Question

The staff on the oncology unit for the day shift (7 am to 3:30 pm) for nine patients includes Sherry Trader, the charge nurse; James Fair, a recently hired staff nurse; and Julie Coggeshall, one of the NAP, who is in nursing school.

A 78-year-old woman admitted with the diagnosis of breast cancer is scheduled for a radical mastectomy at 8:30 am. The patient is nonverbal to James, the nurse assigned to the patient. James tells the charge nurse that he has never prepared a patient who was to go to surgery for a mastectomy. The charge nurse indicates to James that the forms are no different from those for any other surgery.

1. What are the key issues to consider about when to delegate and assign care to this patient?

2. What are the problems presented in this case?

3. What are the possible solutions?

4. To whom and what tasks should be delegated to facilitate the patient's progression to surgery?

Answer 1

1.The key issues to consider are

• The patient needs a pre op preparation which can be done correctly by following the pre op notes and the hospital's surgical protocols, This time is very crucial right from skin preparation, NBM,checking out any pre op medication, getting ready with the consent, laboratory investigations removing dentures and metal objects from body.All this has to be done prior to surgery, any negligence or mistake can postpone or delay the surgery.So it is important to delegate a staff at this time is necessary
• Post operatively the patient needs both personal and medical care,so it is a crucial period to assign both the staff
• To teachbtye new hired staff

2.The main problem presented here are

• Communication barrier existing with the SN to the patient
• Gender differentiation, a male nurse assigned to a female patient
• The privacy of patient is hampered
• Lack of knowledge and confidence in handling the patient

3.The possible solution are

• Trying to establish a therapeutic nurse patient communication
• Educating the new staff about the procedures
• Making the NAP to do the basic care to the patient

4.The skin preparation, bathing,dressing,vitals checking can be delegated to the NAP,transferring, whereas the SN can be delegated to file works and reports, medication, consents and handing over the patient to the surgical nurse.