Delegation models in dysphagia management: Current policy,clinical perceptions and practice patterns

Abstract

Purpose: Delegation to Allied Health Assistants (AHAs) is an effective workforce solution in a number of areas of adult speech-language pathology (SLP) practice. However, reports of AHA delegation in the area of dysphagia management are limited. The aim of this study was to synthesise information from policy documents and current clinical practice to examine the nature of AHA delegation in dysphagia management.

Method: A mixed method design involving a document review of 13 policy documents on AHA delegation, and a survey of 44 SLP managers regarding current delegation models.

Result: Policy and current practice were largely congruent. Despite policy support for AHA delegation, 77% reported using delegation models but only 26% used them fairly often/very often in dysphagia management. Both policy and survey findings support AHA training prior to task delegation, however, the nature of training was unspecified. Good governance is integral to successful delegation and managers recognised the need to increase standardisation of AHA capability assessment.

Conclusion: AHA delegation in dysphagia management is supported by policy and is being implemented in clinical services. However further work detailing governance and training requirements is needed, as well as systematic evaluation of the safety and benefits of these models.     

Managing Delegation to Physiotherapy Assistants: Application of a Functional Analysis Model

This paper addresses the need for systematic delegation of tasks to physiotherapy assistants. A model of delegation is presented that encapsulates the issues necessary to manage delegation in a system that is cost-beneficial without loss of quality.It is argued that task analysis is necessary to enable decisions to be made on whether subtasks are knowledge, rule or skill based and thus suitable for delegation. Following application of criteria to allocate tasks to personnel, cost-benefit analysis is used to consider whether the training investment is worth while.It is suggested that the working relationship and communication network between physiotherapist and assistant, with the arrangement of the working environment, will facilitate delegation and ensure that the patient receives appropriate care.     

Debate in the USA on nurses' delegation of duties to assistants

In the today's rapidly changing practice environment, more nurses than ever are facing delegation dilemmas. The main issues of the debate on delegation of task and activities from nurses to less qualified personnel are reported. Nurses can delegate tasks but remain accountable for the final result. The main rules for delegation are discussed and the need for a correct communication and education to delegate is stressed.     

The acquisition of delegation skills: collaboration between education and service.

Many new patient care delivery models are being developed and evaluated. One of the most important skills needed by registered nurses (RNs) to function within these new models is delegation. For many reasons, RNs find it difficult to develop and implement this skill. The authors outline a program that can be used to assist students in the acquisition of delegation behaviors. As a result, students were able to explore and discover their delegation ability while gaining self-confidence in implementing the RN role.     

The effects of budget, delegation, and other variables on the future of school nursing.

The purpose of this exploratory research study was to survey Kansas school nurses to determine the impact of budget, delegation, and other variables on the future of school nursing. Issues of education and certification status, educational budget, delegation, school nurse-to-student ratio, number of school buildings assigned, Metropolitan Statistical Area, and years of school nursing experience were also investigated. The Budget Impact School Nurse Questionnaire online survey was used to gather data. Findings revealed that school nurses were well prepared academically, but that many school nurses lacked certification. The use of UAPs and the future of school nursing were significantly affected by budget constraints, delegation, number of buildings assigned, legislative contact, and Metropolitan Statistical Area (urban location). Education in delegation and years of experience as a school nurse significantly affected opportunities for health education. The findings depicted budget, school nurse staffing, delegation, and geographic areas as the main variables that have an impact on school nursing.     

Teams and seams: skill mix in primary care

Teams and seams: skill mix in primary care ¶The study described in this paper is set against a background of rapid changes in primary (community) care delivery in the United Kingdom (UK) and consequently the methodology of the study has been shaped by three broad issues — workforce changes, increase in workload and changing roles and boundaries. Ten 'ordinary' general practices (general practitioners (GPs) and the 'attached' community nurses) participated in the study and a large amount of data were collected over a 2-week observation period. Three study objectives are described, relating to workload, delegation and attitudes to delegation. The characteristics of the workload of the three main groups of community nurses (practice nurses, district nurses and health visitors) are described and compared. Thirty-nine per cent of all the GP consultations (836) had a delegatable element and 17% were deemed to be delegatable in their entirety. General practitioners most frequently referred to delegation to practice nurses in the current team and nurse practitioners in an enhanced team. The study identified the activities most amenable to delegation to these two groups of nurses. Attitudes to delegation were sought through focus group discussions, with reservations being expressed by both doctors and community nurses. This study provides evidence that GPs are prepared to delegate a considerable proportion of their workload; this clearly has implications for the nursing profession.     

An educational collaboration for student nurse engagement on the essential skill of delegation

A common goal for healthcare providers and nursing faculty is the provision of effective delivery of care and safe practice settings. Decisions around the delegation of care are critical for quality patient outcomes. The purpose of this collaborative project between schools of nursing and a local community healthcare facility was to provide educational training to prelicensure nursing students on the delegation expectations for nursing professionals.     

Delegation of medication administration: an exploratory study

AIM: To examine the delegation of medication administration, including the frequency of delegation, whether delegation was to a care worker or a registered nurse (RN) and whether care workers were directly supervised when administering medication. METHOD: Administration of 1313 medication doses was observed on two inpatient psychiatric wards for older people. RESULTS: Administration was delegated by the nurse preparing the medication for four out of every five doses, usually to another registered nurse (78% of delegated doses), but also to care workers (22%). Care workers were more likely to administer medications to confused and aggressive patients than were registered nurses. CONCLUSION: Care workers who undertake delegated medication administration should receive regular training to ensure safety. Nurses remain accountable for delegated medication administration.     

