Delegation and Therapeutic Relationship, Skill Building as a Long-Term Need to Strengthen and Improve on Nursing Competence - Assignment Example

Delegation and therapeutic relationship From the previous research and during my group work I have gathered sufficient information and understanding in delegation and therapeutic relationship as major factors of consideration for future nursing transition practice as a GRN. Topic 1: Delegation Task1: Define and describe delegation Delegation is defined as a process of passing authority to someone to achieve results by undertaking a certain task which the authorizer is ultimately accountable for the outcome and processes (Potter, Deshields and Kuhrik (2010). In nursing, delegation means that (Huston, 2008) a nursing assistant or the GRN carries out tasks related to nursing while under the licensed nurse’s supervision and direction. In nursing delegation is inevitable and therefore, nursing assistants (NA) are important (Huston, 2008). It is the duty of the NA; which includes the GRN to assist licensed nurses (LN) in carrying out direct nursing care delegated tasks. On the other hand, (LN) supervises and makes critical healthcare decisions that promote individuals health and nursing care delivery such as delegation of tasks related to nursing to NA (Berkow, Vikstis, Stewart, & Conway,2009). Delegation ensures much target and delivery of healthcare services is provided within healthcare system (Huston, 2008). Hence, delegation should be appropriately embraced by the GRN to meet quality public healthcare demands (Berkow, Vikstis, Stewart, & Conway,2009). To ensure effective delegation execution the NA and the GRN should understand the delegation rights and scope of practice (Selekman, 2009) adds. Therefore, no doubt in nursing transition delegation is fundamental to GRN due to its significance (Toolkit appedix 1A) Task2: Critical discussion. Delegation is vital and inevitable part in nursing practice and sometimes can be misapplied espencially among GRN (Huston, 2008). This can be explained by the fact the there are high demands for nursing services yet the professionals are insufficient (Broussard, 2007). As such, some LN can delegate tasks that are not made to be delegated (Davis-Alldritt, 2009). In addition (Potter, Deshields, & Kuhrik, 2010), GRN may wish to carry tasks beyond their capability for exposure purposes and either end up making mistakes or doing task inappropriately. This will not only affect the nurse trust, but his confidence and create low self esteem. To avoid this (Huston, 2008 and Potter, Deshields & Kuhrik, 2010) emphasises that a NA should have a clear knowledge regarding the “five delegation rights for effective delegation guide. This will ensure the task; the LN, the NA and the patient care are the center of practice. Doing the right task; according to (Brook, 2009) raises confidence and improves the GRN’s self esteem a virtue which is important among new graduates. This is because the GRN will work on what she/ he knows best and is experienced. In addition, the client being attended also builds confidence on the nurse a fact which improves management as compliance is increased. To avoid miss-delegation which may lead to inappropriate service delivery, (Berkow, Vikstis, stewart, & Conway, 2009) recommends that, the registered nurse to always evaluate her knowledge in regard to the health issue, the suitability and competency of the GRN regarding a certain patient. This will help reduce the risk of delegating duty that may lead to poor outcome which subsequently will affect the general healthcare (Davis-Alldritt, 2009) and build confidence on both LN and the GRN. Communication is important in any organisation.however,how information is provided determies the expected results (Trevithick, 2005). In delegation, intra and inter- communication is important as it will help clear doubts, drive away fear, instil confidence, improve motivation and trust among parties (Christensen, Karle & Nystrup , 2007) says. The delegating nurse (Potter, Deshields, & Kuhrik, 2010), should provide concise and clear information to the nursing assistant and the GRN to ensure a task is carried effectively and safely. Excellent patient care and effective delegation can be achieved by both the nurse and NA if they employ open intra and inter-communication and work together. Before taking into any delegated task (Davis-Alldritt, 2009) the GRN should assess his suitability regarding experience and suitability competency and if not suited for the task communicate to the registered or licensed nurse before accepting the assignment. Skill building is a long-term need to strengthen and improve on nursing competence. Berkow, Vikstis, stewart, & Conway,(2009) supports that in delegation, GRN should work under close supervision of the licenced nurse. Doing this improves on task excution, documentation and prefered outcome. This working relationship with the experienced nurse improves on skills for GRN as well as building confidence among the GRN (WHO, 2011) as the licensed