Education Specialist. Prioritization of patients in a hospital setting
According to Ackerman, (2009), the hospital is an extremely complex environment characterised by rapid changes and cases requirements, this makes it difficult for the hospital to have a fixed schedule or priority plan. However, the hospitals need clinical decision-making on which cases to handle as a matter of urgency and which should be put on hold. However, Lake, Cheryle & Duke (2009), argue that due to the urgency of some cases it is imperative for doctors to make clinical judgement in the light of a number of factors such as the severity of the case, the nature of the case, availability of resources, and above all the skill of the hospital staff to handle the cases adequately.
Lamond, & Thompson, (2006) enthuses that nurses have to realize emergent orders in the clinical situations through an advanced nursing prioritization of the general need for care by the patients. It is upon this purpose that we set out to develop a prioritization plan for the hospital settings. The simulator can be used to simulate a nursing framework to assist them in making the decisions when going about their clinical rounds. While working on emergency cases is a priority, there has been an argument in the medical circles that nursing prioritization is just a fad, however, unlike other practices where cases are handled on first come fist served basis, nursing is quite complex and dynamic, this means it is always valuable to expected the unexpected. However, without the use of a prioritization simulator, sometimes it becomes difficult for nurses to determine which cases are unstable even with oxygen saturation of approximately 86%, as either moderate or intermediate. Nurses are required to multitask even in view of falling hospital system (Littlejohn, 2003).
When the student engages in the simulation, it is advisable to assess the following:
How the student attaint the concept through experiential practice and learning
The degree of engagement of the student in the activity
Does the student understand the subtlety of the nursing prioritization
Storyboard of the simulation
The patient arrives at the reception, and is directed to the doctor’s office, where the nurse takes the personal information and the vitals of the case as shown below:
The diagnosis and prescription is followed by shift assessments to determine the condition of the patient at the beginning and the end of every shift.
In these simulators, the student is required to understand the nature of the nursing situation and take note of the various patient care needs of each patient such as the vitals, history of the disease, Pathophysiology and diagnosis (Marsden, 1999).
The student then makes a list of the medical care requirement of each patient, and grades them according to the urgency. In the meantime, the student anticipates emergency cases in the course patient care delivery (McArthur, & Dickinson, 2003).
The student then reports to the RN or clinical officer in charge. However, in the absence of a clinical officer, the student has to prioritize the cases in the hospital based on the severity and the urgency of the case. He can make use of the matrix system inbuilt within the simulator to determine the case with the highest weight (Young, & Burke, 2010). It is imperative to note that the students also know the hospital’s policy on delegation of duties, and management of clinical responsibilities.
The student communicates the summary of the priorities of the people in charge for implementation diagnosis, and intervention, prescription, or treatment.
Lake S, Cheryle M, and Duke J. (2009). Nursing prioritization of the patient need for care: tacit knowledge embedded in the clinical decision-making literature. The International Journall of Nursing Practice Volume 15, Issue 5, pages 376–388,
Marsden, J. (1999). Expert nurse decision-making: telephone triage in an ophthalmic accident and emergency department. NT-Research, 4(1), 44-54
McArthur, J., & Dickinson, A. (2003). Decision making the explicit evidence based way: comparing benefits, harms and costs. Nursing Praxis in New Zealand, 14(1), 33-42
Littlejohn, C. (2003). Critical realism and psychiatric nursing: a philosophical inquiry. Journal of Advanced Nursing, 43(5), 449-456.
Ackerman, A. (2009). Investigation of learning outcomes for the acquisition and retention of CPR knowledge and skills learned with the use of high-fidelity simulation. Clinical Simulation in Nursing. 5(6): e213-e222.
Young, P., and Burke, J.( 2010). Evaluation of a multidisciplinary, simulation-based hospital residency program. Clinical Simulation in Nursing., 6(2): e45-e52.