Chapter 14
Outcome Identification and
Planning
Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins
Goal of Outcome Identification
and Planning Step
• Establish priorities
• Identify and write expected patient outcomes
• Select evidence-based nursing interventions
• Communicate the plan of care
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Outcome Identification and Planning
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A Formal Plan of Care Allows
the Nurse To:
• Individualize care that maximizes outcome achievement
• Set priorities
• Facilitate communication among nursing personnel and
colleagues
• Promote continuity of high-quality, cost-effective care
• Coordinate care
• Evaluate patient response
• Create a record used for evaluation, research,
reimbursement, and legal reasons
• Promote nurse’s professional development
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Three Elements of
Comprehensive Planning
• Initial
• Ongoing
• Discharge
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Deriving Patient Goals/Outcomes and
Nursing Orders from Nursing Diagnoses
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Initial Planning
• Developed by the nurse who performs the nursing history
and physical assessment
• Addresses each problem listed in the prioritized nursing
diagnoses
• Identifies appropriate patient goals and related nursing
care
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Ongoing Planning
• Carried out by any nurse who interacts with patient
• Keeps the plan up to date
• States nursing diagnoses more clearly
• Develops new diagnoses
• Makes outcomes more realistic and develops new
outcomes as needed
• Identifies nursing interventions to accomplish patient
goals
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Discharge Planning
• Carried out by the nurse who worked most closely with
the patient
• Begins when the patient is admitted for treatment
• Uses teaching and counseling skills effectively to ensure
home-care behaviors are performed competently
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Prioritizing Nursing Diagnoses
• High priority—greatest threat to patient well-being
• Medium priority—non-threatening diagnoses
• Low priority—diagnoses not specifically related to current
health problem
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Maslow’s Hierarchy of Human Needs
• Physiologic needs
• Safety needs
• Love and belonging needs
• Self-esteem needs
• Self-actualization needs
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Long-Term vs. Short-Term Outcomes
• Long-term—requires a longer period to be achieved and
may be used as discharge goals
• Short-term—may be accomplished in a specified period
of time
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Categories of Outcomes
• Cognitive—describes increases in patient knowledge or
intellectual behaviors
• Psychomotor—describes patient’s achievement of new
skills
• Affective—describes changes in patient values, beliefs,
and attitudes
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Common Errors in Writing
Patient Outcomes
• Expressing patient outcome as nursing intervention
• Using verbs that are not observable or measurable
• Including more than one patient behavior or
manifestation in short-term outcomes
• Writing vague outcomes
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Parts of a Measurable Outcome
• Subject
• Verb
• Conditions
• Performance criteria
• Target time
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Types of Nursing Interventions
• Nurse-initiated—actions performed by a nurse without a
physician’s order
• Physician-initiated—actions initiated by a physician in
response to a medical diagnosis but carried out by a
nurse under doctor’s orders
• Collaborative—treatments initiated by other providers
and carried out by a nurse
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Actions Performed in Nurse-Initiated
Interventions (Alfaro, 2002)
• Monitor health status
• Reduce risks
• Resolve, prevent, or manage a problem
• Facilitate independence or assist with ADLs
• Promote optimum sense of physical, psychological, and
spiritual well-being
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Structured Care Methodologies
• Procedure—set of how to action steps
• Standard of care—description of acceptable level of
patient care
• Algorithm—set of steps used to make a decision
• Clinical practice guideline—statement outlining
appropriate practice for clinical condition or procedure
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Types of Institutional Plans of Care
• Kardex plans of care
• Computerized plans of care
• Case management plans of care
– Clinical pathways, care maps
• Student plans of care
• Concept map care plan
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Problems Related to Outcome
Identification and Planning
• Failure to involve patient
• Insufficient data collection
• Nursing diagnoses developed from inaccurate or
insufficient data
• Outcomes stated too broadly
• Outcomes derived from poorly developed nursing
diagnoses
• Failure to write nursing order clearly
• Nursing orders that do not solve problems
• Failure to update the plan of care
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Question
Which one of the following nursing actions would most
likely occur during the ongoing planning stage of the
comprehensive care plan?
A. The nurse collects new data and uses them to update
the plan and resolve health problems.
B. The nurse uses teaching and counseling skills to help
the patient carry out self-care behaviors at home.
C. The nurse who performs the admission nursing history
develops a patient care plan.
D. The nurse consults standardized care plans to identify
nursing diagnoses, outcomes, and interventions.
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Answer
Answer: A. The nurse collects new data and uses them to
update the plan and resolve health problems.
Rationale:
In the ongoing planning stage any nurse who interacts
with the patient updates the plan to facilitate the
resolution of health problems, manage risk factors, and
promote function.
Teaching and counseling are the key to discharge
planning.
The nurse performing the admission nursing history
consults standardized care plans during initial planning to
formulate the initial care plan.
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Question
Which of the following nursing diagnoses would most
likely be considered a high priority?
A. Disturbed personal identity
B. Impaired gas exchange
C. Risk for powerlessness
D. Activity intolerance
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Answer
Answer: B. Impaired gas exchange
Rationale:
Impaired gas exchange poses a threat to the patient’s
well-being.
Disturbed personal identity and risk for powerlessness
are non-life threatening and are ranked as medium
priorities.
Activity intolerance, if not specifically related to the
current health problem, is a low priority.
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Question
Which one of the following outcomes is an affective
outcome?
A. By 6/09/08, the patient will correctly demonstrate the
procedure for washing her newborn baby.
B. By 6/09/08, the patient will list three benefits of
eating a healthy diet.
C. By 6/09/08, the patient will use a walker to ambulate
the hallway.
D. By 6/09/08, the patient will verbalize valuing his
health enough to stop smoking.
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Answer
Answer: D. By 6/09/08, the patient will verbalize valuing
his health enough to stop smoking.
Rationale:
An affective outcome describes changes in patient
values, beliefs, and attitudes.
Answers A and B are psychomotor outcomes (learning a
new skill) and Answer C is a cognitive outcome (increase
in patient knowledge).
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Question
Tell whether the following statement is true or false.
A collaborative intervention is an intervention initiated by
a physician in response to a medical diagnosis but carried
out by a nurse in response to a physician’s order.
A. True
B. False
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Answer
Answer: B. False
A physician-initiated intervention is an intervention
initiated by a physician in response to a medical
diagnosis but carried out by a nurse in response to a
physician’s order.
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Question
Tell whether the following statement is true or false.
A protocol prescribes specific therapeutic interventions
for a clinical problem unique to a subgroup of patients
within the cohort.
A. True
B. False
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Answer
Answer: A. True
A protocol prescribes specific therapeutic interventions
for a clinical problem unique to a subgroup of patients
within the cohort.
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