In planning quality nursing care for each client, the nurse assumes responsibility for the coordination of total nursing care. The nurse coordinates the participation of various health care team members to incorporate their recommendations into the delivery of quality nursing care. Critical thinking assists the nurse in establishing collaborative relationships with other members of the health care team and managing complex nursing systems; see the Spotlight On: Caring display that dis- cusses coordination of care.
An important strategy for effective planning is clear com- munication of the client’s plan of care to other health care personnel. The nurse must always communicate the plan of
care in clear, precise terms, avoiding vague terminology such asimproved, adequate,andnormal.
Another strategy for effective planning is to establish a realistic nursing plan of care because this will avoid setting a goal that is too difficult or impossible to achieve. If a goal is too ambitious or is unattainable, the client and nurse may become discouraged or apathetic about the resolution of nursing diagnoses. In addition, goals should be measurable.
Quantitative terms assist in the determination of measure- ment. Finally, the goals should be future oriented. Because a goal is an aim or a desired achievement, goals should be writ- ten in future tense format.
Once appropriate nursing diagnoses are individualized to the client, the plan of care has a stable framework on which an optimum level of wellness for the client can be based. Although some clients may not achieve complete re- solution of all nursing diagnoses, the nursing plan of care that is individualized can improve health to the client’s optimal level.
KEY CONCEPTS
• The outcome identification and planning compo- nent of the nursing process is a sequential, orderly method of using problem-solving skills and critical thinking to formulate a nursing plan of care to resolve nursing diagnoses.
• The planning component of the nursing process includes establishing priorities, setting goals, devel- oping expected outcomes, selecting nursing inter- ventions, and documenting the plan of care.
• The purposes of outcome identification and plan- ning are to provide direction for nursing care, to improve staff communication, and to provide conti- nuity of nursing care.
• The establishment of priorities may be guided by such factors as endangerment of well-being, Mas- low’s hierarchy of needs, client preferences, and anticipation of future diagnoses.
SPOTLIGHT ON
Caring
Coordination of Care
Mr. Eduardo Rodriquez has been admitted with arthritis. His left knee is extremely edematous, and the prescribing practitioner has ordered heat applica- tion of 100°F to the left knee four times a day for 2 hours. In considering the appropriateness of this order, the nurse detects an error regarding the time frame because heat produces maximum vasodilation in 20 to 30 minutes to dissipate the edema; further application of heat may lead to a rebound phenom- enon of tissue congestion and vessel constriction, as well as potential burns. At this point, the nurse needs to seek clarification of the order from the prescribing practitioner. What would be appropriate methods of handling this situation?
• Setting goals and expected outcomes provides guidelines for directing nursing interventions and establishes evaluation criteria by deciding on goals that illustrate a desired change in the client’s behavior.
• Goals and expected outcome objectives include the components of subject, task statement, criteria, con- ditions, and time frame.
• Two common problems frequently encountered in planning goals are improper format and unrealistic, nonmeasurable qualities.
• In planning nursing care, the nurse uses an expan- sive scientific knowledge base and critical thinking
to select independent, interdependent, and depend- ent nursing interventions guided by local and federal standards of care.
• The plan of care documents health care needs, coor- dinates nursing care, promotes continuity of care, encourages communication within the health care team, and promotes quality nursing care.
• Strategies for effective care planning include com- munication of the client’s plan of care within the health care team, establishment of a realistic plan of care, and formulation of measurable and future- oriented goals.
REVIEW QUESTIONS
1. Which of the following best describes the plan of nursing care?
a. Client assessment data, medical treatment re- gime and rationales, and diagnostic test results and significance
b. Prescribing practitioner’s orders, demographic data, and medication administration and ration- ales
c. Collected documentation of all team members providing care for the client
d. Assessment data, nursing diagnoses, goals and expected outcomes, and nursing interventions 2. What is the main purpose of the expected outcome?
a. To describe the education plans to be taught to the client
b. To describe the behavior the client is expected to achieve as a result of nursing interventions c. To provide a standard for evaluating the quality
of health care delivered to the client during the hospital stay
d. To make sure that the client’s treatment does not extend beyond the time allowed under the diagnosis-related group system
3. Which of the following are the essential compo- nents of an expected outcome?
a. Nursing diagnosis, interventions, and expected client behavior
b. Target date, nursing action, measurement crite- ria, and desired client behavior
c. Nursing action, client behavior, target date, and conditions under which the behavior occurs d. Client behavior, measurement criteria, condi-
tions under which the behavior occurs, and tar- get date
4. When planning care, which of the following should the nurse use as a guideline?
a. Choose actions that a nurse can perform without leaving the unit or consulting with medical staff.
b. Make intervention statements specific to ensure continuity of care.
c. Write interventions in general terms to allow maximum flexibility and creativity in delivering nursing care.
d. Make sure that nursing care activities receive pri- ority over other aspects of the treatment regime.
5. Which of the following statements is correctly stated as a client expected outcome?
a. Client will ambulate on fourth postoperative day.
b. Client will ambulate safely.
c. Client will be able to safely walk down the hallway.
d. Client will safely walk unassisted to the end of the hallway within 4 days.
online companion
Visit the DeLaune and Ladner online companion resource atwww.delmar.cengage.comfor additional content and study aids. Click on Online Companions, then select the Nursing discipline.
—GOETHE
CHAPTER 9
Implementation
COMPETENCIES
1. Describe the purposes of the implementation step of the nursing process.
2. Explore the types of skills required for effective implementation.
3. Discuss various implementation activities that nurses execute as directed by the nursing plan of care.
4. Explain the nurse’s roles and responsibilities in the delegation of care to assistive personnel and their impact on implementation.
5. Identify the specific types of nursing interventions that are implemented by the nurse and the characteristics of each type.
6. Discuss the Nursing Interventions Classification (NIC) system.
7. Discuss the importance of documentation in the implementation process.
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mplementation, the fourth step in the nursing process, involves the execution of the nursing plan of care that was developed during the planning phase. It involves com- pletion of nursing activities to accomplish predetermined goals and to make progress toward achievement of specific outcomes. The implementation phase of the nursing process, as with the other phases of the process, requires a broad base of clinical knowledge, careful planning, critical thinking and analysis, and judgment on the part of the nurse.This chapter discusses the purposes of implementation, the specific skills associated with effectively implementing the nursing plan of care, and the activities involved in this process. Although identified as the fourth step of the nursing process, the implementation phase begins with assessment and continually interacts with the other steps of the process to reflect the changing needs of the client and the response of the nurse to those needs.