NUR1010, Nursing Process: Planning

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NUR1010, Nursing Process: Planning
2014-03-03 21:26:40
NUR1010 Nursing Process Planning

NUR1010, Nursing Process: Planning
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  1. What is planning
    • formal planning
    • -desision making
    • -critical thinking
    • -creativity

    • -> involve client and family
    • -> goal is holistic plan

    not all plans written, sometimes informal planning
  2. planning related to other steps
    assessment-> nursing diagnosis-> goals desired outcomes <- nursing interventions (written as nursing orders in planning intervention phase)
  3. initial and ongoing planning
    • initial :
    • -begins with the first patient contact
    • -sometimes begin planning even without complete database-> preliminary plan with given data<- make later more complete

    • ongoing planning:
    • changes made as evaluation of patient responses go on, new data, new diagnoses, -> allows to decide which problem to focus on each day
  4. discharge planning
    = process of planning for self-care and continuity of care after patient leaves healthcare setting

    - begins at assessment

    • ADL, IADL,
    • safety
    • which resources (prepare family members, skilled nurse arrangements...)
    • meds, treatment
  5. written discharge plans
    not always separate written discharge plan needed (may be just discharge assessment and teaching)

    • possible need of formal discharge when:
    • memory deficit, terminal illness, major surgery, no help, complex treatment, long recovery, mental illness, inadequate financial resources, self care deficits, ...

    -> discharge planning form
  6. discharge planning for older adults
    -complex needs, find out at assessment

    test functional abilities, cognition, vision, hearing, social support, psychological well being

    goal: involve all, maintain abilities, improve communication, ...
  7. discharge planning requires collaboration
    • -. continuity and quality important
    • - do with not for the patient
    • -needs often call for a team
    • (home care, privaqte duty, physical therapist, family...)
  8. nursing care plans
    • comprehensive nursing care plan
    • preprinted standardized plans
    • individualized nursing care plans
    • special discharge or teaching plans
    • computerized plans of care
    • student care plans
    • mind-mapping student care plans
  9. Why is a written nursing care plan important?
    • -ensuring care is complete
    • -providing continuity of care
    • -promoting efficient use of nursing efforts
    • -provide a guide for assessments and charting
    • -meeting the requirements of accrediting agencies (Joint commission and others)
  10. Which information on comprehensive nursing care plan?
    1. basic needs and activities of daily living ADL

    2. Medical/ multidisciplinary treatment

    3. nursing diagnoses and collaborative problems/ nursing diagnosis care plan (goals, orders,...)

    4. special discharge needs or teaching needs
  11. form for client profile and basic needs
    often in electronic format (do not change often), might also be printed, kept in central location for all care providers
  12. preprinted standardized plans
    • -save time, promote consistency, help to ensure nurse does not overlook something
    • for example:

    policies and procedures are similar to rules and regulations (use critical thinking for interpretation)

    protocols cover specific actions usually required for a clinical problem unique to a subgroup of patients (falls, seizures, treatments, administration of meds,...)

    unit standards of care describe the care that nurses are expected to provide for all patients is defined situations (minimum level of care that has to be ensured)

    standardized / model nursing care plans detail the nursing care , needed for particular nursing diagnosis or for all nursing diagnoses that commonly occur with a medical condition (more detailed than unit standards of care, incl, specific orders and goals,become part of record, ideal plan instead of minimum...)

