Nursing process(Planning)

Planning
 Deliberate, systematic, problem-
solving phase of nursing process
• Begins with first client contact
• Continues until client (discharge)
• Is multidisciplinary

1- Initial Planning
• Develops initial comprehensive plan of
care
• Begun after initial assessment

2- Ongoing Planning
• Done by all nurses
• Individualization of initial care plan
• At the beginning of a shift
 Determine whether client's health status
changed
 Set priorities for client's care during shift
 Decide which problems to focus on
 Coordinate nurse's activities so that more
than one problem can be addressed at
each client contact

3- Discharge Planning
• Process of anticipating and planning for
needs after discharge
• Addressed in each client's care plan
• Begins at first client contact
• Involves comprehensive and ongoing
assessment

Copyright © 2016, 2012, 2008
Pearson Education, Inc.
All Rights Reserved
Kozier & Erb's Fundamentals of Nursing, Tenth Edition
Audrey Berman | Shirlee Snyder | Geralyn Frandsen
Figure 13–1 Planning—the third phase of the nursing process. In this phase the nurse and client develop client
goals/desired outcomes and nursing interventions to prevent, reduce, or alleviate the client's health problems.

Developing Nursing Care Plans
1- Informal nursing care plan
 A strategy for action that exists in
nurse's mind
2- Formal nursing care plan
 Written or computerized guide

3- Standardized care plan
 A formal plan that specifies actions for a
group of clients with common needs
4- Individualized care plan
 Tailored to meet the unique needs of a
specific client

Standardized Approaches to Care
Planning
• Standards of care
 Nursing actions for clients with similar
medical conditions
 Achievable rather than ideal nursing care
 Interventions for which nurses are
accountable
 Usually, there are agency records that may
be referred to in client's care plan.
 Written from the perspective of the nurse's
responsibilities
 Do not contain medical interventions

Copyright © 2016, 2012, 2008
All Rights Reserved
Figure 13–4 A standardized care plan for the nursing diagnosis of Deficient Fluid Volume.

• Protocols
 Indicate actions commonly required for
a particular groups of clients
 May include both primary care
provider's orders and nursing
interventions
 Example: Protocol for admitting a client
to the intensive care unit

• Policies and procedures
Example: Policy specifying the number of
visitors a client may have

• Standing order
 Written document
• Policies
• Rules
• Regulations
• Orders regarding patient care
 Gives the nurse authority to carry out
specific actions under certain
circumstances

Formats for Nursing Care Plans
• Student care plans
 Rationale
• Evidence-based principle given as the
reason for selecting a particular nursing
intervention
 Concept maps
• Visual tool in which ideas or data are
enclosed in circles or boxes with
relationships indicated by lines or arrows

• Computerized care plans
 Create and store nursing care plans
 Can be accessed at a centrally located
terminal at nurses' station or in clients'
rooms
 Appropriate diagnoses selected from a
menu suggested by the computer

Multidisciplinary (Collaborative) Care
Plans
• known as critical pathways
• Sequence care that must be given on
each day during projected length of
stay for each condition
• Usually organized with a column for
each day listing interventions and
outcomes for that day
• Includes medical treatments to be
performed by other providers

Guidelines for Writing Nursing Care
Plans
1. Date and sign the plan
2. Use category headings
3. Use standardized/approved medical or
English symbols and key words rather
than complete sentences to
communicate your ideas unless agency
policy dictates otherwise
4. Be specific

5. Refer to procedure books or other
sources of information
6. Tailor the plan to the unique
characteristics of the client by
ensuring that the client's choices, such
as preferences about the times of care
and methods used, are included

7. Ensure that the nursing plan
incorporates preventive and health
maintenance aspects
8. Ensure that the plan contains ongoing
assessment of the client

9. Include collaborative and coordination
activities in the plan
10.Include plans for the client's discharge
and home care needs

The Planning Process
• Consists of the following activities:
 Setting priorities
 Establishing client goals/desired
outcomes
 Selecting nursing interventions
 Writing individualized nursing
interventions on care plans

Setting Priorities
1- Establishing priorities sequence for
nursing diagnoses and interventions
 High priority (life-threatening)
 Medium priority (health-threatening)
 Low priority (developmental needs)

2- Factors to consider
 Client's health values and beliefs
 Client's priorities
 Resources available
 Urgency of the health problem
 Medical treatment plan

Establishing Client Goals/Desired
Outcomes
• Goals
 Broad statements about the client's
status
• Desired outcomes
 More specific, observable criteria used
to evaluate whether goals have been
met

Purpose of desired goals/outcomes
 Provide direction for planning
interventions
 Serve as criteria for evaluating progress
 Enable the client and the nurse to
determine when the problem has been
resolved
 Help motivate the client and nurse by
providing a sense of achievement

Short-term and long-term
goals
 By the end of the week or in over the
course of many weeks(long)
 Short-term goals useful for clients who:
• Require health care for a short time
• Are frustrated by long-term goals that
seem difficult to attain
• Need the satisfaction of achieving a
short-term goal

Relationship of goals/desired
outcomes
• to nursing diagnoses
 Goals derived from diagnostic label
 Diagnostic label contains the unhealthy
response (problem)
 Goal is opposite, healthy response
 How client will look or behave if health
response is achieved (observable, time-
limited)
 Achieving goal demonstrates resolution
of the problem

Guidelines for writing
goals/desired outcomes
 Write in terms of client responses
 Must be realistic
 Ensure compatibility with therapies of
other professionals
 Derive from only one nursing diagnosis
 Use observable, measurable terms
 Make sure client considers goals
important

Selecting Nursing Interventions and
Activities
• Actions nurse performs to achieve goals
• Focus on eliminating or reducing
etiology of nursing diagnosis
• Treat signs and symptoms and defining
characteristics
• Interventions for risk nursing diagnoses
should focus on reducing client's risk
factors

Types of nursing interventions
I. Independent interventions
Activities nurses are licensed to initiate
(i.e., physical care, ongoing assessment)
II. Dependent interventions
Activities carried out under primary care
provider's orders or supervision, or
according to specified routines
III.Collaborative interventions
Actions nurse carries out in collaboration
with other health team members

Criteria for choosing nursing
interventions
 Safe and appropriate for the client's
age, health, and condition
 Achievable with the resources available
 Congruent with the client's values,
beliefs, and culture
 Congruent with other therapies
 Based on nursing knowledge and
experience or knowledge from relevant
sciences
 Within established standards of care

• Date when they are written
• Verb
 Action verb starts the interventions and
must be precise.
• Conditions
• Modifiers
• Time element
 How long or how often the nursing
action is to occur

Delegating Implementation
• Delegation occurs during planning.
 Who is decided to do each task?
• Nurse is responsible for correct
implementation of task delegated,
analysis of data, and evaluation of
outcome

Nursing process(Planning)

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