Nursing Process: Planning Flashcards
Third step of the nursing process
Planning
4 Main Purposes of Plan of Care
- Promotes communication among caregivers to promote continuity of care.
- Directs care and documentation.
- Creates a record that can later be used for evaluation, research, and legal reason.
- Provides documentation of health care needs for insurance reimbursement purposes.
ACTIVITIES OF THE PLANNING PHASE
→ Attending to urgent priorities.
→ Clarifying expected outcomes.
→ Deciding which problems must be prescribed.
→ Determining individualized nursing interventions.
→ Making sure the plan is adequately recorded.
TRUE OR FALSE?
Focus on what MUST be achieved before what’s NICE to do.
TRUE
Deciding which problem must be recorded is influenced by your understanding of:
✓ The whole picture of all the problems present
✓ The person’s overall health status and expected discharge outcomes.
✓ The expected length of contact with the patient.
✓ Focus on what MUST be achieved before what’s NICE to do.
✓ The patient’s perception of priorities
✓ Whether there are standard plans that apply, are there critical pathways? Guidelines? Protocols?
“Always check policies and procedures for recording the plan, as they are designed to help ____ ______ and protect ___ ____ ______.”
“Always check policies and procedures for recording the plan, as they are designed to help your patient and protect you from legal liability.”
BASIC PRINCIPLES: ATTENDING TO URGENT PRIORITIES.
- Choose a method of assigning priorities and use it consistently.
- Maslow’s hierarchy of needs.
- Problems usually present in a cluster
TRUE OR FALSE?
Study the relationships among the problems to determine major priorities.
TRUE
TRUE OR FALSE?
Assign high priority to problems that does not contribute to other problems.
FALSE
Assign high priority to problems that contribute to other problems.
It serves the purpose of ordering the delivery of nursing care so that the more important or life-
threatening problems are treated before less critical problems are treated.
Setting Priorities
TRUE OR FALSE?
Consider state laws, hospital policy statements, and outcome criteria established for the particular setting.
TRUE
TRUE OR FALSE?
Do not consider the effect of potential problems when setting priorities.
FALSE
Consider the effect of potential problems when setting priorities.
TRUE OR FALSE?
Consider costs, resources available, personnel and time needed to plan and treat each of the patient’s identified problems.
TRUE
TRUE OR FALSE?
Focus on the problems the patient feel are less important if this priority does not interfere with medical treatment.
FALSE
Focus on the problems the patient feel are MOST important if this priority does not interfere with medical treatment.
TRUE OR FALSE?
It is okay not to consider the patient’s culture, values, and beliefs when setting priorities.
FALSE
Consider the patient’s culture, values, and beliefs when setting priorities.
TRUE OR FALSE?
Maslow’s hierarchy of basic need cannot guide the selection of high- priority problems.
FALSE
Maslow’s hierarchy of basic need can guide the selection of high- priority problems.
CLARIFYING OR ESTABLISHING OUTCOMES (RESULTS)
→ Patient outcome
→ The desired result of nursing care
→ That which one hopes to achieve with the patient and which is designed to prevent, remedy or lessen the problem identified in the nursing diagnosis.
OUTCOME IDENTIFICATION
The nurse identifies expected outcomes individualized to the patients.
The nurse develops outcomes for the patient to achieve showing an optimum or improved level of functioning in the problem areas identified in the nursing diagnoses.
refer to the INTENT.
Goals and Objectives
refers to results.
Outcomes
What you intend to do.
Goals and Objectives
What you expect the patient to be able to do
Outcomes
Describes what will be observed in the patient after care is done to show the benefits of nursing care.
Expected Outcomes
3 MAIN PURPOSES OF EXPECTED OUTCOMES
- They are the “measuring sticks.” For the plan of care.
- They direct interventions.
- They are motivating factors.
At a basic level, determining outcomes requires you to simply “________ ___ _______” or state what
you expect to observe in the patient after you perform an intervention.
“reverse the problem”
Describe the benefits expected to be seen at a certain point in time after the plan has been implemented.
LONG TERM OUTCOME-
State what you expect to observe in the patient when the problems are resolved or controlled.
PROBLEM OUTCOMES
Describe early expected benefits of nursing interventions.
SHORT TERM OUTCOME-
State the benefit you expect to observe in the patient after an intervention is performed.
INTERVENTION OUTCOMES-
Outcome may relate to problems or interventions.
What are they?
TRUE
PROBLEM OUTCOMES
INTERVENTION OUTCOMES
Outcomes describe the specific benefits you expect to see in the patient after care has been given.
TRUE
SHORT TERM OUTCOME
LONG TERM OUTCOMES
COMPONENTS OF OUTCOME STATEMENTS
→ Subject
→ Verb
→ Condition
→ Performance criteria
→ Target time.
Changes in attitude, feelings, or values.
Affective domain
Dealing with acquired knowledge or intellectual skills.
Cognitive domain
Dealing with developing motor skills.
Psychomotor domain
What actions must the person take to achieve the outcome?
VERB
Who is the person expected to achieve the outcome.
SUBJECT
Under what circumstances is the
person to perform the actions?
CONDITION
How well is the person to perform the actions?
PERFORMANCE CRITERIA
By when is the person expected to
be able to perform the actions?
TARGET TIME
An observable activity to the patient will demonstrate at some time in the future showing improvement in the problem area.
Patient Behavior
Not all outcomes will have______.
conditions
TRUE OR FALSE?
