Kozier Erbs Fundamentals of Nursing Concepts Process and
Kozier & Erb's Fundamentals of Nursing Concepts, Process, and Practice TENTH EDITION CHAPTER 13 Planning Kozier & Erb's Fundamentals of Nursing, Tenth Edition Audrey Berman | Shirlee Snyder | Geralyn Frandsen Copyright © 2016, 2012, 2008 Pearson Education, Inc. All Rights Reserved
Learning Outcomes 1. Identify activities that occur in the planning process. 2. Compare and contrast initial planning, ongoing planning, and discharge planning. 3. Explain how standards of care and predeveloped care plans can be individualized and used in creating a comprehensive nursing care plan. continued on next slide Kozier & Erb's Fundamentals of Nursing, Tenth Edition Audrey Berman | Shirlee Snyder | Geralyn Frandsen Copyright © 2016, 2012, 2008 Pearson Education, Inc. All Rights Reserved
Learning Outcomes 4. Identify essential guidelines for writing nursing care plans. 5. Identify factors that the nurse must consider when setting priorities. 6. Discuss the Nursing Outcomes Classification, including an explanation of how to use the outcomes and indicators in care planning. 7. State the purposes of establishing client goals/desired outcomes. continued on next slide Kozier & Erb's Fundamentals of Nursing, Tenth Edition Audrey Berman | Shirlee Snyder | Geralyn Frandsen Copyright © 2016, 2012, 2008 Pearson Education, Inc. All Rights Reserved
Learning Outcomes 8. Identify guidelines for writing goals/desired outcomes. 9. Describe the process of selecting and choosing nursing interventions. 10. Discuss the Nursing Interventions Classification, including an explanation of how to use the interventions and activities in care planning. Kozier & Erb's Fundamentals of Nursing, Tenth Edition Audrey Berman | Shirlee Snyder | Geralyn Frandsen Copyright © 2016, 2012, 2008 Pearson Education, Inc. All Rights Reserved
Introduction • Planning § Deliberate, systematic, problem-solving phase of nursing process • Nursing interventions § Treatment that a nurse performs to enhance patient/client outcomes • Nurse responsible, but input from client essential Kozier & Erb's Fundamentals of Nursing, Tenth Edition Audrey Berman | Shirlee Snyder | Geralyn Frandsen Copyright © 2016, 2012, 2008 Pearson Education, Inc. All Rights Reserved
Types of Planning • Begins with first client contact • Continues until nurse–client relationship ends (discharge) • Is multidisciplinary Kozier & Erb's Fundamentals of Nursing, Tenth Edition Audrey Berman | Shirlee Snyder | Geralyn Frandsen Copyright © 2016, 2012, 2008 Pearson Education, Inc. All Rights Reserved
Initial Planning • Develops initial comprehensive plan of care • Begun after initial assessment Kozier & Erb's Fundamentals of Nursing, Tenth Edition Audrey Berman | Shirlee Snyder | Geralyn Frandsen Copyright © 2016, 2012, 2008 Pearson Education, Inc. All Rights Reserved
Ongoing Planning • Done by all nurses who work with the client • Individualization of initial care plan • At the beginning of a shift § Determine whether client's health status has changed § Set priorities for client's care during shift Kozier & Erb's Fundamentals of Nursing, Tenth Edition Audrey Berman | Shirlee Snyder | Geralyn Frandsen Copyright © 2016, 2012, 2008 Pearson Education, Inc. All Rights Reserved
Ongoing Planning • At the beginning of a shift § Decide which problems to focus on during shift § Coordinate nurse's activities so that more than one problem can be addressed at each client contact Kozier & Erb's Fundamentals of Nursing, Tenth Edition Audrey Berman | Shirlee Snyder | Geralyn Frandsen Copyright © 2016, 2012, 2008 Pearson Education, Inc. All Rights Reserved
Discharge Planning • Process of anticipating and planning for needs after discharge • Addressed in each client's care plan • Begins at first client contact • Involves comprehensive and ongoing assessment Kozier & Erb's Fundamentals of Nursing, Tenth Edition Audrey Berman | Shirlee Snyder | Geralyn Frandsen Copyright © 2016, 2012, 2008 Pearson Education, Inc. All Rights Reserved
