Nursing Leadership and Management
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Read Chapter 6 & 7***APA format*****
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 a miscommunication. What other method of communication would have been more effective? Nursing Leadership and Management
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 delegation. What are the legal ramifications of accountability in 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 the patient care:
A- Give the rationale foryour 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?
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Chapter 6 Communicating With Others and Working With the Interprofessional Team Copyright © 2015. F.A. Davis Company Communication • Giving information is only a small part of communication. • Occurs on several levels • Involves different factors • Requires active listening skills Copyright © 2015. F.A. Davis Company Factors Affecting Communication • • • • • Emotional state of individuals Outside distractions Cultural background Superficial listening Individual attitudes regarding the content of the communication Copyright © 2015. F.A. Davis Company 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 Copyright © 2015. F.A. Davis Company 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 Copyright © 2015. F.A. Davis Company Interpersonal Communication (cont’d) • Occurs on a more intimate level • Systematic process • Individuals hold a specific role within the communication
• Dynamic and ongoing process Copyright © 2015. F.A. Davis Company 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 Copyright © 2015. F.A. Davis Company Barriers to Communication Among HealthCare Providers and Health-Care Recipients Copyright © 2015. F.A. Davis Company Challenges • • • • Low health literacy Cultural diversity Cultural competence of health-care providers Lack of interprofessional communication education among providers Copyright © 2015. F.A. Davis Company Electronic Forms of Communication Copyright © 2015. F.A. Davis Company 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) Copyright © 2015. F.A. Davis Company Advantages of EMR • Track data over time • Identify which patients need preventive screenings or checkups • Monitor patient status • Evaluate and improve overall quality Copyright © 2015. F.A. Davis Company 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 Nursing Leadership and Management
• Designed to share information with other healthcare providers • Assist in maintaining patient confidentiality Copyright © 2015. F.A. Davis Company 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 email Copyright © 2015. F.A. Davis Company 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 Copyright © 2015. F.A. Davis Company Reporting Patient Information Copyright © 2015. F.A. Davis Company 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” Copyright © 2015. F.A. Davis Company Communicating With the Health-Care Provider • • • • Communicate changes in patients’ conditions. Share pertinent information. Discuss modifications in the treatment plan. Clarify orders. Copyright © 2015. F.A. Davis Company 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 Copyright © 2015. F.A. Davis Company 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. Copyright © 2015. F.A. Davis Company ISBARR • • • • • • Introduction Situation Background Assessment Recommendation Read-back Copyright © 2015. F.A. Davis Company Health-Care Provider Orders • • • • Written Telephone Fax EMR orders Copyright © 2015. F.A. Davis Company Teams Copyright © 2015. F.A. Davis Company Purpose • Bring professionals together • Common goal: quality patient care • Collaborative focus Copyright © 2015. F.A. Davis Company 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) Copyright © 2015. F.A. Davis Company 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. Copyright © 2015. F.A. Davis Company 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. Copyright © 2015. F.A. Davis Company Interprofessional Collaboration and the Interprofessional Team Copyright © 2015. F.A. Davis Company 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) Copyright © 2015. F.A. Davis Company Components of Collaboration • • • • Sharing Partnership Interdependency Power Copyright © 2015. F.A. Davis Company 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 Copyright © 2015. F.A. Davis Company Team STEPPS • • • • • Leadership Situation Monitoring Mutual support Communication Copyright © 2015. F.A. Davis Company 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. Copyright © 2015. F.A. Davis Company Methods for the Hand-Off Report • Traditional face-to-face • Audiotape • Computer reporting Copyright © 2015. F.A. Davis Company 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. Copyright © 2015. F.A. Davis Company Chapter 7 Delegation, Prioritization, and Decision Making Copyright © 2015. F.A. Davis Company Delegation of Client Care: Definition The reassigning of responsibility for the performance of a job from one person to another. (ANA, 1996) Copyright © 2015. F.A. Davis Company Concepts of Delegation • The responsibility of the task is transferred. • Accountability remains with the delegator. • Delegation may be direct or indirect. Copyright © 2015. F.A. Davis Company Direct Delegation • Usually verbal direction • RN decides which staff member is capable of performing a specific task. Copyright © 2015. F.A. Davis Company Indirect Delegation • Contained in an approved listing of tasks established by an institution • Permitted tasks may vary from institution to institution Copyright © 2015. F.A. Davis Company 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. Copyright © 2015. F.A. Davis Company Delegation vs. Supervision Copyright © 2015. Nursing Leadership and Management
F.A. Davis Company 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. Copyright © 2015. F.A. Davis Company The Nursing Process and Delegation Copyright © 2015. F.A. Davis Company Assessment • Assess client needs. • Set client-specific goals. • Match the personnel with the appropriate skills to care for the client. Copyright © 2015. F.A. Davis Company Planning • Mentally identify who is best suited for the task or activity. • Planning prevents later problems. Copyright © 2015. F.A. Davis Company Implementation • Assign the appropriate personnel who have the level of expertise necessary to deliver the care or carry out the activities. Copyright © 2015. F.A. Davis Company Evaluation • Oversee the care or activities. • Determine if client care needs have been met. • Allow for feedback. Copyright © 2015. F.A. Davis Company Coordinating Assignments Copyright © 2015. F.A. Nursing Leadership and Management
Davis Company Methods to Help Organize Care • • • • Critical pathways Computerized information sheets Personalized worksheets Delegation tree Copyright © 2015. F.A. Davis Company 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. Copyright © 2015. F.A. Davis Company The Need for Delegation Copyright © 2015. F.A. Davis Company Changes in the Health-Care Environment • • • • • Nursing shortage Health-care reform Increased need for nursing services Demographic trends Use of unlicensed assistive personnel Copyright © 2015. F.A. Davis Company 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 Copyright © 2015. F.A. Davis Company Delegation to UAPs Copyright © 2015. F.A. Davis Company Examples of Tasks • Vital signs • Skills learned through special training – Blood drawing – ECGs • Measuring intake and output • Non-nursing duties Copyright © 2015. F.A. Davis Company Safe Delegation Copyright © 2015. F.A. Davis Company Criteria for Safe Delegation • Potential for harm • Complexity of the task
• Problem-solving and innovation necessary to complete the task or activity Copyright © 2015. F.A. Davis Company Considerations for Safe Delegation • Ability of the individual • Fairness of the task Copyright © 2015. F.A. Davis Company Guidelines for Delegation Nursing Leadership and Management
• https://www.ncsbn.org/delegation_grid_NEW.pdf • https://www.ncsbn.org/contcaregrid.pdf • https://www.ncsbn.org/Working_with_Others.pdf Copyright © 2015. F.A. Davis Company Task-Related Concerns Copyright © 2015. F.A. Davis Company Primary Concern Does the individual assigned to the task have the ability to perform the task? Copyright © 2015. F.A. Davis Company Other Task-Related Concerns • • • • Ability Priorities Efficiency Appropriateness Copyright © 2015. F.A. Davis Company Relationship-Oriented Concerns • • • • • Fairness Learning opportunities Health Compatibility Preferences Copyright © 2015. F.A. Davis Company 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 Copyright © 2015. F.A. Davis Company Barriers to Delegation Copyright © 2015. F.A. Davis Company Barriers • • • • Experience Licensure Quality of care Assigning work to others Copyright © 2015. F.A. Davis Company The Five Rights of Delegation • • • • • Right task Right circumstances Right person Right direction/communication Right supervision/evaluation Copyright © 2015. F.A. Davis Company Conclusion Copyright © 2015. F.A. Davis Company 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. Copyright © 2015. F.A. Davis Company 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 Copyright © 2015. F.A. Davis Company … Nursing Leadership and Management