Ch 16: Outcomes identification and planning Flashcards
What does outcome identification and planning include between people and who
 What 4 things can you do during outcome identification and planning
- Establish
- identifies/write
- select
- communicate
How come identification in planning includes a partnership between patients and families
4 things you can do during out come at identification and planning
- establish priorities
- identify and write expected outcomes
- Select evidence based interventions
- Communicate nursing care plan
How do you define a goal
what is a patient outcome defined as 
Goal = =
What is the difference between an expected outcome and a goal and what does an expected outcome measure
A goal is an aim or end
Patient outcome is an expected conclusion to health problem/expectation
Call = objective = outcome
Expected outcome is specific and measurable v goal: broad
-expected outcomes measure the extent to which a goal has been met

What is informal planning
Why is it important to include family as much as possible
Informal planning is a problem that comes along with patient treatment as we treat other problems that we must address 1st and then go back to the original problem
Including family allows to identify and I’ll come and start planning
What is a formal care plan allow the nurse to do
- personal
- set
- facilitate
- promote
- what is done with care
- response
- record/reimbursement
- promote
 formal care planning allows:
- individualized care to maximize outcome achievement
- Set priorities
- facilitate communication among professionals
- promote high-quality cost effective care -coordinate care
- evaluate response to nursing care -create record for eval, research, reimbursement
- promote professional development
What is the ultimate primary purpose of alchemy identification planning
-what does it allow
How do we see the patient and what are nursing care plans designed to incorporate
What does nursing planning help do
Ultimate primary purpose of outcome identification planning is to:
-design a care plan within for the patient (individualize)
• care plan allows to implement, prevent, reduce, resolve health problems
Nurses see patients holistically
Nursing care plans designed to incorporate independent, dependent, collaborative responsibilities
Nursing planning helps:
- promote wellness,
- prevent disease/illness
- promote recovery
- **facilitate coping with altered functioning
What does successful implementation of each step require a high level of skill in
When does discharge planning begin
To successfully implement each step of the nursing process you must have a high level of skill in critical thinking/reasoning
Discharge planning begins from the moment the patient steps into the hospital (You see patient)
How can you plan healthcare correctly (what must you do)
What is the big picture focus:
To correctly plan healthcare
• be familiar with standards/agency policies for setting priorities
• ID and record patient outcomes select evidenced based nursing interventions record planning (talk to me)
• remember goal of patient centered care is to keep patient interest and preference central
Big picture focus:
-What are discharge goals for the patient and How should this direct shift interventions
Defined the clinical reasoning used during Outcome identification and planning
What do you want to trust and ask for
What is there to value
What is there to respect
Recognize and keep what?
Trust clinical experience/judgment be willing to ask for help when more qualifications and experience are needed
VALUE COLLABORATIVE PRACTICE 
Respect your clinical intuition before establishing priorities, outcomes and selecting interventions be sure that the research supports your plan
-Ask yourself why
Recognize personal bias and keep an open mind
What are questions that facility (produce) clinical reasoning
- What do you do when identifying outcomes and planning
- Setting priorities: what problems require my IMMEDIATE attention/or teams
- Identifying outcomes: what must I observe in patient to demonstrate resolution of problem identified by nursing diagnosis
- Selecting EBP nursing interventions: what Intervention backed by science will help my patient get to the expected outcomes
- Communicating plan of care: does care address the patient’s priority today
Give the three elements of comprehensive planning
- Initial
- On going
- Discharge
What does the initial planning phase begin with (how)
WHO develops the initial planning
What is addressed
What does the initial planning phase identify
Initial planning phase begins with nursing history and physical assessment
 A nurse who performs nursing history and physical assessment develops initial planning
During initial planning each problem listen in the prioritized nursing diagnosis are addressed
Initial planning phase identifies goals and related nursing care

Describe ongoing planning
By why and what do they do? Aka? What is done to diagnosis What is done to outcomes What is identified
Carried out by ANY Nurse who interacts with patients
-Keeps plan up-to-date, manages risk factors, promote function
Aka new problems
Makes modifications if diagnosis is unclear or adjusts to new data
+ makes NEW Diagnosis
Makes outcomes more realistic and develops new outcomes
Identifies nursing interventions to accomplish patient goals
Describe discharge planning
When does discharge planning begin
How do you ensure home care behaviors are performed competently
-what is the key to planning
Begins: when patient is admitted
Carried out by nurse who worked MOST CLOSELY with patient (case manager)
Uses teaching and counseling to ensure home care behaviors are performed competently
-education = key to planning
What is a standardized care plan and what can be used as and how are they modified
Standardize care plans are prepared (set) plans that can be used as a baseline and customize to the patient and their needs
What are the priorities of nursing diagnoses and define them (3)
What is another term for low priority
What is not needed for low priority
High priority diag: greatest threat to patient will being
Medium priority diag : NONTHREATENING diagnoses
Low priority diag: diagnosis NOT SPECIFICALLY REATED TO CURRENT HEALTH PROBLEM
-   risk of (Potential problem)
- no immediate intervention
What priorities are greater than psychosocial
what is the exception
Physiologic priorities> psychosocial needs
Unless patient’s safety is being threatened like suicide
-if you won’t have a patient, it is the highest priority!
What are ways to establish priorities among nursing diagnosis
What are 3 helpful guides to help prioritize patient problems
Develop a prioritized list of nursing diagnoses to help set priorities
 3 helpful guides to prioritize patient problems:
- Maslow‘s HON
- Patient preference
- anticipation of future problems
+ physiological v psychosocial
Describe Maslow’s hierarchy of needs in reference to the most important to the least important of need classification
MOST 1. Physiologic needs 2. safety needs 🦺 3. ♥️ and belonging needs 4. self-esteem 5. self actualization LEAST
What do you meet when considering patient preferences as part of a guide to Prioritize patient needs
-when are they dressed

