Nursing Process- Planning

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Nursing Process Step 3-Planning
BY RENI PRIMA GUSTY, SK.p,M.Kes
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POKOK BAHASAN

• Mendiskusikan pentingnya memprioritas diagnosa
  keperawatan
• Mendiskusikan Intervensi perencanaan yang
  berfokus pada klien yang dibuat perawat dan
  kolaborasi tim kesehatan lainnya
• Mediskusikan peran mandiri kolaborasi perawat
  dalam intervensi.
• Mendiskusikan peran perawa dalam kaitan dengan
  tidakan penceahan terjadinya eror intervensi
  yang dilakukan sendiri maupun team kesehatan
• Mendemonstrasikan kemampuan menulis tujuan dan
  kriteria hasil pada contoh kasus

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Definition

• According to (Potter, Perry, Ross-Kerr Wood,
  2006), planning involves establishing client
  goals and expected outcomes and selecting nursing
  interventions (p.198).

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Planning

• Determine desired outcomes and plan specific
  nursing interventions to achieve them
• This is done with the patient (and family/whanau
  as appropriate)

Outcome
Goal
Objective

Something that follows from an action result
consequence
Of or relating to a goal or aim
The aim or object towards which an endeavour is
directed

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Planning

• It is third stage of the nursing process.
• Interventions are selected to solve the clients
  health needs and to attain goals and outcomes.
• Decision-making and problem solving skills are
  required

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Planning

• Planning require
• review of the literature
• collaborates with client, family and other
  health team members

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Planning

• Effective planning depends on the quality and
  comprehensiveness of the assessment
• Determine the problems
• Establish the risks and priorities- How ill are
  they?
• Can they breath adequately (safe airway?)
• Are they in pain? (physical/ psychological)
• Can they maintain a safe environment? If not why
  not? (Drugs, drink, mental or psychological
  problem?)
• Non-compliance with medical advice

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Priorities

• Priorities are required to help the nurse
  determine nursing interventions when a client has
  a number of problems.
• Because often clients have a number of problems,
  the client and nurse can decide urgency of the
  problem, nature of treatment and relationship
  between diagnoses.

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General Guidelines for Setting Priorities

1. Take care of immediate
   life-threatening issues.
2. Safety issues.
3. Patient-identified issues.
4. Nurse-identified priorities based on the overall
   picture, the patient as a whole person, and
   availability of time and resources.

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Nurse Identified Priorities

• Composite of all patients strengths and health
  concerns.
• Moral and ethical issues.
• Time, resources, and setting.
• Hierarchy of needs.
• Interdisciplinary planning.

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Priorities

• Priorities may be high, intermediate or low.
  Depends on the urgency of the situation.
• High priority if untreated could be harmful to
  the client Ex Decreased cardiac output would be
  high priority
• Intermediate would be considered non urgent, non
  life-threatening. Ex. sore throat
• Low priority may not be connected to the direct
  illness or prognosis but may affect the
  individuals future well-being. Ex. dressing
  change in the ambulatory setting.
• (See Priority Setting Potter et
  al., 2006 p.199)

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Client Goals

• Broad statements that represent the health
  state/level of self care for the client
• Should be realistic and based on the clients
  needs
• Should also aim to prevent and rehabilitate the
  client
• Develop collaboratively between client and nurse
• Note if the client is cognitively or physically
  impaired, the healthcare team works on behalf of
  the client

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Client Goals

• Client Goals can be short or long term goals
• Short-Term Goal- objective is to be attained
  within a short time i.e. a week
• Ex client will achieve comfort within 24 hours
  post surgery
• Long-Term Goal- achieve over a longer period
  of time i.e weeks or months.
• Ex client will follow post-op activity
  restriction for 1 month

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Short-Term Goals

• Outcomes achievable in a few days or 1 week
• Developed form the problem portion of the
  diagnostic statement
• Client-centered
• Measurable
• Realistic
• Accompanied by a target date

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Long-Term Goals

• Desirable outcomes that take weeks or months to
  accomplish for clients with chronic health
  problems

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Expected Outcomes

• Expected Outcomes are developed on the basis of
  the nursing diagnoses and client goals.
• Also known as evaluative criteria
• Desired behaviours or responses that the nurse
  and where applicable, the client expect to occur
  as a result of the interventions taken by the
  nurse
• Enable the nurse and client evaluate whether the
  pan of care has been successful in meeting the
  goal(s)

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Outcomes need to be
S pecific What will happen? M
easurable How will you know it has
happened? A chievable Can it happen? R
ealistic Is it realistic to expect it
to happen? T imeframed When will it
happen?
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Sample outcome statements

• Wound will show 50 granulation within 2 weeks
• Wound will show evidence of epithelialisation
  within 3 weeks
• Comfort will be maintained during episode of
  care, as stated by patient
• Oedema will be reduced within 3 weeks with the
  use of compression bandaging
• Exudate will be contained and strike through
  prevented until infection resolved

