Reflective account: Delegation

Nov 12, 2021 | 0 comments

Nov 12, 2021 | Writing Guide | 0 comments

[image: Reflective accounts form for revalidation]

Please use a separate form for each of your reflective accounts, making sure you do not include any information that might identify a specific patient, service user or colleague.

*Reflective account: Delegation*

*What was the nature of the CPD activity and/or practice-related feedback and/or event or experience in your practice?*

To ensure that this paper is within the Code of Professional Conduct guidelines of Nursing and Midwifery Council (NMC), and to ensure that the confidentiality is maintained the Paper will not use the places and names of the patient, service providers or even the colleagues but will use pseudonyms.
In cases where I had a very busy schedule in the morning, patients with personal problem of bladder retention required my attention. However, at the time I was busy following up medication with my mentor. The problem however required immediate attention. I delegated the task to clinical support officer. Unfortunately, upon follow up I discovered that the tests were not conducted. Enquiries indicated that the officer was not at fault, rather that they were unable to conduct the test since they lacked the knowledge to conduct a bladder scan. In order to be accountable, I reported the matter to my mentor for follow up purposes.

*Listed below are some of the experiences I learnt during the activities of the CPD and my feedback *
Our law needs nurses to provide proper and adequate self-care for their patients. RCN (2017) indicates that nurses have the responsibility to help patients and accord them the right assistance towards making the right decisions promoting their health and wellbeing. Additionally, ‘nurses should delegate care tasks appropriately according to the competency level of the person providing or expected to provide the care.’ Thus, delegated care tasks should supervise, support and assess (RCN, 2017). Lipe and Beasley (2004) defined delegation as the transferring of the authority of care to a skilled and competent person. The NMC code (2015) recommends ‘nurses to be accountable for their delegated care decisions. The basis of accountability is knowledge, competency and experience. Thus, nurses are responsible to equipped with appropriate knowledge, experience and competencies to delegate care. At a minimum, personal accountability of nurse’s values that shaped by education, experience and professional socialisation (Frink et al., 2008; Hall et al., 2015 www.sciencedirect.com/science/article/pii/S002074891730175X#bib0115>). Touchstone, 2010 defines that values of accountability of care include, taking responsibility of decisions, being transparent and accept the answerability of decisions. Hence, nurses should adhere the trust policy and protocols. Failure to follow the policies and protocols could put safety of patients at a risk (Lipe and Beasley (2004).

By analyzing my experience, I learnt that I have a weakness in delegating to the right people tasks (RCN 2017). According to the NMC Code (2015), delegation should only be done to people who possess the right skills and knowledge to perform the tasks assigned. However, it is clear that I did not take the time to identify the skills and knowledge of the clinical support staff. Spilsbury, 2011; Kessler et al, 2010) suggest that as CSWs have better understanding of patients’ needs as they are closer to patients and manage ward environment. This literature suggests that as a nurse I should not under estimate CSWs skills. Conversely, I should avoid assumption of CSWs skills The NMC code 2015). Therefore, I have a responsibility to develop my knowledge to recognize the most competent person to delegate duty of care.

Osborn, (2010) suggests that by choosing the right person, the nurses can reduce risks to patient safety. Thus, unintended harm can be avoided. Conversely, Hopkins, Hughes and Vaughan (2007) suggests that despite the fact that CSWs are trained to promote the safety of patient, it is important to ensure that such skills are monitored and evaluated constantly to avoid poor clinical decisions. As I was trying to link my experiences to this, I realized that I should at least verify my capability to perform bladder scanner by the CSW before assigning the task. Evaluation of the specific task should have been done before assigning the task (NHS, 2016).

A lack of ideal communication skills in addition led to poor instructions to the CSW. They were unable to provide feedback with regard to their ability to complete the task because I did not build a right communication platform. While giving instructions to CSWs nurses should allow the feedback. The feedback will help nurses to recognize the skills and weakness of the person accepting delegation. However, Hansten and Kackson, (2009) suggest that there some professionals have issues in admitting and providing feedback. To face such conflict as a nurse, I should develop attentive listening and show openness to criticisms is also vital. By developing these skills, nurse can provide an opportunity to staff to express their views about care. Thus, the nurses will be able to recognize the skills of CSWs and their ability to perform the task safely (Corazzini et al., 2013).

