Goals and Expected Outcomes

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