Chapter 18: Planning and Outcomes in Nursing Care

Planning and Outcomes in Nursing Care establishes planning as a deliberate, patient-centered activity requiring clinical judgment to prioritize nursing diagnoses, establish goals, and select specific interventions to resolve health problems. The text details methods for establishing priorities by categorizing diagnoses as high, intermediate, or low importance, utilizing frameworks such as Maslow's hierarchy of needs and the ABCs (Airway, Breathing, Circulation) to address life-threatening issues first. A significant portion of the chapter focuses on generating expected outcomes that are Specific, Measurable, Attainable, Realistic, and Timed (SMART), often utilizing the standardized language of the Nursing Outcomes Classification (NOC) to ensure consistency and measurability. The chapter distinguishes between three categories of nursing interventions: independent (nurse-initiated) actions based on scientific rationale, dependent (health care provider-initiated) orders, and interdependent (collaborative) therapies involving other disciplines, which can be organized using the Nursing Interventions Classification (NIC). The selection of these interventions relies on six factors, including the desired patient outcomes, research base, feasibility, and nurse competency. Additionally, the text reviews systems for planning care, such as interprofessional care plans, student care plans, and concept maps, which visually diagram the holistic relationships between diagnoses and interventions. Finally, the chapter addresses the importance of communication in care coordination, detailing protocols for consultation and hand-off reporting, specifically the use of the ISBAR (Identify, Situation, Background, Assessment, Recommendation) format to ensure safety and continuity.