NUR: 473 Exam 1// Fensler

information overload

"data smog" occurs when you are overwhelmed by too much information too fast, and too often, and do not have the skills to interpret the data as useful info

time management

- Considered a preventative action to help reduce the elements of stress - Is a cyclic process - Appropriate use of tools, techniques, and principles to control time spent on low-priority needs and to ensure that time is invested in activities Techniques: -Organization: promotes efficiency and productivity -Focus on goals: to do lists focus on goal achievements -Use Tools: Use the right tool to plan and prep -Time management plan: helps refocus, gain control, and use information -Emails: prioritize (what is important and urgent) -In person meeting vs. phone call vs. email

transformational leadership style

- Empower and inspire followers to achieve a common, long-term vision -looking to transform people into more than what they were// creating leaders to replace when current leader is gone - Role model, ethical, builds others up, inspires, motivates, communicates well, optimistic, involves followers, coaches, and mentors - Build up followers and support followership model - Partnered with followers bring opportunities to meet the goals of the quadruple aim

becoming a leadership tag in the complexity theory

-the term "tag" refers to the philosophic, patient-centered, and values driven characteristics that give an organization its personality, the "energy" that it has; a tag is sometimes called an attractor or a hallmark of culture, similar to values -although clinical organizations often perform similar procedures and fxns, an intangible sense that this particular organization has a "caring" or "good energy" attractor differs from one where the sense is the focus on efficiency and cost only.

encouraging non-hierarchical, "bottom-up" interaction among workers in the complexity theory

-those who lead, manage, and follow may have responsibilities that are not served within the traditional hierarchy -shared governance is an example of a decision-making structure in which staff at any level in the hierarchy are engaged in shaping policy and practices that affect patient care

supervision principles

- Process of directing, monitoring, and evaluating the performance of tasks by another member of the health care team - Occurs after delegation - Was it completed on time? Was it completed at a satisfactory level? Any unexpected findings I need to report/document? Any assistance required? Does this need re-assigned to someone else? - Intervene if necessary (unsafe clinical practice, untimely action, document unexpected outcomes) - Evaluate the task, identify opportunities for quality improvement activities or re-education opportunities (follow up with pts, what was their perspective?)

assigning

- Process of transferring the authority, accountability, and responsibility of client care ot another member of the health care team -completed in a downward or lateral manner -Patient factors must be considered first -Patient condition, monitoring needs, equipment needs, special precautions, extensive time commitment tasks -Healthcare team factors are also considered -Knowledge and skill level, staffing mix, nurse to patient ratio's, experience level

followership

-**each group member contributes while in collaboration with others to achieve clinical or organizational outcomes*** - Often mis-interpreted -One member is not considered "more important" than another -Willing to be led -Followership does not= "group think" (conforming) - Ex. Nurses serving on committees

what happens when it is not a safe assignment? What should you do?

-Discuss with a charge nurse -Request/negotiate a safe assignment -Take the concern up the chain of command*** -Write a written complaint **FAILURE TO ACCEPT AN ASSIGNMENT WITHOUT FOLLOWING THE PROPER CHAIN OF COMMAND CAN BE CONSIDERED PATIENT ABANDONMENT**

communication needs in delegation

-Nurse must provide clear, concise, timely and reliable communication -Give information, give directions, seek clarity, and seek advice -Two-way communication is needed -Healthy work relationships are needed -Trust will develop over time

tips for managing meeting effectively

-is this meeting necessary? -could it be solved by an email or phone call instead? -schedule meetings right before lunch or at the end of the day -have a set start and end time -avoid meetings that will last longer than 2 hrs -distribute an agenda

Which patient should be transferred to the ICU first? A.40 yo alcoholic with esophageal varices who is bleeding orally B.24 yo diabetic in DKA C.65 yo COPD patient who has developed a fever of 103 F D.72 yo with a broken hip who is having left hip pain and swelling

A.40 yo alcoholic with esophageal varices who is bleeding orally

Which of the patients should the nurse see first? A.24 yo diabetic awaiting discharge instructions B.44 yo who had a left mastectomy yesterday and has a Hgb of 11 C.60 yo DVT pt complaining of SOB D.72 yo with acute diverticulitis complaining of gas, bloating, and nausea

C.60 yo DVT pt complaining of SOB

Which of the patients should the nurse see first? A.COPD patient with shortness of breath and O2sat of 91% B.Patient getting IV gentamycin who has developed a rash C.Patient who is experiencing a new bleed from their IV site D.Patient complaining of new calf pain

