follow up discussion

Respond one paragraph with intext citation and reference for the following post 

 

1. Discuss what the nurse should have done to effectively control this situation and limit the risks of wrongful delegation? Give a detailed response and reference 2 evidenced based resources.

According to the American Nurses Association (ANA) and the National Council of State Board of Nursing (NCSBN) jointly published the Position Statement on Delegation (2017) which states:

Delegation is a process that, used appropriately, can result in safe and effective nursing care. Delegation can free the nurse for attending more complex patient care needs, develop the skills of nursing assistive personnel and promote cost containment for the healthcare organization. The RN determines appropriate nursing practice by using nursing knowledge, professional judgment and the legal authority to practice nursing. RNs must know the context of their practice, including the state’s Nurse Practice Act and professional standards as well as the facility/organization’s policies and procedures related to delegation (ANA & NCSBN, 2017).

Based on the scenario, I think the nurse should have told the assistive personnel to call 911 and insisted to take the patient to the ER even though the family members did not want to take her there. Relying on the UAP statement where she said she has re-inserted several GI tubes in her previous job was the wrong thing to do because the RN has never assessed the competency of the UAP, so she shouldn’t have relied on that statement. The nurse should have known immediately that GI tube insertion is out of the scope of practice of the unlicensed assistive personnel (UAP). I believe the nurse should have taken a moment and go through the five rights of delegation and that would have helped her not to allow the UAP to perform such task. I understand that nursing can be very stressful for RN but it is pertinent that when practicing to always think of the patient’s safety first (NCSBN, 2016).

Even though the nurse instructed the UAP not to resume feeding, that information was not properly communicated with all the people taking care of that patient such as her daughter. The best thing the RN would have done was to call the patient’s daughter after she was done talking with the UAP. In the phone call, she would have explained to the client’s daughter what the whole situation is and give specific instructions of what she wants them to do. In that light, the miscommunication would have been avoided.

2. Identify 3 to 4 risk control recommendations that were learned from the required video that could have been utilized in this case.

some risk control recommendations that would have helped prevent such error are as follows. Jennifer Flynn recommended that the nurse;

1. Assess the patient first to have a better understanding of the degree of illness and then make a judgement if it is safe to delegate any task to UAP on that patient. 

2. If the nurse decide to delegate the task to the UAP, she must ensure that the UAP has been properly trained for such task. After letting the UAP perform the task, the nurse must supervise to ensure that the task was properly done.

3. Another thing that the nurse could have done to prevent any risk, was to check the Nurse State Practice Act and the facility policy on delegation. Using the five rights of delegations. That would have given the RN a better understanding about what task are permitted and make a better judgement.

References:

American Nurse Association, & National Council of State Board of Nursing. (2017). Joint statement on delegation. 

Flynn, J., & Health Professional Radio. (2019, January 13). Nursing Risks of Wrongful Delegation. Retrieved January 12, 2021, from https://www.youtube.com/watch?v=f0wq5tvd_lQ

National Council of State Board of Nursing. (2016). National Guidelines for Nursing Delegation. Journal of Nursing Regulation, 7(1), 5-12.  

ReplyReply to Comment

Collapse SubdiscussionMeredith GrantMeredith Grant
YesterdayJan 12 at 10:53amManage Discussion EntryHi, Vanesia,
I agree that the CNA and nurse should have made more of an effort to encourage the patient and family to travel to a nearby emergency department. The patient’s death could have been avoided had the nurse instructed the CNA to give the phone to the family so she herself could educate them about the importance of immediate and proper reinsertion, including the risk of peritonitis, sepsis, and even death with improper reinsertion (Feil, 2017). The nurse could have also given them the option of contacting their primary care physician to see if he or she was available for a last-minute appointment to replace it, but then restress the necessity of going to the hospital if that was not possible. The nurse could also explain to the family that improper reinsertion is even more dangerous that the dislodgement itself, which most patients with long-term tubes experience at least once (Feil, 2017).
Reference
Feil, M. (2017). Dislodged gastrostomy tubes: Preventing a potentially fatal complication. Pennsylvania Patient Safety Authority, 14(1), pp. 9-16. http://patientsafety.pa.gov/ADVISORIES/documents/201703_dislodgedGI