Prioritization Frameworks in Nursing

ATI: Priority-setting frameworks    Prioritizing setting: The delivery of nursing care based on the urgency or importance of client needs. o Used when determining which needs. To be address first for an individual client to care for first o Lack of prioritization skills can have a negative effect on the client’s well-being and health care outcomes o Nurses demonstrate prioritizations when  Choosing interventions for multiple clients  Prioritize individual care for a client  Evaluate a clients plan of care  Revise the plan of care as necessary Maslow’s hierarchy of needs o A theory that suggests there are five categories of needs that motivate human beings. The five categories are psychological, safety, love and belonging, esteem, and self-actualization  Needs to meet needs at the bottom of the pyramid before going to the next. From highest priority  Physiological needs: The most basic human needs for air, water, food, housing, sleep, and sexual activity  Safety needs: The need for secure environment in which one can live, work, and play  Love needs: A need to give love and receive love  Esteem needs: A need to have a high self-image  Self-actualization: A need for achievement and mastery ABCDE approach o Acronym used in prioritizing care for individuals or groups of clients o Used to consider which physical assessments to perform first, which findings are critical and should be addresses, and which interventions should be implemented immediately to manage a potentially life-threatening situation  Airway  Airway blockage, cervical spine injury  Breathing  Tension pneumothorax, pulmonary oedema, bronchospasm  Circulation  Shock (hypovolemic, obstructive, distributive, cardiogenic)  Disability  Seizure, hypoglycemia, meningitis, intracranial hemorrhage or infraction, intoxication  Exposure  Hypothermia or hyperthermia, critical skin conditions such as fasciitis or urticaria          Nursing process o A four or five sequential process that guides nurses in prioritizing care for clients o Used regularly and continuously in client care  Data collection  Planning  Implementation  Evaluation Safety and risk reduction: Priority is given to whatever finding poses the greatest or immediate risk to the clients physical or psychological well-being Least restrictive/least invasive: Interventions are selected that maintain client safety while producing the least amount of restriction to the client; the nurse chooses interventions that are the least invasive. Survival potential: Priority is given to the client who has a reasonable chance of survival with immediate intervention. This framework is typically used in situations where resources are limited, such as with mass casualties and disaster triage Triage: To sort and rank treatment of clients according to the urgency of their need for care Resource allocation: The distribution of resources to a service or department Survival potential framework o Assign a red tag to clients who have life-threating injuries but have a high chance of survival with immediate treatment (emergent, priority for treatment) o Assign a green tag to the walking wounded, or clients who have injuries that are non-life threatening and could wait hours to days for treatment (nonurgent; this priority for treatment) o Assign a black tag to clients who are decreased or have a minimal chance of survival despite treatment, and promote for these clients (expectant, lowest priority) Additional priority framework o Critical: Client care needs require the nurse to intervene immediately to prevent the client from deteriorating (e.g., respiratory difficulty, chest pain, or a change in neurologic status) o Urgent: Client care needs are identified when the client could suffer mild harm or discomfort if there is a delay in addressing the client’s needs (e.g., postoperative pain) o Routine: Client care needs include tasks such as administering routine medications and performing required shift tasks (e.g., routine vital signs, daily physical assessment) o Extra: Client care needs involve activities that are not essential to client care but can promote client comfort (e.g., providing the client with a warm blanket, combing the client’s hair) Acute: Conditions described as a state in which manifestations are severe, appear suddenly, and can worsen rapidly.    o Acute vs chronic: A framework in which acute conditions are prioritized over chronic conditions Urgent: Factors or situations that have a considerable probability of causing harm or discomfort to the client if interventions are not implemented quickly o Urgent vs nonurgent: Priority is given to the client who has an urgent need over a client with a nonurgent need Unstable vs stable: Client has experienced an acute change in condition, whereas a stable client has a condition that changes little over time Rationing: Process in which allocated resources are scare and there will not be enough to meet all the required needs ATI Summary  Nurses should use clinical indicators such as level of consciousness, trending of vital signs, skin color, pain level, and gastrointestinal changes to guide clinical decision making in determining a client’s clinical status.  Although the ABCDE approach has traditionally been used in the acute care setting, it can be used in any health care setting to assess and treat acutely ill clients. This framework places the highest priority on ensuring an adequate airway.  Rationing of care can occur due to inadequate resources, including time, staffing levels, and staff mix.  Rationing of care means that care is left undone, omitted, or missed due to limited resources.  Missed care is considered a medical error that can potentially affect client safety.  Delegation of client care to other members of the interprofessional team is an option when prioritizing client care, as it gives the nurse more time to care for clients who have higher acuity needs.  A nurse may not delegate any task that requires either nursing judgment or critical decision making.  When implementing safety and risk reduction as a priority framework, nurses should choose to intervene first in the situation that poses the greatest risk for injury to a client.  When prioritizing care for a group of clients, nurses should first rank the order in which clients should be seen, and then rank the order of care tasks for each individual client.  To prioritize a group of clients in an ED, the nurse first collects initial focused client data and assigns an acuity level to the client.  Most EDs utilize a five-level acuity system that ranks clients who are severely ill at level 1 and clients who are least ill at level 5.  Nurses can assist with triage of groups of clients in the community following a mass-casualty event by using the survival potential prioritysetting framework.  Mass-casualty triage differs from ED triage, in that the most critically injured clients might receive no treatment if they have minimal chance of survival.