2. Delegation

o Definition of delegation: a process by which responsibility and authority for performing tasks are transferred from one individual to another who accepts that authority and responsibility

o Delegation involves

Responsibility: an obligation to accomplish a task

Accountability: accepting ownership for the results or lack of

Authority: right to act or empower

o Principles of delegation

A nurse can only delegate those tasks for which that nurse is responsible, according to the specific state's nurse practice act

The delegator remains accountable for the task

Along with responsibility for a task, the nurse who delegates must also transfer the authority necessary to complete the task

The delegator knows how to perform the task being delegated

Delegation is a contractual agreement that is entered into voluntarily

Consider the scope of practice of nursing personnel

registered nurses (RNs):

baccalaureate prepared nurses are equipped to care for individuals, families, groups and communities in both structured and unstructured health settings

associate degree prepared nurses are equipped to care for individuals in a structured health care environment

RNs cannot delegate the following activities to unlicensed assistive personnel (UAP):

assessment of clients

evaluation of client data

nursing judgment

client/family education/evaluation

nursing diagnosis/nursing care planning

licensed practical or vocational nurses (LPN/VN)

assist in implementing a defined plan of care and to perform procedures according to protocol

assessment skills are directed at differentiating normal from abnormal

competence to care for physiologically stable clients with predictable conditions

unlicensed assistive personnel (UAP)

because they are unlicensed, they have  no scope of practice

assist in a variety of direct client care activities or tasks, e.g., bathing, transferring, ambulating, feeding, toileting, and obtaining measurements (vital signs, height, weight, intake and output, blood glucose levels)

perform indirect activities such as housekeeping, transporting people and stocking supplies

3. Steps of delegation

o Define the task

o Match the delegatee to the task

determine that the task is within the scope of practice for the delegatee

nurse practice acts: each state defines nursing practice for registered nurses (RNs) and licensed practical/vocational nurses (LPN/VNs)

standards of practice: the American Nurses Association (ANA) defines standards of practice for registered nurses

some nursing tasks can be delegated to unlicensed assistive personnel (UAP) to assist, but not replace, the nurse

only licensed individuals have a legally determined scope of practice

know the employer's role expectations

organizational charts

policies and procedures

job descriptions

competency requirements

o Communicate clearly about expectations regarding the task

clearly state who will do what and by when it will be done

clearly state expected outcomes

o Reach mutual agreement about the task to be completed

the delegator validates with the delegatee that an understanding exists regarding what is to be done and the expected outcomes

potential problems and solutions are discussed

o Supervise the performance of the task

provide directions and clear expectations of how the task is to be performed

monitor performance of the task to assure compliance with established standards of practice, policies and procedures

intervene if necessary

ensure appropriate documentation of the task

o Evaluate the delegation process

assess the degree to which nursing care needs of the client are being met

review the performance by the delegatee of the delegated task

determine the need for further instruction

determine the need to continue or withdraw the delegation

o Provide feedback to individual on outcomes performance; review with the delegatee what went right as well as what went wrong with the process

o Five rights of delegation

Right task

Right circumstances

Right person

Right direction/communication

Right supervision

4. Client care assignments

o Assign the right task

o Assign the task to the right person

o The LPN may assign tasks to the unlicensed assistive personnel or nursing assistants

o Unlicensed assistive personnel (UAP) or nursing assistants cannot delegate to other UAPs or nursing assistants

5. Communication skills and conflict resolution

o Communication:

involves perception to receive a message

involves expectation - the unexpected may be ignored

makes demands on nurses to think and respond

is different than information

o Types of communication

downward: used to relate organizational policy such as position description and rules and regulations

upward: include such things as staff meetings

lateral: between staff members, i.e. to coordinate activities

diagonal: staff from different levels work together on a project

o Causes of conflict

inadequate communication

incorrect facts

unstable leadership or inadequate action plans

misunderstood roles or responsibilities

receiving directions from two or more delegators

lack of or limited staff input into decisions

inability to accept change

power issues

o Prevention of conflict includes

allocating resources fairly

avoiding unexplained changes

clearly stating expectations

addressing staff fears

o Dealing with conflict

take prompt action

help parties resolve conflict among themselves (communicate trust that parties can accomplish resolution)

maintain an objective approach

avoid criticism

use problem solving approach

provide privacy for sensitive issues

negotiate for agreements- not winning or losing

focus on patient care interests

avoid emotional outbursts

include a third party when mediation seems the best choice

6. Performance Improvement & Quality Assurance

o Quality: the degree to which client care services increase the probability of desired outcomes and reduce the probability of undesired outcomes given the current state of knowledge

