Health Care Delivery Systems and Emergency Planning

Health Care Delivery Systems

Managed Care

Definition: Managed care encompasses strategies within the health care delivery system aimed at reducing health care costs.
Outcome-Driven Care: Client care is driven by outcomes and managed through a case management process.
Emphasis: Managed care emphasizes health promotion, client education, responsible self-care, early disease identification, and efficient use of health care resources.

Case Management

Definition: A health care delivery strategy supporting managed care, employing an interprofessional approach for comprehensive client care throughout illness, utilizing available resources for high-quality, cost-effective care.
Components: Includes assessment, care plan development, service coordination, referral, and follow-up.
Tools: Critical pathways are utilized, and variation analysis is conducted.
Core Functions: Assessment, treatment planning, linking clients to resources, advocacy, and monitoring.
Collaboration: Involves consultation and collaboration with an interprofessional health care team.

Case Manager

Role: A professional nurse responsible for coordinating the client’s care from admission through discharge.
Responsibilities: Establishing a plan of care with the client, coordinating interprofessional consultations and referrals, and facilitating discharge.
Expertise: Knowledgeable in various types of health insurance to assist clients in navigating health care options covered by insurance.
Advocacy: Advocates for cost-effective care and promotes client independence.

Health Insurance

Types: State and federal insurance plans exist.
Affordable Care Act (ACA):
- Aim: Reduce uncompensated care costs for the average U.S. family.
- Goals: Expand access to health insurance, reduce costs, and protect clients against arbitrary actions by insurance companies.
State Marketplace Insurance: Insurance companies provide state marketplace insurance; nurses should understand available resources relative to their clinical practice.
Types of Insurance Plans:
- Health Maintenance Organizations (HMOs)
- Preferred Provider Organizations (PPOs)
- Exclusive Provider Organizations (EPOs)
- Point-of-Service (POS) plans
- High-Deductible Health Plans (HDHPs)
- Health Savings Accounts (HSAs)
  These plans offer varying options regarding coverage, out-of-pocket costs, and premiums.
Medicare: Federal health insurance program for individuals 65 or older, certain younger individuals with disabilities, and those with end-stage renal disease (ESRD).
a. Part A: Covers hospital stays, skilled nursing facility stays, hospice care, and some home health care.
b. Part B: Helps pay for services not covered by Part A; Medicare typically covers 80% of approved services, with the client responsible for the remaining 20%, necessitating supplemental insurance.
c. Part C: A health plan offered by private insurance agencies contracting with Medicare to supplement coverage.
d. Part D: Covers prescription medication needs.
Medicaid: A joint federal and state program providing health benefits to eligible low-income adults, children, pregnant individuals, elderly individuals, and people with disabilities.
- Concern: Fraud and abuse; case managers must be knowledgeable in completing insurance applications and astute enough to identify incorrect information reporting.

Critical Pathway

Definition: A clinical management care plan for providing client-centered care and for planning and monitoring the client’s progress within an established time frame.
Basis: Based on evidence-based practice, including medical, budgetary, organizational, and systems-wide information.
Variation Analysis: Continuous process comparing client outcomes with expected outcomes.
Goal: To anticipate and recognize negative variance (client problems) early for appropriate intervention and positive outcomes.
Purpose: Ensure consistent medical care within budget constraints and allow providers to care for more complex clients.
- Example: Ambulatory practices using critical pathways for conditions like blood pressure monitoring or urinary tract infections.

Care Planning and Clinical Judgment Processes

Nursing Care Plan:
- Definition: A written guideline and communication tool identifying assessment data, client problems, goals, interventions, and expected outcomes.
- Purpose: Enhances continuity of care by specifying necessary nursing actions to achieve care goals.
- Involvement: Client and family are involved in developing the plan, identifying short- and long-term goals.
- Documentation: Client problems, goals, interventions, and expected outcomes are documented and modified as the client’s condition changes.
ADPIE: Assessment, Diagnosis, Planning, Implementation, Evaluation; nurses identify client problems rather than diagnose.
Nursing Process: Assessment, Analysis, Planning, Implementation, Evaluation.
SBAR: Situation, Background, Assessment, Recommendation; includes current client information, background details, assessment data, and care recommendations.
SOAP: Subjective, Objective, Assessment, Plan.
NCSBN Clinical Judgment Skills: Recognize cues, analyze cues, prioritize hypotheses, generate solutions, take action, evaluate outcomes.

