Outcome Identification and Planning

Chapter 13

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Purposes of Outcome Identification and Planning

Provide direction to ensure quality nursing care.

A vehicle to improve communication with health care personnel.

Provide continuity in the delivery of individualized nursing care.

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Process of Outcome Identification and Planning

Planning is sequential, dynamic, and future-oriented.

Planning includes establishing priorities, identifying goals and expected outcomes, developing nursing interventions, and documenting the client’s plan of care.

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Process of Outcome Identification and Planning

Critical Thinking• Development of objectives• Formulation of a blueprint to achieve those

objectives• “Based on principles of science and

scientific method” (Alfaro-LeFevre, 1998)

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Process of Outcome Identification and Planning

Establishing Priorities• Nursing diagnoses are ranked in order of

physiological or psychological importance.• Diagnoses should be mutually ranked by the

nurse and client or family/significant others.• Maslow’s Hierarchy of Basic Human Needs

is a common method of selecting priorities.

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Process of Outcome Identification and Planning

Establishing priorities does not mean that one diagnosis must be totally resolved before giving attention to another diagnosis.

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Process of Outcome Identification and Planning

Identifying Expected Outcomes• Outcomes provide guidelines for

individualized nursing interventions. • Outcome statements establish evaluation

criteria.

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Outcome Indicators/Criteria

Expected Outcomes• Realistic• Mutually desired by the client and nurse• Attainable within a defined time period• Depict measurable behavioral change or

evidence of change in the client• Provide a standard for comparison in the

evaluation process

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Outcome Indicators/Criteria

Subject• The subject is the person who will perform

the desired behavior or meet the outcome.• In a client-centered plan of care, the client is

the person who needs to achieve a desired change in behavior.

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Outcome Indicators/Criteria

Task Statement (action verb)• Describes what the client (or subject) will do

to obtain an expected change in behavior.• Enables the evaluator to determine

achievement of observable behavior.• One task statement should be used for each

outcome.

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Outcome Indicators/Criteria

Criteria• Standards used to evaluate whether the

behavior demonstrated indicates accomplishment of the outcome

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Outcome Indicators/Criteria

Criteria • A time limit• Amount of activity• Important characteristics of performance• Description of the performance to be

followed

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Outcome Indicators/Criteria

Conditions• Provide clarity• May include experiences the client is

expected to have before performing the task

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Outcome Indicators/Criteria

Time Frame• A short-term outcome is a statement

demonstrating an expectation of a nursing diagnosis to be resolved in a few hours or days.

• A long-term outcome demonstrates an expectation of a nursing diagnosis to be resolved usually over weeks or months.

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Outcome Indicators/Criteria

Time Frame• Setting long-term outcomes is important in

successful discharge planning.

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Strategies for Well-Written Desired Outcome Statements

State the outcomes in terms of client outcomes, not nursing actions.

Describe the client’s behavior that demonstrates reduction or resolution of a problem-focused nursing diagnosis.

Use positive terms.

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Strategies for Well-Written Desired Outcome Statements

Outcomes should be observable and measurable.

Specify the expected time frame for the client to achieve the expected outcome.

Relate each desired outcome to one specific nursing diagnosis.

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Strategies for Well-Written Desired Outcome Statements

Determine whether the client/support system values the outcome.

Collaborate with the client in the planning process.

Start with short-term outcomes to allow for frequent evaluation of the client’s progress.

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Strategies for Well-Written Desired Outcome Statements

Outcomes must be compatible with the total therapeutic plan.

Outcome statements should reflect professional knowledge and use of resources, and research.

Outcome statements should be compatible with standards of care.

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Planning Nursing Interventions

A nursing intervention is an action performed by a nurse that helps the client to achieve the results specified by the expected outcome.

Intervention terms are based on scientific principles and knowledge.

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Planning Nursing Interventions

Usually, several nursing interventions are developed for each identified outcome.

Interventions are prioritized according to the order in which they will be implemented.

Interventions can be developed from the etiology of each nursing diagnosis.

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Planning Nursing Interventions

Guidelines in selecting appropriate nursing interventions are:• Individual nurse practice acts• Joint Commission on Accreditation of

Healthcare Organizations (JCAHO) standards for nursing care

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Planning Nursing Interventions

Nursing Order• Statement written by the nurse that is within

the realm of nursing practice.• Nursing orders specify direction and

individualize the plan of care.• Nursing orders involve health promotion,

observation, prevention, and treatment. (Wilkinson, 1998)

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Categories of Nursing Interventions

Independent Nursing Interventions • Actions initiated by the nurse.• Do not require direction or an order from

another health care professional.• Sanctioned by professional nurse practice

acts.

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Categories of Nursing Interventions

Interdependent Nursing Interventions• Collaboration• Consultation

Dependent Nursing Interventions• Require an order from another health care

professional.

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Types of Nursing Interventions

(A) independent

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Types of Nursing Interventions

(B) interdependent

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Types of Nursing Interventions

(C) dependent

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Evaluating Care

Involves determining the client’s progress toward achievement of expected outcomes.

The planned outcomes are the yardsticks by which effectiveness of therapies are evaluated.

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Nursing Outcomes Classification (NOC)

Provides a standardized language for classifying client outcomes.

Defines over 190 client outcomes that are sensitive to nursing interventions.

Allows nurses to evaluate client status over time.

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Plan of Care

A written guide that organizes data about a client’s care into a formal statement.

Components of the plan of care are assessment, nursing diagnoses, expected outcomes, nursing interventions, and evaluations.

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Plan of Care

Begins on the day of admission and is continually updated until discharge.

Directs the efforts of the entire health care team regarding each client.

Individualization is enhanced by continuous reviewing and updating of the care plan.

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Plan of Care

Authenticates activities of assessment by maintaining written records.

Provides evidence of nursing interventions, client responses, and changes in client’s condition.

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Plan of Care

Types of Care Plans• Standardized• Institutional• Student-Oriented• Computerized

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Types of Care Plans

The standardized care plan is a preplanned, preprinted guide for the nursing care of client groups with common needs.

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Types of Care Plans

Institutional nursing care plans are concise documents that become part of the client’s medical record after discharge.

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Types of Care Plans

Computerized care plans can be either standardized or individualized.

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Types of Care Plans

The student-oriented care plan promotes learning of problem-solving skills, the nursing process, verbal and written communication skills, and organizational skills.

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Strategies For Effective Care Planning

Clearly communicate the client’s care plan to other health care personnel.

Establish a realistic nursing care plan with outcomes that are measurable.

Establish outcomes that are future-oriented.