PLANNING
Once the nursing diagnoses
have been identified, the planning component of the nursing process begins.
This phase entails the following:
·
Assigning priorities to the nursing diagnoses and
collabo-rative problems
·
Specifying expected outcomes
·
Specifying the immediate, intermediate, and
long-term goals of nursing action
·
Identifying specific nursing interventions
appropriate for attaining the outcomes
·
Identifying interdependent interventions
·
Documenting the nursing diagnoses, collaborative
prob-lems, expected outcomes, nursing goals, and nursing in-terventions on the
plan of nursing care
·
Communicating to appropriate personnel any
assessment data that point to health needs that can best be met by other
members of the health care team
Assigning priorities to the nursing diagnoses and collaborative problems is a joint effort by the nurse and the patient or family members. Any disagreement about priorities is resolved in a way that is mutually acceptable. Consideration must be given to the urgency of the problems, with the most critical problems receiv-ing the highest priority. Maslow’s hierarchy of needs provides a useful framework for prioritizing problems, with importance being given first to physical needs; once those lower-level needs are met, higher-level needs can be addressed.
Expected outcomes of the
nursing interventions are stated in terms of the patient’s behaviors and the
time period in which they are to be achieved, as well as any special
circumstances related to achiev-ing the outcome (Smith-Temple & Johnson,
2002). These out-comes must be realistic and measurable. The Nursing-Sensitive
Outcomes Classification (NOC) (Chart 3-8) and standard out-come criteria for
people with specific health problems estab-lished by health care agencies are
resources for identifying appropriate expected outcomes. These outcomes can be
associ-ated with nursing diagnoses and interventions and can be used when
appropriate (Aquilino & Keenan, 2000). However, NOC may need to be adapted
to establish realistic criteria for the spe-cific patient involved.
The expected outcomes
that define the desired behavior of the patient will be used to measure to what
extent progress toward resolving the problem has been made. The expected
outcomes also serve as the basis for evaluating the effectiveness of the
nurs-ing interventions and for deciding whether additional nursing care is
needed or whether the plan of care needs to be revised.
After the priorities of
the nursing diagnoses and expected out-comes have been established, the
immediate, intermediate, and long-term goals and the nursing actions
appropriate for attaining the goals are identified. The patient and his or her
family are included in establishing goals for the nursing actions. Im-mediate
goals are those that can be reached within a short pe-riod. Intermediate and
long-term goals require a longer time to be achieved and usually involve
preventing complications and other health problems and promoting self-care and
rehabilita-tion. For example, goals for a patient with diabetes and a nurs-ing
diagnosis of deficient knowledge related
to the prescribed diet may be stated as follows:
Immediate goal:
Demonstrates oral intake and tolerance of 1500-calorie diabetic diet spaced in
three meals and one snack per day
Intermediate goal: Plans
meals for 1 week based on diabetic exchange list
Long-term goal: Adheres
to prescribed diabetic diet
In planning appropriate
nursing actions to achieve the desired goals and outcomes, the nurse, with
input from the patient and significant others, identifies individualized
interventions based on the patient’s circumstances and preferences that will
address each outcome. Interventions should identify the activities needed and
who will carry them out. Determination of interdiscipli-nary activities is made
in collaboration with other health care providers as needed.
The nurse identifies and plans patient teaching and return
demonstrations as needed to assist the patient in learning self-care activities
to be performed. Planned interventions should be ethi-cal and appropriate to
the patient’s culture, age, and gender. Standardized interventions, such as
those found on institutional care plans or in the Nursing Interventions
Classification (NIC)
Chart 3-9 describes the NIC
system and provides an ex-ample of an NIC system intervention. It is important
to individ-ualize prewritten interventions to promote optimal effectiveness for
each patient.
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