Nursing Delivery Systems

Functional Nursing

Approach: Involves a task-oriented approach to client care where tasks are delegated by the charge nurse to individual team members.
Characteristics: This system is task-oriented, leading team members to focus on delegated tasks rather than comprehensive client care, resulting in fragmented care and reduced accountability.
Advantages: Allows nurses to care for a greater number of clients.
Disadvantages: Lack of accountability due to fragmented care.

Team Nursing

Structure: Generally led by a registered nurse (team leader) responsible for client assessment, data analysis, planning, and evaluation of the care plan.
Assignments: The team leader assigns tasks, ensuring each staff member works within their educational and clinical expertise and job description.
Accountability: Each staff member is accountable for client care and outcomes in accordance with licensing, practice scope, health care agency policy, and state law.

Relationship-Based Practice (Primary Nursing)

Focus: Emphasizes keeping nurses at the bedside, actively involved in client care, while planning goal-directed, individualized care.
Responsibilities: A primary nurse manages and coordinates the client’s care during their hospital stay and for discharge, with an associate nurse providing care when the primary nurse is off-duty.

Client-Focused Care

Approach: Also known as the total care or case method, where the registered nurse assumes total responsibility for planning and delivering care to a client.
Characteristics: The client may have different nurses assigned during a 24-hour period; the nurse provides all necessary care needed for the assigned time period.

Professional Responsibilities

Accountability

Definition: The process in which individuals have an obligation (or duty) to act and are answerable for their choices, decisions, and actions.
Scope: Involves assuming only the responsibilities within one’s scope of practice and not taking responsibility for activities in which competence has not been achieved.
Transparency: Includes admitting mistakes rather than blaming others and evaluating the outcomes of one’s own actions.
Standards: Includes a responsibility to the client to be competent and provide nursing care in accordance with standards of nursing practice while adhering to professional ethics codes.
Description: Accountability is the acceptance of responsibility for one’s choices, decisions, and actions. Nurses are always responsible for their actions when providing care to clients.

Leadership and Management

Leadership: The interpersonal process that involves influencing others (followers) to achieve goals.
Management: The accomplishment of tasks or goals by oneself or by directing others.

Theories of Leadership and Management

Charismatic: Based on personal beliefs and characteristics of influence.
Quantum: Based on chaos theory; maintaining a balance between tension and order promotes creativity.
Relational: Based on collaboration and teamwork.
Servant: Based on a desire to serve others; the leader emerges when another’s needs assume priority.
Shared: Based on the belief that several individuals share the responsibility for achieving the health care agency’s goals.
Transactional: Based on the principles of social exchange theory using a reward and punishment system.
Transformational: Based on the individual’s commitment to the health care agency’s vision; focuses on promoting change through a shared vision.

Leader and Manager Approaches

Authoritarian Leadership:
- The leader or manager maintains strong control, makes decisions, and addresses all problems.
- The leader or manager dominates the group and commands rather than seeks suggestions or input.
Democratic Leadership:
- Also called participative management.
- Based on the belief that every group member should have input into problem-solving and goal development; the leader seeks participation from the group and then makes the best decision, based on the input from the group.
- A more collaborative and less autocratic style.
Laissez-faire Leadership:
- The leader or manager assumes a passive, nondirective, and inactive approach, relinquishing part or all of the responsibilities to the members of the group.
- Decision-making is left to the group with little guidance, support, or feedback.
Situational Leadership:
- Uses a combination of styles based on the current circumstances and events.
- Styles are adapted according to the needs of the group and the tasks to be achieved.
Bureaucratic Leadership:
- The leader or manager believes that individuals are motivated by external forces.
- The leader or manager relies on organizational policies and procedures for decision-making.
Transformational Leadership:
- Focused on building relationships.
- Motivates staff through a shared vision and mission.
- Encourages and praises staff, inspiring them to improve their performance and earning their respect and loyalty.
Servant Leadership:
- Servant leaders influence and motivate others by building relationships and developing the skills of individual team members.
- Ensures that the needs of individual team members are met and gives each person input in decisions.

