The Five Rights of Delegation

Right Task
One that is delegable for a specific patient.
Right Circumstances
Appropriate patient setting, available resources, and other relevant factors
Right Person
Right person is delegating the right task to the right person to be performed on the right person.
Right Direction/Communication
Clear, concise description of the task, including its objective, limits, and expectations.
Right Supervision
Appropriate monitoring, evaluation, intervention, as needed, and feedback

https://www.ncsbn.org/

Reflection – noticing, interpreting, and responding

There are times when I have patients admitted for their surgical procedure which may be slow, quiet, or even angry. It is part of my job to do an assessment of the patient and review their background. Most of the assessment is objective, yet in the back of my mind I am thinking on how the patient is responding to my questions or actions. Such as one patient I had who was being very slow in changing into their gown, signing documents, and explaining their medical history. This behavior can be quite normal with the older generation, but a little odd with younger ones. I find when I do my vital signs and ask about their pain, I will follow up with other questions to understand their overall wellbeing. In this case I sensed a full trust wasn’t there. Using therapeutic communication, I learned the patient had a full glass of water prior to admittance, but didn’t want to share this knowing the procedure would be cancelled.

I know from my nursing background, the patient’s health and physical, or medications didn’t suggest the patients wary behavior. I was able to “reflect-in-action” to know I had to build a level of trust to get the patient to relax and divulge the information they had. This whole process did end up canceling the procedure. It also kept the patient from possibly aspirating and getting very sick. It is the patient’s feedback, after our responding, where we get our reflection-in-action.

In our center, we do discuss situations where we can all learn ways to help our patients be properly prepared for surgery. We share these items stating them much like the Clinical Judgment Model shown on page 208 in the Journal of Nursing Education. According to an article by Philip Kemp in work-based learning, our staff’s reflection (or reflection-on-action) helps us learn as a group to provide the best care for our patients and support our staff.

Tanner, C. (2006). Thinking like a nurse: A research-based model of clinical judgment in nursing. Journal of Nursing Education, 45(6), 204-211.

Kemp, P., Rooks, J., & Mess, L. (2009). Work-based learning with staff in an acute care environment: a project review and evaluation. Mental Health Practice, 12(10), 31-35

Graduating Class Message

            Thank you Dean Cowell, and thank you everyone for your kind welcome.  As Dean Cowell said, my name is Laura Barron and it is my privilege to speak to you during today’s pinning ceremony and represent this graduating class, Spring 2011, as President.

            This has been the goal of every student here today.  Not everyone who started this journey with us arrived here, along with us.  We offer our hope and encouragement to all of them, and know they can, and will, reach their goals.

            I especially want to thank Dr. Lyder, today’s guest speaker, who took time from his busy schedule to join us on this special occasion, and celebrate along with us.  I also want to thank our AVC President   Dr. Fisher, and Mr. Wilson, our Board of Trustees President.  Their efforts on behalf of all students at Antelope Valley College, and especially the nursing program,   made this day possible.  Our health Sciences Dean, Dr. Cowell, and our class Faculty Adviser, Professor Stewart, for provided outstanding leadership, and instilled in all of us a desire for excellence.  Each and every instructor who guided us through our lessons, including those outstanding professionals on the hospital floor, deserve a special thanks for their wisdom, patience, and technical expertise, only small bits of which we were able to absorb, but it was enough to allow us to reach today’s milestone.

            I’d like to offer a few thoughts regarding the achievement we student nurses are so rightly proud of.

            There is a hand-off sheet used when a patient’s care is being transferred to another responsible party. It is called the SBAR. S for Situation, B for Background, A for Assessment and R for Recommendation

I’d like to give you the SBAR of the Spring Class of 2011.

Respectfully Submitted by Student Nurse Laura,

Thank you

Freud and Ice Cream

Can a person compare the Id, Ego, and Superego

to eating a bowl of ice cream?

The desire for immediate gratification and pleasure to have a sweet bowl of lime sherbet  smothered in dark hot fudge and nuts, comes to me once a month. I believe it may be the Id of me. Yet once I dip into the rich, sour, sweet crunchy scoopfuls, I take my time and taste it. I slow my Ego self down and relish all the beauty of it and how begin to notice the coldness in my throat and head. Not far into my bowl I start to wonder how this bowl of sherbet is going to ruin my dinner in a couple hours, not to mention how the chocolate always makes me break out. The right & wrong feed back system of my Superego has now taken over and sent the remains of the green-brown melted mess down the garbage disposal.

To live through Freud in the matter of a few sticky cold minutes…..

30 Student Nurse Success Secrets

30 Student Nurse Success Secrets

30 Student Nurse Success Secrets

30 Student Nurse Success Secrets

30 Student Nurse Success Secrets

30 Student Nurse Success Secrets

30 Student Nurse Success Secrets

30 Student Nurse Success Secrets

30 Student Nurse Success Secrets

30 Student Nurse Success Secrets

30 Student Nurse Success Secrets

30 Student Nurse Success Secrets

30 Student Nurse Success Secrets

30 Student Nurse Sucess Secrets

30 Student Nurse Sucess Secrets

One Moment In Their Lives

Out of all the different parts of precepting, I have loved getting to know the patients in the emergency department (ED). It is the whole emotional highs and lows of the patient from admit through procedures and medications to discharge or transfer. It’s the mental process of anxiety, pain, insecurity, needs, distrust and dependency. It’s so different from the med/surg floor where you may see an improvement in mental status from waking in the morning, or after a procedure, to the delights of going home.

These patients come into ED all come in for the same reason – an immediate need either in their mind, or in the mind of the one who brings them in. Like a new puzzle waiting to be put back together, some with 50 pieces and others with hundreds.

The doctors and nurses all know these patients, even if they aren’t ‘frequent flyers’, because they know the how the pieces add up and the immediate care each one requires based on their medical condition. They are all treated with respect and care to get them home again or where they need to be. Some patients take a while to make their way through the paperwork/labs/procedures to get there, but they all are efficiently managed.

What amazes me is how vulnerable the human is. We put ourselves out there for care from a stranger because we have to, and all the emotion put into this heightens our anxiety, pain, HR & BP. I have been able to talk to the patients and the caregivers who brought them in from the onset of an assessment, through their meds and after, seeing them relax just by knowing there is someone who cares and listens. Giving a shot of lorazepam or morphine, makes more of an adjustment 🙂  but it also adds to the overall trust they feel in the hands of their healthcare providers.

I get to know many  individuals each shift for that moment in their life when they have their greatest need. I want that time to be healed anyway that it can, and while I am still learning how to administer medications and treatments, I’ve found I can help ease a patients mind along the way not only with my hands but by listening.

I have had my patients say ‘thank you’ after placing an IV. I’m amazed. I know it hurts, even if they say it doesn’t. I get hugs, and patients searching for me to tell me good-bye on their way out. I know where this short piece of emotional attachment comes from, and I understand how we have a need for it, but I’m just happy to be able to be a part of it.

To me, it is the same for the drug seeker, the one who just wants attention, or the one who is seriously ill. Some patients conditions, caused by themselves or by chance, creates the immediate need for the ED. I find it impossible at this time to put them in a category and label them. Those puzzle pieces aren’t flat yet to me. There are so many dimentions. I know even the patient on drugs has a need they can’t control. Many patients  can’t understand things, no matter how it is explained, and there will be nurses and doctors who can’t understand their patient, no matter how hard the patient tries. Some puzzles may have a piece missing, because the cat got it, but we call it finished. To me – it’s this one moment in their lives where I hope I can make a difference and I’m so grateful for the opportunity as a student nurse to help.