The Foundations Of Nursing Science 11- Approach Of Nursing Care- Organisation of Care Targeted Transmission

Lecture 2

Level 100 NPUIB

Second Semester 2019/2020 Academic Year

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Establishing Client Goals and Desired Outcomes

After assigning priorities for your nursing diagnosis, the nurse and the client set goals for each determined priority. Goals
or desired outcomes describe what the nurse hopes to achieve by implementing the nursing interventions and are derived
from the client’s nursing diagnoses. Goals provide direction for planning interventions, serve as criteria for evaluating client
progress, enable the client and nurse to determine which problems have been resolved, and help motivate the client and
nurse by providing a sense of achievement.

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Example of goals and desired outcomes. Notice how they’re formatted/written.

One overall goal is determined for each nursing diagnosis. The terms goal, outcome, and expected outcome are oftentimes
used interchangeably.

Short Term and Long Term Goals

Goals and expected outcomes must be measurable and client-centered. Goals are constructed by focusing on problem
prevention, resolution, and/or rehabilitation. Goals can be short term or long term. In an acute care setting, most goals are
short-term since much of the nurse’s time is spent on the client’s immediate needs. Long-term goals are often used for
clients who have chronic health problems or who live at home, in nursing homes, or extended care facilities.

 Short-term goal – a statement distinguishing a shift in behavior that can be completed immediately, usually within a
few hours or days.
 Long-term goal – indicates an objective to be completed over a longer period, usually over weeks or months.
 Discharge planning – involves naming long-term goals, therefore promoting continued restorative care and problem
resolution through home health, physical therapy, or various other referral sources.

Components of Goals and Desired Outcomes

Goals or desired outcome statements usually have the four components: a subject, a verb, conditions or modifiers, and
criterion of desired performance.

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Components of goals and desired outcomes in a nursing care plan.

 Subject. The subject is the client, any part of the client, or some attribute of the client (i.e., pulse, temperature,
urinary output). That subject is often omitted in writing goals because it is assumed that the subject is the client unless
indicated otherwise (family, significant other).
 Verb. The verb specifies an action the client is to perform, for example, what the client is to do, learn, or experience.
 Conditions or modifiers. These are the ―what, when, where, or how‖ that are added to the verb to explain the
circumstances under which the behavior is to be performed.
 Criterion of desired performance. The criterion indicates the standard by which a performance is evaluated or the
level at which the client will perform the specified behavior. These are optional.

When writing goals and desired outcomes, the nurse should follow these tips:

1. Write goals and outcomes in terms of client responses and not as activities of the nurse. Begin each goal with “Client
will […]” help focus the goal on client behavior and responses.
2. Avoid writing goals on what the nurse hopes to accomplish, and focus on what the client will do.
3. Use observable, measurable terms for outcomes. Avoid using vague words that require interpretation or judgment of
the observer.
4. Desired outcomes should be realistic for the client’s resources, capabilities, limitations, and on the designated time
span of care.
5. Ensure that goals are compatible with the therapies of other professionals.
6. Ensure that each goal is derived from only one nursing diagnosis. Keeping it this way facilitates evaluation of care by
ensuring that planned nursing interventions are clearly related to the diagnosis set.
7. Lastly, make sure that the client considers the goals important and values them to ensure cooperation.

NURSING INTERVENTION

When nurses care for patients they follow the nursing process. This includes making a plan and setting goals for the patient.
Nursing interventions are the actual treatments and actions that are performed to help the patient to reach the goals that

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are set for them. The nurse uses his or her knowledge, experience and critical-thinking skills to decide which interventions
will help the patient the most.

Classification

There are different classifications of nursing interventions that can involve care of the entire patient. This can be anything
from promoting bowel functioning, educating the patient on new medication side-effects or just keeping the patient safe.
Interventions can be focused on basic physiological needs, complex physiological needs, behavioral functioning, promoting
safety, caring for the family, using the health system and/or the overall health of the community. As nurses, we are caring
for the total patient, so there are can be interventions concerning every area of the patient's life.

Just as there are different patients with different medical needs and health conditions, there are different types of nursing
interventions to meet their needs. Luckily, nurses aren’t on their own for choosing the best intervention for their patients—
or even for remembering what all the options are!

The Nursing Interventions Classification system defines more than 550 nursing intervention labels that nurses can use to
provide the proper care to their patients. These interventions are then divided into seven domains, or types of interventions:

 Behavioral nursing interventions include actions that help a patient change their behavior, such as offering support
to quit smoking.
 Community nursing interventions are those that focus on public health initiatives, such as implementing a diabetes
education program.
 Family nursing interventions are those that impact a patient’s entire family, such as offering a nursing woman
support in breastfeeding her new baby, or reducing the threat of illness spreading when one family member is
diagnosed with a communicable disease.
 Health system nursing interventions are actions nurses take as part of a healthcare team to provide a safe medical
facility for all patients, such as following procedures to reduce the risk of infection for patients during hospital stays.
 Physiological nursing interventions are related to a patient’s physical health. These nursing interventions come in
two categories: basic and complex. An example of a physiological nursing intervention would be providing IV fluids
to a patient who is dehydrated.
 Safety nursing interventions include actions that maintain a patient’s safety and prevent injuries. These include
educating a patient about how to call for assistance if they are not able to safely move around on their own.

