Nursing Process: Planning

Expected Outcomes
George Ann Daniels, MS, RN
The steps so far
 Nursing Assessment
 Nursing Diagnosis
 The nurse may arrive at several nursing
diagnosis
 A ranking or “prioritization” must take
place in order to decide which nursing
diagnosis is the most important and
should be worked on first
 Setting priorities for client
care
 A common way to prioritize follows
Maslow’s hierarchy of needs
 Physiological
 Safety/Security

 Love and belonging

 Self-esteem

 Self-actualization
Criteria to address when
setting priorities
 Client’s health values and beliefs
 Client’s priorities
 Resources available
 Urgency of health problem
 Medical treatment plan
General Guidelines
 Basic survival needs must be met first
 Airway, breathing, circulation, nutrition
• What are some NDX in this area?
 Safety needs are next in order
• What are some NDX in this area?
 Once these areas are met, concerns
regarding social, self-esteem, and self-
actualization can be addressed
• What are some NDX in this area?
More guidelines
 Actual diagnosis generally take priority
over high risk diagnosis
 However, this can be situational
 Physiologic problems generally take
priority over developmental problems
 Priorities should not be fixed, they
change as the client’s problem change
Even more guidelines
 The nurse may have to deal with
psychological problems before
dealing with medium to low priority
physiological problems
 FHP’s are not listed in order of
priority
The next step
 After assessment, diagnosis, and
prioritization, the nurse must work
with the client to select an expected
outcome for the diagnosis
What is an expected
outcome?
 A goal, objective, or outcome criteria
related to a particular NDX
 Description of what the nurse & client hope
to achieve
 What the client should achieve in order to
show that the particular health problem
(NDX) is resolved
 Written statements of specific, measurable,
realistic statements of goal attainment
Purpose of EO
 Provide direction for planning nursing
interventions
 Provide a time span for implementation
 Serve as criteria for evaluation of
progress
 Enable nurse and client to determine
when the problem has been resolved
 Help to motivate nurse and client and
keep them on track
Relationship of EO to NDX
 EO is derived from the nursing
diagnosis
 Problem(P) is the unhealthy response
 Problem (P) tells what needs to be changed

 The EO should be the opposite of the

problem
 Remember that the NDX and therefore
the EO must be something realistic
Questions to ask when
developing EO
 What is the problem? (NDX)
 What is the opposite, healthy
response?
 How will the client look or behave if
the healthy response is achieved?
 What must the client do to
demonstrate that the problem has
been resolved?
Components of the EO
 Subject
 Client
 Verb
 Choose a verb that measures success
• “will”
• Will walk
 Condition or modifiers
 E.g. with walker
 Criterion of desired performance
 E.g. 50 feet
 Target/specific time
 E.g. three time a day

 Client will walk with walker 50 feet three

times a day.
 Client will ambulate to feet every shift.en
Guidelines for writing EO
 Write in terms of client behavior
 Begin with “The client will”
 Make appropriate for the chosen NDX
 Make the EO realistic
 Select an expected outcome which is
important to the client
 Check for compatibility with other health
care professionals
 Avoid certain statements
 Enable, allow, let, permit
 If the outcome is accomplished will
the NDX be resolved
 Write EO using observable,
measurable terms
More guidelines
 The expected outcome should be
associated with a single diagnosis
 Include a time frame for each EO
 Determine the EO in collaboration
with the client
Measurement criteria for
ANA
 ANA standard III: Outcome
identification: The nurse identifies
expected outcomes individualized to
the client
 1. Outcomes are derived from the
diagnosis
 2. Outcomes are mutually formulated
with the client and healthcare provider,
when possible and appropriate
 3. Outcomes are culturally appropriate
and realistic in relation to the client’s
present and potential capabilities.
 4. Outcomes are attainable in relation
to resources available to the client.
 5. Outcomes include a time estimate
for attainment
 6. Outcomes provide direction for
continuity of care
 7. Outcomes are documented as
measurable goals