Decision-Making Framework Summary for Nurses and Midwives ...

• Identify need/benefit

  • Has there been a comprehensive assessment by a registered nurse to establish the person’s health and cultural needs?
  • Has there been appropriate consultation with, and consent by, the person receiving care?
  • Is the activity in the best interests of the person receiving care?

• Reflect on scope of practice and nursing practice standards

  • Is this activity within the current, contemporary scope of nursing practice?
  • Have commonwealth or state/territory legislative requirements (i.e. specific qualification needed) been met?
  • If authorisation by a regulatory authority is needed to perform the activity, does the person have it or can it be obtained before the activity is performed?
  • Will performance comply with nursing standards for practice, codes, guidelines and evidence?
  • If other health professionals should assist, supervise or perform the activity, are they available?

• Consider context of practice/governance/identification of risk

  • Is this activity/practice/delegation supported by the organisation and/or by the educational institution for students?
  • Have strategies to avoid or minimise any risk been identified and implemented?
  • If organisational authorisation is needed, does the person have it or can it be obtained before performing the activity?
  • Is the skill mix, model of care and staffing levels in the organisation adequate for the level of support/supervision needed to safely perform the activity/delegation?
  • Is there a system for ongoing education and maintenance of competence in place?
  • If this is a new practice:
    • Are there processes in place for maintaining performance into the future?
    • Have relevant parties and stakeholders been involved in planning for implementation?

• Select appropriate, competent person to perform activities

  • Have the roles and responsibilities of registered nurses, enrolled nurses and health workers been considered?
  • Does the registered nurse, enrolled nurse or health worker have the knowledge, skill, authority and ability (capacity) to do so either autonomously or with education, support and supervision?
  • Is the person competent and confident in performing the activity and accepting the delegation?
  • Does the person understand their accountability and reporting responsibilities?
  • Is the required level of education, supervision/support available?

• Yes to all

  • Perform the activity, or
  • delegate to a competent person, and
  • document the decision and the actions, and
  • evaluate outcome.

• No to any

  • Reconsider decision about whether to implement practice/activity/delegation, and
  • consult/seek advice/collaborate, and/or
  • refer if needed to complete the action, and
  • if appropriate, plan to enable integration/practice changes (including developing/implementing policies, gaining qualifications as needed), and
  • document the decisions and the actions, and
  • evaluate outcome.

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