Nursing Process: Planning Expected Outcomes

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Nursing Process Planning Expected Outcomes

• George Ann Daniels, MS, RN

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The steps so far

• Nursing Assessment
• Nursing Diagnosis
• The nurse may arrive at several nursing diagnosis
• A ranking or prioritization must take place in
  order to decide which nursing diagnosis is the
  most important and should be worked on first

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Setting priorities for client care

• A common way to prioritize follows Maslows
  hierarchy of needs
• Physiological
• Safety/Security
• Love and belonging
• Self-esteem
• Self-actualization

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Criteria to address when setting priorities

• Clients health values and beliefs
• Clients priorities
• Resources available
• Urgency of health problem
• Medical treatment plan

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General Guidelines

• Basic survival needs must be met first
• Airway, breathing, circulation, nutrition
• What are some NDX in this area?
• Safety needs are next in order
• What are some NDX in this area?
• Once these areas are met, concerns regarding
  social, self-esteem, and self-actualization can
  be addressed
• What are some NDX in this area?

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More guidelines

• Actual diagnosis generally take priority over
  high risk diagnosis
• However, this can be situational
• Physiologic problems generally take priority over
  developmental problems
• Priorities should not be fixed, they change as
  the clients problem change

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Even more guidelines

• The nurse may have to deal with psychological
  problems before dealing with medium to low
  priority physiological problems
• FHPs are not listed in order of priority

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The next step

• After assessment, diagnosis, and prioritization,
  the nurse must work with the client to select an
  expected outcome for the diagnosis

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What is an expected outcome?

• A goal, objective, or outcome criteria related to
  a particular NDX
• Description of what the nurse client hope to
  achieve
• What the client should achieve in order to show
  that the particular health problem (NDX) is
  resolved
• Written statements of specific, measurable,
  realistic statements of goal attainment

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Purpose of EO

• Provide direction for planning nursing
  interventions
• Provide a time span for implementation
• Serve as criteria for evaluation of progress
• Enable nurse and client to determine when the
  problem has been resolved
• Help to motivate nurse and client and keep them
  on track

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Relationship of EO to NDX

• EO is derived from the nursing diagnosis
• Problem(P) is the unhealthy response
• Problem (P) tells what needs to be changed
• The EO should be the opposite of the problem
• Remember that the NDX and therefore the EO must
  be something realistic

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Questions to ask when developing EO

• What is the problem? (NDX)
• What is the opposite, healthy response?
• How will the client look or behave if the healthy
  response is achieved?
• What must the client do to demonstrate that the
  problem has been resolved?

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Components of the EO

• Subject
• Client
• Verb
• Choose a verb that measures success
• will
• Will walk
• Condition or modifiers
• E.g. with walker

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• Criterion of desired performance
• E.g. 50 feet
• Target/specific time
• E.g. three time a day
• Client will walk with walker 50 feet three times
  a day.
• Client will ambulate to feet every shift.en

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Guidelines for writing EO

• Write in terms of client behavior
• Begin with The client will
• Make appropriate for the chosen NDX
• Make the EO realistic
• Select an expected outcome which is important to
  the client
• Check for compatibility with other health care
  professionals

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• Avoid certain statements
• Enable, allow, let, permit
• If the outcome is accomplished will the NDX be
  resolved
• Write EO using observable, measurable terms

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More guidelines

• The expected outcome should be associated with a
  single diagnosis
• Include a time frame for each EO
• Determine the EO in collaboration with the client

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Measurement criteria for ANA

• ANA standard III Outcome identification The
  nurse identifies expected outcomes individualized
  to the client
• 1. Outcomes are derived from the diagnosis
• 2. Outcomes are mutually formulated with the
  client and healthcare provider, when possible and
  appropriate

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• 3. Outcomes are culturally appropriate and
  realistic in relation to the clients present and
  potential capabilities.
• 4. Outcomes are attainable in relation to
  resources available to the client.
• 5. Outcomes include a time estimate for
  attainment
• 6. Outcomes provide direction for continuity of
  care
• 7. Outcomes are documented as measurable goals