1 / 44

Goals and Expected Outcomes

Goals and Expected Outcomes. NPN 105 Joyce Smith, RN, BSN. Initial Planning . Developed by the nurse who performs the admission nursing history and the physical assessment

Télécharger la présentation

Goals and Expected Outcomes

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.


Presentation Transcript

  1. Goals and Expected Outcomes NPN 105 Joyce Smith, RN, BSN

  2. 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

  3. 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

  4. 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 Maslow’s Hierarchy?

  5. Establishing Priorities • Because basic needs must be met before a person can focus on higher ones, patient needs may be prioritized according to Maslow’s Hierarchy • Physiologic • Safety • Love and belonging • Self esteem • Self actualization

  6. 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

  7. Goals of Care • Must be patient centered • Must reflect the patient’s 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 ---- “

  8. 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

  9. 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

  10. 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

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

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

  13. 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 Long –Term vs. Short-Term Outcomes

  14. Define Prepare Identify Design List verbalize Describe Choose Explain Select apply demonstrate Helpful Verbs for Measurable Outcomes

  15. Interventions

  16. Interventions • 3 categories • Nurse initiated interventions • Physician initiated interventions • Collaborative interventions

  17. 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

  18. Nursing Intervention • Actions performed by the nurse to: • Monitor health status • Reduce risks • Resolve, prevent, or manage a problem • Facilitate independence or assist with ADL’s • Promote optimal sense of physical, psychological and spiritual well being

  19. 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?

  20. 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

  21. 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

  22. 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

  23. 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

  24. Communicating the Plan of Care • Does this plan of care adequately address the patient’s 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?

  25. 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

  26. Implementation

  27. Implementing • Nursing actions planned in the previous step are carried out

  28. 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

  29. 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 client’s continued health care

  30. Activities of Implementation • Organize resources and care delivery • Anticipate and prevent complications • Communicate nursing interventions • Reassess • Review and revise the care plan

  31. Reassessment • Provides a way for you to determine whether the proposed nursing action is still appropriate for the client’s 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.

  32. Revising the Care Plan • Revise the assessment data to reflect the change • Revise the nursing diagnosis • Revise specific interventions

  33. 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

  34. Communication of Nursing Interventions • Remember: If it wasn’t documented,, it wasn’t done. • Document all nursing interventions • Document the patient’s response to the intervention

  35. 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

  36. Evaluation

  37. 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

  38. Purpose of Evaluation • Collect data to evaluate nursing care • examine patient’s response to nursing interventions • Compare client’s response with outcome criteria • Appraise extent to which patient goals were met

  39. 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 client’s health status

  40. 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

  41. 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

  42. 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

  43. 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

  44. Nursing Care Plan

More Related