Figure 13– 1 Planning—the third phase of the nursing process. In this phase the nurse and client develop client goals/desired outcomes and nursing interventions to prevent, reduce, or alleviate the client's health problems. Kozier & Erb's Fundamentals of Nursing, Tenth Edition Audrey Berman | Shirlee Snyder | Geralyn Frandsen Copyright © 2016, 2012, 2008 Pearson Education, Inc. All Rights Reserved
Developing Nursing Care Plans • Informal nursing care plan § A strategy for action that exists in nurse's mind • Formal nursing care plan § Written or computerized guide Kozier & Erb's Fundamentals of Nursing, Tenth Edition Audrey Berman | Shirlee Snyder | Geralyn Frandsen Copyright © 2016, 2012, 2008 Pearson Education, Inc. All Rights Reserved
Developing Nursing Care Plans • Standardized care plan § A formal plan that specifies actions for a group of clients with common needs • Individualized care plan § Tailored to meet the unique needs of a specific client Kozier & Erb's Fundamentals of Nursing, Tenth Edition Audrey Berman | Shirlee Snyder | Geralyn Frandsen Copyright © 2016, 2012, 2008 Pearson Education, Inc. All Rights Reserved
Standardized Approaches to Care Planning • Established to ensure minimal criteria for care met • Established for efficient use of time Kozier & Erb's Fundamentals of Nursing, Tenth Edition Audrey Berman | Shirlee Snyder | Geralyn Frandsen Copyright © 2016, 2012, 2008 Pearson Education, Inc. All Rights Reserved
Standardized Approaches to Care Planning • Standards of care § Nursing actions for clients with similar medical conditions § Achievable rather than ideal nursing care § Interventions for which nurses are accountable § Usually, there agency records that may be referred to in client's care plan. continued on next slide Kozier & Erb's Fundamentals of Nursing, Tenth Edition Audrey Berman | Shirlee Snyder | Geralyn Frandsen Copyright © 2016, 2012, 2008 Pearson Education, Inc. All Rights Reserved
Standardized Approaches to Care Planning • Standards of care § Written from the perspective of the nurse's responsibilities § Do not contain medical interventions Kozier & Erb's Fundamentals of Nursing, Tenth Edition Audrey Berman | Shirlee Snyder | Geralyn Frandsen Copyright © 2016, 2012, 2008 Pearson Education, Inc. All Rights Reserved
Standardized Approaches to Care Planning • Standardized care plans § Predeveloped guides for nursing care of client with a need arising frequently in agency § Written from the perspective of what care the client can expect Kozier & Erb's Fundamentals of Nursing, Tenth Edition Audrey Berman | Shirlee Snyder | Geralyn Frandsen Copyright © 2016, 2012, 2008 Pearson Education, Inc. All Rights Reserved
Figure 13– 4 A standardized care plan for the nursing diagnosis of Deficient Fluid Volume. Kozier & Erb's Fundamentals of Nursing, Tenth Edition Audrey Berman | Shirlee Snyder | Geralyn Frandsen Copyright © 2016, 2012, 2008 Pearson Education, Inc. All Rights Reserved
Standardized Approaches to Care Planning • Protocols § Indicate actions commonly required for a particular groups of clients § May include both primary care provider's orders and nursing interventions § Example: Protocol for admitting a client to the intensive care unit Kozier & Erb's Fundamentals of Nursing, Tenth Edition Audrey Berman | Shirlee Snyder | Geralyn Frandsen Copyright © 2016, 2012, 2008 Pearson Education, Inc. All Rights Reserved
Standardized Approaches to Care Planning • Policies and procedures § Developed to govern handling of frequently occurring situations § Cover situations pertinent to client care § Example: Policy specifying the number of visitors a client may have Kozier & Erb's Fundamentals of Nursing, Tenth Edition Audrey Berman | Shirlee Snyder | Geralyn Frandsen Copyright © 2016, 2012, 2008 Pearson Education, Inc. All Rights Reserved
