Overview
This lecture reviews key frameworks and decision-making models for patient prioritization in nursing, including the nursing process, Maslow’s hierarchy, ABCs, and special triage situations.
Patient Prioritization Frameworks
- The nursing process includes assessment, diagnosis, planning, implementation, and evaluation (ADPIE).
- Always assess before intervening or contacting providers.
- Planning involves setting patient goals and possible discharge plans.
- Implementation is performing interventions for the patient (e.g., medications, procedures).
- Evaluation assesses the effectiveness of interventions.
- Maslow's hierarchy prioritizes physiological needs before safety, psychological, or self-actualization needs.
- Address physiological issues (e.g., nutrition, pain) before psychosocial or higher-level needs.
ABCs and Other Priority Settings
- ABC (Airway, Breathing, Circulation) order is used unless performing CPR.
- Patients with airway or breathing compromise are prioritized over those with circulation issues unless otherwise noted.
- Always consider threats to airway (e.g., stridor, coma), breathing (e.g., asthma, COPD), and circulation (e.g., bleeding).
Acute vs. Chronic & Expected vs. Unexpected
- Acute conditions take priority over chronic or baseline issues.
- Unexpected findings or acute changes should be prioritized over expected or stable symptoms.
- Always ask: "What will harm or kill the patient fastest?"
Least Restrictive/Invasive First
- Begin with least invasive/restrictive interventions, escalating only as needed.
- Use non-invasive techniques before resorting to invasive procedures or restraints.
Mass-Casualty Triage
- In mass-casualty situations, prioritize patients most likely to survive with intervention.
- Do not prioritize patients who are pulseless, have agonal breathing, or non-survivable injuries.
- Triage order: sickest and salvageable first, then less urgent, then walking wounded.
Key Terms & Definitions
- Nursing Process (ADPIE) — Systematic method: Assess, Diagnose, Plan, Implement, Evaluate.
- Maslow’s Hierarchy of Needs — Framework ranking physiological, safety, and psychological needs.
- ABC Prioritization — Order: Airway, Breathing, Circulation for emergency response.
- Least Restrictive/Invasive — Choosing the simplest, least harmful intervention first.
- Mass-Casualty Triage — Sorting patients by survivability during disasters.
Action Items / Next Steps
- Review and memorize the steps of the nursing process and ABCs.
- Practice patient prioritization scenarios using Maslow’s hierarchy and acute vs. chronic concepts.
- Complete suggested quiz questions to test understanding:
- Maslow priority: imbalanced nutrition vs. body image.
- CHF expected vs. unexpected findings.
- Mass-casualty triage—who to prioritize.
- Prepare for next session by reviewing leadership styles in nursing.