o Performance improvement/assurance: the process of attaining a new level of performance or quality that is superior to any previous level of performance or quality

o Total quality management: a philosophy that emphasizes a commitment to excellence throughout the organization

o Six characteristics of total quality management

Focus on customer, i.e., client

Focus on outcomes

Total organizational involvement

Multi-professional approach

Use of quality tools and statistics for measurement

Identification of key areas for improvement with an emphasis on SAFETY

o Mandated by the Joint Commission (formerly called Joint Commission on Accreditation and Healthcare Organizations)

7. Nursing Care Delivery Systems

o Functional nursing (task nursing)

Needs of clients are broken down into tasks

Tasks are assigned to various levels of health care workers according to licensure and skill

Example: RN gives medications and UAP give bed baths for one group of clients

o Team nursing

Most common nursing care delivery system

A team of nursing personnel provides total care to a group of clients

Team leaders supervise client care teams, which usually consist of an RN, LPN, and UAP

Team leader reviews the client's plan of care and progress with team members during team conference

o Total client care (case method)

An RN is responsible for all aspects of care of one or more clients

The LPN may be assigned to assist the RN

Currently, this type of care is provided in areas requiring high level of nursing expertise, such as the critical care unit (CCU) or the post-anesthesia recovery unit (PACU)

o Primary nursing

The RN maintains a client load of primary clients

The primary nurse designs, implements and is accountable for the nursing care of those clients during their entire stay on the unit

has the benefit of continuity of care but may not be feasible with varying schedules

has been found to result in greater nurse satisfaction, more personalized care, less turn over, and fewer negative outcomes for patients

o Practice partnerships

An RN and an assistant (UAP, LPN, less-experienced RN, graduate nurse, or nurse intern) agree to be practice partners

Partners work together on same schedule with same group of clients

Senior partner directs the work of the junior partner within the scope of each partner's practice

Remember the steps in the Nursing Process -  A   D elicious PIE

 A =Assessment D =Diagnosis P =Planning I = Implementation

 E =Evaluation

6. Case management o Model for identifying, coordinating, and monitoring the implementation of

services needed to achieve desired client outcomes within a specified period of time

o Organizes client care by major diagnosis or Diagnosis Related Group (DRG)

o A collaborative health care team defines the expected outcomes of care and care strategies for a client population by defining critical paths

o A registered nurse manager is assigned to coordinate, communicate, collaborate, problem solve, facilitate and evaluate client care for a group of clients

o Case manager usually does not provide direct client care but coordinates care provided by licensed and unlicensed nursing personnel according to a critical path

o Critical pathways are plans for providing care to the client and family

identify desired outcomes

state expected amount of time and resources to be used

focus on specific diagnoses or procedures that are high volume and or high resource use (and therefore costly)

promote collaboration among disciplines (health care professionals)

o The essential components of case management include

collaboration of all health care team members

identification of expected patient outcomes with time frames

use of principles of continuous quality improvement (CQI) and variance analysis

promotion of professional practice

o Client involvement and participation is key to successful case management

7. Differentiated practice

o Identifies distinct levels of nursing practice based on defined abilities that are incorporated into job descriptions

o Structures nursing roles according to education, experience, and competency

8. Client-centered care

o The RN coordinates a team of multi-functional unit-based caregivers

o All client care services are unit-based, including admission, discharge, diagnostic testing and support services

o Uses UAPs to perform delegated client care tasks

9. Documentation

o Types of patient records

Problem-oriented medical record (POMR)

1. a decision is made on the nature of the client's problem or problems and these problems are assessed regularly

2. recorded using a standardized format, by narrative notes in the S.O.A.P. format or by flow sheets

3. discharge summary relates the overall assessment of progress during treatment and plans for follow-up care, encouraging continuity of care

4. four parts

1. data base: the client's present health status

2. problem list: numbered list of health problem(s)

3. initial plan: plan to help overcome health problem(s)

4. progress notes: all disciplines chart on the same page

Source-oriented

1. most traditional type of charting, with different disciplines charting on separate forms

2. drawback: records become very bulky, very quickly

o Methods (styles) of charting

narrative charting

1. the nurse records observations, data (including reactions from the client) in a sequential and chronological order

