Delegation of Nursing Care

by Kelly, Patricia; Marthaler, Maureen T

• ISBN13: 9781401814052
• ISBN10: 1401814050
• Edition: 1st
• Format: Paperback
• Copyright: 2004-08-02
• Publisher: CENGAGE Delmar Learning

Summary

The long standing nursing shortage has prompted many institutions to rely on nurses to delegate critical tasks. Delegation of Nursing Care establishes safe delegation as an indispensable skill in delivering quality patient care. The book discusses the demanding roles of a professional nurse and explores the elements of decision making nurses use most. It also highlights the importance of communication, time management, and accountability, and is designed to build the diverse skills needed in the world of nursing.

Author Biography

Patricia Kelly-Heidenthal earned a Diploma in Nursing from St. Margaret Hospital School of Nursing, Hammond, Indiana; a baccalaureate in nursing from DePaul University in Chicago, Illinois; and a master's degree in nursing from Loyola University in Chicago, Illinois. She has worked as a staff nurse and as a school nurse. Pat has traveled extensively, teaching conferences for the Joint Commission on Accreditation of Healthcare Organizations. She was director of quality assurance for nursing at the University of Chicago Hospitals and Clinics in Chicago, Illinois. Pat has taught at Wesley-Passavant School of Nursing, Chicago State University, and Purdue University Calumet in Hammond, Indiana. She is Professor Emerita, Purdue University Calumet, Hammond, Indiana. Pat has taught fundamentals of nursing, adult nursing, nursing leadership and management, nursing issues, nursing trends, and legal aspects of nursing. She has taught nursing conferences in almost every state in the United States, as well as in Puerto Rico and Canada on quality improvement. Pat also teaches NCLEX reviews nationally with Health Education Systems, Inc., and is a member of Sigma Theta Tau and the American Nurses Association. She is listed in Who's Who in American Nursing, 2000 Notable American Women, and the International Who's Who of Professional and Business Women. Pat has served on the Board of Directors of Tri City Mental Health Center, St. Anthony's Home, and Mosby's Quality Connection. She is the editor and author of Nursing Leadership and Management, Delmar, 2003; Essentials of Nursing Leadership and Management, Delmar, 2004; and she contributed a chapter entitled "Preparing the Undergraduate Student and Faculty to Use Quality Improvement in Practice" to Improving Quality, Second Edition, by Claire Gavin Meisenheimer, Aspen, 1997. Pat has written several articles, including "Chest X-Ray Interpretation" and many articles on quality improvement. Pat is a disaster volunteer for the American Red Cross and volunteers at a church food pantry in Austin, Texas. Throughout much of her career, she has taught nursing at the university level and has continued to work part time as a staff nurse in the Emergency Department. This has allowed her to wear several hats and see nursing from many points of view. Pat currently lives in Austin, Texas, and can be reached at [e-mail]. Maureen T. Marthaler earned a baccalaureate degree in nursing from Lewis University in Romeoville, Illinois, and a master's degree in nursing education from DePaul University in Chicago. She taught at Prairie State College in Chicago Heights, Illinois. Currently, Maureen is an assistant professor at Purdue University Calumet in Hammond, Indiana. Maureen has taught fundamentals of nursing, adult nursing, nursing leadership and management, nursing ethos, and critical care nursing courses. She has taught nursing conferences on various neurological conditions, such as assessment, seizures, Guillian-Barre, Parkinson's Disease, and blood gas assessment. Maureen has also taught NCLEX reviews nationally. She is the treasurer for Mu Omega Chapter of Sigma Theta Tau and is a member of the National League for Nursing. Maureen contributed a chapter on delegation of nursing care to the Kelly-Heidenthal textbook published by Delmar, Nursing Leadership and Management, 2003. Maureen also wrote a continuing education program for Sigma Theta Tau International on delegation. Her most recent publication "SARS: What Have We Learned" in the nursing journal Registered Nurse, was co-authored with her colleagues at Purdue University Calumet. She has traveled to Romania and assisted a nursing school there with curriculum development. Throughout her career, she has continued to work part time as a staff nurse in the Intensive Care Unit at St. Margaret's Hospital in Hammond, Indiana. Maureen has been licensed as an RN for over 23 years. She is married to David, a very supportive husband. She is the mother of two wonderful teenage boys, Luke, 15, and Jake, 13. They live in Crete, Illinois, where Maureen can be reached at [e-mail].

