PRIORITIZING
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Nursingleadershipandprioritization11.pptxNursing leadership prioritization disaster planning Safety
PNSG 1522
Leadership styles
Authoritative
Democratic
Laissez-faire
Authoritative
Make decisions for the group
Motivates by force
Communicates down chain of command
High work output (good in crisis situation)
Effective for employees with little or no formal education
Democratic
Include group when making decisions
Motivates by support achievements
Communication up and down the chain of command
Work output is good quality (good when cooperative and collaboration are necessary)
Laissez-faire
Very few decision/little planning
Motivation is largely placed on staff members
Communication up and down chain of command
Work output is low unless leader evolves to form group
Effective with professional employees
Characteristics of leaders
Initiative
Inspiration
Energy
Positive attitude
Communication skills
Respect
Problem solving and critical thinking skills
Emotional intelligence
Ability to perceive and manage emotions of self and others
Important characteristic of nurses
As nurses, we need to acknowledge and understand our own emotions and those of your patient and their family to create or continue with patient-centered care
Traits of emotionally intelligent leaders
Insight into the emotions of team members
Understand others’ perspectives
Open to new ideas
Focused while multitasking
Manages own emotions and channels them into a positive direction
Committed to delivery of high quality patient care
Prioritization
PNSG 1522
Prioritization
Always, always, always think ABC’s and Maslow’s
Some clues that help establish priorities
Information received during report and communications between members of healthcare team
Detailed reviews of documents
Continuously receiving and understanding client data
Prioritization principles
Prioritize systemic before local (“life before limb”)
Whole body system problem opposed to single extremity
Prioritize acute problems before chronic
New onset of chest pain as opposed to someone with oxygen saturation of 88% with known COPD
Prioritize actual problems before potential problems
Acute pain first then someone’s IV that ‘could’ infiltrate
Prioritization principles cont.
Listening carefully to patients
New chest pain following shoulder repair—something else must be going on (impending doom)
Recognize and respond to trends vs. transient findings
Gradual deterioration in LOC and/or GCS
Recognize signs of medical emergencies and complications vs. “expected client findings”
Apply clinical knowledge to procedural standards to determine the priority action
Noting the importance of administration of antidiabetic and antimicrobial medications compared to other meds
Prioritization
Acute then chronic
Unstable then stable
Maslow’s hierarchy of needs
5) Self actualization
4) Self esteem
3) Love and belonging
2) Safety and security
1) Physiological
ABC framework
1) Open airway-necessary for breathing (highest priority)
2) Breathing-necessary for oxygenation of blood
3) Circulation-necessary for oxygenated blood to reach tissues
ABC Framework
Airway
Any obstruction? Stridor?
Establish airway
3-5 minutes without oxygen can cause irreversible brain damage from cerebral anoxia
Breathing
Effective breathing? If not-reposition, give Narcan?
Circulation
Hypotension, dysrhythmia, decreased cardiac output?
Disability
Neuro deficits, stroke symptoms?
Facility protocols
Reporting incidents
Definition: Records made of unexpected or unusual incidents that affect a patient, volunteer or visitor in a health care facility.
May be referred to as unusual occurrence or quality variance reports by a health care facility.
Examples of circumstances
Medication errors
Procedure/treatment errors
Equipment related injuries/errors
Needle stick injuries
Client falls/injuries
Visitor/volunteer injuries
Threat made to client or staff
Loss of property (dentures, jewelry, personal wheelchair, etc)
Nursing role in reporting incidents
In an event of an incident that involves a client, employee or visitor, the nurse’s priority is to assess the individual for injuries and institute any immediate care measures necessary to decrease further injury.