Effective Leader and Manager Behaviors and Qualities

Behaviors

Treats followers as unique individuals.
Inspires followers and stimulates critical thinking.
Shows followers how to think about old problems in new ways and assists with adapting to change.
Is visible to followers, is flexible, and provides guidance, assistance, and feedback.
Communicates a vision, establishes trust, and empowers followers.
Motivates followers to achieve goals.

Qualities

Effective communicator; promotes interprofessional collaboration.
Credible
Critical thinker
Initiator of action
Risk-taker
Is persuasive and influences employees

Functions of Management

Planning: Determining objectives and identifying methods that lead to achievement of objectives.
Organizing: Using resources (human and material) to achieve predetermined outcomes.
Directing: Guiding and motivating others to meet expected outcomes.
Controlling: Using performance standards as criteria for measuring success and taking corrective action.

Problem-Solving Process and Decision Making

Problem Solving: Involves obtaining information and using it to reach an acceptable solution to a problem.
Decision Making: Involves identifying a problem and deciding which alternatives can best achieve objectives.
Steps of the Problem-Solving Process: Similar to the steps of the nursing process and the cognitive skills of the National Council of State Boards of Nursing (NCSBN) Clinical Judgment Measurement Model (NCJMM).

Types of Managers

Front-Line Manager
- Responsibilities: Supervises those involved with client care, may temporarily assume a client care role, and coordinates the activity of all staff who provide client care. Typically includes roles such as charge nurse, team leader, and client care coordinator.
Middle Manager
- Responsibilities: Supervising staff, preparing budgets, creating work schedules, implementing policies, and maintaining the quality of client services. Roles typically include unit manager and supervisor.
Nurse Executive
- Responsibilities: Top-level nurse manager who assists with carrying out the mission of a healthcare organization, supervises numerous departments, works closely with the administrative team to ensure optimal client care, and ensures that all client care is consistent with the objectives of the health care organization. May be the director of nursing services or the vice president for client care services.

Power

A. Definition: The ability to influence others and control their actions to achieve desired results.

B. Characteristics:

Powerful people can modify behavior and influence others to change, even with resistance.
Change agents lead or create positive change to support or maintain high-quality care and decrease adverse effects.

C. Use of Power by Nurse Leaders: Effective nurse leaders use power to improve the delivery of care and enhance the profession.

D. Types of Power:

Reward: Ability to provide incentives.
Coercive: Ability to punish.
Referent: Based on attraction, loyalty, and respect.
Expert: Based on having an expert knowledge foundation and skill level.
Legitimate: Based on a position in society.
Personal: Derived from a high degree of self-confidence.
Informational: When one person provides explanations as to why another should behave in a certain way.

E. Importance of Following Policies: The nurse must follow policies, procedures, and protocols of the health care agency in which they are employed.

Empowerment

A. Definition: An interpersonal process of enabling others to do for themselves.

B. Outcome: Empowerment occurs when individuals are able to influence what happens to them more effectively.

C. Components: Involves open communication, mutual goal setting, and shared decision making.

D. Application: Nurses can empower clients and others through teaching and advocacy.

Formal Organizations

A. Mission Statement: Communicates the organization’s reason for existence and its attitudes, beliefs, and values.

B. Goals and Objectives: Measurable activities specific to developing designated services and programs.

C. Organizational Chart: Depicts arrangements of activities, authority relationships, and communication channels.

D. Policies, Procedures, and Protocols:

Policies: Guidelines that define directives on courses of action.
Procedures: Based on policies and define methods for tasks.
Protocols: Prescribe a specific course of action for a specific type of client or problem.

