help: goal & outcome

  1. I'm working on the client goals and outcome criteria on my care plan. This is the first time we've got to that part and I have some questions. I think my patients top nursing diagnosis is "Impaired tissue integrity R/T mechanical factors, wheelchair AEB small wound on left lower leg". This is a small scrape on the shin area that has scabbed over (took dressing off Thurs.) I assume this takes precedence since she has no ABC problems and her other priority lists include self care deficits since she needs assistance in all areas of ADL's.
    would a good Goal be: "client's tissue perfusion will heal within two weeks"?
    would Outcome Criteria be: "client's skin integrity will be intact"?
    Or is there a better way to state this?
    •  
  2. 12 Comments

  3. by   Daytonite
    I would try wording the goal this way: This client's wound on the shin will be healed in two weeks.

    The Outcome Criteria would be: The client's wound will show a measurable decrease in size and show the formation of granulation tissue.
  4. by   Medsport
    Thanks, I probably should try to do the interventions and ratonale too, even though they are not due on this one, but I believe that would complete the care plan correct? We have to have 3 complete ones by the end of the semester. I'm not sure if you have to fill out the evaluation or not either.
    We are supposed to cite a reference for the intervention from our textbook.
    The only thing I could find for wounds (not surgical or pressure ulcer) was to monitor daily for S&S of infection, and I could'nt find a rationale in my book...
  5. by   Bonny619
    Do you have any care plan books? They can be great resources for interventions.

    But one thing ive learned from doing care plans, make sure your intervention directly relates to your expected outcome. It could be a great intervention, but it might not be directly linked to your goal.
    Last edit by Bonny619 on Oct 30, '06
  6. by   Daytonite
    you should be able to find the rationales for your nursing interventions in your nursing textbooks. you are just not knowing where to look. here is a link to the ackley and ladwig online care plan constructor site for the nursing diagnosis of impaired tissue integrity
    http://www1.us.elsevierhealth.com/ev...ex.cfm?plan=49
    it includes nursing interventions along with rationales that include references. there are also some client outcomes listed.

    with regard to continuity and linkage between the parts of your care plan--this is true. it all has to link together. this is why some instructors have gone to using concept mapping. it forces you to make these links in a visual way. it is sometimes hard to see the linking when you are looking at a couple of pages of text. the actual information that goes into a care plan can actually be broken down to shortened key words/phrases. this is what is done in concept mapping. nursing interventions link to aeb data. rationales link and support nursing interventions. goals and outcomes link back to either aeb data or nursing diagnosis labels. it's all one big related cycle. it would be a shame to nail the nursing diagnosis and assessment data correctly only to lose points because of not properly relating goals, outcomes or interventions appropriately.
  7. by   Bonny619
    Thanks for reminding me about the concept mapping. My previous clinical instructor was big into that, I keep meaning to look into it.
  8. by   Daytonite
    Quote from bonny619
    thanks for reminding me about the concept mapping. my previous clinical instructor was big into that, i keep meaning to look into it.
    here are two links for you. one is an explanation of what concept mapping for nursing care plans is. the other is an allnurses thread to which 2 students kindly posted samples of their concept maps to.

    http://cord.org/txcollabnursing/onsite_conceptmap.htm - this is a nice explanation about what concept mapping is with an example of what one looks like and how it is put together.

    http://allnurses.com/forums/f50/conc...ps-155445.html
  9. by   Lori RN_09_2b
    This brings up something I'm having a problem with. Must be a mental block or something, but I'm having a terrible time differentiating between a goal and an outcome. Could somebody explain it to me? Sometimes just a different explanation will help something sink in. (I did my first care plan and did great on it, so obviously I'm doing something right. I just think it might've been more luck than anything. :spin

    Thanks!
  10. by   Bonny619
    Same thing, I believe. Just different wording.
  11. by   Daytonite
    The difference between goals and outcomes. . .a tall order. A bit difficult to explain. I've been trying to word this so it sounds logical to read (which is why it's taken me so long to respond to your question) although I know the difference between them in my mind.

