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170:poster Priority setting across different levels of decision-making: the way forward
AbstractBackground Priority setting involves the practice of ranking interventions in order of their importance. In principle, the same priority setting criteria may be used across all levels of decision-making in health care. This may include decision-making on the macro (cabinet and the health ministry), meso (resource allocation within hospitals and health trusts) and micro level (bedside rationing). Objective The aim of this article is to present a systematic discussion of priority setting across different levels of decision-making. Should different criteria for priority setting apply at the different levels? How can we decide which criteria fall into which category? And what should count as a sufficient argument for having different principles at different levels? Methods We present the current literature on the topic through a scoping review. We expand on the literature to suggest useful definitions of levels of priority setting and candidate reasons for significant differences between the levels. Results We found that definitions and the suggested number of levels differ, but the most favoured approach was two or three levels of priority setting. We present descriptive differences between the levels and suggest what we believe are useful definitions of levels of priority setting. We further present and discuss candidate reasons for ethically significant differences between the levels with applications for priority setting. Discussion We consider this article to be a first step towards a more rigorous approach to priority setting across levels of decision-making in health care. We recommend that the levels of priority setting are more consistently and comprehensively defined. We argue in favour of further systematic discussion of this topic in future and conclude that this topic should be unavoidable in further discussions. http://creativecommons.org/licenses/by-nc/4.0/ This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ . Statistics from Altmetric.comRequest PermissionsIf you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways. Read the full text or download the PDF:Log in using your username and passwordIn this section of the NCLEX-RN examination, you will be expected to demonstrate your knowledge and skills of establishing priorities in order to:
Actual needs and problems take priority over wellness, possible risk and health promotion problems and short term acute patient care needs and problems typically take priority over longer term chronic needs. Applying a Knowledge of Pathophysiology When Establishing Priorities for Interventions with Multiple ClientsAs previously mentioned with the “Integrated Process related to the Nursing Process“, priorities are established using a number of methods and frameworks including the ABCs, Maslow's Hierarchy of Needs and the ABCs/MAAUAR method. Knowledge of these frameworks and an in-depth knowledge about pathophysiology facilitate the proper establishment of priorities relating to the interventions that are then provided to individual clients and groups of clients with diverse needs of varying acuity and differing priorities. The ABCs identifies the airway, breathing and cardiovascular status of the patient as the highest of all priorities in that sequential order. Maslow's Hierarchy of Needs identifies the physiological or biological needs, including the ABCs, the safety/psychological/emotional needs, the need for love and belonging, the needs for self-esteem and the esteem by others and the self-actualization needs in that order of priority. Some examples of each of these needs according to Abraham Maslow's Hierarchy of Needs are: Physical and Biological Needs
Safety and Psychological Needs
Love and Belonging
Self Esteem and Esteem by Others
Self Actualization
The ABCs / MAAUAR method, which was previously detailed, places the ABCs as the highest and greatest priorities which are then followed with the 2nd and 3rd priority level needs. The 2nd priority needs include MAAUAR which is mental status, acute pain, acute impaired urinary elimination, unresolved and unaddressed needs, abnormal diagnostic test results, and risks. The 3rd level priorities include all concerns and problems addressed with the 2nd level priority needs. Prioritizing the Delivery of Client CareThe delivery of client care is prioritized as just discussed above. In addition to prioritizing and reprioritizing, the nurse should also have a plan of action to effectively manage their time; they should avoid unnecessary interruptions, time wasters and helping others when this helping others could potentially jeopardize their own priorities of care. Evaluating the Plans of Care for Multiple Clients and Revising the Plan of Care as NeededIn addition to providing guidance and direction in terms of nursing care delivery, plans of care, including nursing care plans and other systems like a critical pathway, provide the mechanism with which the outcomes of the care can be measured and evaluated. Appropriate and effective client care is dependent on the accuracy and appropriateness of the client's plan of care. For this reason, reasessments and updating and revising a plan of care as based on the client's current status is necessary. RELATED NCLEX-RN MANAGEMENT OF CARE CONTENT:
SEE – Management of Care Practice Test Questions
Alene Burke, RN, MSN Alene Burke RN, MSN is a nationally recognized nursing educator. She began her work career as an elementary school teacher in New York City and later attended Queensborough Community College for her associate degree in nursing. She worked as a registered nurse in the critical care area of a local community hospital and, at this time, she was committed to become a nursing educator. She got her bachelor’s of science in nursing with Excelsior College, a part of the New York State University and immediately upon graduation she began graduate school at Adelphi University on Long Island, New York. She graduated Summa Cum Laude from Adelphi with a double masters degree in both Nursing Education and Nursing Administration and immediately began the PhD in nursing coursework at the same university. She has authored hundreds of courses for healthcare professionals including nurses, she serves as a nurse consultant for healthcare facilities and private corporations, she is also an approved provider of continuing education for nurses and other disciplines and has also served as a member of the American Nurses Association’s task force on competency and education for the nursing team members.  Latest posts by Alene Burke, RN, MSN (see all) What are priority settings?Priority setting is understood as a notional approach to find out what to regard as more important or less important in health care. It primarily means to bring aspects into a ranking order.
What are the steps of priority setting?described priority setting in four steps: (1) identification of health care needs, (2) allocation of resources, (3) communication of decisions to stakeholders, and (4) management of feedback from them [13].
What are the priority levels in nursing?One version includes five levels of needs: those related to physiological, safety, love, esteem, and self-actualization (Maslow, 1943), which can help prioritize care in nursing. Figure 1.2 presents one adapted version of Maslow's Hierarchy.
What are third level priorities?The third-level priorities are matters essential to patient health but can be attended to after the more critical health problems are addressed. Long-term interventions are required to treat these problems. These would include a lack of knowledge, mobility, family coping, activity, and rest.
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