Centralization: Decision-making by a few individuals at the top of the organization or by managers, communicated to employees thereafter.
Decentralization: Distribution of authority throughout the organization to allow for increased responsibility and delegation, moving decision-making as close to the client as possible.

Evidence-Based Practice

A. Importance of Research: Plays a vital role and provides a foundation for improvement in nursing practice.

B. Definition: An approach to client care where the nurse integrates the client’s preferences, clinical expertise, and the best research evidence to deliver quality care.

C. Client Preferences: Determining personal, social, cultural, and religious preferences ensures individualization and is a component of implementing evidence-based practice.

D. Nurse’s Role: To observe, identify, and question situations requiring change or resulting in less-than-desirable outcomes.

E. Use of Information Technology: Online resources, including research publications, provide current research findings related to areas of practice.

F. Adherence to Protocols: The nurse needs to follow institution-developed evidence-based practice protocols and question the rationale for nursing approaches if necessary.

G. Evaluation Criteria: The nurse should use appropriate evaluation criteria when determining areas in need of research.

Requires that the nurse base nursing practice on the best and most applicable evidence from clinical research studies. The nurse should also be alert to clinical issues that warrant investigation and develop a researchable question about the problem.

Quality Improvement

A. Definition: Also known as performance improvement, focusing on processes or systems that significantly contribute to client safety and effective client care outcomes.

B. Quality Improvement Processes: May be named quality assurance, continuous quality management, or continuous quality improvement.

C. Staff Involvement: In a health care agency, every staff member becomes involved in ways to improve client care and outcomes when quality improvement is part of the philosophy.

D. Retrospective Audit: An evaluation method used to inspect the medical record after the client’s discharge for documentation compliance with standards.

E. Concurrent Audit: Used to inspect compliance while nurses are providing care during the client’s stay.

F. Peer Review: Nurses evaluate the quality of nursing care delivered to the client.

G. Process Similarity: Similar to the nursing process and involves an interprofessional approach.

H. Outcome Evaluation: Comparison of client responses with expected outcomes indicates the effectiveness of interventions, client progress, standards met, and whether changes are necessary.

I. Nurse's Responsibility: Recognizing trends in nursing practice, identifying recurrent problems, and initiating opportunities to improve the quality of care.

Improves the quality of care delivery to clients and the safety of health care agencies.

Change Process

A. Definition: A dynamic process that leads to an alteration in behavior.

B. Change Agent: Can effectively facilitate change and manage staff member reactions, connecting and balancing all aspects of the organization affected by change.

C. Influence of Leadership: Leadership style influences the approach to initiating the change process.

D. Lewin’s Basic Concept: Three elements for successful change: unfreezing, moving and changing, and refreezing.

Unfreezing: First phase, identifying the problem with fact gathering to support the basis for change.
Moving and Changing: Change is planned and implemented.
Refreezing: The change becomes stabilized.

E. Types of Change:

Planned Change: A deliberate effort to improve a situation.
Unplanned Change: A reactive response to a disruption; the change may be beneficial but may go unnoticed.

F. Resistance to Change:

Definition: Rejecting proposed new ideas without critically thinking about the proposal.
Causes: Lack of understanding the nature of change, energy requirement, and uncertainty of positive outcomes.

G. Overcoming Barriers:

Create a flexible and adaptable environment.
Encourage people involved to plan and set goals.
Include all involved in the plan for change.
Focus on the benefits of change.
Delineate the drawbacks of failing to make the change in relation to client care.
Evaluate the change process ongoing and keep everyone informed.
Provide positive feedback.
Commit to the time it takes to change.

Conflict

A. Definition: An internal or external friction that arises from a perception of incompatibility or difference in beliefs, attitudes, values, goals, priorities, or decisions.

B. Types of Conflict:

Intrapersonal: Occurs within a person.
Interpersonal: Occurs between and among clients, nurses, or other staff members.
Organizational: Occurs when an employee confronts the policies and procedures of the organization.