nurse helps in problem solving during task execution. Task 3: Importance of delegation as a GRN From this study I believe delegation is essential in my profession as I look forward to play my role as a licensed nurse in future (Toolkit appedix 1A). Delegation focuses on the healthcare system needs in general, the patient and the nurses available to offer services (Broussard, 2007). Both the licensed nurse and assistant have equal responsibility towards ultimate healthcare (Berkow, Vikstis, Stewart, & Conway, 2009). Therefore, as a GRN I will need great attention to relationship building with the LN through delegation processes (toolkit appedix 1A). In addition, I need to understand deeply my rights and scope of practice expected of me as a GRN (Selekman, 2009 and toolkit appedix 1A. This will ensure I know what to deliver at what time. I will also know when to say no to some tasks and when to embrace them. This will ensure that the patients needs are not compromised, my resource are not abused or misused in anyway and I maintain the repuation of both my profession and that of others as I build confidence and trust among the patients I will attend (toolkit appedix1A). In addition delegation, will help in building my nursing skills (toolkit appedix1A). This is because the supervisor will in most case be by my side and as such I will get to know and inquire more information on different tasks that I will be assigned to carry (Berkow, Vikstis, Stewart, & Conway, 2009). Delegation comes with its own challenges (Goodwin, 2007), as well this is because sometimes the patient may get to hear when the supervisor is correcting or directing issue to GRN and feel may be as I attend to them am not satisfactorily qualified. However, I believe that being a nurse is a lifelong skill building, I will embark on repuatation builidng to gather the patient confidence in the little I do. In addition, I will strengthen my rapport with patients across all ages and condtion. I will always feel free to refer them to other staff where I feel I can not manage. As such I am sure I will win their confidence as time go by (toolkit appedix1). Topic 2: Therapeutic relationship Task1: Define and Describe In nursing therapeutic relation is the association developed between the patient and the nurse (Zwarenstein, Goldman, & Reeves, 2009). According to (Skott and Lundgren, 2006), successful recovery relies highly on therapeutic relationship aspect. In fact, it has been argued that therapeutic relationship is vital than the therapeutic approach employed during patient management for human development and survival (Skott and Lundgren, 2006). Consequently, therapeutic relationship should be practiced by all nurses in practice. According to (Masters, 2012) therapeutic relationship looks forward to meet a specific client need. Therefore, therapeutic relationship does not have a specific structure as it will always be influenced by the client’s and nurse’s goals, client’s needs and the context. Hence, both affective and cognitive levels of interaction should be employed in the relationship as it is dynamic. Effective therapeutic relationship is built on four main components; intimacy, respect, trust and power which the nurse employs on daily delivery of services (Macnee, & McCabe, 2007) highlights. The main reason for nurse-client relationship is to provide therapeutic care (Skott and Lundgren, 2006). Therefore (Macnee, & McCabe, 2007), it is purely based on intimacy, respect, and trust and use of power appropriately. A good nurse-patient relationship is achieved where the nurse understands the beliefs and values of the client and their capacity to deliver on the need of the client. As a GRN understanding what one is able to deliver not only improves self esteem but, also confidence in what one does (Zhang, Luk, Arthur & Wang, 2001). Task 2: Critical discussion. In nursing processes, therapeutic relation is the heart of delivery (Skott, & Lundgern, 2006). Masters, (2012) emphasizes that therapeutic relationship is effectively managed by a competent nurse full of professionalism attributes. The nurse establishes and maintains the client-nurse association using professional behaviors, caring attitudes, skills and knowledge. It has been found that GRN are aggressive in executing their task (Rafii, Oskouie, & Nikravesh, 2004). Hence, GRN will look forward to deliver and attend to as many patients as possible. With time this leads to wearing down and the GRN can turn out to be ineffective and inefficiency a fact which can lead to stress. Another challenge with interrelationship in therapeutic is where by the patient reaches a point to only depend on a specific nurse to offer care (Gaufberg, 2006). This perspective leads to change of diagnosis and management direction (Skott, & Lundgern, 2006). To avoid change of management and stress (Macnee, & McCabe, 2007), like any other nurse a GRN should come up with a comprehensive plan of how care will be performed together with members of health team; the family and the client. Such plan should also