How do I make these "Measurable Outcomes"

Jules A, MSN · Nov 10, 2008

I am working on a Care Plan of Disturbed Thought Process. Pt is confused (Alzheimer-like symptoms). I have a hard time making subjective Expected Outcomes into measureable Goals. Any help? Are these even good expected outcomes?
1) Absence of confusion
2) No inappropriate responses
3) Ability to follow simple commands
4) No longer needs restraints
5) Responds to commands appropriately
Tamara:banghead:

I've always used my interventions right from the book which includes outcomes. But for Absence of confusion I'd do the A/O x3 as the measurement. Ability to follow simple commands you will need to come up with some skills and attempt to get the patient to do them. No longer needs restraints is pretty obvious, if they aren't harming themself etc. you can try releasing the restraints and document the outcome.

vsigns · Nov 10, 2008

Straight out of "Nursing Diagnosis Handbook"
Remember Depression is associated with impaired thought processes or alzheimers. Refer to psychotherapy- signs will be weight loss, insomnia or seasonal affective disorder.
Consider a nutritional status for and outcome or goal
Check for high Cholesterol, it is associated with alzheimers if it is high, refer to dietician or a physician for help to lower.
Evaluate all prescribed and otc drugs, they can be the cause of alzheimers.
Help the patient and family to use memory reminders, like a calendar or a clock or a list of things to do.
Also encourage the patient to believe in themselves and to work on memory improvement. Remember if the brain is stimulated, a process called neurogenesis will cause the formation of new neurons and memory or impaired thought processes will improve in 50 % of patients.

Hope this info helps you out!:)

LaceyRN · Nov 11, 2008

I am working on a Care Plan of Disturbed Thought Process. Pt is confused (Alzheimer-like symptoms). I have a hard time making subjective Expected Outcomes into measureable Goals. Any help? Are these even good expected outcomes?
1) Absence of confusion
2) No inappropriate responses
3) Ability to follow simple commands
4) No longer needs restraints
5) Responds to commands appropriately
Tamara:banghead:

Measurable outcomes have criteria and a time frame for success. They also must be attainable. If the pt. has alzheimers, depending on the stage, absence of confusion may not be an acheivable goal. Your goals are a great start but you just need to add to them:

1. Pt will experience decreased incidence of confusion by end of shift on 11/12/08.

2. Pt will demonstrate no incidents of inappropriate behavior by 1800 on 11/12/08.

3. Pt will successfully follow 3 simple commands by end of shift 11/12/08.

I didn't use #4 because the patient shouldn't be restrained, except in rare circumstances. The focus should be on keeping the environment safe for the patient without restraining him.

Hope this helps!!

teeniebert, LPN · Nov 11, 2008

1. Pt will experience decreased incidence of confusion by end of shift on 11/12/08.
2. Pt will demonstrate no incidents of inappropriate behavior by 1800 on 11/12/08.
3. Pt will successfully follow 3 simple commands by end of shift 11/12/08.
I didn't use #4 because the patient shouldn't be restrained, except in rare circumstances. The focus should be on keeping the environment safe for the patient without restraining him.
Hope this helps!!

Remember to be as specific as possible--for 1. above, what does 'decreased incidence of confusion' mean? Does it mean A&O x3? Does it mean recognizing staff or family members? Does it mean identifying everyday objects? For 2., what behaviors are you talking about? wandering, disrobing, combativeness? For 3. which commands will you work on? I find that putting 'as evidenced by' in the expected outcome helps me when it's time to evaluate/revise the goals.

AggieNurse99, BSN, RN · Nov 11, 2008

So you have:

Nursing Diagnosis r/t related to factors AEB something.

1. intervention

2. intervention

3. intervention

4. intervention

Expected outcome: the pt will......

Goal: met, partially met, not met and how

Evaluate and revise as appropriate

It took me a while to get this.... what part of the nursing diagnosis statement shows that there is a problem? What actually is the problem? Look up some of DayToNite's posts on care planning.

Disturbed thought process (for those of us non-psych personnel) can be hard to care plan around. Is the disturbed thought process actually more of a r/t factor? E.G. Self-care deficit (grooming) r/t pt's belief of harmful substances in the water AEB pt's refusal to shower x 3 months and disturbing body odor. Goal: the pt will use alternative to water-based bathing (wipes/shampoo cap) tomorrow. Interventions: blah blah blah

Is the disturbed thought process likely to change in an Alzheimer's pt?

1. Absence of confusion - how does the pt demonstrate confusion (what is the data from the assessment), how are you assessing confusion, is this attainable, what interventions are you planning

2. No inappropriate responses - again, how does this pt demonstrate inappropriate responses, is this realistic, what are you planning

3. Ability to follow simple commands - so pt demonstrates inability here - where is the problem by not following commands. Goal could be "Pt will drink using cup by self when prompted during breakfast" and your eval would be something like pt required prompting 3 times during breakfast and drank from cup 23 times during breakfast.

4. No longer needs restraints - in most facilities, part of the restraint order actually sets criteria for release. Look at the order for this pt.

5. Responds to commands appropriately - what are the AEB inappropriate responses/which commands (all/some), how do you assess appropriateness, what commands are necessary for safety/physical needs, what is your plan.

sxybuttrfly · Nov 11, 2008

"alzheimer-like" sympt0mz...? alzheimer/dementia iz a pr0gressive dx... make ur expected 0utc0mez m0re realistic; ie: safety- pt will remain free fr0m injury: pr0vide cl0ze 0bservati0n, frequent re0rientati0n, etc...