Chapter 18: Planning Nursing Care

Introduction to Planning in Nursing

• Planning is the step after identifying patient diagnoses and collaborative problems.
• Involves setting priorities based on diagnoses, identifying goals, expected outcomes, and prescribing nursing interventions.
• Care should be individualized, with patient-centered goals.
• Requires critical thinking, decision making, and problem-solving skills.

Priority Setting

• Order nursing diagnoses or patient problems to establish preferential intervention order.
• Problem-focused diagnoses usually take priority over wellness and health promotion problems.
• Short-term acute needs often prioritized over long-term or chronic needs.
• Priority setting involves clinical importance rather than numerical ordering by severity.
• High priority: Airway, breathing, circulation, safety, and pain.

Roles in Planning

• Involves communication with patients, families, and healthcare teams.
• Dynamic process; care plan evolves with patient needs.
• Nurses classify patient priorities as high, intermediate, or low based on potential harm.

Three forms of communication channels: -kinesthetic -verbal -visual

Goals and Expected Outcomes

• Specific statements about patient behavior or response to resolve diagnoses.
• Serve as direction for interventions and measures for effectiveness.
• Goals are broad statements, measurable, and time-limited.
  • Types of Goals:
    • Short-term: Achievable in less than a week.
    • Long-term: Achievable over days, weeks, or months, often seen as discharge goals.
• Patient involvement in goal setting is crucial for effective care.

Interprofessional Collaboration

• Collaboration improves patient care, satisfaction, and reduces clinical errors.
• Nurses play a key role in communicating patient needs to healthcare teams.

Nursing Interventions

• Determined during the planning phase but implemented later.
• Types of interventions:
  • Nurse-Initiated (Independent): No need for supervision or orders.
  • Direct Care Measures: Interaction with the patient.
  • Indirect Care Measures: Actions on behalf of the patient.
  • Provider-Initiated (Dependent): Require orders from healthcare providers.
  • Interdependent: Involve combined knowledge from multiple providers.

Guidelines for Writing Goals and Expected Outcomes

• Utilize SMART criteria: Specific, Measurable, Attainable, Realistic, and Time-framed.
• Consider six factors when choosing interventions:
  • Desired outcomes
  • Characteristics of diagnosis
  • Evidence-based knowledge
  • Feasibility and cost
  • Patient acceptability
  • Nurse competency
• Nursing Outcomes Classification (NOC) and Nursing Interventions Classification (NIC) as resources.

Nursing Care Plans

• Include diagnoses, goals, outcomes, interventions, and evaluation.
• Promote continuity of care and communication.
• Student care plans help apply classroom knowledge to practice.

Concept Maps

• Visual representation of diagnoses and interventions.
• Improve self-reflection and critical thinking.

Enhanced Recovery After Surgery (ERAS)

• Evidence-based plan for patient's surgical journey.
• Includes timelines for mobility, diet advancement, and therapy cessation.

Consultation in Planning

• Necessary when expertise on specific problems is needed.
• Occurs during the planning phase of the nursing process.
• Collaboration may involve consulting with specialists like nutritionists.