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Difficulty: MediumAssignment, Delegation and Supervision

An outpatient orthopedic clinic is experiencing a high volume of walk-in appointments. The clinical coordinator must distribute client care activities between a registered nurse (RN) and an unlicensed assistive personnel (UAP). Which of the following tasks is most appropriate to delegate to the UAP?

  1. Assisting a stable older adult client with transferring from a wheelchair to the examination table.Answer
  2. B
    Evaluating the neurovascular status of a client's distal extremity immediately following cast application.
  3. C
    Demonstrating the proper technique for cleansing pin sites to a client with a newly placed external fixator.
  4. D
    Obtaining vital signs for a client in the waiting area who is suddenly reporting severe, crushing chest pain.

Answer

Assisting a stable older adult client with transferring from a wheelchair to the examination table.
The correct answer is assisting the stable older adult client with a wheelchair transfer. According to the Five Rights of Delegation, tasks delegated to a UAP should be routine, pose low risk, and be performed on stable clients with predictable outcomes. Assisting with a transfer falls well within the UAP's standard scope of practice.

Step-by-Step Solution

1
Analyze each task to determine if it requires advanced nursing knowledge, assessment, or teaching.
Evaluating neurovascular status is an assessment. Demonstrating pin care is teaching. Assisting with a wheelchair transfer is a basic mobility task.
The RN cannot delegate tasks involving clinical judgment, assessment, or initial teaching (often remembered by the EAT acronym: Evaluate, Assess, Teach).
2
Evaluate the clinical circumstance and stability of each client.
The client reporting severe, crushing chest pain is highly unstable and experiencing a potential medical emergency. The older adult client requiring a transfer is stable.
The 'right circumstance' principle of delegation dictates that UAPs should only be assigned to stable clients with predictable outcomes. Unstable clients require immediate RN attention.
3
Select the task that best aligns with the UAP's scope of practice and the principles of safe delegation.
Assisting the stable client with a transfer is the only task that meets all criteria for safe delegation.
Basic mobility assistance for a stable client poses minimal risk and does not require nursing judgment.

Key Concept

Delegation of routine care for stable clients to Unlicensed Assistive Personnel (UAP)
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Topics

Assignment, Delegation and Supervision

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