Chapter 13: Outcome Identification and Planning
and planning are essential components of the nursing process. The
purposes of outcome identification and planning are to
provide direction to ensure quality nursing care, to improve communication
within the health care system, and to provide continuity of care.
An outcome statement for a client with a problem-oriented
diagnosis should describe the expected client status (behavior or
function) when a nursing diagnosis has been resolved and the modification
of the condition that places the client at risk. The outcome statement
when a client has a wellness diagnosis should be a statement of
the enhancement of a client’s positive adaptation.
are part of the planning process. Nursing-sensitive client outcomes
are those that reflect the direct influence of nursing interventions.
The four elements of outcome identification and planning are (1)
establishing diagnosis priorities, (2) developing expected client
outcomes and establishing outcome criteria, (3) planning nursing
strategies, and (4) writing the nursing care plan and nursing orders.
The nursing care plan includes the diagnosis, outcome statements,
nursing interventions, and evaluation criteria for determining whether
outcomes have been met. Ideally, the nurse and client should be
planning for the discharge of the hospitalized client as soon as
possible after admission. Developing expected outcomes and writing
a nursing care plan require critical (problem-solving) thinking.
The four types
of care plans are student-oriented, standardized, institutional,
and computerized. Student-oriented care plans are detailed
documents used for teaching. Standardized care plans are
preplanned and preprinted guidelines for the nursing care of client
groups with common needs. Institutional nursing care plans
are documents used by individual hospitals and agencies that are
usually a part of the medical record. They may be individualized.
Computerized care plans are standardized plans created
and stored in the computers. They also may be individualized.
When determining priorities,
the nurse should consider the client’s basic needs and safety
first, along with anticipated nursing diagnoses, based on the client’s
situation. Determining priorities also requires involvement by the
client, family members, and significant others. Priorities are not
constant. They change with changes in the client’s condition
outcome statements include (1) the subject, or client; (2)
a task statement, the hoped-for client behavior or function; (3)
the criteria by which the nurse will determine whether the expected
outcome is met, usually the absence of the defining characteristics
for the nursing diagnosis; (4) the conditions, or qualifying statements
or conditions for meeting the expected outcome, such as “in
a wheelchair” or “while on a soft diet;” and (5)
the time frame within which that outcome is expected to be reached.
Each expected outcome
statement should address only one nursing diagnosis. A single nursing
diagnosis may require more than one expected outcome. Short-term
expected outcomes focus on the etiology of a problem and cover a
short period of time, within hours or days. Long-term expected outcomes
focus on the problem and cover a longer time frame. Expected outcomes
should be constructed to be realistic, mutually desired by the client
and nurse, and attainable within a defined time period.
intervention is an action performed by a nurse that helps the
client achieve the results specified by the expected outcome. More
than one intervention may be needed for each outcome. Interventions
are prioritized according to the order in which they will be implemented.
Interventions should (1) address the “etiology” component
of the nursing diagnosis, (2) be based on clinical guidelines and
standards for nursing care when available, (3) be compatible with
the client’s abilities and value system, and (4) pose minimal
order is a statement written by the nurse that is within the
realm of nursing practice to plan and initiate. The elements of
nursing orders are (1) the date; (2) an action verb stating the
nurse’s action; (3) a detailed description of what, when,
where, and how the nurse will act; (4) a description of when, how
often, and how long the nursing action is in effect; and (5) a signature
implying legal and ethical accountability.
are classified as independent, interdependent, and dependent. Independent
nursing interventions are those sanctioned by professional nurse
practice acts. They do not require direction or an order from another
health care professional. Interdependent nursing interventions
are actions that are implemented in a collaboration or consultation
with other health care professionals. Dependent nursing
interventions are those that require an order from other health
care professionals. All nursing interventions require critical thinking.
All nursing interventions should be accompanied by appropriate rationale
or scientific explanations.
Evaluation of care involves
tracking the client’s progress toward achievement of expected
outcomes. Nursing researchers at the University of Iowa have developed
the Nursing Outcomes Classification (NOC), focusing on function,
physiology, psychosocial aspects, health knowledge and behavior,
perceived self-health, and family health.