B. Patient getting IV gentamycin who has developed a rash

While working on the antepartum clinic, the nurse should assess which patient first? A.14 weeks gestation pt with thick white vaginal discharge and irritation B.28 weeks gestation with a 9 lb weight gain within 1 week C.40 weeks gestation complaining of urinary incontinence D.36 weeks gestation with a cold and WBC count of 9.6

B.28 weeks gestation with a 9 lb weight gain within 1 week

General Adaptation Syndrome (GAS)

perceived stressor -> stage 1: fight or flight response -stage 2: emotional rxn: surprise, shock, anger, happiness -stage 3: cognitive or intellectual response: positive or negative thinking -stage 4:: physical rxn to stress: increased BP, fatigue and sleep alterations -stage 5: change in stressor: eliminated or coping or no change -stage 6: adaptation or burnout

role stress

incongruence between perceived role and expectations and achievement

trait theory of leadership

leaders have specific traits that make them a good leader, born that way

eustress

positive attributes of stress •Example: Birth of a child

thinking systematically in the complexity theory

principles of this theory: -thinking of the big picture -balancing short and long term actions and their effects -recognizing the dynamic, complex, and independent nature of systems// all things are connected and rely on each other -using measurable versus non-measurable data systems

accountability

ties to your license**// accountable to ANA guidelines -determines if the actions were appropriate and provides a detailed explanation of what occurred -(rests within the decision to delegate while responsibility rests within the performance of the task)

passive delegation

when a position description contains functions that are normally performed or are an essential part of the practice of a licensed individual

barriers in delegation

Under delegation: -Lacking confidence -Lack of time -Fear of loss of control Over delegation: -Overburdens a delegate with too many tasks/responsibilities Improper delegation: -Delegating tasks outside of the delegates training or education

Leader

- the art of motivating a group of people to act towards achieving a common goal -the use of individual traits and abilities, in relationship with others, to interpret the environment/context where a situations is emerging and enter that situation without the use of a predesigned plan

leadership styles

Authoritative Democratic Laissez-faire Transformational Transactional authentic

delegation decision making

consider: -safety -critical thinking, the intensity and complexity of nurses' decision making process -stability of the pt -time, intensity, and length of the interactions with the pt

delegator

the licensed nurse WHO IS RESPONSIBLE TO PROVIDE CLEAR DIRECTIONS WHEN A TASK IS DELEGATED

example of assistive personnel

Patient care tech, or CNA

examples of tasks that nurses can delegate to practical nurses and assistive personnel

To PN: -monitoring findings (as input to the RN's ongoing assessment) -reinforcing client teaching from a standard care plan (re-education) -performing tracheostomy care -suctioning -checking NG tube patency -administering enteral feedings -inserting a catheter -administering medications (excluding IV meds in some states) To AP: -ADL's -bathing -grooming -dressing -toileting -ambulating -feeding (without swallowing precautions) -positioning -routine needs -bed making -specimen collection (**AS LONG AS IT DOES NOT REQUIRE STERILE TECHNIQUE**) -I&O's -Vital Signs (**AS LONG AS THE PT IS STABLE**)

reflection

active process where you think about and explore your thoughts, actions and reactions--> helps you assess the effect your choices have on both you and others around you - helps the leader develop new knowledge 1. What happened? 2.Why did I respond the way I did? 3.What precipitated my behavior? 4. Were my values in conflict with others? 5.Did I honor the view of others? - Exploring the thoughts you have about your experiences, actions, and reactions, is an active process you can use to strengthen your ongoing professional growth -Thinking-in-action occurs when an individual employs existing knowledge to guide behaviors as a situation develops -Thinking-on-action: recounting of the situation, inviting self-evaluation.

OB modification theory of leadership

analysis of clear expectations, behavioral analysis and determination, and consequence analysis

organizational accountability

Adequate resources and appropriate nurse/UNP ratios -driving principle in decision making is pt safety, so in order to accomplish that there needs to be adequate resources and safe ratios

Which infant would you assess first? A.2-day old developing jaundice B.2-day old who has only had 2 BM's today C.1-day old with a heart rate of 194 D.1 day old who will not breastfeed

C.1-day old with a heart rate of 194

example of licensed personnel?

