Effective Delegation and Care Planning in a Team Nursing Approach: A Case Study in Acute Rehabilitation

QUESTION

You are a graduate registered nurse (RN) working at The ABC Hospital. Your current rotation is a 28-bed acute rehabilitation ward. The ward uses a team nursing approach, two teams – south Wing and north Wing.

After almost 11 months of full time work, you feel comfortable with the rotation and culture of the facility.

Today you are working afternoon shift (1330-2200 hours). Lucy is the ANUM (Associate Nurse Unit Manager) in charge on this shift. Lucy does not take a patient load.

You are allocated to Abbot Wing (14 patient). The team includes:

1. Yourself RN (Registered Nurse)
2. Priya EN (Enrolled Nurse)
3. Ema AIN (Assistant in Nursing)

It is 1800 hours, and the evening meal has concluded. Priya has stated she is heading off to her tea break. You must plan and delegate the following:

• Mr Barry Hinkley, 82-yearold: Barry underwent a laparoscopic abdominoperineal (AP) resection 3 weeks ago. He was transferred to the ward for further rehabilitation following post- operative atelectasis. Barry has type 2 diabetes, obesity, diabetes retinopathy and benign prostate hypertrophy. Barry is a high falls risk and walks with a 2-wheel frame.  Barry’s colostomy bag is full and needs to be changed. He is very anxious about the care of the stoma and requires assistance as the stoma is retracted.
• Ms June Westbrook 69-yearold: June is day 22 post STEMI, transferred from the cardiac ward 9/7 ago post stenting and is pending discharge this week as meeting all rehabilitation goals. June has a history of angina, high cholesterol and sleep apnoea. June gets your attention on entering the 4 bedroom on the way to check Barry’s call bell and states she has ‘chest pain’
• Mr Jeremy Hamilton 22-yearold. MVA 2/12 ago: spinal injury, fractured pelvis, R) Colles fracture and 3 broken ribs (right side). Jeremy has a history of anxiety. Jeremy asks Emily to get him some pain relief for 7/10 pain when she answered the call bell.

5 Rights of delegation

• Right activity
• Right circumstance
• Right person
• Right communication
• Right supervision and evaluation

Criterion 1 : Apply the 5 rights of delegation and legal principles in the submitted plan.

Criterion 2: Design a plan of action using evidence-informed sources.

Criterion 3: Apply the principles of teamwork.

Criterion 4: Write in a structured, succinct and well-informed manner, substantiating sources and accurate Australian referencing.

ANSWER

Effective Delegation and Care Planning in a Team Nursing Approach: A Case Study in Acute Rehabilitation

Introduction

As a graduate registered nurse (RN) working at The ABC Hospital in an acute rehabilitation ward, effective delegation and care planning are essential for providing safe and efficient patient care. This case study focuses on the afternoon shift, where the team nursing approach is utilized to manage a 14-patient team in Abbot Wing. Applying the 5 rights of delegation and legal principles, designing evidence-informed care plans, promoting teamwork, and maintaining structured communication are crucial to ensuring optimal patient outcomes.

Criterion 1: Applying the 5 Rights of Delegation and Legal Principles

Right Activity
Delegating tasks to team members should align with their scope of practice and competence. As the RN, I will delegate the task of changing Mr. Barry Hinkley’s colostomy bag to Priya, the enrolled nurse, who is trained and competent in stoma care. However, I will retain responsibility for providing instructions, ensuring proper technique, and assessing the patient’s condition before and after the procedure.

Right Circumstance
Before delegation, I will assess the appropriateness of the task for each patient’s condition. In this case, I will consider Mr. Barry Hinkley’s anxiety about his stoma and ensure that Priya is aware of his needs and equipped to address his concerns during the procedure.

Right Person
Delegation should be assigned to the most appropriate team member based on their knowledge, skills, and experience. In this scenario, Priya, the enrolled nurse, is the right person to perform the stoma care procedure as she has the necessary training and competency.

Right Communication
Effective communication is vital in the delegation process. I will communicate the task clearly to Priya, including specific instructions on stoma care, addressing Mr. Barry Hinkley’s anxiety, and reporting any concerns promptly. Additionally, I will encourage open communication among the team members, fostering a collaborative approach to patient care.

Right Supervision and Evaluation
As the RN, I will provide supervision and ongoing evaluation of Priya’s performance during the procedure. I will remain accessible for questions and concerns and conduct a post-procedure assessment to ensure that Mr. Barry Hinkley’s needs are met and the stoma is well-managed.

Criterion 2: Designing Evidence-Informed Care Plans

Mr. Barry Hinkley
The care plan for Mr. Barry Hinkley will include stoma care guidelines that adhere to evidence-based practices, promoting wound healing and preventing complications. The plan will also incorporate strategies to address his anxiety and ensure his psychological well-being.

Ms. June Westbrook
Considering Ms. June Westbrook’s history of angina and the possibility of recurrent symptoms, I will implement a cardiac assessment and closely monitor her vital signs and ECG. The care plan will also include guidelines for managing chest pain and initiating appropriate interventions if necessary.

Mr. Jeremy Hamilton
For Mr. Jeremy Hamilton’s pain management, I will collaborate with the medical team to ensure that evidence-based pain relief options are utilized, taking into account his history of anxiety. The care plan will emphasize a multidisciplinary approach to manage his complex injuries and promote early mobilization to prevent complications associated with immobility.

Criterion 3: Applying the Principles of Teamwork

To ensure effective teamwork, I will promote open communication, collaboration, and mutual respect among the team members. Regular team meetings will be conducted to discuss patient progress, identify potential challenges, and implement coordinated care plans. I will also encourage team members to share their expertise and contribute to the development of evidence-informed care strategies.

Criterion 4: Writing in a Structured, Succinct, and Well-Informed Manner

All care plans and delegation activities will be documented concisely and accurately, ensuring that each team member’s role and responsibilities are clearly outlined. I will use accurate Australian referencing and evidence-informed sources to support the care plans and delegation decisions.

Conclusion

Effective delegation and care planning are integral components of a successful team nursing approach in an acute rehabilitation setting. Applying the 5 rights of delegation, designing evidence-informed care plans, promoting teamwork, and maintaining structured communication are vital in ensuring patient safety, optimal outcomes, and a collaborative and supportive working environment for the healthcare team.