2. baseline charted every shift

3. source-oriented

S.O.A.P.: problem-oriented charting; comes from a medical model

1. S = subjective; what client tells you

2. O = objective; what you observe, see, etc.

3. A = assessment; what you think is going on based on the data

4. P = plan; what you are going to do

Focus charting

1. charting on an acute condition, a potential problem, a treatment or procedure, or a client behavior

2. components of this type of charting include: information about the condition/problem, action, and client's responses

P.I.E. charting; uses the nursing process

1. P = problem

2. I = intervention

3. E = evaluation

Charting by exception

1. uses flowsheets

2. emphasis on abnormal (or what is abnormal for this particular client); normal routine is presumed as having been done, without any problems

Documentation has six key components -  CO-ACTS: 

 C onfidential O rganized (chronologically) A ccurate C omplete T imely S ubjective and objective data

3. Documentation guidelines o General

check that you have the correct chart

record the facts as accurately as possible

chart as you go

never chart for another person

do not mention incident reports

avoid the use of abbreviations - when in doubt, write it out!

all health care institutions have a list of accepted abbreviations

refer to the Joint Commission's official "Do Not Use" list of abbreviations

never alter a client's record (altering a client chart is a criminal offense)

six things that nurses must document

assessment

nursing diagnosis and client needs

interventions

care provided

client response to care

client's ability to manage continuing care after discharge

o Legal guidelines for charting

electronic health record (EHR) charting

never share access or password with another person

change your password frequently

maintain confidentiality of documented information printed from the computer

carefully check your information before you press enter

access information for clients under your care only

log off when you are finished

date and time are automatically recorded

paper-ink

do

write in chronological order

use permanent black ink

chart the time and date for each entry

include consent for or refusal of treatment, client responses to interventions, calls made to other health care professionals

write legibly

cross through the error once, date and initial the change

correct any errors in a timely manner

do not

erase, scratch out or use correction fluid (Liquid Paper or Wite Out®)

document for others or change documentation by others

leave blank spaces

recopy any charting form

make photocopies without permission

NCSBN Learning Extension offers several continuing education courses, including  Documentation: A Critical Aspect of Client Care . For more information, go to http://www.learningext.com.

The American Recovery and Reinvestment Act (ARRA) will require all health care facilities to use electronic medical records by 2014.

Review the Joint Commission's Official "Do Not Use" List of abbreviations (last updated 3/5/2009)

6. Establishing Priorities o Prioritizing: decisions of which needs or problems require immediate

attention or action and which ones can be delayed until a later time if they are not urgent

o Needs that are life-threatening or could result in harm to the client if left untreated are high priorities

o Actual problems or needs have higher priority than potential problems or needs

o Problems or needs identified by client are of a higher priority

o Consider Maslow's principles (hierarchy of needs) or the ABCs (airway, breathing, circulation) of emergency care to guide decisions

o Mutual decision-making for priorities may be made with the client based on the client's physiologic needs, desires, and safety

Get a good night's sleep the night before the test.

6. Establishing Priorities o Prioritizing: decisions of which needs or problems require immediate

attention or action and which ones can be delayed until a later time if they are not urgent

o Needs that are life-threatening or could result in harm to the client if left untreated are high priorities

o Actual problems or needs have higher priority than potential problems or needs

o Problems or needs identified by client are of a higher priority

o Consider Maslow's principles (hierarchy of needs) or the ABCs (airway, breathing, circulation) of emergency care to guide decisions

o Mutual decision-making for priorities may be made with the client based on the client's physiologic needs, desires, and safety

Get a good night's sleep the night before the test.

8. Standards of Nursing Practice and Standard of Care o The American Nurses Association (ANA) publishes its Standards of

Nursing Practice, which defines the responsibilities of the RN to all clients for quality of care

o Each institution sets standards of care, both across the institution and for specific clinical populations

Learn more about the Standards of Nursing Practice by visiting the National League for Nursing (NLN) and American Nurses Association (ANA) web sites.

9. Legal Responsibilities o Negligence: legally, a breach of the duty to provide nursing care to the

client

Malpractice is professional negligence

The unintentional failure of an individual to perform or not perform an act that a reasonable person would or would not perform in a similar set of circumstances

o Negligence involves four legal concepts:

Duty: nurses have a legal obligation to provide nursing care to clients

must meet a reasonable and prudent standard of care under the circumstances

must deliver care as any other reasonable and prudent nurse of similar education and experience would, under similar circumstances

Breach of duty: failure to provide expected, reasonable standard of care under the circumstances (includes errors of omission or commission)

Proximate cause:

relationship between the breach of duty and the resulting injury

the injured party must prove that the nurse's action or omission led to the injury

Damages: the injury and the monetary award to the plaintiff

A former client sues a nurse for negligence. The client must prove that the nurse not only committed a breach of duty but that this breach of duty was the proximate cause of any damages incurred by the client.