C. Modes of Conflict Resolution:

Avoidance:

Unassertive and uncooperative.
Do not pursue their own needs, goals, or concerns and do not assist others.
Postpone dealing with the issue.

Accommodation:

Neglect their own needs, goals, or concerns (unassertive) while trying to satisfy those of others.
Obey and serve others, often feeling resentment and disappointment.

Competition:

Pursue their own needs and goals at the expense of others.
May stand up for rights and defend important principles.

Compromise:

Assertive and cooperative.
Work creatively and openly to find solutions that fully satisfy important objectives and goals.

Roles of Health Care Team Members

Nurse Roles:

Promote health and prevent disease.
Provide comfort and care.
Make decisions.
Act as client advocate.
Lead and manage the nursing team.
Serve as case manager.
Communicate effectively.
Educate clients, families, and communities.
Act as a resource person.
Allocate resources cost-effectively.
Ensure client-centered care.
Recognize limitations and seek help as needed.
Work effectively in interprofessional teams.

Primary Health Care Provider (PHCP)

Diagnoses and treats disease.

Physician’s Assistant (PA)

Acts in the role of the physician during the physician’s absence.
Conducts physical examinations, performs diagnostic procedures, assists in the operating room and emergency department, and performs treatments.
Certified and licensed PAs in some states have prescriptive powers.

Nurse Practitioner

An advanced practice registered nurse (APRN) is educated to diagnose and treat acute illness and chronic conditions and focuses on health promotion and maintenance.
May work in various specialty areas, including family practice, internal medicine, gerontology, women's health, acute care, pediatrics, or other specialty areas.
APRNs have independent practice authority in most states.
Some states require APRNs to have collaborative agreements with an agency or physician/physician group.

Physical Therapist

Assists in examining, testing, and treating clients recovering from injuries, illness, or surgery and physically disabled clients. May also play a major role in providing wound care in some settings.
Physical therapy assistants may be employed to help the physical therapist.

Occupational Therapist

Develops adaptive devices that help chronically ill clients or clients with a disability perform activities of daily living and focuses on coordination retraining.
Occupational therapy assistants may also be available.

Respiratory Therapist

Delivers treatments to improve the client’s ventilation and oxygenation status.

Speech Therapist

Evaluates a client’s ability to swallow safely and evaluates speech and communication ability. The speech therapist develops a plan to treat communication and swallowing disorders.
They use exercises to develop new speech habits and also work to prevent, assess, diagnose, and treat speech, language, and cognitive communication disorders.

Nutritionist

Assists in planning dietary measures to improve or maintain a client’s nutritional status.

Continuing Care Nurse

Coordinates discharge plans for the client.

Assistive Personnel

Helps the registered nurse with specified tasks and functions.

Pharmacist

Formulates and dispenses medications, checks medication safety, interactions, and side effects.

Social Worker

Counsels clients and families about home care services and assists the continuing care nurse with planning and facilitating discharge.

Chaplain

Offers spiritual support and guidance to clients and families.

Administrative Staff

Organize and schedule diagnostic tests and procedures and arrange for services needed by the client and family.

Interprofessional Collaboration

A. Client Care Planning

Accomplished through referrals, consultations, or interprofessional collaborations with other health care specialists and through client care conferences involving members from all health care disciplines. This approach helps ensure continuity of care.

B. Reports

Characteristics: Factual, accurate, current, complete, and organized.
Components: Include essential background information, subjective and objective data, any changes in the client’s status, client problems/nursing diagnoses, treatments and procedures, medication administration, client teaching, discharge planning, family information, client’s response to treatments, and the client’s priority needs.
Change-of-Shift (Hand-Off) Report:

Facilitates continuity of care among nurses by describing the client’s health status and informing the nurse who assumes care about the client’s needs and priorities.
Report formats include written, oral, audiotaped, walking rounds at the client’s bedside, or a combination, allowing the client to participate in care planning and establishing the stability of the client before the oncoming nurse assumes care.

Telephone Reports:

Purposes include informing a PHCP of changes in status, communicating information about a client’s transfer, and obtaining laboratory or diagnostic test results.
Documentation: Includes when the call was made, who made the call, who was called, to whom information was given, what information was given, and what information was received.

