A newly hired unlicensed assistive personnel (UAP) is assigned to a home healthcare team along with two experienced UAPS. Which intervention should the home health nurse implement to ensure adequate care for all clients?

Rationale

A. Pairing the newly hired UAP with the most experienced UAP can provide mentoring and guidance. This allows the experienced UAP to share knowledge, demonstrate best practices, and help the new UAP navigate unfamiliar situations or complex care needs. It promotes skill development and ensures that care is provided effectively and safely.

B. Assigning less complex clients to the newly hired UAP initially can help ease them into their role and build confidence. It allows them to focus on learning routines, policies, and procedures without the added stress of managing highly complex care situations. However, this approach should be temporary and paired with opportunities for training and skill development.

C. Direct observation of the newly hired UAP's care delivery is crucial to assess their competency in various tasks. It provides firsthand insight into their skills, adherence to protocols, and ability to handle

client needs independently. Based on observations, appropriate feedback and additional training can be provided as needed.

D. Reviewing the UAP's skills checklist and discussing their previous experience with the hiring manager or supervisor provides essential background information. This helps in understanding the UAP's strengths, areas for improvement, and any specific training needs. It ensures that appropriate assignments and support are provided based on their skill level.

Rationale

A. In heart failure exacerbation, decreased cardiac output can lead to poor peripheral perfusion, potentially manifesting as weak or diminished pedal pulses. However, in the context of acute symptoms such as palpitations or chest discomfort, assessing the rhythm and rate of central pulses (like the apical pulse) may be more immediate and informative.

B. Capillary refill time assesses peripheral perfusion and can indicate circulatory status. Prolonged capillary refill (>2 seconds) may indicate poor perfusion, which could occur in heart failure exacerbation due to reduced cardiac output. It is a valuable assessment, but in this scenario, focusing on more central aspects such as the heart rhythm is typically more immediate.

C. Assessing the rhythm of the apical pulse is crucial in this scenario. The client's sensation of "flopping" in the chest suggests palpitations or irregular heartbeats, which could indicate arrhythmias such as atrial fibrillation or other dysrhythmias.

D. Skin elasticity primarily assesses hydration status and may provide information about overall skin integrity but is less directly related to the acute symptoms described by the client. While important in general assessments, it does not directly address the urgent need to assess for arrhythmias or irregular heartbeats.