Goals and Expected Outcomes

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Goals and Expected Outcomes

• NPN 105
• Joyce Smith, RN, BSN

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Initial Planning

• Developed by the nurse who performs the admission
  nursing history and the physical assessment
• Comprehensive plan that addresses each problem
  listed in the prioritized nursing diagnosis and
  identifies appropriate patient goals and the
  related nursing care

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Planning Purposes and Activities

• Purposes
• Direct client care activities
• Promote continuity of care
• Focus charting requirement
• Allow for delegation of specific activities
• Activities
• Plan nursing interventions plan
• Write a nursing plan of care

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Establish Priorities

• Which problems require my immediate attention?
• Which problems are my responsibility and which
  should I refer to someone else?
• Which problems are the most important to the
  patient?
• Which problem has the highest level of need based
  on Maslows Hierarchy?

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Establishing Priorities

• Because basic needs must be met before a person
  can focus on higher ones, patient needs may be
  prioritized according to Maslows Hierarchy
• Physiologic
• Safety
• Love and belonging
• Self esteem
• Self actualization

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Writing Goals

• Purpose
• Provide individualized care
• Promote client participation
• Plan care that is realistic and measurable
• Select evidenced based nursing care
• Communicate the plan of care

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Goals of Care

• Must be patient centered
• Must reflect the patients highest level of
  functioning
• It is a prediction of the resolution of a problem
• Each goal is written with a time limitation,
  which depends on the nature of the problem
• Short term
• Long term
• Are written in terms of patient will ----

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Guidelines for Writing Goals/Outcomes

• Focus on the client
• Address only one goal or outcome
• Develop outcomes that are observable
• Write outcomes that can be measured
• Clearly state time frame
• Consult with the client
• Be realistic

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Writing Measurable Goals

• To be measurable, outcomes need
• Subject the patient or some part of the patient
• Verb indicates the action the patient will
  perform
• Performance criteria describe in observable,
  measurable, terms the expected patient behavior
  or manifestation
• Target time specifies when the patient is
  expected to be able to achieve the outcome

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Outcome Examples

• Nursing Diagnosis
• Pain
• Outcome
• The patient will report a decrease in pain from
  an 8 on the pain scale to a 4 within 30 minutes

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Outcome Examples

• Nursing Diagnosis
• Imbalanced Nutrition More than body requirements
• Outcome
• By 5/5/07, patient will reach target weight of
  122 lbs

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Outcome Examples

• Nursing diagnosis
• Impaired mobility
• Outcome criteria
• Before dismissal, patient dismissal, patient will
  ambulate the length of the hallway independently

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Long Term vs. Short-Term Outcomes

• Long-term outcomes require a longer period of
  time
• Typically, long-term goals require more than a
  week to resolve
• Can be shorter if need be
• May be used as dismissal goals

• Short term goals can be hours to days
• Usually less than a week

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Helpful Verbs for Measurable Outcomes

• Define
• Prepare
• Identify
• Design
• List
• verbalize

• Describe
• Choose
• Explain
• Select apply
• demonstrate

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• Interventions

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Interventions

• 3 categories
• Nurse initiated interventions
• Physician initiated interventions
• Collaborative interventions

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Nursing Intervention

• Any treatment based on clinical judgment and
  knowledge, that a nurse performs to enhance
  patient outcomes
• An autonomous action based on scientific
  rationale that a nurse executes to benefit the
  patient in a predictable way related to the
  nursing diagnosis and projected outcomes

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Nursing Intervention

• Actions performed by the nurse to
• Monitor health status
• Reduce risks
• Resolve, prevent, or manage a problem
• Facilitate independence or assist with ADLs
• Promote optimal sense of physical, psychological
  and spiritual well being

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Using Evidenced Based Nursing Interventions

• Determine what nursing science suggests is the
  likelihood that this particular intervention will
  help mu patient realize his or her expected
  outcome?
• How can I tailor my interventions to increase the
  benefit to the patient?
• How likely is harm to result from this
  intervention and how can I minimize the risk?

