Learning Outcomes Chapter 13 Fundamentals PDF

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Learning Outcomes: Chapter 13 - Planning

1) Identify activities that occur in the planning process. Activities that occur during the planning process include: decision making and problem solving. In planning, the nurse refers to the patient's assessment data and diagnostic statements for direction in formulating patient goals and designing the nursing interventions required to prevent, reduce, or eliminate the patients health problems. The planning process may involve a nursing intervention which is any treatment based upon clinical judgement and knowledge that a nurse performs to enhance patient outcomes. Types of planning include the initial planning, ongoing planning, and discharge planning.

2) Compare and contrast initial planning, ongoing planning, and discharge planning. Initial planning is formulated usually by the nurse who conducted the admission assessment. He/she will develop the initial comprehensive plan of care. The same nurse has the benefit of seeing the patient’s body language and can also gather some intuitive kinds of information that is not available solely from the written database. Ongoing planning is formulated by all the nurses who work with the patient. Each nurse who works with the patient can evaluate and obtain new information about the patients responses to care and can individualize the initial care plan further. Ongoing planning occurs at the beginning of a shift as the nurse plans the care to be given that day. Discharge planning is the process of anticipating and planning for needs after discharge, which is a crucial part of the comprehensive health care plan and should be addressed in each patient’s care plan. Discharge planning begins at first client contact and involves

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comprehensive and ongoing assessment to obtain information about the patient’s ongoing needs.

3) Explain how standards of care and predeveloped care plans can be individualized and used in creating a comprehensive nursing care plan. Standard of care describe nursing actions for clients with similar medical conditions rather than individuals, and they describe achievable rather than the ideal nursing care. Standards of care do not include medical interventions and are not part of a patient's care plan, but they may be referred to in the plan. They are written from the perspective of the nurses responsibilities. Standardized care plans are predeveloped care guides for the nursing care of a client who had a need that arises frequently in the agency. They are written from the perspective of what care the patient can expect. Standardized care plans become a permanent part of a patient’s medical records once they are discharged.

4) Identify essential guidelines for writing nursing care plans. ● Date and sign the plan. ● Use category headings; “Nursing Diagnoses”, “Goals/Desired Outcomes” ● Use standardized/approved medical or English symbols and keywords rather than complete sentences to communicate you ideas unless agency policy dictates otherwise. ● Be specific ● Refer to procedure books or other sources of information rather than including all the steps on a written plan.

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● Tailor the plan to the unique characteristics of the patient by ensuring that the patients choices, such as preferences about the times of care and the methods used, are included. ● Ensure that the nursing plan incorporates preventive and health maintenance aspects as well as restorative ones. ● Ensure that the plan contains ongoing assessment of the patient. ● Include collaborative and coordination activities in the plan. ● Include plans for the patient's discharge and home care needs.

5) Identify factors that the nurse must consider when setting priorities. Nurses will identify priorities with a patient to categorize which nursing diagnoses should go first, second, third, etc… A nurse may group up the diagnosis as, “high priority, medium priority, and low priority.” Life-threatening problems will always be set as high priority, health-threatening problems will be set as medium priority, and problems that require minimal needs will be set as low priority. Some A nurse must consider a variety of factors when assigning priorities: ● Patient’s health values and beliefs ● Patients priorities ● Resources available to the nurse and patient ● Urgency of the health problem ● Medical treatment plan 6) Discuss the Nursing Outcomes Classifications, including an explanation of how to use the outcomes and indicators in care planning.

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NOC is a taxonomy developed for describing patient outcomes that respond to nursing interventions. The taxonomy has over 385 outcomes but all belong to one of the 7 domains and a class within the domain. The NOC outcomes are broadly stated and conceptual. They are variable concepts, meaning that patient’s responses to interventions can be evaluated over time. An outcome must be made more specific by identifying indicators that apply to a particular patient. Indicators are stated in neutral terms, and each outcome includes a five-point scale that is used to rate a patient’s status on each indicator. When using a NOC taxonomy to write a desired outcome on a care plan, the nurse writes the label, the indicators that apply to the particular patient, the NOC rating at initiation (initial client status), and the outcome target (location on the measuring scale that desires for each indicator)

7) State the purposes of establishing client goals/desired outcomes. ● Provide direction for planning nursing interventions ● Serve a criteria for evaluating patient progress ● Enable the client and nurse to determine when the problems have been resolved ● Help motivate the patient and nurse by providing a sense of achievement 8) Identify guidelines for writing goals/desired outcomes. ● Write goals and outcomes in terms of patient responses, not nursing activities. ● Be sure that desired are realistic for the patient’s capability, limitations, and designated time span. ● Ensure that the goals and desired outcomes are compatible with the therapies of other professionals.

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● Make sure that each goal is derived from on;y one nursing diagnosis. ● Use observable, measurable terms for outcomes. ● Make sure that the patient considers the goals/desired outcomes important and values them. 9) Describe the process of selecting and choosing nursing interventions. Nursing interventions and activities are the actions that nurse performs to achieve patient goals. The specific intervention chosen should focus on eliminating or reducing the etiology of the nursing diagnosis. When unable to change the etiologic factors, the nurse chooses interventions to treat signs and symptoms or the defining characteristics in NANDA International terminology. Choosing nursing interventions should include: Safe and appropriate for the individuals age, health, and condition, achievable with the resources available, congruent with patients values, beliefs, and culture, congruent with other therapies, based on nursing knowledge and experience or knowledge from relevant sciences, within established standards of care as determined by state laws, professional organizations, accredited organizations, and the policies of the institution.

10) Discuss the Nursing Interventions Classification, including an explanation of how to use the interventions and activities in care planning. A taxonomy of nursing interventions referred to as the Nursing Interventions Classification (NIC). NIC is described as, standardized language to describe the interventions that nurses perform. This taxonomy consists of three levels: level 1, domains ; level 2, classes; level 3, interventions. More than 542 interventions have been developed. Each broadly stated intervention includes a label(name), a definition, and a list of activities that outlines the key

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actions of nurses in carrying out interventions. All NIC interventions have been linked to NANDA nursing diagnostic labels. The nurse can look up a client's nursing diagnosis to see which nursing interventions are suggested...