Nursing goals provide direction for planning interventions to achieve desired changes in clients. They specify expected outcomes of nursing care and serve as criteria for evaluating client progress and the effectiveness of interventions. Goals can be short-term, aimed at achieving objectives within a week, or long-term, aimed at objectives over weeks or months. Expected outcomes describe measurable behaviors clients are expected to achieve as a result of nursing goals and care. In the implementation phase, nurses perform interventions, reassess clients, prioritize care, organize resources, and record actions. Evaluation compares clients' responses to predetermined goals and outcomes to judge care effectiveness and determine if goals were met, the plan needs revision, or new problems have arisen.

1. NURSINGGOAL,
IMPLEMENTATION
AND
EVALUATION
By:-
DeveshwarP.D.

2. 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.

3. 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,

4. 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.

5. (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".

6. 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

7. 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

8. 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.

9. 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

10. 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.

11. 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?

12.  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

13. 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.