Nursing process Expected outcomes

1. EXPECTED OUTCOME AND
EVALUATION IN NURSING
PROCESS
Anmol Prashar
B.Sc. Nursing 4th year
(Intern)
Roll no 6

2. CONTENTS
• Introduction- Expected Outcome
• Short term and Long term goals
• Components of Goals and Expected Outcome
• Writing Tips
• Selecting Nursing Interventions
• Writing tips
• Providing rationale
• Protocols and Standing Orders
• Purposes of Protocols and Standing Orders

3. • Advantages of Protocols and Standing Orders
• Types of Standing Orders
• General Standing Order Instructions
• Role of Nurse
• Evaluation
• Purposes of Evaluation
• Components of Evaluation
• Outcomes of Care
• Review and Modifications in Evaluation
• References

4. INTRODUCTION
EXPECTED OUTCOME:
Goals or expected outcomes describe what the nurse
hopes to achieve by implementing the nursing interventions
and are derived from the client’s nursing diagnoses. Goals
provide direction for planning interventions, serve as
criteria for evaluating client progress, enable the client and
nurse to determine which problems have been resolved,
and help motivate the client and nurse by providing a sense
of achievement.

5. One overall goal is determined for each nursing diagnosis.
The terms goal, outcome, and expected outcome are
oftentimes used interchangeably.

6. SHORT TERM AND LONG TERM GOALS
• Goals and expected outcomes must
be measurable and client-centered. Goals are constructed
by focusing on problem prevention, resolution, and/or
rehabilitation. Goals can be short term or long term. In an
acute care setting, most goals are short-term since much of
the nurse’s time is spent on the client’s immediate needs.
Long-term goals are often used for clients who have chronic
health problems or who live at home, in nursing homes, or
extended care facilities.

7. • Short-term goal – a statement distinguishing a shift in behavior that can
be completed immediately, usually within a few hours or days.
• Long-term goal – indicates an objective to be completed over a longer
period, usually over weeks or months.
• Discharge planning – involves naming long-term goals, therefore
promoting continued restorative care and problem resolution through
home health, physical therapy, or various other referral sources.

8. COMPONENTS OF GOALS AND
DESIRED OUTCOMES
• Goals or desired outcome statements usually have the four components: a
subject, a verb, conditions or modifiers, and criterion of desired performance.
•
Subject. The subject is the client, any part of the client, or some attribute of
the client (i.e., pulse, temperature, urinary output). That subject is often
omitted in writing goals because it is assumed that the subject is the client
unless indicated otherwise (family, significant other).
• Verb. The verb specifies an action the client is to perform, for example, what
the client is to do, learn, or experience.

9. • Conditions or modifiers. These are the “what, when, where, or how” that are
added to the verb to explain the circumstances under which the behavior is to
be performed.
• Criterion of desired performance. The criterion indicates the standard by which
a performance is evaluated or the level at which the client will perform the
specified behavior. These are optional.

10. WRITING TIPS
When writing goals and desired outcomes, the nurse should follow
these tips:
• Write goals and outcomes in terms of client responses and not as
activities of the nurse. Begin each goal with “Client will […]” help
focus the goal on client behavior and responses.
• Avoid writing goals on what the nurse hopes to accomplish,
and focus on what the client will do.
• Use observable, measurable terms for outcomes. Avoid using vague
words that require interpretation or judgment of the observer.
• Desired outcomes should be realistic for the client’s resources,
capabilities, limitations, and on the designated time span of care.

11. • Ensure that goals are compatible with the therapies of other
professionals.
• Ensure that each goal is derived from only one nursing diagnosis.
Keeping it this way facilitates evaluation of care by ensuring that
planned nursing interventions are clearly related to the diagnosis
set.
• Lastly, make sure that the client considers the goals important and
values them to ensure cooperation.

