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Assignment 2: Delegation
Digital Clinical Experience Score
Total Time
67 minutes interacting with patients 0 minutes spent in post-exam activities
The DCE score represents a weighted score based on all learning activities in this assignment. Some learning activities have been assigned greater value than others. This score may not be your final grade if your instructor chooses to include additional components, such as rationales or time spent.
Experience Overview
67 minutes
86.7%
Time: 1330
Activity Scores 86.66/100 points
Bedside Shift Report 8.5/10 points
Team Delegation 26.67/30 points
Interprofessional Communication 16.5/20 points
Prioritizing Individual Patient Needs 20.0/20 points
Prioritizing Delivery of Care 15.0/20 points
Bedside Shift Report Score: 8.5 out of 10
You scored
Holly: Oh, thanks for reminding me! Mr. Liu's provider is Dr. Gina Tremblay.
Why is this the best question to ask Holly about Samuel Liu's Situation?
The provider name belongs in the Situation section of a Shadow General SBAR, and it's a good idea to get a verbal confirmation of information even when it already appears in your patient's EHR.
1.0 out of 1
The correct answer is:
The provider name belongs in the Situation section of a Shadow General SBAR, and it's a good idea to get a verbal confirmation of information even when it already appears in your patient's EHR.
Holly: Mr. Liu reported at our ED a week ago with 3 broken ribs (left 7th-9th) after falling off his neighbor's roof. A chest X-ray revealed that he was negative for pneumothorax. He was observed for 8 hours and discharged with instructions to return if his symptoms worsened. Yesterday, he was reaching for something on a high shelf when he experienced sharp chest pain on his left side followed by difficulty breathing.
Holly: He reported to the ED within the hour, where he was diagnosed with pneumothorax secondary to blunt chest trauma, confirmed via chest X-ray. Physical examination revealed tracheal deviation to the left, air in the left side of the chest, and absent breath sounds on the left side of the chest.
Holly: At 1600 hours yesterday, Mr. Liu received a 28 F chest tube, inserted at the left 4th intercostal space, anterior axillary line.
Holly: Mr. Liu has a hydromorphone patient-controlled analgesia pump at a concentration of 2 mg/mL. He was given a loading dose of 0.4 mg, and set up with with an on-demand bolus of 0.1 mg. The PCA pump has a lockout interval of 10 minutes and an hourly dose limit of 0.6 mg.
Holly: Mr. Liu's vital signs are all within normal limits. His respirations are 18 per minute and his oxygen saturation is 94%.
Holly: Current provider's orders are to monitor the chest tube and drainage unit every hour, to record patient vitals every hour, and to monitor Mr. Liu's pain level and level of consciousness every hour, in addition to checking the dressing at the site of the chest tube insertion once every 2 hours.
What else do you need to ask Holly about Samuel Liu's Background?
You scored
1.0 out of 1
The correct answer is:
Does Mr. Liu take any home medications or have any allergies?
You scored
Holly: Mr. Liu's pain is being controlled with PCA, and he last rated his pain as a 3 out of 10.
Why is this the best question to ask Holly about Samuel Liu's Assessment?
Learning about the efficacy of the pharmacological treatment for your patient's pain will help you to determine what further interventions may be necessary.
1.0 out of 1
The correct answer is:
Learning about the efficacy of the pharmacological treatment for your patient's pain will help you to determine what further interventions may be necessary.
Holly: I recommend that, every hour, when you check in with Mr. Liu, you monitor his chest tube and drainage unit, monitor and record his vital signs, and check the dressing on his chest tube insertion site. It will also be important to check his respiratory status and level of consciousness.
What else do you need to ask Holly about her Recommendation for Samuel Liu's care?
What does Mr. Liu's schedule look like today?
You scored
1.0 out of 1
The correct answer is:
What does Mr. Liu's schedule look like today?
You scored
Holly: Mr. Liu has no procedures scheduled for today, and he is not expecting any visitors.
