Planning

• Nursing Process: Planning

  1. Deliberative, systematic phase of the nursing process

  2. Involves decision making and problem solving

  3. Begins with the first client contact and continues until the nurse-client relationship ends

  4. End product: plan of care
• Nursing Intervention


  • Any treatment, based upon clinical judgment and knowledge, that a nurse performs to enhance client’s outcomes
  • Actions in order to reach goals
• Multidisciplinary


  • Involves all health care providers interacting with the client
  • Includes the client and the family
  • Nurses encourage the client to participate actively
• Types of Planning

  • Initial Planning
  • Ongoing Planning
  • Discharge Planning
• Initial Planning


  1. Should be initiated ASAP after initial assessment

  2. Done by the nurse who performs the admission assessment
• Ongoing Planning

  1. Done by nurses who work with the client

  2. Can individualize the initial care plan further

  3. Can occur at the beginning of the shift

  4. Daily planning based on ongoing assessment data
• Discharge Planning

  1. Process of anticipating and planning for needs after discharge

  2. Begins at first client contact

  3. Involves comprehensive and ongoing assessment
• Developing Nursing Care Plans

  Nursing diagnosis is an initial part of the nursing care plan
• Nursing Care Plan (NCP)

  • Informal NCP exists in the nurse’s mind
  • Formal NCP is a written or computerized guide that organizes information about the client’s care
• Types of Formal Care Plan

  • Standardized Care Plan
  • Individualized Care Plan
• Standardized Care Plan

  Specifies the nursing care for groups of clients with common needs
• Individualized Care Plan


  Tailored care plan to meet the unique needs of a specific client addressed by the standardized plan
• Formats for Nursing Care Plans

  • Problem/Nursing Diagnosis
  • Goals/Desired Outcomes
  • Nursing Interventions
  • Evaluation
• Sections of the Nursing Care Plan (NCP)

  • Problem/Nursing Diagnosis
  • Goals/Desired Outcomes
  • Nursing Interventions
  • Evaluation
• Guidelines for Writing NCP's:
• Planning Process

  1. Setting Priorities

  2. Establishing client goals/desired outcomes

  3. Selecting nursing interventions and activities

  4. Writing individualized nursing interventions on care plans
• Process of establishing a preferential sequence of addressing nursing diagnosis and interventions
• Priority levels for nursing diagnoses

  • High priority (Life-threatening problems)
  • Medium priority
  • Low priority
• Nursing Diagnosis Prioritization

  1. Identify number 1 priority among nursing diagnoses

  2. Group diagnoses as HIGH, MEDIUM, & LOW priority based on severity
• Prioritization levels for nursing diagnoses

  • HIGH: Life-threatening problems
  • MEDIUM: Health-threatening problems
  • LOW: Arises from normal developmental needs
• Possible Nursing Diagnosis for Gastroenteritis

  • Deficient knowledge
  • Imbalanced nutrition: less than body requirements
  • Risk for fluid volume deficit
  • Diarrhea
• Prioritization for Gastroenteritis nursing diagnoses

  • Diarrhea
  • Risk for fluid volume deficit
  • Imbalanced nutrition: less than body requirements
  • Deficient knowledge
• Source: '"Used by student nurses to identify prioritization of the nursing diagnosis"'
• Priority must be under the physiological needs according to Maslow's hierarchy of needs
• If you could address two or three problems at once, then it is much better
• Considerations for prioritization

  • Client’s values & beliefs
  • Client’s priorities
  • Resources available to the nurse & client
  • Urgency of the health problem
  • Medical treatment plan
• Establishing Client Goals/Desired Outcomes

  1. One nursing diagnosis - one outcome

  2. Describes what the nurse hopes to achieve by implementing the nursing interventions
• Desired Outcomes/Goals

  • Provide direction for planning interventions
  • Serve as criteria for evaluating client progress
  • Enable the client & nurse to determine when the problem has resolved
  • Help motivate the client and nurse by providing a sense of achievement
• The Nursing Outcomes Classification (NOC) is a standardized nursing language that describes client outcomes responding to nursing interventions
• NOC is linked to NANDA
• Long-term vs. Short-term Goals
• Types of goals

  • Short-term goals
  • Long-term goals
• Short-term goals

  • Used for those who are frustrated by long-term goals that seem difficult to attain & who need the satisfaction of achieving
• Long-term goals

  • Used for those who live at home & have chronic health problems
  • Used for those who are in nursing homes, extended care facilities & rehabilitation parties
• Long-term goal

  Clients will be able to regain full use of their right arm in 6 weeks
• Short-term goal

  Client will be able to raise arm at the level of the client’s head 5 days after mastectomy
• Relationship of Desired Goals/Outcomes to Nursing Diagnoses

  Goals are derived from the client’s nursing diagnosis-primarily from the diagnostic level
• Desired outcomes


  The client will reestablish fluid balance, as evidenced by urinary and stool output in balance with fluid intake, normal skin turgor and moist mucous membranes (totally opposite of the problem should be your goal)
• When developing desired outcomes

  Ask the following questions: What is the client’s problem? What is the opposite, healthy response? How will the client look or behave if the healthy response is achieved? What must the client do and how well must the client do it to demonstrate problem resolution or to demonstrate the capability of resolving the problem?
• Guidelines for Writing Desired Outcome

  • Should be in terms of client responses, not nursing activities
  • Ensure that desired outcomes are realistic for the client’s capabilities, limitations, and designated time span
  • Ensure that the goals and desired outcomes are compatible with the therapies of other professionals
  • Make sure that each goal is derived from only one nursing diagnosis
  • Use observable, measurable terms for outcomes
  • Make sure the client considers the desired outcomes important and values them