LPN

style theories of leadership

Leadership perspective that suggests that leaders have particular behavioral styles that make them more or less effective leaders -pursue effective relationships with their colleagues

internal sources of stress

•Personal stress triggers •Life events •Environment- noisy, interruptions, fast-pace •Negative self-talk •Fear of change •Perfectionism •Unhealthy life-style choices

ABC framework

◦Airway ◦Obstructions or impending obstructions ◦Anaphylaxis, heavy bleeding from mouth/nose, lodged foreign body, infectious process such as epiglottitis or croup a. Establish an airway if indicated b. Recognize that 3-5 mins without oxygen causes irreversible brain damage secondary to cerebral anoxia ◦Breathing ◦How effective are the respirations/gas exchange? ◦Hypoxia, cyanosis, respiratory rate changes with confusion, severe bradypnea or tachypnea a. intervene as needed ◦Circulation ◦Is there enough blood and blood pressure to meet tissue demands? ◦Hypotension, loss of pulses either systemically or in a limb, hemorrhage a. Institute actions to reverse or minimize circulatory alteration ◦Disability (Neuro) ◦Is there changes in normal mental status or are there neurologic deficits? ◦paralysis, severe localized weakness, new confusion, increased agitation a. Implement actions to slow down development of disability ◦Exposure ◦Is there a hidden injury, rash, bite, or lesion? remove clients close to allow for complete assessment or resuscitation ◦Snake bite, bug bite, burn, allergic reaction a. Implement measures to reduce the risk for hypothermia (provide warm blankets and IV solutions or use cooling measures for clients exposed to extreme heat)

time management prioritization according to pt needs

◦What must be done immediately? ◦What must be done at a certain time? ◦What must be done by the end of the shift? ◦What can I delegate? ◦Do I have extra time? If yes, offer to help others when crisis or overwork occurs within your team ◦Have I taken a break for my own meal or self-care?

personal leadership

- An integration of you, your ideas, and your personhood, into the path you set for your life// don't forget the whole load is not on you, you should also look for subject matter experts and collaborate - Ability to lead from your core beliefs and values - A role responsibility that comes to life because of who you are -Leadership integration is inclusive of nurse, person, and leader

Leadership development

- First step to leading is following - True leaders do not create followers, they create more leaders - Resources: EBP - Resources + potential + support = increased leadership capacity

authentic leadership

- Focus on honest relationships - Be truthful and open - Have a passion for people - Connect with people - Be consistent - Do not be fake—be the real you

transactional leadership style

- Focus on immediate problems, maintaining the status quo and using rewards to motivate followers

the emotionally intelligent leader...

- Has insight into the emotions of members of the team - Understands the perspective of others - Encourages constructive criticism and is open to new ideas - Manages emotions and channels them in a positive direction - Committed to the delivery of high-quality care - Refrains from judgement in controversial or emotionally charged situations until all facts are gathered

democratic leading style

- Includes group when decisions are made - Motivated by staff achievements - Communication up and down chain - Work output is good when cooperation and collaboration

authentic leadership style

- Inspire others to follow them by modeling a strong internal moral code

authoritative leading style

- Makes decisions for the group - Motivates by coercion - Communication occurs down the chain of command - Work output is high, good for crisis situations - Good for employees with little or no formal education

informal leadership

- No "official" title - No "authority" - Influence others because they are engaged with those around them - Often are the "behind the scenes" team members - Nurses are often called to be informal leaders—knowledge experts -(mentors are considered this)

complexity theory

- Nontraditional theory that has emerged over time from works of physical and social science - Complexity science promotes the idea that the world is full of systems that interact and adapt through relationships - Nurses must be flexible and dynamic to be in tune with the everchanging system of people, health care, public policy, and human relationships - Change is immerging and highly influenced by everyone involved - Complexity science users: develop networks, encourage nonhierarchical interaction among workers, focus on immergence and thing systematically

stress management techniques

- Prayer, exercise, counseling, support groups, stress prevention- identify the source, self-reflection, reframing expectations, humor, increasing leisure time, social/family support, connect with a mentor - Empathy and compassion granted to yourself and others, train brain to deal with chaos, encourage well-being activities, allow time to disconnect and socialize outside of work

formal leadership

- President, chief executive, director, manager, pastor, professor, charge nurse - Exert influence over others - Has the "authority" - Rely on informal leaders to help move forward and improve productivity

laissez faire leadership style

- Very few decisions made, little planning - Motivation is based upon the individual - Work output is low, unless an informal leader emerges - Effective with professional employees - Communication occurs up and down chain of command, and between group members

