17Fundamentals of Nursing: The Art & Science of Person Centered Care, 10th Edition; Taylor, Lynn, Bartlett. Chapter 17 Outcome Identification and Planning

A nurse is planning care for a patient admitted to the hospital for treatment of a drug overdose. What actions will the nurse take during the outcome identification and planning step of the nursing process? Select all that apply.

a Formulating nursing diagnoses

b Identifying expected patient outcomes

c Selecting evidence-based nursing interventions

d Explaining the nursing care plan to the patient

d Assessing the patient’s mental status

e Evaluating the patient’s outcome achievement

b, c, d.

During the outcome identification and planning step of the nursing process, the nurse, patient, and family collaborate to establish priorities and identify and write expected patient outcomes. The nurse selects evidence-based nursing interventions, and communicates the care plan. These steps may overlap; however, formulating and validating nursing diagnoses are typically performed during the diagnosing step. Assessing mental status is part of the assessment step, and evaluating patient outcomes occurs during the evaluation step of the nursing process.

Nurses on a hospital unit work to improve staff communication, as outlined in The Joint Commission’s National Patient Safety Goals. What process will best provide for continuity of the plan of care?

a Checking two patient identifiers, such as name and date of birth, prior to administering medications

b Ensuring two nurses check doses of high-risk medications such as anticoagulants or insulin

c Giving handoff report in the patients’ rooms to update the next nurse on the plan of care

d Obtain a patient sitter for a confused individual who has fallen trying to get out of bed

c.

One of the published standards and requirements for accreditation and certification required by The Joint Commission is to “improve staff communication.” Communicating the plan of care with the patient and oncoming and off going nurses meets this goal. Using patient identifiers relates to the goal of safely identifying patients, checking high-risk medications relates to decreasing medication errors, and obtaining a patient sitter relates to general safety and fall reduction.

A nurse on a mother–baby unit engages in informal planning while providing ongoing nursing care. What actions are included in this type of planning? Select all that apply.

a Sitting down with a patient and prioritizing existing diagnoses

b Assessing a woman for postpartum depression during patient education

c Planning interventions for a patient with a risk for bleeding

d Taking time to speak with a new mother who just received bad news

e Reassessing a patient who reports their pain medication is not working

f Coordinating home care for a patient being discharged later today

b, d, e.

Informal planning is a link between identifying a patient’s strength or problem and providing an appropriate nursing response, often while rearranging priorities. Examples of this include the nurse integrating assessment for postpartum depression during patient care, providing a therapeutic presence for a patient who received bad news, or reassessing a patient for pain during rounding. Formal planning involves prioritizing diagnoses, formally planning interventions, and coordinating the home care of a patient being discharged.

To plan the day, a nurse is prioritizing patient diagnoses according to Maslow’s hierarchy of human needs. What patient problem will the nurse address first?

a Altered body image perception

b Impaired gas exchange

c Grief

d Situational low self-esteem

b.

Because basic needs must be met before a person can focus on higher ones, Maslow’s hierarchy of needs sets the priorities as: (1) physiologic needs, (2) safety needs, (3) love and belonging needs, (4) self-esteem needs, and (5) self-actualization needs. Answer (b) is an example of a physiologic need, (a and d) are examples of a self-esteem need, and (c) is an example of a love and belonging need.

Nurses on an oncology unit plan to adopt use of critical pathways for patients receiving chemotherapy. What positive features of this system will the nurses anticipate? Select all that apply.

a Accessible computerized practice standards, easily individualized for patients

b Binary decision tree for stepwise assessment and intervention

c Ability to measures the cause-and-effect relationship between pathway and patient outcomes

d Research-based practice recommendations that may or may not have been tested in clinical practice

e Preprinted provider prescriptions, using standards validated through research, to streamline care

f Outcomes with suggested time frames for achievement

a, c, f.

Critical pathways represent a sequential, interdisciplinary, minimal practice standard for a specific patient population, that provide flexibility to alter care to meet individualized patient needs. They provide the ability to measure a cause-and-effect relationship between pathway and patient outcomes. An algorithm is a binary decision tree that guides stepwise assessment and intervention with intense specificity and no provider flexibility. Guidelines are broad, research-based practice recommendations that may or may not have been tested in clinical practice, and an order set is a preprinted provider order used to expedite the order process after a practice standard has been validated through analytical research.