12. SELECTING NURSING INTERVENTIONS
• Nursing interventions are activities or actions that a nurse performs to
achieve client goals. Interventions chosen should focus on eliminating or
reducing the etiology of the nursing diagnosis. As for risk nursing diagnoses,
interventions should focus on reducing the client’s risk factors. In this step,
nursing interventions are identified and written during the planning step of
the nursing process; however, they are actually performed during the
implementation step.
• Types of Nursing Interventions
• Nursing interventions can be independent, dependent, or collaborative

14. • Independent nursing interventions are activities that nurses are licensed
to initiate based on their sound judgement and skills. Includes: ongoing
assessment, emotional support, providing comfort, teaching, physical care,
and making referrals to other health care professionals.
• Dependent nursing interventions are activities carried out under the
physician’s orders or supervision. Includes orders to direct the nurse to
provide medications, intravenous therapy, diagnostic tests, treatments,
diet, and activity or rest. Assessment and providing explanation while
administering medical orders are also part of the dependent nursing
interventions.
• Collaborative interventions are actions that the nurse carries out in
collaboration with other health team members, such as physicians, social
workers, dietitians, and therapists. These actions are developed in
consultation with other health care professionals to gain their professional
viewpoint.

15. Nursing interventions should be:
• Safe and appropriate for the client’s age, health,
and condition.
• Achievable with the resources and time available.
• Inline with the client’s values, culture, and beliefs.
• Inline with other therapies.
• Based on nursing knowledge and experience or
knowledge from relevant sciences.

16. WRITING TIPS
• Write the date and sign the plan. The date the plan is written is essential for
evaluation, review, and future planning. The nurse’s signature demonstrates
accountability.
• Nursing interventions should be specific and clearly stated, beginning with an
action verb indicating what the nurse is expected to do. Action verb starts the
intervention and must be precise. Qualifiers of how, when, where, time,
frequency, and amount provide the content of the planned activity. For
example: “Educate parents on how to take temperature and notify of any
changes,” or “Assess urine for color, amount, odor, and turbidity.”
• Use only abbreviations accepted by the institution.

17. PROVIDING RATIONALE
• Rationales, also known as scientific explanation, are the underlying
reasons for which the nursing intervention was chosen for the NCP.
• Rationales do not appear in regular care plans, they are included to
assist nursing students in associating the pathophysiological and
psychological principles with the selected nursing intervention.

19. PROTOCOLS AND STANDING ORDERS
• A protocol is a document that’s developed to guide decision-making around
specific issues, whether it be how to diagnose, treat and care for someone with a
specific condition, what procedures to follow to halt the spread of infection, or
how to report that a specific event has taken place.
• The protocol sets out in a step-by-step way what actions should be taken,
explaining the reason and justification for each action as it goes. It’s like a
‘guidebook’ for health care staff, helping them to make sure they’re taking the
right action to get the best outcomes and avoid any possible problems.

20. Standing orders are specific instruction regarding treatment for
condition that nurses and other health workers may encounter in
home, school and industries where a doctor is not readily available.
The standing order are intended to provide treatment only in
emergencies and temporarily in the absence of a doctor, they should
be limited.

21. PURPOSES
• To meet emergency situation.
• To deliver care at home, school, community.
• To provide temporary treatment in the absence
of a doctor.
• To promote health services in community.

22. ADVANTAGES
• Community standing orders provides timely treatment during
emergencies.They enhances the quality and activity Of health
services.
• They provide a feeling of confidence and responsibility in the
nursing staff and other health workers.
• They help to decentralize the health responsibilities.
• They help to strenthn the primary services in the community.

23. TYPES OF STANDING ORDERS
• I .lnstitutional standing orders:-They are meant keeping in mind available
resources ,staff position and the objectives of a medical institution or
hospitalEx-standing order of PHC can be differat from those of district hospital.
• 2.Specific standing order:-These orders are meant for trained medical
personnel, mainly the nurses , technical knowledge and specific skills are
require to implement these orders.Ex-giving care at home ,injections , oxygen
therapy.
• 3.General standing orders:-Owning to a large population , vast geographical
area and the shortage of resources , some standing order are used to
propagate health care messages to the masses.Ex-preventive measures against
AIDS.

24. GENERAL STANDING ORDER INSTRUCTIONS
• Standing order instructions should be issued jointly by an authorized medical
office and a nurse or a committee with a nurse representative.The community
health nurse working in rural areas may be only qualified professional person
readily available to the family , so standing instruction must be used with
caution and discretion.
• Standing orders are these to promote health services in the community.The
medical officer is legally responsible for issuing standing orders, and he should
have faith in the sound judgment of his staff.

25. • They reduce danger in acute condition.
• They create the feeling of responsibility among the members of the health
team.Every health service should issue standing instruction to meet the health
need of the areas.

