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Establishing Priorities

by Jessica Reuter
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    00:02 Hi, I'm Jessica Spellman. I'm going to be reviewing Establishing Priorities with you.

    00:09 After taking this course, you'll be able to better understand the concepts of time management, prioritization, critical thinking, decision making and their effect on establishing priorities as a nurse. Managing client care involves many different topics.

    00:29 It involves time management, prioritization, critical thinking, and decision making. Time management is making the best use of time to achieve client care. Prioritization is assigning importance to tasks from highest priority to lowest. Critical thinking is analyzing patient information and decision making is evaluating options and determining an action plan.

    01:01 Let's go over time management first. Time management, to review, is making the best use of time to achieve client care.

    01:09 There are a few guidelines for us as nurses. It involves organization, planning, focus, evaluation, and flexibility. Let's review each one of these individually.

    01:23 Organization. You need to be able to organize your patient information and review patient data.

    01:31 Planning. You need to be able to create a plan for achieving client care.

    01:36 Focus. Limit distractions, do not procrastinate and stay on task in order to meet all of the needs of all of your clients on your assignment.

    01:49 Four, evaluate. Evaluate progress towards each patient's plan and make adjustments in it as necessary.

    01:59 And it involves some flexibility, in fact, a lot of flexibility! Nurses need to be flexible in making time for emergencies and urgent things that arise.

    02:10 It's not acceptable to just continue with your routine plan of care when urgent situations arise.

    02:16 So adaptation is required. So next we'll move on to prioritization. That's assigning importance to tasks from highest priority to lowest. There are couple of ways that we can do this, and I'll go over a couple concepts for you on how you can better prioritize. But caring for multiple clients requires setting and evaluating priorities almost continuously. So how do we prioritize? The concepts I'd like to go over are the CAB or the ABC model, we'll discuss both of those. We'll go over Maslow's hierarchy of needs. And we'll discuss assigning severity.

    02:57 So the first model, the ABC, versus CAB. Let's go over the ABC portion first.

    03:05 ABC stands for Airway, Breathing, Circulation. It's used in a clinical setting involving healthcare professionals. We have multiple providers.

    03:17 It's very difficult to do alone, so multiple providers are necessary.

    03:21 And it's the model used on NCLEX when they ask you questions about what you would do first in an emergency situation.

    03:29 CAB is more for lay people in a non-clinical setting that may be witnessing or participating in an emergency alone.

    03:40 And it's the model used by the American Heart Association to teach CPR.

    03:45 So CPR now addresses circulation first and airway and breathing if time or resources allow.

    03:56 Maslow's hierarchy of needs. I think most of us have probably seen this before, but I wanna go over it a little bit more in depth and review it for everybody, for those who haven't seen it for a while. There's several concepts in Maslow's hierarchy of needs and it's a pyramid shape that represents the priorities that humans have, they have to have met in order to survive. The basic needs are on the very bottom of the pyramid, are on the base of the pyramid, and you can't move on to the next level unless the level below that has been met.

    04:38 So each level from the bottom up needs met before self actualization will occur.

    04:44 Let's start at the bottom with the physiological needs. Examples from a nursing point of view are: temperature, oxygen, vital signs, fluids, nutrition, shelter, elimination and rest.

    05:00 Those are the very basic needs that our clients have.

    05:05 So when there's something at that level that is causing their disease or illness, they cannot think about any other levels of development until that level has been treated and gets met.

    05:25 So nursing diagnosis you may see when they have physiological needs that need met would be ineffective tissue perfusion, ineffective airway clearance, airway obstruction, impaired gas exchange, impaired spontaneous ventilation, constipation, imbalanced nutrition more or less than required, fluid volume deficit or excess, ineffective thermoregulation, sleep pattern disturbances, impaired urinary elimination, or electrolyte imbalances, are things, nursing diagnosis, that you may encounter at the physiological level.

    06:04 Under safety needs, there's physiological safety which includes treatment of mental disorders and taking care of confused or combative clients. And then there's the physical safety, which includes things like fall risk, patient safety and pain control.

    06:23 Remember pain control is under the physical safety and psychological safety and not under physiological.

    06:31 That is something in NCLEX that can be difficult to distinguish between.

    06:38 So pain falls under physical safety. Nursing diagnosis that you might see in this level of the pyramid would be: altered level of consciousness, pain, risk for fall, risk for infection, acute confusion, self neglect, or impaired memory. The next level on Maslow's hierarchy of needs is belongingness and love needs. This includes things like family involvement, providing reassurance for anxiety and establishing trust.

    07:12 So in your clients that are not having these needs met, they might have things like ineffective coping, defensive coping, powerlessness, anxiety, loneliness, dysfunctional family processes, compromised family coping, self care deficits, risk for injuries and isolation.

    07:34 The next level on Maslow's hierarchy of needs is esteem needs.

    07:39 This is the prestige and feeling of accomplishment. From a nursing perspective, it involves self care, promoting confidence, providing education, a sense of control and participating in healthcare decisions. So when a client is not having this level met, you'll see things like chronic low self-esteem, situational low self-esteem, self neglect, self care deficits, risk for self-mutilation, risk for suicide, risk for self-directed violence, post-traumatic syndrome, ineffective coping, ineffective health maintenance and impaired social interaction.

    08:24 And the top level of the pyramid is self-actualization, or achieving ones full potential.

    08:30 Someone's full potential includes having hope for the future and improved state of health.

    08:36 They're aware of personal growth opportunities and are involved in their own wellness.

    08:44 And if somebody is not having their self-actualization needs met, they're going to have nursing diagnoses, such as: ineffective role performance, ineffective health maintenance, risk for suicide, hopelessness and chronic low self-esteem.