Transfer Reports:

Maintain continuity of care, given by telephone or in person.
Repeat transfer information to ensure client safety and ask clarifying questions about the client’s status.

Situation, Background, Assessment, Recommendation (SBAR):

A structured, standardized communication technique improving communication among team members when sharing information on a client.
Includes up-to-date information about the client’s situation, associated background information, assessment data, and recommendations for care, such as treatments, medications, or services needed.

SBAR Example: A nurse calling a doctor

Situation: "Dr. Smith, this is Nurse Jones calling from Med-Surg Unit regarding Mr. Johnson in Room 302. He is experiencing increased shortness of breath and his oxygen saturation is currently at 88% on room air."
Background: "Mr. Johnson is a 68-year-old male admitted three days ago for community-acquired pneumonia. He has a history of COPD and hypertension. He has been on oxygen at 2L via nasal cannula, which has maintained his saturation above 92% until now."
Assessment: "His respiratory rate is 28 and labored, heart rate is 110, and blood pressure is 150/90. Auscultation reveals decreased breath sounds with wheezing in both lungs. He is alert but anxious. I have already increased his oxygen to 4L, but his saturation remains low."
Recommendation: "I recommend we consider ordering a chest X-ray to rule out any complications such as a pneumothorax or fluid build-up, and assess the need for bronchodilator treatment. Would you like me to initiate these orders?"

Interprofessional Consultation

A. Definition: A process in which a specialist is sought to identify methods of care or treatment plans to meet the needs of a client.

B. Need for Consultation: Arises when the nurse encounters a problem that cannot be solved using nursing knowledge, skills, and available resources.

C. Unclear Problem: A consultant can objectively and more clearly assess and identify the exact nature of the problem.

D. Rapid-Response Teams: Provide nursing staff with internal consultative services offered by expert clinicians.

E. Role of Rapid-Response Teams: Assist nursing staff with early detection and resolution of client problems.

F. Prevention: Teams of health care providers respond to hospitalized clients with early signs of deterioration to prevent respiratory or cardiac arrest.

G. Medication Reconciliation: Collaboration among the client, PHCPs, nurses, and pharmacists to ensure medication accuracy when clients experience changes in health care settings or levels of care, are transferred from one care unit to another, and upon discharge.

Discharge Planning

A. Initiation: Begins when the client is admitted to the hospital or health care facility.

B. Process: An interprofessional process ensuring that the client has a plan for continuing care after leaving the health care facility and assists in the transition from one environment to another.

C. Caregiver Involvement: All caregivers are involved in discharge planning, and referrals to other PHCPs or agencies may be needed, including a PHCP’s prescription and approval by the client’s health care insurer.

D. Anticipation and Referral: The nurse should anticipate the client’s discharge needs and make the required referral as soon as possible involving the client and family.

E. Education: The nurse needs to educate the client and family regarding care at home.

Delegation and Assignments

A. Delegation

Definition: The process of transferring the performance of a selected nursing task in a situation to an individual who is competent and has the authority to perform that specific task.
Involvement: Delegation involves achieving outcomes and sharing activities with other individuals who have the authority to accomplish the task.
Nurse Practice Act: Defines which aspects of care can be delegated and which must be performed by a registered nurse, including any practice limitations (institutional policies and procedures and job descriptions of personnel provided by the institution).
Accountability: Even though a task may be delegated, the nurse who delegates maintains ultimate accountability for the task.
Assessment of Competence: The knowledge and skills of the person being delegated to need to be assessed, and tasks need to match the person’s skills and abilities.
Nursing Judgment: The nurse cannot delegate any activity that involves nursing judgment or critical decision-making.
Five Rights of Delegation: Include the right task, right circumstances, right person, right direction/communication, and right supervision/evaluation.

