NURSING PLANNING - THIRD COMPONENT

The Nursing Planning in the nursing process involves decision making and problem solving. In planning nurse formulates the client / patient goals (short term and long term) and decision strategies to prevent, reduce, or eliminate the problem.

Nursing Planning and Outcome Identification

Planning and outcome identification are the third component of the nursing process and include both establishing guidelines for the proposed course of nursing action to resolve the nursing diagnoses and developing the client’s plan of care. Planning Process involve three main steps

• Priority setting
• Goal setting
• Selecting strategies

Priority setting
In this process preferential orders for nursing strategies are made. Life threading problem such as loss of the respiratory or cardiac functions are called high priority.

Goal setting

The goal may be short term or long term. In acute cases, immediate needs most goals are short term goal.

Selecting strategies

 In this nursing strategies are selected to achieve the goal.

Clinically, nursing planning occurs in three phases: initial, ongoing, and discharge.

Initial planning: involves development of a preliminary plan of care by the nurse who performs the admission assessment and gathers the comprehensive admission assessment data. Progressively shorter stays in the hospital make initial planning very important to ensure resolution of the problems.

Ongoing planning: updates the client’s plan of care. New information about the client is collected and evaluated and revisions made to the plan of care.

Discharge planning: involves anticipation of and planning for the client’s needs after discharge.

The planning phase involves several tasks:

• Prioritizing the nursing diagnoses
• Identifying and writing client-centered long- and short-term goals and outcomes (outcome identification)
• Identifying specific nursing interventions
• Recording the entire nursing care plan in the client’s record
• Prioritizing the Nursing Diagnoses
• Involves deciding which diagnoses are the most important and require attention first.

Maslow’s hierarchy of needs is one of the most common methods of selecting priorities. After basic physiological needs (e.g., respiration, nutrition, temperature, hydration, and elimination) are met to some degree, the nurse can then consider needs on the next level of the hierarchy (e.g., safe environment, stable living condition, affection, and self-worth) and so on up the hierarchy until all the nursing diagnoses have been prioritized.

1. First-level priority problems (immediate):

• Airway problems.
• Breathing problems.
• Signs (vital sign problems).

2. Second-level priority problems (immediate, after treatment for first level problems is initiated):

• Mental status change.
• Acute pain.
• Acute urinary elimination problems.
• Abnormal lab values.
• Risks of infection, safety, or security (for client or others).

3. Third-level priority problems:

• Health problems that do not fit in the above categories.

Identifying Outcomes

Outcome identification includes establishing goals and expected outcomes, which together provide guidelines for individualized nursing interventions and establish evaluation criteria to measure the effectiveness of the nursing care plan. Goals a goal is an aim, intent, or end. Goals are broad statements that describe the desired or intended change in the client’s condition or behavior. Client-centered goals are established in collaboration with the client when possible. Goal statements refer to the diagnostic label (or problem statement) of the nursing diagnosis. Client-centered goals ensure that nursing care is individualized and focused on the client.

A short-term goal is a statement that profiles the desired resolution of the nursing diagnosis over a short period of time, usually a few hours or days (less than a week).

A long-term goal is a statement that profiles the desired resolution of the nursing diagnosis over a longer period of time, usually weeks or months. It focuses on the problem part of the nursing diagnosis. 

Expected Outcomes After the goals have been established, the expected outcomes can be identified based on those goals. An expected outcome is a detailed, specific statement describing the methods to be used to achieve the goal.

Identifying Specific Nursing Interventions

A nursing intervention is an action performed by the nurse that helps the client achieve the results specified by the goals and expected outcomes. Nursing interventions refer directly to the related factors or the risk factors in nursing diagnoses. Nursing interventions that reduce or remove the related factors and risk factors resolve or prevent the problem. There may be a number of nursing interventions for each nursing diagnosis. Nursing interventions are stated in specific terms. Examples of nursing interventions are as follows:

• Assist client to turn, cough, and deep breathe.
• Weigh client each day at the same time.

Categories of Nursing Interventions:

Nursing interventions are classified into one of three categories: independent, interdependent, or dependent.

1. Independent nursing interventions: are initiated by the nurse and do not require direction or an order from another health care professional.

Example: elevating a client’s extremity having edema.

2. Interdependent nursing interventions: are implemented collaboratively by the nurse in conjunction with other health care professionals. For example, the nurse may assist a client to perform an exercise taught by the physical therapist.

3. Dependent nursing interventions: require an order from a physician or another health care professional. Example: Administration of a medication.

Dependent nursing interventions must be governed by appropriate knowledge and judgment.

Recording the Nursing Care Plan

Nursing care plans usually include components such as assessment, nursing diagnoses, goals and expected outcomes, and nursing interventions. The care plan is begun on the day of admission and is continually updated until discharge. Care plans may be standardized, institutional, or computerized.

The standardized care plan, is a printed guide for the care of clients with common needs. This care plan usually follows the nursing process format. It may be individualized by including handwritten notes for unusual problems.

Institutional nursing care plans, are concise documents that become a part of the client’s medical record after discharge. This care plan may simply include the nursing diagnoses, nursing interventions, and evaluation.

Now a days computers can generate both standardized and individualized nursing care plans.

THE NURSING PLANNING - THIRD COMPONENT OF NURSING PROCESS | POST RN BSN Nursing Resources