    09:02 So when we summarize Maslow's hierarchy of needs, the nursing needs need to be prioritized from the bottom of the pyramid upward. So that would mean physiological needs would need to be met before esteem needs were met. And nursing diagnoses can occur in several areas of the pyramid.

    09:21 For example, the risk for suicide came under physical safety and it also came under self-actualization.

    09:28 And you'll prioritize the need under physical safety prior to the need under self-actualization.

    09:39 A fluid volume deficit is a high priority where ineffective health maintenance is a low priority.

    09:46 Besides Maslow's hierarchy of needs, we can assign priority to our tasks and how to establish priorities for performing our patient care.

    09:55 The first level we would assign is a high emergency situation, such as a cardiac arrest. The second level would be a normal level of priority, important but not urgent. And then three, low priority, which can wait.

    10:13 Couple of additional thoughts on prioritization. Steven Covey wrote the book "The Seven Habits of Highly Effective People," and he actually categorizes tasks by using these four categories.

    10:27 Important and urgent, important but not urgent, not important but urgent, and not important and not urgent.

    10:35 And I think we can apply these to the priorities that we set as nurses.

    10:40 I have some examples listed here. Important and urgent is treating hypoglycemia.

    10:46 That's important and urgent. The next level or category, important but not urgent.

    10:53 A dressing change is important but it may not always be urgent.

    10:58 Some events that are non important but urgent, assisting someone to the restroom.

    11:03 It may feel important to them and it's urgent for them, but it's not always important when we're prioritizing level of care.

    11:15 But it's urgent that we get them to the restroom. Not important and not urgent. You may be saying to yourself, "Why are we doing it if it's not important and not urgent?" But things like completing a pre-operative checklist prior to a patient going to surgery, it's not as important as providing direct patient care, and it's not urgent in that hopefully the patient is not going to surgery for a while. So it can be put off.

    11:42 So an emergency situation, or an emergent situation, if not taken care of, fatality could occur.

    11:50 So you wanna apply a tourniquet to stop bleeding so that you can save life before limb, that would be an emergent situation.

    11:58 An urgent situation, it's important to take care of but not emergent.

    12:04 And a good example of that is medicating for pain. Something that's routine.

    12:09 Normal occurring tasks. Examples include recording intake and output at the end of every shift.

    12:17 Low priority status would be needs to get done, but isn't necessarily time-oriented.

    12:23 Example, making the patient assignment sheet for the next shift does need to get done within the shift, but it's a low level priority that can occur at any time.

    12:35 We're gonna move on to critical thinking. And critical thinking is the ability to analyze available information.

    12:43 It must happen before decision making and all possible solutions are analyzed.

    12:51 Then we'll move on to decision making. After we've done our critical thinking and determined our possible options in a situation, we need to move on to decision making, which is evaluating those options and then deciding on an action plan.

    13:07 So there's a few steps in decision making that I would like to discuss. The first is define your objectives. Second, gather data. Third is determine your options.

    13:20 Fourth is evaluate the options, and fifth is make the decision.

    13:26 So problem solving starts with good decision making. We want to identify the issue. We wanna collect and analyze the data, we wanna identify and evaluate all possible solutions, select a solution and implement and the re-evaluate that to make sure we don't need to make changes or modify our care plan.

    13:49 The problem solving model is very similar to the nursing process model.

    13:56 We're all familiar with the nursing process. In problem solving we identify the issue, we collect and analyze data, we identify and evaluate solutions, we select a solution and implement, and then we evaluate. I have the nursing process here so that we can compare.

    14:13 In the nursing process we assess our clients, we assign nursing diagnoses, we create care plans, we implement interventions, and then we evaluate the outcome and modify care plans.

    14:24 So it's very similar in what we're already doing as a nurse.

    14:30 So to summarize, establishing priorities involves critical thinking, good decision making skills, managing time effectively. We've introduced several models for you to use for assisting with assigning priority to your tasks and your nursing functions.

    14:47 You can use any of these or a mixture of all of them. The first one, the airway breathing circulation, or ABC model helps us prioritize tasks in an emergent situation.

    15:00 Maslow's hierarchy of needs assists with prioritizing nursing interventions for a patient based upon their needs.

    15:10 And then assigning status to interventions, such as emergent, urgent, routine or low priority, can help us also establish the priorities of how to structure our nursing tasks.

    15:28 I am Jessica Spellman and this has been Establishing Priorities.


    About the Lecture

    The lecture Establishing Priorities by Jessica Reuter is from the course Management of Care. It contains the following chapters:

    • Establishing Priorities
    • Prioritization
    • Maslow's Hierarchy of Needs
    • Nursing Diagnoses
    • Assigning priority
    • Critical Thinking

    Included Quiz Questions

    1. A 50 year old postoperative with a potassium level of 6.0 mEq/L
    2. A 70 year old female COPD patient who is waiting to be discharged.
    3. A 45 year old man with pancreatitis who received pain medication 1 hours ago for 8/10 pain.
    4. An 65 year old female with left lower extremity cellulitis whose dressing has fallen off.
    1. Assess the patient’s knowledge of diabetes and its treatment.
    2. Encourage client to set a goal of being able to self-administer an insulin injection.
    3. Establish that the patient has a knowledge deficit and begin teaching.
    4. Evaluate the ability of the patient to demonstrate how to draw up an insulin injection.
    1. Assess the patient
    2. Review the labs
    3. Call the physician
    4. Medicate with acetaminophen 650 mg by mouth

    Author of lecture Establishing Priorities

     Jessica Reuter

    Jessica Reuter


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