2. Planning
Third step of the Nursing Process, begins with
the first client contact and continues until
discharge.
Nurse formulate goals to help the client with
their problems based on assessment data and
diagnostic statements
Expected outcomes are identified
Interventions (nursing orders) are selected to
aid the client reach these goals.
The end product of this phase is a client care
plan.
4. TYPES OF PLANNING
Initial Planning:
Initiated on admission after initial
assessment
The nurse conduct the admission
assessment develop initial
comprehensive plan of care
Ongoing planning:
Done by all nurses who work with the
client
Individualization of initial plan 4
5. 5
The nurse carries out daily planning
(ongoing planning) for the following
Purposes:
♣To determine whether the client’s
health status has changed
♣To set priorities for the clients care
during the shift.
♣To decide which problems to focus
on during the shift
6. 6
Discharge Planning
Process of anticipating and planning for
needs after discharge
Clients usually discharged still needing
care
Begins at first client contact and
Involves comprehensive and ongoing
assessment to obtain information about
the client ongoing needs
7. DEVELOPING NURSING CARE
PLANS
Informal nursing care plan: is
strategy for action that exists in
nursing mind
e.g. the nurse may think “Mr. (x) is
tired. I will need to reinforce her
teaching after she is rested”
Formal nursing care plan: is a written
or computerized guide that organizes
information about the client’s care.
Benefit of this type is that it provides 7
8. Formal nursing care plan
Standardized care plan: is
formal plan that specifies
nursing care for groups of
clients with common needs
(e.g., all clients with
myocardial infarction)
Individualized care plan: is
tailored to meet the unique
needs of specific client - needs
8
10. Documents included in a
complete CP
Problem list
Kardex cards for client profile, basic
need…etc
Special discharge plan
Special teaching plan
Policies and procedures
Protocols
Standards of care
Individualized NCP.
10
11. Formats for Nursing Care Plans
Care plan formats differ according
to health agency:
It might be organized in 4 columns
(one for diagnosis, one for
goalsdesired outcomes, one for
nursing intervention, the last for
evaluation)
Or organized in 3 columns ( one for
diagnosis, one for goals and
11
13. 13
Student care plans: detailed,
handwritten, column for rationale of
interventions, citation for literatures
used.
Concept maps ( mind map ): may
containing of boxes or circles that
connected by arrows or lines, it’s a tool
for student learning of a disease.
Computerized care plans: created and
stored NCP, it can be standardized and
individualized
Multidisciplinary (collaborative) care
16. Guidelines for Writing Nursing Care Plans:
Date and sign the plan
Date: for evaluation, review, and future
planning
Signature: demonstrate accountability to
the
Use category headings: “ Nursing
Diagnosis”, “goals/Desired
outcomes”,…etc
Use standardized medical or English 16
17. 17
Be specific: expected timing (e.g., dressing
q shift vs q 12h)
Refer to procedure books or other
source of information: do not include all
the steps (e.g., see unit procedure book for
tracheostomy care)
Tailor the plan to unique characteristics
of the client by ensuring that the clients
choices, such as preferences about the
times of care and methods included
Ensure that the nursing plan incorporates
preventive and health maintenance aspect as
well as restorative one (active assist in ROM:
prevent joint contracture & maintain muscle
strength)
Ensure that the plan contains intervention for
19. 1. Setting Priorities
Is the process of establishing a
preferential sequence for addressing
nursing diagnoses and interventions
◦High priority (life-threatening as loss of
respiratory or cardiac function)
◦Medium priority (health-threatening such
as acute illnesses )
◦Low priority (developmental needs)
Nurses use Maslow’s hierarchy of
needs when setting priorities (physiologic
19
20.
21. Factors to Consider When Setting
Priorities
Client’s health values and beliefs
Client’s priorities
Resources available to the nurse and client
Urgency of the health problem
Medical treatment plan
21
22. 2. Establishing Client Goals/
Desired Outcomes
Goals/desired outcome:
describe, in terms of observable
client responses, what the
nurse hopes to achieve by
implementing the nursing
interventions
( Expected outcome, outcome
criterion, objective, predicted
outcomes are interchangeable 22
23. Goal ( broad statement): e.g. to
maintain fluid volume balance
Desired outcome (specific): drink
3L of fluids by the end of the day
*The care plan must include both
goals and desired outcomes. Some
time they are combined (e.g.
improved nutritional status as
evidenced by weight gain of 5 kg by
April 25)
*E.g. (2): Nsg Dx: Impaired physical
mobility
Goal (broad): improved mobility 23
24. Types of Goals
Short term goals:
- useful for clients who require health
care for a short time
- For patient who are frustrated by long-
term goals
- Acute care settings where the nurse
spent most of there time on client
immediate need
E.g., “ client will raise right arm to
shoulder height by Friday” short-
term goal 24
25. Goals are patient-centered and
SMART
Specific
Measurable
Attainable
Relevant
Time Bound
Pt will walk 50 ft.
