Nurse Logic Module Reflection #2 – Priority Setting Frameworks

Nurse Logic Module Reflection #2 – Priority Setting Frameworks

As discussed in this module, nurses set priorities for patient care many times each shift through the use of priority setting frameworks. Though I was at least somewhat familiar with each of these frameworks before completing this lesson, it was helpful to work through realistic examples that allowed me to practice ‘thinking like a nurse.’ 

One example presented that stood out to me was that of two patients, both with oxygen saturation levels of 88%. At first glance, this value would be alarming to the nurse. However, upon further analysis of the patients, the nurse learns that one has an asthma exacerbation, while the other has COPD. Using nursing knowledge and the priority setting framework of acute vs. chronic, it is clear that the nurse needs to see the asthmatic patient first. Patients with COPD typically live with lower oxygen levels, and, as I learned in the module, these low values are actually necessary for continued stimulation of the drive to breathe. This example emphasizes the importance of understanding a patient’s history and baseline level of functioning. Without context, making decisions about prioritization becomes much more complex.

Last semester, I had the opportunity to put together an independent study course exploring the role of the school nurse, a field I am very interested in pursuing. Part of the study involved shadowing nurses working in this setting. I found that, especially among younger students, it was common to stop by the health office with minor pain, stomachaches, or fatigue. At any given moment, there might be half a dozen or more students in the office, often with the exact same complaint (I lost count of how many 9-year-olds walked in and announced, “I need an ice pack!”) It was up to the school nurse, based on both an assessment of the patient and her knowledge of the student’s baseline and history, to make decisions about priority setting and treatment. It is common for two patients to have the exact same chief complaint but very different outcomes. For example, one school nurse I worked with told me about a student who came into her office complaining of elbow pain after falling. He presented normally, so she gave him an ice pack and sent him on his way. The next day, the student showed up to school in a sling. He had badly dislocated the elbow. When the nurse, shocked, asked him why he didn’t tell her how bad he was truly feeling, he responded that he “didn’t want to bother her.” On the other hand, I witnessed multiple students in seemingly much more distress, with injuries that turned out to be nothing more than a small scrape or bruise. Thus, I would add to the priority-setting frameworks discussed in this lesson the importance of understanding a patient’s normal level of functioning and history, which further allows the nurse to evaluate the urgency of a given situation. As an aspiring school nurse, I know that a combination of priority setting frameworks and truly getting to know the students I work with will be crucial in my work.