)

Components of Collaboration
Sharing
Partnership
Interdependency
Power

Interprofessional Communication
TJC attributes a high percentage of sentinel events to breakdowns in communication among health-care providers.
Core competency for interprofessional collaborative practice
ISBARR
Team STEPPS

Team STEPPS
Leadership
Situation
Monitoring
Mutual support
Communication

Building an Interprofessional Team
Communicate through conferences.
Focus on the needs of the patients and/or clients.
Each member has roles and functions that contribute to patient care.
Each member contributes and the contributions are valued.
Monitor and/or evaluate effectiveness of team goals.

Methods for the Hand-Off Report
Traditional face-to-face
Audiotape
Computer reporting

Conclusion
Communication skills are needed to deliver safe, quality, and effective patient care.
TJC, IOM, QSEN, and MAGNET promote interprofessional communication.
Use of Team STEPPS and IBARR promote interprofessional team work and communication.

Delegation, Prioritization, and Decision Making
Chapter 7

Delegation of Client Care: Definition
The reassigning of responsibility for the performance of a job from one person to another.
(ANA, 1996)

Concepts of Delegation
The responsibility of the task is transferred.
Accountability remains with the delegator.
Delegation may be direct or indirect.

Direct Delegation
Usually verbal direction
RN decides which staff member is capable of performing a specific task.

Indirect Delegation
Contained in an approved listing of tasks established by an institution
Permitted tasks may vary from institution to institution

Assigning Tasks
The RN may assign a more skilled individual to perform a task.
The RN may not assign an individual to perform an activity outside a job description or the scope of practice.

Delegation vs. Supervision

Supervision
Supervision is usually more direct than delegation.
It requires directly overseeing the work or performance of others.
It includes checking with individuals during the day.
It may entail delegation of tasks and activities.
The nurse manager performs both.

The Nursing Process and Delegation

Assessment
Assess client needs.
Set client-specific goals.
Match the personnel with the appropriate skills to care for the client.

Planning
Mentally identify who is best suited for the task or activity.
Planning prevents later problems.

Implementation
Assign the appropriate personnel who have the level of expertise necessary to deliver the care or carry out the activities.

Evaluation
Oversee the care or activities.
Determine if client care needs have been met.
Allow for feedback.

Coordinating
Assignments

Methods to Help Organize Care
Critical pathways
Computerized information sheets
Personalized worksheets
Delegation tree

Tips for Organizing Care
Plan time around activities that must be performed at a certain time.
Perform high-priority activities first.
Cluster activities that may be performed together.
Consider your peak time when performing optional activities.

The Need for Delegation

Changes in the Health-Care Environment
Nursing shortage
Health-care reform
Increased need for nursing services
Demographic trends
Use of unlicensed assistive personnel

Unlicensed Assistive Personnel (UAPs)
Individuals trained to function in an assistive role to the nurse
Perform delegated tasks
Under direct supervision of the RN
May or may not be certified

Delegation to UAPs

Examples of Tasks
Vital signs
Skills learned through special training
Blood drawing
ECGs
Measuring intake and output
Non-nursing duties

Safe Delegation

Criteria for Safe Delegation
Potential for harm
Complexity of the task
Problem-solving and innovation necessary to complete the task or activity

Considerations for Safe Delegation
Ability of the individual
Fairness of the task

Guidelines for Delegation

https://www.ncsbn.org/delegation_grid_NEW

https://www.ncsbn.org/contcaregrid

https://www.ncsbn.org/Working_with_Others

Task-Related Concerns

Primary Concern
Does the individual assigned to the task have the ability to perform the task?

Other Task-Related Concerns
Ability
Priorities
Efficiency
Appropriateness

Relationship-Oriented Concerns
Fairness
Learning opportunities
Health
Compatibility
Preferences

Summary of Expectations of Professionals
Respect of others
A reasonable workload
Appropriate wages
Determining his/her own priorities
Ask for what he/she wants
Accountability
Give and receive information as a professional

Barriers to Delegation

Barriers
Experience
Licensure
Quality of care
Assigning work to others

The Five Rights of Delegation
Right task
Right circumstances
Right person
Right direction/communication
Right supervision/evaluation

Conclusion

Points to Consider
Delegation is not new.
The role is essential for good working relationships.
Organizational skills are a prerequisite for delegation.
Understanding client needs is essential for appropriate delegation.

The RN Needs to Understand
The State Nurse Practice Act
The capabilities of each staff member
The tasks that may be delegated
The concept of accountability in delegation

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