Page 139 - Essentials of Nursing Leadership and Management, 5th Edition

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126 unit 2 | Working Within the Organization CikguOnline
table 9-1
Direct and Indirect Client Care Activities
Direct Client Care Activities Indirect Client Care Activities
Assisting with feeding and drinking Providing a clean environment
Assisting with ambulation Providing a safe environment
Assisting with grooming Providing companion care
Assisting with toileting Providing transportation for noncritical clients
Assisting with dressing Assisting with stocking nursing units
Assisting with socializing Providing messenger and delivery services
Adapted from American Nurses Association. (2002). Position Statement on Utilization of Unlicensed Assistive Personnel.
Washington, DC: American Nurses Association.

Inherent in today’s health-care environment is yourself to see that it is done correctly. When you
the safety of the client. The quality of client care delegate, you control the delegation. You decide to
and the delievery of safe and effective care are cen- whom you will delegate the task. Remember that
tral to the concept of delegation. RNs are held there are levels of acceptable performance and that
accountable when delegating care activities to oth- not every task needs to be done perfectly.
ers. This means that they have an obligation to
Assigning Work to Others
intervene whenever they deem the care provided is
unsafe or unethical. It is also important to realize Assigning work can be difficult for several reasons:
that a delegated task may not be “sub-delegated.” 1. Some nurses think they must do everything
In other words, if the RN delegated a task to the themselves.
LPN, the LPN cannot then delegate the task to the 2. Some nurses distrust subordinates to do things
UAP, even if the LPN has decided that it is within correctly.
the abilities of that particular UAP. There may be 3. Some nurses think that if they delegate all the
legal implications if a client is injured as a result of technical tasks, they will not reinforce their
inappropriate delegation. Take the following case: own learning.
In Hicks v. New York State Department of Health, 4. Some nurses are more comfortable with the
a nurse was found guilty of patient neglect because technical aspects of client care than with the
of her failure to appropriately train and supervise more complex issues of client teaching and
the UAP working under her. In this particular discharge planning.
situation, a security guard discovered an elderly Families and clients do not always see professional
nursing home client in a totally dark room activities. Rather, they see direct client care
undressed and covered with urine and fecal materi- (Keeney, Hasson, McKenna, & Gillen, 2005).
al. The client was partially in his bed and partially Nurses believe that when they do not participate
restrained in an overturned wheelchair. The court directly in client care, they do not accomplish any-
found the nurse guilty on the following: the nurse thing for the client. The professional aspects of
failed to assess whether the UAP had delivered nursing, such as planning care, teaching, and dis-
proper care to the client, and this subsequently led to charge planning, help to promote positive out-
the inadequate delivery of care (1991). comes for clients and their families.When working
with LPNs, knowing their scope of practice helps
Quality-of-Care Issues
in making delegation decisions.
Nurses have expressed concern over the quality of
client care when tasks and activities are delegated Models of Care Delivery
to others. Remember Nightingale’s words earlier in
the chapter, “Don’t imagine that if you, who are in Functional nursing, team nursing, total client care,
charge, don’t look to all these things yourself, those and primary nursing are models of care delivery that
under you will be more careful than you are.” She developed in an attempt to balance the needs of the
added that you do not need to do everything client with the availablity and skills of nurses. Both