In a previous study by Wagner, Bezuidenhout and Roos, (2014) the results proposed that nurses should try and entrust their assistants by opening a two-way communication system, where they not only give instructions but also allows for the individuals to give back feedback. As a result, there could be a release of a better and greater health effect. Again in this study, there was an identification of a reduction in pressure damages, a reduction in the fall rates and an improvement in the patient’s satisfaction (Wagner, Bezuidenhout and Roos, 2014). In general, this literature proposes that communication skills are a major key to delegation.

Supervision is also a vital component of the nurses’ skills, vital for providing the best healthcare. RCSLT (2006) suggests that it is upon the individual nurse to determine the importance and value that supervision will add to the patient care. However, it is argued that personality clashes, work place culture mainly affect the supervision (Cox,2010). In order to avoid conflict, nurses may avoid the value of supervision. However, with the executive management creating an ideal work culture to manage conflict and maintain accountability supervision becomes easier and also necessary. Overall, once the nurses’ skills of delegation and the friendly workplace culture are in place the nurses can provide due care for patients (Cox,2010).

Today’s nurses provide care for patients with complex, chronic and acute conditions. Nurses must have the right knowledge and information with regard to the competencies and skills of all CSW’s working under them. This allows them to maintain the accountability channel. This can be achieved by assessing the care tasks and supervising the Planning the work and Identifying the skill level of CSWs and selecting the most appropriate person to delegate the task. In addition to skills and knowledge, workload plays into the ability of the CSW to conduct proper care. However, in order to properly evaluate both skills and availability, the nurse needs to undergo mandatory training.

*Listed below is how this study helped me improve my practice *

Before, assigning any care aspect to a CSW, there must be a complete assessment of the right skills and competencies for the job (NMC Code, 2015). Thus, the CSWs skills, length of experience, and ability deal with patient’s condition were mainly measured. For instance, I choose CSWs that have knowledge of VERA communication tool to deal with patients who have dementia (Blackhall et al., 2011) The above-mentioned communication tool helps to maintain better interaction with the patients who have dementia. Overall this approach helped to delegate care appropriately.

As the person who delegates, my responsibility is to make the level of supervision of CSWs a priority (NMC code, 2015). Despite the busy schedules and the challenging nature of the settings of a health care, I started to maintain direct and indirect supervision. According to Nehrey and Lashley (2004), the first step is identifying the risk that is associated with delegating. In some cases as supported by Goode (1995) delegation may make the pursuit of health and wellbeing of the patient more difficult and in some cases much worse for the patient. Overall, I developed my skills of assessment, orchestration, implementation and evaluation of delegated care tasks (Kelly and Marthaler, 2011). Hence, I maintained multiple discussion and observation of care.

I began maintaining a better inter-professional relationship with the staff. Keller et al. (2013) emphasise that to maintain effective communication the team should value and respect each other feedback and ideas. Hence, I utilised two-way communication and attentive listening. Thus, I allowed the CSWs to express their views about the care tasks and listen to them. This approach thereby built a better interaction between us and I was able to delegate with confidence. In addition, I managed to discuss with the CSWs before starting the shift to plan care. This approach was helpful in recognising CSWs skills (RCN, 2006).

*The relevance of this study to the code are as follows*
Select one or more themes: Prioritise people – Practise effectively – Preserve safety – Promote professionalism and trust

The skills of delegation can assist nurses in the preservation of the safety of patients (NMC code, 2015). We as nurses we are obligated to make sure that care is offered accordingly despite how busy a care setting is. These skills assist in achieving the perfect mix of skills in these situations. The abilities of CSWs rely on experiences, skills, the knowledge they have and various trainings they attend. It is therefore very important for the CSWs’ knowledge and skills to be understood carefully. Hence, the care of patients can be safely managed and harm can be prevented (NLIAH, 2010).

