Planning Chapter 12

Initial Planning: Initiated as soon as possible after initial assessment

Ongoing Planning: This phase involves continuously revising and adapting the plan based on emerging insights and feedback throughout the project's duration.

  • To determine whether the client’s health status has changed

  • To set priorities for the client’s care during the shift

  • To decide which problems to focus on during the shift

  • To coordinate the nurse’s activities so that more than one problem can be addressed at each client contact.

Discharge Planning: process of anticipating and planning for needs after discharge. people are sometimes discharged still needing care. Effective discharge planning begins at first client contact and involves comprehensive and ongoing assessment to obtain information about the client’s ongoing needs.

Informed Nursing Care Plan: strategy for action that exists in the nurse’s mind.

Formal Nursing Care Plan: written or computerized guide that organizes information about the client’s care. The most obvious benefit of a formal written care plan is that it provides for continuity of care. Also, for direction about what needs to be documented in client progress notes and as a guide for delegating and assigning staff to care for clients.

Standardized Care Plan: formal plan that specifies the nursing care for groups of clients with common needs

Individual Care Plan: tailored to meet the unique needs of a specific client—needs that are not addressed by the standardized plan.

Standards of care, standardized care plans, protocols, policies, and procedures are developed and accepted by the nursing staff in order to (a) ensure that minimally acceptable criteria are met and (b) promote efficient use of nurses’ time by removing the need to author common activities that are done repeatedly for many of the clients on a nursing unit.

  • Standards of care describe nursing actions for clients with similar medical conditions rather than individuals, and they describe achievable rather than ideal nursing care.

  • Standardized care plans are predeveloped guides for the nursing care of a client who has a need that arises frequently in the agency. They are written from the perspective of what care the client can expect. Kept with client and when discharged become a part of client’s permeant medical record. Checklists, blank lines, or empty spaces to allow nurse to individualize goals and nursing interventions.

    • Typically, are written in the nursing process format:

      • Problem → Goals/Desired Outcomes → Nursing Interventions → Evaluation.

  • Protocols are predeveloped to indicate the actions commonly required for a particular group of clients. may include both the primary care provider’s orders and nursing interventions. May or may not be included in client’s permeant record.

  • Policies and procedures are developed to govern the handling of frequently occurring situations. Policies are institutional records and do not become a part of the care plan or permanent record.

    • Standing order is a written document about policies, rules, regulations, or orders regarding client care.

Care plan is often organized into four sections: (1) problem or nursing diagnoses, (2) goals or desired outcomes, (3) nursing interventions, and (4) evaluation.

  • Guidelines for writing Nursing Care Plans: Date and sign the plan, use category headings, use standardized, approved medical or English symbols and key words, be specific, refer to procedure books or other sources rather than including all steps in written plan, tailor plan to client, ensure nursing plan incorporates preventive and health maintenance aspects as well as restorative ones, ensure plan contains ongoing assessment, include collaboration, and include plans for discharge

Planning Process

  • Setting priorities

    • High priority: Life threatening problems

    • Medium Priority: health threatening (acute illness, decreased coping)

    • Low Priority: Normal developmental needs require minimal nursing support.

Nursing Outcomes Classification: Describing client outcomes that respond to nursing interventions. NOC outcomes are broadly stated and conceptual. They are variable concepts, meaning that the client’s responses to interventions can be evaluated over time

Short-term goals are useful for clients who (a) require healthcare for a short time or (b) are frustrated by long-term goals that seem difficult to attain and who need the satisfaction of achieving a short-term goal.

Exam Question Examples

After being admitted directly to the surgery unit, a 75-year-old client who had elective surgery to replace an arthritic hip was discharged from the post anesthesia recovery unit. The client has been on the orthopedic floor for several hours. Which type of planning will be least useful during the first shift on the orthopedic unit?

  1. Initial

  2. Ongoing

  3. Discharge

  4. Strategic

The client with a fractured pelvis requests that family members be allowed to stay overnight in the hospital room. Before determining whether or not this request can be honored, the nurse should consult which of the following?

  1. Hospital policies

  2. Standardized care plans

  3. Orthopedic protocols

  4. Standards of care

The nurse assesses a postoperative client with an abdominal wound and finds the client drowsy when not aroused. The client’s pain is ranked 2 on a scale of 0 to 10, vital signs are within preoperative range, extremities are warm with good pulses but skin is very dry. The client declines oral fluids due to nausea, and reports no bowel movement in the past 2 days. Hip dressing is dry with drains intact. Which element is most likely to be considered of high priority for a change in the current care plan?

  1. Pain

  2. Nausea

  3. Constipation

  4. Potential for wound infection

The nurse selects the nursing diagnosis of potential for altered skin integrity related to immobility, dry skin, and surgical incision. Which of the following represents a properly stated goal or outcome? The client will

  1. Turn in bed q2h.

  2. Report the importance of applying lotion to skin daily.

  3. Have intact skin during hospitalization.

  4. Use a pressure-reducing mattress.

The care plan includes a nursing intervention “4/2/15 Measure client’s fluid intake and output. F. Jenkins, RN.” What element of a proper nursing intervention has been omitted?

  1. Action verb

  2. Content

  3. Time

  4. None

Place the following activities of planning in the correct order of their use.

  1. Establish goals or outcomes.

  2. Write the care plan.

  3. Set priorities.

  4. Choose interventions.

  • Set priorities, establish goals or outcomes, choose interventions, write care plan

The nurse recognizes which of the following as a benefit of using a standardized care plan?

  1. No individualization is needed.

  2. The nurse chooses from a list of interventions.

  3. They are much shorter than nurse-authored care plans.

  4. They have been approved by accrediting agencies.

Which of the following is likely to occur if a goal statement is poorly written?

  1. There is no standard against which to compare outcomes.

  2. The nursing diagnoses cannot be prioritized.

  3. Only dependent nursing interventions can be used.

  4. It is difficult to determine which nursing interventions can be delegated.

When written properly, Nursing Outcome Classification (NOC) outcomes and indicators

  1. Do not require customization.

  2. Address several nursing diagnoses.

  3. Are broad statements of desired end points.

  4. Reflect both the nurse’s and the client’s values.

Which principle does the nurse use in selecting interventions for the care plan?

  1. Actions should address the etiology of the nursing diagnosis.

  2. Always select independent interventions when possible.

  3. There is one best intervention for each goal or outcome.

  4. Interventions should be “doing,” not just “monitoring.”