Delegation And Patient Management

In this critical reflection essay, the challenges experienced during an incident while managing a group of patients as student nurses in my third-year placement is discussed. The essay is going to explore the impact of delegation and poor handover of nursing duties on me and patient management at my workplace. The Rolfe’s Reflective Model is to be used for critically reflecting the situation. In this case, the pseudonym Javed is to be used for ensuring confidentiality of the service user. This is because the NMC Code of Conduct 2015 informs that the confidentiality of the patients or individuals is to be maintained by the nurses while delivering them care to ensure protection of abuse or harm as well as abiding by the professional standards of care (NMC, 2015).

During shift change at the medical ward, the day staff nurses delegated and handed over their duties to me and my manager. Moreover, during the delegation process we received two calls from the bay which we had to attend as the NMC informs that the safety of the patient is the primary concern for the nurses. However, this resulted in creating interruption during the handover process which led the staff nurses to have less time for explaining the delegation duties. Thus, they were seen to be in a hurry to handover their duties as a result of which I was unable to ask few questions raised regarding the patients to be cared for. After the delegation, my manager asked me to manage two nursing bay together with three patients each as there was shortage of staffs and she also had to immediately attend to a call from another bay in the medical ward. However, she assured to come back after some time and help me in managing the bays.

I was panicked and anxious regarding my responsibilities to manage two bays without my manager. Further, in the second bay where I was performing my duties, a patient named Javed who was aged 70 years suffering from Alzheimer was admitted by the nurses two days before my shift. While I was caring for the patients, Javed started to shout for no reason and reported to throw things at me within the ward including his pillow, jug of water, medicines and others. I immediately attend to his care to calm him and ask what he required so that no one else in the ward is harmed. The situation led me to get shocked, bewildered and frustrated as during the delegation process no information was mentioned that Javed is to be managed with caution.

The detailed information about each of the patients is to be provided during the delegation process so that the other nurse on whom the duties are handover remains aware of the way patients are to be cared to ensure their safety and quality care (Siegel et al. 2018). This is because lack of proper information regarding patients leads the nurse in duty face confusion to understand the way each patient have to be cared. As asserted by Magnusson et al. (2017), establishment of effective communication is essential during delegation from one shift to another for helping nurses decide provision of care for the patients. However, it was seen that the nurses in the previous shift executed interrupted and hurried communication to me and my manager due to which many information is being missed. It result me to experience lack of knowledge regarding which patient is to be treated in which way and what are their individual needs to be fulfilled.

In this situation, I blame myself being responsible for not actively listening to the nurses while delegation as I lost my focus while attending to the call from the bay. The lack of active listening during delegation leads to poor care as the nurses do not have effective information regarding the health complication of the patients and the way they are to be cared (Christina & Susan, 2016). Moreover, I also blame that it was my responsibility to have missed to ask the question being raised even if the nurses were in hurry as it is my role to ensure effective care to the patients by knowing details related to their care provision. The delegated nurses by not resolving raised questions regarding patients lead them to face hindrance in providing proper care. This is because they lack proper and detailed information about care provision for patients (Perry et al. 2019).

The patients suffering from Alzheimer are seen to have confusion regarding place and time as well as understanding people. This is because out of their familiar environment makes Alzheimer patient feel at risk which raises them to be aggressive and anxious (Marshall & Hale, 2017). Thus, Javed may have reacted in such a way by seeing me as I was not formally introduced to him and other patients by the nurses during delegation. It led him to think I may harm him which resulted in his sudden change of behaviour. I immediately called for help by pressing the calling alarm to alter other staffs in the adjacent bay to help me cope with the situation. This is because the NMC Code informs that safety of the patients is my key priority and in case of any risk, I require to call for help and alert concerning authorities (NMC, 2015). Since there was lack of staff in the bays I was attending thus I need to call for help through alarm as I cannot leave the patients as it may lead them to get harmed by Javed. It also helped me to follow NMC guidelines where assessing risk in the bay for Javed and patients I alarmed concerned authorities.

After the alarm, I found a nurse from the adjacent bay came to my help in controlling Javed. Moreover, by the time I used the alarm, I also found my manager had just came to the bay completing her previous call in the other bay. The NMC Code under the domain of “Practice effectively” informs that the nurses are required to work cooperatively by sharing skills and expertise for quality care provision for the patients (NMC, 2015). In case of Javed, it was seen that since he did not know me or my manager thus he reported to show aggressive behaviour towards us. However, the nurse who came from the other bay along with me and my manager introducing ourselves to Javed and tried cooperatively to make him calm down. As mentioned by Bradley et al. (2015), shortage of nursing staff causes lower quality and delay care to the patients. This is because the nurses are unable to holistically care for the patient as result of lower workforce. However, the Francis report argued that shortage of nursing staff is not an issue to be mentioned for causing hindered care or delay of support for the patients (www.nursingtimes.net, 2017). Thus, the nurses require working collaboratively to work in best interest of the patients by making them the centre for arranging care services.

I found that Javed was also deaf and I have no knowledge of using sign language to communicate with a deaf patient. However, my manager reported that she has basic knowledge about sign language. Thus, I asked her to teach me the way I can communicate to Javed to ask him to calm down. As I learnt and use the sign language, Javed seemed to calm down and initiated to converse with me through further signs. As stated by Yoon, Kim & Shin (2016), effective communication in delegated care with the patient is established when they seen their emotional and psychological demands and needs are understood by others. This is because it leads the patients they are being valued and acknowledged by others. I found that communicating through sign language with the help of my manager along with empathetic and polite behaviour helped me to develop a therapeutic relationship with Javed to ensure good care provision for him.

