1. Chapter 8 Outcome Identification and Planning Fundamentals of Nursing: Standards & Practices, 2E

2.  Copyright 2002 by Delmar, a division of Thomson Learning 8-2 Planning Planning is the third step of the nursing process. It includes the formulation of the guidelines that establish the proposed course of action in the resolution of nursing diagnoses and the development of the client’s plan of care.

3.  Copyright 2002 by Delmar, a division of Thomson Learning 8-3 Four Critical Elements of Planning  Establishing priorities  Setting goals and outcome identification  Planning nursing interventions  Documentation

4.  Copyright 2002 by Delmar, a division of Thomson Learning 8-4 Purposes of Outcome Identification and Planning  Provides adequate direction to ensure quality nursing care for individual clients  Presents a vehicle to improve staff communication  Provides continuity in the delivery of individualized, quality nursing care to all clients

5.  Copyright 2002 by Delmar, a division of Thomson Learning 8-5 Three Phases of Planning  Initial planning Developed following the admission assessment  Ongoing planning Continuous updating of the client’s plan of care

6.  Copyright 2002 by Delmar, a division of Thomson Learning 8-6  Discharge planning Anticipation and planning for the client’s needs after discharge

7.  Copyright 2002 by Delmar, a division of Thomson Learning 8-7 Process of Outcome Identification and Planning  Establishing priorities The nurse ranks the nursing diagnoses in order of physiological or psychological importance. Diagnoses should be mutually ranked by the nurse and client or family/significant other.

8.  Copyright 2002 by Delmar, a division of Thomson Learning 8-8 One of the most common methods of prioritizing diagnoses involves using Maslow’s Hierarchy of Needs. Another consideration in the designation of priorities is client preference.

9.  Copyright 2002 by Delmar, a division of Thomson Learning 8-9 An additional concern is the anticipation of future problems when low and moderate priority diagnoses involve prevention of other risk diagnoses. Establishing priorities does not mean that one diagnosis must be totally resolved before giving attention to another diagnosis.

10.  Copyright 2002 by Delmar, a division of Thomson Learning 8-10  Establishing goals and expected outcomes The purpose of setting goals and expected outcomes is to provide guidelines for individualized nursing interventions, and to establish evaluation criteria.

11.  Copyright 2002 by Delmar, a division of Thomson Learning 8-11 A goal is a globally written statement describing the intended or desired change in the client’s behavior, response, or outcome.  Short-term goals  Long-term goals

12.  Copyright 2002 by Delmar, a division of Thomson Learning 8-12 An expected outcome is a detailed, specific statement that describes the methods through which the goal will be achieved.  It is constructed to be realistic, mutually desired by the client and nurse, and attainable within a defined time period.

13.  Copyright 2002 by Delmar, a division of Thomson Learning 8-13  These desired outcomes are the measurable steps toward achieving the previously established goals.  Usually each nursing diagnosis has one global goal and several expected outcomes.

14.  Copyright 2002 by Delmar, a division of Thomson Learning 8-14 Goals and expected outcomes include several essential components: subject, task statement, criteria, conditions (if necessary), and time frame.  The subject identifies the person who will perform the desired behavior.

15.  Copyright 2002 by Delmar, a division of Thomson Learning 8-15  The task statement will describe what the client will do to obtain an expected change in behavior.  Criteria are standards used to evaluate whether the behavior demonstrated indicates accomplishment of the goal.

16.  Copyright 2002 by Delmar, a division of Thomson Learning 8-16  Conditions may provide clarity and assist the client in demonstrating the expected behavior.  A time frame should be included in which the client should perform the desired behavior or task.

17.  Copyright 2002 by Delmar, a division of Thomson Learning 8-17 Problems frequently encountered in goal development  Goals are nurse-centered instead of client-centered.  Goals are unrealistic.  Goals are negative rather than positive.

18.  Copyright 2002 by Delmar, a division of Thomson Learning 8-18  Goals are copied generically from a reference and are not individualized to the client.  Goals are unmeasurable, nonspecific, nonbehavioral, vague, and/or too wordy.  Goals lack a time frame or have an inappropriate time frame.  Goals are selected without client input.

19.  Copyright 2002 by Delmar, a division of Thomson Learning 8-19  Planning nursing interventions Nursing orders Categories of nursing interventions  Independent  Interdependent  collaboration and consultation  Dependent

20.  Copyright 2002 by Delmar, a division of Thomson Learning 8-20  Evaluating care Involves determining the client’s progress toward achievement of expected outcomes The planned outcomes are the measurements by which effectiveness of therapies are evaluated.

21.  Copyright 2002 by Delmar, a division of Thomson Learning 8-21 Nursing Outcomes Classification (NOC)  Developed by nurse researchers at the University of Iowa  Provides a standardized language that can be used to measure the effects of nursing practice on client outcomes  Defines over 190 client outcomes that are sensitive to nursing interventions

22.  Copyright 2002 by Delmar, a division of Thomson Learning 8-22 Plan of Care  A written guide that organizes data into a formal statement of the strategies that will be implemented to help the client achieve optimal health  Usually includes components such as assessment, nursing diagnoses, goals and expected outcomes, nursing interventions

23.  Copyright 2002 by Delmar, a division of Thomson Learning 8-23  The nurse usually begins a nursing care plan on the day of admission and continually updates it until discharge.  Individualization is enhanced by continuous reviewing and updating of the care plan.  The care plan is the final result of the planning step in the nursing process.

24.  Copyright 2002 by Delmar, a division of Thomson Learning 8-24  Types of care plans Standardized Institutional Student-oriented Computerized

25.  Copyright 2002 by Delmar, a division of Thomson Learning 8-25 Strategies For Effective Care Planning  Clearly communicate the client’s care plan.  Establish a realistic nursing care plan - this will avoid setting a goal that is too difficult to achieve.  Individualize nursing diagnoses in order to create a stable framework upon which an optimum level of wellness can be reached.