The document discusses the nursing process and its various phases including planning, implementation, and evaluation. Planning involves prioritizing problems, formulating goals and outcomes, selecting interventions, and writing orders. Types of planning include initial, ongoing, and discharge planning. Guidelines are provided for setting priorities, outcomes, goals, and selecting interventions. Various formats for documenting the nursing care plan are also outlined.

1. The Nursing Process
Kalyani Mohanraj
Associate Professor
CCN

2. Planning
• Deliberate systematic phase of the nursing
process that involves problem solving and
decision making.
– Prioritizing problems (nursing diagnosis)
– Formulate goals/desired outcomes
– Select nursing interventions
– Write nursing orders

3. Types of Planning
• Initial planning
– Initiated soon after the initial assessment
– Comprehensive plan based on the data
• Ongoing planning/daily planning
– Individualize the initial plan
– Modified every shift
– Evaluate effectiveness of care
• Discharge planning
– Deals with care needs at home/hospice

4. Setting Priorities
• Establishing preferential sequence of
addressing nursing diagnoses and
interventions.
– High priority – life threatening conditions
– Medium priority – health threatening problems
– Low priority – minimum nursing interventions

5. Guide Lines to Set Priorities
• Abraham Maslow’s hierarchy of needs
• Clients preference
• Resources available
• Health beliefs and values of client
• Medical treatment plan

6. Setting Outcome Criteria
• They describe in observable client
responses what the nurse hopes to
achieve by implementing the nursing
interventions.
– Goals/desired outcome/objective/outcome
criteria/expected outcome all these terms are
used interchangeably.

7. Components of Goals
• Derived from the problem in the nursing
diagnoses
• It is stated as the opposite healthy client
response
• Must have the following clauses
– Subject – client/part or attribute of client
– Verb – action the client is expected to perform
– Conditions/modifiers – what/when/where/how
– Criterion of performance – standard/quality of
perfomance

8. Guide Lines for Writing Goals
• In terms of client responses
• Realistic/Achievable
• Address one nursing diagnosis
• Observable and measurable terms
• In collaboration with client

9. Samples
Nursing Diagnoses Goals/desired outcome
Impaired physical
mobility
Improved mobility -
Ambulates with crutches
by the end of this week
Ineffective airway
clearance
Effective airway
clearance – coughs and
deep breathes every two
hours

10. Subje
ct
Verb Conditions/
Modifiers
Criterion
Client Drinks 2500ml of fluid Daily (time)
Client Admini
sters
Correct insulin
dose
Using aseptic
technique (quality
standard)
Client Lists 3 hazards of
smoking
Accuracy

11. Nursing Interventions
• Actions taken by the nurse to achieve the
goals/expected outcome
• Focus on eliminating/reducing/modifying
the etiology of the nursing diagnosis
• If not possible, to treat the signs and
symptoms (defining characteristics)
– E.g.
• Anxiety related to hospitalization
• Pain related to surgical incision

12. Types of Nursing Interventions
• Independent interventions
– Activities the nurses are licensed to initiate on the
basis of their knowledge and skills
• Dependent interventions
– Activities carried out under the physicians’ orders or
supervision or according to specified routines
• Collaborative interventions
– With other health team members e.g.
physiotherapists, social workers dieticians etc.,

13. Criteria for selecting the
Interventions
• Safe and appropriate
• Achievable with the resources available
• Congruent with the client’s values and
beliefs
• Compatible with other therapies
• Based on nursing knowledge or
experience
• Within established standards of care

14. Formats of Care Plans
• Student care plans
• Computer generated care plans
– Standardized care plans
– Individualized care plans
• Concept maps
• Collaborative care plans/Critical path ways

15. Student care plan
Asse
ssme
nt
data
Nursi
ng
diagn
osis
Goals Plann
ing
Ratio
nale
Imple
ment
ation
Evalu
ation

16. Implementing
• The phase in which the nurse carries out
or delegates the planned interventions.
– Reassess the client
– Determine the need for assistance
– Implement the intervention
– Supervise delegated care
– Document nursing activities