Establishing Priorities: NCLEX-RN

In this section of the NCLEX-RN examination, you will be expected to demonstrate your knowledge and skills of establishing priorities in order to:

• Apply knowledge of pathophysiology when establishing priorities for interventions with multiple clients
• Prioritize the delivery of client care
• Evaluate the plan of care for multiple clients and revise plan of care as needed

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 Clients

As 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

• Some physical needs include the need for the ABCs of airway, breathing and cardiovascular function, nutrition, sleep, fluids, hygiene and elimination.

Safety and Psychological Needs

• The psychological or emotional, safety, and security needs include needs like low level stress and anxiety, emotional support, comfort, environmental and medical safety and emotional and physical security.

Love and Belonging

• The love and belonging needs reflect the person's innate need for love, belonging and the acceptance of others including a group.

Self Esteem and Esteem by Others

• All people have a need to be recognized and respected as a valued person by themselves and by others. People have a need self-worth and self-esteem and they need the esteem of others.

Self Actualization

• Self-actualization needs motivate the person to reach their highest level of ability and potential.

The ABCs / MAAUAR method, which was previously detailed, places the ABCs as the highest and greatest priorities which are then followed with the 2^nd and 3^rd priority level needs.

The 2^nd 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 3^rd level priorities include all concerns and problems addressed with the 2^nd level priority needs.

Prioritizing the Delivery of Client Care

The 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 Needed

In 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:

• Advance Directives 
• Advocacy
• Assignment, Delegation and Supervision
• Case Management 
• Client Rights
• Collaboration with Interdisciplinary Team
• Concepts of Management
• Confidentiality/Information Security
• Continuity of Care
• Establishing Priorities (Currently here)
• Ethical Practice
• Informed Consent
• Information Technology
• Legal Rights and Responsibilities
• Performance Improvement & Risk Management(Quality Improvement)
• Referrals

SEE – Management of Care Practice Test Questions

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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.