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Organizing and Managing Organizing and Managing ResourcesResources
Prioritizing and Organizing Care for a Group of Patients
Priority-Setting PrinciplesPriority-Setting PrinciplesThe nurse must be able to judge
priority needs in common situations for:
◦individual patients
◦a group of patients
Individual Patient NeedsIndividual Patient NeedsTo determine and rank priority of
individual patient needs, the nurse must:◦assess the patient’s condition and
responses to health problems and treatment
◦determine perceived urgency of the patient’s needs in terms of predictable risks or consequences
Categories of priority Categories of priority needsneeds1. First-order priority needs
2. Second-order priority needs
3. Third-order priority needs
4. Fourth-order priority needs
First-Order Priority NeedsFirst-Order Priority NeedsThreats to immediate survival or
safety
Those that demand immediate nursing intervention(s)
Second-Order Priority Second-Order Priority NeedsNeedsActual problems for which the
patient or family has requested help
Those that require prompt nursing intervention(s) to prevent problems from becoming worse
Third-Order Priority NeedsThird-Order Priority NeedsActual or potential problems of
relative urgency that the patient or family does not recognize
Those that require the nursing staff to monitor and manage them
Fourth-Order Priority Fourth-Order Priority NeedsNeedsActual or potential problems that
the patient or family may need help to resolve in the future
Those that require the nursing staff to assess the ability of the patient or family to perform care or provide assistance after discharge
Needs of a Group of Needs of a Group of PatientsPatientsThe nurse must know the needs
and priorities of needs of each patient by:
◦considering data from change-of-shift report and/or acuity classifications
◦completing all patient assessments ASAP while attending to first- and second-order priority needs
Needs of a Group of Needs of a Group of PatientsPatientsThe nurse must consider factors
that affect prioritization of care, such as:
◦the amount of time and types of skills required to complete nursing activities
◦the types and numbers of available, qualified staff
Needs of a Group of Needs of a Group of PatientsPatientsThe nurse must be flexible in
responding to priority needs by:
◦allocating resources to meet unpredicted first- and second-priority needs
◦considering each patient’s primary goals
◦collaborating with other disciplines to address priority needs
Needs of a Group of Needs of a Group of PatientsPatientsThe nurse must be creative in
responding to priority needs by:
◦emphasizing patient abilities and strengths
◦facilitating patient adjustment to limitations and disabilities
◦considering the influence of diverse cultural and ethnic backgrounds
Principles of Work Principles of Work OrganizationOrganizationDetermine short- and long-term
patient outcomes
◦Short-term outcomes establish work priorities for a specified period of time, i.e. during a work shift
◦Long-term outcomes guide work organization over longer periods of time, i.e. during a hospital stay
Principles of Work Principles of Work OrganizationOrganizationMake a “things-to-do” list
◦At the beginning of each shift, determine the essential activities that must be accomplished during the shift
◦Then make a written list including those essential activities
Principles of Work Principles of Work OrganizationOrganizationRank activities on the “things-to-
do” list
◦Identify those that have a specific time limit to accomplish or those that have specific scheduled times
◦Note the amount of time needed to complete each activity
◦Determine which activities require the help of others to complete
Principles of Work Principles of Work OrganizationOrganizationEliminate unnecessary steps and work
◦ Assemble needed equipment and supplies prior to entering patient care areas
◦ Group similar tasks done at the bedside◦ Complete one task or group of tasks before
beginning another task or group of tasks◦ Collaborate with co-workers to avoid
duplication of gaps in care◦ Involve support staff in non-clinical duties
to the greatest extent possible◦ Evaluate time management efforts
continuously
Principles of Work Principles of Work OrganizationOrganizationPlan for unexpected demands
◦Unpredicted situations and needs must be expected and included in time management plans
◦Ideally time should be allotted to a skilled team member to manage unexpected demands
Principles of Work Principles of Work OrganizationOrganizationSet limits on unreasonable
demands
◦Unreasonable assignments are those that cannot be accomplished with the available time and resources regardless of educational preparation, practice skills, and good intentions
◦Notify the supervisor if the assignment is unreasonable
◦See BON rule 217.11 (1)(T) and BON rule 217.12 (I)(E)
Principles of Time Principles of Time ManagementManagementUnderstand personal time perception
and time inclinations
◦ Personal time perception and time inclinations can affect how an individual uses time and responds to time
◦ Individual time perception is influenced by personality, culture, and environment
◦ Personal time inclinations are determined by time style, time orientation, and dominant brain side
Principles of Time Principles of Time ManagementManagementStreamline work
◦ Streamlining work refers to doing the work that cannot be eliminated or delegated more efficiently
◦ Some suggestions are: Gather materials for a task all at one time Multitask at the patient’s bedside Schedule a special time for priority tasks Ask questions about treatments or medications
before proceeding, if necessary Trust your intuition about changing patient status
Principles of Time Principles of Time ManagementManagementKeep a time log
◦Time perception is “elastic”◦A time log is an objective source of
information about how time is actually spent
◦Time logs can help an individual eliminate or reduce the amount of time spent on nonproductive or minimally productive activities
Principles of Time Principles of Time ManagementManagementReduce interruptions
◦ Interruptions are a part of the nursing work environment
◦ Some tips to handle interruptions are: Close the door to a patient’s room when engaged
in patient care activities Ask visitors, colleagues, physicians and other
professionals to wait until you can complete what you are doing in a firm but courteous manner
Involve non-licensed personnel, if appropriate, in patient care activities and assisting others
Principles of Time Principles of Time ManagementManagementCategorize activities
◦Cluster related activities or tasks as much as possible, i.e. document assessment findings during the assessment
◦Try to see one task through to completion before starting another task
Principles of Time Principles of Time ManagementManagementBe aware of factors that inhibit
effective time management and some possible solutions reduce or eliminate these factors
◦ There are a variety of personal and environmental factors that inhibit the effective use of time, such as: Procrastination Complaining Disorganization Trying to do too much