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Communication is a fundamental aspect of any relationship. Communication refers to the sharing of information as well as the non-verbal messages (Weiss, Tappen & Grimley, 2019). Communication needs to be effective in every relationship because this is the basis for many interactions and their success. Communication can be effective in the personal relationship, the therapeutic and the interprofessional one when the person states the message clearly, assertively when necessary and engages in active listening in return (Weiss et al., 2019).
Some relationships are different from others and can take on different tones. Personal relationships can be more informal as opposed to interprofessional and therapeutic ones and very often they are by choice. Boundaries must be established by nurses as to not overlap them. However, despite the differences, one key component in all these relationships is the trust and professionalism that is inherent. Professional relationships are limited to the location where you are practicing and therapeutic as well, but personal relationships have no specific setting (Professional Versus Social Relationships, 2018).
The concept of congruence in communication refers to the balance and harmony between what is spoken and what is shown. This means that if someone is talking and you are actively listening you should demonstrate it by summarizing what is said at intervals and ask questions, focus solely on the speaker avoiding distractions, and providing feedback (Use Active Listening Skills When Coaching Others, 2020).
In large organizations it is customary to communicate via e-mail with any employee regardless of their location. This makes it accessible to exchange information. One of the pitfalls of e-mail communication is that a message can be sent accidentally to more than one receiver, thus engaging in a breach of confidentiality and exposing information to unnecessary parties (Weiss et al., 2019). In the vent that specific information needs to be shared with one person in particular it is best to place a phone call and speak directly to avoid putting the information in the wrong hands.
When communicating with physicians ISBAR has proven to make the process of communication precise and productive while reducing miscommunication and preventing adverse effects (Weiss et al., 2019). I have personally communicated with doctors using the ISBAR method when sharing critical information regarding patient’s condition in order to obtain new orders or medication.
Patient: Jane Doe, 65 y/o
Room: 101 Door
Diagnosis: COPD exacerbation admitted on 5/25/2020
Patient’s attending physician is Dr. ABC. Ms. Doe is AOx4, no known allergies, verbal and ambulatory, she is currently in bed awaiting chest x-ray to r/o pneumonia, received breathing treatment at 14:30 and it was effective for shortness of breath. Last vital signs are B/P=131/75 HR: 94 RR: 20 Temperature: 97.8 Sat: 96% at 2L via NC continuously. She is on a regular diet and will be discharged home tomorrow.
The system currently used in my facility is verbal hand off report at the bedside and this is effective because we have the opportunity to ask questions and seek clarification when needed as well as visualize the patient at time of report.
I would notify the doctor that I am the nurse assigned to this patient, apologize for the delay and look for the lab results, if they are available, I would hand them if not I would call the laboratory and inquire on the results. Then I would analyze why the results were not ready and if this was a mistake of mine I would work on it as to not have it happen again.
Accountability in delegation specifies that the person delegating is responsible for the outcome of the action associated with the delegation as long as the person who the task was delegated to performed it competently (Weiss et al., 2019). Delegating beyond the scope of the person can incur in legal repercussions for the person delegating. They can face disciplinary action stated by the board of nursing of their state once the information has been gathered and analyzed (MNA, 2020).
The responsibilities of the RN include assessment, IV medications, blood administration, care planning, obtaining physician orders and teaching. The LPN can obtain vital signs, administer some IV medication depending on the state and provide physical care. The NAP/UAP can assist with personal care, hygiene and feeding (Weiss et al., 2019). Keeping these tasks in mind, Dennie and Elias can delegate safely those tasks that are within the scope of each person in the staff. The RNs can divide the workload evenly to perform assessments and provide IV medication, the LPN can obtain vital signs and administer oral medication and the UAP/NAP can assist with meals and hygiene activities. In this manner all patient’s needs are safely met by the appropriate staff member
10. Discuss the differences between direct delegation and indirect delegation.
Direct delegation refers to a verbal indication to perform a task in an indicated situation from an RN who chooses a staff member to delegate to based on ability to perform this task. Indirect delegation involves a list of approved tasks that may vary depending on the institution (Weiss et al., 2019)
The RN must follow the rights of delegation to ascertain this is done safely and appropriately. The RN needs to consider whether the person being delegated on has the skills necessary to carry out the task and that the instructions and expectations are clearly stated and understood by both parties.
It is necessary to assess the census in order to assign fairly and safely to the rest of the staff what needs to be done. It is important for example to be aware of which patients require total care to be able to assign the right personnel, so all the needs are met.
a. I have had patients who were not able to feed themselves and in many occasions I could have delegated this task to a UAP however, because they were already attending to other patients and their needs I decided to complete the task as to not delay it and cause distress in the patient.
b. My preceptor had many years of experience in nursing which made her very capable of delegating and supervising others.
c. My preceptor when delegating tasks to other staff would supervise at intervals, ask if there was any difficulty in completing the task and evaluated the results after. She obtained feedback from the person she delegated to and she would use this as experience for the next time she had to delegate.
Accepting, Rejecting & Delegating a Work Assignment: A Guide for Nurses. (2020). Retrieved from https://www.massnurses.org/nursing-resources/nursing-practice/accept-reject/legal
Professional versus social relationships. (2018, October 31). Retrieved from https://www.cno.org/fr/exercice-de-la-profession/outils-educatifs/ask-practice/social-versus-professional-relationships/
Use Active Listening Skills When Coaching Others. (2020). Retrieved from https://www.ccl.org/articles/leading-effectively-articles/coaching-others-use-active-listening-skills/
Weiss, S. A., Tappen, R. M., & Grimley, K. A. (2019). Essentials of nursing leadership and management (7th ed.). Philadelphia, PA: F.A. Davis Company.