CARE PRIOITIZATION
PRIORITY SETTING
Priority Setting
• Introduction
– A complex step in the decision-making process
– Used to rank patient needs, determine the order
of nursing activities, and manage resources
– “Critical thinking” supplies the logic within this
process
Priority Setting
• Definition – a priority is something that is
more important than anything else at a given
time
• On a nursing unit, this may include patient,
team, or organizational needs
• Unique to each patient
• There are principles that assist in arranging
activities based on urgency, importance,
significance, or preference
Priority Setting
• Time Management – an important skill
• Proactive vs reactive: planning your time vs
“putting out fires” as they occur.
• See Box 4-1 p.60 [Critical Thinking} – depicts a
plan of action for managing time on a busy
nursing unit
Priority Setting
• Time Management (cont.)
– Steven Covey (1989) recommendation:
• Determine: “must do”, “should do”, “nice to do”
– Once priorities are set, a time frame should be
developed
– See Box 4-2 p.60 [Critical Thinking]
Priority Setting
• Prioritizing Patient Needs
– Use Maslow’s Hierarchy of Needs
• A theory of motivation based on human needs
• The basic needs found at the base of the pyramid
(physiologic needs) must be at least partially met
before the individual can concentrate on the other
needs.
– Eg. If a person is starving, self-esteem is not a
pressing issue.
Maslow’s Hierarchy of Needs
Priority Setting
• Prioritizing Patient Needs (cont.)
– This pyramid can help the nurse in selecting nursing dx.,
and determining the priority of the dx.
– Physiologic needs always take precedence.
• Exception: when a psychosocial problem interferes with
the patient’s ability to participate in the physiologic
care.
– Eg. Mastectomy patient unable to learn how to
dress the wound for home management because
she is not able to look at the surgical site.
Priority Setting
• Other models of prioritizing needs have
modified or expanded on Maslow’s to be
more specific.
• Prioritizing Nursing Diagnosis
– May want to follow Craven and Hirnle (2003)
model : organizes priorities into 3 categories:
high, medium, low
– Prioritizing Nursing Diagnoses  determining the
priority of nursing activities.
Priority Setting
• High-Priority Situations
– Life-threatening
•
•
•
•
Airway difficulties
Cardiovascular changes
Tissue perfusion changes
Alteration in fluid volume
– Threats to patient safety
– Situations in which pain and anxiety relief is a
concern
Priority Setting
• Medium-priority situations
– Nursing diagnoses that involve problems that
“could result in unhealthy consequences, such as
physical or emotional impairment, but are not
likely to threaten life” (Craven & Hirnle, 2003.
p.187)
– Examples
• Anxiety caused by a Lack of Knowledge
• Urgent events that are not life threatening
• Preparation for a test or discharge preparation
Priority Setting
• Low-priority situations
– Nursing dx. involve problems that can usually be
resolved with minimal interventions
– Have little potential to cause significant
dysfunction
– No major effect on the person
– See Box 4-3 [Critical Thinking…]
Priority Activities
• Other factors that influence the scheduling of
activities
– Availability of material and staff
Priority Activities
– Multitasking
• Several needs or concerns are frequently
addressed simultaneously by the nurse
• Must be able to recognize the top priority
• Prepare a daily “to do” list – organizing your
work increases productivity
• Develop early in the shift
Prioritizing within the Nursing Process
• In the prioritizing process, the nurse may need
to use concepts from more than one source of
guidance
– Assessment – always takes precedence when
prioritizing time!
• Data gathered, sorted, and problems identified
• “Clusters” of data = sorted by defining characteristics
• Conclusions drawn from a cluster  Nursing diagnosis
Prioritizing within the Nursing Process
– Analysis – List of pt. needs prepared + a list of
nursing diagnoses
– Outcome Identification – goals and measurable
outcomes; priorities est. to help the nurse achieve
the desired outcome.
– Plan – nursing activities appropriate for the
specified nursing diagnoses are selected.
– Implementation – Established priorities and listed
activities must be implemented
Prioritizing within the Nursing Process
• FIRST, perform those immediate actions necessary to prevent
harm
• SECOND, perform actions that could result in unhealthy
consequences or physical or emotional impairment
• Low priority = needs that would not be affected if not attended to
until a later date
– The stated goals should be used as a framework to deliver
nursing care. Outcomes should be reviewed before taking
action.
– Document nursing actions and patient response
Prioritizing within the Nursing Process
• Evaluation – reevaluate the plan as the patient
status or the situation changes.
– Assess the pts. Progress toward the outcome
criteria est. in the plan of care.
– Monitor for improvement or deterioration
Pitfalls in Priority Setting
• Failure to identify tasks that cannot be delayed
without serious consequences
• Inadequate assessment and evaluation of patient
needs
• Failure to differentiate between priority and
nonpriority tasks
• Acceptance of others’ priorities without assessing all
the variables
• Performance of tasks with a “first identified, first
completed” approach
• Completion of the easiest task first
Misc.
• Rubenfeld and Scheffer (1999)
– 4 levels of priority: Life-threatening, safety, patient
priorities, and nursing priorities.
• Life – threatening [ABC’s]
• Safety – protecting the patient from injury
» Includes fall prevention, safety devices, seizure
precautions
Priority Activities
• Patient Priorities
– Patient should be consulted in planning activities
– Legal requirement to involve patients in health care decisions
– After the any life-threatening or safety issues considered
• Safety (cont.) –
– Providing nursing care within the Scope of practice and
maintaining professional competence
– Includes recognizing a changed or unstable patient status.
When a patient has a changing, unstable condition, nursing
activities related to this condition assume more importance.
Priority Activities
• Patient Priorities
– Patient should be consulted in planning activities
– Legal requirement to involve patients in health care decisions
– After the any life-threatening or safety issues considered
• Safety (cont.) –
– Providing nursing care within the Scope of practice and
maintaining professional competence
– Includes recognizing a changed or unstable patient status.
When a patient has a changing, unstable condition, nursing
activities related to this condition assume more importance.
– Nursing Priorities
• Composite of patient strengths and health concerns;
moral and ethical decisions, etc.
• Includes health promotion and illness prevention