The third-year nursing students are required to implement the delegation skills learned on the job as a part of the placement for ensuring to meet all the learning objectives (Hasson, 2013). Thus, I acted as a team leader to delegate responsibilities between two healthcare assistant allocated by my manager for helping me with caring for Javed and other patients at the ward. I delegated one of the members to look after patients and provide them appropriate care by understanding their needs in the bay adjacent to Javed’s. The second member had the knowledge of using sign languages. Thus, I delegated her to work with me in the bay where Javed was cared for to help me in communicating with Javed to understand his needs and look after and care for other patients in the bay.

The delegation is referred to assignment of the responsibility to another person for carrying out certain activities (Johnson et al. 2015). The NMC Code also under the domain of “Practice effectively” informs that the nurses are accountable to take decision in delegating task and duties to other to ensure better health outcome of the patients. However, the delegated members are required to be adequately supervised to ensure quality care (NMC, 2015). As mentioned by Molefe & Sehularo (2015), poor delegation results to create deteriorated health outcome for the patients. This is because the appropriate care patients require for improved health outcome are not given to them by the delegated members. Thus, I ensured that proper supervision is received by each of the two delegated members from me and my manager to perform their delegated task with efficiency in the ward. It is required so that effective care can be provided to the patients in the bay. I tried to document each of the information about Javed’s care within a folder. This is required as the NMC Code informs that effective documentation of patient’s case helps nurses in future to learn care strategies they can implement to resolve similar situation (NMC, 2015). However, while documentation of Javed’s case I face issues with maintain his confidentiality. This is because there were chances of unauthorised access, disclosure, loss or theft or modification of data regarding Javed’s while his case files would be accessed later by anyone in the hospital.

During Javed’s care, I was initially panicked, bewildered and stressed. At present, I feel positive as the incident led me to resolve my fear of delegation and manage Javed’s care as well as others in allocated bays to me with efficiency. The NMC Code informs that nurses are required to provide leadership to protect patient’s well-being and improve their experience and satisfaction regarding care services (NMC, 2015). Thus, my leadership strategy of explaining all information required in delegation regarding patients to be cared for in the bay by the recruited delegates with beneficial. As per Huber (2017), leaders are required to have effective expertise in their field of operation. However, I lacked the skill of using sign language that did not have effective expertise regarding all the requirements in the field. Thus, in future, I would take training in using sign language to communicate with deaf and blind people to ensure effective leadership. Moreover, I would ask raised question during delegation so that after the handover I have effective information regarding the way to treat each patient. I would also improve my active listening skill as well as mention password to protect document regarding Javed and other patients that would be shared on informed consent of the owner.

The above discussion is seen to have informed that effective listening; asking question to clarify data regarding patient's to care for and others are important aspect of focus during delegation. The experience has improved my delegation along with leadership skills and has enhanced my knowledge regarding the way to cooperatively work with other staffs to offer quality care to the patients.

References

• Bradley, S., Kamwendo, F., Chipeta, E., Chimwaza, W., de Pinho, H., & McAuliffe, E. (2015). Too few staff, too many patients: a qualitative study of the impact on obstetric care providers and on quality of care in Malawi. BMC pregnancy and childbirth, 15(1), 65.
• Christina LMSN, R. N., & Susan MDNP, R. N. (2016). Use of Simulated Psychosocial Role-Playing to Enhance Nursing Students' Development of Soft Skills. Creative nursing, 22(3), 171.
• Hasson, F., McKenna, H. P., & Keeney, S. (2013). Delegating and supervising unregistered professionals: The student nurse experience. Nurse EducationToday, 33(3), 229-235.
• Huber, D. (2017). Leadership and Nursing Care Management-E-Book. Elsevier Health Sciences.
• Johnson, M., Magnusson, C., Allan, H., Evans, K., Ball, E., Horton, K., ... & Westwood, S. (2015). ‘Doing the writing’and ‘working in parallel’: How ‘distal nursing’affects delegation and supervision in the emerging role of the newly qualified nurse. Nurse education today, 35(2), e29-e33.
• Magnusson, C., Allan, H., Horton, K., Johnson, M., Evans, K., & Ball, E. (2017). An analysis of delegation styles among newly qualified nurses. Nursing Standard (2014+), 31(25), 46.
• Marshall, K., & Hale, D. (2017). Delirium, Dementia, and Depression. Home healthcare now, 35(9), 515-516.
• Molefe, J., & Sehularo, L. A. (2015). Nurses' perceptions on factors contributing to job dissatisfaction in a public psychiatric hospital in North West Province, South Africa. African Journal for Physical Health Education, Recreation and Dance, 21(2), 472-482.
• Perry, A. G., Faan, R. E., Potter, P. A., Faan, R. M. P., & Ostendorf, W. (2019). Nursing interventions & clinical skills. Mosby.
• Siegel, E. O., Bettega, K., Bakerjian, D., & Sikma, S. (2018). Leadership in Nursing Homes: Directors of Nursing Aligning Practice With Regulations. Journal of gerontological nursing, 44(6), 10-14.
• Yoon, J., Kim, M., & Shin, J. (2016). Confidence in delegation and leadership of registered nurses in long‐term‐care hospitals. Journal of nursing management, 24(5), 676-685.

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