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Expected Outcomes

• Client Centered -reflect client behavior
  response
• Singular - address only one behavior or specify
  one outcome
• Measurable to the extent possible-the desired
  outcome can be determined or not
• Client specific-where possible the degree of
  proficiency required for the outcome to be
  considered achieved by the client is stated
• Time limited- where appropriate, the time frame
  for an expected response should be included
• Mutual- where possible, the client should be in
  agreement with the outcomes to ensure a greater
  chance of being successful
• Realistic -must be attainable

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Examples of Expected Outcomes

• Client will explain reasons for activity
  restriction by day of discharge.
• Client will sit up in chair 20 minutes without
  abnormal heart rate by day 2.
• See handout for examples of verbs to help
  formulate client outcomes (p.4)

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Goals and Expected Outcomes

• Critical thinking is required
• Nursing knowledge coupled with experience will
  help the nurse determine the goal
• A client centered goal is specific and able to be
  measured and reflects the persons highest level
  of wellness.
• Goal needs to lead to prevention.

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Nursing Interventions

• Nursing interventions are decided after goals and
  expected outcomes are confirmed.
• Assist the client to move form his/her present
  state of health to that which is identified in
  the goal and outcomes.

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Interventions should

• Monitor, prevent manage health
  problems/concerns risk factors
• Promote optimum function, independence sense of
  wellbeing
• Achieve expected outcomes

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Interventions

• Direct interventions actions performed
  through interaction with clients.
• Indirect interventions actions performed
  away from the client, on behalf of
  a client or group of clients.

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Selecting Nursing Interventions

• Planning the measures that the client and nurse
  will use to accomplish identified goals involves
  critical thinking.
• Nursing interventions are directed at eliminating
  the etiologies.

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Selecting an intervention

• The nurse selects strategies based on the
  knowledge that certain nursing actions produce
  desired effects.
• Nursing interventions must be safe, within the
  legal scope of nursing practice, and compatible
  with medical orders.

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Communicating The Plan

• The nurse shares the plan of care with nursing
  team members, the client, and clients family.
• The plan is a permanent part of the record.

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Types of Planned Client Focused Interventions

• Nurse-Initiated Interventions
• Physician-Initiated Interventions
• Collaborative Interventions

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Nurse-Initiated Interventions

• Nurse-Initiated Interventions are the
  independent response of the nurse to the clients
  health care requirements. They are automatic
  reactions based on scientific rationale that are
  expected to benefit the client
• No order required from the physician
• Ex. Interventions to increase persons knowledge
  of nutrition- Discuss Canadas food guide

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Physician-Initiated Interventions

• Physician-Initiated Interventions-interventions
  based on physicians response to treat the
  client.
• Nurses carry out physicians orders
• Requires expertise in technological nursing
  knowledge and nursing responsibility
• Ex. Give a medication or change a dressing

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Collaborative Interventions

• Collaborative Interventions-therapies that
  require the knowledge and skills of a number of
  professionals to provide care to a client.
• Ex. Client with a stroke-requires multiple
  interventions from nursing, physiotherapy etc.

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Client Interventions

• Client Interventions- are interventions carried
  out by the client to meet his/her goals and
  expected outcomes.
• Also remember that client interventions are not
  mirror nursing interventions
• Ex Client attends the fitness program three
  times per week

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Writing Interventions

• Interventions must be written in the following
  format verb-noun-modifier
• Ex Administer Tylenol 325 mg po for temperature
  gt than 38.5
• Note Interventions are action verbs

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Independent and Interdependent Role of the Nurse

• A nurse thinks clearly and does not select
  interventions randomly
• Nurse considers a number of factors such as
  characteristics of the nursing diagnosis,
  expected outcomes, nursing knowledge, feasibility
  of the intervention, acceptability to the client,
  and nursing competencies.
• Collaboration with the client, family and other
  members of the health team is necessary
• Review previous clinical experiences and
  priorities to select the best nursing
  interventions

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Prevention of Intervention Errors

• Nurse initiated, physician initiated and
  collaborative interventions require the nurse to
  us critical thinking and decision making.
• Nurse must decide if the interventions are
  appropriate for the client
• Important to recognize errors such as a
  physicians order, incorrect therapy, etc.

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And Always on the Move
Assess
Evaluate
Diagnose
Implement
Plan
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Summary

• Prioritization of nursing diagnosis
• Discussion on the types of planned client focused
  interventions
• Discussion on the independent and interdependent
  role of the nurse in relation to interventions
  directed by other health care professionals.
• Discussion on the role of the nurse as it relates
  to the prevention of intervention errors
• Demonstrate ability to write short and long term
  goals and expected client outcomes based on
  simulated client situations

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Thank you
Thank you