Module 7 Flashcards
Outcome Identification is essentially..
a goal
Steps of Outcome Identification / Planning
- Establish priorities
- ID and write expected patient outcomes
- Select EBP nursing interventions
- Communicate care plan
What things does a formal care plan allow the nurse to do?
Individualize Care
Facilitate Communication
Set Priorities
Give high quality care
Have coordinated care
Evaluate patient response
Create a record
Promote professional development
To Clinically Reason in the Planning (Outcome ID stage) you must…
Be familiar with policies
Keep patient at the center
Keep the “big picture” in mind
Trust clinical judgment, but do not fear asking for help
Trust your intuitions
Recognize biases and keep an open mind
What standards must be applied to planning and outcome ID?
The Law
National Practice Standards
Specialty Professional Organization
Joint Commission
AHRQ
Employer Standards
3 Elements/Types of Comprehensive Planning
Initial
Ongoing
Discharge
Initial Planning
Done by nurse who does health history and phys assessment on admission
Comes up with priority problems and identifies appropriate patient goals and related nursing care - puts nursing plan together to achieve goals
Ongoing Planning
Non-admission nurses continue care plan and might add something to the diagnosis, keep it up to date, manage risks, promote function, and state the diagnosis and new diagnosis more clearly
Makes outcomes realistic and develops new ones as needed
ID’s nursing interventions to accomplish goals
Discharge Planning
Carried out by nurse working closely with patient
Begins on admission and teaches/counsels them in effective skills and knowledge to ensure home care behaviors are done competently
Prioritizing Nursing Diagnoses
High Priority > Medium > Low
Greatest threat to well being > non threatening diagnosis > diagnoses not specifically related to current health problem
Keep maslows in mind while prioritizing
Maslow’s Hierarchy Levels
Physiologic Needs > Safety > Love and Belonging > Self-Esteem > Self-Actualization
When clinically reasoning and establishing priorities, what things should be kept in mind?
What problems need immediate attention
What is my responsibility and what to refer to others
Which problem can use standard plans
Which problems don’t have protocols or standard plans but need addressing
Has the health status changed?
Have changes in patient changed ability of the diagnosis to address the problem?
Are there diagnoses relationships that have a hierarchy of which to work on first?
Can several problems be dealt with at once?
Long-Term Outcomes
require longer periods to be achieved
Maybe used as discharge goals
Short Term Outcomes
may be accomplished in a specified time period
The parts of a measurable outcome can be determined by using ____
S M A R T
What does SMART stand for
Specific
Measurable
Attainable
Relevant
Time
Decker Care Plan Outlines Include
Nursing Diagnosis
Long Term Goal
2 Short Term Goals
2 Evidence Based Interventions
IOM
Institute of Medicine
They have stated 6 goals to be met by healthcare systems to reach quality of care
6 IOM Goals Regarding Quality of Care
Safe Care
Effective Care
Patient Centered Care
Timely Care
Efficient Care
Equitable Care
Categories of Outcome Goals
Cognitive
Psychomotor
Affective
Cognitive Outcome
Described increases in patient knowledge or intellectual behaviors
Psychomotor Outcomes
Described patient’s achievement of new skills
Affective Outcomes
Described changes in patient values, beliefs, and attitudes
3 Types of Outcomes
Clinical
Functional
Quality of Life
Clinical Outcome
describe the expected status of health issues at certain points in time, after treatment is complete.
They address whether the problems are resolved or to what degree they are improved
Functional Outcomes
describes the person’s ability to function in relation to the desired usual activities
Quality of Life Outcomes
Focus on key factors that affect someone’s ability to enjoy life and achieve personal goals
Common Errors when writing patient outcomes?
Expressing patient outcome as a nursing intervention
Using verbs that are not observable or measurable
Including more than 1 patient behavior/manifestation in short term outcomes
Writing vague outcomes
Types of Nursing Interventions
Nurse Initiated
Physician Initiated
Collaborative
Nurse Initiated Intervention
Actions performed by the nurse without a physician’s order
Physician Initiated Intervention
Action initiated by a physician in response to a medical diagnosis but carried out by a nurse under doctor’s orders
Collaborative Intervention
treatments initiated by other providers and carried out by a nurse