Define anticipation of future problems
Patient preferences:
-meet patient needs at that time That patient thinks are the most important
-ADDRESSED 1st
🚫you can cause problems by not addressing those patient needs
Anticipation of future problems:
Considering the potential effects of different nursing actions
What are 4 questions you ask yourself to prioritize patient care
Q1. What problems need immediate attention/which can wait
Q2. What problems are your responsibility what can you refer to someone else
-work within your scope
Q3. What problems can be dealt with by using standard plans
- What problems are not covered by protocol standards but must be addressed to ensure safe hospital state and timely discharge
What changes as a patient’s health status changes
What changes come about in response patient’s response to health/illness (condition)
What do you do if there’s a relationship among diagnoses
What can we do if patient has multiple nursing diagnoses that are related
As a patient health status changes our priorities change or become influenced by change
If patients have a change in response to health and illness there is a change in a nursing diagnosis
If there is a relationship among diagnoses One maybe worked on before another
If patient has multiple related diagnosis they can be treated together

What are outcomes derived from give an example
What do problems usually reflect (2)
-what do problem directly demonstrate
What is the minimum number of outcomes per diagnosis
What language is used for diagnosis
Outcomes derived from problem statements
I.e: (P): pain,  (O) within eight hours patient will say pain is diminished
Problems usually Reflect that the objective (cool) has been achieved or demonstrates direct resolution of problem statement
Minimum 1 Outcome per diagnosis
use standardize language
Long-term goals(Outcomes):
- how long
- what can long-term goals be used as
S short term outcomes:
When is it accomplished
Give an example

Long-term goals:
- Last longer than 1 week
- maybe used as discharge goals
Short term outcomes:
-accomplish in a specific time frame (days/hours)
I.E no signs of infection
What is the first thing you should do to determine patient centered outcomes
What are things to keep into consideration when developing patient centered outcomes -status/overall -stay -G & D - Considerations X changes indicating what
For outcomes: #1 is ask patient to describe 2 to 3major goals they would like to achieve
Consideration for patient centered outcomes:
- patient health status and overall prognosis
- expected length of stay
- growth and development values
- cultural considerations (preferences) -incorporate in outcomes other therapies (do not duplicate)
- available human material, financial resources, risks, benefits, current scientific evidence (EBP)
- ***Changes in status that indicate the need to modify usual outcomes
- “patient changes so we change”
What is one of the most important considerations in writing outcomes and why
What are most important considerations in writing outcomes is encourage family involvement (or patient) to explore will help patient chief goals
What are the IOM‘s six aims to meet by healthcare system regarding quality of care (highest) -avoid -How old are used -how is care centered -What do we want to reduce -Avoid what due to high cost -What must not very
IOM 6 Aims for higher quality of care
- Safe: avoid injury
- Effective: avoid over/underuse
- Patient centered: respond to patients preferences, needs , values
- Timely: reduce weights and delays
- Efficient: avoid waste due to high costs
- Equitable: provide care of that does not vary (two equally)
What are outcomes classified by

Give the 3 categories of patient outcomes and describe them
Outcomes: classified by type of change needed by patient
3 outcomes:
- Cognitive: describes increase in knowledge or intellect( shows learning)
- verbal!
- “ listing “  - Psycho motor: describes (demonstrates) patient achievement of new skill
Effective: dealing with patients values, beliefs, attitudes (emotions)
3.
What do clinical outcomes identify
-what does it describe

Describe functional outcomes
Describe quality of life outcomes
Clinical outcomes identified status of health issue at certain points in time (post treatment)
-Describes whether problems are resolved or if improvement
Functional outcomes: the ability to function (do) certain activities (desired)
Quality of life outcomes:
-Focus on key factors that affect quality of life

