Outcome ID and Goals Flashcards
What is the difference between a goal and an expected outcome?
An outcome is more specific and measurable. Hence, an outcome is used to evaluate the extent to which a goal has been met
In which phase are the outcomes and goals are set, along with how these outcomes are met and evaluated?
The outcome identification phase
In which step does the nurse establish priorities.
Identify and write expected patient outcomes?
Select evidence-based nursing interventions?
Communicate the care plan?
Outcome Identification and Planning Step
A formal care plan has multiple functions. Select all that apply.
1. Individualize care that minimizes outcome achievement
2. . Does not set priorities
3. Facilitate communication among nursing personnel and colleagues
4. Promote continuity of high-quality, cost-effective care
5. Evaluate patient response to nursing care
6. Create a record used for evaluation, research, reimbursement, and legal reasons
7. Promote nurse’s professional development
3, 4, 5, 6, & 7
What are three goals for a successful care plan? Can you name them?
Be familiar with standards and agency policies for setting priorities, identifying and recording expected patient outcomes, selecting evidence-based nursing interventions, and recording the care plan.
Remember that the goal of patient-centered care is to keep the patient and the patient’s interests and preferences central in every aspect of planning and outcome identification.
Keep the “big picture” in focus: What are the discharge goals for this patient, and how should this direct each shift’s interventions?
Nursing interventions are based on what type of evidence?
Evidenced Based Research
What are the three (3) phases of care planning ?
Initial
Ongoing
Discharge
What or which nurse begins the initial plan (POC)?
The nurse who does the nursing history & physical assessment
What or which nurse identifies appropriate patient goals and related nursing care ?
The nurse who does the nursing history & physical assessment
Which nurse develops the patient or client problems listed in a nursing diagnosis?
The nurse who does the nursing history & physical assessment
What type of planning, is involved in these steps: Carried out by any nurse who interacts with patient
Keeps the plan up to date, manages risk factors, promotes function
States of nursing diagnoses more clearly
Develops new diagnoses
Makes outcomes more realistic and develops new outcomes as needed
Identifies nursing interventions to accomplish patient goals
Ongoing planning
Which type of planning begins on the day of admission?
Discharge Planning
Which nursing action 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 who first performed the physical assessment starts the planning
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.
Teaching the patient/client and family about how to empty a Jackson-Pratt drain and wound care are done in which phase or planning?
Discharge Planning
A nursing diagnosis is based on what?
Priorities
What is the highest hierarchy of human needs?
Physiologic needs
What is the lowest hierarchy of human needs?
Self-actualization needs
A nurse is preparing a discharge summary for a client who has had knee arthroplasty and is going home. Which of the following information about the client should the nurse include in the discharge summary? Select all that apply
1. Advance directives’ status
2. Instructions for diet and medications
3. Follow-up care
4. Most recent vital signs
5. Contact information for the home health agency
2,3,5 (1 & 4 are not options, is necessary for a transfer to a rehab, 4-vital signs are important for a transfer situation-not for going home
Learning to establish priorities is a responsibility for a nurse, True or False?
True
By the second post -op day, a patient has not achieved satisfactory pain relief, as evidenced by the patient stating his pain level in his abdominal incision is a 9 out of 10 1 hour after receiving pain medication. Based on the evaluation, which of the following actions should the nurse take, according to the nursing process?
1. Reassess the patient to determine the reasons for inadequate pain relief.
2. Wait to see if the pain lessens during the next 25 hours.
3. Change the plan of care to provide different pain relief interventions.
4. Teach the patient about the plan of care for managing the pain.
- You will need further data from the patient as to why they have not achieved satisfactory pain relief. Reassess is the priority.
There are four categories of outcomes, which one describes the change in the patient’s physical condition or physiology ?
Physiologic
Describe an affective outcome.
Changes in patient values, beliefs, and attitudes
Which category describes patient’s achievement of new skills?
