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formal planning

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conscious and deliberate planning that invovles decision making, critical thinking, and creativity d

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informal planning

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occurs while you re performing other nursing process steps

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initial planning

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begins with the first patient contact. It refers to the development of the initial comprehensive care plan, which should be written as soon as possible after the initial asssessment

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outgoing plannign

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refers to changes made in the plan (1) as you evaluate the patients responses to care, or (2) as you obtain new data and make new nursing diagnoses

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discharge planning

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the process of planning for self care and continuity of care after the patient leaves a healthcare setting.

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discharge planning begins at initial assessment

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you will need the following patient data: 1. physical conditiona dn functional and self care limitations 2. emotional stability and ability to learn 3. finacnial resources 4. family or other caregivers availible 5. caregiving responsibilities the patient may have for others 6. environment, both home and community for supplies and equipment, availibility of transportaion to health care services, stairs, etc. 7. use of community services before admission

question

a comprehensive discarge process for older adults should help to achieve the following objectives

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1. maintain functional ability 2. lengthen the time between rehosptializations 3. invovle all concerned parties in decision making 4. improve interagency communication 5. emphasize client and family involvemet and interdisciplinary collabortaion

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comprehensive discharge planning

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inovles collaboration. ideally, it is done with, not for, the patient

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comprehensive nursing care plan

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is the central source of information needed to guide holistic, goal oriented care to address each patietns unique needs. it is a document, usually several documents, that specifices dependent, interdependent, and independent nursing actions necessary for care of a specific patient. It usually combines both standardized and individiualized approaches to care

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why is a written nursing care plan important

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1. ensures care is complete 2. proves continuity of care 3. promotes deficient use of nursing efforts 4. provides a guide for assessments and charting 5. meets the requirements of accrditing agencies

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policies and procedures what information does a comprehensive nursing care plan contain?

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1. basic needs and activities of daily living 2. medical/multidisciplinary treatment 3. nursing diagnoses and collaborative problems 4. special discharge needs or teaching needs

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What documents make up a comprehensive nursing care plan?

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1. form for client profile and basic needs 2. reprinted, standardized plan 3. individualized care plans to address nursing diagnosis 4. special discharge plan and/or instructions 5. special teaching plan

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client profile and basic needs

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age, providers, diagnostic tests and treatments

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reprinted standardized plans

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save nursing time, promote consistency of care, and help ensure that nurses do not overlook important interventions.

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policies and procedures

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similar to rules and regulations. when a situation occurs, you go to check policy to govern how its handled when it requires a consistent response regardless of who handles it

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protocols

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cover specific actions usually required for a clinical problem unique to a subgroup of patients (ex: not every patient on the med/surg floor it at risk for falls, but many are) so the nurse would therefore add a falls protocol to the care plan for a patient that is in that subgroup

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unit standards of care

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describe the care the nurses are expected to provide for all patietns in defined situations (all women addmitted to a labor unit or all patients ddmitted to a critical care unit) however, they: 1. apply to every patient in the defined situation, rather than a subgroup 2. do not become part of the patients care plan but are kept on file on the unit 3. do not usually include specific medical orders

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standardized (model) nursing care plans

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detail the nursing care that is usually needed for a particular nursing diagnosis or for all nursing diagnoses that commonly occur with a medical condition

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althought similar to unit standards of care, model care plans are different in that they usually:

answer

1. provide more detailed interventions..they may add to or delete from unit standards of care 2. are organized by nursing diagnosis and include spciric patient goals and nursing orders 3. are a part of the patietns comprehensive care plan and become a part of the permanent record 4. describe ideal rather than minimum nursing acre 5. allow you to incorporate addendum care plans 6. include checklists, blank lines, or empty spaces so that you can individualize goals and interventions

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critical pathyways

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are often used in managed care systems. they are outcomes-based, interdisciplinary plans that sequence patient care according to case type. they specify predicted patient outcomes and broad interventsion for each day, or in some situations, for each hour. they describe the minimal standard of care required to meet the recommended lenght of stay for patients with a particular condition or diangosis related group

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integrated plans of care (IPOCs)

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are standardized plans that function as care plans as well as documentation forms. Therefore, there is a different form-or sometimes a different column-for each day of care. Many critical pathways are designed as IPOCs; however, IPOCs do not necessarily: 1. orgnize care according to diagnossi 2. describe minimal standards of care 3. specific a timeline for interventiosn and outcomes

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individualized nursing care plans

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nurses use these to address nursing diagnoses unique to a particular client. they reflect hte independent component of nursing practice, and therefore best demonstrate the nurses critical thinking and clinical expertise.

