Desired Outcomes/Goals? HELP!

Nrs_angie, BSN, RN · Apr 30, 2005

The goal is aimed at the nursing diagnosis.

The expected outcomes are aimed at meeting the goal.

1. must be patient-centered.

2. Address only ONE response.

3. include observable and measurable factors.

4. need a target date

5. use behaviorable verbs.

it is usually written like this:

The patient will state 3 ways to treat hypoglycemia by 05/01/05.

It was patient centered (the patient will), only one response (treat hypoglycemia), was observable and measurable (3 ways), had a target date (by 05/01/05), and used a behaviorable verb (will state).

You should not say the pateint will state 3 ways to treat hypoglycemia and will know signs and symptoms of hypoglycemia by ...

Because that is addressing two responses. And using the word 'know' is not very measurable. You can not prove they "know" or they "understand" something.

a few Behaviorable verbs to use:

list

name

participate

perform

state

verbalize

express

demonstrate

identify

I hope this helps you. I do have more information on creating a basic care plan that explains the rules and such. But I can not find it at the moment. I am cleaning up my desk though. So later this weekend I will post.

Good Luck,

Angie

arealqt · Apr 30, 2005

The goal is aimed at the nursing diagnosis.
The expected outcomes are aimed at meeting the goal.
1. must be patient-centered.
2. Address only ONE response.
3. include observable and measurable factors.
4. need a target date
5. use behaviorable verbs.
it is usually written like this:
The patient will state 3 ways to treat hypoglycemia by 05/01/05.
It was patient centered (the patient will), only one response (treat hypoglycemia), was observable and measurable (3 ways), had a target date (by 05/01/05), and used a behaviorable verb (will state).
You should not say the pateint will state 3 ways to treat hypoglycemia and will know signs and symptoms of hypoglycemia by ...
Because that is addressing two responses. And using the word 'know' is not very measurable. You can not prove they "know" or they "understand" something.
a few Behaviorable verbs to use:
list
name
participate
perform
state
verbalize
express
demonstrate
identify
I hope this helps you. I do have more information on creating a basic care plan that explains the rules and such. But I can not find it at the moment. I am cleaning up my desk though. So later this weekend I will post.
Good Luck,
Angie

Perfect! Any info that will help me I will appreciate. Your explanation is wonderful too. I think I am finally catching on. The more and more I read them the more I am understanding and knowing what to look for. You just dont know how much I appreciate this. I have finals next week. This is my 2nd time taking this Concepts course (Fundamentals) and I am really stressing the areas in which the mistakes were made (all in one area) just because I didnt understand. This is really helping me. I dont have any friends in the program that I can form a study grp with, I basically keep to myself. So I am really tryin to do this on my own. I am on borderline now (80% is a C our grading scale) Any point less and I am out the door I know. I am trying to stay encouraged.

truern · Apr 30, 2005

I thought goals and outcomes were interchangable??

Nrs_angie, BSN, RN · Apr 30, 2005

I thought goals and outcomes were interchangable??

Not exactly. I have more information on writing good care plans but I am cleaning my desk right now. When I get to that I will post it ASAP.

Basically the goal is aimed at the nursing diagnosis it self.

The expected outcomes are "steps in the process of meeting the goal".

The interventions are basically aimed at meeting the expected outcomes.

Example:

Decreased cardiac output r/t a reduction in stroke volume as a result of mechanical malfunction

Goal: The pt will resume and maintain an adequate cardiac output as indicated by a heart rate and rhythm WNL by 03/22/05.

Expected Outcomes:

The pt will maintain BP wnl by 03/22/05.

the pt will experience strong peripheral pulses by 03/22/05.

The pt will have no dysrhythmias present by 03/22/05.

The pt will not experience side effects or adverse reactions to medications by 03/22/05.

There are other expected outcomes you may use... but hopefully this is a better example.

This is a more complex nursing care plan. But for AREALQT if you are in your first semester of Nursing 100 the care plans are usually less complex. So if you give me an example of a Nursing Dx that you would like help on... I can come up with something for you.

Good luck,

Angie

Nrs_angie, BSN, RN · Apr 30, 2005

Perfect! Any info that will help me I will appreciate. Your explanation is wonderful too. I think I am finally catching on. The more and more I read them the more I am understanding and knowing what to look for. You just dont know how much I appreciate this. I have finals next week. This is my 2nd time taking this Concepts course (Fundamentals) and I am really stressing the areas in which the mistakes were made (all in one area) just because I didnt understand. This is really helping me. I dont have any friends in the program that I can form a study grp with, I basically keep to myself. So I am really tryin to do this on my own. I am on borderline now (80% is a C our grading scale) Any point less and I am out the door I know. I am trying to stay encouraged.

