CARE PRIOITIZATION

1. CARE PRIOITIZATION PRIORITY SETTING

2. Priority Setting • Introduction • A complex step in the decision-making process • Used to rank patient needs, determine the order of nursing activities, and manage resources • “Critical thinking” supplies the logic within this process

3. Priority Setting • Definition – a priority is something that is more important than anything else at a given time • On a nursing unit, this may include patient, team, or organizational needs • Unique to each patient • There are principles that assist in arranging activities based on urgency, importance, significance, or preference

4. Priority Setting • Time Management – an important skill • Proactive vs reactive: planning your time vs “putting out fires” as they occur. • See Box 4-1 p.60 [Critical Thinking} – depicts a plan of action for managing time on a busy nursing unit

5. Priority Setting • Time Management (cont.) • Steven Covey (1989) recommendation: • Determine: “must do”, “should do”, “nice to do” • Once priorities are set, a time frame should be developed • See Box 4-2 p.60 [Critical Thinking]

6. Priority Setting • Prioritizing Patient Needs • Use Maslow’s Hierarchy of Needs • A theory of motivation based on human needs • The basic needs found at the base of the pyramid (physiologic needs) must be at least partially met before the individual can concentrate on the other needs. • Eg. If a person is starving, self-esteem is not a pressing issue.

7. Maslow’s Hierarchy of Needs

8. Priority Setting • Prioritizing Patient Needs (cont.) • This pyramid can help the nurse in selecting nursing dx., and determining the priority of the dx. • Physiologic needs always take precedence. • Exception: when a psychosocial problem interferes with the patient’s ability to participate in the physiologic care. • Eg. Mastectomy patient unable to learn how to dress the wound for home management because she is not able to look at the surgical site.

9. Priority Setting • Other models of prioritizing needs have modified or expanded on Maslow’s to be more specific. • Prioritizing Nursing Diagnosis • May want to follow Craven and Hirnle (2003) model : organizes priorities into 3 categories: high, medium, low • Prioritizing Nursing Diagnoses  determining the priority of nursing activities.

10. Priority Setting • High-Priority Situations • Life-threatening • Airway difficulties • Cardiovascular changes • Tissue perfusion changes • Alteration in fluid volume • Threats to patient safety • Situations in which pain and anxiety relief is a concern

11. Priority Setting • Medium-priority situations • Nursing diagnoses that involve problems that “could result in unhealthy consequences, such as physical or emotional impairment, but are not likely to threaten life” (Craven & Hirnle, 2003. p.187) • Examples • Anxiety caused by a Lack of Knowledge • Urgent events that are not life threatening • Preparation for a test or discharge preparation

12. Priority Setting • Low-priority situations • Nursing dx. involve problems that can usually be resolved with minimal interventions • Have little potential to cause significant dysfunction • No major effect on the person • See Box 4-3 [Critical Thinking…]

13. Priority Activities • Other factors that influence the scheduling of activities • Availability of material and staff

14. Priority Activities • Multitasking • Several needs or concerns are frequently addressed simultaneously by the nurse • Must be able to recognize the top priority • Prepare a daily “to do” list – organizing your work increases productivity • Develop early in the shift

15. Prioritizing within the Nursing Process • In the prioritizing process, the nurse may need to use concepts from more than one source of guidance • Assessment – always takes precedence when prioritizing time! • Data gathered, sorted, and problems identified • “Clusters” of data = sorted by defining characteristics • Conclusions drawn from a cluster  Nursing diagnosis

16. Prioritizing within the Nursing Process • Analysis – List of pt. needs prepared + a list of nursing diagnoses • Outcome Identification – goals and measurable outcomes; priorities est. to help the nurse achieve the desired outcome. • Plan – nursing activities appropriate for the specified nursing diagnoses are selected. • Implementation – Established priorities and listed activities must be implemented

17. Prioritizing within the Nursing Process • FIRST, perform those immediate actions necessary to prevent harm • SECOND, perform actions that could result in unhealthy consequences or physical or emotional impairment • Low priority = needs that would not be affected if not attended to until a later date • The stated goals should be used as a framework to deliver nursing care. Outcomes should be reviewed before taking action. • Document nursing actions and patient response

18. Prioritizing within the Nursing Process • Evaluation – reevaluate the plan as the patient status or the situation changes. • Assess the pts. Progress toward the outcome criteria est. in the plan of care. • Monitor for improvement or deterioration

19. Pitfalls in Priority Setting • Failure to identify tasks that cannot be delayed without serious consequences • Inadequate assessment and evaluation of patient needs • Failure to differentiate between priority and nonpriority tasks • Acceptance of others’ priorities without assessing all the variables • Performance of tasks with a “first identified, first completed” approach • Completion of the easiest task first

20. Misc.

21. Rubenfeld and Scheffer (1999) • 4 levels of priority: Life-threatening, safety, patient priorities, and nursing priorities. • Life – threatening [ABC’s] • Safety – protecting the patient from injury • Includes fall prevention, safety devices, seizure precautions

22. Priority Activities • Patient Priorities • Patient should be consulted in planning activities • Legal requirement to involve patients in health care decisions • After the any life-threatening or safety issues considered • Safety (cont.) – • Providing nursing care within the Scope of practice and maintaining professional competence • Includes recognizing a changed or unstable patient status. When a patient has a changing, unstable condition, nursing activities related to this condition assume more importance.

23. Priority Activities • Patient Priorities • Patient should be consulted in planning activities • Legal requirement to involve patients in health care decisions • After the any life-threatening or safety issues considered • Safety (cont.) – • Providing nursing care within the Scope of practice and maintaining professional competence • Includes recognizing a changed or unstable patient status. When a patient has a changing, unstable condition, nursing activities related to this condition assume more importance.

24. Nursing Priorities • Composite of patient strengths and health concerns; moral and ethical decisions, etc. • Includes health promotion and illness prevention