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standardized plans

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do not address unusual problems and may not meet a patietns individual needs. therefore you should always adapt these by adding the necessary nursing diangoses, goals/outcomes and nursing orders

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special purpose/addedum care plans

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you can address routine discharge planning and teaching needs by these

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computer generated care plans

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the computer stores standardized plans, and when you enter a diagnosis or a desired outcome, the computer generates a list of suggested intervenstions. you then choose appropriate intervenstion from the list, individualize by choosing from checklists or type in your own interventsions -reduce time and paperwork

question

student learning plans look different because

answer

they are both the real thing and a learning excercise

question

rationales

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state the scientific principles or reaserch that supports nursing interventions. writing rationales helps ensure that you understand the reasons for the interventions-understanding why you do what you do

question

mind mapping

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a technique for showing relationships among ideas and concepts in a graphical or pictorial, way. this is thought to stimulate "whole-brain" and critical thinking, and to foster the development of holistic plans of care. uses shapes and pictures to represent the parts of the nursing process

question

What is the process for writing and individualized nursing care plan?

answer

1. make a working problem list 2. decide which problems can be managed with standardized care plans or critical pathways 3. individualize the standardized plan as needed (add in things, cross out others0 4. transcribe medical orers to appropriate documents 5. write ADLs and basic care needs in special sections of the Kardex, Care plan, or computer 6. develop individualized care plans for problems not addressed by standardized documents

question

goals (expected outcomes, desired outcomes or predicted outcomes)

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describe the chagnes in patient health status that you hope to achieve

question

nurse sensitive outcomes

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are those that can be influenced by nursing interventions

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the purposes of precise, descriptive, clearly state goals/expected otucomes are to

answer

1.provide a guide for selecting nursing interventions by describing what you wish to achieve 2.motivate the client and the nurse by providing a sense of achievement when the goals re met. this is especially imporant when the client must make difficult lifestyle changes 3. form the criteria you will use in the evaluation phase of the nursing process

question

outcome (used alone)

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means any patient response (postitive or negative) tos intervention

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desired positive patient response words are used as

answer

goals, expected outcomes, desired outcomes, or predicted outcomes

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the term goal is pretty broad while outcome is

answer

more specific

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short term goals

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are those you expect hte patient to achieve within a few hours or days. they are imporant: 1. in situations in which the patient may be discharged before you can evaluate progress towrd long term goals 2. for providing positive reinforcement to clients who are workign toward long term goals

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long term goals

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are chagnes in health status that you wish to achieve over a longer period (week, month, or longer)

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components of a goal statement

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1. subject (understood to be the client, but it can also be a function or part of a client) (lung sounds clear, mrs. johnson can walk to hallway and back) 2. action verb (walk) 3. performance criteria ( how, what, when or where somethign is to be done. Amount quality, accuracy, speed, distance, and so forth) 4. target time (the realistic date/time by which the client should achieve the performance or behavior, OR even perhaps the nursing diagnosis, expected outcome, target time, or evaluate) 7. special conditions (describe the amount of assistance or resources needed or the experiences/ tereatments the client should have to perform the behavior

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expected outcomes are derived directly from the

answer

nursing diagnosis

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essential patient goals

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flow from the problem side of the nursing diagnosis because the problem side describes the unhealthy response you intend to change

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the desired outcome is always that

answer

a complication will not develop abdominal surgery. goal: they will not be paralyzed in the ileum

question

NOC (Nursing Outcomes Classification)

answer

a standardized vocabulary of more than 385 nursing sensitive outcomes developed by a research team at the University of Iowa.

question

in the NOC vocabulary, an outcome is:

answer

an individual, family, or community state, behavior or perception that is measured along a continuum in response to nursing interventions

question

outcome label

answer

broadly stated. it is a neutral label to allow for positive, negative, or no change in patient health status. because NOC outcomes are linked to NANDA-I nursing diagnoses, you can look up a nursing diagnosis to see the list of outcomes suggested for it

question

indicators

answer

are the observable behaviors and states that you can use to evaluate patient status.

question

measurement scale

answer

for each outcome, NOC has a 5 point measurement scale for describing patient status for each indicator. As a rule, 1 is least desriable and 5 is most desirable. iF you are using NOC, you do not need to write traditional goal statments. you simply write the label, choose the appropraite indicators, and assign the number from the measurment scale

question

community health goals (public health goals)

answer

those you would use to specify and evaluate the health of groups, aggregates, or populations. they tend to emphasize health promotion, health maintenenace nad disease prevention

question

UPSPHS has proposed four group goals: (the NOC has 10)

answer

1. attain high qulaity, longer lives free of preventable disease, diability, injury and premature death 2. achieve health equity, elimnate disparities, and improve the health of all groups 3. create social and physical enivonrments that promote good health for all 4. promote quality of life, healthy development and healthy behaviors across all life stages

question

The clinical care classification (CCC)

answer

CCC system was developed by virgina Saba, a nurse reaseracher for use in home health nursing, in the CC, you form goals by adding modifiers to the nrusing diagnoses. This system has 4 nursing diagnoses that are clearly for faily units: family coping impariment, compromised family coping, disabled family coping and family processes alteration

question

the omaha system

answer

was developed specifically for communityhealth nursing. in taht ysstem you must albel al nursing diagnsoses as individual, family, or group