Standardized Approaches to Care Planning • Standing order § Written document • • Policies Rules Regulations Orders regarding patient care § Gives the nurse authority to carry out specific actions under certain circumstances Kozier & Erb's Fundamentals of Nursing, Tenth Edition Audrey Berman | Shirlee Snyder | Geralyn Frandsen Copyright © 2016, 2012, 2008 Pearson Education, Inc. All Rights Reserved
Standardized Approaches to Care Planning • Individualization of standardized care plans § Fit the unique needs of each client § Usually both preauthored and nursecreated sections § For predictable, commonly occurring problems § Individual plan for unusual problems or problems needing special attention Kozier & Erb's Fundamentals of Nursing, Tenth Edition Audrey Berman | Shirlee Snyder | Geralyn Frandsen Copyright © 2016, 2012, 2008 Pearson Education, Inc. All Rights Reserved
Formats for Nursing Care Plans • Student care plans § Rationale • Evidence-based principle given as the reason for selecting a particular nursing intervention § Concept maps • Visual tool in which ideas or data are enclosed in circles or boxes with relationships indicated by lines or arrows Kozier & Erb's Fundamentals of Nursing, Tenth Edition Audrey Berman | Shirlee Snyder | Geralyn Frandsen Copyright © 2016, 2012, 2008 Pearson Education, Inc. All Rights Reserved
Formats for Nursing Care Plans • Computerized care plans § Create and store nursing care plans § Can be accessed at a centrally located terminal at nurses' station or in clients' rooms § Appropriate diagnoses selected from a menu suggested by the computer Kozier & Erb's Fundamentals of Nursing, Tenth Edition Audrey Berman | Shirlee Snyder | Geralyn Frandsen Copyright © 2016, 2012, 2008 Pearson Education, Inc. All Rights Reserved
Figure 13– 5 A sample pathophysiology concept map. Kozier & Erb's Fundamentals of Nursing, Tenth Edition Audrey Berman | Shirlee Snyder | Geralyn Frandsen Copyright © 2016, 2012, 2008 Pearson Education, Inc. All Rights Reserved
Multidisciplinary (Collaborative) Care Plans • Also known as critical pathways • Sequence care that must be given on each day during projected length of stay for each condition • Usually organized with a column for each day listing interventions and outcomes for that day • Includes medical treatments to be performed by other providers Kozier & Erb's Fundamentals of Nursing, Tenth Edition Audrey Berman | Shirlee Snyder | Geralyn Frandsen Copyright © 2016, 2012, 2008 Pearson Education, Inc. All Rights Reserved
Guidelines for Writing Nursing Care Plans 1. Date and sign the plan 2. Use category headings 3. Use standardized/approved medical or English symbols and key words rather than complete sentences to communicate your ideas unless agency policy dictates otherwise 4. Be specific continued on next slide Kozier & Erb's Fundamentals of Nursing, Tenth Edition Audrey Berman | Shirlee Snyder | Geralyn Frandsen Copyright © 2016, 2012, 2008 Pearson Education, Inc. All Rights Reserved
Guidelines for Writing Nursing Care Plans 5. Refer to procedure books or other sources of information rather than including all the steps on a written care plan 6. Tailor the plan to the unique characteristics of the client by ensuring that the client's choices, such as preferences about the times of care and methods used, are included. continued on next slide Kozier & Erb's Fundamentals of Nursing, Tenth Edition Audrey Berman | Shirlee Snyder | Geralyn Frandsen Copyright © 2016, 2012, 2008 Pearson Education, Inc. All Rights Reserved
Guidelines for Writing Nursing Care Plans 7. Ensure that the nursing plan incorporates preventive and health maintenance aspects as well as restorative ones 8. Ensure that the plan contains ongoing assessment of the client continued on next slide Kozier & Erb's Fundamentals of Nursing, Tenth Edition Audrey Berman | Shirlee Snyder | Geralyn Frandsen Copyright © 2016, 2012, 2008 Pearson Education, Inc. All Rights Reserved
