STRATEGIES FOR PROFESSIONAL PRACTICE: UNIT two

1. STRATEGIES FOR PROFESSIONAL PRACTICE: UNIT two II: TIME MANAGEMENT C: SETTING PRIORITIES

2. SETTING 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

3. PRIORITY 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?

4. EXAMPLES OF IMPACT OF BIG PICTURE 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

5. CRITICAL 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?

6. FIRST PRIORITY: LIFE THREATENING PROBLEMS 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

7. SECOND PRIORITY: SAFETY 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

8. THIRD PRIORITY: Comfort, 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

9. WHO IS SEEN LAST? • Stable pts • who need standard, unchanging procedures • and have predictable outcome are seen last

10. TOP PRIORITY PATIENT CARE GROUPS: respiratory • Airway compromise • Severe respiratory distress, indadequate breathing • Critical asthma • Chest trauma with respiratory distress

11. TOP PRIORITY PATIENT CARE GROUPS:Cardiovascular and Neurological CARDIOVASCULAR • Cardiac arrest • Shock or hypotension • Ex-sanguinating hemorrhage NEUROLOGICAL • Major head injury • Unconscious or unresponsive • Active seizure state

12. TOP PRIORITY PATIENT CARE GROUPS: Musculoskeletal and Skin MUSCULOSKELETAL • Major trauma • Traumatic amputation –extremity • Major cold injury – hypothermia SKIN • Burn, greater than 25% body surface area (BSA) or airway involvement

13. TOP PRIORITY PATIENT CARE GROUPS: Gastrointestinal and Gynecological GASTROINTESTINAL • Difficulty swallowing with airway or respiratory compromise • Abdominal trauma • Penetrating or blunt GYNECOLOGICAL: • Vaginal bleeding, patient with abnormal vital signs

14. TOP PRIORITY PATIENT CARE GROUPS: /Immunologic/Endocrine/Infection/Child or Elder Abuse IMMUNOLOGIC: • Anaphylaxis ENDOCRINE • Hypoglycemia – altered consciousness INFECTION • Septic shock CHILD OR ELDER ABUSE: Unstable situation or conflict