26. ROLE OF NURSE
• The community health nurse should be skillful in recording the history and in physical
examination in order to detect abnormality. The community health nurse should be prompt
in detecting appropriate action for particular situation.The nurse should maintain a record of
vitals and other care given to the patient.
• The nurse should have thorough knowledge to identify the actual problem of the patient and
to plan appropriate nursing intervention.The nurse should intervene with services according
to the given community standing orders.The nurse should develop a good therapeutic
relationship with the individual and family.The nurse should use referral system if it is
possible.
• The nurse should inform the health officer immediately if there is a communicable
disease.He/she should keep the medication safe and ready to follow standing orders.He/she
should ensure a safe and healthy environment for patient.Recording and reporting is a
essential part of community health services.

27. EVALUATION
• Evaluation is defined as the judgment of the effectiveness of nursing care to meet
client goals; in this phase nurse compare the client behavioral responses with
predetermined client goals and outcome criteria. –CRAVEN 1996
• It is the final step of the nursing process, is crucial to determine whether, after
application of the nursing process, the client’s condition or well-being improves.
The nurse applies all that is known about a client and the client’s condition, as
well as experience with previous clients, to evaluate whether nursing care was
effective. The nurse conducts evaluation measures to determine if expected
outcomes are met, not the nursing interventions.

29. PURPOSES OF EVALUATION
• Determine client’s behavioral response to nursing interventions.
• Compare the client’s response with predetermined outcome criteria.
• Appraise the extent to which client’s goals were attained.
• Assess the collaboration of client and health care team members.
• Identify the errors in the plan of care.
• Monitor the quality of nursing care.

30. COMPONENTS OF EVALUATION
• Collecting the data related to the desired outcomes
• Comparing the data with outcomes
• Relating nursing activities to outcomes
• Drawing conclusion about problem status
• Continuing, modifying, or terminating the nursing care
plan

31. • Collecting the data
• The nurse collects the data so that conclusion can be drawn about
whether goals have been met. It is usually necessary to collect both
subjective & objective data. Data must be recorded concisely and
accurately to facilitate the next part of the evaluating process.
• Comparing the data with outcomes
• If the first part of the evaluation process has been carried out
effectively , it is relatively simple to determine whether a desired
outcome has been met. Both the nurse and client play an active role in
comparing the client’s actual responses with the desired outcomes.
• Relating nursing activities to outcomes
• The third aspect of the evaluating process is determined whether the
nursing activities had any relation to the outcome.

32. • Drawing conclusion about problem status
• The nurse uses the judgement about goal achievement to determine whether the care plan was
effective in resolving, reducing or preventing client problems. When goals have been met the nurse
can draw one the following conclusions about the status of the client’s problem.
• The actual problem stated in the nursing diagnosis has been resolved , or the potential problem is
being prevented and the risk factors no longer exist. In these instances , the nurse documents
that the goals have been met and discontinues the care for the problem.
• The potential problem is being prevented, but the risk factors still present. In this case , the nurse
keeps the problem on the care plan.
• The actual problem still exists even though some goals are being met. In this case the nursing
interventions must be continued.
• Continuing , modifying , or terminating the nursing care plan
• After drawing conclusion about the status of the client’s problems , the nurse modifies the care plan
as indicated. Whether or not goals were met, a number of decision need to be made about
continuing, modifying or terminating nursing care for each problem.
• Before making individual modification, the nurse must first determine why the plan as a whole was
not completely effective. This require a review of the entire plan.

33. OUTCOMES OF CARE

34. REVIEW AND MODIFICATIONS IN
EVALUATION

35. REFERENCES
1. Munro N. Evidence-based assessment: no more pride or prejudice. AACN Clin
Issues 2004; 15(4):501-5.
2. Alfaro-Lefevre R. Nursing Process Overview. In: Kogut H,editor. Applying
Nursing Process. 6 th ed. Philadelphia:Lippincott Williams & Wilkins; 2006. p. 4-
41.
3. Davis BD, Billings JR, Ryland RK. Evaluation of nursing 1 process documentation.
J Adv Nurs 1994; 19(5):960-8.
5. Ehrenberg A, Ehnfors M, Thorell-Ekstrand I. Nursing documentation in patient
records:experience of the use of the VIPS model. J Adv Nurs 1996; 24:853-67.

36. 5.Funnell R, Koutoukidis G, Lawrence K. Tabbner’s Nursing Care. Elsevier
PubAustralia. 2009;72.
6.Adejumo PO, Olaogun AA. Nursing process: A tool for holistic approach to
Nursing care. West Afr J
Nurs. 2009;20(1):34–9