DELEGATIONThis case study is based on a real life medicolegal issue resulting in a lawsuit against a nurse. In this case study, we will examine proper delegation of nursing tasks to unlicensed assistive personnel (UAP).A registered nurse (RN) employed by a home healthcare agency. The RN received a call from the certified nursing assistant (CNA) that the patient’s gastrointestinal tube (G-tube) had somehow been dislodged. Because the RN was not immediately available to assess the patient, she instructed the CNA to have the patient transported to the emergency department (ED) to be evaluated and have the G-tube reinserted.The family did not want to make a trip to the ED and the CNA informed the RN that she was experienced in replacing dislodged G-tube due to her previous 10 years of experience at a nursing home. The RN agreed to allow the CNA to replace the G-tube, which the CNA promptly did. She subsequently informed the RN that placement of the G-tube was easy and that she had confirmed placement. The RN instructed the CNA not to resume the tube feedings until she arrived and assessed the patient.The RN eventually arrived and noted that the tube feeds were running and the patient’s caregiver stated that they never received instructions to hold the tube feedings. The patient complained of abdominal pain and nausea and on assessment the RN noted that the patient’s abdomen was firm, distended, and tender to touch. EMS was called and the patient was transported to the ED where the patient was diagnosed with peritonitis due to the G-tube being incorrectly placed in the peritoneal space rather than the stomach.The family filed a lawsuit against the RN and the home healthcare agency. A settlement for $255,000 was reached between the family, the nurse, and the healthcare agency.Questions:1. What are the five rights of delegation?2. Was the task the RN delegated to the CNA improper? If so, which of the five rights of delegation were not followed by the RN? Explain your reasoning.3. Which of the following would be examples of proper delegation to UAP? Select all that apply. For all the incorrect examples of delegation, explain which of the five rights is violated and why.□ The nurse asks the UAP to take vital signs on Mr. Hernández in room 413.□ The nurse asks the UAP to perform the initial dressing change on a complex post-surgical wound on Mrs. Beasley who had surgery 12 hours ago.□ The nurse asks the UAP to assist Mr. Jones in room 506 with toileting.□ The nurse is planning care for one his patients. As part of this care, the nurse decides to delegate one of the steps of the nursing process, in particular to evaluate the effectiveness of the teaching conducted earlier in the shift when both the RN and UAP were present in the room.4. If you were the RN in this case, how would you have handled the above scenario? Exactly what steps would you have taken?
DELEGATION
This case study is based on a real life medicolegal issue resulting in a lawsuit against a nurse. In this case study, we will examine proper delegation of nursing tasks to unlicensed assistive personnel (UAP).
A registered nurse (RN) employed by a home healthcare agency. The RN received a call from the certified nursing assistant (CNA) that the patient’s gastrointestinal tube (G-tube) had somehow been dislodged. Because the RN was not immediately available to assess the patient, she instructed the CNA to have the patient transported to the emergency department (ED) to be evaluated and have the G-tube reinserted.
The family did not want to make a trip to the ED and the CNA informed the RN that she was experienced in replacing dislodged G-tube due to her previous 10 years of experience at a nursing home. The RN agreed to allow the CNA to replace the G-tube, which the CNA promptly did. She subsequently informed the RN that placement of the G-tube was easy and that she had confirmed placement. The RN instructed the CNA not to resume the tube feedings until she arrived and assessed the patient.
The RN eventually arrived and noted that the tube feeds were running and the patient’s caregiver stated that they never received instructions to hold the tube feedings. The patient complained of abdominal pain and nausea and on assessment the RN noted that the patient’s abdomen was firm, distended, and tender to touch. EMS was called and the patient was transported to the ED where the patient was diagnosed with peritonitis due to the G-tube being incorrectly placed in the peritoneal space rather than the stomach.
The family filed a lawsuit against the RN and the home healthcare agency. A settlement for $255,000 was reached between the family, the nurse, and the healthcare agency.
Questions:
1. What are the five rights of delegation?
2. Was the task the RN delegated to the CNA improper? If so, which of the five rights of delegation were not followed by the RN? Explain your reasoning.
3. Which of the following would be examples of proper delegation to UAP? Select all that apply. For all the incorrect examples of delegation, explain which of the five rights is violated and why.
□ The nurse asks the UAP to take vital signs on Mr. Hernández in room 413.
□ The nurse asks the UAP to perform the initial dressing change on a complex post-surgical wound on Mrs. Beasley who had surgery 12 hours ago.
□ The nurse asks the UAP to assist Mr. Jones in room 506 with toileting.
□ The nurse is planning care for one his patients. As part of this care, the nurse decides to delegate one of the steps of the nursing process, in particular to evaluate the effectiveness of the teaching conducted earlier in the shift when both the RN and UAP were present in the room.
4. If you were the RN in this case, how would you have handled the above scenario? Exactly what steps would you have taken?
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