Guidelines for Writing Nursing Care Plans 9. Include collaborative and coordination activities in the plan 10. Include plans for the client's discharge and home care needs Kozier & Erb's Fundamentals of Nursing, Tenth Edition Audrey Berman | Shirlee Snyder | Geralyn Frandsen Copyright © 2016, 2012, 2008 Pearson Education, Inc. All Rights Reserved
The Planning Process • Consists of the following activities: § Setting priorities § Establishing client goals/desired outcomes § Selecting nursing interventions § Writing individualized nursing interventions on care plans Kozier & Erb's Fundamentals of Nursing, Tenth Edition Audrey Berman | Shirlee Snyder | Geralyn Frandsen Copyright © 2016, 2012, 2008 Pearson Education, Inc. All Rights Reserved
Setting Priorities • Establishing a preferential sequence for addressing nursing diagnoses and interventions § High priority (life-threatening) § Medium priority (health-threatening) § Low priority (developmental needs) Kozier & Erb's Fundamentals of Nursing, Tenth Edition Audrey Berman | Shirlee Snyder | Geralyn Frandsen Copyright © 2016, 2012, 2008 Pearson Education, Inc. All Rights Reserved
Setting Priorities • Factors to consider § § § Client's health values and beliefs Client's priorities Resources available to nurse and client Urgency of the health problem Medical treatment plan Kozier & Erb's Fundamentals of Nursing, Tenth Edition Audrey Berman | Shirlee Snyder | Geralyn Frandsen Copyright © 2016, 2012, 2008 Pearson Education, Inc. All Rights Reserved
Establishing Client Goals/Desired Outcomes • Goals § Broad statements about the client's status • Desired outcomes § More specific, observable criteria used to evaluate whether goals have been met Kozier & Erb's Fundamentals of Nursing, Tenth Edition Audrey Berman | Shirlee Snyder | Geralyn Frandsen Copyright © 2016, 2012, 2008 Pearson Education, Inc. All Rights Reserved
Table 13– 2 Deriving Desired Outcomes from Nursing Diagnoses Kozier & Erb's Fundamentals of Nursing, Tenth Edition Audrey Berman | Shirlee Snyder | Geralyn Frandsen Copyright © 2016, 2012, 2008 Pearson Education, Inc. All Rights Reserved
Establishing Client Goals/Desired Outcomes • The nursing outcomes classification § Taxonomy for describing client outcomes that respond to nursing interventions § Outcomes broadly stated and conceptual continued on next slide Kozier & Erb's Fundamentals of Nursing, Tenth Edition Audrey Berman | Shirlee Snyder | Geralyn Frandsen Copyright © 2016, 2012, 2008 Pearson Education, Inc. All Rights Reserved
Establishing Client Goals/Desired Outcomes • The nursing outcomes classification § Made more specific by identifying indicators that apply to a particular client • Stated in neutral terms • Each outcome includes a five-point scale to rate the client's status. continued on next slide Kozier & Erb's Fundamentals of Nursing, Tenth Edition Audrey Berman | Shirlee Snyder | Geralyn Frandsen Copyright © 2016, 2012, 2008 Pearson Education, Inc. All Rights Reserved
Establishing Client Goals/Desired Outcomes • The nursing outcomes classification § To write a desired outcome using NOC taxonomy, indicate: • • Label Indicators that apply to client Initial client status Location on the measuring scale desired for each indicator § Can be stated in traditional (lay) language Kozier & Erb's Fundamentals of Nursing, Tenth Edition Audrey Berman | Shirlee Snyder | Geralyn Frandsen Copyright © 2016, 2012, 2008 Pearson Education, Inc. All Rights Reserved
Establishing Client Goals/Desired Outcomes • Purpose of desired goals/outcomes § Provide direction for planning interventions § Serve as criteria for evaluating progress § Enable the client and the nurse to determine when the problem has been resolved § Help motivate the client and nurse by providing a sense of achievement Kozier & Erb's Fundamentals of Nursing, Tenth Edition Audrey Berman | Shirlee Snyder | Geralyn Frandsen Copyright © 2016, 2012, 2008 Pearson Education, Inc. All Rights Reserved