Teaching nursing delegation: An on-line case study

This study examined a delegation content-focused multimodal instructional design based on constructivism and andragogy. These new teaching strategies were offered in a professional concepts course offered on-line during the final semester before graduation of an associates of nursing program. This study found supporting evidence that this pedagogical framework is effective in delivering essential delegation concepts and skills in an on-line course and contributing to student self-efficacy related to delegation abilities.     

Oncology nursing in cuba: report of the delegation

In December 2011, the first delegation of oncology nurses from the United States visited Havana, Cuba. The delegation included oncology nurses, educators, and leaders from across America and provided opportunities to learn about the healthcare system, cancer, and oncology nursing in Cuba. Delegation members attended lectures, toured facilities, and enjoyed Cuban culture. This exchange highlighted the similarities in cancer care and oncology nursing between countries and opened doors for future collaborations.     

Assisted living issues for nursing practice

Assisted living has become a popular setting for older people and their families. Although health care services in these settings are limited, many residents require some level of medication management. In some states, unlicensed assistive personnel can perform medication management, suggesting delegation of nursing activities. However, confusion may arise between the licensing requirement for settings and the nurse practice act on this issue. This report discusses assisted living, nurse delegation with regard to medication management, and recommendations for nursing practice for both delegator and delegate.     

Follow the team leader

Successful team leaders exude certain competencies that enhance patient care, including the ability to teach, coach, and foster effective delegation strategies.     

Registered nurse leadership style and confidence in delegation

Saccomano S.J. & Pinto- Zipp G. (2011) Journal of Nursing Management 19 , 522–533
Registered nurse leadership style and confidence in delegation Background and aims Leadership and confidence in delegation are two important explanatory constructs of nursing practice. The relationship between these constructs, however, is not clearly understood. To be successful in their roles as leaders, regardless of their experience, registered nurses (RNs) need to understand how to best delegate. The present study explored and described the relationship between RN leadership styles, demographic variables and confidence in delegation in a community teaching hospital. Methods Utilizing a cross-sectional survey design, RNs employed in one acute care hospital completed questionnaires that measured leadership style [Path-Goal Leadership Questionnaire (PGLQ)] and confidence in delegating patient care tasks [Confidence and Intent to Delegate Scale (CIDS)]. Results Contrary to expectations, the data did not confirm a relationship between confidence in delegating tasks to unlicensed assistive personnel (UAPs) and leadership style. Nurses who were diploma or associate degree prepared were initially less confident in delegating tasks to UAPs as compared with RNs holding a bachelor’s degree or higher. Further, after 5 years of clinical nursing experience, nurses with less educational experience reported more confidence in delegating tasks as compared with RNs with more educational experience. Conclusions The lack of a relationship between leadership style and confidence in delegating patient care tasks were discussed in terms of the PGLQ classification criteria and hospital unit differences. As suggested by the significant two-way interaction between educational preparation and clinical nursing experience, changes in the nurse’s confidence in delegating patient care tasks to UAPs was a dynamic changing variable that resulted from the interplay between amount of educational preparation and years of clinical nursing experience in this population of nurses. Clearly, generalizability of these findings to nurses outside the US is questionable, thus nurse managers must be familiar with the Nurse Practice Act in their country in order to ensure proper delegation of tasks to appropriate assistive personnel. Implications for nurse managers It is imperative that nurse managers provide nurses with the educational opportunities necessary to develop delegation and supervision strategies to adapt to the changing RN role while adhering to differences in scope of practice. Globally, RNs are caring for increasing numbers of acutely ill patients with scarce resources ensuring an adequately trained RN/UAP team can help support optimal patient care.     

European study of research and development in mobility technology for persons with disabilities

In the fall of 2010, the National Science Foundation, the National Institutes of Health and the U.S. Veteran's Administration jointly supported a review of mobility technology in Europe. A delegation of American Scientists traveled to Europe to visit a number of research centers and engaged in a demonstration and dialogue related to the global state-of-the-art for mobility impairment rectification and augmentation. From the observations and exchanges between the U.S. delegation and host institutions, the researchers were able to derive a series of papers which are now published in this thematic series of Journal of NeuroEngineering and Rehabilitation. The papers describe the main themes of the European mobility technology research activities showing a healthy picture of research and innovation in the field.     

Sharing the care

The expansion of healthcare support workers' roles has created tensions and opportunities for all staff. Key issues include delegation and accountability, education, regulation and pay.     

Public attitudes toward some changes in the division of labor in medicine.

This study examined public attitudes toward the delegation of medical tasks to nonphysician health workers. Data were obtained in household interviews of a probability sample of the adult residents of Cuyahoga County, Ohio (N = 808). The proportions of the sample giving approval to care from nonphysicians varied widely among the 18 tasks on which opinions were elicited. The results of the public survey were compared to those from an earlier national survey of physicians. Physicians' responses paralleled the responses of the lay public regarding most tasks. However, with respect to regular checkups on babies and prenatal checkups, markedly higher proportions of the physicians than the public were willing to delegate to nonphysicians. The analysis indicated that public attitudes toward task delegation in medical practice do not bear strong relationships to social status indicators, political self-designations, or preceived health status.