Specific aides which will facilitate the patient performing a behavior at the level in the criteria and within specified time frame.
TRUE
TRUE OR FALSE?
Specific aids that will help the patient perform a behavior at the level specified in the criteria portion of the outcome statement.
TRUE
A stated level or standard for the patient behavior stated in the outcome.
PERFORMANCE CRITERIA
It specifies a realistic improvement in functioning in the problem area by stated time and will be used to determine whether the outcome was satisfactorily achieved.
PERFORMANCE CRITERIA
A time or date to clarify how long it would realistically take for the patient to reach the level of functioning stated in the criteria part of the outcome.
TIME FRAME
A designated time or date when the patient should be able to achieve the behavior.
TIME FRAME
It clarifies and individualizes the outcome based on the patient’s ability and a realistic expectation for the level of functioning in the future.
PERFORMANCE CRITERIA
TYPES OF TIME FRAME
A. INTERMEDIATE OUTCOMES
B. LONG TERM OR FINAL OUTCOMES
C. DISCHARGE OUTCOMES.
It identifies behavior a patient can achieve quickly.
A. INTERMEDIATE OUTCOMES
B. LONG TERM OR FINAL OUTCOMES
C. DISCHARGE OUTCOMES.
A. INTERMEDIATE OUTCOMES
It gives direction for the nursing care over time.
A. INTERMEDIATE OUTCOMES
B. LONG TERM OR FINAL OUTCOMES
C. DISCHARGE OUTCOMES.
B. LONG TERM OR FINAL OUTCOMES
It appears in the end of the critical pathways used with the hospitalized patient.
C. DISCHARGE OUTCOMES.
It tries to identify the maximum level of functioning possible for a patient with a particular nursing diagnosis.
A. INTERMEDIATE OUTCOMES
B. LONG TERM OR FINAL OUTCOMES
C. DISCHARGE OUTCOMES.
B. LONG TERM OR FINAL OUTCOMES
It identifies the behavior the patient is expected to achieve to be safely discharged from the institution.
A. INTERMEDIATE OUTCOMES
B. LONG TERM OR FINAL OUTCOMES
C. DISCHARGE OUTCOMES.
C. DISCHARGE OUTCOMES.
TRUE OR FALSE?
Keep outcome long.
FALSE
Keep outcome short.
TRUE OR FALSE?
Make outcome specific.
TRUE
TRUE OR FALSE?
Whenever possible, the outcome is important and valued by the patient and family only
FALSE
Whenever possible, the outcome is important and valued by the patient, family, the nurse and the physician.
TRUE OR FALSE?
The outcome is an observable or immeasurable patient behavior.
FALSE
The outcome is an observable or measurable patient behavior.
TRUE OR FALSE?
The outcome is congruent with and supportive of other therapies.
TRUE
TRUE OR FALSE?
For an actual nursing diagnosis, the outcome is a patient behavior that demonstrates reduction or alleviation of the problem.
TRUE
TRUE OR FALSE?
The outcome is a realistic for the patient’s capabilities in the time span you designate in your outcome.
TRUE
TRUE OR FALSE?
For at risk medical diagnosis, the outcome is a patient behavior that demonstrates the maintenance of the current status of health or functioning.
FALSE
For at risk NURSING diagnosis, the outcome is a patient behavior that demonstrates the maintenance of the current status of health or functioning.
TRUE OR FALSE?
Derive each outcome from only one nursing diagnosis.
TRUE
TRUE OR FALSE?
The outcome can be unrealitic for the nurse’s level of skill, experience and time/ workload.
FALSE
The outcome realistic for the nurse’s level of skill, experience and time/ workload.
TRUE OR FALSE?
Designate a specific time for the achievement of each outcome.
TRUE
TRUE OR FALSE?
Write outcomes in terms of nursing actions behavior, patient behavior.
FALSE
Write outcomes in terms of patient behavior, not nursing actions.
3 BASIC STEPS TO DETERMINING WHICH PROBLEMS MUST BE RECORDED
- Create a problem list.
- Decide which problem must be managed in order to achieve the overall outcomes of care
- Determine what documentation will guide how to teach problem will be managed.
PLANNING – BEGIN BY PRIORITIZING CLIENT PROBLEMS
→ Prioritize list of client’s nursing diagnoses using Maslow.
→ Rank as high, intermediate or low.
→ Client specific
→ Priorities can change.
TYPES OF PLANNING
→ Initial
→ Ongoing
→ Discharge
Admission
A. Initial
B. Ongoing
C. Discharge
A. Initial
Confinement
A. Initial
B. Ongoing
C. Discharge
B. Ongoing
Before discharge
A. Initial
B. Ongoing
C. Discharge
C. Discharge
PLANNING – TYPES OF GOALS
→ Short term goals
→ Long term goals
GOALS ARE PATIENT CENTERED AND SMART
o S - Specific
o M – measurable
o A – attainable
o R – relevant
o T – time bound
INTERVENTIONS – 3 TYPES
→ INDEPENDENT (Nurse initiated)
→ DEPENDENT (Physician initiated)
→ COLLABORATIVE
Any action the nurse can initiate without direct supervision.
INDEPENDENT (Nurse initiated)
Nursing action requiring MD orders.
DEPENDENT (Physician initiated)
Nursing actions performed jointly with other health care team members.
COLLABORATIVE
OTHER FACTORS IN PRIORITIZING:
→ Client’s health status and belief.
→ Client’s priorities
→ Available resources
→ Urgency of the health problem
→ Medical treatment plan.
