(3) Outcome Identification& Planning

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• After the nurse collects and interprets patient
data,
• identifying patient strength and health
problems,

• It is time to plan for nursing action.

Outcome Identification and Planning
*Planning: During the planning step of the
nursing process, the nurse works in
partnership with the patient and family to:
1-Establish priorities
2-Identify and write expected patient
outcomes
3-Select evidence- based nursing interventions
4-Communicate the plan of nursing care
• -Goal is an aim or an end
• -Patient outcome is an expected conclusion to
a patient health problem

• The word, goal objective and outcome are

often has the same meaning.
• -Expected outcome; is used to refer to the
more specific, measurable criteria used to
evaluate the extent to which a goal has been
met.

• The nurse, patient & family should work

together as much as possible in the outcome
identification & planning stage.
• Informal planning is often also observed by
students in practice settings.

• This is the link between identifying a patient's

strength or problem and providing an
appropriate nursing response.
• The primary purpose of the outcome identification
and planning step of the nursing process is to:
• Design a plan of care for & 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
expectation s as identified in the patient outcomes.
*The element of planning includes the
following:
1-Establishing priorities
2-Writing goals/outcomes that determine the
evaluative strategy
3-Selecting appropriate nursing interventions
4-Communicating the plan of nursing care.
• Unique Focus of Nursing Outcome
Identification and Planning:
• The primary purpose of outcome identification
& planning step of nursing process to design a
plan of care with & for the patient that, once
implemented results in:
• Prevention
• Reduction
• And resolution of the health problems & the
attainment of patient’s health expectations
 Critical Thinking/ Clinical Reasoning in Outcome Identification and Planning

1-Be familiar with standards & agency policies to

set priority, identifying & recording expected
patient’s outcomes, selecting evidenced- based
nursing interventions & record plan of care.

2-Remember that the goal of person- centered

care is to keep the patient & patient’s interests
& preferences central in every aspect of
planning and outcome identification.
3-Discharge goals must also kept in mind.

4-Trust clinical experience & judgment & value

collaborative practice

5-Respect your clinical intuition

6-Recognize your personal bias & keep an open

mind.
 Interpersonal Competences in Outcome
Identification & Planning
• Working with patient & family
Your interpersonal competence influence your
success in planning
• To understand patient’s and family needs,
expectation, hopes, & fears that allow nurses to
develop effective plans of care.
• The more active that the patients & families are
in the planning process, the more motivated
they will be to achieve valued goals.
 *Comprehensive Planning
1-Initial Planning; is developed by the nurse
who performs the admission nursing history
and the physical assessment. This
comprehensive plan addresses each problem
listed in the prioritized nursing diagnosis and
identifies appropriate patient goals and
related nursing care
 Standardized care plans

Are prepared plans of care that identify the

nursing diagnoses, goal/outcomes, and related

nursing intervention common to a specific

population or health problem.

 2-Ongoing Planning
It is problem oriented & is carried out by any nurse
who interacts with the patient.
• The chief purpose is to keep the plan up to date to
facilitate the resolution of health problems, manage
risk factors, & promote function.

• The nurse caring for the patient uses new data as

they are collected & analyzed to make the plan
more specific & accurate & therefore more
effective.
 3-Discharge Planning
It is best carried out by the nurse who has
worked most closely with the patient and the
family, possibly in conjunction with a nurse or
social worker with a broad knowledge of
existing community resources.
• Comprehensive planning begins when the
patient is admitted for the treatment.
 *Establishing Priorities
To develop a prioritized list of nursing diagnosis, the
nurse needs guidelines for ranking diagnosis as:
1- High priority diagnosis pose the greatest threat to
the patient's well- being
2- Medium priority diagnosis are those which are non-
life- threatening diagnosis
3-Low priority diagnosis, not specifically related to the
current health problem .
--In all aspects, psychological & physiological needs
must be considered.
 1-Maslow's Hierarchy of human Needs

a- Physiologic needs
b- Safety needs
c- Love & belonging needs
d- Self- esteem needs
e- Self-actualization needs
 2-Patient Preference

• It is best to the first meet the needs the

patient thinks are most important, if this
order does not interfere with other vital
therapies
 3-Anticipation of Future Problems,

• Nurses must tap their knowledge based to

consider the potential effects of different
nursing diagnosis.
• Assessing low priority to a diagnosis that the
patient wants to ignore but that can result in
harmful future consequences for the patient
might be nursing negligence.
 4- Critical Thinking/ Clinical Reasoning and
Establishing Priorities:

Set priorities enables the nurse to make sure

that time and energy being directed first
to the patient's most important problems.
 Identifying & Writing Outcomes

1-Deriving goals/outcomes from Nursing

Diagnosis:
for each nursing diagnosis in the plan of care at
least one goal should be written and
demonstrates a direct resolution of the
problem statement.
2-Long – Term versus Short – Term Goals /
outcomes;
long term outcomes require a longer
period( usually more than a week) to be
achieved.
Also they may be called discharge goals
Short – term goal usually hours until 3 days.
 3- Determining Patient- Centered
Outcomes
Alfaro- leFevre (2014) recommends that nurses be
realistic and consider the following:
1-Patient's health sate, overall prognosis

2-Expected length of stay

3-Growth and development

4-Patient values & cultural consideration

5-Other planned therapies for the patient

6-Available human, material, and financial

resources

7-Risks, benefits and current scientific evidence

8-Changes in status that indicate you to modify

usual expected outcomes
 4-Ensuring Quality Outcomes
1-Safe: avoiding injury
2-Effective: avoid overuse and underuse
3-Patient- centered: responding to pt needs,
values and preferences
4-Timely: reduce waits and delays
5-Efficient: avoiding waste
6-Equitable: providing care that does not vary in
quality to all recipients.
 5-Cognitive, Psychomotor, and Affective Goals

• Cognitive goal describe increases in patient

knowledge or intellectual behaviors.
• Psychomotor goals describe the patient’s
achievement of new skills.
• Affective goals describe changes in patient
values, beliefs and attitudes.
• Difficult both to write and to evaluate,
affective outcomes might be critical to the
resolution of a complex patient problem
• 6- Identifying Clinical, Functional, and Quality
of Life Outcomes:

• -Clinical Outcomes, describe the expected

status of health issues at certain points in
time, after treatment is complete.
• They address whether the problems are
resolved or to what degree they are improved.
• -Functional Outcomes, describe the person’s
ability to function in relation to the desired
usual activities.

• -Quality of Life Outcomes, focus on key factors

that affect someone's’ ability to enjoy life and
achieve personal goals.
7- Identifying culturally appropriate outcomes:
8- Identifying outcomes supportive of the total
treatment plan:
Every outcome you wrote should support the
overall treatment plan and "make
sense" in terms of overall plan
 - Writing patient- centered measurable
outcomes
a- first each goal/outcome must have a subject which
is the patient.
b- a verb which indicates the action the patient will
performs
c- conditions: specifies the particular circumstances in
or by which the outcome is to be achieved.
d-A performance criteria which describes in
observable measurable terms.
e- Target time: specifies when the patient is expected
to be able to achieve the outcome.
• The goal should be SMART:
• S- Specific
• M- Measurable
• A: Attainable
• R: Realistic
• T: Time bound.
• Verbs helpful in writing goals are the
followings:
• Define , Identify , List , Describe , Explain ,
apply Prepare , Design , Verbalize , Choose ,
select , Demonstrate .
• -Sometimes goal / outcome manifest an Error
usually occurs when using verbs that are not
observable and measurable.
 Identifying Nursing Intervention;
*Is any treatment, based on clinical judgments
and knowledge that a nurse performs to
enhance patient outcomes.
1-Nurse- initiated intervention
2-Physician- initiated intervention
3-Collaborative interventions
 Nursing Consultation
• It is a process in which two or more individuals
with varying degrees of experience and
expertise discuss a problem and its solution ,
often helpful , nurse consult other nurse or
other health providers ( physician, social
worker ----- etc) .
 Writing the Plan of Nursing Care
*Patient plan of care is the written guide that
directs the efforts of the nursing team as the
nurses’ work with the patients to meet health
goals.

• It specifies nursing diagnoses, goal/outcomes

and associated nursing interventions.
 Kardex
• -Kardex care plan, in which the plan of nursing
care for each patient is concisely
recorded on a folded card and placed in
a central kardex file where it is easily
accessible. The plan is eventually placed in the
patient's health record.
• Communicating and Recording the Plan of
Nursing care:

• The plan is written and communicated with

the persons who will help in the care of the
patient. According to nursing process.
Problems Related to Outcome Identification
and Planning

• Failure to involve patient

• Insufficient data collection
• Nursing diagnoses developed from inaccurate or
insufficient data
• Outcomes stated too broadly
• Outcomes derived from poorly developed nursing
diagnoses
• Failure to write nursing order clearly
• Nursing orders that do not solve problems
• Failure to update the plan of care
The End
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