Priority Setting Framework and Client Care Management

Time Management

• The process of planning time available in accordance with goals to achieve.

• It is essential for nurses to know how to prioritize client care activities according to time constraints.

Client Care Coordination

• In order to provide quality client care and reduce the risk of adverse events, client care coordination is a necessity.

• Nurses must be aware of their role on the health care team and how to effectively manage time and organize client care activities.

Delegation

• Defined as one person assigning tasks to another person.

• In nursing, this process should be standardized and have clear guidelines to ensure activities are not delegated that are out of the health care personnel’s scope of practice.

• All licensed nurses and assistive personnel (AP) have a personal responsibility to know what their role and scope of practice entails.

The Five Rights of Delegation

• Right task

• Right circumstance

• Right person

• Right directions and communication

• Right supervision and evaluation

Team Nursing

• Pairs two or more nurses together as a team to care for a group of clients.

• Utilizes the nurses’ various experience levels and skills while sharing the responsibilities.

• Increased teamwork results in more effective and safer client care.

Interprofessional Collaboration

• Due to the ever-increasing complexity of client health conditions and treatments, the need for interprofessional collaboration and communication has never been greater.

Barriers to Interprofessional Collaboration

• Miscommunication

• Distrust

• Lack of respect among provider types

• Different levels of perceived importance

• Misunderstanding of each other’s roles

SMART Goals

• One way to organize your day is to implement SMART goals.

• These goals are:

  • (S) Specific

  • (M) Measurable

  • (A) Attainable

  • (R) Realistic

  • (T) Timely

Priority Setting

• Defined as the delivery of nursing care based on the urgency or importance of client needs.

• Involves the organization of client care whereby the most critical intervention or action is completed first.

• Priority setting is an essential skill for all nurses, as the nurse’s ability to intervene on the highest risk problems first can decrease avoidable adverse client outcomes.

Maslow’s Hierarchy of Needs

• Illustrated as a pyramid with five levels ranging from basic needs at the base of the pyramid, psychological needs in the middle of the pyramid, and self- fulfillment at the peak of the pyramid.

• Physiological needs must typically be met before individuals attempt to fulfill higher levels in the pyramid.

• Individuals may move back and forth through the levels at different times in their life.

ABCDE Method

• The ABCDE method is an algorithm that can be used in establishing priorities for an individual or group of clients and is appropriate in any clinical crisis.

• A - Airway

• B - Breathing

• C - Circulation

• D - Disability

• E - Exposure

The CURE Hierarchy

• Nurses can use the CURE hierarchy (critical, urgent, routine, and extras) acronym to prioritize client care when managing numerous clients’ needs.

• Critical: Emergent, life-threatening situations.

• Urgent: Situations in which the client could suffer harm of discomfort if there is a delay in addressing the client's needs.

• Routine: Routine tasks associated with client care.

• Extras: Tasks that are not essential to client care but promote comfort.

Triage

• Triage is like prioritization, although there is a distinct difference.

• Prioritization involves ranking potential nursing actions in order of importance.

• Triage assigns priority to what is being ranked based upon a quick initial, focused assessment followed by the assignment of an acuity level indicative of the amount of time a client can safely wait for screening and treatment.

Triage Levels

• The 5-level triage system designates level 1 as the most urgent category with clients experiencing a life-threatening illness and level 5 as the least urgent category with clients being stable and suffering from nonemergency ailments.

• The most common 5-level triage system used in the United States is the Emergency Severity Index (ESI) and the Canadian Triage Acuity Scale (CTAS), which categories clients into those who need to be seen emergently versus urgently.

Resource Allocation

• Resource allocation is the process of assigning a portion or amount of a service.

• Priority setting involves the allocation of resources, as users must decide how resources will be distributed in caring for their clients.