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Difficulty: MediumAssignment, Delegation and Supervision

During a severe weather emergency, a medical-surgical unit is operating with a modified staffing model consisting of one registered nurse (RN) and one unlicensed assistive personnel (UAP). To maintain safe and effective care, which of the following client care activities is most appropriate for the RN to delegate to the UAP?

  1. Assisting a clinically stable client who had an ischemic stroke three days ago with routine oral hygiene and turning.Answer
  2. B
    Evaluating the swallowing ability of a client with new-onset dysphagia before providing their first oral feeding.
  3. C
    Demonstrating proper crutch-walking techniques to a client who is scheduled for discharge later in the shift.
  4. D
    Obtaining the initial set of vital signs for a client arriving directly from the emergency department with suspected sepsis.

Answer

Assisting a clinically stable client who had an ischemic stroke three days ago with routine oral hygiene and turning.
The correct delegation decision involves assigning routine, predictable tasks that do not require nursing judgment to the unlicensed assistive personnel. Assisting a stable client with activities of daily living perfectly matches the UAP's scope of practice.

Step-by-Step Solution

1
Analyze each client care activity to identify requirements for clinical judgment, assessment, evaluation, or teaching.
Evaluating swallowing, demonstrating crutch-walking, and conducting an admission assessment all require RN-level cognitive skills and licensure.
The National Council of State Boards of Nursing (NCSBN) explicitly prohibits the delegation of nursing judgment, assessment, and teaching to unlicensed personnel.
2
Determine the clinical stability and acuity of the clients described in each scenario.
The newly admitted client with sepsis is highly unstable, whereas the client who had an ischemic stroke three days ago is described as clinically stable.
Delegation is only appropriate for clients whose conditions are stable and whose care yields predictable outcomes.
3
Apply the Five Rights of Delegation to select the appropriate activity for the UAP.
Providing routine oral hygiene and assisting with turning for the stable stroke client is the only legally and clinically safe task to delegate.
This task involves routine activities of daily living (ADLs) that are standard within the UAP's training and do not require nursing judgment.

Key Concept

Delegation of client care tasks and UAP scope of practice
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Topics

Assignment, Delegation and Supervision

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