Term
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Definition
| case management tools used to communicate the standardized, interdisciplinary plan of care for a particular group of patients; care guidelines and outcomes are specified for each day of the patient's stay |
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Term
| computerized plans of nursing care |
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Definition
| plans of patient care developed by computer software programs that enable the nurse to call up screens listing causes, goals, and related nursing interventions for nursing diagnoses and medical diagnoses |
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Definition
| process in which two or more individuals with varying degrees of experience and expertise deliberate about a problem and its solution |
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Definition
| specified behavior; for example, the measurable criteria in a patient goal specifies how the patient must perform the desired behavior |
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Definition
| systematic process of preparing the patient to leave the healthcare facility and for maintaining continuity of care |
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Definition
| specific, measurable criteria used to evaluate whether the patient goal has been met |
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Definition
| planning that addresses each problem listed in the prioritized nursing diagnoses and identifies appropriate patient goals and the related nursing care |
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Definition
| trade name for a care plan documentation system that encompasses (1) prescriptions for nursing care related to activities of daily living; (2) nursing diagnoses and related patient goals and nursing orders; and (3) the nursing care related to diagnostic measures and the medical regimen |
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Term
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Definition
| any treatment, based on clinical judgment and knowledge, that a nurse performs to enhance patient outcomes; there are nurse-initiated, physician-initiated, and collaborative interventions |
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Term
| nursing interventions classification (NIC) |
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Definition
| first comprehensive, validated list of nursing interventions applicable to all settings that can be used by nurses in multiple specialties and facilitates the work of identifying appropriate interventions |
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Term
| nursing outcomes classification (NOC) |
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Definition
| developed by the Iowa Outcomes Project and presents the first comprehensive standardized language used to describe the patient outcomes that are responsive to nursing intervention |
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Definition
| planning carried out by any nurse who interacts with patient to keep the plan up to date, to facilitate the resolution of health problems, to manage risk factors, and to promote function |
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Term
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Definition
| observation of the patient to demonstrate the resolution of the problems identified by the nursing diagnoses and general problem list, along with the time frame for accomplishing these outcomes |
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Term
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Definition
| expected conclusion to a patient health problem, or in the event of a wellness diagnosis, and expected conclusion to a patient's health expectation |
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Term
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Definition
| written guide that directs the efforts of the nursing team as the nurses work with patients to meet health goals; it specifies nursing diagnoses and determination of related nursing interventions |
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Definition
| establish patient goals to prevent, reduce, or resolve the problems identified in the nursing diagnoses and determination of related nursing interventions |
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Term
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Definition
| prepared plan of care that identifies the nursing diagnoses, patient goals, and related nursing orders common to a specific populations or problem |
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