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CHAPTER 17

 PLANNING NURSING CARE

Mosby items and derived items © 2005 by Mosby, Inc.


Planning

 Establishing priorities-rank ND in
order of importance
– Urgency, safety, pt. desires,
treatments
 Determining client-centered goals
and outcomes
 Selecting nursing interventions

Mosby items and derived items © 2005 by Mosby, Inc.


Planning (cont'd)

 Priorities
– High- basic needs
– Intermediate-non-life threatening
– Low-may not be directly related to the
identified problem
– Reordering of priorities may be
needed at he beginning of each shift,
day, hourly,
Mosby items and derived items © 2005 by Mosby, Inc.
Planning (cont'd)

 Goals-provide a clear focus of


interventions needed
– Guidelines
– Time limited
 Short term-less than a week
 Long term- weeks or months

Mosby items and derived items © 2005 by Mosby, Inc.


Outcomes

– Progressive steps
 Specific measurable change in
status
– Linked to goals and nursing
diagnoses
 Specific Results achieve the General
goal
 Response/result to an intervention

– Guidelines-measurable
Mosby items and derived items © 2005 by Mosby, Inc.
Goals and Outcomes
 Guidelines
– Client centered- “Client will…”-
– Singular- one response only
– Observable- by nurse
– Measurable- be specific
– Time limited- must evaluate/reasonable
– Mutual-increases client
motivation/cooperation
– Realistic – can be achieved
Mosby items and derived items © 2005 by Mosby, Inc.
Mosby items and derived items © 2005 by Mosby, Inc.
Nursing Interventions

 Types
– Nurse initiated-autonomous
actions based on scientific
rationale
– Physician initiated-treats/manages
a medical diagnosis
– Collaborative-multiple health care
support

Mosby items and derived items © 2005 by Mosby, Inc.


Nursing Interventions (cont'd)

 Selection criteria
– Characteristics of nursing diagnosis-
altering/palliative?
– Expected outcomes-NIC/NOC
– Research base-EB/scientific principles
– Feasibility-personnel, time, cost
– Acceptability to the client-culture,
cooperation
– Nurse competencies-skills/knowledge

Mosby items and derived items © 2005 by Mosby, Inc.


Mosby items and derived items © 2005 by Mosby, Inc.
Care Plans
 CP include goals, outcomes, & specific nursing
actions
 Student-scientific rationale
 Institution-Kardex, computerized plans,
handwritten
 Community-based settings-client/family
 Critical pathways –integrated care for a
projected length of stay.
 Concept maps-Diagram of pt’s problems &
interventions showing relationship to one
another.
Mosby items and derived items © 2005 by Mosby, Inc.
Critical Pathways
 All disciplines develop an integrated
plan of care
 Maps the responsibility of each health
team member
 Monitors a client’s progress and
provides documentation
 Eliminates other forms of nursing
documentation except “charting by
exception”

Mosby items and derived items © 2005 by Mosby, Inc.


Mosby items and derived items © 2005 by Mosby, Inc.