include specific strategies for the client and both short and long-term goals. This will allow management transferability among health team. In addition (Zhang, Luk, Arthur & Wang, 2001), the client will feel safe and secure since the health team handling them were presence during the plan a fact which will improve trust and build confidence in both the GRN and the client. Another challenge facing the GRN is defining the social relationship and therapeutic relationship (Masters, 2012). In therapeutic relationship the client’s needs come first (Skott, & Lundgern, 2006). According to (NBSA, 2002) GRN and RN are always privileged as the client entrust their care to them. The GRN and the RN however, should utilize the power inherent within her/ him in the profession not to abuse the client trust. Hence the nurse should only use client’s personal relationship to positively impact on the client’s needs. This will reduce level of dependence commonly discovered among GRN and RN-client relationship and will not compromise on the quality of care required by the client (Gaufberg, 2006). In addition, the client should be well informed that her care calls for management by different parties a fact which will lower the level of intimacy as a component of therapeutic relationship; crossing boundaries of therapeutic relationship during the management as stated in (NSBSA, 2002) standards of practice. Being open to clients, builds confidence to the client and trust and improves the GRN nursing skill, self esteem, strengthens respect and confidence on duty (Zhang, Luk, Arthur & Wang, 2001) supports. Task 3: Importance of therapeutic relationship as a GRN in transition to RN Upon completing my studies as a graduate nurse, I look forward to specialize in pediatric nursing; (toolkit appendix 1B) hence therapeutic relationship is a vital in my future practice. In pediatric management, therapeutic relationship care is focused to the family, the parent and the child (Rakel, 2007). This is because the child will not only need direct therapeutic care from the nurses but, also from the care givers (McPhee, Papadakis, & Tierney, 2010). In addition, Paediatric patients are a great challenge to deal with. This is because the under fives in particular rarely do know how to explain on what is happening within them either due to lack of knowledge or because of fear. Hence, (Macnee, & McCabe, 2007), increased level of exposure and theoretical information review is a major requirement for me as I work with the peads (toolkit appendix 1B). This will help me understand their feelings and their needs as well be able to translate the information to the conditions they are suffering from and built my relationship with them. In addition, this will help in building and winning the children trust with time in my future experience (toolkit appendix 1B). Being a GRN the parents might have some doubts regarding my experiences as it happens frequently in the health sector as some new GRN have been found to mismanage patients (Masters, 2012). This is a challenge to me as I will need to have the parents support for effective service delivery. I believe according to (Zhang, Luk, Arthur & Wang, 2001) first trusting in my capabilities and respecting the client will ensure that I win the parents confidence in my skills through a well developed therapeutic relationship and always reassuring the families and the parents that I understand what they are going through and we should always work together to ensure their child is in good health. Also keeping my promises to the parents and families will be another way for building trust with the parents and families (toolkit appendix 1B). This way the parents will start gaining trust in me that will be deepened with time. In addition (Christensen, Karle & Nystrup, 2007), being aware that am not exposed to dealing with children in the past as a GRN I will work on sharpening my knowledge through inquiring from the licensed nurses on controversial issues in my undertaking. This will help me realize my level of competence. References Berkow, S., Vikstis, K., stewart, J. & Conway, L. (2009). Assessing new graduate nurse performance. Nurse Educator, 34(1):17-22. Brook, P.S. (2009). Legally speaking….when can you say no? Nursing 2009, 39(7):42-46. Broussard, L. (2007). Empowerment in school nursing practice: a grounded theory approach. Journal Of School Nursing, 23:322-328. Christensen I., Karle H. & Nystrup J. (2007). Process-outcome interrelationship and standard setting in medical education: the need for a comprehensive approach, Med Teach, 29:672-677. Davis-Alldritt, L. (2009). If I delegate, am I at risk? NASN School Nurse, 24(5):180-183. Gaufberg, E. (2006). Alarm and altruism:professional boundaries and the medicals student. The Clinical Teacher. Goodwin, D. (2007). Upsetting the order of teamwork: Is “the same way everytime” a good inspiration? Sociology, 41(2): 259-275. Huston, C. (2008). Preparing nurse leaders for 2020. Journal of Nursing Management, 16:905-911. Masters, K (2012). Nursing Theories: A Framework