What is the main purpose of the expected outcome nursing?

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Identifying outcomes
Expected outcomes
Problems during planning
Planning for nursing intervention
Types of nursing interventions
Documenting the intervention

The Nursing Outcomes Classification (NOC) is a comprehensive, standardized classification of patient, family and community outcomes developed to evaluate the impact of interventions provided by nurses or other health care professionals. Standardized outcomes are essential for documentation in electronic records, for use in clinical information systems, for the development of nursing knowledge and the education of professional nurses and students. An outcome is defined as a measurable individual, family, or community state, behavior or perception that is measured along a continuum in response to nursing interventions. The outcomes are developed for use in all clinical settings and with all patient populations. NOC outcomes can be used across the care continuum to follow patient outcomes throughout an illness episode or over an extended period of time. Nurses in tertiary care hospitals, community hospitals, community agencies, nursing centers, and nursing homes evaluated the use of NOC outcomes in their practice as part of a federally funded NIH grant. Since the outcomes describe patient, family or community status, other disciplines may find them useful for the evaluation of the interventions they provide to patients.

The 540 outcomes in Nursing Outcomes Classification (NOC) (6th ed.) are listed in alphabetical order in the classification. Each outcome has a definition, a list of indicators that can be used to evaluate patient status in relation to the outcome, a target outcome rating, a measurement scale(s) to measure patient status, and a short list of references used in the development and refinement of the outcome. A five-point Likert scale is used with all outcomes and indicators. A rating of a '5' is always the best possible score and '1' is always the worst possible score. Examples of measurement scales used with the outcomes are: 1= Extremely compromised to 5= Not compromised and 1= Never demonstrated to 5= Consistently demonstrated. The NOC outcomes are grouped in a coded taxonomy that organizes the outcomes within a conceptual framework to facilitate nurses identifying an outcome for use with a patient, family or community. The outcomes are grouped into thirty-four classes and seven domains for ease of use. The seven domains are: Functional Health, Physiologic Health, Psychosocial Health, Health Knowledge & Behavior, Perceived Health, Family Health, and Community Health. Each outcome has a unique code number that facilitates its use in computerized clinical information systems and allows manipulation of data to answer questions about nursing care quality and effectiveness. The classification is continually updated to include new outcomes and to revise outcomes based on new research or user feedback.

The outcomes have been linked to NANDA International diagnoses, to Gordon's functional patterns, to the Taxonomy of Nursing Practice, to Omaha System problems, to resident admission protocols (RAPs) used in nursing homes, to the OASIS System used in home care and to NIC interventions. In addition linkages have been developed between the International Classification of Functioning, Disability and Health (ICF) and NOC in an attempt to explore the components of ICF and its international and interdisciplinary use. A more in depth look at the linkage between NOC, NIC, and NANDA-I is available in a separate book NOC and NIC Linkages to NANDA-I and Clinical Conditions: Supporting Critical Reasoning and Quality Care.

NOC is one of the standardized languages recognized by the American Nurses' Association (ANA). NOC is included in the Unified Medical Language System (UMLS) in the National Library of Medicine (NLM) and in the Cumulative Index to Nursing and Allied Halth Literature (CINAHL). NOC is currently being mapped into SNOMED Clinical Term (SNOMED CT). The use of NOC in practice, nursing education, and research is the most accurate indicator of the classification’s usefulness. NOC has been adopted in a number of clinical sites for the evaluation of nursing practice and is being used in educational settings to structure curricula and teach students clinical evaluation. Interest in NOC has been demonstrated in other countries. NOC has been translated into Chinese (simplified and traditional), Dutch, French, German, Indonesian, Italian, Japanese, Korean, Norwegian, Portuguese, and Spanish and several other translations are in progress.

Source: Moorhead, S., Swanson, E., Johnson, M., & Maas, M., (Eds.). (2018). Nursing outcomes classification (NOC): Measurement of Health Outcomes (6th ed.). St. Louis, MO: Elsevier.

