How to Write Nursing (Client)
Outcomes
Gail Ladwig, RN, MSN, CHTP
Mosby items and derived items © 2011 by Mosby, Inc., an affiliate of Elsevier Inc.
Definition: Outcomes
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An individual, family, or community state,
behavior, or perception
Measured along a continuum
Uses a measurement scale
Uses a five-point Likert-type scale (Nursing
Outcomes Classification system: NOC)
Can be compared with a baseline over time
(Moorhead et al., 2008)
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Process
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Writing outcomes is part of the planning
phase of the nursing process.
Measurable outcomes are based on the
nursing diagnosis identified in the
assessment.
The client is involved.
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Process:
How to Write Measurable Outcomes
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Writing outcomes
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Step one
• Assessment
Step two
• Analyze assessment information
• Formulate nursing diagnosis
Step three
• Planning phase
• Write measurable outcomes based on nursing diagnosis
identified in the assessment
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Step One
Assessment
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Assessment and Nursing
Outcomes
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Comprehensive assessment leads to an
appropriate client outcome
Collection of information about the client:
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Holistic and detailed
 Supports critical thinking
 Determines problems and strengths
 Beginning and ongoing during all phases of the
nursing process
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Assessment
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Assess the client
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Perform a thorough holistic nursing assessment
Use the format adopted by the facility or
educational institution
Nursing assessments based on conceptual
models:
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Gordon's functional health patterns
Orem’s self-care model
Roy’s adaptation model
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Critical Thinking
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Look for normal and abnormal findings
Validate the data with the client
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“This is what I have noticed.”
“Does this describe how you feel?”
“Tell me more.”
“What can I do to help?”
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Immediate Reporting
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Report, record, and ACT on information that
requires immediate attention
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Some examples:
• Sharp, unrelenting pain
• Vital signs greatly deviated from normal
• Change in level of consciousness
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When in doubt, report and ACT
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Documentation
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Record all information obtained from the
health history and physical assessment.
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In some institutions, enter this information
into a computer.
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Confidentiality
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Share only information that is of benefit to
the nursing and medical team for planning
care.
Keep notes safe.
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Do not leave them at site of interview.
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Confidentiality (continued)
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The client’s name should appear only on
agency documents.
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Do not put client's name on any notes used for
classroom work.
Follow Health Insurance Portability and
Accountability Act (HIPAA) guidelines
regarding client confidentiality.
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Step Two
Nursing Diagnosis
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Analyze Assessment Information
Formulate Nursing Diagnosis
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Identify diagnosis
Identify related factors
List defining characteristics
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Nursing Diagnosis
Critical Thinking
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Analyze information
Based on client assessment information,
ask:
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Can a change occur with a nursing
intervention?
 Does it fit the NANDA definition?
 Are the defining characteristics in the
assessment?
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Use of Assessment Information
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Organize the information
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Identify patterns in the assessment
• Highlight problems
Make a list of all problems and potential problems
Group like problems together
Make initial inferences or impressions
Prioritize the problems
• Use Maslow’s hierarchy
Record and report the information
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Nursing Diagnosis List
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Select the appropriate nursing diagnosis for
the client from the NANDA-I approved list.
Nursing Diagnoses: Definitions and
Classification 2007-2008
Ackley/Ladwig, Nursing Diagnosis; EvidenceBased Guide to Planning Care; or online at
Evolve Care Plan Constructor.
List of 203 “approved nursing diagnoses”
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Critical Thinking Check
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The three-part diagnostic statement may be
referred to as the PES system:
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(P)roblem: nursing diagnosis label
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(E)tiology: “related to” phrase
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(S)ymptoms: defining characteristics
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Document Selected Nursing Diagnoses
on the Nursing Plan of Care
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Step Three
Planning: Nursing (Client) Outcomes
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Select Appropriate Outcomes
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Use NOC (Nursing Outcomes Classification)
-OR-
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Write outcome statement
(Both methods are included in Ackley/Ladwig, 2010,
and on the EVOLVE Care Plan Constructor site.)