What does the American nurses association standard practice direct
What should the outcome support
ANA standard directs: practicing  in a manner congruent to culture and diversity including The principles
Outcome should support overall treatment
What must MEASURABLE OUTCOMES contain (components)
- Subject:
- Verb: the ACTION Performed by patient
- Condition: the circumstance in/by which the outcome is achieved
• performance criteria
-expected patient behavior or observable manifestations
What must patient outcomes and goals be?
(what was planning Be? )
Patient outcomes and goals must be SMART
S-specific (how) M measurable (number) A Attainable (reasonable) R realistic/result oriented* T Time framed (date and time) 
What are a few errors in writing patient outcomes
-writing
-non-verbs
-more than one
-Excess

- writing outcome as nursing intervention
- Using non-observable/measurable verbs
- I.E: patient will know
 3. more than one behavior in short term outcome
- Vague outcomes
Using verbs what do you want to avoid
Avoid using verbs that are non-measurable
-🚫 miserable =🚫use 
What are verbs you do not use in patient outcomes
- Know
- understand
- learn
- become aware
What is the nursing intervention classification (NIC) definition of nursing interventions
What interventions are used
What are two specific categories used during nursing interventions and give examples of each
Nursing interventions:
-treatment based on clinical judgment and knowledge that a nurse performed to enhance patient outcomes
Nurses use both independent and collaborative interventions
Use of physiologic and psychologic
Physiologic:
-Hypo glycemic treatment
Psychological
-Decreasing anxiety


What are the major focuses of nursing interventions
ACTUAL DIAG
-contributing factors
-promoting + (decreasing)
-Monitor
-
To rule out/Confirm
Major focus of nursing interventions:
- Reduce/eliminate contributing factors of diagnosis
- promote higher level of wellness ⬇️ problem
- Monitor and eval status
- collect additional data to rule out/confirm diag
- eval response
 What are major focuses of interventions for at risk diagnosis
- we want to decrease or eliminate contributing risk factors
- prevent potential problems
- Monitor and eval patient status
What are types of nursing interventions
I
Nurse
Physician
collaborative
Nurse initiated: INDEPENDENT
- Select appropriate, individualize(to patients ability) , record in record
Physician initiated: initiated by physician in response to medical diagnosis but carried out by nurse
Collaborative: treatment by OTHER providers carried out by a nurse

What are 3 actions done in nursing interventions
1. Resolve, prevent, manage problem
- Facility Independence or assist with ADL
- Promote optimum sense of physical, psychological, spiritual well-being
What are six factors to consider when choosing interventions
what is our goal
What do we want to consider
What do we want to be
What must patient due to intervention
What is there to determine about the nurse
For interventions Consider:
- desired patient outcome
- character of nursing diagnosis
- be feasible
- patient must accept to do intervention
- capability of nurse to do intervention
- ?
Describe the following structured care methodologies used in nursing care
 procedure
standard of care
algorithm
clinical practice guidelines
 procedure: set of how to do action
Standard of care: acceptable level of patient care
Algorithm: set of steps TO MAKE A DECISION
-gives no provider flexibility
Clinical practice guidelines: statement with appropriate practice for clinical condition or procedure
Define consulting
Who can consult
What is an ethicists
Consulting: process in which two are more people with varying degrees of experience discuss a topic, and suggest solutions for problem
Consultations may be done by anyone including social workers, pastoral, caregiver
Ethicist: evaluate case and make suggestions on practices
What are evaluative strategies defined by
When are patient outcomes meaningless and what must you do when evaluating the patient outcomes
Give the ratings of patient outcomes
Evaluative strategies defined by well written outcomes
Patient outcomes are meaningless if the Nurse does not evaluate progress towards achievement
Met, Partially met, not meant
What does a care plan equal
What are a few factors in the world written care plan
Care plans = guide to meeting goals
Factors in a well written care plan:
- have effective philosophy of nursing and advance nursing aims
- prepared BY BURSE
- Clearly identifies nursing assistance the patient needs and nursing collaborative responsibilities
- directs the nursing assessment priorities*
What does documentation usually specify
Documentation usually specifies nursing diagnosis and outcomes + any associated nursing interventions needed to achieve goals
Describe the following plans of care
Computerized
Concept maps
Change of shift report “ hand off”
Multidisciplinary (collaborative) care plan
Computerized :
-EHR
Concept maps:
-DIAGRAMS to reflect problem, interventions and I’ll come
Change of shift report “ hand off”
-Giving critical information to other nurse
Multidisciplinary (collaborative) care plan
-helps communication with others about patient status
What are a few problems Recognized when developing nation care plans
•Not involving patient
•insufficient data
•Inaccurate data outcomes or too broad •outcomes derived from poorly development diagnosis
-bad diagnosis = bad outcomes
• failure to write nursing orders clearly •nursing orders that are not resolve the problem
•failure to update
What are the benefits of using NIC (nursing intervention classification
- Demonstrate impact of nurses and healthcare delivery
- define The knowledge base for nursing curriculum
- standardize language facility selection of appropriate nursing interventions
- facility communication
- enable researchers to examine effectiveness and cost
What does the NIC (nursing intervention classification) equal?
NIC = universal standardized language to communicate 