Psychomotor
Cognitive: describes decreases in patient knowledge or intellectual behaviors, True or False
False, Cognitive: describes increases in patient knowledge or intellectual behaviors
A nurse is discussing the nursing process with a newly licensed nurse. Which of the following statements by the new nurse should identify as appropriate for the planning step of the nursing process? Which statement is the evaluation step? Select two answers
1. I will determine the most important patient problems that we should address.
2. I will review the past medical history on the patient’s record to get more information.
3. I will carry out the new prescriptions from the provider.
4. I will ask the patient if their nausea has resolved?
- Prioritize the patient’s problems during the planning step. 4. Gathering information about the patient’s problem & resolution is the evaluation step.
What type of outcomes is this ? : 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-
Clinical outcomes
What outcome is described as the focus on key factors that affect someone’s ability to enjoy life and achieve personal goals.
Quality of Life
True or False Functional outcomes describe the person’s ability to function in relation to the desired usual activities.
True
Which outcome is an affective outcome?
A. By 6/09/19, the patient will correctly demonstrate the procedure for washing her newborn baby.
B. By 6/09/19, the patient will list three benefits of eating a healthy diet.
C. By 6/09/19, the patient will use a walker to ambulate the hallway.
D. By 6/09/19, the patient will verbalize valuing his health enough to stop smoking.
D.Answer: D. By 6/09/19, 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 C are psychomotor outcomes (learning a new skill) and Answer B is a cognitive outcome (increase in patient knowledge).
A charge nurse is observing a new nurse caring for a patient who reports pain. The new nurse checked the patient’s medication administration record (MAR) and noted the last dose of pain medication was 6 (six) hours ago. The prescription reads every 4 hr PRN for pain. The new nurse administered the pain medication and checked with the patient 40 minutes later, when the patient reports’ improvement. The new nurse left out which of the following steps of the nursing process?
1. Assessment
2. Planning
3. Intervention
4. Evaluation
- The new nurse should have used the assessment step by asking the patient to evaluate the severity of pain on a 0 to 10 scale. Also, it is important to ask about the characteristics of the pain & assessed for any changes that might have contributed to worsening pain.
The planning step is used by evidence of checking to see it was the appropriate time to give the Rx. The intervention is giving the Rx. & Last, the new nurse did evaluate the therapeutic effect of the Rx.
Name the parts of a Measurable Outcome. There are five parts.
Subject
Verb
Do not use:know, understand, learn, become aware
Do use: define, verbalize, explain, apply, identify, select, demonstrate, list, prepare, design, choose.
Conditions
Performance criteria
Target time
Ex. By 10/30/2022 the patient will identify delayed wound healing by explaining three symptoms of wound infection
True or False, A smart goal always has a time bound.
True
Is this an example of a smart goal? Patient will demonstrate the use of an incentive spirometer when short of breath by using it for 10 times Yes or No
No - because the time is open - it should reflect by HS is an example
Name the six (6) characteristics of outcomes-One way to remember is this is: Sally
Eats
Popcorn
Toast
Every
Evening
Safe: avoiding injury
Effective: avoiding overuse and under use
Patient-centered: responding to patient preferences, needs, and values
Timely: reducing waits and delays
Efficient: avoiding waste
Equitable: providing care that does not vary in quality to all recipients
What are 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
What is an intervention? Are they treatments alone? Yes or No why or why not
Treatments based upon clinical judgement and knowledge a nurse performs to enhance patient outcomes
An action for the nurse to carry out the care plan and to meet the outcomes
Is an action necessary in an intervention? Yes or No
Yes, an action is a requirement in a care plan necessary to meet an outcome.
Can a nurse intervention be completed without a physician order? Yes or No
Yes
Who can carry out a physician-initiated: actions ?
A nurse only with a physician order
Collaborative: treatments initiated by other providers and carried out by a physician. True or False
False (carried out by a nurse)
What are nurse -initiated interventions - think of the word independent nursing functions-there are five ?
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.