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NOC Outcome Definition
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An individual, family, or community state, behavior, or
perception
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Measured along a continuum
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Response to a nursing intervention
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Group of indicators used to determine patient status
in relation to the outcome
(Moorhead et al., 2008)
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NOC Rating Scale
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Five-point Likert-type rating scale
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Used to evaluate progress toward achieving
the outcome
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Example:
NOC Rating Scale
(Nursing Outcomes Classification, 2000)
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Writing Outcomes Criteria if you are
not using the NOC list
Outcomes must be:
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Measurable
Related to a time frame
Client-centered
Attainable
Realistic
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Case Scenario
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Identify
Nursing diagnosis
Identify outcomes
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Sample Case Study
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A 73-year-old man has been admitted to the
unit with an admitting medical diagnosis of
COPD (chronic obstructive pulmonary
disease). He states that he has “difficulty
breathing when walking short distances” (RR
= 26). He also states that his “heart feels like
it is racing” at the same time (HR = 120). He
states that he is “tired all the time,” and while
talking to you, he is continually wringing his
hands and looking out the window.
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Select Appropriate
Nursing Diagnosis
Write Nursing
Diagnostic Statement
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Nursing Diagnostic Statement
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(P) Activity Intolerance
(E) Related to imbalance between oxygen
supply and demand
(S) Verbal report of fatigue
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Abnormal heart rate in response to activity
• “Heart feels like it is racing”
Exertional dyspnea
• “Difficulty breathing when walking short distances”
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Select Appropriate Outcomes
Write Appropriate Outcomes
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Critical Thinking:
Writing Outcomes
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What will the client change?
How will you know?
What information will be needed to
demonstrate the change?
What statement will the client make that
demonstrates change?
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Areas for Client
Change (Improvement)
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Activity intolerance
Verbal report of fatigue
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Abnormal heart rate in response to activity
• “Heart feels like it is racing”
Exertional dyspnea
• “Difficulty breathing when walking short distances”
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Client Outcomes for
Activity Intolerance
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Client will:
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Participate in prescribed physical activity with
appropriate increases in heart rate (HR), blood
pressure, and respiratory rate (RR).
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Demonstrate increased activity tolerance.
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Critical Thinking:
Measurable Outcomes
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What will be measured after the physical
activity?
How will it be measured?
How will activity tolerance be demonstrated?
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Demonstrate Measurable
Outcomes
Use the term “as evidenced by”
-OR Use the acronym “AEB”
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Measurable Outcomes:
AEB
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HR (>100 beats/min) and RR (>20
breaths/min) after activity
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Client will state subjective feelings after
activity
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Time Frame
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How often will nursing activity be done with
the client?
How long will the nursing activity be done
with the client?
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Time Frame:
Examples of outcomes associated
with nursing intervention of assisting
the client with increasing activity
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Assist the client to walk in the hall for 5
minutes.
Have the client perform this activity three
times a day.
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Individualized Outcomes
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How will the activity be individualized?
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Individualized Outcomes:
Example
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Client will walk in the hall for 5 minutes three
times a day.
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Attainable Outcomes
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What is reasonable and attainable for this
client?
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Attainable Outcomes:
Example
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Client will be able to walk in the hall three
times a day for 5 minutes.
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Realistic Outcomes
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What was client able to do before?
What changes would be possible for this
client?
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Realistic Outcomes:
Examples
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Client-reported fatigue
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“Heart racing after activity”
“Difficulty breathing when walking short distances”
Outcomes selected
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Walk for 5 minutes in the hall
Do this three times a day
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Individualized Outcome
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Activity tolerance improved
AEB
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Client will walk in the hall for 5 minutes three times a
day.
 Client’s HR will be >100 beats/min and RR will be >20
breaths/min after activity.
 Client will state positive subjective feelings after activity.
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Document Outcomes
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Document appropriate outcomes on the
nursing plan of care.
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Critical Thinking:
Evaluation of Outcomes
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Activity intolerance improved
AEB
Client states, “I do not feel tired all the time
anymore.”
 HR is 90 beats/min after walking in the hall for 5
minutes.
 Client states, “My heart isn’t racing anymore.”
 RR is 18 breaths/min after walking in hall for 5
minutes.
 Client states, “My breathing is easier.”
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Summary:
Writing Outcomes
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Perform assessment
Formulate nursing diagnosis
Begin planning
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Write measurable, realistic, attainable, clientfocused outcomes with a time frame based on the
nursing diagnosis identified in the assessment.
Involve the client.
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Complete the Nursing Process
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You can write outcomes
Great job!
What's next:
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Finish the plan
Deliver care
Don’t forget to document each step
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References
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Moorhead S, Johnson M, Maas M et al:
Nursing Outcomes Classification, ed. 4, St.
Louis, Mosby, 2008.
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