Establishing Client Goals/Desired Outcomes • Short-term and long-term goals § By the end of the week or in over the course of many weeks § Short-term goals useful for clients who: • Require health care for a short time • Are frustrated by long-term goals that seem difficult to attain • Need the satisfaction of achieving a short -term goal Kozier & Erb's Fundamentals of Nursing, Tenth Edition Audrey Berman | Shirlee Snyder | Geralyn Frandsen Copyright © 2016, 2012, 2008 Pearson Education, Inc. All Rights Reserved
Establishing Client Goals/Desired Outcomes • Relationship of goals/desired outcomes to nursing diagnoses § Goals derived from diagnostic label § Diagnostic label contains the unhealthy response (problem) § Goal is opposite, healthy response. continued on next slide Kozier & Erb's Fundamentals of Nursing, Tenth Edition Audrey Berman | Shirlee Snyder | Geralyn Frandsen Copyright © 2016, 2012, 2008 Pearson Education, Inc. All Rights Reserved
Establishing Client Goals/Desired Outcomes • Relationship of goals/desired outcomes to nursing diagnoses § How client will look or behave if health response is achieved (observable, timelimited) § Achieving goal demonstrates resolution of the problem Kozier & Erb's Fundamentals of Nursing, Tenth Edition Audrey Berman | Shirlee Snyder | Geralyn Frandsen Copyright © 2016, 2012, 2008 Pearson Education, Inc. All Rights Reserved
Establishing Client Goals/Desired Outcomes • Components of goal/desired outcome statements § § Subject Verb Conditions or modifiers Criterion of desired performance Kozier & Erb's Fundamentals of Nursing, Tenth Edition Audrey Berman | Shirlee Snyder | Geralyn Frandsen Copyright © 2016, 2012, 2008 Pearson Education, Inc. All Rights Reserved
Establishing Client Goals/Desired Outcomes • Guidelines for writing goals/desired outcomes § Write in terms of client responses § Must be realistic § Ensure compatibility with therapies of other professionals continued on next slide Kozier & Erb's Fundamentals of Nursing, Tenth Edition Audrey Berman | Shirlee Snyder | Geralyn Frandsen Copyright © 2016, 2012, 2008 Pearson Education, Inc. All Rights Reserved
Establishing Client Goals/Desired Outcomes • Guidelines for writing goals/desired outcomes § Derive from only one nursing diagnosis § Use observable, measurable terms § Make sure client considers goals important Kozier & Erb's Fundamentals of Nursing, Tenth Edition Audrey Berman | Shirlee Snyder | Geralyn Frandsen Copyright © 2016, 2012, 2008 Pearson Education, Inc. All Rights Reserved
Selecting Nursing Interventions and Activities • Actions nurse performs to achieve goals • Focus on eliminating or reducing etiology of nursing diagnosis • Treat signs and symptoms and defining characteristics • Interventions for risk nursing diagnoses should focus on reducing client's risk factors Kozier & Erb's Fundamentals of Nursing, Tenth Edition Audrey Berman | Shirlee Snyder | Geralyn Frandsen Copyright © 2016, 2012, 2008 Pearson Education, Inc. All Rights Reserved
Selecting Nursing Interventions and Activities • Types of nursing interventions § Independent interventions • Activities nurses are licensed to initiate (i. e. , physical care, ongoing assessment) § Dependent interventions • Activities carried out under primary care provider's orders or supervision, or according to specified routines continued on next slide Kozier & Erb's Fundamentals of Nursing, Tenth Edition Audrey Berman | Shirlee Snyder | Geralyn Frandsen Copyright © 2016, 2012, 2008 Pearson Education, Inc. All Rights Reserved
Selecting Nursing Interventions and Activities • Types of nursing interventions § Collaborative interventions • Actions nurse carries out in collaboration with other health team members • Reflect overlapping responsibilities of health care team Kozier & Erb's Fundamentals of Nursing, Tenth Edition Audrey Berman | Shirlee Snyder | Geralyn Frandsen Copyright © 2016, 2012, 2008 Pearson Education, Inc. All Rights Reserved
