help: goal & outcome

[Medsport]

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?

[Daytonite, BSN, RN]

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/NursingDepartment/200%20Level/nursing_process.htm#Return%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?!