STRATEGIES FOR PROFESSIONAL

PRACTICE: UNIT twoII: TIME MANAGEMENTC: SETTING PRIORITIES

SETTING PRIORITIESSETTING PRIORITIES• To plan effective use of time, nurses must understand the

“big picture.”

• No nurse works in isolation:

• Nurses should know what is expected of their – Cooworkes– What is happening on the other shifts– What is happening in the agency– What is happening in the community

PRIORITY SETTINGPRIORITY SETTING How do you set priorities for each patient?

What strategies will you use to priority set for each patient?

What parts of your data will help you set priorities for each patient?

EXAMPLES OF IMPACT OF BIG EXAMPLES OF IMPACT OF BIG

PICTURE ON NURSEPICTURE ON NURSE

If the previous shift nurses were stressed by a crisis, the next shift may not get started smoothly

If areas outside of the unit are overwhelmed, a nurse/tech might be moved to assist on the overwhelmed unit

When nurses take the “big picture” into consideration, they are less likely to be frustrated when asked to assist others

The nurse can then build into their time management plan the possibility of giving and receiving assistance

CRITICAL PROBLEMSCRITICAL PROBLEMS How do you determine you have a critical

problem?

What do you do with your plan of care at this point?

What characteristic is necessary in the caregiver to make critical problems bearable?

FIRST PRIORITY: LIFE THREATENING FIRST PRIORITY: LIFE THREATENING

PROBLEMS WITH ABC’SPROBLEMS WITH ABC’S

Pt whose condition is life-threatening is the highest priority and requires monitoring until transfer or stabilization These can occur at any time during the shift and may or

may not be anticipated

ABC’S. Remember Maslow’s Hierarchy of Needs.

See high-priority unstable patients who have threats to their ABCs (airway, breathing, and circulation) These patients require nursing assessment, judgment,

evaluation until transfer or stabilization Monitor equipment and assess observations used to

support the status of patient’s ABCs

SECOND PRIORITY: SECOND PRIORITY: SAFETYSAFETY

Ask yourself:

Are there any threats to patient safety and security such as threats of violence, need for fall prevention, infection control

See these patients next

THIRD PRIORITY: THIRD PRIORITY:

Comfort, Teaching and other needsComfort, Teaching and other needs

Assess the patients’ other needs and prioritize using Maslow’s hierarchy.

May include love and belonging, self-esteem, and self-actualization

WHO IS SEEN LAST? WHO IS SEEN LAST? Stable pts

who need standard, unchanging procedures and have predictable outcome are seen last

TOP PRIORITY PATIENT TOP PRIORITY PATIENT CARE GROUPS: CARE GROUPS:

respiratoryrespiratory

Airway compromise

Severe respiratory distress, indadequate breathing

Critical asthma

Chest trauma with respiratory distress

TOP PRIORITY PATIENT CARE GROUPS:TOP PRIORITY PATIENT CARE GROUPS:

Cardiovascular and NeurologicalCardiovascular and Neurological

CARDIOVASCULAR

• Cardiac arrest

• Shock or hypotension

• Ex-sanguinating hemorrhage

NEUROLOGICAL

• Major head injury

• Unconscious or unresponsive

• Active seizure state

TOP PRIORITY PATIENT CARE GROUPS: TOP PRIORITY PATIENT CARE GROUPS:

Musculoskeletal and SkinMusculoskeletal and Skin

MUSCULOSKELETAL

Major trauma

Traumatic amputation –extremity

Major cold injury – hypothermia

SKIN

Burn, greater than 25% body surface area (BSA) or airway involvement

TOP PRIORITY PATIENT TOP PRIORITY PATIENT CARE GROUPS: Gastrointestinal and CARE GROUPS: Gastrointestinal and

GynecologGynecologicalical

GASTROINTESTINAL

Difficulty swallowing with airway or respiratory compromise

Abdominal trauma

Penetrating or blunt

GYNECOLOGICAL:

Vaginal bleeding, patient with abnormal vital signs

TOP PRIORITY PATIENT CARE GROUPS: TOP PRIORITY PATIENT CARE GROUPS:

/Immunologic/Endocrine/Infection/Child or Elder /Immunologic/Endocrine/Infection/Child or Elder

AbuseAbuse

IMMUNOLOGIC:

• Anaphylaxis

ENDOCRINE

• Hypoglycemia – altered consciousness

INFECTION

• Septic shock

CHILD OR ELDER ABUSE:

Unstable situation or conflict