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teaching objectives

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describe what the patient is to learn and the observalbe behaviors that will demosntrate learnign. they shoudl state wehather learnign is to be cognitive, psychomotor, or affective

question

Begin chapter 6

answer

alrighty

question

nursing interventions

answer

actions, based on clinical judgemnt and nursing knowledge, that nurses perform to achieve client outcomes. also referred to as nursing actions, measures, strategies, and activities. include a broad range of activites: 1. direct care interventions 2. indirect care interventions

question

direct care interventions

answer

performed through interaction with the clients (physical care, emotional support, patient teaching)

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indirect care interventions

answer

performed awayf rom the client but on behalf of a client or group of clients (advocacy, managing the environment, consulting with other members of the healthcare team, making referrals)

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independent interventions

answer

one that RNs are licensed to prescribe, perform, or delegate based on their knowledge and skills. does not require a doctors order

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autonomous

answer

knowing how, when and why to perform an activity makes the action independent

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depedent interaction

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one that is prescribed by a physician or advanced practice nurse but carried out by the bedside nurse (orders for tests, diet, activitiy, meds)

question

interdependent (collaborative) interventions

answer

one that is carried otu in colaboration with other health team members (physical therapists, phiscians)

question

uses ANA standards to guide you in selecting

answer

interventiosn appropriate for the clients nursing diagnoses

question

theory

answer

a set of interrelated concepts (ideas) that describes or explains something. A theory, like a lens, influences your perspective: what you notice, what you consider to be a problem-and how you define a problem

question

ideally, a nurse should choose an intervention based on

answer

firm evidence (ANA standard 4, 9) (QSEN competenc)

question

critical pathways (also called clinical pathways and collaborative care plans)

answer

standardized plans of care for requently occuring conditions (total hip replacement) for which similar outcomes and interventiosn are appropriate for all patietns who have the condition

question

evidence-based practice (EBP)

answer

an approach that uses firm scientific data rather than anecdote, tradition, inutition , or folklore in making decisions about medical and nursing practice.

question

steps in the EBP process include the following:

answer

1. formulating an answerable question about prevention, diagnosis, prognosis, and interventions 2. conducting a systematic review of published evidence to find studies that shed light on the desired topic 3. evaluating or grading the quality of the evidence obtained. quality involes validity, appicability, and impact 4. compiling and analyzing the data to prepare a structured report of the review 5. translating the evidence into guidelines for practice 6. integrating the guidelines and evidence with clinal expertise and the patietns preferences and characteristics

question

evidence reports

answer

state of the art, systematic reviews of clincial topics for the purpsoe of providing evidence for practice guidelines, quality improement, quality measures, and insurance coverage decisions. usualy developed by scientists rather than clinicans, patietns, and advocacy groups

question

clincial practice guidelines *form the basis for nursing interventions

answer

systematically developed statments to assist practictioners and patietns in making decisions about appropriate healthcare for a particular disease or procedure. these are usually developed by clinicans, patietns, and advocacy groups and are published by speciality organizations, universities, and government agencies ex: -joanna brigss institute best practice information sheet on topical sin care in aged care facilities

question

what process can i use for generateing and selecting interventions

answer

1 review the nursing diagnosis -the etiology of a nursing diagnosis describes the factors that contribute to the unhealthy response (it might not be possible to change or you might not know the etiology-appraoching somebody that seems nervous but you don't know why) 2. review the desire patient outcomes (goals) 3. identify several interventions or actions -to achieve those goals 4. choose the best interventions for the patient -using contexutal awareness -credible sources -considering alternatives -analyszing assumptions -reflecting sketically 5. individualize standardized interventions 6. computer generated interventions

question

How Can I use standardized language to plan interventions

answer

1. the ANA has recognized 12 standardized vocabularies for recording and tracking the clinical care process. Commonly used: NIC, CCC, OMaha system

question

NIC (nursing interventions classification)

answer

was the first comprehensive standardized classifcation of nursing interventiosn (pronouced nick), is versatile, appropriate for use in all specailty and practice areas, including home health and community nursing.

question

each NIC consists of

answer

a label (conisting of 2 or 3 words-is the standardized terminology), definition (explains the meaning of the label), and a list of the specific activies nruse perofrm in carrying out the intervention.

question

NIC interventions are linked to

answer

NANDA-I nursing diagnoses and NOC outcome labels in a linkages book. In this book, you can look up a nursing diagnosis to see the list of outcomes suggested for it and the interventions for achieveing each outcome

question

the NIC, OMaha, and CCC DO include

answer

interventions to address health promotion and cultural and spiritual needs. if you have a holistic attude, you will give holistic care

question

nursing orders

answer

instructions that describe how and when nursing interventions are to be implemented. They are usually written on a nursing care plan. Other nurses and nursing assistive personnel (NAP) are responsible and accountable for eimplementing nruisng orders

question

components of a nursing order

answer

1. date (change each time you revise as well) 2. subject (is the order of the nurse) 3. action verb (tells the nurse which action to take) 4. times and limits (state when, how often, and how long the activity si to be done) (consider usual routines, rest times, scheduled tests, procedures) 5. signature (that you accept legal and ethical accountability for your orderes and allows others to known whom to contact if they have questions or comments)

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