NURSING PROCESS

PLANNING

INTRODUCTION
Planning is a deliberative, systematic phase of
the nursing process.
Involves decision making and problem solving.
Refer to the clients assessment data and
diagnostic statements for direction in
formulating client goals and designing the
nursing interventions required to prevent reduce
or eliminate the clients health problems.

DEFINITATION
Plan is a scheme, program, or method worked
out beforehand for the accomplishment of an
objective. A category of nursing behaviour in
which a strategy is designed to achieve the goals
of care for an individual patient, as established
in assessing and analyzing.
Planning (also called forethought) is the process
of thinking about and organizing the activities
required to achieve a desired goal. A nursing
care plan is a part of the nursing process which
outlines the plan of action that will be
implemented during a patients medical care.

TYPES OF PLANNING
1. Initial planning
.Admission assessment based on the initial care.
.As nurse obtain new information and evaluate
the clients responses to care, they can
individualize the initial care plan further.

2. Ongoing Planning
.Done by all nurses who work with the client.
.Ongoing planning also occurs at the beginning of
a shift as the nurse plans the care.
.Purposes of ongoing planning
a. To determine any changes in clients health
status.
b. To set priorities for the clients care
c. To decide which problems to focus on during the
shift
d. To Co-ordinate the nurses activities so that more
than one problem can be addressed at each client
contact.

3. Discharge planning
.Is the process of anticipating and planning for
needs after discharge,
.Is a crucial part of comprehensive health care
and should be addressed in each clients care
plan to be given that day.

DEVELOPING NURSING CARE PLANS

An informal nursing care plan
Is a strategy for action that exists in the nurses mind.
A formal nursing care plan
Is a written or computerized guide that organizes
information about the clients care. It provides
continuity of care.
A Standardized care plan
Is a formal plan that specifies the nursing care for
groups of clients with common needs. (All clients with
myocardial infarction)

 An individualized care plan

Is tailored to meet the unique needs of a specific
client needs that are not addressed by
standardized plan.

GUIDELINES FOR WRITING NURSING CARE

PLANS
1. Date and sign the plan
2. Use category headings assessment/ nursing
diagnoses/ planning /Implementation
/Evaluation.
3. Use standardized Medical or English symbols
and key words rather than complete sentences to
communicate your ideas.
Eg. Clean wound with H2O2 b.i.d rather than clean
the clients wound morning & evening with
Hydrogen peroxide twice a day.

4. Be specific. Because Nurses are now working

shifts of different lengths, some working 12
hrs. & some working 8 hour shifts it is even
more to be specific about expected timing of an
intervention. If the order reads change
incision dressing q shift
5. Refer to procedure books or other sources of
information rather than including all the steps
on a written plan.
6. Tailor the plan to the unique characteristics of
the client by ensuring that the clients choices,
such as preferences about the times of care &
the methods used are included

7. Ensure that the nursing plan incorporates

preventive and health maintenance aspects as
well as restorative ones.
8. Ensure that the plan contains interventions for
ongoing assessment of the client (eg. Inspect
incision q8h)
9. Include collaborative and co-ordination
activities in the plan
10. Include plans for the clients discharge and
home care needs.

THE PLANNING PROCESS

1.
2.
3.
4.

Setting priorities
Establishing client goals/ desired outcomes.
Selecting nursing interventions
Writing nursing orders

1. Setting priorities
. It is the process of establishing a preferential
sequence for addressing nursing diagnoses &
interventions.
.The client & nurse decides which nursing
diagnosis requires attention Primarily, which
secondary and so on.
.Instead of rank ordering diagnoses, nurses can
group then as having high, Medium, or Low
priority requires minimal nursing support.
. High: Life threatening problems such as loss of
respiratory or cardiac function

Medium: Health threatening problems like acute

illness, decreased coping.
Use Maslows hierarchy
The nurse must consider some factors when
assigning priorities, it includes.
Clients health values and beliefs
Clients priorities
Resources available to the nurse & client.
Urgency of health problem
Medical treatment plan.

2. Establishing client goals & Desired outcomes

. After establishing priorities, the nurse & client
set goals for each nursing diagnosis.
. Goal-(Broad) improved nutritional status,
desired outcome (specific) - Gain kg by 2
weeks.
. Short term goals: - than 6 weeks of period.
.Long term goals: - Goal achieved by 6 weeks &
more

3. Selecting Nursing interventions & activities

Nursing interventions & activities are the action not a
nurse performs to achieve client goals.
Types of nursing interventions
a. Independent Interventions: - activities that are nurses
are licensed to initiate. Eg. Physical care, ongoing
assessment, counseling, Emotional support,
environmental Management.
b. Dependent Interventions: - activities carried out under
physicians order. Eg. Medications, diagnostic tests, diet
Activity.
c. Collaborative Interventions: - Nurse carries out in
collaboration with other health team members - Such as
physiotherapies social workers, dietitians, physicians,
Eg. Crutch walking.

4. Writing Nursing orders

. After choosing appropriate nursing
interventions the nursewrite those on care plan
on nursing orders.
.Components of Nursing order
DATE

ACTION
VERB

CONTENT
AREA

TIME
ELEMENT

4/4/60

Monitor

Vital Sign

Every q4h

Auscultate

Abdomen

q6h

SIGN