Careful planning involves
seeing the relationships among a patient’s problems, recognizing that certain problems take precedence over others, and proceeding with a safe an efficient approach to care.
- setting priorities
- identifying patient-centered goals and expected outcomes
- prescribing individualized nursing interventions
- critical thinking
- deliberate decision making
- problem solving
- communication and ongoing consultation
placing a nursing diagnosis in an order that considers urgency and/or importance to establish preferential treatment for nursing actions
Priority Setting helps you
anticipate and sequence nursing interventions when a patient has multiple nursing diagnoses and collaborative problems
Priorities are mutually agreed upon with your patient based on:
- urgency of the problem
- the patient’s safety and desires
- the nature of the treatment indicated
- the relationship among the diagnoses
Classification of Priorities: Dynamic
- High Importance
- Intermediate Importance
- Low Importance
Airway status, Ciruclation, Safety (physiological and psychological) and pain.
- non-emergent/nonlife-threatening [but necessary] needs.
- impaired mobility
- risk for infection
usually dealing with long-term health care needs
With priority setting, be sure to remember:
- always assign priorities on the basis of good nursing judgement
- order of the priorities changes with patient’s condition
- appropriate ordering of priorities ensures you meet a patient’s needs in a timely and effective way.
- involve patients in priority setting whenever possible
What are environmental factors that may affect priority setting (cognitive shifts)?
- the organization of the nursing unit
- staffing levels
- interruptions from other care providers
- available resources (material and clinical specialists)
- policies and procedures
- access to supplies
Once a nursing diagnosis has been identified for your patient, ask yourself:
- What is the best approach to address and resolve each problems?
- What do I plan to achieve?
broad statement that describes a desired change in a patients condition or behavior.
ex. “patient expresses understanding of postoperative risks”
a measurable criterion to evaluate goal achievement
ex. “patient identifies 3 S&S of wound infection” or “patient will demonstrate correct use of the incentive spirometer”
objective behavior or response that you expect a patient to achieve in a short time
usually less than a week .
objective behavior or response that you expect a patient to achieve over a longer period
usually over several days, weeks or months
to participate in goal setting the patient must be/have:
- some degree of independence in completing ADL’s
- problem solving ability
- decision making ability
Outcomes need to meet intellectual standards by being
(S)pecific/Singular (M)easureable (A)ttainable (R)ealistic (T)imed
Seven Guidelines for Writing Goals & Expected Outcomes
- Singular Goal or Outcome
is a specific measureable change in a patient’s status that you expect to occur in response to nursing care.
Nursing-Sensitive Patient Outcome
measureable patient, family, or community state, behavior or perception largely influenced by and sensitive to nursing interventions.
- treatments or actions based on clinical judgement and knowledge that nurses perform to meet patient outcomes.
- individualized to each patient.
Choosing nursing interventions involves competency in three areas:
- knowing the scientific rationale for the intervention
- possessing the necessary psychomotor and interpersonal skills.
- being able to function using the available health care resources effectively
What are the three categories of nursing interventions?
- collaborative interventions
- initiated by nursing
- do not require an order from another professional
- based on scientific rationale
- actions that require an order from a physician or other health care provider
- advanced practice nurses may write dependent nursing interventions
-therapies that require the combined knowledge, skill, and expertise of multiple health care professionals.
When preparing dependent or collaborative interventions,
do not automatically implement the therapy but determine whether it is appropriate for the patient.
Six Factors when Choosing Interventions:
- desired patient outcomes: nursing outcomes classification
- characteristics of the nursing diagnosis: address the r/t and AEB factors
- Researched based
- feasibility of the interventions
- acceptability to the patient
- capability of the nurse
Nursing Care Plans include:
- nursing diagnosis
- goals and/or expected outcomes
- specific nursing interventions
- evaluation of the findings/results
Plans of care may be recorded in
- standardized care plans (written)
- computerized care plans: electronic health records
Nursing Plans of Care:
- reduce the risk for incomplete, incorrect, or inaccurate care.
- details specific supplies/equipment necessary to use
- makes it easy to continue care from one nurse to another
- includes details on discharge planning
Planning care for patient in community based setting are designed to:
- educate the patient/family about the necessary care techniques and precautions
- teach the patient/family how to integrate care within family activities
- guide the patient/family on how to assume a greater percentage of care over time
- evaluate the expected outcomes
Standard practice for all off-going nurses to on-coming shift.
-discusses plans of care and overall progress.
nurses collaborate and
-share important information that ensure the continuity of care.
Report is given in
Situation: pts brief c/o or reason for hospitalization
Background: brief hx
Assessment: pertinent data including labs, radiographs, tests
Recommendation: what was left undone, how to continue care
Walking Rounds or Bedside Report
- allows pts to be involved in decision-making and confirm information
- allows the off-going nurse to “talk-up” her peer
- allows the on-coming nurse to ask questions and clarify any miss-communication
- visual representation of all of the pts nursing diagnoses
- diagram of interventions related to each nursing diagnosis
- visualizes how interventions may apply to more than one diagnosis.
- provides a holistic view of your patients health care needs
Process by which you seek the expertise of a specialist to identify ways to handle problems in patient management or the planning and implementation of therapies.
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Nursing instructor Physicians Clinical educators Physical therapists Nutritionists Social workers Pharmacists
When to consult
When you identify a problem that you are unable to solve using personal knowledge, skills, and resources.
Six Steps to Consultation
- Identify the general problem area
- Direct the consultation to the right professional
- Provide the consultant with relevant information about the problem
- Do not prejudice or influence consultants. Avoid bias!
- Be available to discuss the consultant’s findings and recommendations
- Incorporate the consultant’s recommendations into the care plan