4.6 Planning - fundamentals of care (2023)

planningit is the fourth step in the nursing process (and the fourth standard of practice established by the American Nurses Association). This standard is defined as follows: “The registered nurse develops a collaborative plan that includes strategies to achieve the expected outcomes.” The RN works with the consumer, family, key figures and the interprofessional team to develop an individual, holistic plan and evidence-based plan. The elements of the plan are prioritized. The plan will be modified based on the ongoing assessment of health consumer response and other indicators. The plan is documented in standardized language or terminology.^[1]

Once the expected outcomes are determined, the caregiver begins planning the nursing interventions to be performed.they are evidence-based actions that the nurse takes to achieve patient outcomes. Just as a provider makes medical diagnoses and prescribes prescriptions to improve a patient's medical condition, a nurse makes nursing diagnoses and plans nursing interventions to solve a patient's problems. Nursing interventions should focus on eliminating or reducing related factors (etiology) of nursing diagnoses whenever possible.^[2]Nursing interventions, goals, and expected outcomes are recorded in the nursing plan for continuity of care across shifts, nurses, and health workers.

nursing intervention planning

You may be wondering, “How do I know which evidence-based nursing interventions to include in my nursing plan?” There are several sources that nurses and student nurses can use to select nursing interventions. Many agencies have care planning and referral tools that are included in the electronic medical record and can be easily documented in the patient record. Caregivers can also refer to other care planning books from our sources, such as B. the system of nursing intervention classification (NIC). Based on research and input from the nursing profession, NIC categorizes and describes nursing interventions that are constantly evaluated and updated. The interventions included in the NIC are considered evidence-based nursing practices. The caregiver is responsible for using their clinical judgment to decide which interventions are most appropriate to meet a patient's individual needs.^[3]

Direct and indirect attention

Nursing interventions are considered direct nursing or indirect nursing. refers to interventions that are performed in personal contact with patients. Examples of direct care interventions are wound care, repositioning and ambulation. Interventions are delivered when the caregiver is providing care in an environment different from that of the patient. Examples of indirect nursing interventions include attending nursing conferences, documenting, and communicating about patient care with other providers.

Classification of nursing interventions

There are three types of nursing interventions: independent, dependent, and collaborative. (See Figure 4.12^[4]for an image of a nurse collaborating with the healthcare team in planning procedures).

Independent nursing interventions

An intervention is any intervention that the nurse can perform independently without a prescription.. An example of an independent caregiver intervention is when caregivers monitor a patient's 24-hour check-in/out record for trends due to risk of fluid volume imbalance. Another example of autonomous nursing interventions is therapeutic communication, which a nurse uses to help patients cope with a new medical diagnosis.

Example.See Scenario C in the Evaluation section of this chapter. Lady. J. was diagnosedExcess volume of liquid.. An example of an evidence-based independent nursing intervention is:"The nurse will frequently reposition the dependent edema patient if necessary."^[5]The nurse would individualize this evidence-based intervention to patient and agency policies by noting:"The nurse changes the patient's position every 2 hours."

Nursing interventions for family members

require a prescription before they can be performed. Prescriptions are orders, procedures, remedies or treatments prescribed or ordered by a licensed general practitioner.^[6]Ais a healthcare team member (usually a doctor, nurse, or physician assistant) who is licensed and authorized to write prescriptions on behalf of the client. For example, drug administration is a dependent care activity. The nurse integrates the dependent interventions into the patient's global care plan and links each intervention to the appropriate nursing diagnosis.

Example.See Scenario C in the Evaluation section of this chapter. Lady. J. was diagnosedExcess volume of liquid.. An example of a dependent care intervention is,"The nurse will administer the scheduled diuretics as prescribed."

Collaborative nursing interventions

They are interventions that the nurse carries out in collaboration with other members of the health care team such as doctors, social workers, physical therapists, physiotherapists and occupational therapists. These measures are developed in consultation with other health professionals and incorporate their professional perspectives.^[7]

Example.See Scenario C in the Evaluation section of this chapter. Lady. J. was diagnosedExcess volume of liquid.. An example of a collaborative care intervention is consulting a respiratory therapist when the patient exhibits deteriorating oxygen saturation levels. The respiratory therapist schedules the oxygen therapy and obtains a prescription from the provider. The nurse would document"The nurse, in collaboration with the respiratory therapist, administers oxygen therapy.” no care plan.

Individualization of interventions

It is critical that planned procedures are individualized for patient success. For example, adding prune juice to a patient's breakfast with constipation will only work if the patient enjoys drinking the prune juice. If the patient does not like prune juice, this procedure should not be included in the care plan. Collaboration with the patient, family, caregivers, and interprofessional team is critical to selecting effective interventions. The number of interventions included in a care plan is not a hard and fast rule, but the interventions must be individualized and of sufficient quality to achieve the identified outcomes for that patient.

Creation of care plans

Nursing plans are created by Registered Nurses (RNs). Documentation of individualized care plans is mandated by law by the Centers for Medicare & Medicaid Services (CMS) in long-term care facilities and the Joint Commission in hospitals. The CMS guidelines state: “Residents and their representatives must have the opportunity to participate in their care planning process and to be involved in decisions and changes in care, treatment and/or interventions. This applies both to initial decisions about care and treatment and to the refusal of care or treatment. Institutional staff should support and encourage participation in the care planning process. This may include ensuring residents, family members or representatives understand the overall care planning process, holding care planning meetings at times of the day when a resident is performing best and allowing patient representatives to be present, giving advance notice of the meeting, scheduling these meetings to include a representative of the resident Provide space (e.g. by conducting the meeting in person, by telephone conference or video conference) and allow sufficient time for information exchange and decision-making. A resident has the right to select or decline certain treatment options before the care plan is implemented."^[8]The Joint Commission envisions the care planning process as a framework for coordinating the communications that lead to safe and effective care.^[9]

Many institutions have standardized care plans with lists of possible interventions that can be customized for each individual patient. Other institutions require the caregiver to independently develop each care plan. Regardless of the format, care plans must be individualized to meet the specific and unique needs of each patient. See Figure 4.13^[10]to an image of a standardized care plan.

Nursing plans created in nursing school can also be in different formats such as concept maps or spreadsheets. Some are fun and creative while others are more formal.Anhangcontains a template that can be used to create care plans.