Read Chapter 6 & 7
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?
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?
Expert Solution Preview
Effective communication is crucial in various aspects of healthcare, including personal relationships, therapeutic relationships, and interprofessional teamwork. Communication plays a vital role in ensuring patient safety, promoting positive outcomes, and fostering collaborative healthcare environments. In this response, we will discuss the importance of effective communication, the concept of congruence between verbal and nonverbal communication, pitfalls of electronic communication, the use of ISBAR in clinical experiences, accountability in delegation, and the responsibilities of different healthcare professionals in a given situation.
Effective communication is fundamental in personal relationships, as it allows individuals to express their thoughts, feelings, and needs, fostering understanding and trust. In a therapeutic relationship between a healthcare provider and a patient, effective communication enables accurate assessment, diagnosis, and treatment. It helps healthcare providers understand patients’ concerns, gather relevant information, and provide appropriate interventions. Within the interprofessional healthcare team, effective communication promotes collaboration, coordination, and shared decision-making, ultimately leading to improved patient outcomes. It ensures that all team members are well-informed and can work together cohesively towards a common goal.
In personal relationships, therapeutic relationships, and interprofessional interactions, there are similarities and differences in the dynamics of communication. Commonalities include the need for active listening, empathy, clarity, and respect. In all these interactions, effective communication involves both sending and receiving messages, using appropriate verbal and nonverbal cues, and adapting to the communication styles and preferences of others. However, there are differences in the context and goals of communication. Personal relationships may focus on emotional support and connection, while therapeutic relationships prioritize accurate information exchange and patient-centered care. Interprofessional team communication requires additional skills such as effective delegation, assertiveness, and collaborative decision-making.
Congruence between verbal and nonverbal communication refers to the alignment or consistency between what is expressed verbally and the accompanying nonverbal cues. It is important because incongruence can lead to misunderstandings and misinterpretations. For example, if a healthcare provider verbally reassures a patient but displays anxious nonverbal behavior, the patient may not fully trust the reassurance. Congruent communication enhances the clarity and credibility of the message, fostering understanding and building trust in relationships. It involves paying attention to body language, facial expressions, tone of voice, and other nonverbal cues to ensure they align with the intended verbal message.
One situation where electronic communication may result in miscommunication is when conveying sensitive information or complex instructions without the opportunity for immediate clarification or feedback. For instance, an email message discussing a critical patient’s condition and treatment plan may lack the ability to promptly address questions or concerns. In such cases, a more effective method of communication would be face-to-face or synchronous communication, such as a phone call or video conference. These modes allow for immediate interaction, clarifications, and the ability to gauge the recipient’s understanding.
In my clinical experiences, I have seen the use of ISBAR (Introduction, Situation, Background, Assessment, and Recommendation) during hand-offs between healthcare providers. ISBAR is a structured communication tool that ensures the comprehensive transfer of patient information, enhancing patient safety and continuity of care. It facilitates clear and concise communication by providing a systematic framework for reporting relevant patient details, current status, and recommendations for ongoing care. This structured approach minimizes the risk of important information being missed or misunderstood during transitions of care.
As a medical professor, I instruct students on developing a hand-off report to ensure safe and effective nursing care. The hand-off report should include pertinent information such as patient demographics, diagnosis, current condition, medications, allergies, relevant assessments, ongoing treatments, and any specific patient preferences or concerns. By using the information from the chapter, students can determine the effectiveness of the current shift-to-shift report system on their unit. They should assess if the existing system adheres to the recommended guidelines for comprehensive and accurate communication, ensuring that essential information is conveyed consistently and efficiently.
As a nurse, I would respond to Dr. Roberts in a calm and professional manner. I would acknowledge his concerns and take responsibility for finding out the status of Mr. Adams’s lab reports. I would inform Dr. Roberts that I will investigate the matter immediately and ensure that the reports are obtained promptly. I would avoid blaming anyone and focus on addressing the issue efficiently. It is essential to maintain a collaborative and respectful approach, fostering effective communication and teamwork in the healthcare setting.
Accountability in delegation refers to the responsibility of the delegator (the person delegating tasks) to ensure that appropriate tasks are assigned to a competent delegatee (the person receiving delegated tasks). The delegator remains accountable for the outcomes of delegated tasks and should provide adequate guidance, support, and supervision. Legal ramifications of accountability in delegation may vary depending on the jurisdiction and context. Generally, if a delegator fails to appropriately delegate tasks or delegates tasks beyond the delegatee’s scope of practice, legal concerns may arise if patient harm occurs as a result. It is crucial for delegators to adhere to legal and ethical standards, as well as organizational policies and protocols, when delegating tasks.
In this scenario, the responsibilities of the RN, NAP/UAP, and LPN can be identified based on their scope of practice and capabilities. The RN is responsible for tasks that require nursing judgment, assessment, planning, and evaluation of care. The NAP/UAP can assist with activities of daily living, vital signs, basic hygiene, and mobility, under the supervision and direction of the RN. The LPN can contribute to direct patient care, such as medication administration, wound care, and selected treatments, within their authorized scope. However, considering that there are only two RNs for 48 clients, it may not be feasible to delegate all client care tasks effectively and ensure safe care for all patients. Delegation decisions should prioritize patient acuity and complexity, taking into account available resources and staffing levels.
Direct delegation involves the transfer of authority and responsibility for a specific task from one healthcare professional to another within their scope of practice. The delegator provides clear instructions and supervision, while the delegatee performs the task independently. Indirect delegation, on the other hand, involves the transfer of responsibility from one healthcare professional to another without direct supervision or instructing the delegatee. It usually occurs when the delegator authorizes the delegatee to perform certain tasks independently based on their ongoing assessment and judgment. Indirect delegation relies on trust, experience, and the delegatee’s competence to make appropriate decisions and provide safe care within their authorized scope of practice.
When delegating patient care, the RN must consider various factors. These include the complexity and acuity of the patient’s condition, the delegatee’s competency and training, and the scope of practice and legal regulations regarding delegation. The RN should ensure that clear communication and instructions are provided to the delegatee, emphasizing the importance of patient safety and adherence to protocols. The RN should also be available for support, guidance, and ongoing evaluation of the delegated tasks.
When prioritizing patient care based on the unit census, several factors should be considered. These include the urgency of patient needs, the severity and stability of their conditions, and the resources available. Rationale choices may involve addressing life-threatening emergencies first, ensuring timely administration of critical medications, and providing care to patients with changing or deteriorating conditions. The goal is to optimize patient outcomes by effectively allocating resources and addressing immediate needs while considering the overall patient population’s well-being and safety.
a. During my clinical experiences, I encountered tasks that could have been delegated, such as obtaining vital signs, performing basic hygiene, and assisting with ambulation for stable patients.
b. Overall, my nurse/preceptor was effective in delegating tasks to others. Clear instructions were provided, and the delegatees’ competencies were considered when making assignments.
c. To ensure safe and appropriate completion of delegated tasks, my nurse/preceptor supervised, provided guidance when needed, and regularly checked on the progress of the tasks. The nurse/preceptor emphasized the importance of adhering to protocols, maintaining patient privacy and dignity, and promptly reporting any concerns or changes in patient conditions.