Samuel: Nobody wants to see me? I guess I'm just not very popular today.
Why is this the best question to ask Holly about her Recommendation for Samuel Liu's care?
Scheduled patient procedures and visitations are part of the Recommendation section of a Shadow General Bedside Shift Report. It is important to know about these events so that you can build your own schedule to best support your patient's needs.
1.0 out of 1
The correct answer is:
Scheduled patient procedures and visitations are part of the Recommendation section of a Shadow General Bedside Shift Report. It is important to know about these events so that you can build your own schedule to best support your patient's needs.
You scored
Holly: Do you have any additional questions for me?
What else would you like to ask Holly?
Is there anything else I should know?
1.0 out of 1
The correct answer is:
Is there anything else I should know?
Debrief
Time: 1605 You have just completed the assignment about delegation. We're going to take some time to debrief you on what you've done so far. To begin, you'll have the opportunity to identify and discuss thoughts and feelings about the assignment. Next, we will consider how the models and processes you've read about in the Leadership Toolkit apply to the events of the assignment. We'll finish the debrief by working through ways you can integrate what you've learned with future clinical practice. This debriefing activity does not impact your scoring in this assignment, and you can speak freely about your experiences. You can expect this activity to take 30-45 minutes.
Understood. Let's get started.
Great. For this beginning portion of the debrief, I will ask you about your perceptions and thoughts of the simulation and your performance in it. You can expect to spend 5 minutes on each question in this section of the debrief.
How do you feel about your performance during this assignment?
I have neutral or mixed feelings about my performance.
I understand. This is a challenging assignment full of complex material. Please explain what went well and what you wish had gone differently.
Answer Preceptor Diana's question here.
Knowing what to say to people and how they feel can be hard sometimes
I appreciate you taking the time to tell me that. During this assignment, you discovered that Nurse Holly misinterpreted the provider's orders and clamped Mr. Liu's chest tube when she should not have. How did you feel about discovering this error?
taught me how not to offend someone is stressful situations
Now that we've discussed your perception of the simulation and your performance, I'm going to ask you some questions about applying the models and processes you used in the simulation. You can expect to spend 3-5 minutes on each question in this section of the debrief.
You delegated the task of changing Mr. Patel's saline bag to the correct healthcare professional. What are three consequences of delegating a task to a non-qualified healthcare professional?
Answer Preceptor Diana's question here.
infection, not proper documentation, and incorrect procedures
Evaluate your application of the "Five Rights of Delegation" model in this assignment. You can discuss successful use of the model, reconsider moments you wished you had acted differently, or otherwise assess your application of the "Five Rights."
Patients five rights are essential
In this assignment, Nadia approached you because she felt guilty for not noticing that Mr. Liu's chest tube had been clamped contrary to his provider's orders. Review how you responded to her.
Nadia: I can't help but feel like it's my fault that Mr. Liu had to go through that. It had to be pretty scary when his breathing got worse, and if I'd noticed that his chest tube was clamped when I brought him his water, maybe I could have mentioned it to you and he would have gotten help immediately. Your answer: There was no expectation for you to check up on the orders for Mr. Liu's chest tube. Nadia: That's a relief to hear. I'd still like to talk this out a bit with you, if that's OK. Honestly, I'm a little shaken.
You selected the correct response when speaking with Nadia. Explain your rationale for selecting this answer.
Answer Preceptor Diana's question here.
Its not her job duty to assess the patient, but she had doubts and concerns within her self to help meet the patients needs.
Why do you feel that way about the debrief?
Answer Preceptor Diana's question here.
it was good way to understand how to treat and talk with others due to overwork load mistake.
Excellent. We have completed the debrief. Proceed to see the results page for this assignment.
You scored
How will you ask Holly about her incorrect execution of the provider's orders?
The provider’s orders show that the chest tube was supposed to remain unclamped. What might have caused the misinterpretation?
1.0 out of 1
The correct answer is:
The provider’s orders show that the chest tube was supposed to remain unclamped. What might have caused the misinterpretation?
