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Delegation in Nursing: A Reflective Account

Mar 12, 2023 | 0 comments

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Mar 12, 2023 | Essays | 0 comments

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

Confidentiality has been maintained using pseudonyms names due to privacy which is in line with the Nursing and Midwifery Code of Professional Conduct (2015).

In a busy morning, there was a patient who needs scan the bladder due to retention of urine. I was busy with medication round with the mentor.  Hence, I delegated the bladder scan to the clinical support worker. Due to busy nature of the ward, I could not continue to supervise the bladder scan. Yet, after a short while, I wanted to ensure that the bladder scan performed. I found that the bladder scan is not performed. The CSW informed me, she cannot undertake the bladder scan.  She informed me that she has never done bladder scan before.   I Immediately reported the incident to the mentor. I continue to take the bladder scan for the patient.

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

This experience pointed out my weakness in safe delegation of care. The RCN (2017) guidance to delegation and accountability recommend that ‘nurses are legally liable to provide safe care for patients. Additionally, ‘nurses should delegate care tasks appropriately according to the competency level of the person who accepting 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). 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 analysing my experience, I learnt that I am a lack of skills to delegate care to CSWs. Thereby I must have the ability to perform care actively (RCN 2017). According to the NMC Code (2015), I should only assign the care to CSWs who within the scope of skills. However, due to my inability to find out the CSWs role and experience, I did not recognized the CSWs skills. 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 my recognize the 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 avoid. Conversely, Hopkins, Hughes and Vaughan (2007) suggests that despite the fact that CSWs are trained to promote the safety of patient still, it is vital to keep monitoring the quality of their and avoid asking them to make a clinical judgment. When linking this to my experience, I realised that I should have verified the ability to perform bladder scanner by the CSW before assigning the task. Hence, I should have found out the mandatory training and experience of the specific aspect of care beforehand (NHS,2016).

I realised that my lack of communication skills was halting me with providing instructions clearly to CSW. While giving instructions to CSWs nurses should allow the feedback. The feedback will help nurses to recognise 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 this skills, nurse can provide an opportunity to staff to express their views about care. Thus, the nurses will be able to recognise the skills of CSWs and their ability to perform the task safely (Corazzini et al., 2013).

A study undertaken by Wagner, Bezuidenhout and Roos, (2014) suggested that nurses should delegate to their assistants and should recognise the better communication method to build efficacious cooperation such as two-way communication method. Consequently, a better health outcome could be achieved. Also, this study identified reduced falls rates, reduced pressure damages and improved patient satisfaction (Wagner, Bezuidenhout and Roos, 2014). Overall, this literature suggests that communication skills as a key to delegation.

This experience made me learn that supervision of delegation as part of nurse’s accountability. RCSLT (2006) emphases that the nurses should judge the need for supervision depending on the competencies of the CSWs. Due to my lack of skills I was failed to recognise the need for supervision. Hence, I missed to opportunity to observe, discuss, exchange views and maintain direct and indirect supervision. However, it is argued that personality clashes, work place culture mainly affect the supervision (Cox,2010). In such situations, nurses may be reluctant to supervise. To address such issues, the intervention of management to promote friendly welcoming work culture could enhance the delegation and communication. 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. Hence, to delegate care safely, nurses should understand the level competencies of CSWs. Therefore, to make accurate delegation decision, the nurse should comprehend the responsibility and authority and accountability relate to each delegated task (Muller) . 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. The Issue of workload and acuity of patients affect the delegation. Hence, I learnt that in such situation, the nurses might struggle to delegate efficiently in such situation. However, To be complying with NMC guideline the I should undertake mandatory training.

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

Before, assigning aspect of care to CSWs, I assessed their competencies and verified the ability to perform the care safely (NMC Code,2015). By doing that I Identified the potential patient’s safety issues that relate to the delegation. Thus, the CSWs skills, length of experience, and ability deal with patient’s condition were mainly measured. For instance, I choose CSW s who 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 delegator, my responsibility is to prioritise the appropriate level of supervision of CSWs (NMC code,2015). Regardless of the busy and challenging nature of the health care setting, I started to maintain direct and indirect supervision. Thus, I worked alongside with the CSWs and continued to support regular supervision of care. This approach made care tasks are being performed safely and patients’ satisfaction. The patients feedback highlighted that they were confident of presenting a nurse or student nurses when receiving care. 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 started to maintain a better interprofessional 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. Also, I managed to discuss with the CSWs before starting the shift to plan care. This approach was helpful in recognising CSWs skills (RCN,2006).

How is this relevant to the Code?

