Ch 13 - Outcome Identification And Planning

Front 1

Outcome Identification
Def

Back 1

the formulation of goals and measurable outcomes that provide the basis for evaluating nursing diagnoses

Front 2

Outcome Identification serves the following purposes:

Back 2

* Providing individualized care
* Promoting client participation
* Planning care that is realistic and measurable
* Allowing for involvement of support people

Front 3

Activities performed in the Outcome Identification phase:

Back 3

- establish priorities
- establish client goals and outcome criteria

Front 4

Nursing Outcomes Classification
(NOC)

Back 4

organized according to categories, classes, labels, outcome indicators, and measurement activities for outcomes
- Each NOC has a definition, a measurement scale, and associated indicators and measures

Front 5

Outcome Identification Priorities

Back 5

*High-Priority ND's - always take precedence over routine care -ABC's
*Medium-Priority ND's - involve problems that could result in unhealthy consequences - Stress Incontinence
*Low-Priority ND's - usually easily resolved with minimal intervention or potential for significant dysfunction - Pain after surgery

Front 6

Priorities - Nurse's VS Client's

Back 6

sometimes clients and nurses disagree on the priority given to problems
ex - pain vs ambulation

Front 7

Client Outcome

Back 7

directly addresses the problem stated in the ND
- an educated guess, made as a broad statement, about client's state after n intervention is effected

Front 8

Qualifier

Back 8

description of the parameter for achieving the outcome

Front 9

Short-Term Outcome

Back 9

can be met in a relatively short period
-within days or less than a week

Front 10

Long-Term Outcome

Back 10

requires more time
- several weeks or months
-may indicate ongoing activity
-usually describe benefits expected to be seen after the plan has been implemented

Front 11

Client Outcomes

Back 11

nurse needs to revise outcomes if the client's situation or medical condition changes

Front 12

Outcome Criteria

Back 12

specific, measurable, realistic statements of goal attainment

Front 13

Outcome Criteria- answer the questions:

Back 13

Who/ Subject
What actions/ Verb
Under What Circumstances/Condition
How Well/Criteria
When/Specific time

Front 14

Planning

Back 14

the development of nursing strategies designed to ameliorate client problems. A plan of care is developed to direct nursing care activities related to the person for whom the goals and outcome criteria were developed. A written plan of care directs the activities of the nursing staff in the provision of client care.

Front 15

Purposes of Planning:

Back 15

* Direct client care activities.
* Promote continuity of care.
* Focus charting requirements.
* Allow for delegation of specific activities.

Front 16

Activities of the Planning Phase:

Back 16

- planning nursing interventions
- writing the client plan of care

Front 17

Nursing Intervention Classification
(NIC)

Back 17

3-level taxonomy: domains, classes & interventions
- interventions can be direct or indirect care activities

Front 18

NIC Taxonomy
7 Domains

Back 18

* Physiologic: Basic
* Physiologic: Complex
* Behavioral
* Safety
* Family
* Health system
* Community

Front 19

Each N Intervention consists of:

Back 19

- a definition
- a list of activities that describe the nursing actions that need to be performed

Front 20

Nursing Interventions

Back 20

any treatment, based upon clinical judgment and knowledge, that a nurse performs to enhance patient/client outcomes

Front 21

Nursing Interventions

Back 21

used to monitor health status; prevent, resolve, or control a problem; assist with activities of daily living (ADLs); or promote optimum health and independence. Interventions are written as specific activities on the plan of care

Front 22

Types of N Interventions include:

Back 22

* Psychomotor (positioning, inserting, applying)
* Psychosocial (supporting, exploring, encouraging)
* Educational (demonstrating, teaching, observing return demonstrations)
* Maintenance (skin care, hygiene)
* Surveillance (detecting changes)
* Supervisory (other healthcare providers)
* Sociocultural (spending time, incorporating cultural differences into care regimen)

Front 23

Writing a Client Plan of Care

Back 23

JCAHO - the plan must be developed by a registered nurse, it must be documented in the client's health record, and it must reflect the standards of care established by the institution and the profession

Front 24

Two Important concepts to guide a Client Plan of Care:

Back 24

- the plan of care is client centered
- the plan of care is a step-by-step process

Front 25

Instructional Client Plans of Care

Back 25

allow students to learn a variety of client problems and the processes nurses use to solve them
- involve citing scientific rationales form nursing literature

Front 26

Instructional Client Plans of Care include:

Back 26

Nursing Diagnosis
Client Goals
Client Outcome Criteria
Nursing Interventions
Scientific Rationale
Evaluation

Front 27

Scientific Rationale

Back 27

justification or reason for carrying out the intervention

Front 28

Clinical Plans of Care

Back 28

use the NP, but the plan is organized in a practical, concise format for daily use
-focus is to individualize the plan of care for each client using findings from the nursing assessment and identified nursing diagnoses

Front 29

Steps of a Clinical Plan of Care

Back 29

Assessment and Data Collection
Nursing Diagnosis
Outcome Identification
Interventions
Rationale
Evaluation

Front 30

Clinical Client Plans of Care

Back 30

*Individual P'sOC - written for each client by an RN
*Standardized P's OC - written by a group of nurses for client population with a specific medical diagnosis
Generic P'sOC - written for a specific ND & include goals and interventions most commonly seen
*Computerized P'sOC - customizable generic/standardized plans linked to assessment data

Front 31

Collaborative Care Plan: Critical Pathways

Back 31

becoming the current standard guideline for nursing care in many hospitals
- focused on outcome management, cost control and continuous quality improvement

Front 32

Critical Path

Back 32

a cause-and-effect grid that describes a client's problems with intermediate outcomes and multidisciplinary staff actions along a time-line

Front 33

Critical Path method

Back 33

addresses key events in the treatment process that must be accomplished to achieve predetermined outcomes at a minimal cost

Front 34

DRG

Back 34

Diagnostic-Related Grouping

Front 35

LOS

Back 35

Length Of Stay
(for hospitalized clients)

Front 36

Critical Paths & $

Back 36

if CP's were followed, and clients were discharged within the predetermined LOS, hospitals are reimbursed the predicted cost

Front 37

Critical Paths & %'s

Back 37

some hospitals use CP's as a guideline for client care in almost 80% of the hospital's population

Front 38

Variances

Back 38

result when deviation occurs in the path that alters and expected outcome or the date of discharge
- client, staff, system and community variances occur

Front 39

Data Mining

Back 39

the extraction of hidden predictive information from large databases

Front 40

Variance Measurement

Back 40

has the potential for identifying client problems and complications early in hospitalization, variations in practice patterns and system problems

Front 41

Integration of the Nursing Process within the Critical Path Framework

Back 41

is essential to ensure an outcome-based, accountability-driven system