1st Things 1st ….and hurry up!

Managing Patient Care

RANC Objectives Apply principles of priority setting to

patient care situations. Apply time management strategies to the

reality of delivering effective nursing care. Relate time management strategies to

enhance personal productivity.

Why prioritize? Identifies relevance & /or significance Increases quality care

Allows for delegation & collaboration Enhances preventative care

Promotes time management Increases productivity Not a linear activity

variables occur simultaneous actions (multitasking) is a must

Elements of Managing Pt Care Competency (Box 21-1) Facility/Unit Vision Model of Care Organizational Structures Leadership Decision-Making Skills Knowledge Base & Con’t Educ Communication Teamwork!

On Your Mark… Know yourself!

Strengths & limitations Increase knowledge

Holistic care Specialization Evidence-based practice Strive for excellence

Sharpen critical thinking skills Practice hands-on skills Communicate effectively Team-player (aka “collaboration”)

…Get Set… Assessment 1st

Focused vs complete assmnt Thoroughness

Developing rapport Critical thinking

Making clinical judgments Affects decision-making

Nursing process Know your limitations & ask for help

…Go!!! Anticipate pt needs look for cues

verbal/nonverbal, history info, meds, environment, etc Involve the pt Priority setting

High life-threatening (“MUST do”)

Intermediate Non-emergent (“SHOULD do”)

Low Related to other needs (“Nice to do”)

Note condition changes Time availability

Length of stay, interruptions, etc

Start with the ABC’s! 1st priority sustain life & safety Physiological needs usually 1st unless

psychosocial need Physiological:

Airway Breathing Circulation

Psychosocial: Anxiety Fear Depression Ineffective coping

Maslow’s Hierarchy of Needs

▪ Physiological 1st

▪ Safety 2nd

*See p48, 71-72

Prioritizing on the “same” level Most urgent 1st

If the airway isn’t clear the oxygen won’t get to the lungs to be circulated to the tissues!

If the need to void is more urgent than the need to eat

If rest is more important than sex!

Acute vs. Chronic problems LOC change: acute confusion vs

Alzheimer’s Surgery-related pain vs. arthritic pain Immobility post-op vs. anxiety

Patient Preference prn Motivation to participate Perception of event Value system of the patient (not the nurse!) Advocacy prn Family/Significant Other involvement Right to refuse care

Informed consent *Nurses are responsible to act in the best

interest of the client

Case Study A 16-yr-old male pt was involved in a MVA

and was ejected from the car. Initial assmnt reveals a patent airway, response to painful stim, laceration (L) thigh covered with drsg, contusions to (L) flank.

Prioritize these interventions: Immobilize head and neck Assess LOC & Neuro deficits Assess (L) thigh & Apply clean pressure drsg Call parents for consent to Tx Insert Foley catheter

Managing Time Time analysis/assessment

How do you usually spend your time? When are you most efficient?

Time frame Organized method of planning

Principle of time mngmt “Organize & execute around priorities”

(Covey, 1989, p149) ADOPIE (Nrsg Process)

Avoid “Pitfalls” along the way: Procrastination, easiest thing done 1st,

distractions, 1st seen=1st done, socialization overload, failure to differentiate priorities, or accepting someone else’s priorities!

Time Management Tips ID important aspects/ needs ID barriers to completion Prioritize needs Develop reasonable time frames Delegate appropriate tasks Avoid the need to be perfect Evaluate your efforts & note areas to be

improved

Lipe, S. K. & Beasley, S. (2004) Critical thinking in nursing: A cognitive skills workbook

Managing to Find the Time! Organize priorities after shift report

Nursing Process Make lists & cross off items as you go SET GOALS

“A goal without a deadline is a dream” Judith Brumm, RN, CNOR

THINK ahead-be prepared! “If you don’t spend time using your brain, you’ll

spend time using your feet!” (E. Heim, ) Plan time for documentation

Personal Time Management

Nursing Spectrum: Student Corner http://www.nursingspectrum.com/Student

sCorner/StudentFeatures/TimeSide.htmStudent website

http://caring4you.net/tests.html

Finally….

The End

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Garret, my brand new grandson!