As you can see, nursing interventions go beyond simply ―fixing‖ a patient. Nursing interventions are a vital service for
patients as nurses care for them in every aspect, including physically, mentally, emotionally and socially. The men and
women who perform nursing interventions every day can make a lasting, positive impact on their patients.

Example of Nursing Intervention

To get a sense of how interventions work, let's take the case of an imaginary patient, Mrs. James. Mrs. James has recently
been admitted into the hospital. She is a 72-year-old female with a blood pressure reading of 200/100. She is complaining
of a headache and dizziness. We are going to learn some of the nursing interventions that we could provide while caring for
Mrs. James. Now let's see how different types of nursing interventions might be applied to Mrs. James.

Types of Nursing Interventions

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Some of the nursing interventions will require a doctor's order and some will not. There are different types of interventions:
independent, dependent and interdependent. Let's learn about each and go over a few examples:

 Independent - These are actions that the nurse is able to initiate independently. The following would be an example
of a health promotion nursing intervention, which is an independent nursing action:
o Mrs. James has started a new medication for her high blood pressure. She is concerned about the side-effects
and is refusing to take the medication. The nurse intervenes by educating the patient on the purpose of the
medication, the side-effects of the medication and the possible consequences of high blood pressure.
 Dependent - These interventions will require an order from another health care provider such as a physician:
o Mrs. James's blood pressure is consistently 180/100. The nurse reports this to the physician. The physician
orders an antihypertensive medication for the patient. The nurse administers the oral medication to the patient
as ordered.
 Interdependent( Collaborative) - These are going to require the participation of multiple members of the health care
team:
o Mrs. James reveals to the nurse that she consumes a diet very high in sodium. The nurse includes diet
counselling in the patient care plan. To help the patient even more, the nurse enlists the help of the dietician
that is available in their facility to spend time with Mrs. James to educate her on the role that diet plays in the
control of high blood pressure.

Nursing interventions should be:

 Safe and appropriate for the client’s age, health, and condition.
 Achievable with the resources and time available.
 Inline with the client’s values, culture, and beliefs.
 Inline with other therapies.
 Based on nursing knowledge and experience or knowledge from relevant sciences.

When writing nursing interventions, follow these tips:

1. Write the date and sign the plan. The date the plan is written is essential for evaluation, review, and future planning.
The nurse’s signature demonstrates accountability.
2. Nursing interventions should be specific and clearly stated, beginning with an action verb indicating what the nurse is
expected to do. Action verb starts the intervention and must be precise. Qualifiers of how, when, where, time,
frequency, and amount provide the content of the planned activity. For example: ―Educate parents on how to take
temperature and notify of any changes,‖ or ―Assess urine for color, amount, odor, and turbidity.‖
3. Use only abbreviations accepted by the institution.

Assessment vs. nursing intervention

Nursing interventions and assessments are two separate steps in a larger nursing process. Nurses follow this step-by-step
procedure to provide the best care possible for their patients.

Assessment is the first step in the nursing process, according to the American Nurses Association (ANA). Nurses need to
understand a patient’s medical history, the medications they may be taking and current health condition before they can
provide proper care. Assessment is when nurses gather this information and use active listening skills to talk with patients
and learn more about their concerns, mental health and any changes in their condition.

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Nurses use the information they gathered during assessment to form a diagnosis and create an outcome plan for their
patient. Once all this planning has been completed, interventions can take place. These are the actions nurses take to
implement a patient’s care plan and help them then achieve their health goals.

Justifying Nursing Practice:THE SCIENTIFIC RATIONALE.

Rationales, also known as scientific explanation, are the underlying reasons for which the nursing intervention was chosen
for the Nursing Care Plan.Example: Nursing Intervention- Turn patient in bed every 2 hours. Rationale – To prevent the
development of bedsores.

EVALUATION

Evaluating is a planned, ongoing, purposeful activity in which the client’s progress towards the achievement of goals or
desired outcomes, and the effectiveness of the nursing care plan (NCP). Evaluation is an important aspect of the nursing
process because conclusions drawn from this step determine whether the nursing intervention should be terminated,
continued, or changed.

PUTTING IT ON PAPER( DOCUMENTATION)

The client’s NCP is documented according to hospital policy and becomes part of the client’s permanent medical record
which may be reviewed by the oncoming nurse. Different nursing programs have different care plan formats, most are
designed so that the student systematically proceeds through the interrelated steps of the nursing process, and many use a
five-column format.