A nurse is developing outcomes in the affective domain for a patient with a foot ulcer related to diabetes. Which outcome best addresses this domain?

a Within 1 day after teaching, the patient will list three benefits of continuing to apply moist compresses to foot ulcer after discharge.

b By 6/12/25, the patient will correctly demonstrate application of wet-to-dry dressing on the foot ulcer.

c By 6/19/25, the patient’s pressure ulcer will decrease in size from 3 to 2.5 inches.

d By 6/12/25, the patient will verbalize they value their health sufficiently to control diabetes and prevent recurrence of diabetic ulcers.

d.

Affective outcomes describe changes in patient values, beliefs, and attitudes. Cognitive outcomes (a) describe increases in patient knowledge or intellectual behaviors; psychomotor outcomes (b) describe the patient’s achievement of new skills; and (c) is an outcome describing a physical change in the patient.

A nurse is developing a clinical outcome for a patient who is an avid runner and is recovering from a stroke resulting in right-sided paresis. Which clinical outcome is most appropriate to include in the care plan?

a After receiving 3 weeks of physical therapy, patient will demonstrate improved movement on the right side of her body.

b By 8/15/25, patient will be able to use right arm to dress, comb hair, and feed herself.

c Following physical therapy, patient will begin to gradually participate in walking/running events.

d By 8/15/25, patient will verbalize feeling sufficiently prepared to participate in running events.

b.

Clinical outcomes describe the expected status of health issues at certain points in time, after treatment is complete. Functional outcomes (b) describe the person’s ability to function in relation to the desired usual activities. Quality-of-life outcomes (c) focus on key factors that affect someone’s ability to enjoy life and achieve personal goals. Affective outcomes (d) describe changes in patient values, beliefs, and attitudes.

A nurse is caring for a patient with dehydration who has a prescription to encourage oral fluids. Which outcome statement will best direct nursing interventions?

a Offer patient 60 mL of fluid every 2 hours while awake.

b During the next 24-hour period, patient’s fluid intake will total at least 2,000 mL.

c Teach the patient the importance of drinking enough fluids to prevent dehydration by 1/15/25.

d At the next visit on 12/23/24, patient will know to drink at least 3 L of water per day.

b.

The outcomes in (a) and (c) make the error of expressing the patient goal as a nursing intervention. Incorrect: “Offer the patient 60 mL fluid every 2 hours while awake.” Correct: “The patient will drink 60 mL fluid every 2 hours while awake, beginning 1/3/25.” The outcome in (d) makes the error of using verbs that are not observable and measurable. Verbs to be avoided when writing outcomes include “know,” “understand,” “learn,” and “become aware.”

A nurse is writing outcomes for a patient admitted with a cardiac condition causing fluid overload and edema. Which reflects an appropriately worded outcome?

a Offer to elevate the patient’s legs on a stool while out of bed

b Patient will restrict fluids to 1,500 mL per 24-hour period

c Monitor the patient’s intake and output

d Weigh the patient each morning prior to breakfast

b.

The terms goal, objective, and outcome are often used interchangeably to refer to the expected conclusion to the patient’s health problem or expectation. Nurses use the phrase expected outcomes to refer to the more specific, observable, and measurable changes. Options a, c, and d are stated as interventions, rather than outcomes.

A nursing student is presenting their concept map care plan for a patient with sickle cell anemia in post-conference. How does the student best describe the “concepts” that are being diagrammed in the plan?

a Protocols for treating the patient’s medical problem

b Evidence-based treatment guidelines

c Synthesis of the patient’s problems and treatment

d Clinical pathways reflecting evidence-based treatment for sickle cell anemia

c.

A concept map care plan is a diagram synthesizing patient problems and interventions. The nurse’s ideas about patient problems and treatments are the “concepts” that are diagrammed. These maps are used to organize patient data, analyze relationships in the data, and provide a holistic view of the patient’s situation. Answers (a) and (b) are incomplete because the concepts being diagrammed may include protocols and standardized treatment guidelines but the patient problems are also diagrammed concepts. Clinical pathways are tools used in case management to communicate the standardized, interdisciplinary care plan for patients.

A nurse is updating the plan of care with nurse-initiated interventions. Which intervention is appropriate to include?

a Administering acetaminophen for a headache

b Offering emotional support to a patient

c Consulting with a physical therapist

d Attending a team meeting for care planning

b.

A nurse-initiated intervention is related to the nursing diagnosis and projected outcome. It is an autonomous action based on scientific rationale. The physician or health care provider uses a physician-initiated interventions or order in response to the medical diagnosis: nurses execute these interventions safely and effectively. Collaborative interventions are initiated by other providers including pharmacists, respiratory therapists, or physician assistants.