PLANNING

“The nurse develops

a plan of care that
prescribes interventions
to attain expected outcomes”
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 4 Main Purposes of the Plan of Care

1. Promotes communication among caregivers to

promote continuity of care.
2. Directs care and documentation.
3. Creates a record that can later be used for
evaluation, research & legal reasons.
4. Provides documentation of health care needs for
insurance reimbursement purposes.

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 Activities of the PLANNING PHASE

▪ Attending to urgent priorities

▪ Clarifying expected outcomes
▪ Deciding which problems must be prescribed
▪ Determining Individualized Nursing
interventions
▪ Making sure the plan is adequately recorded

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 ACTIVITY OF THE PLANNING PHASE

1. SETTING PRIORITIES

▪ it serves the purpose of ordering the

delivery of nursing care so that the
more important or life threatening
problems are treated before less
critical problems are treated

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 BASIC PRINCIPLES:
ATTENDING TO URGENT PRIORITIES
1. Choose a method of assigning priorities
and use it consistently.
➢ example: some nurses use the ABC method
➢ make sure that the patient has NO THREATS to his
A → AIRWAY
➢ B → BREATHING
➢ C → CIRCULATION

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 BASIC PRINCIPLES:
ATTENDING TO URGENT PRIORITIES
2. Maslow’s Hierarchy of Needs
Priority 1→ Physiologic Needs – problems with breathing, circulation,
nutrition, hydration, elimination, temperature regulation, physical
comfort
Priority 2 → Safety and Security -- environmental hazards, fear
Priority 3 → Love & Belonging -- isolation, loss of loved one
Priority 4 → Self Esteem -- inability to perform normal activities
Priority 5 → Personal Goals -- Threat to the ability to achieve personal
goals

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 BASIC PRINCIPLES:
ATTENDING TO URGENT PRIORITIES

3. Problems usually present in a cluster – study the

relationships among the problems to determine
major priorities.
❑ Assign high priority to problems that contribute to
other problems.
example: if someone has chest pain and difficulty of
breathing, pain management is a high priority because pain
causes increased stress and oxygen demand

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 Guidelines for Setting Priorities
Maslow’s hierarchy of basic needs
1.
can guide the selection of high-priority
problems.
2. Focus on the problems the patient feels
are most important if this priority does
not interfere with medical treatment.

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 Guidelines for Setting Priorities

3. Consider the patient’s culture, values and

beliefs when setting priorities.

4. Consider the effect of potential problems

when setting priorities

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 Guidelines for Setting Priorities

5. Consider costs, resources available,

personnel and time needed to plan &
treat each of the patient’s identified
problems
6. Consider state laws, hospital policy
statements, and outcome criteria
established for the particular setting.

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 ACTIVITY OF THE PLANNING PHASE

2. CLARIFYING OR ESTABLISHING
OUTCOMES (RESULTS)
Patient Outcome
→the desired result of nursing care;
→that which one hopes to achieve with
the patient and which is designed to
prevent, remedy or lessen the problem
identified in the nursing diagnosis

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 OUTCOME
IDENTIFICATION
“The nurse identifies expected
outcomes individualized
to the patient”
 OUTCOME IDENTIFICATION
▪ the nurse develops outcomes for
the patient to achieve showing an
optimum or improved level of
functioning in the problem areas
identified in the nursing diagnoses

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A shift from GOALS & OBJECTIVES to
OUTCOMES

▪ GOALS & OBJECTIVES

▪ refers to the INTENT
▪ What you intend to do

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 A shift from GOALS & OBJECTIVES to
OUTCOMES

▪ OUTCOMES
▪ refers to RESULTS
▪ what you expect the patient to
be able to do

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▪ Expected Outcomes → describes what will
be observed in the patient after care is done
to show the benefits of nursing care.
3 MAIN PURPOSES
1. They are the “measuring sticks”
for the plan of care.
2. They direct interventions.
3. They are motivating factors.

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 PRINCIPLE OF PATIENT- CENTERED OUTCOMES

1. Outcome describe the specific benefits

you expect to see in the patient after
care has been given.
SHORT TERM OUTCOME – describe early expected
benefits of nursing interventions

LONG TERM OUTCOME – describe the benefits

expected to be seen at a certain point in time after
the plan has been implemented

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 PRINCIPLE OF PATIENT- CENTERED OUTCOMES

2. Outcome may relate to problems or

interventions.
PROBLEM OUTCOMES -- state what you expect
to observe in the patient when the problems
are resolved or controlled
INTERVENTION OUTCOMES -- state the benefit
you expect to observe in the patient after an
intervention is performed

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 PRINCIPLE OF PATIENT- CENTERED OUTCOMES

3. To create explicit (very specific

outcomes, include the following
components.
> subject
> verb
> condition
> performance criteria
> target time
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▪ SUBJECT: Who is the person expected to
achieve the outcome (e.g. Patient or parent)
▪ VERB: What actions must the person take to
achieve the outcome?
▪ CONDITION: Under what circumstances is the person
to perform the actions?
▪ PERFORMANCE CRITERIA: How well is the person to
perform the actions?
▪ TARGET TIME: By when is the person expected to be
able to perform the actions?
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COMPONENT OF AN OUTCOME STATEMENT

PATIENT BEHAVIOR
▪An observable activity the
patient will demonstrate at
some time in the future
showing improvement in the
problem area

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EXAMPLES OF PATIENT BEHAVIOR

❑ (the patient) will void

❑ Decrease in (the patient’s) BP
❑ (the patient) will ambulate
❑ (the patient) will report
❑ (the patient) will drink

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COMPONENT OF AN OUTCOME STATEMENT

