The nurse cares for several patients on a medical-surgical unit and is now ending the shift. When giving hand-off report to the oncoming nurse, what information does the nurse include to facilitate a smooth transition of care? Select all that apply.

Delegation in nursing is guided by the five rights of delegation, scope of practice regulations, client stability, and level of predictability of outcomes, ensuring that tasks assigned to unlicensed assistive personnel (UAP) are non-invasive, routine, and do not require clinical judgment or evaluation.

Rationale:

A. Reporting pain levels after medication administration requires interpretation of therapeutic response and potential need for further intervention. This involves clinical judgment and is part of nursing assessment, making it inappropriate for delegation to UAP.

B. Assisting a patient with ambulation four days post-surgery is appropriate delegation. This is a stable, routine, non-invasive activity within UAP scope, and does not require assessment or clinical decision-making, making it safe and appropriate.

C. Teaching a patient how to check blood glucose is a nursing responsibility. Patient education requires assessment of understanding, teaching skills, and evaluation of learning outcomes, which are not within UAP scope of practice.

D. Applying topical medications is considered a medication administration task. Even though topical, it still involves pharmacologic responsibility and requires nursing judgment, making it inappropriate for UAP delegation.

Elder abuse is a complex public health issue involving the mistreatment or neglect of older adults. Nurses play a critical role in advocacy and protection by identifying the signs of vulnerability and ensuring that legal and ethical safeguards are implemented to prevent further harm and maintain the dignity of the older adult population.

Rationale:

A. Most elder abuse is unfortunately unreported. Many victims suffer in silence due to fear of retaliation, embarrassment, or a desire to protect family members who may be the perpetrators. Research suggests that only a small fraction of actual cases ever reach the attention of protective services or law enforcement.

B. While financial exploitation is a major concern, neglect is actually the most prevalent form of elder abuse reported. Neglect involves the failure of a caregiver to provide for an older adult’s basic needs, such as food, water, or medicine. Financial abuse is significant but does not typically hold the highest statistical prevalence.

C. In the vast majority of jurisdictions, healthcare professionals are mandatory reporters for suspected elder abuse. This legal obligation requires nurses to report any reasonable suspicion of maltreatment to Adult Protective Services (APS) or other designated authorities. Failure to report can result in legal and professional penalties.

D. Abuse is rarely an isolated event; most older adults who experience mistreatment suffer from multiple types simultaneously. For example, a victim of physical abuse may also be experiencing emotional trauma and financial theft. This overlap complicates the assessment and requires a comprehensive intervention strategy.

E. Self-neglect occurs when an older adult cannot meet their own basic needs due to cognitive or physical decline, and in many states, this is legally classified as a form of maltreatment. This allows protective services to intervene and provide necessary resources or guardianship to ensure the individual's safety.

F. Older adults are often reluctant to report abuse. They may feel a sense of loyalty to their abuser (who is often a child or spouse) or fear that reporting will lead to their placement in a nursing home. The nurse must create a safe, non-judgmental environment to encourage disclosure.