Nursing Process
Planning
Defined
• Establishing client centered goals
• Identifying expected client outcomes
• Establishing nursing interventions
Prioritizing
• Put the Nursing Diagnoses in order of
importance
– High – life-threatening if not treated
– Intermediate – non-emergent or non-life threatening
– Low – may affect future well-being
• May need to be re-evaluated and re-ordered as
time progresses
• Involve the patient when possible
Goals & Outcomes
• Specific statements of behavior or responses
• Serve as focal point for interventions
– Selection of appropriate ones
– Evaluation of effectiveness
Goals
• Must be:
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Specific
Observable
Singular
Measurable
Time-limited
Also . . .
• Client-centered
– Focused on optimum level of wellness &
independence
– Agreeable with patient (and family)
– Realistically based on patient needs & resources
– Preventative as well as restorative
More . . .
• Short-term
– Usually expected to be accomplished in about
1 week
• Long-term
– Achieved over a period of weeks or months
Expected Outcomes
• Desired response of client’s condition in any
area
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Physiological
Social
Emotional
Developmental
spiritual
E. O.s are . . .
• Measurable
• Specific
• Proof of the effectiveness and efficiency of
interventions
Writing E. O.s
• Several for EACH diagnosis and goal
• Written sequentially
– Often one builds on another, like taking steps
• Given time frames
– When should this be accomplished?
• In terms that allow measurement
– Not “less” pain, but “pain rating decreased to 3 on
1-10 scale”
The Plan of Care
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Focuses on the patient
Utilizes research-based knowledge and practice
Involves other health care disciplines
Includes the patient’s family
Draws on community resources
scenario
• 74 yom, s/p R humerus fx. DC’d to home
tomorrow. Widowed; only child lives 3 hr away.
• Goals?
• Outcomes?
• Resources?
Which Interventions?
• Apply critical thinking to determine which will
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Assist patient to achieve goals
Are pertinent to the patient’s situation
Meet the standards of care
Fulfill the objectives stated in goal and expected
outcomes
Intervention Types
• Nurse-initiated
– Does not require physician order
• Physician-initiated
– Does require physician (or NP) order
• Collaborative
– May require physician order
Nurse-initiated
Autonomous actions
• Based on scientific rationale
• Within the nurse’s own scope of practice
• Predictable benefit to patient-centered goal
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ADLs
Health education
Health promotion
Counseling
Physician-initiated
• Requires order by physician or nurse practitioner
working in collaboration with physician
• Allows nurse to fit the order into the patientcentered plan
• Nurse must still act within the appropriate scope
of practice
Collaborative
• Acting as coordinator between various health
care teams
• Ensure appropriate, timely interventions
Nursing responsibility
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ALWAYS stay within the scope of practice
ALWAYS be a patient advocate
ALWAYS check orders for correctness
Select interventions that are appropriate for each
patient’s individual plan of care
Nursing Care Plan
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A written plan
Focuses on clinical care
Aids in thorough, accurate delivery of care
Identify and coordinate resources
Organizes nursing information
Student Care Plans
• Divided into columns to facilitate understanding
of the various aspects of the plan
• Scientific rationale is required to assist students
to understand the “why” of what is planned
Institutional Care Plans
• Often utilize Kardex system
– Brief synopsis of care plan
– Usually kept at nurses’ station
– Updated daily
• Computerized
– Standard form
– Easy to follow
– Prompts attention to each system
Institutional Care Plans
• Community-based tools
– Includes family and outside resources in the
assessment
– Focus on family education to provide many of the
implementations
• Critical pathways
– All disciplines of health care team work together to
develop a generic tool that can be applied to most
patients with a similar diagnosis (example hip fx)
Concept Map
• Flowchart style
• Uses diagrams to show relationship between
client problems and interventions
• Can be used throughout the day to assist
students in noting how various problems,
treatments, nursing diagnoses and plans
interrealate
Consultation
• When an identified problem cannot be solved
with available knowledge and resources
• 1st- identify the problem
• 2nd– find the appropriate consultant
• 3rd- share pertinent data with consultant
• 4th- stick to the facts, no opinions
• 5th- discuss consultant’s recommendations
• 6th- incorporate 5 into plan of care