NURSING 3821 Discussion Board Week 4

Florida International University - NURSING 3821 Discussion Board Week 5 Discussion Board Week 5 Nursing Leadership and Management Professor Angel Cano Florida National University 1. Discuss the importance of effective communication in the personal relationship, the therapeutic relationship, and the relationship within the interprofessional health-care team. Lack of communication creates situations where medical errors can occur. These errors have the potential to cause severe injury or unexpected patient death. Medical errors, especially those caused by a failure to communicate, are a pervasive problem in today’s health care organizations. Collaboration in health care is defined as health care professionals assuming complementary roles and cooperatively working together, sharing responsibility for problem-solving and making decisions to formulate and carry out plans for patient care. Collaboration between physicians, nurses, and other health care professionals increases team members’ awareness of each other’s’ type of knowledge and skills, leading to continued improvement in decision making. Effective teams are characterized by trust, respect, and collaboration. When considering a teamwork model in health care, an interdisciplinary approach should be applied. Unlike a multidisciplinary approach, in which each team member is responsible only for the activities related to his or her own discipline and formulates separate goals for the patient, an interdisciplinary approach coalesces a joint effort on behalf of the patient with a common goal from all disciplines involved in the care plan. The patient finds that communication is easier with the cohesive team, rather than with numerous professionals who do not know what others are doing to manage the patient. 2. What similarities and differences can you identify among the above interactions? Therapeutic communication is a collection of techniques that prioritize the physical, mental, and emotional well-being of patients opens in new window. Nurses provide patients with support and information while maintaining a level of professional distance and objectivity. With therapeutic communication, nurses often use open-ended statements and questions, repeat information, or use silence to prompt patients to work through problems on their own. 3. Explain the concept of congruence between verbal and nonverbal communication. It’s important that people are taught the importance of congruence in their verbal and non-verbal communication. Conflicting Verbal and nonverbal messages within the same interaction can send conflicting messages. For example, a person verbally expressing a sad message while at the same time smiling may convey a mixed message to the receiver in the interaction. Conflicting messages may occur for a variety of reasons often stemming from feelings of uncertainty, ambivalence, or frustration. When mixed messages occur, nonverbal communication becomes the primary tool that people use to attain additional information to clarify the situation. 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? Communication using computer technology is the norm today in nursing practice and health-care institutions. Exchange of e-mails between a nurse and a patient may result in miscommunication. The nurse may fail to see gestures, facial expressions or the tone of the voice by using the e-mail. It may result in the nurse not understanding what the patient is going through. The nurse should have used a phone, Skype or requested the patient to come in person. 5. How have you seen ISBAR used during your clinical experiences? ISBAR (Identify, Situation, Background, Assessment and Recommendation) is a mnemonic created to improve safety in the transfer of critical information. I have use ISBAR when there has been a rapid change on a patient status and I must call a doctor and inform him or her about the situation. I normally give an introduction of the patient and what is the situation that the patient is going through. 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. Effective handoff communication is critical for patient safety. Research is needed to understand how information processes occurring intra-shift impact handoff effectiveness. Arriving and leaving the handoff with this level of information promoted patient safety. However, intra-shift disruptions often impeded nurses in their processes to grasp the story thus posing risks to patient safety. Intershift handoff is defined as the exchange of information, responsibility, and accountability between nurses about patients at shift change. Nurses' handoffs are situated within a 24-hour cycle of clinical care in which the nursing, medical, and technical knowledge relevant to each patient needs to be transferred seamlessly between outgoing and oncoming nurses as they work to maintain safety. Quality handoff information enables nurses to recognize quickly changes in patient status and to anticipate risks thereby promoting safe care. 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? Dr. Roberts I’m the nurse responsible for Mr. Adam’s. I called the laboratory and they are faxing the results to me. 8-Explain the concept of accountability in delegation. What are the legal ramifications of accountability in delegation? Delegation is the transfer of responsibility for the performance of an activity from one individual to another while retaining accountability for the outcome. To delegate task safely, nurses must delegate appropriately and supervise adequately. When delegating we must be very careful because we are being accountable for the actions we are taking in regards of the patient’s care. To delegate we need to know the level of acuity of the patient and the level of unlicensed assistive personnel and license nurse capability. 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. First, I don't believe two new nurses that just finished orientation can effectively delegate client care tasks and care safely for all 48 clients. In my opinion this is too much to provide appropriate/safety patient care. 10. Discuss the differences between direct delegation and indirect delegation. Direct delegation is usually verbal direction by the RN delegator regarding an activity or task in a specific nursing care situation. Indirect delegation is done using an approved listing of activities or tasks that have been established in the policies and procedures of the health care institution or facility. 1. You have to observe delegation procedures in your assigned unit: A-What considerations does the RN take into account when delegating patient care? Prior to delegating a nursing task, the nurse shall determine the nursing care needs of the patient. The nurse shall retain responsibility and accountability for the nursing care of the patient, including nursing assessment, planning, evaluation, and nursing documentation. 2-You have to look at the unit census and prioritize the patient care: A- Give the rationale for your choices. As the primary nurse, the RN has all of the information about the patient's care priorities while the other members may look only at their area of expertise. 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? Delegation decisions are sometimes made based on a list of tasks found in a job description, such as taking vital signs, bathing, or ambulating patients. In these cases, the RN is really assigning tasks rather than using professional judgment to match the staff member’s skills to patient needs. Assigning nursing assistants to perform all the baths or take all the vital signs for a group of patients indicates that the delegation is task based rather than judgment based. Making assignments based on a list of tasks in a job description short-circuits the critical thinking skills of the RN because the RN’s judgment is not utilized. Matching the staff member’s expertise to patient needs is essential for sound delegation decisions. b. How effective was your nurse/preceptor in delegating tasks to others? Very effective. c. How did your nurse/preceptor ensure that the tasks were completed safely and appropriately? Confirmed is done and asking for feedback References Whitehead, D. K., Weiss, S. A., & Tappen, R. M. (2010). Essentials of nursing leadership and management. Philadelphia: F.A. Davis. Abraham J, Kaanapali TG, Patel VL. Bridging gaps in handoffs: A continuity of care-based approach. Journal of Biomedical Informatics. 2012; 2:240–254. doi: 10.1016/.2011.10.011. Walsh, D. The Nurse Mentor’s Handbook: Supporting Students in Clinical Practice. New York: McGraw Hill; 2010.