My best advice to you is find some one you can be friends with. Having support is the only way to make it through nursing school. Nursing 101 is much more difficult. So make sure to get a good grasp on the basics now. Make some friends because you will need them. They will help you as much as you help them. Remember that when you have clinicals with these people... you may need their help. So be friendly and form a good circle of friends. I can't tell you how many times I have been sooo busy on clinicals doing total cares, total feeds, total assists, ect for several patients and I felt like pulling my hair out. If it weren't for my friends who helped me to feed some of my patients ( cuz the trays all come at the same time, hard to feed 3 people at the same time ) I would have never made it through the day without my friends. I am working on getting more information on care plans for you... but i am cleaning my desk. When i get to it i will post it ASAP. So stay tuned!

truern · Apr 30, 2005

OP, try this site and see if things make more sense....

http://www.everything2.com/index.pl?node_id=1417020

Nrs_angie, it would seem I've already been writing outcomes and just didn't know it :rotfl:

VickyRN, MSN, DNP, RN · Apr 30, 2005

The goal is aimed at the nursing diagnosis.
The expected outcomes are aimed at meeting the goal.
1. must be patient-centered.
2. Address only ONE response.
3. include observable and measurable factors.
4. need a target date
5. use behaviorable verbs.
it is usually written like this:
The patient will state 3 ways to treat hypoglycemia by 05/01/05.
It was patient centered (the patient will), only one response (treat hypoglycemia), was observable and measurable (3 ways), had a target date (by 05/01/05), and used a behaviorable verb (will state).
You should not say the pateint will state 3 ways to treat hypoglycemia and will know signs and symptoms of hypoglycemia by ...
Because that is addressing two responses. And using the word 'know' is not very measurable. You can not prove they "know" or they "understand" something.
a few Behaviorable verbs to use:
list
name
participate
perform
state
verbalize
express
demonstrate
identify
I hope this helps you. I do have more information on creating a basic care plan that explains the rules and such. But I can not find it at the moment. I am cleaning up my desk though. So later this weekend I will post.
Good Luck,
Angie

Wonderful advice, Angie. Thanks so much. What I have been teaching my students is much along these lines, but I go a little further and teach the "pattern of reversal" method.

#1. The student obtains objective/ subjective assessment data.

#2. From this assessment data, the student formulates high priority nursing diagnoses (in PES format - problem, etiology, and signs/ symptoms). Make sure the nursing dx are current and NANDA-approved. (Every few years or so, NANDA changes the wording on their diagnoses ever-so-slightly.) Write the nursing diagnosis based on the major/ minor defining characteristics. This is the nursing diagnosis stem.

#3. Next, write the "related to" portion of the nursing diagnosis. The "related to" (etiology) part of the nursing diagnosis phrase is very important, because this makes the nursing diagnosis unique and precise to the individual client situation. The "related to" statement directs the independent and collaborative nursing interventions and gives direction for client care.

#4. The student writes the client goal, by reversing the nursing diagnosis stem. Nursing diagnoses are written in negative language, such as "Decreased Cardiac Output," "Imbalanced Nutrition: Less Than Body Requirements," or "Ineffective Individual Coping." For the client goal, the stem is simply written in reverse, "The client will demonstrate increased cardiac output...." or "The client will cope effectively..."

The nursing diagnosis stem points to the goal and ultimate client outcome.

The goal is simply the nursing diagnosis stem written positively (in reverse) in measurable terms, with a time element ("by end of student nurse's shift on...," "by hospital discharge," "throughout hospital stay," etc.). Make sure, as Angie pointed out, that measurable verbs are used.

The "related to" (etiology) points to the nursing interventions. In other words, the nursing interventions for "Decreased cardiac output r/t atrial tachydysrhythmia" must be directed not towards the "Decreased cardiac output" stem, but towards assisting with the "atrial tachydysrhythmia" etiology instead. Remember, each intervention must be accompanied by a scientific rationale.

The outcome is simpy the final evaluation of the achievement of the earlier stated client goal AFTER the nursing interventions have been performed. (This is the difference between the goal and outcome). You are adding an element of judgment to the earlier stated goal (i.e., achievement or non-achievement). To do this, the student must evaluate the client's progress/ lack of progress towards the expected outcome. A new set of assessment data are gathered to "back up" the claim of achievement of/ non-achievement of client goal. Hence, the "circular" nature of the nursing process. So, you would state one of three choices:

Goal met

Goal not met

Unable to evaluate goal due to lack of time

For all three, the student will need to give "AEB" data. For the last one, the student should state, "Unable to evaluate goal, due to lack of time. However, if I were present at time of discharge (or other designated date), I would state 'Goal Met" if the following outcome criteria were achieved:..." Then give the outcome criteria that would satisfactorily meet this goal.

