During the outcome identification and planning steps of the nursing process, the nurse works in partnership with the patient and family to do 4 things. List them
-establish priorities
-identify and write expected patient outcomes
-select evidence-based nursing interventions
-communicate the plan of nursing care
Patient outcome
expected conclusion to a patient health problem
Difference between goal and outcome
outcome is used to describe goals achieved
The words 'goal', 'objective', and 'outcome' are often used....
interchangeably
What is the primary purpose of the outcome identification and planning step of the nursing process?
to design a plan of care for and with the patient that, once implemented, results in the prevention, reduction, or resolution of patient health problems and the attainment of the patient's health expectations, as identified in the pt. outcomes.
List the nursing's broad aims
promote wellness
prevent disease and illness
promote recovery
facilitate coping with altered functioning
This is a common problem in all healthcare settings
failure to update the plan of care
What is the chief purpose of initial planning?
it addresses each problem listed in the prioritized nursing diagnoses and identifies appropriate pt. goals and the related nursing care
What is the chief purpose of ongoing planning?
to keep the plan up to date to facilitate the resolution of health problems, manage risk factors, and promote function.
Discharge planning is best carried out by..
the nurse who worked most closely with the patient + a social worker
Maslow's Hierarchy of Human Needs
1. physiologic needs
2. safety needs
3. love and belonging needs
4. self-esteem needs
5. self-actualization needs
Outcomes are derived from the _________ of the nursing diagnosis
problem statement
This is the first comprehensive standardized language used to describe the patient outcomes that are responsive to nursing intervention
The nursing outcomes classification
Cognitive outcomes
describe increases in pt. knowledge or intellectual behavior
Psychomotor outcomes
describes the pt's achievement of new skills
Affective outcomes
Describes changes in pt's values, beliefs, and attitudes
This directs the nurse to derive culturally appropriate expected outcomes from the diagnoses
The ANA standards of practice act
To be measurable, outcomes should have what 5 things?
-subject
-verb
-conditions
-performance criteria
-target timing
Verbs to be avoided when writing goals
know, understand, learn, become aware
Verbs that helpful when writing outcomes are ______ and _____.
observable and measurable
Evaluative statements include...
a statement about achievement of the desired outcome and the actual patient behavior as evidence supporting the statement
Nursing intervention
any treatment based on clinical judgment and knowledge that a nurse performs to enhance pt. outcomes
Nursing interventions are...
nurse-initiated, physician initiated, and collaborative initiated
Nurse initiated intervention
an autonomous action based on a scientific rationale that a nurse executes to benefit the pt in a predictable way related to the nursing diagnosis and projected outcomes
Nurse initiated interventions do not require..
a physician's order
This suggests the nursing interventions
etiology
Comprehensive nursing interventions specify....
-what observations need to be made and how often
-what nursing interventions need to be done
-what teaching, counseling, and advocacy needs patients and families have
Standard of care
a description of an acceptable level of patient care or professional practice
Algorithm
a set of steps that approximates the decision process of an expert clinician and is used to make decisions
Who writes the plan of nursing care? When is it done?
the nurse who best knows the patient and is recorded on the day the patient presents for treatment and care according to agency policy
Clinical pathways
tools used to communicate the standardized, interdisciplinary plan of care for patients
What is the purpose of implementing?
to assist the patient in achieving valued health outcomes: promote health, prevent disease and illness, restore health, and facilitate coping with altered functioning
During this step, the nurse continues to collect data and to modify the plan of care as needed
implementing
Whereas other healthcare pros focus on selected aspects of the patient's treatment regimen, nurses are concerned with...
how the patient is responding to the plan of care in general
These people are specialists in the role of care coordinator
nursing care managers
Nursing intervention
any treatment based upon clinical judgment and knowledge that a nurse performs to enhance patient/client outcomes
Protocols
written plans that detail the nursing activities to be expected in specific situations
This is the nurse's most important task and should receive top priority
the plan of care
Nurses modify their nursing actions according to what 3 things?
1. changing ability and willingness to participate in the plan of care
2. previous responses to nursing interventions and progress toward goal/outcome achievement
3. developmental stage and psychosocial bg
Nurse variables that influence the implementation of the plan of care
1. levels of expertise
2. creativity
3. willingness to provide care
4. available time
Unlicensed assistive personnel (UAPs) are also known by what name?
nurse-extenders
What is the purpose of evaluation?
to allow the patient's achievement of expected outcomes to direct future nurse-patient interactions
This is the most important act of evaluation performed by nurses
evaluating outcome achievement with the patient
5 classic elements of evaluation of care
1. identifying evaluative criteria and standards
2. collecting data to determine whether these criteria and standards are met
3. interpreting and summarizing findings
4. documenting your judgment
5. terminating, continuing, or modifying the plan
What is evaluative criteria? Evaluative criteria is also the ____ of the evaluation.
the patient outcomes developed during the planning step
core
What are the functions of evaluation?
Determining whether these outcomes have been or are being met and then identifying the appropriate nursing response are the functions of evaluation.
Criteria
measurable qualities, attributes, or characteristics that specify skills, knowledge, or health states. They describe acceptable levels of performance by stating the expected behaviors of the nurse or the patient
Define Standards. How are they established?
the levels of performance accepted and expected by the nursing staff or other health-team members.
They are established by authority, custom, or consent
Whereas the nurse collects data in the nursing assessment to identify patient health problems, the data collected in the evaluation step are used......
to determine whether the identified health problems have been or are being resolved through outcome achievement.
This can determine whether affective outcomes have been achieved.
Observation of patient behavior and conversation
The most common mistake nurses make when evaluating in acute care settings is...
waiting until the day the patient is to be discharged before evaluating outcome achievement
After the data have been collected and interpreted to determine patient outcome achievement, the nurse makes and documents a judgment summarizing the findings. What is this called?
evaluative statement
What does the evaluative statement entail?
includes a decision about how well the outcome was met, along with patient data or behaviors that support this decision
The following four steps are crucial in improving performance
1. Discover a problem.
2. Plan a strategy using indicators.
3. Implement a change.
4. Assess the change; if the outcome is not met, plan a new strategy.
quality-assurance programs
Specially designed programs that promote excellence in nursing
The ANA model directs attention to three essential components of quality care. List them.
structure, process, and outcome
Quality improvement
the commitment and approach used to continuously improve every process in every part of an organization, with the intent of meeting and exceeding customer expectations and outcomes
Quality improvement vs. quality assurance
unlike quality assurance, quality improvement is internally driven, focuses on patient care rather than organizational structure, focuses on processes rather than individuals, and has no end points.
Concurrent evaluation
direct observation of nursing care, patient interviews, and chart review to determine whether the specified evaluative criteria are met.
Retrospective evaluation
postdischarge questionnaires, patient interviews (by telephone or face to face), or chart review (nursing audit) to collect data
Factors to consider before delegating any nursing intervention
1. pt's condition
2. complexity of activity
3. potential for harm
4. degree of problem solving and innovation to carry out the task
5. level of intervention required with the patient
6. capabilities of the person being delegated to
7. availability of the