Pt will eat 75% of meal
Pt will be OOB 2-4hrs
Pt will maintain HR<100
Pt will state pain level is acceptable 6 (0-10)
27. Non measurable verbs (Do not use)
Know
Understand
Appreciate
Think
Accept
feel
27
28. Components of Outcomes
Subject: who is the person expected to
achieve the outcome?
Verb: what actions must the person take to
achieve the outcome?
Condition: under what circumstances is the
person to perform the actions?
Performance criteria: how well is the person
to perform the actions?
Target time: by when is the person expected
to be able to perform the actions?
31. 31
Example
Mr. Jamal will walk with a use of
crutches at least to the end of the
hall and back by Friday
Subject: Mr. Jamal
Verb: Will Walk
Condition: with the use of crutches
Performance criteria at least to the
end of the
hall and back
Target time: by Friday
32. Guidelines for Writing Goals/ Desired outcomes
Write goals+ outcome in terms of
client response, not nurse
actions
start with : the client will
e.g., client will drink 100cc of water
per hour (client behavior) √
e.g., maintain client hydration
(nursing action) X
Be sure that desired outcome are
realistic for client capabilities or
limitation 32
33. 33
Ensure that Goals & outcome are
compatible with therapy of other
professional
e.g., Dr order for pt: bed rest
→the Outcome : “will increase the time
spent out of bed by 15 minutes/day”
is not compatible with the Dr.
order
Make sure each goal is derived
from only one nursing diagnosis
34. 34
Use observable, measurable
terms for outcomes
(↑) daily exercise→ incorrect
Make sure the client considers the
goal/ desired outcomes
important and values them.
E.g. self esteem → must involve
choices that are best made by the
client or in collaboration with the
client
35. Identify if the statement are written
correctly
Gaber will know the four basic food groups by
3/30/08
X
The verb is not measurable
√ Gaber will list the four basic food groups by
3/30/08
35
36. Identify if the statement are written
correctly
After 1 hour Mrs. G will verbalize decrease
level of pain from 10/10 to 3/10.
√
Subject: Mrs G
Verb: will verbalize
Condition: decrease level of pain
Performance criteria: from 10/10 to 3/10
Target time: after 1 hour
36
37. Identify if the statement are written
correctly
Mrs. S will demonstrate how to use her walker
unassisted by Saturday
√
Subject: Mrs. S
Verb: will demonstrate
Condition; how to use her walker
Performance criteria unassisted
Target time: by Saturday
37
38. Actions nurse performs to
achieve goals/desired outcomes
Focus on eliminating or
reducing etiology of nursing
diagnosis
OR
Treat signs and symptoms and
defining characteristics
38
3. Selecting nursing
interventions
39. Nursing Interventions
Direct care
◦ Intervention performed through
interaction with the client
Indirect care
◦ Intervention performed away from
but on behalf of client
39
40. Types of Nursing Interventions
Independent interventions
Those activities nurses are licensed to
initiate (i.e., no order needed: physical
care, ongoing assessment, elevate
edematous legs)
Dependent interventions
Activities carried out under physician’s orders
or supervision, or according to specified
routines (Administering of medications)
Collaborative interventions
◦ Actions nurse carries out in collaboration
with other health team members
◦ Reflect overlapping responsibilities of health 40
41. Criteria for Choosing Appropriate Interventions
Safe and appropriate for the client’s
age, health, and condition
Achievable with the resources
available
Congruent with the client’s values,
beliefs, and culture
Congruent with other therapies
Based on nursing knowledge and
experience or knowledge from
41
42. Writing nursing intervention
ΩInstructions for specific individualized
activities the nurse perform to help the
client meet established health care
goals
ΩComponents of nursing intervention:
≈ Date
≈ Action verb
≈ Content area
≈ The time element
≈ Signature 42
43. Relationship of nursing intervention
to problem status
Depending on the type of client
problem, the nurse writes
interventions for:
Observation ( observe redness
over sacrum q4hr’s)
Prevention (turn, cough, and
deep breathing exercise q2hr’
Treatment order (teach patient
deep breathing and coughing
exercise) 43
