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NURSINGGOAL,
IMPLEMENTATION
AND
EVALUATION
By:-
DeveshwarP.D.
NursingGoal
NursingGoal:-A specificexpectedoutcomeofnursing
interventionasrelatedtotheestablishednursingdiagnosis.
PURPOSEOFGOAL
•Providedirectionforplanningnursinginterventionsthatwillachievethe
desiredchangesintheclient.Ideasforinterventionscomemoreeasilyif
thegoalsstateclearlyandspecificallywhatthenursehopestoachieve.
•Provideatimespanforplannedactivities.
•Serveascriteria forevaluation ofclientprogresstowardsderived
outcome.Although developed in the planning step ofthe nursing
process,theexpectedoutcomesserveascriteriaforjudgingnursing
interventionsandclientprogressintheevaluationstep.
•Enabletheclientandnursetodeterminewhentheproblem hasbeen
resolved.
•Helpmotivatetheclientandnursebyprovidingasenseofachievement.
TYPESOFGOALS
Dependingupontheclient'sneedsandthenatureofnursingservices,
thegoalsareoftwotypes.
A.SHORTTERMGOALS
Shortterm goalisanobjectivethatisexpectedtoachieveina
shorterperiodusuallylessthanaweek.Shortterm goalsarethedirection
fortheimmediatenursingcareplan.
Example:
NursingDiagnosis:Ineffectiveairwayclearancerelatedtotheeffectofsedation.
Goalwillbetheabsenceofabnormallungsoundswithintwodays.Short
termgoalsarethesteppingstonestoreachlongtermgoals.
B.LONGTERMGOALS
Alongterm goalisanobjectivethatisexpectedtobeachievedovera
longerperiodoftimeusuallyoverweeksormonths.Thesecanbecarried
outafterdischarge.Example
Longtermgoalforaclientwithanineffectiveairwayclearancemaybe
to"remainfreeofupperrespiratoryinfectionfor6months."Longterm
goalsareusedindischargeplanningandlongterm goalsareusedfor
patientsreceivingmentalhealthservices.
Throughgoals,thenurseisabletosetgoalswithclientthathelpto
increaseunderstandingsaboutplanofcareandgiveincentivetobothclient
andnurse.
Ultimatelygoalleadstothedevelopmentofexpectedoutcomes.
EXPECTEDOUTCOME
Expectedoutcomedescribethebehaviourthepatientisexpectedto
achieve.Itisthespecificstepbystepobjectivethatleadstotheattainment
ofthegoalandtheresolutionoftheetiologyforthenursingdiagnosis.
Outcomeisameasurablechangeoftheclient'sstatusinresponsetothe
nursingcare.
Forexample:IftheNursingdiagnosisispotentialimpairedskinintegrity
relatedtoirritatingstomaldischarge.
The expected outcome is the "skin around stoma free ofredness,
excoriationthroughoutofhospitalization.
NursingGoal
(1)Describewhatthenurseexpectstodoforaccomplishingclient
goal.
Example:toteachtheclienthowtododeepbreathingexercise.
(2)Givesdirection/pathwaytoselectnursingactivities.
(3)Usuallydevelopedmentallymayormaynotbedocumented.
(4)Mayincludenurse'sownpersonalobjectiveforlearning.
ClientOutcomes
(1) Describewhattheclientisexpectedtoattainasaresultofnursing
goal.Example:Willdemonstratedeepbreathingexercise.
(2) Givesdirectiontoclientactivities.
(3) Clearlydocumentedonnursingcareplan.
(4) Includesonlyclientorientedobjectives.
(5)
SELECTIONOFINTERVENTION
Whenselectinginterventionsforaclient,thenurse,usingclinicaldecision
makingskills,deliberatesaboutsixfactorstheyare
(i) Characteristics ofthe Nursing Diagnosis:Interventions mustbe
directedtowardsalteringtheetiologicalfactorsorsignsandsymptoms
associatedwiththediagnosticlevel.
Interventionsmaybedirectedtowardsalteringoreliminatingriskfactors,
whichareassociated"riskfor"nursingdiagnosis.
(ii) Expectedoutcomes:Outcomesarestatedinmeasurabletermsand
usedtoevaluatetheeffectivenessoftheinterventions.
(iii) Research Base:Review clinical nursing research related to
diagnosticlabelandclientproblem.
Reviewarticlesthatdescribetheutilizationofresearchfindingsinsimilar
clinicalsituationsandsettings.
(iv) Feasibility:Interactionofnursinginterventionswithtreatmentbeing
providedbyotherhealthprofessional'sfeasibilityincludes.
Cost:isinterventionbothclinicallyeffectiveandcostefficient?
Time:Aretimeandpersonnelresourceswellmanaged?
(V)Acceptabilitytotheclient:Treatmentplanmustbesuitablewithclient's
goalsandhealthcarevalues.
(Vi).Mutuallydecidednursinggoals:Clientmusthaverequiredselfcare
abilitiesorha+éliåhÉcrs6nawhocanassistwithhealthcare.