Nrs_angie, BSN, RN · May 1, 2005

Wonderful advice, Angie. Thanks so much. What I have been teaching my students is much along these lines, but I go a little further and teach the "pattern of reversal" method.
#4. The student writes the client goal, by reversing the nursing diagnosis stem. Nursing diagnoses are written in negative language, such as "Decreased Cardiac Output," "Imbalanced Nutrition: Less Than Body Requirements," or "Ineffective Individual Coping." For the client goal, the stem is simply written in reverse, "The client will demonstrate increased cardiac output...." or "The client will cope effectively..."
The nursing diagnosis stem points to the goal and ultimate client outcome.
The goal is simply the nursing diagnosis stem written positively (in reverse) in measurable terms, with a time element ("by end of student nurse's shift on...," "by hospital discharge," "throughout hospital stay," etc.). Make sure, as Angie pointed out, that measurable verbs are used.

Vicky,

That is a great point you made. Actually we never learned about the "pattern of reversal". I guess it was just sort of assumed that we (students) would know to do that. Maybe that is why I sort of struggled with care plans for a while. But somewhere along the way it just 'clicked' and careplans are kind of fun now. hehehe.

Great, thourough, advice there Vicky!

Have a great day,

Angie

ricced · Feb 1, 2008

thank you much for pointing out the differences and the examples help out too.

Daytonite, BSN, RN · Feb 2, 2008

this is a rather old thread that i had not seen before. let me clarify this issue because the explanation of the difference between goals and outcomes is not totally correct. i did some research on this issue a few years back.

outcomes are the predicted results of our independent 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. an expected outcome is measurable, patient centered, and specific. when you identify an outcome, you accept responsibility and accountability for helping the patient achieve that outcome. outcomes describe patient states that follow and are expected to be influenced by an intervention.

goals are the predicted results of collaborative nursing actions. collaborative nursing actions are those things nurses can only do for patients with an order of a physician or another healthcare provider--things like administer medications or provide certain treatments, etc. goals may also be measurable, patient centered and specific.

what differentiates a goal from an outcome is that the nurse cannot take full responsibility and accountability for helping the patient to achieve a goal. goals are achieved because of the collaborative management of many.

mybestguy · Feb 26, 2012

Guys, hi, I'm a 3rd year nursing student, and I'm wondering if you could check out my nursing care plan, to see if it's good enough.. I've learned a lot from your conversation here and i really need your help with this one. Comments and suggestions will help.

The patient is a 31 y/o female, 2 days post-cholecystectomy.

[TABLE=class: MsoTableGrid]

[TR]

[TD=width: 125]

Assessment

[/TD]

[TD=width: 98]

Diagnosis

[/TD]

[TD=width: 114]

Scientific Rationale

[/TD]

[TD=width: 162]

Planning

[/TD]

[TD=width: 168]

Interventions

[/TD]

[TD=width: 192]

Rationale

[/TD]

[TD=width: 198]

Evaluation

[/TD]

[/TR]

[TR]

[TD=width: 125]

Subjective:

“Masakit ang tahi ko.” – as verbalized by the patient

Ø Reports pain to be 7 in a scale of 10

Objective:

Ø Facial grimace

Ø Guarding behavior

Ø T = 37.8C

Ø post cholecystectomy (2^nd day), abdominal incision on the RUQ

[/TD]

[TD=width: 98]

Acute pain r/t surgical incision as manifested by verbalized pain of 7 in a scale of 10 and evident facial grimace

[/TD]

[TD=width: 114]

Break in the skin integrity prompts the body to produce chemical responses to combat such injury. A release of chemical mediators causes inflammatory process and stimulates nociceptors that produce the unpleasant sensation.

[/TD]

[TD=width: 162]

Short term goal:

After 8 hours of nursing intervention the client will be:

1. Will verbalize a decrease in pain as evidenced by 4 in a scale of 10 in the pain scale.

Short term objectives:

Ø Will be able to state the importance of ambulation and use of coughing and deep breathing exercises.

Ø Be able to splint abdominal incision using a pillow during turning with assistance

Ø Demonstrate coughing and deep breathing exercises effectively.