NCSBN Learning Extension offers continuing education courses on Professional Accountability and Legal Liability for Nurses  and Disciplinary Actions: What Every Nurse Should Know . For more information on this and other available courses, go to www.learningext.com.

10. Professional Misconduct o The impaired professional

Remember that the impaired nurse is compromising client care

Be sure that the problem exists and can be proven

Communicate specific concerns to appropriate persons such as a nurse manager or risk manager

Document incidents in terms of behaviors, specific times, dates - be objective

File a report according to the policies and procedures of the institution

o Boundary violations

Definition: actions that overstep established interpersonal boundaries and meet the needs of the nurse rather than the client.

Guiding principles in determining professional boundaries

nurse is responsible for setting and keeping boundaries

nurse must avoid simultaneous professional and personal relationship with a client

nurse must avoid flirtation

Learn more about the American Nurses Association's Code of Ethics for Nurses.

NCSBN Learning Extension offers a continuing education course called Ethics of Nursing Practice . For more information about this course, and the other courses that are available, go to http://www.learningext.com.

11. Client Rights o Privacy

Confidential information may only be released by signed consent of the client

Unauthorized release of client data may be an invasion of privacy

Health Insurance Portability and Accountability Act of 1996 (HIPAA)

provides individuals with access to their medical records and more control over how their personal health information is used

provides privacy protection for consumers of health care

Health care workers must release information when a court orders it or when statutes require it (as in child abuse or communicable diseases)

Special regulations apply to release of information about psychiatric illness or HIV

Learn more about HIPAA from the US Department of Health & Human Services

NCSBN Learning Extension offers a continuing education course called Patient Privacy . For information on this, and all other available courses, please go to www.learningext.com.

2. Advance directives

o As part of the Omnibus Budget Reconciliation Act (OBRA) of 1990, Congress established the Patient Self-Determination Act; this requires states to provide written information to clients outlining their rights to make health care decisions

o These rights include:

the right to refuse or accept treatment

the right to formulate advance directives

o Nurses and other members of the health care team are required to

assess the clients knowledge of advance directives and their status regarding the advance directive process

provide information and assistance to the client in developing advance directives

plan care that incorporates the clients decisions regarding advance directives Three common advance directives are:

living will: identifies what a client wishes for his care should he become unable to communicate these wishes

durable power of attorney for health care decisions: the client has appointed a person to make decisions about their care if they are unable to do so.

do not resuscitate (DNR) status: this has been expanded to include identification of medications that may be given without any defibrillation attempts (comfort measures only)

follow the facility policy on obtaining and implementing DNR orders

generally, the order must be written by a physician; some facilities may have a policy to allow verbal orders under specific conditions

the order must be communicated clearly to all personnel caring for the client

the client or her or his health care proxy can withdraw the order at any time

a nurse who attempts to resuscitate a client with a valid DNR order may be committing battery

3. Refusal of treatment - competent clients may refuse treatment, even life-sustaining treatment

4. Freedom from safety devices/restraints

o Physical restraints/safety devices require a signed, dated physician's order specifying the type of restraint/safety device and a time limit

o Types of restraints/safety devices

chemical - central nervous system depressants, paralytics

physical - vest restraints, side rails

o Use the least restrictive form of restraint/safety device

o know agency guidelines for use of restraints

o The nurse must document three factors

why restraints/safety devices were used

how the client responded

whether the client needs continued restraints/safety devices

o Restraining clients without consent or sufficient justification may be interpreted as false imprisonment

5. Informed consent

o Basic requirements

capacity

voluntariness

information

o The client must understand

purpose of the procedure and expected results

anticipated risks and discomforts

potential benefits

any reasonable alternatives

that consent may be withdrawn at any time

o The care provider has the legal obligation to obtain informed consent for medical treatment, but the nurse should confirm consent and answer the client's questions

6. Transition planning - recognizes that clients are not discharged from care but moved across the continuum to another level of care

7. Ethics in Nursing

o Ethics

A theory or system of moral values, based on the ideas of right and wrong

It governs our relationships with others

o A code of ethics provides standards and values for a profession; individuals must integrate the values of the profession with their own values

o Ethical principles

Respect for others

Autonomy

Nonmaleficence - "do no harm"

Beneficence - do good and avoid evil

Justice

Veracity - the ethical duty to tell the truth

Confidentiality

Fidelity - loyalty, faithfulness and honoring commitments

Learn more about the American Nurses Association's Code of Ethics for Nurses.