The safety of patients is very important in minimizing harm that is unintended to patients that have the chances of acquiring them in their care period (NMC code, 2015). Therefore, nurses should be responsible in maintaining the highest state of care safe practices. Incidents that are not intended for may happen because the care workers and nurses lack the required skills and knowledge. From the discussion of reflective accounts, nurses remain to take the responsibility of maintaining the safest care level in the settings of a healthcare. Hence, the code of NMC of safety of patient offers a very clear guide to nurses accountable in making care decisions (NHS, 2018).

The code of NMC of making patients care a priority, suggests that nurses are obligated to have the urge of knowing and assessing the needs of a patient. Furthermore, should be able to offer effective care avoid assumptions to various care tasks that are acquired without delay (NMC code, 2015). If I am able to understand the CSWs level of competency and also be capable of working in accordance to the NMC guideline, I will be able to make the patient care a priority. On the other hand, Glasper, (2018) states that previous studies detected that most problems come from the shortage of nurses. Staff shortages also reduce the chances of prioritizing patient care. I therefore feel I am required to have a greater competency level in order to take accountability of providing patient safety.

*Reflective account: moving and handling*
*What was the nature of the CPD activity and/or practice-related feedback and/or event or experience in your practice?*

One of the mornings, I helped in moving and handling a patient. This patient had back pains from metastatic spinal cord compression (MSCC). This form of back pain can come as a result of movement of malignancy from the body to the spinal cord. When there is damage in the spinal code, the affected patients have a hard time making movements because the pain worsens (Byrne and Waxman, 1990). On the other hand, I had no awareness of the kind of condition the patient had. From the beginning, there was the patient’s cooperation with this task. When the pain grew more acute, there were reluctant signs from the patient when he was needed to move from where he was seated. I assisted the patient safely to the bed in order to avoid giving him more distress.

*What did you learn from the CPD activity and/or feedback and/or event or experience in your practice?*
The Health and Safety Executive (HSE 2004) states that moving, and handling is the process of transporting, of a patient. This may be undertaken by sliding, rolling and lifting. To do that nurses use suitable equipment. Gibson (1991) describes that the concept empowering patients to engage with their own care may have better impact on sense of control. However, keeping that in mind I started to help the patient to move to the chair and I did not critically think about my competency in moving and handling. Urden *et al.* (2006) indicates that nurses who feel they lack the skills and competence to manage the patient’s needs; they can seek further assistance from the senior officers. Managing the patient’s pain is beyond my skills and I was unable to manage the same, making it difficult for me to assist in the right manner.
I am accountable to perform moving and handling tasks with required skills and training (RCN, 2016). Furthermore, I also have a responsibility of reading records, handling and moving assessment plan and the patient’s drug chart to acquire the original actions that should be taken before taking tasks of moving and handling. Thus, falls assessment plans are helpful in finding out the procedures of moving, the need of equipment and the number of staff that should be engaged with tasks (Kneafsey, Clifford and Greenfield, 2013). The HSE (2002) recommend undertaking pre-assessment of moving and handling to avoid risk of injury to both the patient and the healthcare worker. However, my lack of understanding of my responsibility as student nurse made me face such situation.

I learnt to perform moving and handling task safely I should I should work in accordance with the HSE (2002) recommendation of verifying and documenting the weight limits, expiry dates and local trust policies before handling mobility equipment. Thus, Overall, safe moving and handling assessments reduce injuries (Kneafsey, Clifford and Green-field, 2013). A study conducted by Cornish and Jones, (2012) concluded that the standard guidelines are ideal in reducing the injuries and providing positive treatment.