Ø temperature will subside to

[/TD]

[TD=width: 168]

1. Provide quiet and well-ventilated environment

2. Discuss the importance of ambulation and position changes.

3. Instruct to use pillow over the incision site during turning activities.

4. Assist the patient in turning from side to side or changing of position in bed

5. Assist the patient in performing relaxation techniques such as coughing and deep breathing exercises.

6. Perform tepid sponge bath

7. Administer antipyretic and analgesics as prescribed.

8. Document client’s responses to interventions and baseline vital signs.

[/TD]

[TD=width: 192]

1. A quiet and well-ventilated environment promotes rest and relaxation

2. To obtain the client’s cooperation.

3. Splinting reduces the pressure exerted by the abdominal organs through the incision site.

4. Prevents venous stasis and promotes good blood flow to dependent areas of the body

5. Full expansion of the lungs is necessary to improve gas exchange. Coughing establishes patent airway and prevents aspiration by expectorating accumulated mucus in the lungs during immobility.

6. To relieve heat from the body via conduction

7. Pharmacologic means to relieve pain and lower temperature.

8. To establish data for future comparison/evaluation.

[/TD]

[TD=width: 198]

After 8 hours of nursing intervention, the client was able to verbalize a decrease in pain felt as evidenced by 4 in a scale of 10.

- The patient was able to state the importance of ambulation and use of coughing and deep breathing exercises.

- The patient’s temperature subsided to 36.8C

- The patient was able to demonstrate coughing and deep breathing exercises effectively

- The patient was able to demonstrate the use of pillow as an abdominal splint during turning with assistance.

CRITERIA

4/4 objectives – fully met

2/4 objectives – partially met

0/4 objectives – unmet

*Goal is met

*the objectives are fully met

[/TD]

[/TR]

[/TABLE]

[TABLE=class: MsoTableGrid]

[TR]

[TD=width: 125]

Assessment

[/TD]

[TD=width: 98]

Diagnosis

[/TD]

[TD=width: 114]

Scientific Rationale

[/TD]

[TD=width: 162]

Planning

[/TD]

[TD=width: 192]

Interventions

[/TD]

[TD=width: 168]

Rationale

[/TD]

[TD=width: 198]

Evaluation

[/TD]

[/TR]

[TR]

[TD=width: 125]

Objective:

Ø Shallow respirations

Ø RR = 12 breaths/min

Ø Prolonged expiration phases (1:3)

Ø Alterations on depth of breathing

[/TD]

[TD=width: 98]

Ineffective breathing pattern r/t pain in the incision site as manifested by shallow respirations.

[/TD]

[TD=width: 114]

Full expansion of the lungs is required for adequate gas exchange and to prevent post-operative complications such as pneumonia and atelectasis. But due to the patient’s pain, it causes her to take shallow breaths.

[/TD]

[TD=width: 162]

Short term goal:

After 8 hours of nursing intervention the client will be able to establish an effective respiratory pattern as evidenced by normal respiratory rate (16-22bpm) and inspiration-expiration ratio (1:2)

Specific objectives:

1. Verbalize the importance of normal breathing pattern

2. Perform relaxation and deep breathing exercises

[/TD]

[TD=width: 192]

1. Assess the patient’s respiratory status; Auscultate lungs sounds and record baseline vital signs.

2. Discuss the importance of normal breathing pattern in post-operative patients.

3. Elevate the head of the bed

4. Administer analgesics as prescribed

5. Assist the patient in performing full and deep breathing exercises.

6. Encourage slower/deeper respirations, use of pursed lip technique.

7. Splint abdomen during deep breathing exercises

[/TD]

[TD=width: 168]

1. To establish baseline data for future comparison

2. To obtain the patient’s cooperation.

3. To promote physiological ease of maximal inspiration

4. Pharmacologic means to provide pain relief

5. To ensure the patient’s compliance.

6. To promote effective exchange in oxygen in the lungs and to enhance carbon dioxide release.

7. Pressure from splinting provides relief during deep breathing exercises.

[/TD]

[TD=width: 198]

After 8 hours of nursing intervention:

- The patient was able to establish effective respiratory pattern as evidenced by RR=22, inspiratory and expiratory ratio of 1:2 and full respiratory excursion.

- The patient was able to verbalize the importance of normal breathing pattern.

- The patient was able to perform relaxation and deep breathing exercises effectively.

CRITERIA

3/3 objectives – fully met

2/3 objectives – partially met

0/3 objectives – unmet

*the objectives are fully met

[/TD]

[/TR]

[/TABLE]

I would appreciate your help in improving my work. :) thanks!