Planning involves:
Setting priorities, Identifying patient-centered goals and expected outcomes,
and Select interventions for the nursing care plan.
Priority setting
The ordering of nursing diagnoses or patient problems using determinations of urgency and/or importance to establish a preferential order for nursing actions.
Nurse established "high" priority...
If untreated, result in harm to a patient or others (those related to airway status, circulation, safety, and pain)
Nurse established "Intermediate" priority...
Involve nonemergent, non-threatening needs of patients.
Ex: deficient knowledge, impaired physical mobility
Nurse established "Low" priority...
Are not always directly related to a specific illness or prognosis but affect the patient's future well-being.
Maslow's Hierarchy of Needs (High-to lowest priority)
Listed Most Important - Least important but can change depending on the circumstance.
Physiological: Basic Human Needs< Oxygen-Fluids-Nutrition-Body Temperature-Elimination-Shelter-Sex
Safety and Security: Physical and Psychological safety
Love and belonging needs
Self-esteem
Self-actualization
Goals and Expected outcomes are:
Specific statements of patient behavior or physiological responses that you set to resolve a nursing diagnosis or collaborative problem.
During planning you select goals and outcomes for each nursing diagnosis to provide a clear focus for the type of interventions needed to care for your patient and then to evaluate the effectiveness of these interventions.
The goals and outcomes need to meet established intellectual standards by being relevant to patient needs, specific, singular, observable, measurable, and time limited.
Goal
A broad statement that describes a desired change in a patient's condition or behavior. Time-limited
Ex: Diagnoses (deficient knowledge, regarding postoperative care) A goal of care for this diagnosis ("Patient expresses understanding of postoperative risks") The goal requires making Mr. Jacobs aware of the risks associated with his type of surgery.
Expected outcome
A measurable criterion to evaluate goal achievement.
A specific measurable change in a patient's status that you expect to occur in response to nursing care.
-Outcomes determine when a specific patient-centered goal has been met.
-Sometimes several expected outcomes must be met for a single goal.
Patient-centered goal
Specific and measurable behavior or response that reflects a patient's highest possible level of wellness and independence in function.
Short-term goal
Objective behavior that you expect the client wilt achieve in a short time, usually less than one week.
Long-term goal
Objective behavior or response that you expect a patient to achieve over a long period, usually over several days, weeks, or months.
In setting goals the time frame depends on
The nature of the problem, etiology, overall condition of the client, and treatment setting
Nursing-sensitive patient outcome
An individual, family, or community state, behavior, or perception that is measurable in response to a nursing intervention
There are seven guidelines to follow when writing goals and expected outcomes. List them:
1. Patient centered, 2. Singular goal/outcome, 3.Observable, 4. Measurable, 5. Time limited, 6. Mutual, 7.Realistic
1. Patient-centered goal
Outcomes and goals reflect the patient behavior and responses expected as a result of nursing interventions
2. Singular goals/outcomes
Precise in evaluating a patient response to a nursing action addresses only one behavior or response per goal
3. Observable
The nurse should be able to observe if a change takes place in a patient's status.
4. Measurable
Terms describing quality, quantity, frequency, length, or weight allow the nurse to evaluate outcomes precisely.
5. Time-limited
A time-limited outcome is written so it indicates when the nurse expects the response to occur.
6. Mutual
A mutual goal or outcome is one in which the patient and nurses agree on the direction and time limits of care.
7. Realistic
A realistic goal or outcome is one that a patient is able to achieve.
Critical Thinking in planning nursing care
Includes the next 5 slides, Nursing interventions, Independent, Dependent, and Collaborative nursing interventions, and the 6 factors nurses use to select nursing diagnoses.
Nursing Interventions
Treatments or actions based on clinical judgement and knowledge that nurses perform to meet patient outcomes.
--Choosing suitable nursing interventions involves critical thinking and your ability to be competent in 3 areas:
1. Knowing the scientific rationale for the intervention
2. Possessing the necessary psychomotor and interpersonal skills
3. Being able to function within a particular setting to use the available health care resources effectively.
Types of Interventions
Independent nursing interventions- Nurse-initiated intervention
Dependent nursing interventions- Physician-initiated interventions
Collaborative interventions- Interdependent interventions
-Independent nursing interventions
Actions that a nurse initaites that do not require direction or an order from another health care professional
-Dependent nursing interventions
Physician-initiated interventions that require an order for a physician or other health care professional.
-Collaborative interventions
Require the combined knowledge, skill, and expertise of multiple health care professionals
The six factors that nurses use to select nursing interventions for a specific patient.
1. Characteristics of the nursing diagnosis
2. Goals and expected outcomes
3. Evidence-based interventions
4. Feasibility of the interventions
5. Acceptability to the patient
6. Your own competency
Nursing care plan
Includes nursing diagnoses, goals and/or expected outcomes, specific nursing interventions, and a section for evaluation findings so any nurse is able to quickly identify a patient's clinical needs and situation.
--Sometimes takes several forms- nursing Kardex, standardized care plans, and computerized plans.
Define the purpose of the nursing care plan
The nursing care plan should direct clinical nursing care and decrease the risk of incomplete, incorrect, or inaccurate care, identifies and coordinates resources for delivering care, lists the interventions needed to achieve the goals of care
Interdisciplinary care plans
Include contributions from all disciplines involved in patient care.
Designed to improve the coordination of all patient therapies and communication among all disciplines.
Describe a Student care plan
Student written care plan (SWCP)
Useful for learning the problem-solving technique, nursing process, skills of written communication, and organizational skills needed for nursing care.
How do SWCP differ from care plans used in hospitals?
- A student care plan helps you apply knowledge gained from the nursing and medical literature and the classroom to a practice situation.
-Students typically write a plan of care for each nursing diagnosis.
-The student care plan is more elaborate than a care plan used in a hospital or community agency because its purpose is to teach the process of planning care.
What are the components of a well written nursing intervention?
Actions, Frequency, Quantity, Method, or person to perform them.
Describe Critical Pathways
Patient care management plans that provide the multidisciplinary health care team with the activities and tasks to be put into practice sequentially (over time), their main purpose is to deliver timely care at each phase of the care process for a specific type of patient.
Clearly defines transition points in patient progress and draws a coordinated map of activities by which the health care team can help to make these transitions as efficient as possible.
Improve continuity of care because they clearly define the responsibility of each health care discipline.
Concept maps
A concept map provides a visually graphic way to show the relationship between patient's nursing diagnoses and interventions.
- When planning care for each nursing diagnosis, analyze the relationships among the diagnoses. Draw dotted lines between nursing diagnoses to indicate their relationship to one another.
Consultation
Is a process in which you seek the expertise of a specialist to identify ways to handle problems in client management or the planning and implementation of therapies
List six responsibilities of the nurse when seeking consultation
1.Identify the general problem area
2. Direct the consultation to the right professional
3. Provide the consultant with relevant information about the problem area
4. Do not prejudice or influence the consultants
5. Be available to discuss the findings and recommendations
6. Incorporate the recommendations into the plan of care
The Nursing Interventions Classification (NIC) taxonomy
Provides a standardization to assist nurses in selecting suitable interventions for clients' problems
client-centered goal
specific and measurable behavior or response that reflects a client's highest possible level of wellness and independence in function
collaborative interventions
interdependent nursing interventions - therapies that require the combined knowledge, skill, and expertise of multiple health care professionals
consultation
process in which you seek the expertise of a specialist, such as your nursing instructor, to identify ways to handle problems in client management or the planning and implementation of therapies
critical pathways
multidisciplinary treatment plans that outline the treaments or interventions clients need to have while they are in a health care setting for a specific disease or condition
dependent nursing interventions
physician-initiated interventions - actions that require an order from a physician or another health care professional
expected outcome
measurable criteria to evaluate goal achievement
goal
an aim, intent, or end - a broad statement that describes the desired change in a client's condition or behavior
independent nursing interventions
actions that the nurse initiates
kardex
trade name for a card filing system that allows quick reference to the needs of the client for certain aspects of nursing care
long-term goal
objective behavior or response that you expect a client to achieve over a longer period - usually several days, weeks, or months
nursing care plan
enhances the continuity of nursing care by listing specific nursing interventions needed to achieve the goals of care
nursing-sensitive client outcome
individual, family, or community state, behavior, or perception that is measurable along a continuum in response to a nursing intervention
planning
the 3rd step of the nursing process - sets client-centered goals and expected outcomes and plans nursing interventions
priority setting
ordering of the nursing diagnoses or client problems using notions of urgency and/or importance to establish a preferential order for nursing actions
scientific rationale
reason that you chose a specific nursing action, based on supporting evidence
short-term goal
objective behavior or response that you expect a client to achieve in a short time, usually less that a week