Outcome Identification and Planning

Planning is the third step of the nursing process and includes the formulation of guidelines that establish the proposed course of nursing action in the resolution of nursing diagnoses and the development of the client’s plan of care. Once the nursing diagnoses have been developed and client strengths have been identified, planning can begin. The planning phase involves several tasks:
• The list of nursing diagnoses is prioritized.
• Client-centered long- and short-term goals and outcomes are identified and written.
• Specific interventions are developed.
• The entire plan of care is recorded in the client’s record.
Once the list of nursing diagnoses has been developed from the data, decisions must be made about priority. Critical thinking enables the nurse to make decisions about which diagnoses are the most important and need attention first. There are a number of frameworks used to prioritize nursing diagnoses; however, those diagnoses involving life-threatening situations are given the highest priority. For example, the following nursing diagnoses would be stated in this order of priority:
• Ineffective Airway Clearance related to excessive and thick secretions and pain secondary to surgery and inability to cough effectively; respirations: 25, shallow, wheezing
• Risk for Injury (falls) related to unsteady gait
• Imbalanced Nutrition: Less Than Body Requirements related to nausea and vomiting
Client-centered goals are established in collaboration with the client whenever possible. A goal is an aim, intent, or end. Goals are broad statements that describe the intended or desired change in the client’s behavior. Goal statements refer to the diagnostic label (or problem statement) of the nursing diagnosis. If the client or significant others are unable to participate in goal development, the nurse assumes that responsibility until the client is able to participate. Client-centered goals assure that nursing care is individualized and focused on the client. Expected outcomes are specific objectives related to the goals and are used to evaluate the nursing interventions. They must be measurable, have a time limit, and be realistic. Once goals and expected outcomes have been established, nursing interventions are planned that enable the client to reach the goals.
A nursing intervention is the activity that the nurse will execute for and with the client to enable accomplishment of the goals. Nursing interventions refer directly to the related factors in the actual nursing diagnoses and the risk factors in risk nursing diagnoses. If
the nursing interventions can remove or reduce the related factors and the risk factors, the problem can be resolved or prevented. Nursing interventions also refer to the diagnostic label for possible diagnoses and focus on data needed to confirm or eliminate the diagnosis.