NCSBN-ANA Decision-Making Tree in Nursing

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Part I: Post your scores and decisions on the four tasks for delegation from the power point slide patient following the instructions in the power point Include any comments as instructed. DO NOT COPY OR EMBED GRID INTO MODULE POSTING. Your mentor may ask you to send a copy of your working grid if they do not understand/agree with your decisions.

Part II: Using the short scenario below, answer the questions that follow in paragraph format. Use the readings on communication and delegation for context and citations, and the NCSBN-ANA Delegation Decision Tree as directed. Must have minimum of 2-3 in text citations that follow APA format.

A young nurse working on a med/surg unit has just received a new admission from the emergency room. The patient is a 60-year-old male with COPD just admitted with an exacerbation of COPD. The quick assessment revealed that he has a slight increase in his work of breathing and mild expiratory wheezes. He is anxious and frequently asking to be repositioned and wants the head of the bed elevated at all times. He is wet from being incontinent of urine while on the ER stretcher and needs vital signs in addition to being cleaned up.

The nurse speaks to the UAP and asks that he obtain vital signs, clean the patient, and remove the wet sheets from underneath the him. His response is “ok, no problem”. About 20 minutes later the nurse realizes that the UAP has not brought them the vital signs, but when looking at the computer, sees that they have been entered. The charted vital signs are BP 150/80, HR 120, RR 20, and PO Sat 90%. The nurse is concerned that the UAP did not report the elevated HR and decreased PO Saturation and is not convinced that the documented respiratory rate is correct.

One – Two Paragraphs:

1. Using Step two in the NCSBN-ANA Decision-Making Tree (Communication) as your guide to address below

a. Describe your perception of the effectiveness of the communication between the nurse and the UAP

b. Identify the primary limitation with the way the request was communicated (delegated) to the UAP and acknowledge (received) by the UAP

Sample Solution

Communication Effectiveness:

Based on the scenario, the communication between the nurse and the UAP seems partially effective at the surface level. The UAP acknowledged the task by saying “ok, no problem,” indicating initial understanding. However, deeper analysis reveals communication gaps hindering effective delegation.

Limitations of the Communication:

  1. Lack of Specificity: The nurse’s request lacked specific instructions on assessing and reporting critical observations. While obtaining vital signs, cleaning the patient, and removing sheets were mentioned, crucial details like reporting abnormal findings or reassessing respiratory status were absent. This ambiguity leaves room for misinterpretation and incomplete task execution (American Nurses Association, 2017).
  2. Limited Assessment of Competence: The scenario doesn’t mention if the nurse assessed the UAP’s competence and knowledge regarding COPD, vital sign interpretation, and potential complications. Without proper assessment, delegation of tasks exceeding the UAP’s skillset can lead to errors and jeopardize patient safety (NCSBN & ANA, 2016).
  3. **Passive ** The 20-minute gap between delegation and realizing the UAP didn’t report abnormal findings suggests passive follow-up. Effective communication involves actively checking for understanding, monitoring progress, and promptly addressing any concerns (Giddens & Kinney, 2018).

Addressing the Limitations:

To improve communication, the nurse should:

  • Provide clear and specific instructions: Specify the need to report any abnormal vital signs, including respiratory rate and oxygen saturation, and emphasize reassessing respiratory status due to the COPD exacerbation.
  • Assess UAP competence: Verify the UAP’s understanding of COPD, vital sign interpretation, and reporting protocols. If unsure, provide education or delegate to a more competent individual.
  • **Implement active ** Actively check on the UAP after a reasonable timeframe, inquire about findings, and clarify any concerns directly.

By addressing these limitations, the nurse can foster effective communication, ensure tasks are completed competently, and ultimately, prioritize patient safety and well-being

 

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