P&P Chapter 18: Planning Nursing Care

P&P Chapter 18: Planning Nursing Care

1. Explain the relationship of planning to assessment and nursing diagnosis.

   • Planning allows for the nurse to collaborate with the patient, their family, and the health care team to adequately apply knowledge gained in the assessment and diagnosis to expected outcomes and goals that have been individualized for the patient. Creating a plan prioritizes patient needs and requires critical thinking.

2. Describe how use of a PICOT question can influence a patient's plan of care.

   • -Population/ Patient Problem: Who is your patient? (Disease or Health status, age, race, sex) -Intervention: What do you plan to do for the patient? (Specific tests, therapies, medications) -Comparison: What is the alternative to your plan? (ie. No treatment, different type of treatment, etc.) -Outcome: What outcome do you seek? (Less symptoms, no symptoms, full health, etc.) -Time: What is the time frame? (This element is not always included.)
   • Individualizing a patient’s nursing plan by using PICOT questions while formulating a plan ensures that the plan is comprehensive and appropriate in its care of the patient, as well as unique to the patient’s needs.

3. Discuss criteria used in priority setting.

   • Organizing desired outcomes versus just listing care tasks
   • Rank nursing diagnoses in order of importance & always monitor pt for changes, then rank nursing interventions
   • -High Priority: if left untreated will cause harm to the pt→ Maslow’s -Intermediate Priority: nonemergent, nonlife-threatening needs of pts -Low Priority: not always directly related to a specific illness or prognosis but affects a pt’s future well being
   • Involve patients in priority setting whenever possible

4. Explain the benefits of using the nursing outcomes classification.

   • Allows outcome measurement at any point on a five-point Likert scale from most negative to most positive
   • Organizes treatment plan and corresponding nursing interventions
   • Makes it possible to measure aspects of nursing care on a national and international level
   • NOC descriptions of outcomes are more general, but comes closer to a goal statement in clinical application

5. Discuss the difference between a goal and an expected outcome.

   • Goal: broad statement that describes a desired change in a pt’s condition, perceptions, or behavior (the ultimate outcome)
   • Expected Outcome: measurable change that must be achieved to reach a goal

6. Correctly write an outcome for a goal of care.

   • Diagnosis: acute pain related to surgical incision → Goal: pt will achieve pain relief by day of discharge → Outcome: pt reports pain level of 3 or below by discharge, pt transfers from bed to chair with no increase in pain in 48 hours, pt’s incisional area shows signs of wound healing by discharge

7. Develop a plan of care from a nursing assessment.

   • Assessment: recent surgery w/ slightly inflamed incision site, pt not sure of correct at home care procedures once discharged → Diagnosis: Acute pain related to trauma of surgical incision, Readiness for enhanced knowledge related to impending discharge with self-care needs, Risk for infection → Planning: Set outcomes and goals based on each diagnosis, involve family with goal aimed at home health care needs, monitor pt for changes in s/sx & pain levels, continue measures to reduce risk of infection (antibiotics, wound cleaning), prioritize goals based on immediate pt needs

8. Discuss the process of selecting nursing interventions during planning.

   • Independent nursing interventions: nurse initiates without supervision or direction of others that benefit a pt in a predicted way related to nursing diagnoses and pt goals
     • ex: preventing pressure ulcers, instructing about side effects
   • Dependent nursing interventions: require an order from a health care provider that respond to treating or managing a medical diagnosis
     • ex: administering a med or implementing an invasive procedure (Foley catheter, IV)
   • Collaborative Interventions: therapies that require the combined knowledge, skill, and expertise of multiple health care providers
   • Utilize Nursing Interventions Classification (NIC) to organize specific classes and interventions based on their 3 levels

9. Describe the role that communication plays in planning patient-centered care.

   • Patient-centered care would be impossible without communicating with ALL aspects of a health care team, which includes: providers, nurses, NAPs, techs, other therapists, the patient, family. Comprehensive treatment and proper education is essential to ensuring the best possible outcomes and healing.