Prioritizing Care

What is Maslow's Hierarchy of Needs used for in nursing?

To organize needs from most-urgent to less-urgent.

Which needs must be met first according to Maslow?

Basic, physiologic needs, such as self-esteem

• house food water

Which nursing diagnosis has higher priority: nausea or impaired social function?

Nausea.

How does severity affect the nursing process?

Life-threatening problems require immediate action.

• would we treat pain or COPD pt with 88% o2 sat?

  • Pain because 88% is likely normal for that patient

What does ABCD stand for in life support prioritization?

Airway, Breathing, Circulation, Disability.

Do nurses always involve patient input in critical situations?

No, instant clinical reasoning is used.

In ABCDS prioritization, what is assessed first?

Airway.

After airway, what is the next priority in ABCDS?

Breathing.

After breathing, what comes next in ABCDS?

Circulation.

After circulation, what is assessed in ABCDS?

Disability (neurological).

After disability, what is next in ABCDS?

Safety concerns.

After safety, what is assessed in ABCDS?

Pain.

All of the ones on the left

left

What can cause conflicting priorities in nursing care?

Nurse priority versus patient priority; differing beliefs and values.

How can conflicting priorities be alleviated?

Nurse–patient collaboration in goal-setting.

What is a core nursing responsibility related to planning?

Patient teaching.

When does a nurse start prioritizing?

During hand-off or bedside report.

What should be reported during hand-off?

Priorities the oncoming nurse must attend to.

Why is systematic reporting important?

To prevent error.

What situations require a nurse to report priorities?

Significant clinical changes.

What should a nurse report for new admissions?

Immediate treatments planned.

What should be reported for patients preparing for procedures or treatments?

Status of interventions.

What should be reported for patients returning from diagnostic or operative procedures?

Current physical status.

Why should reporting be systematic?

To prevent error.

Four patients all require the attention of the nurse.
Who should the nurse see first?
A. The 12-year-old with asthma asking to ambulate
B. The 16-year-old with a pneumothorax complaining
of shortness of breath
C. The 15-year-old post-op patient complaining of
continuous, achy pain
D. The 8-year-old waiting to be discharged

B

If a patient is exhibiting signs and symptoms of each
of the following nursing diagnoses, which should the
nurse address first while planning care?
a. Fatigue
b. Acute Pain
c. Knowledge Deficit
d. Body Image Disturbance

B

What is delegation according to ANA and NCSBN?

Transfer of responsibility or authority while retaining accountability.

• we are still held accountable for what we delegate as a nurse

What should a nurse do if significant findings occur during delegated care?

Report findings like skin changes or shortness of breath and address them in the plan of care.

• the nurse is then responsible for assessing the alterations and addressing them in the plan of care

What does T.A.P.E. stand for in nursing?

Teaching, Assessment, Planning, Evaluation.

• things you cannot delegate

What is the first principle of delegation?

Nurses must know the Nurse Practice Act in their state.

What is the second principle of delegation?

The RN cannot delegate assessment, planning, evaluation, or accountability for the assigned task.

What is the third principle of delegation?

The person assigned the task cannot delegate it to someone else.

What is the 'Right Task' in delegation?

Task is appropriate for delegation.

What is the 'Right Circumstances' in delegation?

Patient and environment are suitable.

What is the 'Right Person' in delegation?

Delegate to competent staff.

What is the 'Right Direction/Communication' in delegation?

Clear instructions given.

What is the 'Right Supervision' in delegation?

Monitor and give feedback.

What is the first step to effective delegation?

Assess the knowledge and skills of the delegatee.

What is the second step to effective delegation?

Match tasks to the delegatee’s skills.

What is the third step to effective delegation?

Communicate clearly: task, outcome, time.

What is the fourth step to effective delegation?

Listen attentively.

What is the fifth step to effective delegation?

Provide feedback.

What is the sixth step to effective delegation?

Follow up to ensure task completion and proper documentation.

RN Delegation to Patient Care Technicians (PCT)

Case Study: Jennifer is a nurse who is assigned the following three
patients:
Mrs. Sinclair, who is scheduled for surgery to repair
a fractured right hip
Mr. Timmons, who has finished lunch and is ready
for pain medication
Mr. Dodson, who has a postoperative wound
infection and is due for antibiotic medication

Which patient should the nurse see first?

Mrs. Sinclair – pre-op, anxious, checklist must be done before surgery.

Why is Mrs. Sinclair prioritized first?

Surgery soon, checklist incomplete, needs assessment and support.

How is Mr. Timmons managed while attending Mrs. Sinclair and why?

Unit clerk informs him nurse will come in 20 min – keeps patient informed and safe.

How is Mr. Dodson's care handled and why?

Delegate antibiotic to another RN, complete dressing later – ensures timely care without delaying urgent patient.

You are taking care of 4 patients today while orienting a new RN to
your unit. With your busy schedule, you ask the new RN to delegate
some tasks to the nursing assistance. Which of the following tasks
that the new RN delegates needs to be re-evaluated? (Select all
that apply)
A. Apply hydrocortisone cream to eczema on skin after giving the
patient 1 a bath.
B. Assisting patient 2 with administrating a Fleet Enema
C. Emptying patient 3’s ostomy bag
D. Collecting and recording patient 4’s blood pressure, heart rate,
temperature, oxygen saturation, respirations, and pain rating.

Applying hydrocortisone cream and administering a Fleet Enema – these are beyond the scope of a nursing assistant.