1. Outcome Identification and Planning
Chapter 13
Outcome Identification and Planning

2. 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.
Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

3. 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.
Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

4. 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)
Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

5. 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.
Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

6. 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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7. Process of Outcome Identification and Planning
Identifying Expected Outcomes
Outcomes provide guidelines for individualized nursing interventions.
Outcome statements establish evaluation criteria.
Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

8. 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
Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

9. 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.
Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

10. 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.
Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

11. Outcome Indicators/Criteria
Standards used to evaluate whether the behavior demonstrated indicates accomplishment of the outcome
Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

12. Outcome Indicators/Criteria
A time limit
Amount of activity
Important characteristics of performance
Description of the performance to be followed
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13. Outcome Indicators/Criteria
Conditions
Provide clarity
May include experiences the client is expected to have before performing the task
Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

14. 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.
Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

15. Outcome Indicators/Criteria
Time Frame
Setting long-term outcomes is important in successful discharge planning.
Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

16. 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.
Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

17. 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.
Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

18. 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.
Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

19. 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.
Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

20. 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.
Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

21. 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.
Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

22. 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
Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

23. 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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24. 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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25. Categories of Nursing Interventions
Interdependent Nursing Interventions
Collaboration
Consultation
Dependent Nursing Interventions
Require an order from another health care professional.
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26. Types of Nursing Interventions
(A) independent
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27. Types of Nursing Interventions
(B) interdependent
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28. Types of Nursing Interventions
(C) dependent
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29. 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.
Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

30. 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.
Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

31. 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.
Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

32. 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.
Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

33. 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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34. Plan of Care Types of Care Plans Standardized Institutional
Student-Oriented
Computerized
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35. Types of Care Plans
The standardized care plan is a preplanned, preprinted guide for the nursing care of client groups with common needs.
Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

36. 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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37. Types of Care Plans
Computerized care plans can be either standardized or individualized.
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38. 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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39. 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.
Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.