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

3. 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

4. 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?

5. 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

6. 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?

7. 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

8. 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

9. 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

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

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

12. 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

13. 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

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

15. 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