Chapter 14 Outcome Identification and Planning

1. Chapter 14Outcome Identification and Planning

2. Goal of Outcome Identification and Planning Step • Establish priorities • Identify and write expected patient outcomes • Select evidence-based nursing interventions • Communicate the plan of care

3. Outcome Identification and Planning

4. A Formal Plan of Care Allows the Nurse To: • Individualize care that maximizes outcome achievement • Set priorities • Facilitate communication among nursing personnel and colleagues • Promote continuity of high-quality, cost-effective care • Coordinate care • Evaluate patient response • Create a record used for evaluation, research, reimbursement, and legal reasons • Promote nurse’s professional development

5. Three Elements of Comprehensive Planning • Initial • Ongoing • Discharge

6. Deriving Patient Goals/Outcomes and Nursing Orders from Nursing Diagnoses

7. Initial Planning • Developed by the nurse who performs the nursing history and physical assessment • Addresses each problem listed in the prioritized nursing diagnoses • Identifies appropriate patient goals and related nursing care

8. Ongoing Planning • Carried out by any nurse who interacts with patient • Keeps the plan up to date • States nursing diagnoses more clearly • Develops new diagnoses • Makes outcomes more realistic and develops new outcomes as needed • Identifies nursing interventions to accomplish patient goals

9. Discharge Planning • Carried out by the nurse who worked most closely with the patient • Begins when the patient is admitted for treatment • Uses teaching and counseling skills effectively to ensure home-care behaviors are performed competently

10. Prioritizing Nursing Diagnoses • High priority—greatest threat to patient well-being • Medium priority—non-threatening diagnoses • Low priority—diagnoses not specifically related to current health problem

11. Maslow’s Hierarchy of Human Needs • Physiologic needs • Safety needs • Love and belonging needs • Self-esteem needs • Self-actualization needs

12. Long-Term vs. Short-Term Outcomes • Long-term—requires a longer period to be achieved and may be used as discharge goals • Short-term—may be accomplished in a specified period of time

13. Categories of Outcomes • Cognitive—describes increases in patient knowledge or intellectual behaviors • Psychomotor—describes patient’s achievement of new skills • Affective—describes changes in patient values, beliefs, and attitudes

14. Common Errors in Writing Patient Outcomes • Expressing patient outcome as nursing intervention • Using verbs that are not observable or measurable • Including more than one patient behavior or manifestation in short-term outcomes • Writing vague outcomes

15. Parts of a Measurable Outcome • Subject • Verb • Conditions • Performance criteria • Target time

16. Types of Nursing Interventions • Nurse-initiated—actions performed by a nurse without a physician’s order • Physician-initiated—actions initiated by a physician in response to a medical diagnosis but carried out by a nurse under doctor’s orders • Collaborative—treatments initiated by other providers and carried out by a nurse

17. Actions Performed in Nurse-Initiated Interventions (Alfaro, 2002) • Monitor health status • Reduce risks • Resolve, prevent, or manage a problem • Facilitate independence or assist with ADLs • Promote optimum sense of physical, psychological, and spiritual well-being

18. Structured Care Methodologies • Procedure—set of how to action steps • Standard of care—description of acceptable level of patient care • Algorithm—set of steps used to make a decision • Clinical practice guideline—statement outlining appropriate practice for clinical condition or procedure

19. Types of Institutional Plans of Care • Kardex plans of care • Computerized plans of care • Case management plans of care • Clinical pathways, care maps • Student plans of care • Concept map care plan

20. Problems Related to Outcome Identification and Planning • Failure to involve patient • Insufficient data collection • Nursing diagnoses developed from inaccurate or insufficient data • Outcomes stated too broadly • Outcomes derived from poorly developed nursing diagnoses • Failure to write nursing order clearly • Nursing orders that do not solve problems • Failure to update the plan of care

21. Question Which one of the following nursing actions would most likely occur during the ongoing planning stage of the comprehensive care plan? A. The nurse collects new data and uses them to update the plan and resolve health problems. B. The nurse uses teaching and counseling skills to help the patient carry out self-care behaviors at home. C. The nurse who performs the admission nursing history develops a patient care plan. D. The nurse consults standardized care plans to identify nursing diagnoses, outcomes, and interventions.

22. Answer Answer: A. The nurse collects new data and uses them to update the plan and resolve health problems. Rationale: In the ongoing planning stage any nurse who interacts with the patient updates the plan to facilitate the resolution of health problems, manage risk factors, and promote function. Teaching and counseling are the key to discharge planning. The nurse performing the admission nursing history consults standardized care plans during initial planning to formulate the initial care plan.

23. Question Which of the following nursing diagnoses would most likely be considered a high priority? A. Disturbed personal identity B. Impaired gas exchange C. Risk for powerlessness D. Activity intolerance

24. Answer Answer: B. Impaired gas exchange Rationale: Impaired gas exchange poses a threat to the patient’s well-being. Disturbed personal identity and risk for powerlessness are non-life threatening and are ranked as medium priorities. Activity intolerance, if not specifically related to the current health problem, is a low priority.

25. Question Which one of the following outcomes is an affective outcome? A. By 6/09/08, the patient will correctly demonstrate the procedure for washing her newborn baby. B. By 6/09/08, the patient will list three benefits of eating a healthy diet. C. By 6/09/08, the patient will use a walker to ambulate the hallway. D. By 6/09/08, the patient will verbalize valuing his health enough to stop smoking.

26. Answer Answer: D. By 6/09/08, the patient will verbalize valuing his health enough to stop smoking. Rationale: An affective outcome describes changes in patient values, beliefs, and attitudes. Answers A and B are psychomotor outcomes (learning a new skill) and Answer C is a cognitive outcome (increase in patient knowledge).

27. Question Tell whether the following statement is true or false. A collaborative intervention is an intervention initiated by a physician in response to a medical diagnosis but carried out by a nurse in response to a physician’s order. A. True B. False

28. Answer Answer: B. False A physician-initiated intervention is an intervention initiated by a physician in response to a medical diagnosis but carried out by a nurse in response to a physician’s order.

29. Question Tell whether the following statement is true or false. A protocol prescribes specific therapeutic interventions for a clinical problem unique to a subgroup of patients within the cohort. A. True B. False

30. Answer Answer: A. True A protocol prescribes specific therapeutic interventions for a clinical problem unique to a subgroup of patients within the cohort.