Holly: Oh shoot, you’re right. You know what it was -- I had two patients with chest tubes, and I bet I misread one of their orders as the other one's.
Why is this the best way to ask about the cause of Holly's error?
You contextualize your question by citing the provider's orders.
You scored
1.0 out of 1
The correct answer is:
You contextualize your question by citing the provider's orders.
How should you ask Holly about whether she read provider's orders for the other patient?
Alright. Is the other patient breathing without difficulty?
Holly: Yes, I'm sure of it. [AUDIO COMING SOON]
OK. Did you read the orders to determine how to manage the other patient’s chest tube?
You scored
0.5 out of 1
The correct answer is:
OK. Did you read the orders to determine how to manage the other patient’s chest tube?
Holly: That one I’m sure I did right -- I read the patient's name and the provider's orders literally right before I touched the clamp. Just a minute ago, actually, I heard that patient is doing well.
Why is this the most effective way of checking on the other patient's status?
You remind Holly to read the provider's orders before interacting with a patient's chest tube.
You ask if Holly completed the task whose omission caused Samuel's symptoms.
You scored
0.5 out of 1
The correct answer is:
You ask if Holly completed the task whose omission caused Samuel's symptoms.
How should you ask Holly about following policy with Samuel?
Did you follow policy when you carried out Samuel’s orders?
Holly: Yes, as far as I know.
Did you read Samuel’s provider's orders before clamping his chest tube?
You scored
0.5 out of 1
The correct answer is:
Did you read Samuel’s provider's orders before clamping his chest tube?
Holly: I didn’t bother for Samuel -- the physician and I had spoke before giving me the orders, and I remembered exactly what Sam's were. Or, at least I thought I did.
Why is this the most appropriate way to determine if policy was followed for Samuel?
You emphasize there is no reason to have read the provider's orders for one patient and not the other.
You reference the specific medical apparatus involved.
You scored
0.0 out of 1
The correct answer is:
You reiterate the policy itself.
Nadia: Hi, can I speak with you?
Sure! What do you need?
Nadia: I heard about what happened with Mr. Liu. I just feel so bad that I came in to see him earlier and didn't realize what was going on.
Nadia: I can't help but feel like it's my fault that Mr. Liu had to go through that. It had to be pretty scary when his breathing got worse, and if I'd noticed that his chest tube was clamped when I brought him his water, maybe I could have mentioned it to you and he would have gotten help immediately.
What is the most appropriate response to Nadia in this situation?
There was no expectation for you to check up on the orders for Mr. Liu's chest tube.
You scored
1.0 out of 1
The correct answer is:
We all make mistakes. It's good that you came to me; now we can talk about what happened and what we can do to prevent it in the future.
Nadia: That's a relief to hear. I'd still like to talk this out a bit with you, if that's OK. Honestly, I'm a little shaken.
Why is this the best response to Nadia's concern?
You reassure Nadia that noticing the clamped tube was not her responsibility.
You scored
1.0 out of 1
The correct answer is:
You reassure Nadia that noticing the clamped tube was not her responsibility.
You scored
What else is on your mind?
Nadia: I still feel like there's something more I should have done. Like I should have been on the alert for any signs of problems with Mr. Liu's chest tube and drainage unit.
While everyone on this floor appreciates it when you report issues to us, it is not your responsibility to formally assess patients. However, if a patient appears in distress, you can ask them how they are doing.
1.0 out of 1
The correct answer is:
While everyone on this floor appreciates it when you report issues to us, it is not your responsibility to formally assess patients. However, if a patient appears in distress, you can ask them how they are doing.
You scored
Nadia: That's true. OK, I'll remember.
Why is this the best response to Nadia's concern?
It would be unethical and potentially dangerous for Nadia to attempt to assess a patient's condition independently.
1.0 out of 1
The correct answer is:
It would be unethical and potentially dangerous for Nadia to attempt to assess a patient's condition independently.