NCSBN Learning Extension offers a continuing education course called Ethics of Nursing Practice . For more information about this course, and the other courses that are available, go to http://www.learningext.com.

A licensed registered nurse (RN) has a legal duty to account for every task that he or she delegates.

Points to Remember← Nursing practice is governed by legal restrictions and professional standards.

← What a nurse can do depends on the nurse practice act in the state in which the nurse is licensed.

← Each state defines what constitutes professional misconduct.

← The state board of nursing has the authority to impose a penalty for professional misconduct.

← Penalties include probation, censure, reprimand, suspension or revocation of the license.

← Standards of nursing practice apply to all nurses in all practice settings.

← Standards of care are based on facility policy and procedure, nursing education, experience, and publications of professional nursing associations and accrediting groups.

← To avoid negligence:

← Know the standard of care

← Deliver care that meets the standard and follows the facility's policies and procedures

← Document care accurately and in a timely manner

← The only employee of a health care organization who may be the legal witness to the signing of an advance directive is a clinical social worker. It is at the discretion of each health care facility as to whether or not this is done. Always check the policy of your facility. A relative or heir to the estate should never be the witness to the signing of an advance directive.

← Ethics guide the nurse toward client advocacy and the development of a therapeutic relationship.

← Ethical dilemmas result from conflicts in values.

← An effective leader modifies his/her style according to the situational requirements.

← Final responsibility for any delegated task resides with the RN.

← The RN must monitor delegated tasks and evaluate the outcomes.

1. At a nursing staff meeting, there is discussion of perceived inequities in weekend staff assignments. As a follow-up, the nurse manager should initially   take which action?

Clarify reasons for current assignments

Help staff see the complexity of issues

Facilitate creative thinking on staffing

Allow the staff to change assignments

With an alert of an internal disaster and the need for beds, a charge nurse is asked to list the clients who are potential discharges within the next hour. Which one of these clients should the charge nurse select?

A school-aged child who was admitted at the change of shifts with a diagnosis of

suspected bacterial meningitis

A middle-aged client who was admitted yesterday with an internal automatic

defibrillator and complaints of “passing out at unknown times”

An adolescent admitted the prior night with Tylenol intoxication

An older adult client who has been diagnosed with type 2 diabetes mellitus for

over 20 years, admitted with diabetic ketoacidosis 24 hours ago

The nurse assigns an unlicensed assistive personnel (UAP) to care for a client diagnosed with a musculoskeletal disorder. The client ambulates with a leg splint. Which task requires supervision of the UAP during the care of this client?

Assist the client to transfer from a bed to a chair

Monitor the client's response to ambulatory activity

Encourage for the client's independence in self-care

Report signs of redness overlying a joint

A newly admitted older adult client is diagnosed with severe dehydration. When planning care for this client, the nurse should assign which task to an unlicensed assistive personnel (UAP)?

Converse with the client to determine if the mucous membranes are impaired

Monitor client's ability for movement in the bed from side to side

Check skin turgor every four hours along with the need to change the adult diaper

Report hourly outputs of less than 30 mL/hr within 15 minutes of the check

Which one of these tasks for a client who has a nasogastric tube after colon surgery can be safely delegated to an unlicensed assistive personnel (UAP)?

Monitor the client for nausea or other gastric complications

Irrigate the nasogastric tube with the ordered irrigant

Perform nostril and mouth care on an every two hour schedule

Monitor the type and amount of nasogastric tube drainage

1. The triage nurse identifies that a 16 year-old teenager is legally married and has signed the consent form for treatment. What should be an   appropriate   action by the nurse?

Proceed with the triage process in the same manner as any adult client

Ask the teenager to wait until a parent or legal guardian can be contacted

Refer the teenager to a community pediatric hospital emergency department

Withhold treatment until telephone consent can be obtained from the partner

1. A client is admitted with a diagnosis of schizophrenia. The client refuses to take any medication and states “I don’t think I need those medications. They make me too sleepy and drowsy. I want you to explain their use and side effects.” The nurse should respond with an understanding of which statement?