    First off, let me start by reminding you that there are independent nursing actions and what are called collaborative nursing actions. Independent nursing actions are those things that a nurse can prescribe, or order, for a patient that do not require a physician order. Collaborative nursing actions are those things nurses do for patients upon the order of a physician or another healthcare provider (i.e. give medications, carry out PT orders, draw blood, etc.). The difference between goals and outcomes lies with these two types of nursing actions.

    Outcomes are the predicted results of independent nursing actions.
    Goals are the predicted results of collaborative nursing actions.

    Using an example of a patient who has a nursing diagnosis of pain. . .an outcome might be that the patient will use the numerical 1 to 10 pain rating scale to identify his/her pain intensity. Now, that is something that comes about by the independent nursing activity of the nurse teaching and explaining the 1 to 10 pain rating scale to the patient. On the other hand, you are giving a patient medication for pain as ordered by his/her doctor. The goal is going to be that the patient is pain free. The nurse cannot take complete credit for the patient being pain free because the physician, by way of ordering the pain medication, had a part in the achievement of that final result. But, with regard to the outcome, the nurse can rightfully claim full responsibility for that achievement.

    Does that make sense to you?
  12. by   Bonny619
    ohh I see what you're saying.
  13. by   Lori RN_09_2b
    Daytonite, thank you! That REALLY helped1 It's getting much clearer in my head now--I think I just need to sit down with a few scenarios and actually hash them out. I knew there was a difference but couldn't put my finger on what exactly it was. Using your rationale, it should be much easier. My professor had explained it--sort of--and left half the class feeling that they're the same thing. I knew that wasn't the case but, like you said, it's hard to put into words. And was driving me nuts.

    I really appreciate your taking the time to explain it! You're great! :bowingpur
  14. by   Daytonite
    I'm still thinking about the difference between goals and outcomes. I've been reviewing some of the information on nursing outcome classifications at the University of Utah website since last evening. They are saying that the outcomes they developed and that have been accepted by NANDA are primarily nursing intervention based. That means when you identify an outcome you are saying that as the nurse you are accepting responsibility and accountability for helping the patient achieve that outcome. In addition, the outcome should be measurable, patient centered, and specific. However, they are also saying that other disciplines beside nursing can also use these NOCs (Nursing Outcome Classifications). I'm assuming they don't mean medical doctors. I was looking at the NANDA NOC outcomes for the nursing diagnosis that the OP wants to use (Impaired Tissue Integrity) and they are:
    • Report any altered sensation or pain at site of tissue impairment
    • Demonstrate understanding of plan to heal tissue and prevent injury
    • Describe measures to protect and heal the tissue, including wound care
    • Experience a wound that decreases in size and has increased granulation tissue
    (Nursing Diagnosis Handbook: A Guide to Planning Care, 7th Edition, by Betty J. Ackley and Gail B. Ladwig. page 1237.)

    Now, I think we are to conclude that as practitioners we are to individualize any of those outcomes if we choose to use one or more and place some measurable quantifiers within them. However, I was thinking that the healing of a wound is a natural process to begin with--a physiological process that, in a normal person, is going to proceed on it's own. What interventions is the nurse taking to promote healing other than to assess and monitor the healing process? That apparently entitles us to take credit for that outcome. It doesn't seem quite fair, but I am now understanding the logic of this. Monitoring, observing, assessing or evaluating a patient's condition is a type of nursing intervention. Silly me for forgetting that! In any case, I'm sure I am on the right track with what I posted above.

    I would encourage you all to question your nursing instructors about this point of the difference between a goal and an outcome and see what they have to say. You might also review any notes you have from your class lectures or handouts on care planning and see if this is addressed. I did review one website on care planning and all it did was address outcomes. It only mentions the word "goals" three times in the text and never explains the term. It does, however, explain outcomes.
    http://www.mac.edu/faculty/NursingDe...urn%20to%20top

    In all honesty, the only source I found that even addresses goals being related to collaborative problems is good old Carpenito's care plan book in the beginning sections of it in two different places. And, I had to read it over a couple of times to make sure I was understanding it correctly. It stands to reason, however, since every other source I've looked at is very definitely ascribing outcomes to the independent actions of the nurse--period--than everything else has to fall into the category of a goal, by default.

    Don't you just love this kind of collegiate discussion?!
    Last edit by Daytonite on Oct 30, '06

close