for Professional Practice; Gale, cengage learning. Macnee, C. & McCabe, S. (2007). Understanding Nursing Research, Reading and Using Research In Evidence-Based Practice 2nd Ed. Wolters. Kluwer,Lippincott, williamsand wilkins: Philadelphia. McGee, S. (2007). Evidence-Based Physical Diagnosis 2nd Ed. Philadelphia: Saunders. McPhee, S., Papadakis, M., & Tierney, L. (2010) Current Medical Diagnosis and Treatment. McGraw-Hill; New York. Nurses Board of South Australia. (2002). Standard for Therapeutic Relationships and Professional Boundaries. Potter, P., Deshields, T. & Kuhrik, M. (2010). Delegation practices between registered nurses and nursing assistive personnel. Journal of Nursing Management, 18:157-165. Rafii, F., Oskouie, F. & Nikravesh, M. (2004). Factors involved in nurses responses to burnout: a grounded theory study. BMC Nursing, 3:6. Rakel, R. (2007). Textbook of Family Medicine 7th Ed. Philadelphia: Elsevier. Skott, C. & Lundgern, S. 2006. The value of caring episodes of desired change. International Journal for Human Caring, 10(1):32-39. Selekman, M. (2009). Developing a policy for delegation of nursing care in the school setting. Journal of School Nursing, 25: 98-107. Trevithick, P. (2005). Social Work Skills: A Practice Handbook of Communication Skills. 2nd ed, Open University Press, Mcgraw- Hill Education. World Health Organization (2011). Life in 21st Century. A Vision for Everyone. Zhang, Z. X., Luk, W., Arthur, D. & Wang, T. (2001). Nursing competencies: personal characteristics contributing to effective nursing performance. Journal of Advanced Nursing, 33(4):467-474. Zwarenstein, M., Goldman, J. & Reeves, S. (2009). Interproffesional collaboration: effects on professional practice and health care outcomes.(Cochrane review). Issue 3, 2009. John Wiley & Sons; London. Appedix 1: Toolkit Appedix1A: Delegation Strategies Rationale Understand delegation rights This will ensure both the RN and GRN know their specific roles in delegation of tasks (Selekman, 2009) Understand the delegation importance as outlined in rights of delegation This will ensure delegation in tasks is not abused by either the RN or the GRN (Davis-Alldritt, 2009, Huston, 2008 & Potter, Deshields, & Kuhrik, 2010 ). Inter and intra-effective-communication importance Clear and concise inter and intra-communication is vital to both the RN and GRN (Christensen, Karle & Nystrup , (2007), Potter, Davis-Alldritt, 2009 and Deshields, & Kuhrik, 2010),) Skill building Allows the GRN to increase self-awareness of delegation aptitudes which in turn will improve their practice and patient’s safety(Berkow, Vikstis, stewart, & Conway,(2009) and WHO, 2011) Appendix 1B: Therapeutic relationship Strategies Rationale Understand therapeutic relationship This will ensure both the RN and GRN know what is their specific roles in therapeutic relationship and the expectation during client-nurse sessions on care delivery (Skott and Lundgren, 2006, Zwarenstein, Goldman, & Reeves, 2009). Understand the therapeutic relationship importance as outlined in nursing standard of practice This will ensure therapeutic relationship in task execution is not abused by either the RN or the GRN (NBSA, 2002) Understand components of therapeutic relationship Understanding the four components of therapeutic relationship is importance and how they should be applied as well as boundaries of therapeutic relationship in practice (Macnee, & McCabe, 2007) Skill building allows the GRN to increase self-awareness of therapeutic relationship which in turn will improve their practice and patient’s safety; win their trust and confidence (Zhang, Luk, Arthur & Wang, 2001) Understand sources of stress in therapeutic relationship and how to avoid Understanding what brings about burnout among GRN will help in reducing the chances of getting stressed and demonstration of inefficiency and ineffectiveness in therapeutic relationship; comprehensive planning is encouraged (Zhang, Luk, Arthur & Wang, 2001, Rafii, Oskouie, & Nikravesh, 2004) Appendix 1: Perspective Reflection models The 5 R’s model (Bain, Ballantyne, Mills & Lester, 2002) The 5 Rs In brief ... This includes .... Reporting A descriptive account of a situation/issue What happened What the situation/issue involves Responding Emotional/personal responses to the situation/issue Observations , feelings, questions about the situation/ issue Relating Relationship between personal/theoretical understandings and the situation/issue Making connections between the situation/issue and your experience, skills, knowledge, understanding Reasoning Exploration/explanation of the situation/issue Significant factors underlying the situation/issue, and why important to an understanding of what happened/what´s involved Reconstructing Drawing conclusions and developing a future action plan based upon a well reasoned understanding of the situation/issue A deeper level of understanding about the situation/issue developed through reasoning used to reframe/reconstruct future practice or professional understanding The Gibbs model (1988) Read More