Table of Contents

Contributors	vii
Reviewers	xi
Preface	xiii
Organization	xiv
Chapter Features	xv
Acknowledgments	xvii
About the Authors	xix
List of Patient Descriptions	xxi
Concept of Delegation	1	(28)
Perspectives on Delegation	2	(7)
Delegation	6	(1)
Assignment	6	(1)
Assignment versus Delegation	7	(1)
Supervision	8	(1)
Accountability	8	(1)
Authority	9	(1)
Responsibility	9	(4)
Types of Delegation	13	(3)
Direct Patient Care Activities	14	(1)
Indirect Patient Care Activities	14	(1)
Underdelegation	15	(1)
Overdelegation	15	(1)
Organizational Responsibility for Delegation	16	(4)
Chain of Command	18	(2)
Critical Thinking, Decision-Making, and an Ethics Test	20	(1)
Decision Making Process and Delegation	21	(1)
Case Study	21	(2)
An Ethics Test	23	(1)
Review Questions	23	(1)
Review Activities	24	(1)
Exploring the Web	25	(1)
References	26	(1)
Suggested Readings	27	(2)
Delegation Decision-Making Grid and the Five Rights	29	(24)
The National Council of State Boards of Nursing (NCSBN) Delegation Decision-Making Grid	30	(2)
The Five Rights of Delegation	32	(3)
State Boards of Nursing	35	(1)
Knowledge and Skill of Delegation	35	(1)
Power	35	(5)
Delegation Responsibilities of Health Team Members	40	(7)
Nurse Manager Responsibility	40	(1)
New Graduate Responsibility	41	(1)
Registered Nurse Responsibility	41	(1)
LPN/LVN Responsibility	42	(2)
UAP Responsibility	44	(3)
Delegation Suggestions for RNs	47	(2)
Review Questions	49	(1)
Review Activities	50	(1)
Exploring the Web	51	(1)
References	51	(1)
Suggested Readings	52	(1)
Effective Communication	53	(44)
Elements of the Communication Process	54	(1)
Sender and Message	54	(1)
Communication Channel and Receiver	55	(1)
Feedback and Educational, Cultural, Emotional, and Perceptual Influences	55	(1)
Communication and Delegation	55	(6)
Communication Skills	56	(2)
Attending	58	(1)
Responding	58	(1)
Clarifying	58	(1)
Confronting	58	(3)
Culture and Delegation	61	(2)
Communication	61	(1)
Space	61	(1)
Social Organization	61	(1)
Time	62	(1)
Environmental Control	62	(1)
Biological Variations	62	(1)
The Professional Role of the Nurse	63	(4)
Potential Barriers to Communication	67	(6)
Gender	67	(1)
Anger	68	(1)
Incongruent Responses	69	(1)
Conflict	70	(1)
Thought Distortions	70	(3)
Additional Barriers to Communication	73	(1)
Overcoming Communication Barriers	73	(1)
Helpful and Non-Helpful Roles in Communication	73	(5)
Destructive or Difficult Behaviors	75	(3)
Myers-Briggs Personality Types	78	(1)
Workplace Communication	79	(11)
Communicating with Superiors	81	(1)
Communicating with Co-Workers	82	(3)
Communicating with other Nursing and Medical Practitioners	85	(5)
Review Questions	90	(2)
Review Activities	92	(1)
Exploring the Web	92	(1)
References	93	(1)
Suggested Readings	94	(3)
Time Management and Setting Priorities	97	(34)
General Time Management Techniques	99	(1)
Outcome or Goal Orientation	100	(1)
Analysis of Nursing Time	100	(6)
Value of Nursing Time	100	(1)
Use of Time	101	(1)
Activity Log	101	(3)
Create More Time	104	(2)
Effective Use of Available Time	106	(6)
Setting Priority Patient Outcomes	106	(1)
Priority Traps	107	(1)
Considerations in Setting Priorities	108	(3)
More Priority Setting	111	(1)
Shift Report and Making Assignments	112	(8)
Making Assignments	115	(2)
Making Patient Care Rounds	117	(2)
Evaluation of Outcome Achievement	119	(1)
Review Questions	120	(3)
Review Activities	123	(5)
Exploring the Web	128	(1)
References	129	(1)
Suggested Readings	130	(1)
Legal Aspects of Patient Care and Delegation	131	(32)
Tort Law	132	(9)
Negligence and Malpractice	133	(7)
Do Not Attempt to Resuscitate (DNAR) Orders and Following Orders	140	(1)
Resources for Safe, Legal, and Ethical Nursing Practice	141	(9)
State Nurse Practice Act	141	(1)
Policies and Procedures of the Institution	141	(1)
Good Samaritan Laws	142	(1)
Good Communication	142	(2)
Documentation	144	(1)
Patient Advocacy and Ethical Behavior	144	(1)
Risk Management Programs	145	(3)
Malpractice/Professional Liability Insurance	148	(2)
Nursing Risk in Litigation	150	(4)
Common Monetary Awards	151	(1)
Selected Monetary Liability Limits	152	(1)
Other Legal Risks for the Nurse/Practitioner/Hospital	152	(2)
Nurse-Attorney Relationships in a Lawsuit	154	(1)
Review Questions	155	(1)
Review Activities	156	(1)
Exploring the Web	156	(1)
References	157	(1)
Suggested Readings	158	(1)
Case References	158	(5)
Glossary	163	(2)
Index	165