For further information contact:

Center for Nursing Classification & Clinical Effectiveness The University of Iowa, College of Nursing 407 CNB Iowa City IA 52242-1121 319-335-7051 Fax: 319-335-9990

email:

expected outcome (iks-pekt-id) n. a statement in the care plan of what the nursing intervention is intended to achieve, usually described in terms of the patient's expected behaviour. See behavioural objective.

Planning and outcome identification is the third step of the nursing process and includes both establishing guidelines for the proposed course of nursing action to resolve the nursing diagnoses and developing the client’s plan of care. After the nursing diagnoses and the client’s strengths have been identified, planning begins.

The planning occurs in three phases: initial, ongoing, and discharge. Initial planning involves the development of a preliminary plan of care by the nurse who performs the admission assessment and gathers the comprehensive admission assessment data. Progressively shorter stays in the hospital make initial planning very important to ensure resolution of the problems.

Ongoing planning updates the client’s plan of care. New information about the client is collected and evaluated and revisions made to the plan of care.

Discharge planning involves anticipation of and planning for the client’s needs after discharge.

The planning phase involves several tasks:

Prioritizing the nursing diagnoses
Identifying and writing client-centred long and short-term goals and outcomes (outcome identification)
Identifying specific nursing interventions
Recording the entire nursing care plan in the client’s record

Once the list of nursing diagnoses has been developed from the data, decisions must be made about priority. Critical thinking enables the nurse to make decisions about which diagnoses are the most important and need attention first. There are a number of frameworks used to prioritize nursing diagnoses; however, those diagnoses involving life-threatening situations are given the highest priority.

An additional point regarding the establishment of priorities is the anticipation of future diagnoses. Nursing diagnoses of low and moderate priorities often involve the prevention of anticipated potential or risk diagnoses. Although potential nursing diagnoses may not be a current threat to the client, their seriousness may require that the nurse consider the development of nursing interventions directed toward prevention of the problem.

For example, a client in the Postanesthesia Care Unit may have a high-priority nursing diagnosis of Ineffective Breathing Pattern related to anaesthesia and sedative drugs. Despite the fact that the client currently has no problem in this area, this diagnosis is indeed the basis for the Postanesthesia Care Unit protocol of monitoring the client closely.

Identifying outcomes

Goals: A goal is an aim, intent, or end. Goals are broad statements that describe the desired or intended change in the client’s condition or behaviour. Client-centred goals are established in collaboration with the client when possible. Goal statements refer to the diagnostic label of the nursing diagnosis. Client-centred goals ensure that nursing care is individualized and focused on the client.

A goal is of two types i.e. i) Short term goal and ii) Long term goal

A short-term goal is a statement that profiles the desired resolution of the nursing diagnosis over a short period of time, usually a few hours or days (less than a week). It focuses on the aetiology part of the nursing diagnosis.

A long-term goal is a statement that profiles the desired resolution of the nursing diagnosis over a longer period of time, usually weeks or months. It focuses on the problem part of the nursing diagnosis.

For example A client with depression who had a leg amputation, the short term goal will be client will verbalise his feelings. Long term goal is will be client will accept his amputation and take the initiatives to do the daily livings work with prosthetics.

Expected outcomes

Expected Outcomes After the goals have been established, the expected outcomes can be identified based on those goals. An expected outcome is a detailed, specific statement describing the methods to be used to achieve the goal. It includes direct nursing care, client teaching, and continuity of care. Outcomes must be measurable, realistic, and time-limited.

Problems during planning

Nursing students, as beginners in the use of the nursing process, often fall into some common pitfalls when applying the steps to practice. These pitfalls are described with the intent of providing a clear direction for the use of this process and proposing suggestions for avoiding these common errors.

In regard to writing goals, the errors frequently observed in this component involve improper format. Format errors include goals that are nurse-centred instead of client-centred, unrealistic, negative rather than positive, generically copied from a reference and not individualized to the client, unmeasurable, nonspecific, nonbehavioral, vague, wordy, and without a time frame.

