Nursing Process Planning Phase

1. Prof Nagamani.T

2. Introduction
 Planning is the third phase of Nursing Process,
in which the nurse and client develop client
goals/ desired outcomes and nursing strategies
to prevent, reduce, or alleviate the client’s
health problem.
 It provides direction for nursing interventions.
 Each problem is committed to a clear,
measurable goal for the expected beneficial
outcome.

3. Definition
 Planning is deliberative, systematic phase
of the nursing process. It involves
decision making and problem solving.
 Planning is a category of nursing
behaviors in which client centered goals
and expected outcomes are established
and nursing interventions are selected.

4. Planning
 The planning phase is where goals and outcomes are
formulated that directly impact patient care based on
evidence-based practice (EBP) guidelines.
 Planning is the procedure to manage the
problem

5. Types of Planning
Planning starts with the first client contact and resumes
until the nurse-client relationship ends, preferably
when the client is discharged from the health care
facility.
 Initial Planning
 Ongoing Planning
 Discharge Planning

6. Initial Planning
 Initial planning is done by the nurse who conducts the
admission assessment. Usually, the same nurse would
be the one to create the initial comprehensive plan of
care.

7. Ongoing Planning
 Ongoing planning is done by all the nurses who work
with the client. As a nurse obtain new information and
evaluate the client’s responses to care, they can
individualize the initial care plan further. An ongoing
care plan also occurs at the beginning of a shift.
Ongoing planning allows the nurse to:
 determine if the client’s health status has changed
 set priorities for the client during the shift
 decide which problem to focus on during the shift
 coordinate with nurses to ensure that more than one
problem can be addressed at each client contact

8. Discharge Planning
 Discharge planning is the process of anticipating and
planning for needs after discharge. To provide
continuity of care, nurses need to accomplish the
following:
 Start discharge planning for all clients when they are
admitted to any health care setting.
 Involve the client and the client’s family or support
persons in the planning process.
 Collaborate with other health care professionals as
needed to ensure that biopsychosocial, cultural, and
spiritual needs are met.

9. The planning Process
It consists of the following activities
 Establishing priorities
 Establishing Goals and Expected Outcomes
 Selection of interventions: protocols and standing
Orders
 Writing the Nursing care Plan

10. 1. Establishing priorities
 It is the process of establishing a preferential sequence
for addressing nursing diagnoses 7 interventions.
 Priority setting involves ranking nursing diagnoses in
order of importance.
 With prioritizing, the nurse can attend to the client's
most important needs and organize ongoing care
activities.

11.  Priorities are classified as high, intermediate, or low.
High-priority nursing diagnoses are those that if
untreated, could result in harm to the client. In many
cases, these diagnoses protect basic needs of safety,
adequate oxygenation, and comfort. Example: Risk for
other-directed violence, impaired gas exchange, acute pain,
risk for ineffective airway clearance.
 Intermediate priority nursing diagnoses involve non-
emergent, non-life threatening needs of the client.
Example: Ineffective peripheral tissue perfusion in a post-
operative patient,therefore maintaining normal circulation
to the lower extremities becomes an immediate priority.
 Low priority diagnoses are client needs that may not be
directly related to a specific illness or prognosis but may
affect the client's future well-being. Many focus on the
long-term health care needs of the client.

12. Factors to consider
 Client health values and beliefs
 Client’s priorities
 Resources available
 Urgency of the health problem
 Medical treatment plan

13. 2.Establishing Client goals/ Desired outcomes
 After identifying nursing diagnoses for the client, the nurse
must determine what the best approach to address and
resolve the problem.
 Goals and expected outcomes are established to guide the
plan of care. These are specific statements of client
behavior or physiological responses that a nurses uses to
resolve a problem (Potter & Perry, 2005).
 A client-centered goal is a specific and measurable
behavior or response that reflects a client's highest possible
level of wellness and independence in function (Potter &
Perry, 2005).
 An example of a client-centered goal is: "Client will
perform self-care hygiene independently", "Client will
remain free of infection", "Client will accept body image
alteration".

14. There are two types of goals: short-term goals and long-term goals
 Short-term goals are objectives that are expected to be
achieved within a short time frame, usually less than a week.
Short-term goals are applicable for the immediate care plan
due to shorter hospital stays (Potter & Perry, 2005).
 Long-term goals are objectives expected to be achieved over
a longer time frame, usually over weeks or months. Long-term
goals are more appropriate for after discharge, especially from
acute care settings. These goals are more appropriate for those
clients in home care settings and "adapting to chronic
illnesses who reside in long-term care facilities and for those
clients in rehabilitation, mental health, ambulatory care, and
community nursing settings (Carpenito, 1997 as cited in
Potter & Perry, 2005).

15. 3. Selecting Nursing Interventions and
activities
 Actions nurse perform to achieve goals
 Focus on eliminating or reducing etiology of nursing
diagnosis
 Treat signs and symptoms and defining characteristics
 Interventions for risk nursing diagnoses should focus
on reducing client’s risk factors.

16. Types of nursing interventions
There are three types of nursing interventions:
 Dependent,
 Independent, and
 Collaborative.
Dependent nursing interventions. Also called as
physician-initiated interventions, these are activities
that require doctor’s orders or directions from other
health care professionals.

17.  Independent nursing interventions. Nurses, as
health care professionals, do not completely rely on
the medical management in order to provide care to
their patients.
 Collaborative nursing interventions. This pertains
to the involvement of other disciplines in the medical
management of the patient. A doctor cannot fully treat
a patient with breathing problems without the
assistance of a respiratory therapist or ensure the
complete recovery of an injured patient without the
help of a physical therapist.

18. Criteria for choosing Nursing interventions
 Safe and appropriate for the client’s age, health and condition
 Achievable with the resources available
 Congruent with client’s values, beliefs, and culture
 Congruent with other therapies
 Based on nursing knowledge and experience or knowledge from
relevant sciences
 Within established standards of care
 Date when they are written
 Verb: Action verb starts the interventions and must be precise.
 Conditions
 Modifiers
 Time element. How long or how often the nursing action is to
occur.

19. 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.

20. 4.Writing nursing orders
Developing Nursing care plans
 An informamal nursing care plan
 A formal nursing care plan
 A standardized care plan
 An invidualized care plan
 Kardex care plan

21. Guidelines for writing Nursing care Plans
 Date and sign the plan
 Use category headings- assessment/ Nursing diagnosis/
expected outcome/ Planning/
rationale/Implementation/ Evaluation.
 Use standard medical terms and key words
 Be specific.
 Refer to procedure books or other sources of
information.
 Tailor the plan to the unique characteristics of the
client.

22. 
Ensure that the nursing plan incorporates preventive
and health maintenance aspects as well as restorative
aspects
 Ensure that the plan contains interventions for
ongoing assessment of the client
 Include collaborative and coordination activities in the
plan
 Include plans for the client’s discharge and home care
needs.

23. Keep watching…….