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Difficulty: MediumClient Care Assignments and Collaboration

A practical nurse (PN) is coordinating care for a group of clients in a long-term care facility and decides to delegate the application of a prescribed moisture barrier cream to an assistive personnel (AP). Arrange the steps of the delegation process in the correct chronological sequence.

  1. 1Determine that applying the barrier cream to intact skin is a safe and appropriate task for this specific AP.
  2. 2Instruct the AP on the specific method of application and to immediately report any signs of skin breakdown.
  3. 3Monitor the AP's performance during the shift to ensure the cream is applied according to the instructions.
  4. 4Evaluate the client's skin condition later in the shift to confirm the desired outcome is being achieved.
  5. 5Provide feedback to the AP regarding their completion of the delegated skin care task.

Answer

The correct chronological sequence is to first determine task appropriateness, then instruct the AP, monitor their performance, evaluate the client's outcome, and finally provide feedback to the AP.
The National Council of State Boards of Nursing (NCSBN) outlines a specific, chronological process for safe delegation. It begins with assessment and planning (determining the Right Task and Person), followed by communication (Right Direction). Once the task begins, the nurse must provide surveillance (Right Supervision). Finally, the nurse must evaluate the client's outcome and provide feedback to the delegatee to complete the process.

Step-by-Step Solution

1
Analyze the first phase of the delegation process before interacting with the AP.
The PN must determine if the task is appropriate for the specific client and within the AP's trained capabilities.
Safe delegation always begins with identifying the Right Task, Right Circumstance, and Right Person.
2
Determine the necessary action required right before the AP begins the task.
The PN must clearly instruct the AP on how to perform the task and what abnormalities to report.
The Right Direction and Communication ensures the AP knows exactly what is expected and what requires escalation.
3
Identify the PN's responsibility while the task is ongoing.
The PN must monitor the AP's performance.
The Right Supervision entails periodic checks to maintain client safety and ensure correct task execution.
4
Determine the required action regarding the client after task completion.
The PN must personally evaluate the client's skin condition.
The PN transfers responsibility for the task but retains accountability for client care, meaning they must verify the effectiveness of the intervention.
5
Identify the final action required to close the delegation loop.
The PN provides constructive feedback to the AP.
Feedback acknowledges safe performance and identifies any areas for improvement in future assignments.

Key Concept

The Five Rights of Delegation and the chronological process of delegating nursing tasks.
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Topics

Client Care Assignments and Collaboration

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