Incident reports
Should be completed by the person that it happened to or witnessed it
Complete ASAP and within 24 hours
Considered confidential and not shared with the client
Not placed in the client’s health care record
Include a description of the incident and actions taken as well as assessment and treatment of any injuries
Forwarded to the risk management department or officer
Provide data that may be used in performance improvement studies
When completing incident report the nurse should include
Name and hospital ID number, date, time and location
A factual description of incident and injures incurred
Names of any witnesses to the incident and any clients or witness comments
Corrective actions that were taken, including: name and dose of any medications or ID number of any piece or equipment that was involved in the incident
Disaster planning and emergency response
Disaster planning
Disaster-event that causes serious damage, destruction, injuries and sometimes death
Mass casualty incident-catastrophic event that overwhelms local resources and multiple resources (federal and state) are necessary to handle the crisis
Each health care facility must have an emergency operating plan (EOP)
An essential component of the plan is the provision of training of all personnel regarding each component of the EOP
Nurses should understand their responsibilities in the EOP
Healthcare facilities accredited by the Joint Commission must have an Emergency Operating Plan and are mandate to test the plan twice a year
Disaster planning
The EOP should interface with local, state and federal resources
Disasters that health care facilities face include internal and external emergencies
Internal emergencies are events that occur within a facility and include loss of electric power or potable water and severe damage or casualties related to fire, severe weather (tornado and hurricane) an explosion or terrorist act
External emergencies are events that affect a facility indirectly and include severe weather (tornado and hurricanes), volcanic eruptions, earthquakes, pandemic flu, chemical plant explosions, industrial accidents, building collapses, major transportation accidents and terrorist acts
Disaster planning
To receive assistance with a mass casualty incident (MCI) a state must request assistance
Nurses should be aware that all health care facilities have color code designations for emergencies (code purple, code blue, etc)
Nurses should be familiar with procedures and policies that outline proper measures to take when one of these emergencies are called
Nursing role in disaster planning and emergency response
Emergency response plans
Each health care institution must have an emergency preparedness plan that has been developed by a planning committee
Nurses as well as a cross section of other members of the health care team, should be involved in the development of an EOP for such emergencies
Nurse should create an action plan for personal family needs
Mass casualty triage
Principles of mass casualty triage should be followed in health care institutions involved in a mass casualty event
During mass casualty events, casualties are separated in relation to their potential for survival and treatment is allocated accordingly. This type of triage is based on doing the greatest good for the greatest number of people
Nurses may find this situation very stressful because clients who are not expected to survive are cared for last
Categories of triage during mass casualty events
Emergency category (Class 1)-highest priority is given to clients who have life threatening injuries but also have a high possibility of survival once they are stabilized
Urgent category (Class II)-second highest priority; major injuries, not life threatening; can wait 45-60 minutes for treatment
Non-urgent category (Class III)-given to clients who have minor injuries that are not life-threatening; do not need immediate attention
Expectant category (Class IV)-lowest priority given to clients who are not expected to live and will be allowed to die naturally. Comfort measures may be provided but restorative care will not.
Discharge/relocation of clients
During an emergency such as a fire or mass casualty event, decisions may need to be made regarding them so their beds can be given to patients with higher priority needs
Criteria should be followed when identifying patients requiring minimal care should be discharged or relocated first
Patients requiring assistance should be next and arrangements should be made for continuation of their care
Patients who are unstable and/or require nursing care should not be discharged or relocated unless they are in imminent danger
Fire
If a nurse discovers a fire that threatens the safety of a client, the nurse should use the RACE pneumonic (rescue, alarm, contain and extinguish) to guide the order of actions
Severe thunderstorm/tornado
Draw shades, close drapes to protect against shattering glass
Lower all beds to the lowest position and move beds away from windows
Place blankets over all clients who are confined to beds
Close all doors
Relocate ambulatory clients to the hallways
Do not use elevators
Turn on the severe weather channel to monitor severe weather warnings
Biological incidents
Be alert to indications of a possible bioterrorism attack because early detection and management is key
Use appropriate isolation measures
In most instances, infection from biological agents are not spread from one client to another
Management of the incident includes recognition of the occurrence directing personnel in the proper use of personal protective equipment and in some situations decontamination and isolation
Tables on pages 100 and 101 in book
Chemical incidents
May occur as a result of an accident or due to purposeful action such as terrorism
Take measures to protect self and to avoid contact if possible
Assess and intervene to maintain the clients airway, breathing and circulation
Administer first aid if needed
Remove the offending chemical by undressing the client and removing all identifiable particulate matter
Provide irrigation and prolonged irrigations of contaminated area-the patient’s skin should be irrigated with running water
Gather history of the injury including name and concentration of the chemical as well as duration of exposure
In the event of chemical attack, have knowledge of which facilities are open to exposed clients and which are open only to unexposed clients
Hazardous material incidents
Take measures to protect self and to avoid contact
Approach scene with caution
Identify hazardous material
Try to contain the material
If individual contaminated, decon them as much as possible
Radiological incidents
The amount of exposure is related to the duration of exposure, distance from source and amount of shielding
The facility where victims are treated should activate interventions to prevent contamination of treatment areas
Staff should wear water-resistant gloves, double gloves and fully cover their bodies with caps, booties, masks, and goggles
Staff should wear radiation or dosimetry badges to monitor of their radiation exposure
Patients should be surveyed with a radiation meter to determine amount of contamination
Decontaminate with soap and water and disposable towels—should happen prior to patient entering facility
After decon, patients should be resurveyed for residual contamination
Bomb threat
When a phone call is received
Extend the conversation as long as possible
Listen for distinguishing background noises
Note distinguishing voice characteristics of caller
Ask where and when the bomb is set to explode
Note whether the caller is familiar
Bomb threat
If bomb-like device is located-DO NOT TOUCH!