B. Principles and Guidelines of Delegating

Delegate the right task to the right delegatee by being familiar with their experience, scopes of practice, agency policy, and state nurse practice act.
Provide clear directions about the task and ensure understanding.
Determine the degree of supervision required.
Authorize the delegatee with a deadline.
Evaluate the outcome.
Provide performance feedback.

C. Client Care Task Assignments

Definition: The transfer of performance of client care activities to specific staff members.
Guidelines:

Always ensure client safety.
Be aware of individual variations in work abilities.
Determine which tasks can be delegated and to whom, based on the nurse practice act and any practice limitations.
Provide clear, concise, accurate, and complete directions.
Validate the delegatee's understanding.
Communicate a feeling of confidence and provide prompt feedback.
Maintain continuity of care.

Time Management

A. Description

Definition: A technique designed to assist in completing tasks within a definite time period.
Components: Requires learning how, when, and where to use time, as well as establishing personal goals and time frames.
Requirements: Requires an ability to anticipate the day’s activities, combine activities when possible, and minimize interruptions.
Principles: Emphasizes efficiency in completing tasks quickly and effectiveness in deciding on the most important task to do (i.e., prioritizing) and doing it correctly.

B. Principles and Guidelines

Identify tasks, obligations, and activities and write them down.
Organize the workday and identify deadlines.
Prioritize client needs according to importance.
Anticipate the needs in advance.
Begin by focusing on daily tasks, start with top priorities while keeping goals in mind, split tasks into manageable parts.
Collect client data at the beginning of the shift.
Delegate tasks as appropriate.
Maintain a daily log, structuring it along the day.
Wise distribution of healthcare agency resources.
Organize paperwork.
Evaluate effectiveness at day’s end.

Prioritizing Care

A. Description: Deciding which needs or problems require immediate action and which ones could tolerate a delay in response until a later time because they are not urgent.

B. Guidelines:

Rank the client's needs in order of importance based on preferences, safety, and physical and psychological needs.
Classify priorities as high, intermediate, or low.
Address life-threatening needs or those that could result in harm first.
Manage non-emergency and non-life-threatening next.
Address needs not related to the client’s illness last.
Prioritize airway, breathing, and circulation.
Consider vital signs and respond to abnormal values.
If CPR is necessary, prioritize compressions, airway, and breathing (CAB) and consider actual threats.
Consider time constraints and resources and the client’s problems with Maslow’s Hierarchy of Needs: physiological ->safety ->belonging -> esteem -> self actualization.

C. Setting Priorities for Client Teaching

Determine the client’s immediate learning needs.
Identify individual and group factors.
Review the client learning objectives to follow.
Evaluate what the client perceives to be important.
Assess the client’s anxiety level and the time available to teach.

Disasters and Emergency Response Planning

A. Description

Disaster: Any human-made or natural event that causes destruction and devastation requiring outside assistance.
Types of Disasters:

Internal: Occur within the health care agency (e.g., fire).
External: Occur outside the health care agency (e.g., mass transit accident).

Casualty Levels:

Multi-casualty: A limited number of victims managed by currently available resources.
Mass casualty event: Resource capabilities exceed the hospital’s, which is known as a disaster.

Emergency Response Plan (ERP): A formal plan of action that coordinates the response of health care in the event of a disaster in the health care agency or the community.

B. American Red Cross (ARC)

Authorized by the federal government to provide disaster relief.
All assistance is free with its numerous local offices.
Participates with the government by testing and developing community disaster plans.
Educates the public about how to prepare through identification and training of emergency assistance for labor or organizational disaster plans.
Operates shelters and provides emergency assistance; handles inquiries from family and members of health organizations and plans.
Nurses assume roles as educators and responders involved directly within programs.

C. HAZMAT (Hazardous Materials) Team

Generally formed by nursing and ED staff, as will encounter potential dangers first; have been exposed to and educated about methods of exposure.

D. Phases of Disaster Management

Federal Emergency Management Agency (FEMA): Mitigation, Preparedness, Response, and Recovery.
Mitigation:

Actions that can prevent occurrence/reduce damaging effects.
Community hazards and awareness/accessibility of potential resources and minimization, chaos within confusion.