Thompson, (2008) suggests that the patients’ contribution to care tasks can have better health outcome. I learnt that the use of simple prompting commands ‘ready, steady, stand’ will encourage patients to cooperate with me on mobility tasks. This will reassure the patients the support they will receive throughout the task (Thompson, 2008). Wong and Cummings (2007) a poor communication system does not allow the patient to provide feedback on what they are physically feeling and emotionally able to deal with. There are sundry factors such as disability, language barrier and pain that obstruct building interaction with patients. However, attentive listening, allowing feedback and the use of picture cards for patients who have communication difficulties can enhance interaction with patients (Bramhall, 2014).

The NMC code (2015) recommends nurses to maintain awareness of the risk of harm and therefore to take action to minimize harm. It is important to read and understand the moving and handling guidelines before performing care tasks to maintain safety. I have attended moving and handling sessions at university. However, the training did not cover the different aspects of moving and handling such as mobility tasks with patients who have dementia and patients who are in pain. Tomey (2009) supports that the university curriculum often falls short when it comes to dealing with an actual movement of a patient in severe chronic patient. Therefore, I should take part in hospital training sessions on moving and handling to gain skills to help patients with different mobility needs.

It is of paramount importance to read and understand the assessment guidelines and the patients’ drug chart to find out possible side effects of drowsiness and pain management. It is also imperative to communicate with the patient to verify whether the patient had pain killers and ascertain the pain score (Byrne and Waxman, 1990). Schnelle *et al. *(1990) concludes that without understanding the patient goals, it would be completely difficult to ensure that they reach the right goal.

*How did you change or improve your practice as a result?*

I managed to improve my professional, personal awareness and accountability of patient’s moving and handling tasks. Cipriano, (2010) states that accountability can be considered as our personal actions responsibility. I was made aware that I should treat patients in my best way possible just as I would love to be treated. Chulay and Burns (2010) show the importance of evaluating a patient’s needs and hence come up with the best pattern for each and every one of them. As a nurse, I am required to draw attention in order to avoid misconduct, patient abuses and ignorance by reporting these actions (Jasper 2006).

On the professional level of accountability, I should adhere to the NMC code (2015) and raise concerns when I realize that I have engaged in a task that is beyond my training and level of competency. When linking this to my experience, I should have sought help from the mentor to engage in moving and handling tasks without carrying them out on my own. Moreover, I am accountable to assess accurately the worsening of patients’ conditions (NMC Code, 2015). Further, I will be registered with the NMC and therefore, I must adhere to the NMC codes of conduct.

I am responsible and accountable for my actions of patient care to the civil and the criminal court in the UK. The civil law in the UK applies to issues of negligence and consent (Cox, 2010) consent is not an option, it must be gained from the patient. Morton *et al. *(2017). Clarifies that it is not only about consent but rather about informed consent. They should be aware of all the details with regard to their treatment thus making the right decision. Furthermore, I should maintain the precise record of my actions as evidence of the decisions made by me for legal use if needed (Jasper, 2006). Therefore, I started to assess the patients’ pain, and capacity cooperates with mobility before undertaking it.

Overall, as nurses are entrusted with the task of dealing with human lives, the relevance and the importance of the duty of care cannot be overstated. The primary responsibility of nurses is to ensure that no harm is caused to the patient when performing their duties. Hence, nurses have to comply with the standards of practice set by their regulatory body when performing their duties (RCN, 2006) and they will be held accountable for their actions or for the failure to act (Cox. 2010).

As I explicated earlier in this reflective account, I should have first read the patient’s medication chart, assessment of mobility and mobility care plan. If I had done so, I would have performed tasks differently minimizing the pain and gaining the trust of the patient. In future, in such situations I will ensure that I will help patients to transfer safely without causing any pain or injury. It is also vital for me to reflect further on similar experiences and engage in moving and handling training programs to develop my skills and become an autonomous expert practitioner (Benner and Tanner 1987).