Such education is an independent decision of the individual nurse whether or not

to teach clients about their medications

Clients with schizophrenia are at a higher risk of psychosocial complications when

they know about their medication's uses and side effects

A referral is needed to the psychiatrist who should provide the client with answers

to the request

The client has a right to know about the use and side effects of the prescribed

medications

1. After working with a client, an unlicensed assistive personnel (UAP) tells the nurse, "I have had it with that demanding client. I just can’t do anything that pleases him. I’m not going in there again." The nurse should respond by saying

"He may be scared and taking it out on you. Let's talk to figure out what to do

next."

"Ignore him and get the rest of your work done. Someone else can care for him

the rest of the day."

"He has a lot of problems. You need to have patience with him."

"I will talk with him and try to figure out what to do or what the problem is."

1. Privacy and confidentiality of client information is legally protected. In which of these situations would a nurse make an exception to this practice?

When the provider decides the family has a right to know the client's diagnosis

When the client threatens self-harm or harm to others

When a family member offers information about their loved one

When a visitor insists that the visitor has been given permission by the client

1. During seizure activity which observation is a   priority   to enhance further direction of any treatment?

Determine if loss of bowel or bladder control occurs

Identify the pattern of breathing

Observe the sequence or types of movement

Note the time from beginning to end

1. The nurse manager informs the nursing staff at morning report that the clinical nurse specialist will be conducting a research study on staff attitudes toward client care. All staff are invited to participate in the study if they wish. This affirms which ethical principle?

Justice

Anonymity

Beneficence

Autonomy

1. A client is admitted to a voluntary hospital mental health unit with the diagnosis of suicidal ideation. The client has been on the unit for two days and now states “I demand to be released now!” The appropriate response from the nurse should be which of these statements?

”You cannot be released because you are still at risk of being suicidal"

"You have a right to sign out as soon as we get the health care provider's

discharge order."

"You can be released only if you sign a no suicide contract before you leave"

"Let’s discuss your decision to leave and then we can prepare you for discharge."

1. During the evaluation phase for a client, the nurse should focus on which aspect?

Setting short and long-term goals to insure continuity of care from hospital to

home

Findings of physical and psychosocial stressors of the client and in the family

The client's status, progress toward goal achievement, and ongoing reevaluation

Select interventions that are measurable and achievable within selected

timeframes

1. Decentralized scheduling is used on a nursing unit. What is the advantage of this management strategy?

considers client and staff needs

conserves time spent on planning

frees the nurse manager to handle other priorities

allows requests for special privileges

1. When caring for a client with an intravenous (IV) infusion for pain control, a nurse should ask an unlicensed assistive personnel (UAP) to do which action?

Check the IV site for drainage and loose tape when in the room

Readjust the set rate on the pump by two mL/minute

Assist the client with ambulation after supervising a gown change

Monitor the client for the degree of pain relief

1. During assessment of clients, a nurse should be informed about cultural issues related to the client's background for what reason?

Normal patterns of behavior may be labeled as deviant, immoral, or insane

The nurse should rely on any knowledge of different developmental stages

Personal values will guide the interaction between persons from two cultures

The meaning of the client's behavior can be derived from conventional wisdom

1. During an interview of a prospective employee who just completed the agency application, which approach should a nurse manager use to assess skills' competence of this potential employee?

"Let's talk about your comfort zones for working independently."

"What types of complex client care tasks or assignments do you prefer?"

"Let’s review your skills check-list for type and level of skill for tasks."

"What degree of supervision for basic care do you think you need?"

1. The RN is responsible for the care of a client who is two days post-reconstructive nasal surgery. Which task can be safely delegated to an unlicensed assistive personnel (UAP)?

Ask the client if the medication for pain was effective

Remind the client to report increased or changes in discomfort

Suggest that the client ask for pain medication every few hours

Observe for restlessness or changes in breathing

1. A client with a diagnosis of bipolar disorder has been referred to a local boarding home for placement consideration. The social worker telephoned the hospital unit to obtain information about the client’s mental status and adjustment during hospitalization. The appropriate response of the nurse should be which of these statements?

"Since this is a referral, I can give you a limited amount of information."

"I am sorry. Referral information can only be provided by the client’s providers."

"I can never give any information out by telephone. How do I know who you are?"

"I need to get the client’s written consent before I release any information to you."

A client tells the nurse, "I have something very important to tell you if you promise not to tell." The nurse should respond with which statement?

"I must report everything to the treatment team."

"I must document and report any information."

"I can’t make such a promise."

"That depends on what you tell me."