Clear the area, isolate the device
Notify the appropriate authorities and personnel
Cooperate with the police and others
Keep elevators available for authorities
Remain calm and alert and try not to alarm patients
Security plan
Nurses should be aware that security measures include:
ID Badges
Electronic security systems
Key codes
Wrist bands
Alarms
Nurses should be prepared to take immediate action when breaches in security occur
Time is of the essence!
Safety
Safe use of equipment
Make sure learn how to use new and/or existing technology-your facility should provide proper training for technology on the unit
Check that equipment is set and functioning properly at the beginning of the shift (oxygen, suction)
Ensure that outlet covers are in place in units that individuals are at risk for sticking items into them
Unplugging equipment using the plug, not the cord-prevents bending of the plug prongs which can increase the risk for electrical shock
Disconnect electrical equipment prior to cleaning
Ensure all pumps (IV and PCA) have free-flow protection to prevent an overdose of fluids or medications
Fall prevention
Major nursing priority
Older adults have an increased risk for falls because of decreased strength, impaired mobility and balance, and endurance limitations combined with sensory perception
Prevention of falls:
Complete fall risk assessment upon admission and throughout care
Individualized care based on fall risk assessment
Make sure call light is within reach and they understand how to use it
Answer call lights in timely manner
Hourly rounding
Place patients at increased risk for falls near the nursing station
Bed in lowest position with rails up
Seizure precautions
Used in clients who have a history of seizures that involve the entire body and/or result in unconsciousness
Make sure there is rescue equipment (oxygen, oral airway, suction equipment) is at the bedside
Advise family and caregivers to not place anything in the patient’s mouth in the event of a seizure
Advise family and caregivers not to restrain the client in the event of a seizure. Make sure that the patient is safe by lowering them to the floor or bed, protecting the head, remove nearby furniture, provide privacy, place patient on their side with head slightly flexed, loosen clothing to prevent injury and maintain dignity
Stay with the patient if a seizure occurs, make them safe from injury, call for assistance, and note the duration of seizure and type of movement
After the seizure, explain to the patient what happened, provide comfort and a quiet environment for recovery
Restraints
Physical restraint-application of a device that limits the client’s movement, can limit a single body part or entire body
Chemical restraints-medications that are used to control the client’s disruptive behavior
Risks associated with restraints: death by asphyxiation and strangulation or pressure ulcers, urinary and fecal incontinence and pneumonia
restraints
Restraints should be ordered for the shortest duration necessary and only when less restrictive measures have not been successful
It can be the nurse’s responsibility to explain the purpose of the restraint and that the restraint is only temporary
Restraints must NEVER be used for:
Convenience of the staff
Punishment for the patient
Patients who are extremely physically and mentally unstable
Restraints
Restraints should:
Never interfere with treatment
Restrict movement as little as is necessary to ensure safety
Fit properly
Be easily changed to decrease the chance of injury
The treatment must be prescribed by the provider based on a face-to-face assessment of the client
Prescription or order must have a specific reason for the restraint, type of restraint, location of the restraint, how long it may be used, and type of behaviors that the patient has been exhibiting
Order must be rewritten every 24 hours
Nursing responsibilities for restraints
Complete CMS checks every 2 hours
Offer food and fluids
Vital signs
Use a quick-release knot to tie the restraint to the bed frame
Ensure that the restraint is loose enough for range of motion and space of 2 fingers between the device and the patient
Never leave patient unattended without the restraint
Document using the appropriate flow sheets