follower characterisitcs

- acting synergistically with others, being enthusiastic and responsible, speaking and acting with principle and integrity, adding value to the work being accomplished, and questioning decisions and directions that are not congruent with purpose of group - often are the nurses doing the day to day care of patients - help influence and advance the leaders goal - often trusted by their peers -have the ability to divert or negatively impact the leaders initiatives

management

- focus is on planning, organizing, staffing, directing, controlling; a "formal" title or position -Makes decisions about the function of the organization, including resources, budget, hiring, firing -ability to plan, direct, control, and evaluate others in situations where outcomes are known or preestablished, where one or more ways of performing have been agreed on based on evidence, where feedback and communication is shared to improve clinical processes and outcomes - Needed to provide structure, a sense of purpose, and safety

RN delegation CAN's and CANNOTS

- licensed nurses can NEVER delegate nursing judgement or critical decision making - Licensed nurse delegating must base decision on: - Individual patient needs, facility policies, job descriptions, and experience of those delegating to, state nurse practice acts, professional standards, legal/ethical concerns ***CANNOT be delegated by RN: - Nursing process items (ADPIE) - Patient education (initial education) - Tasks that require clinical judgement*** -reeducation can be delegated, but not the initial education **RN's CAN DELEGATE to other RN's, PN's (practical nurses), and AP's (assistive personnel) -Must provide clear directions when delegating -Must provide periodic reassessment of delegated item -Must evaluate the outcome of the delegated task**

Leader characteristics

- no title needed, requires emotional intelligence (developed over time), desires to help develop people and help them to reach their full potential - Inspiring, takes initiative, energetic, positive outlook, effective communication skills, respectful, problem solver, critical thinker, influence willing followers to move towards a goal -should establish a shared vision amongst followers -achieve workplace unity -develop trust

The quadruple aim

1. Improves access to care 2. Improves quality of care 3. Improves cost of care 4. Improves work life of healthcare team - Guiding healthcare professionals to achieve the quadruple aim will help achieve the goal of improved health while keeping the providers engaged and decreasing turnover - Leaders cannot achieve the quadruple aim alone - Followers can impact it because they are often the ones doing the day-to-day work, influencing peers, and are a trusted source - Followers are often aware of the important details, workflows, and barriers in the day to day that influence achieving the Quadruple Aim

Maslow's Hierarchy

1. Physiological (breathing, food, water, etc.) 2. Safety and security (employment and access to resources) 3. Love and belonging (friendship and fam) 4. Self-esteem (confidence, achievement) 5. Self-actualization (morality, creativity, problem solving)

prior to delegating, consider the following

1. Predictable outcome? 2. Potential for harm? 3. Are complex tasks required? 4. Will it require problem solving? 5. Will high level of interaction or new education be needed?

5 rights of delegation

1. Right task a. A right task is repetitive, requires little supervision, and is relatively noninvasive 2. Right circumstance a. Match the complexity of care demands to the skill level of the health care team member and consider load of that member 3. Right person a. Task must be within that member scope of practice, and they must have the necessary competence/training 4. Right direction and communication a. Specific task to be performed and client-specific instructions 5. Right supervision and evaluation ***DO NOT GET CONFUSED WITH THE 5 MED RIGHTS, THESE ARE DIFFERENT***

5 domains of emotional intelligence

1. Self-awareness 2. Self-regulation (Managing emotions) 3. Motivating self (internally driven) 4. Empathy (value differences and not choose a side) 5. Social sills (handling relationships)

Your patient is a fall risk and keeps getting out of bed, which of the following do you implement first? A.Move the patient closer to the nurse's station B.Make sure all 4 bed rails are up C.Apply soft restraints to the patients' arms D.Sedate the patient

A. Move the patient closer to the nurse's station

situational-contingency theory of leadership

Adapt to situation, consider needs of people involved, what you are comfortable with Task-oriented or Relationship-oriented **Low Least Preferred Coworker (LPC) authoritarian style and task-oriented (react fairly negatively to coworkers you least like) **High LPC - democratic style and relationship-oriented (react fairly positively to coworkers you least like)

perfectionism

An unhealthy compulsion to do things perfectly -tendency to never finish anything bc it is not yet perfect

Which best demonstrates followership? A. Completing tasks associated with your patient assignment w/o intent of receiving praise from manager B. Preparing for meeting by reviewing agenda so you can be an active participant. C. Assessing clinical situation and following guidelines to delegate tasks to unlicensed personnel D. Administering meds to pt in conjunction with other nursing actions in order to make effective use of time

