- a.Basic human needs: The nursing care plan
should concisely communicate to caregivers
data about the patient’s usual health habits and
patterns obtained during the nursing history
that are needed to direct daily care (e.g.,
requires assistance setting up food tray).
b.Nursing diagnoses: The plan should contain
goals/outcomes and nursing interventions for
every nursing diagnosis, as well as a place to
note patient responses to the plan of care; for
instance, if the nursing diagnosis is Impaired
Skin Integrity related to mobility deficit, a goal
should be written to turn patient frequently
and assess for skin breakdown.
c. Medical and interdisciplinary plan of care: The
plan of care should record current medical orders
for diagnostic studies and specified related nurs-
ing care; for instance, if a diagnostic test is
scheduled for the morning, appropriate fasting
measures should be included in the plan of care. - a.Have changes in the patient’s health status
influenced the priority of nursing diagnoses?
b.Have changes in the way the patient is respond-
ing to health and illness or the plan of care
affected those nursing diagnoses that can be
realistically addressed?
c. Are there relationships among diagnoses that
require that one be worked on before another
can be resolved?
d.Can several patient problems be dealt with
together? - a.Mrs. Myers learns one lesson on nutrition per
day, beginning 2/16/12.
b.After viewing film on smoking, Mrs. Gray iden-
tifies three dangers of smoking.
c. X
d.X
e.By next visit, patient will list three benefits of
psychotherapy.
f. X
9.Sample answers:
a.By 11/12/12, patient will reestablish fluid balance
as evidenced by (1) an approximate balance
between fluid intake and fluid output, to average
approximately 2,500 mL; (2) urine specific grav-
ity within the normal range (1.010–1.025).
b.By next visit, patient will report a resumption
of usual level of sexual activity following her
acceptance of her new body image.
c. By 6/4/12, patient will report a decrease in the
number of stress incontinent episodes (less than
one per day), following her use of Kegel exercises.
d.By 8/10/12, patient reports he has sufficient
energy to carry out the priority activities identi-
fied 8/2/12.
e.By end of shift, patient reports better pain man-
agement (pain decreased to less than 3 on a
scale of 10), related to new administration
schedule.- a.Be familiar with standards and agency policies
for setting priorities, identifying and recording
expected patient outcomes, selecting evidence-
based nursing interventions, and recording the
plan of care.
b.Remember that the goal of patient-centered
care is to keep the patient and the patient’s
interests and preferences central in every aspect
of planning.
c. Keep the “big picture” in focus. What are the
discharge goals for this patient, and how should
this direct each shift’s interventions?
d.Trust clinical experience and judgment but be
willing to ask for help when the situation
demands more than your qualifications and expe-
rience can provide; value collaborative practice.
e.Respect your clinical intuition, but before estab-
lishing priorities, identifying outcomes, and
selecting nursing interventions, be sure that
research supports your plan.
f. Recognize personal biases and keep an open
mind. - a.What problems need immediate attention, and
which ones can wait?
b.Which problems are your responsibility, and
which do you need to refer to someone else?
c. Which problems can be dealt with by using
standard plans (e.g., critical paths, standards
of care)?
d.Which problems are not covered by protocols
or standard plans but must be addressed to
ensure a safe hospital stay and timely
discharge?
REFLECTIVE PRACTICE USING CRITICAL
THINKING SKILLS
Sample Answers
1.How might the nurse respond to Ms. Kronk’s ques-
tions regarding fitness?
The nurse can teach Ms. Kronk about low-salt, low-
fat diets and encourage her to begin an exercise pro-
gram, such as walking each day or joining a gym.
The nurse could also refer Ms. Kronk to a dietitian
to explain the types of diets and diet supplements
that are available, including diets that are healthy
and foods to avoid with high blood pressure.
2.What would be a successful outcome for this patient?
Ms. Kronk lists 3 benefits of following a heart healthy
diet and starting an exercise program to lose weight.
3.What intellectual, technical, interpersonal, and/or
ethical/legal competencies are most likely to bring
about the desired outcome?
Intellectual: knowledge of what information is
needed to develop a plan of care that meets the
nursing needs of a woman who wants to improve
her fitness level
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