Selecting Nursing Interventions and Activities • Considering the consequences of each intervention § Choose that are most likely to achieve the desired client outcomes' § Requires nursing knowledge and experience Kozier & Erb's Fundamentals of Nursing, Tenth Edition Audrey Berman | Shirlee Snyder | Geralyn Frandsen Copyright © 2016, 2012, 2008 Pearson Education, Inc. All Rights Reserved
Selecting Nursing Interventions and Activities • Criteria for choosing nursing interventions § Safe and appropriate for the client's age, health, and condition § Achievable with the resources available § Congruent with the client's values, beliefs, and culture § Congruent with otherapies continued on next slide Kozier & Erb's Fundamentals of Nursing, Tenth Edition Audrey Berman | Shirlee Snyder | Geralyn Frandsen Copyright © 2016, 2012, 2008 Pearson Education, Inc. All Rights Reserved
Selecting Nursing Interventions and Activities • Criteria for choosing nursing interventions § Based on nursing knowledge and experience or knowledge from relevant sciences § Within established standards of care Kozier & Erb's Fundamentals of Nursing, Tenth Edition Audrey Berman | Shirlee Snyder | Geralyn Frandsen Copyright © 2016, 2012, 2008 Pearson Education, Inc. All Rights Reserved
Writing Individualized Nursing Interventions • Date when they are written • Verb § Action verb starts the interventions and must be precise. • Conditions • Modifiers • Time element § How long or how often the nursing action is to occur Kozier & Erb's Fundamentals of Nursing, Tenth Edition Audrey Berman | Shirlee Snyder | Geralyn Frandsen Copyright © 2016, 2012, 2008 Pearson Education, Inc. All Rights Reserved
Writing Individualized Nursing Interventions • Relationship of nursing interventions to problem status § § Observations Prevention interventions Treatments Enhancement or promotion interventions Kozier & Erb's Fundamentals of Nursing, Tenth Edition Audrey Berman | Shirlee Snyder | Geralyn Frandsen Copyright © 2016, 2012, 2008 Pearson Education, Inc. All Rights Reserved
Delegating Implementation • Delegation occurs during planning. § Who is decided to do each task? • Nurse is responsible for correct implementation of task delegated, analysis of data, and evaluation of outcome. Kozier & Erb's Fundamentals of Nursing, Tenth Edition Audrey Berman | Shirlee Snyder | Geralyn Frandsen Copyright © 2016, 2012, 2008 Pearson Education, Inc. All Rights Reserved
The Nursing Interventions Classification • Taxonomy of nursing interventions • Developed by the Iowa Intervention Project • First published in 1992 • Updated every 4 years Kozier & Erb's Fundamentals of Nursing, Tenth Edition Audrey Berman | Shirlee Snyder | Geralyn Frandsen Copyright © 2016, 2012, 2008 Pearson Education, Inc. All Rights Reserved
The Nursing Interventions Classification • Consists of three levels § Level 1 • Domains § Level 2 • Classes § Level 3 • Interventions Kozier & Erb's Fundamentals of Nursing, Tenth Edition Audrey Berman | Shirlee Snyder | Geralyn Frandsen Copyright © 2016, 2012, 2008 Pearson Education, Inc. All Rights Reserved
The Nursing Interventions Classification • Interventions § More than 542 developed § Each intervention includes: • A label (name) • A definition • A list of activities that outline key actions § Linked to NANDA diagnostic labels § Select appropriate intervention and customize Kozier & Erb's Fundamentals of Nursing, Tenth Edition Audrey Berman | Shirlee Snyder | Geralyn Frandsen Copyright © 2016, 2012, 2008 Pearson Education, Inc. All Rights Reserved
Concept Map Ineffective Airway Clearance (Gas Exchange) Kozier & Erb's Fundamentals of Nursing, Tenth Edition Audrey Berman | Shirlee Snyder | Geralyn Frandsen Copyright © 2016, 2012, 2008 Pearson Education, Inc. All Rights Reserved
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