Who is responsible for evaluating the outcome of a task delegated to the unlicensed assistive personnel UAP )?

3.
A 68-year-old client with multiple sclerosis, 2 days postoperative open cholecystectomy with recurrent mucous plugs, who is scheduled for a bronchoscopy this morning

To prepare a client for a bronchoscopy, the nurse must be able to perform basic assessment skills, such as assessing vital signs, lung sounds, ability to swallow, and gag reflex; maintain nothing-by-mouth status; prepare a checklist before the procedure; and monitor for respiratory difficulty after the procedure. Because these are skills a graduate nurse possesses, this is an appropriate assignment.
(Option 1) Initiating a heparin infusion according to institution protocol involves collecting baseline serum specimens (eg, partial thromboplastin time [aPTT], International Normalized Ratio [INR], prothrombin time, platelets, hemoglobin, hematocrit), calculating weight-based dosages, (eg, bolus dose, infusion rate in units/hr), and calculating intravenous infusion pump hourly rate. Serum aPTT and INR levels are monitored every 6 hours or according to protocol. Frequent changes in rate or dose based on these levels may be necessary to maintain a therapeutic level of heparin. For these reasons, this is not an appropriate assignment for a new graduate nurse.
(Option 2) A client with newly diagnosed cancer who is refusing radical surgery that will result in the loss of speech and inability to communicate normally is demonstrating fear and anxiety. This client needs preoperative teaching about the surgical procedure, what to expect immediately after surgery, methods for speech restoration, and general preoperative teaching (eg, deep breathing, suctioning, pain management). Emotional support, education, and advanced therapeutic communication skills are necessary to help allay fear and anxiety. For these reasons, this is not an appropriate assignment for a new graduate nurse.
(Option 4) The elderly client with new-onset confusion is at risk for developing hospital-induced delirium related to advanced age, surgery, hypoxia, fluid and electrolyte disturbances, immobility, pain, and/or drugs. The nurse must perform neurological assessments to determine the cause and intervene appropriately. For these reasons, it is not an appropriate assignment for a new graduate nurse.
Educational objective:When assigning clients to the appropriate staff member, the RN must consider the individual client needs and the skills of the staff member. The more experienced RN is assigned to the client with the more complex physiologic and psychologic needs, who requires a more advanced level of nursing skill. The new graduate nurse is assigned to the client with less complex needs, who requires basic nursing skills, such as measurement of vital signs and basic physical assessment.

What is the responsibility of the UAP in accepting delegation?

The UAP is responsible for accepting the delegation, seeking clarification of and affirming expectations, performing the task correctly and timely communicating results to the nurse. Only the implementation of a task/activity may be delegated. Assessment, planning, evaluation and nursing judgment cannot be delegated.

Can a UAP evaluate?

Assessments are outside of the UAP's scope of practice and should never be delegated to them. UAPs can count the heart rate and respiratory rate, but they cannot decide if it is appropriate for the patient.

What is the role of the UAP?

Unlicensed assistive personnel (UAP) are paraprofessionals who assist individuals with physical disabilities, mental impairments, and other health care needs with their activities of daily living (ADLs).

Which task can the nurse delegate to an unlicensed assistive personnel UAP?

In general, simple, routine tasks such as making unoccupied beds, supervising patient ambulation, assisting with hygiene, and feeding meals can be delegated. But if the patient is morbidly obese, recovering from surgery, or frail, work closely with the UAP or perform the care yourself.