*How is this relevant to the Code? *
Select one or more themes: Prioritise people – Practise effectively – Preserve safety – Promote professionalism and trust

Promote professionalism and trust, prioritise people

Safe moving and handling help preserve patients’ safety. The NMC code (2015) recommends that nurses ensure ‘safety of patients is secured.’ It is not safe to manually lift patients or undertake moving and handling tasks without the required number of staff. Equipment such as hoists, sling aids, Rota stands are used in current health care settings. However, if the equipment is handled wrongly it could cause serious injury to patients and the staff as well. Duxbury and Whittington (2005) nurses must have knowledge of both the patient’s condition as well as the equipment they will be using to manage the movement. Further inadequate knowledge of moving and handling also results in serious harm and to prevent such harm it is vital to be equipped with skills of safe moving and handling (HSE, 2002).

The NMC code (2015) recommends that ‘nurses practice professionalism and build trust on patients’. Once the patients feel they are safe in the care of the nurse they start to rely and trust in nurses. Thus, this established trust promotes patients’ engagement in their care. After reflecting on my experience, I realized that I should have had the knowledge about the patient’s needs in advance. Once, I am equipped with this I will be able to work collaboratively with patients in their care. Hence, the task should be planned with the assistance of the patient. I learnt that the contribution of the patient is vital in moving and handling. In order to gain that contribution, trust should be built between the nurse and the patient (Dawson-Rose, et al., 2016).

The NMC Code (2015) recommends that nurses maintain evidence-based practice. Linking this to my experience I realized that my current level of competencies is appropriate to practice according to the NMC Code (2015). I am continuing to develop my professional practice further to gain the required knowledge to promote safe and effective practice. According to the HSE (2002) moving and handling have many risks that should be prevented and avoided by health care professionals. Therefore, I feel that it is imperative to continue my development in mobility skills and maintain the required knowledge (NMC Code, 2015).

[image: Reflective accounts form for revalidation]
*Reflective account:*

*What was the nature of the CPD activity and/or practice-related feedback and/or event or experience in your practice?*

*What did you learn from the CPD activity and/or feedback and/or event or experience in your practice?*

*How did you change or improve your practice as a result?*

*How is this relevant to the Code? *
Select one or more themes: Prioritise people – Practise effectively – Preserve safety – Promote professionalism and trust.

[image: Reflective accounts form for revalidation]
*Reflective account:*
*What was the nature of the CPD activity and/or practice-related feedback and/or event or experience in your practice?*

*What did you learn from the CPD activity and/or feedback and/or event or experience in your practice?*

*How did you change or improve your practice as a result?*
.

*How is this relevant to the Code? *
Select one or more themes: Prioritise people – Practise effectively – Preserve safety – Promote professionalism and trust

Promote professionalism and trust, prioritise people

*References*
Chulay, M., & Burns, S. (2010). *AACN essentials of critical care nursing pocket handbook*. McGraw-Hill Professional.
Duxbury, J., & Whittington, R. (2005). Causes and management of patient aggression and violence: staff and patient perspectives. *Journal of advanced nursing*, *50*(5), 469-478.
Goode, C. J. (1995). Impact of a CareMap and case management on patient satisfaction and staff satisfaction, collaboration, and autonomy. *Nursing economic$*, *13*(6), 337-48.
Morton, P. G., Fontaine, D., Hudak, C. M., & Gallo, B. M. (2017). *Critical care nursing: a holistic approach* (p. 1056). Lippincott Williams & Wilkins.
Nehring, W. M., & Lashley, F. R. (2004). Current use and opinions regarding human patient simulators in nursing education: An international survey. *Nursing Education Perspectives*, *25*(5), 244-248.
Schnelle, J. F., Newman, D. R., & Fogarty, T. (1990). Management of patient continence in long-term care nursing facilities. *The Gerontologist*, *30*(3), 373-376.
Tomey, A. M. (2009). Nursing management and leadership. *USA: Mosby Elsevier*.
Urden, L. D., Stacy, K. M., Thelan, L. A., & Lough, M. E. (2006). *Thelan’s critical care nursing: diagnosis and management*. Mosby Inc.
Wong, C. A., & Cummings, G. G. (2007). The relationship between nursing leadership and patient outcomes: a systematic review. *Journal of nursing management*, *15*(5), 508-521.