IMPLEMENTATION
Definitions: Campbell (1990) stated, "A
nursing intervention is a single nursing
actiontreatment, procedure or activity-
designed to achieve an outcome to a
diagnosis-nursingormedicalforwhichthe
nurseisaccountable".
PURPOSEOFIMPLEMENTATION
Toprovidetechnicalnursingcare.
Toprovidetherapeuticnursingcare.
Tohelpclienttoachieveoptimum levelof
health.
ACTIVITIESOFIMPLEMENTATION
Implementationphaseofnursingprocess
includes reassessment, setting priorities,
organizing resources, performing nursing
interventionandrecordingaction.
1.Reassess:Whenevernursemeetsclient,
shewillassesstheclient'sconditionwhich
maychangequickly.Reassessmentinthis
phaseensuresthattheplannedinterventions
arestillrelevant/appropriateornot.
2.SettingPriorities:Prioritiesshouldbeset
basedonreassessment.Ultimately,nursing
careplanneedtobemodified.Nurseranks
the nursing problems based on following
factors:
Client'scondition
Newinformationfromreassessment
Timeandresourcesavailable
Feedbackfrom client/family/healthcare
staff
Nurse's knowledge and experience in
settingpriority.
3. Organizing Resources: Means
arrangementofequipmentandpersonnelfor
providingbestnursingcaretoclint.
4. Performing Nursing Interventions:-
Nursinginterventionsarethoseactivities
whichareperformedbythenurseandthe
clienttopreventillness(oritscomplications)
andtopromote,maintainorrestorehealth.
Followingarethenursinginterventionswhich
anursecanperform:-
Directlyperforminganactivityforaclient.
eg.Giving bed bath,mouth care,vital
monitoringofunconsciousclient.
Assistingtheclienttoperform anactivity
himself.eg.Assistingclientindoingrange
ofmotionexercise.
Supervising the clientwho performs an
activityhimselfeg.Crutchwalking,achild
clientdoingpainting.
5.Recording:
As soon as nursing interventions are
carriedout,theyarerecordedintheclient's
healthrecord.Recordingthenursingcare/
activity/actionisalegalrequirementsofall
healthcaresystems.
EVALUATION
DEFINITION:-
Evaluationisdefinedasthejudgementofthe
effectivenessofnursingcaretomeetclient
goals.In this phase,nurse compares the
client in behavioral responses with
predetermined client goals and outcome
criteria.(Craven1996)
PURPOSESOFEVALUATION
 Collectdata formaking judgements
aboutnursingcaredelivered.
 Determineclient'sbehavioralresponse
tonursinginterventions.
 Compare the client's response with
predeterminedoutcomecriteria.
 Appraisetheextenttowhichclient's
goalswereattained.
 Appraise / appreciate the
involvementofclient/familymemberin
healthcaredecision.
 Assessthecollaborationofclientand
healthcareteammembers.
 Identifytheerrorsinihe•planofcare.
 Monitorthequalityo/nursingcare.
EVALUATIONPHASES
Evaluationphaseofnursingprocessinvolves
followingactivities:
1) Review theclientgoalsandout-come
criteria:Revisingtheclientgoalsandout-
come criteria of nursing plan is very
importanttomeasurethegoalattainment.
Nursewilljudgetheattainmentofgoalby
measuringtheoutcomecriteriaofplanning
phase.
2) Collectdata:Subjectiveandobjective
dataiscollectedsystematicallytoevaluate
thegoalattainmentandoutcomeofcare.
Collection of data is also helpfulto
determine the effectiveness ofnursing
careprovided.Sourcesforcollectingthe
subjectivedataareclient,familymembers,
nursing personnel, other health team
members.
3) Measure Goal Attainment: After
collectingthedata,nurseformsapicture
regardingclienesbehavioralresponseto
the predetermined outcome criteria i.e.
Nursecomparestheclient'sactionwiththe
predetermined goals in planning phase.
Shewilldothefollowingactivities.
 Makealistofgoalsthatwerealready
setinplanningphase,eg:Clientwilltake
500mlliquid/fluidintakeinhalfanhour.
 Nursewillassesswhattheclientisable
todoinrelationtothegoals.eg:Can
clienttakefluidorallybyself.
 Nursewillcompare:
 Cantheclientdoeveryactivitysetforth
bygoal?
 Howwelldoesheperform activitiesset
forthbygoal?
Hasthegoalbeenpartiallyorcompletely
met?
4)ReviseormodifytheNursingPlanof
Care
Revision includes complete
reassessment of the Nursing
Process.
Nursing diagnosis, that were
resolved,neednointerventioncanbe
omitted.
Gatherdata to determine ifnew
problemisarisen.
Lookforallthefactorsaffectinggoal
attainmentdescribedinfigure.
Examinethelistofnursingdiagnosis
andsetnewpriorities.
Reassess the accuracy and
appropriateness of the framed
diagnosis.
Makesgoalsrealistic,accurate.
Examine the intervention thatare
identified, change or delete the
inappropriateones.
Don'tforgettoinvolveclient/family
members/health team members
whileprovidingcare.
Incorporate factors leading to
successfulattainmentofgoal.
Doreevaluationagain.

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