Delegation of Hygiene Care from Nurses to Nursing Assistants in General Wards of Acute Care Hospitals

Abstract

This ethnographic study aims to describe how nurses delegate hygiene care to nursing assistants at general wards in acute care hospitals. Participant observations and semi-structured interviews were conducted in a ward of two facilities for approximately three months involving two head nurses, eight nurses with five years experience or more and six assistants. Eight often observed common interactions included: 1. Nurses perceived hygiene care as essential nursing work and only requested help from assistants when the workload was too much for them. 2. Nurses were prepared to take full responsibility for the tasks they delegated to assure the safety of patients and assistants. 3. Nurses identified what could be delegated to assistants who didn't have medical qualifications. 4. Nurses, keeping in mind not to give excessive work, delegated so the assistants could easily carry out their duties. 5. Considering the background of each assistant, nurses succinctly communicated with the assistants what they were delegated to do to facilitate their understanding. 6. For safety, nurses and assistants shared necessary information in advance. 7. Nurses performed observation and treatment during hygiene care to reduce the burden on the patient. 8. Hygiene care jointly performed by a nurse and an assistant progressed smoothly without exchanging words. Interactions specific to ward A were that assistants performed hygiene care based on their judgement to help busy nurses, while in ward B, delegation from a lead nurse, who only thinks about optimal hygiene care for the patient, to an assistant, who didn't follow instructions, created difficulties.