Nurse Logic- Priority Setting Frameworks

Nurse Logic 2.0 Module: Priority Setting Frameworks Physiological Needs        Oxygenation Circulation Nutrition Elimination Fluid balance Activity and exercise Rest and sleep Safety and Security Needs    Living in safe environment Adequate income Shelter from environmental elements Love and Belonging Needs    Love Affection Relationships Involvement with community and spiritual groups help to meet this need. Self Esteem Needs    Self-respect Personal worth Social recognition Self-actualization Needs   Personal growth Fulfilling own potential Maslow’s belief: Very few individuals reach this level. Client Care Focus    Higher levels may compete with lower levels (depends on client situation) Maslow’s Hierarchy provides a framework Consider all client factors before determining order Airway, Breathing, and Circulation Airway, Breathing, and Circulation  Priority of initial assessment  Referred to as ABCs  All are critical to survival Alteration in one could indicate threat to life/need for resuscitation Airway  Highest priority action  Must be open and clear  Client might need: o Temporary oral or artificial airway (tracheostomy or endotracheal tube) o Supplemental oxygen Breathing    Second highest priority Essential for oxygen exchange: o Respiratory rate within expected reference range o Adequate ventilatory effort Client might need: o Artificial ventilation o Negative pressure gradient in pleural cavity o Chest tube might re-establish negative pressure Circulation   Third highest priority Heart rate and blood pressure within expected reference range necessary for adequate cardiac, cerebral, and peripheral perfusion o Chemical and/or physical cardiac support o Resuscitation o Supplemental fluids (to re-establish intravascular fluid volume and blood pressure) Client Care Focus    Health care providers use ABC framework frequently Dictates order of care in emergency situations and with unstable clients Helps recognize early signs of complications Safety and Risk Reduction Safety and Risk Reduction   Assigns priority to the factor or situation posing the greatest: o Safety risk to the client o Greatest risk to the client's physical or psychological well-being Multiple risks may require another priority setting framework to identify risk posing greatest threat. Sources of Safety Issues       Client Nurse Provider Medical equipment and environment Home environment Community Risk Reduction    Types of risk o External – Risks in client’s environment o Internal – Laboratory values and vital signs outside expected reference range Maslow’s Hierarchy or ABC priority setting framework to determine alteration posing greatest risk Risk posing immediate threat usually becomes the highest priority Client Care Focus   Assess for external factors o Complete risk assessment o Integrate interventions o Assistive devices Assess for internal factors o ABC combined with safety and risk reduction Least Restrictive/Least Invasive Least Restrictive/Least Invasive   Priority goes to interventions that are least restrictive and least invasive to a client. Make sure it won't put the client at risk for harm or injury. Least Restrictive     Protects clients civil and legal rights Unauthorized use of restraints can be: o Assault and battery o False imprisonment Use least restrictive methods of restraining first. Physical restraints only when client, staff, or others' safety is at risk Least Invasive   Reduce number of organisms introduced into body to reduce hospital acquired infections Reduce client infections to reduce need for antibiotics Client Care Focus   Least o o o o Least o o o restrictive interventions Close and constant supervision Assessing medications Bed and wheelchair alarms Mattress on floor next to client's bed invasive interventions Incontinent clients on bladder routine Incentive spirometers/inhalation treatments Oral or rectal administration of medications Survival Potential Survival Potential    Chance client has for survival during mass casualty event Appropriate use of resources to save greatest number of lives Different from civilian triage system in emergency departments Emergent    Class I – Life threatening injuries Immediate treatment = chance for survival Highest priority Urgent    Class II – Serious and extensive injuries Do not pose immediate threat to life Potential for survival even with delayed treatment Nonurgent    Class III – Less serious and less extensive injuries Do not pose a threat to life No threat to life even with delayed treatment Expectant    Class IV – Injuries are not compatible with life Potential for survival does not exist, even with treatment Scare resources reserved for Classes I, II, and III Client Care Focus    Mass casualty situations when resources are scarce Client least likely to survive = lowest priority Client with severe injuries (but potential to survive with treatment) = highest priority Additional Priority Setting Frameworks Priority goes to:  Acute over chronic alterations in health  Urgent over nonurgent needs  Unstable over stable clients