B. Preparing for meeting by reviewing agenda so you can be an active participant.

Your ER has implemented their mass casualty protocols for a multi-vehicle car accident. Which patient do you assess first? A.22 yr old not breathing B.34-year-old with arterial bleeding from a leg wound C.44-year-old complaining of chest pain and SOB D.20-year-old with no pulse

B.34-year-old with arterial bleeding from a leg wound

Which of the following takes priority for a patient with dyspnea and an 02 sat of 70%? A.Auscultate breath sounds B.Assess heart rate and level of consciousness C.Contact provider for orders D.Apply high concentration O2 using a non-rebreather mask

D. Apply high concentration O2 using a non-rebreather mask

Which statement is true regarding complexity theory? A. Complexity theory is used to predict health and illness trajectory of critically ill PT B. Nurses can understand the dynamic nature of health care processes using Com. Theory C. Need for additional staff can be justified based on complexity theory D. Com. Theory is used to explain the relationships among leading, managing, and following

D. Com. Theory is used to explain the relationships among leading, managing, and following

procrastination

Intentionally putting off doing something that should be done

prioritization

Nurses must continuously assess and reassess, set and reset priorities in order to ensure patient needs are met and they maintain safety ◦Priority Setting - Determines the order in which ◦Patients are seen ◦Assessments are completed ◦Interventions are provided ◦Procedures are completed ◦Components of care are completed ◦Nurses base priorities off data obtained from: ◦Shift report ◦Communications with other team members ◦Review of patient documents/chart ◦Continuous collection and assessment of data

active delegation

RN assesses the situation, determines what is appropriate for patient care, directs a UNP to perform certain tasks and hold the individual accountable.

individual accountability

The individuals' ability to explain their actions and results

delegation

Transfer of authority and responsibility for activities and procedures from one person to another while retaining the accountability for the outcome -important to know the competence of individual you are delegating to -need to give clear instructions and follow up on care -need to specify to delegatee what info we would like after the task is completed -get feedback of pt that task was actually done

assignment

Transfer of authority, accountability, and responsibility of routine care activities and procedures within one's scope of practice -when an RN assigns a pt to another RN, both responsibility and accountability are transferred (think charge Nurse giving assignments) -when an RN delegates care to UNP, responsibility is transferred, but accountability ties back to the nurse

burnout

a state of physical, emotional, and mental exhaustion created by long-term involvement in an emotionally demanding situation and accompanied by lowered performance and motivation -diminished interest caused by an unrelenting workload without relief -can feel overwhelming, hopeless, depressing, anxiety provoking, dreadful, low energy, apathetic, lack of motivation -3 hallmark signs: feeling of physical, mental and emotional exhaustion can be recognized, depersonalization, and a decreased sense of professional accomplishment and competency -healthy pee discussion can help to identify when a nurse is troubled, but it is often the task of the assistant nurse manager or supervisor to address and refer nurses to seek help for themselves, before the stress escalates to a state of crisis

expectancy theory of leadership

a view that people will be motivated to behave in particular ways if they believe that doing so will bring them rewards they both seek and value. Expectancy theory was first applied in the context of the workplace by Victor Vroom in the 1960s. He defined the concepts of valence and expectancy to explain how people decide to act. Valence refers to somebody's perception of the value of the reward or outcome that might be obtained if he or she performs a task successfully.

manager characterisitcs

ability to identify recurring problems and design EB routines to create structure and improve work efficacy, persistent and vigilant behavior in self and others, communication, gives direction, maintains status quo, plans detail, reactive, power and control, policies, and procedures

legal authority

ability to transfer select nursing activities in a given situation to a competent individual

complaining

act of expressing dissatisfaction or annoyance with persons, places, things, and situations

focusing on emergence in the complexity theory

addresses how individuals in positions of responsibilities engage with and discover, through active organizational involvement, those networks that are best suited to respond to problems in creative, surprising, and artful ways- those who think "outside the box" -tied to unleashing constructive energy rather than constraining energy

delegatee

competent recipient who is to perform the task, accepts the task/activity, accepts the responsibility of the task

effective vs ineffective followers

effective: -Engaged and participating -independent thinker -Communicates effectively -Brave, speaks up & advocates -Involved in the day to day care of patients -Optimistic -Autonomous in their work -Spark excitement among their peers ineffective: -Relies heavily on leaders -Wont ask questions or question authority -Have difficulty voicing opinions, concerns, or discussing feedback -Complain without solutions -No loyalty to their team or company -Inflexible -Fights against change

motivation

energizes what we value personally and professionally, and stimulates growth and movement toward the vision

two factor theory of leadership

hygiene factors such as working conditions, salary, status, and security motivate workers by meeting safety and security needs and avoiding job disatisfaction

journaling

method to support ongoing development, self-confidence, professional practice, critical thinking - Allow you to retrace your thinking and to see improvements in your thinking actions

distress

negative attributes of stress •Example: Loss of a job

developing networks in the complexity theory

network is any related group with common involvement in an area of focus or concerns -social networks are found within organizations but also beyond organizational boundaries that are not served within the traditional hierarchy. -i.e. nursing program// not considered a part of the hospital where clinical expertise takes place, but common interests (supply and preparation of a qualified workforce and demand for clinical services) make this network critically important for both organizations

responsibility

obligation and dependability of person to accomplish task

emotional intelligence

possession of social skills, interpersonal competence, psychological maturity, and emotional awareness devoted to helping people work well together; - Ability of an individual to perceive and manage the emotions of self and others - Nurse must be able to perceive and understand their own emotions of the client and family in order to provide client-centered care - Single biggest predictor of performance in leadership - Awareness of strengths and weaknesses help us grow and mature as leaders

hierarchy of needs theory in leadership

ppl are motivated by a hierarchy of needs

supervision

providing of guidance and oversight of a delegated nursing task

four agreements

set of agreements that we can make with ourselves to enhance personal growth and awareness 1. Be impeccable with your word and follow through (speak truth) 2. Do not take anything personally 3. Do not make assumptions (ask clarifying questions) 4. Always do your best

depersonalization

state characterized by distancing oneself from the work itself and developing negative attitudes toward work in general

developing self-awareness

stepping outside oneself to envision the context of what is happening while recognizing and owning feelings associated with the event -deepen this and encourage others to do the same

stress

the gap between what we want life to be and what it really turns out to be •Consequence or response to life •interpretation of life's events determine our level of stress •Decreases our efficiency and decreases our ability to contribute effectively

thinking in action vs on action

think in action as we provide care vs thinking on action when you are looking back and considering what led up to the situation, what else you could have done, what you might do different next time Thinking in action --> providing care, working a code Thinking on action --> post CPR debriefing

management of stress

•Coping Strategies •Train the brain to deal with chaos •Take your breaks •Empathy and compassion granted to yourself and others •Model and encourage well-being activities •Allow time to disconnect and socialize outside of work •Workplace stress prevention - determine and manage the source

signs of stress

•Increased sickness •Changing sleep patterns •Fatigue •Weight gain •Increased use of unhealthy coping activities •Mental and emotional changes •Forgetfulness •Depression •Confusion •Anxiety •Irritability •Spiritual distress

stress management

•Is this stressor even important? Stressors are not all equally important!!! •Does this stressor affect me or my unit... is it a hospital wide issue that you have minimal ability to impact? •Can I change this situation?

external sources of stress

•Unbalanced role expectations •Staffing shortage •Fatigue, burn out •Interpersonal relationships •Peers, patients, family •Work-home life balance •Technology

high priority issues

◦Systemic before local (life before limb) ◦Shock vs abdominal pain ◦Acute before chronic, urgent before non-urgent, unstable before stable// within first 2 hours we have better chance of survival) ◦Stroke symptoms starting 2 hours ago vs stroke symptoms that started yesterday ◦Real problems vs possible future problems ◦Post-op patient with a fever of 102 F vs the patient who has a high risk of systemic infection from a dog bite ◦Trends before one-time findings (unless the one-time finding is an emergency) ◦Patient respirations have been steadily increasing over the past 8 hours from 16 breaths/minute to 30 breaths/minute vs. the patient with a respiratory rate of 22 ◦What if the patient has a respiratory rate of 4? ◦Impending medical emergencies before expected findings ◦Stroke patient who has a worsening headache and pupil changes vs a stroke patient with left sided paralysis and speech difficulties ◦Post op patient 4 hours out with a fever vs a post-op patient 4 hours out with a bloody ABD dressing ◦Timely medicines before routine meds ◦Insulin vs a PPI ◦IV antibiotics vs blood pressure pill - Apply clinical knowledge to procedural standards to determine the priority action