Select one or more themes: Prioritise people – Practise effectively – Preserve safety – Promote professionalism and trust

Delegation skills can help nurses preserve patients’ safety (NMC code, 2015). Nurses have a responsibility to ensure care is delegated appropriately in busy care settings. Delegation skills help to achieve the right skill mix in such situations. Capability of CSWs depends on skills, experience, training and knowledge. Therefore, it is important to have a better understanding of CSWs’ skills and knowledge. Thus, patient care can be managed safely and prevent harm (NLIAH, 2010).

Patient safety is vital in minimising unintended harm to the patients that could occur during the period of care (NMC code,2015). Thus, the nurses are responsible to maintain the maximum level of safe practice of care. Unintended incidents may occur due to the lack of knowledge and skills of nurses and care workers. As discussed in the reflective account nurses primarily remain responsible to maintain a safe level of care in health care settings. Therefore, the NMC code of ‘patient safety’, gives clear guidance to nurses on accountability in care decisions in delegation (NHS,2018).

The NMC code of ‘prioritise patients care’, recommends that ‘the nurse must have the interest to recognise and assess patients’ needs. Further, the nurse should provide care efficaciously and preclude assumptions to ascertain care tasks are being achieved without delay (NMC code, 2015). On the whole, my skills of understanding the level of competencies of CSWs and my ability to work according to NMC guidelines will help me to prioritise the care. However, Glasper, (2018) suggest that many studies have found out that issues arise due to nurse shortages. The shortage of staff hinders prioritising of care. Therefore, I feel that I still need to have a better level of competency to take accountability of my delegations to provide 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 morning, I assisted a patient with moving and handling. The patient was suffering from back pain due to metastatic spinal cord compression (MSCC). MSCC can occur due to the spreading of malignancy to the spinal code. As the spinal cord is damaged, patients find it difficult to move due to worsening pain (Byrne and Waxman, 1990). However, I was not aware of the condition the patient was suffering from. Initially, the patient cooperated with the task. As the pain gradually became more acute, the patient displayed signs of reluctance to move to the chair. To avoid causing more distress to the patient I helped the patient back to bed safely.

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 untaken by sliding, rolling and lift-ing. To do that nurses use suitable equipment. Gibson (1991) describes that the concept empowering patients to engage with their own care may have better im-pact on sense of control. However, keeping that in mind I started to help the pa-tient to move to the chair and I did not critically think about my competency in moving and handling. As nurses are accountable for their actions they should only perform care tasks they are competent with (NMC,2015). Accordingly, nurses should seek intervention from senior staff when necessary. I learnt, I have not been well pre-pared to take on the responsibility of moving and handling tasks of patients in pain (Cox,2006). Bearing this in mind, I started to reflect on what I have learnt from this experience to perform mobility tasks safely.

I am accountable to perform moving and handling tasks with required skills and training (RCN,2016). Furthermore, I also have a responsibility to read the daily care record, mov-ing and handing assessment plan and the drug chart of the patient to find out the initial actions to be taken before undertaking moving and handling tasks. Thus, falls assess-ment 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) identified that some accidents could be avoided if the staff comply with the recommended guidelines. This literature indicates the nurses responsibility to undertake assessments before engaging in moving and handling tasks.

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). I real-ised the issue of the lack in communication skills was the main factor that hindered me from performing moving and handling tasks efficiently. Hence, I need to develop skills to communicate with patients. There are sundry factors such as disability, language bar-rier and pain that obstruct building interaction with patients. However, attentive listen-ing, 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 minimise 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. Therefore, I should take part in hospi-tal 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). Without knowing the patient’s desire and needs I cannot provide person centered care. The main factor I became aware of are taking reasonable care for my own safety and the safety of patients.

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

I improved my awareness of personal, professional and legal accountability on moving and handling patients. Cipriano, (2010) suggests that accountability is the responsibility of our own actions. On the personal level of accountability, I learnt that I should treat patients the way I myself wish to be treated. Hence, I should assess the patients’ capability to cooperate with their own care and understand the possibility and the degree of pain the patients may suffer from. I further, realised the importance of advocating for patients to uphold patients’ needs. I also need to draw attention to prevent misconduct, abuses and ignorance by taking action such as ‘whistle-blowing’ and reporting (Jasper 2006).

On the professional level of accountability, I should adhere to the NMC code (2015) and raise concerns when I realise 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) Therefore, I am responsible to gain consent before I engage in tasks and take prompt action to provide appropriate care for patients. 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 cooperate 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 ac-tions 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 minimising 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 programmes 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. 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 practise 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 realised 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 realised that my current level of competencies is appropriate to practise 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).

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