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Identifying and Selecting Appropriate
Interventions

• Interventions must be directed toward altering
  the signs and symptoms associated with the
  diagnosis
• Outcomes are stated in measurable terms
• Use research to determine the effectiveness of
  this intervention
• Consider the possibility of the interaction with
  other interventions (cost and time involved)
• Is the intervention acceptable to the patient
• Can the intervention be carried out

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Well Written Interventions

• They must meet specific criteria
• They must be concise and describe a nursing
  action (answers who, what, where, when, and how)
• They must be dated when written and when the plan
  of care is reviewed
• Must be signed by the RN who assist with the
  implementation
• Use only accepted abreviations

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Examples of Interventions

• Offer the patient 60 mL of water or juice q 2
  hours while awake for a total minimum PO intake
  of 500 mL
• Assist patient to the bathroom for toileting z 2
  hours while awake

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Standardized Care Plans

• Prepared plans of care that identify the nursing
  diagnosis, outcomes, and related nursing
  interventions common to a specific population or
  health problem
• Nurse must individualize plan of care and direct
  time limitations

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Communicating the Plan of Care

• Does this plan of care adequately address the
  patients priorities today?
• Is this plan of care individualized to my
  patient?
• Can anyone reading the plan of care know how to
  intervene effectively with this patient?
• Does the patient understand and agree with the
  plan of care?

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Consultations

• Vital part of care planning
• Use when you need to seek another care giver for
  resources
• Always give unbiased information
• Be available for discussion
• Incorporate the recommendations into the care plan

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• Implementation

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Implementing

• Nursing actions planned in the previous step are
  carried out

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Implementation

• Purpose
• To assist the patient in achieving valued health
  outcomes
• To promote health
• to prevent disease and illness
• To restore health
• To facilitate coping with altered function

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Implementation

• Implementation includes
• performing, assisting, or directing the
  performance of activities of daily living,
• counseling and teaching the client or family,
• providing direct care.
• Delegating and supervising,
• Evaluating the work of staff members.
• Recording and exchanging information relevant to
  the clients continued health care

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Activities of Implementation

• Organize resources and care delivery
• Anticipate and prevent complications
• Communicate nursing interventions
• Reassess
• Review and revise the care plan

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Reassessment

• Provides a way for you to determine whether the
  proposed nursing action is still appropriate for
  the clients level of wellness
• It occurs each and every time you enter a
  patients room
• Ex. you plan to ambulate a patient following
  lunch. You enter the room and find the patient
  short of breath and increased fatigue, and must
  assist the patient back to bed.

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Revising the Care Plan

• Revise the assessment data to reflect the change
• Revise the nursing diagnosis
• Revise specific interventions

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Anticipate and Prevent Complications

• Know pathophysiology of disease process too help
  identify complications early
• Identify areas where assistance is needed
• Situations requiring additional personnel vary
• You may need additional knowledge
• Check facilities policies caring for patients

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Communication of Nursing Interventions

• Remember If it wasnt documented,, it wasnt
  done.
• Document all nursing interventions
• Document the patients response to the
  intervention

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Evaluation

• Critical thinking skills
• Five steps of objective evaluation
• Identify evaluative criteria and standards
• Collect data
• Interpret and summarize findings
• Document findings
• Terminate, continue, or revise the care plan

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• Evaluation

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Evaluation

• During this phase, the nurse and the patient
  together measure how well the patient has
  achieved the outcomes specified in the plan of
  care

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Purpose of Evaluation

• Collect data to evaluate nursing care
• examine patients response to nursing
  interventions
• Compare clients response with outcome criteria
• Appraise extent to which patient goals were met

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Purpose of Evaluation

• Appraise involvement and collaboration of others
  in healthcare decision
• Provide basis for revisions of care plan
• Monitor quality of nursing care and its effect on
  clients health status

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Evaluation Activities

• Review client goals and outcome criteria
• Collect data
• Measure goal attainment
• Record appraisal or measurement of goal
  attainment
• revise or modify nursing plan of care if
  indicated

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What to do After Evaluation?

• Discontinue the care plan to ensure other nurses
  will not unnecessarily continue an outdated plan
• Modify the care plan after reassessment, new
  nursing diagnosis, goal, and expected outcomes

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Skills Needed to Evaluate the Care Plan

• Knowledge of standards of care
• Knowledge of normal patient responses
• Ability to monitor effectiveness of nursing
  interventions
• Awareness of clinical research

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Care Plan Revision and Critical Thinking

• Discontinuing a care plan
• Modifying a care plan
• Reassessment
• Nursing diagnoses
• Goals and expected outcomes
• Interventions
• Appropriateness of care
• Correct application of interventions

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Nursing Care Plan