Fundamentals of Nursing and Midwifery 2e

Unit III Thoughtful practice and the process of care

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adequate, you must identify and remedy the factors con- tributing to the person’s non-adherence. Common reasons for a failure to cooperate include: • Lack of involvement by the person in the planning phase of the process • Lack of family or other support • Lack of understanding about the benefits of adherence to the plan • Low value attached to goals or related interventions • Adverse physical or emotional effects of treatment (such as pain and fatigue) DELEGATING CARE Because of the pressure of escalating healthcare costs and the increasing demand for nursing and midwifery services in the midst of a critical shortage, many employers have increased their use of enrolled nurses and unregulated care workers. In Australia, enrolled nurses (ENs), also known as Divi- sion 2 nurses, provide a second level of nursing care as specified by the registering authority’s licence to practice, educational preparation and the context of care (Australian Nursing & Midwifery Council [ANMC], 2002; Australian Nursing Federation [ANF], 2005). ENs are mainly educated through advanced certificate or associated diploma level courses in colleges of technical and further education, of which the duration is less than three years. Their role is to assist the registered nurse or midwife in the provision of care activities as delegated by them (ANF, 2011). See Chapter 4 for an overview of the role of the registered nurse, the registered midwife and the EN. Assistants in nursing (AINs), also known as personal care workers in some healthcare settings, are unregulated care workers who provide direct or hands-on care in community, acute care or residential settings. ‘Hands-on’ care may include assistance with activities of daily living such as showering, dressing, eating, mobilising and assisting with self-medication, and support activities such as diversional therapy. In most healthcare settings, AINs operate under the direction and supervision of registered nurses or midwives and assist in providing nursing care. They may also assist allied healthcare professionals in their activities. In some cases, the increased use of AINs is concerning, particularly when care is provided to frail, vulnerable and dependent people by workers who are not regulated in the same way as health professionals. In Australia this problem was highlighted in the National Review of Nursing Educa- tion’s Our duty of care report published in 2002. The report recommendations included the development of a national nomenclature, a minimum Certificate III TAFE qualification for the health and community services training package, and suitability checks for unregulated care workers by 2008. Commonwealth, state and territory ministers for health sup- ported these recommendations as a means of ensuring • Inability to afford treatment • Limited access to treatment.

quality care and public safety and establishing a national standard for unregulated care worker education and enhanced employment opportunities (National Nursing & Nursing Education Taskforce [N 3 ET], 2006). In this evolving healthcare environment, registered nurses and midwives must understand their responsibilities when delegating to both ENs and unregulated care workers, and stay appraised of ongoing developments and changes to delegation guidelines. ENs should also have an understanding of their responsibilities in accepting dele- gated aspects of nursing care from a registered nurse or midwife. The registered nurse or midwife assumes ‘accountability and responsibility for their own actions and delegation of care to enrolled nurses and healthcare workers. Delegation takes into consideration the education and training of enrolled nurses and healthcare workers and the context of care’ (ANMC, 2006a, p. 2). They give ‘direction and super- vision to ensure that delegated care is provided safely and accurately’ (ANMC, 2006a, p. 10) (bolding added). Box 18- 2 outlines the key elements of the delegation and supervision guidelines for nurses and midwives developed by the ANMC. In New Zealand, the Nursing Council of New Zealand and the Midwifery Council of New Zealand are responsible for providing delegation guidelines. For details on these guidelines go to their websites: www.nursing council.org.nz and midwiferycouncil.health.nz. It is crucial for nurses and midwives to critically identify which care interventions should be performed by them and which can be safely delegated. This can be especially chal- lenging for new graduates. The following are examples of factors to consider when delegating aspects of nursing or midwifery care: • What is the person’s health status? • Has the care plan been recently evaluated and modified • What level of qualification, skill, knowledge and experience is required of the practioner to whom the activity is being delegated? • In what context is the delegated activity to be performed? • Is it reasonable to expect the practioner to accept the delegated activities? • Is the practioner able to manage the delegated activities within their current workload? • Is the activity within that practioner’s role? Delegation and the student nurse/midwife Student nurses and midwives may find themselves in a situ- ation of delegated care where they cannot perform safely. in line with changes in the person’s condition? • What comorbidities and/or disabilities must be considered? • To what extent is the registered nurse or midwife required and/or able to supervise and monitor the activity being delegated?