Another challenge in the development of goals and expected outcomes is the establishment of appropriate time frames for the accomplishment of the intended results. Although this component may be difficult at first to master, nursing professionals should practice writing goals that are realistic and include appropriate time frames using available literature and resources to gain expertise. It is preferable for a goal to include an excessively short, rather than an excessively long, time frame because the goal is brought to attention in the evaluation process more frequently.

By inserting the time frame “daily” for specific goals, the expected outcome will be brought up frequently for evaluation. Through a process of building on continued professional growth and experience.

Planning for nursing intervention

Once the goals have been mutually agreed on by the nurse and client, the nurse should use a decision-making process to select appropriate nursing interventions. Nursing intervention is an action performed by a nurse that helps the client to achieve the results specified by the goals and expected outcome. These terms are based on scientific principles and knowledge from behavioural and physical sciences.

The effective nurse plans interventions that are directed toward the cause of the client’s nursing diagnosis or problem.

For example, for a client with angina who may have the nursing diagnosis of Pain related to myocardial ischemia, an appropriate nursing intervention would be to help the client conserve energy (i.e., bedrest).

In determining which nursing interventions to use, the nurse should critically consider the consequences and the risks of each intervention. After considering these factors, the nurse selects those that are most likely to be effective with the minimum of risk.

After setting the goals and planning the appropriate nursing interventions, the nurse writes nursing orders to communicate the exact nursing interventions that are to be implemented for the client. A nursing order is a statement written by the nurse that is within the realm of nursing practice to plan and initiate. These statements specify the direction and individualize the client’s plan of care.

Types of nursing interventions

Nursing interventions are classified into one of three categories: independent, interdependent, or dependent.

Independent nursing interventions are initiated by the nurse and do not require direction or order from another health care professional. In most areas nursing personnel practice independent nursing interventions for activities such as daily living, health education, health promotion, and counselling. An example of independent nursing intervention is elevating a client’s edematous extremity.

Interdependent nursing interventions are implemented collaboratively by the nurse in addition to other health care professionals. For example, the nurse may assist a client to perform an exercise taught by the physical therapist.

Dependent nursing interventions require an order from a physician or another health care professional. Administration of medication is an example of a dependent intervention. This intervention requires specific nursing knowledge and responsibilities, but it is not within the realm of legal practise for nurses to prescribe medications.

The nurse is responsible for knowing the classification, normal dosage, pharmacological action, contraindications, adverse effects, and nursing implications of the drug. Dependent nursing interventions must be governed by appropriate knowledge and judgment.

Documenting the intervention

The implementation step also involves documentation and reporting. Data to be recorded include the client’s condition before the intervention, the specific intervention performed, the client’s response to the intervention, and client outcomes. Documentation provides valuable communication among health care team members to ensure continuity of care and evaluate progress toward expected outcomes. Written documentation also provides data necessary for reimbursement.

Verbal communication between nurses generally occurs at the change of shift, when caring responsibility changes. Nursing students must report relevant information to the nurse responsible for their clients when they leave the unit. Information that should be shared in the verbal report includes:

Completed activities and those not completed
Status of current relevant problems
Assessment changes or abnormalities
Results of treatments
Diagnostic tests scheduled or completed (and results)

Both written and verbal communication must be objective, descriptive, and complete. It must include observations, not opinions and be stated or written to show an accurate picture of the client’s condition. Communication of implementation activities is basic to client care and evaluation of progress toward goals.

Evaluation

Evaluation is done to assess the effectiveness of intervention and also to check whether the goal is met or not.

It is the fifth step in the nursing process, which determines whether client goals have been met, partially met, or not met. When a goal is met, the nurse decides whether nursing interventions should stop or continue for the status to be maintained. When a goal is partially met or not met, the nurse reassesses the situation. The reasons the goal is not met and modifications to the plan of care are determined by more data collection. Reasons that goals are not met or are only partially met include: