outcome identification and planning chapter 13. 13-2 copyright 2004 by delmar learning, a division...
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13-2Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Purposes of Outcome Identification and Planning
Provide direction to ensure quality nursing care.
A vehicle to improve communication with health care personnel.
Provide continuity in the delivery of individualized nursing care.
13-3Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Process of Outcome Identification and Planning
Planning is sequential, dynamic, and future-oriented.
Planning includes establishing priorities, identifying goals and expected outcomes, developing nursing interventions, and documenting the client’s plan of care.
13-4Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Process of Outcome Identification and Planning
Critical Thinking• Development of objectives• Formulation of a blueprint to achieve those
objectives• “Based on principles of science and
scientific method” (Alfaro-LeFevre, 1998)
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Process of Outcome Identification and Planning
Establishing Priorities• Nursing diagnoses are ranked in order of
physiological or psychological importance.• Diagnoses should be mutually ranked by the
nurse and client or family/significant others.• Maslow’s Hierarchy of Basic Human Needs
is a common method of selecting priorities.
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Process of Outcome Identification and Planning
Establishing priorities does not mean that one diagnosis must be totally resolved before giving attention to another diagnosis.
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Process of Outcome Identification and Planning
Identifying Expected Outcomes• Outcomes provide guidelines for
individualized nursing interventions. • Outcome statements establish evaluation
criteria.
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Outcome Indicators/Criteria
Expected Outcomes• Realistic• Mutually desired by the client and nurse• Attainable within a defined time period• Depict measurable behavioral change or
evidence of change in the client• Provide a standard for comparison in the
evaluation process
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Outcome Indicators/Criteria
Subject• The subject is the person who will perform
the desired behavior or meet the outcome.• In a client-centered plan of care, the client is
the person who needs to achieve a desired change in behavior.
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Outcome Indicators/Criteria
Task Statement (action verb)• Describes what the client (or subject) will do
to obtain an expected change in behavior.• Enables the evaluator to determine
achievement of observable behavior.• One task statement should be used for each
outcome.
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Outcome Indicators/Criteria
Criteria• Standards used to evaluate whether the
behavior demonstrated indicates accomplishment of the outcome
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Outcome Indicators/Criteria
Criteria • A time limit• Amount of activity• Important characteristics of performance• Description of the performance to be
followed
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Outcome Indicators/Criteria
Conditions• Provide clarity• May include experiences the client is
expected to have before performing the task
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Outcome Indicators/Criteria
Time Frame• A short-term outcome is a statement
demonstrating an expectation of a nursing diagnosis to be resolved in a few hours or days.
• A long-term outcome demonstrates an expectation of a nursing diagnosis to be resolved usually over weeks or months.
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Outcome Indicators/Criteria
Time Frame• Setting long-term outcomes is important in
successful discharge planning.
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Strategies for Well-Written Desired Outcome Statements
State the outcomes in terms of client outcomes, not nursing actions.
Describe the client’s behavior that demonstrates reduction or resolution of a problem-focused nursing diagnosis.
Use positive terms.
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Strategies for Well-Written Desired Outcome Statements
Outcomes should be observable and measurable.
Specify the expected time frame for the client to achieve the expected outcome.
Relate each desired outcome to one specific nursing diagnosis.
13-18Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Strategies for Well-Written Desired Outcome Statements
Determine whether the client/support system values the outcome.
Collaborate with the client in the planning process.
Start with short-term outcomes to allow for frequent evaluation of the client’s progress.
13-19Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Strategies for Well-Written Desired Outcome Statements
Outcomes must be compatible with the total therapeutic plan.
Outcome statements should reflect professional knowledge and use of resources, and research.
Outcome statements should be compatible with standards of care.
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Planning Nursing Interventions
A nursing intervention is an action performed by a nurse that helps the client to achieve the results specified by the expected outcome.
Intervention terms are based on scientific principles and knowledge.
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Planning Nursing Interventions
Usually, several nursing interventions are developed for each identified outcome.
Interventions are prioritized according to the order in which they will be implemented.
Interventions can be developed from the etiology of each nursing diagnosis.
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Planning Nursing Interventions
Guidelines in selecting appropriate nursing interventions are:• Individual nurse practice acts• Joint Commission on Accreditation of
Healthcare Organizations (JCAHO) standards for nursing care
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Planning Nursing Interventions
Nursing Order• Statement written by the nurse that is within
the realm of nursing practice.• Nursing orders specify direction and
individualize the plan of care.• Nursing orders involve health promotion,
observation, prevention, and treatment. (Wilkinson, 1998)
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Categories of Nursing Interventions
Independent Nursing Interventions • Actions initiated by the nurse.• Do not require direction or an order from
another health care professional.• Sanctioned by professional nurse practice
acts.
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Categories of Nursing Interventions
Interdependent Nursing Interventions• Collaboration• Consultation
Dependent Nursing Interventions• Require an order from another health care
professional.
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Types of Nursing Interventions
(A) independent
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Types of Nursing Interventions
(B) interdependent
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Types of Nursing Interventions
(C) dependent
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Evaluating Care
Involves determining the client’s progress toward achievement of expected outcomes.
The planned outcomes are the yardsticks by which effectiveness of therapies are evaluated.
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Nursing Outcomes Classification (NOC)
Provides a standardized language for classifying client outcomes.
Defines over 190 client outcomes that are sensitive to nursing interventions.
Allows nurses to evaluate client status over time.
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Plan of Care
A written guide that organizes data about a client’s care into a formal statement.
Components of the plan of care are assessment, nursing diagnoses, expected outcomes, nursing interventions, and evaluations.
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Plan of Care
Begins on the day of admission and is continually updated until discharge.
Directs the efforts of the entire health care team regarding each client.
Individualization is enhanced by continuous reviewing and updating of the care plan.
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Plan of Care
Authenticates activities of assessment by maintaining written records.
Provides evidence of nursing interventions, client responses, and changes in client’s condition.
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Plan of Care
Types of Care Plans• Standardized• Institutional• Student-Oriented• Computerized
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Types of Care Plans
The standardized care plan is a preplanned, preprinted guide for the nursing care of client groups with common needs.
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Types of Care Plans
Institutional nursing care plans are concise documents that become part of the client’s medical record after discharge.
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Types of Care Plans
Computerized care plans can be either standardized or individualized.
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Types of Care Plans
The student-oriented care plan promotes learning of problem-solving skills, the nursing process, verbal and written communication skills, and organizational skills.
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Strategies For Effective Care Planning
Clearly communicate the client’s care plan to other health care personnel.
Establish a realistic nursing care plan with outcomes that are measurable.
Establish outcomes that are future-oriented.