CONDITIONS
© specific aids that will help the
patient perform a behavior at the
level specified in the criteria portion
of the outcome statement
NOTE: “not all outcomes will have
conditions”

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 COMPONENT OF AN OUTCOME STATEMENT

CONDITIONS
specific aides which will facilitate the patient
performing a behavior at the level in the criteria and
within the specified time frame
▪ With the help of a walker
▪ With the use of a wheelchair
▪ With the help of the family
▪ With the use of medication
▪ Using oral analgesics q3-4 hrs
▪ Using IM Demerol q3-4 hrs

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COMPONENT OF AN OUTCOME STATEMENT

PERFORMANCE CRITERIA
♥ a stated level or standard for the patient
behavior stated in the outcome
♥ it specifies a realistic improvement in
functioning in the problem area by a stated
time and will be used to determine whether the
outcome was satisfactorily achieved
♥ It clarifies and individualizes the outcome
based on the patient’s ability and a realistic
expectation for the level of functioning in the
future

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COMPONENT OF AN OUTCOME STATEMENT

TIME FRAME
☼ a time or date to clarify how long it
would realistically take for the patient to
reach the level of functioning stated in
the criteria part of the outcome
A. INTERMEDIATE OUTCOMES
☻ it identifies behavior a patient
can achieve fairly quickly
e.g. : in an 8-hr shift, daily basis

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COMPONENT OF AN OUTCOME STATEMENT

B. LONG TERM OR FINAL OUTCOMES

☻ it gives direction for the nursing care
over time
☻ it tries to identify the maximum level of
functioning possible for a patient with a
particular nursing diagnosis
e.g. : breastfeeding 10 to 15mins/
breast every 2 to 5 hrs, within 2 wks of delivery

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 COMPONENT OF AN OUTCOME STATEMENT

▪ TIME FRAME
- a designated time or date when the
patient should be able to achieve the
behavior
▪ Within the next hour
▪ By discharge
▪ At the end of this shift
▪ By Dec. 25
▪ In 2 months

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 COMPONENT OF AN OUTCOME STATEMENT
C. DISCHARGE OUTCOMES
☼ it appears at the end of the critical
pathways used with the hospitalized
patients
☼ it identifies the behavior the patient is
expected to achieve to be safely
discharged from the institution
e.g.: Return of the swallow-gag reflex
vital signs in the normal range for this patient
D. HEALTH PROMOTION / WELLNESS OUTCOMES

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 PRINCIPLES OF PATIENT- CENTERED
OUTCOMES

4. Use measurable verbs (verbs that

describe things you can see, feel, smell
or hear).

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 PRINCIPLES OF PATIENT- CENTERED OUTCOMES

5. Consider affective, cognitive and

psychomotor outcomes.
❑ Affective domain -- changes in attitude,
feelings, or values
❑ Cognitive domain – dealing with acquired
knowledge or intellectual skills
❑ Psychomotor domain – dealing with
developing motor skills

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 EXAMPLES OF VERBS REPRESENTING THE 3
DOMAINS
COGNITIVE AFFECTIVE PSYCHOMOTOR

Teach Express Demonstrate

Discuss Share Practice
Identify Listen Perform
Describe Communicate Walk
List Relate Administer
Explore Give

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 PRINCIPLES OF PATIENT- CENTERED
OUTCOMES

At a basic level,
determining outcomes
requires you to simply
“reverse the problem”,
or state what you expect to
observe in the patient after
you perform an intervention.

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 GUIDELINES FOR WRITING OUTCOME
STATEMENTS OR OBJECTIVES
1. For an actual nursing diagnosis, the outcome is
a patient behavior that demonstrates reduction
or alleviation of the problem.
2. For at risk nursing diagnosis, the outcome is a
patient behavior that demonstrates
maintenance of the current status of health or
functioning.
3. The outcome is realistic for the patient’s
capabilities in the time span you designate in
your outcome
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 GUIDELINES FOR WRITING OUTCOME
STATEMENTS OR OBJECTIVES
4. The outcome is realistic for the nurse’s level of
skill, experience and time/ workload.
5. The outcome is congruent with and supportive
of other therapies.
6. Whenever possible, the outcome is important
and valued by the patient, family, the nurse and
the physician.
7. The outcome is an observable or measurable
patient behavior

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 GUIDELINES FOR WRITING OUTCOME
STATEMENTS OR OBJECTIVES
8. Write outcomes in terms of patient behavior,
not nursing actions.
9. Keep the outcome short.
10. Make the outcome specific.
11. Derive each outcome from only one nursing
diagnosis.
12. Designate a specific time for the achievement
of each outcome.

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 ACTIVITY OF THE PLANNING PHASE
3. Deciding Which Problem Must Be
Recorded is influenced by your understanding of :
✓ the whole picture of all the problems present
✓ the person’s overall health status and expected discharge
outcomes
✓ the expected length of contact with the patient. Focus on
what MUST be achieved before what’s NICE to do.
✓ the patient’s perception of priorities
✓ whether there are standard plans that apply, are there critical
pathways? Guidelines? Protocols?

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 Always check
policies and procedures
for recording the plan,
as they are designed
to help your patients
and protect you
from legal liability.

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 3 Basic Steps To Determining Which
Problems Must Be Recorded

1. Create a problem list.

2. Decide which problem must be
managed in order to achieve the
overall outcomes of care.
3. Determine what documentation will
guide how each problem will be
managed.

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 It’s your responsibility to
make sure that any problems,
diagnoses, risk factors that
are likely to impede progress
toward outcome achievement
are addressed somewhere on
the patient record.

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