Cognitive Stacking
Part 1. Reflecting on your past or current clinical work experience, describe what a typical shift might look like on your unit or at your facility.
Nursing work shifts might make it tough to do a meaningful job. Twelve hours of any exercise can be exhausting, let alone 12 hrs. of hurriedly dashing around while providing treatment to endangered individuals. It is an efficient method of exhaustion. Many physicians are willing to put up with the stress of performing these lengthy shifts since the rewards surpass the hazards. Nursing organization shifts and health facility caregiver shifts are the more apt to have 12-hour intervals. Because of the degree of care provided to sufferers and the immediacy with which it is necessary, acute-care clinicians should expect to perform 12-hour sessions. Registered nurses are also being considered for longer shift duties. If a typical shift would happen in the department I do operate in; many changes would arise. Since I do operate in night hours, it means that I would be shifted to operate during the day from 7 a.m to 7 p.m. This would increase the workload since there is a higher demand for nursing services in the healthcare.
Having a typical shift, the healthcare from the normal shift to 7 a.m to 7 p.m would increase the number of patients from four to many, which necessitates total dedication and commitment to ensure patient safety. Due to the increased serviced demand during the day shift, this would necessitate an increased number of staff to ensure quality service delivery to the patients and increase job satisfaction. Since the Progressive Care Unit requires a high commitment, this would also lead to operating for additional hours apart from the normal 12 working hours (Walden University, 2019). During this shift, it would also necessitate an assistant nursing practitioner who would help in acknowledging and notifying suspicious indications and behaviors and ensure patient safety. They would also help in bathing, dressing and feeding the patients and assist with communication and reporting the issues of the patients.
During this shift, the timetable of events would also change from the previous night shift. This means that the major tasks would also change. The major tasks would include:
- Reviewing patients’ files upon admission to the progressive care section, prescription regimes, and test findings.
- Monitoring routine vital indicators such as heartbeat rate, blood pressure, and cardiac oxygen saturation
- Analyzing measurements with advanced healthcare instruments
- Tracking and dispensing specified medications, as well as pharmaceutical dosage titration
- Conducting diagnostic evaluations of changes in measures, as well as specified treatments
- Reporting worsening symptoms to medical care professionals and according to treatment recommendations
- Keeping ward records, client documents, and health files up to date and in good condition.
- Supervising nursing aides and supporting workers on the Progressive Care Unit.
- Addressing inquiries and describing therapies and processes to clients and their relatives.
This shift would also have some challenging moments, especially when it comes to time management. One of the challenges would include distractions from phone calls while attending to a patient. Time management would also be hampered by surroundings distractions, disruptions, and superfluous tasks. Other issues contributing to inadequate time planning include failing to delegate, laziness, procrastination, and perfectionism (Maryniak, 2020). The workload is also an inefficient technique that would lead to time mismanagement. However, due to these implications of poor time management, there would be measures to mitigate this from progressing, which would, in turn, affect the outcomes of the patient. One of the measures would include effective planning. In planning the, I would plan the day-to-day activities and minimize the disruptions as much as possible. I would utilize calendars, index cards and wall charts to manage time effectively. The other measure would be organizing and prioritizing the most important and urgent tasks. Concentrating on what I intend to achieve will give total management over my time. Lastly, I would avoid distractions in order to have full control over my time. Most of the distractions come as a result of phones. Unplanned phone contacts and emails are major sources of distractions (Dahl, 2018). So, I would turn off the cell cellphone and set my workplace cellphone to voicemail. All these measures would be effective in managing time during this shift to ensure quality service delivery. Also, I would encourage the other team members to always consult the experienced nurses in case they face challenges to avoid poor service delivery.
Part 2. Experienced RNs include knowledge of the work environment routines, norms, resource availability and competencies in combination with other knowledge content to inform their decision-making about clinical care.
Define cognitive stacking
Cognitive stacking is an unseen and continuous mechanism in which nurses arrange and restructure operations during the shift in response to variations in priorities (Cindy, Connie & Pamela, 2017).
Routinization
This is a structured framework of processes and routines that individuals carefully observe over time.
- Firstly, I understand the type of patients I am dealing with and how to attend to each. Since many patients in the progressive care unit suffer from cardiovascular issues, owing to these recurring occurrences, I am able to become acquainted with how every sort of person should be administered. This pattern enables me to classify and categorize individuals based on the disease they possess and then begin to administer for them appropriately.
- Conducting the patient evaluations. To effectively sequence the chronology of patient evaluations, I consider every client’s medical state.
- Recording the findings while still in the patient’s room to avoid distractions.
- Administer medications to the patients.
- Documenting the patient’s condition, treatment and services.
Prioritization
This is the arrangement of nursing concerns based on immediacy and/or significance in an effort to determine a preference sequence for nursing interventions (Cho et al., 2019). In my approach, I utilize CURE to prioritize the interventions.
Critical needs: Firstly, I determine the conditions of the patient which require the most attention to prevent further harmful effects to the patient. These conditions include major accidents as a result of fires and crashes.
Urgent needs: These are conditions that can possibly harm the patient if not effectively managed. These conditions include minor injuries and fever. By addressing these conditions, I prevent further harmful effects to the patient.
Routine needs: These are the needs that I do fulfill on a daily basis, such as conducting patient’s evaluations, recording the findings, administering medications to the patients and documenting the patient’s condition, treatment and services.
Extras: These are conditions or activities I offer to the patients that are not a must but provide comfort to them. These activities include helping the patients to eat and also helping the patients in dressing.
Delegation
Activities that I usually delegate are frequently ones that I conduct regularly, have little danger, and do not involve the nursing processes. Transferring healthy clients for diagnostics, bringing samples to the laboratory, administrative responsibilities, handling the telephone, remaking bedding, delivering instruments, and providing client dinners are just a few examples. Before delegating these activities to the UAP, I make sure that he can effectively handle them and that they have training in such activities.
References
Dahl, J. (2018, October 26). Nine core time management principles everyone should know. Medium. https://medium.com/@jacobdahl_35850/9-core-time-management-principles-everyone-should-know-647beb0c65e5
Kim Maryniak. (2020). Time management for nurses. https://www.rn.com/featured-stories/time-management/
Kohtz Cindy, Gowda Connie, & Guede Pamela. (2017). Have you heard of cognitive stacking? : Nursing made it incredibly easy. LWW. https://journals.lww.com/nursingmadeincrediblyeasy/FullText/2017/07000/Have_you_heard_of_cognitive_stacking_.2.aspx
Sung-Hyun Cho, Ji-Yun Lee, Sun Ju You, Kyung Ja Song, & Kyung Jin Hong. (2019, December 18). Nurse staffing, nurses prioritization, missed care, quality of nursing care, and nurse outcomes. Wiley Online Library. https://onlinelibrary.wiley.com/doi/full/10.1111/ijn.12803
Walden University. (2019, January 22). What-is-progressive-care-nursing. Accredited Online University | Online Degree Programs | Walden University.
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