    • critical pathways
    • often used in managed care systems, outcome based, case types, describe minimal standard of care required
  13. individualized nursing care plans
    standardized plans can be used (common problems) + individual plan

    sometimes include also medical orders (especially as a student)
  14. special discharge or teaching plan
    special purpose/ addendum care plans

    can be individual or standardized
  15. computerized plans of care
    enter diagnosis or desired outcome-> computer generates list of suggestions

    choose appropriate interventions

    might reduce intuition, insight, ability to care , nursing expertise

    - do not accept one size fits all solutions
  16. student care plan
    • also learning activity
    • may contain more detailed nursing orders or other data
    • rationales state the scientific principles or research that supports nursing interventions
    • (understand reason, why do what)
  17. mind mapping student care plans
    technique for showing relationships among ideas and concepts in a graphical way
  18. process of writing an individualized nursing care plan
    1. make a working problem list (prioritized list of problems, risks)

    2. decide which problem can be managed with a standardized care plan

    3. individualize the standardized plan as needed (mark off, add, individualize)

    4. transcribe medical orders to appropriate documents

    5. write ADLs and basic care needs in special sections

    6.develop individualized care plans for problems not addressed by standardized documents
  19. planning patient goals/ outcomes (expected, desired, predicted)
    the change in health status we hope to achieve

    goal outcome formulation is responsibility of professional nurse

    involve client (if possible)

    nursing sensitive outcomes are those that can be influenced by nursing interventions
  20. terms goal and outcome
    outcome = any patient response to interventions

    • goals/ desired, predicted, expected ¬†outcomes = wanted positive response
    • -> do specify,

    • not constipation reliefed
    • instead constipation will be reliefed as evidenced by soft...within 24 hours
  21. purpose of goal/ outcome statements
    guide for selecting nursing interventions

    motivate client and nurse

    form criteria to use in evaluation phase
  22. how distinguish between short term and long term goal?
    • short term :expect the patient to achieve within a few hours or days
    • important in discharge, positive reinforcement while working on long term goal

    long term goal: changes in health status over longer period, week, month, more

    describe optimum level of functioning expected to achieve -> ideally normal function again
  23. components of goal statement
    subject (client, function, part of client, "breathsounds")

    Action verb (actions that can be seen, measured,....)

    performance criteria (how, what , when , amount , quality)extend of expected action, behavior

    target time (realistic date or time until performance/behavior should be achieved)

    special conditions (amount of assistance,..."with the help of one person")
  24. how do goals relate to nursing diagnoses
    goal directly derived from nursing diagnose

    goal states the opposite of the problem

    e.g. absence of pain - relaxed body pioosture, does not complain of pain, ...
  25. essential goals

    (non essential->does not resolve/improve problem)
    essential : flow from the problem side of the nursing diagnosis, because the problem side describes the unhealthy response you intend to change

    For every nursing diagnosis -> one goal, that if achieved  woukd demonstrate resolution/ improvement of the problem
  26. goals for actual, risk , possible nursing diagnoses
    to promote, maintain, restore health depending on the status of the nursing diagnosis
  27. goals for collaborative problems
    always desired: complication will not appear

    are not nurse sensitive (not primalrily depend on nursing intervention)-> not appropriate to include this goal in the nursing care plan (nurses are not primarily accountable for the outcome)

    early detection of complication, should it o
  28. standardized terminology for outcomes
    • NOC Nursing outcomes classification
    • for all specialty and practice areas

    broad outcome e.g. Decision Making

    outcome label "the outcome"-> positive, negative or no change

    + 5 point measurement scale for describing patient status to each indicator 5=best

    • no need to write traditional label, just :
    • weite the label, choose indicator,and assign a number from measurement scale

    NANDA-I-> suggested outcome for diagnosis

    indicators = observable behaviors and states you can use to evaluate patient status
  29. reflecting critically about outcome
    • 1 at least one outcome that, when met, shows problem resolution
    • 2. goal addresses nursing diagnosis
    • 3. goal appropriate for nursing diagnosis
    • 4. outcome derived from only one nursing diagnosis
    • 5 each outcome describes only one response
    • 6. outcome stated as patient response not nursing activity
    • 7. outcome stated in positive term
    • outcome measurable or observable
    • 9. performance criteria specific and concrete
    • 10. each goal includes all necessary parts
    • 11. expected outcome realistic and achievable
    • 12.does goal conflict with medical or collaborative treatment plan
    • 13does client ... value the goal
    • 14.does goal conflict with any religious or cultural values