Planning in Nursing Process

In the Nursing Process, Planning is strategic step between identifying a problem and taking action.

Once a nurse has assessed a patient and formulated a nursing diagnosis, planning phase tells direction of care.

It is a deliberate, systematic phase that involves decision-making and problem-solving.

Definition 

Planning is the third step of the nursing process (ADPIE) where the nurse, in collaboration with patient and healthcare team, develops a blueprint for nursing interventions.

The primary goal is to prevent, reduce, or eliminate the health problems identified in the nursing diagnosis.

Components of Planning

The planning phase is consists of four sub-steps:

1. Prioritizing Diagnosis

Since patients often have multiple health issues, the nurse must decide what to address first.

• Maslow’s Hierarchy of Needs: Life-threatening issues (Airway, Breathing, Circulation) always take priority over psychological or long-term needs.
• High Priority: Ineffective breathing, acute pain, or risk for violence.
• Medium Priority: Knowledge deficit or physical mobility issues.
• Low Priority: Long-term coping strategies or future health maintenance.

2. To establish goals and outcomes

Goals are what patient want to achieve.

• Short-term Goals: Achievable within hours or days (e.g., “Patient will report pain level <3 within 1 hour”).
• Long-term Goals: Achievable over weeks or months (e.g., “Patient will walk 100 feet unassisted by the time of discharge”).

3. Selecting Nursing Interventions

These are specific actions nurse performs to help patient reach their goals.

• Independent: Actions a nurse can do without a doctor’s order (e.g., elevating a swollen limb, providing patient education).
• Dependent: Actions requiring a physician’s order (e.g., administering oxygen or medication).
• Collaborative: Actions performed in coordination with other team members (e.g., working with a physical therapist).

Writing Nursing Care Plan (NCP)

This is a written guide that organizes information so that every nurse on every shift knows exactly what goal is and how to achieve it.

For the planning phase to be effective, every goal must be SMART.

This ensures plan is objective and can be evaluated later.

Letter	Meaning	Example
S	Specific	State exactly what the patient will do E.g., “Ambulate”.
M	Measurable	Use numbers or observable facts E.g., “50 feet”
A	Attainable	Is this physically possible for this patient?
R	Relevant	Does it address the nursing diagnosis?
T	Time-bound	Set a deadline E.g., “by the end of the shift”.

Why is Planning Important?

1. To promotes continuity of care: Ensures that different nurses on different shifts are working toward the same objective.
2. It enhances communication: Provides a clear record for the entire multidisciplinary team (doctors, therapists, etc.).
3. Good Evaluation: Without a plan and a specific goal, you cannot judge whether your nursing care was successful or if the patient is improving.

Example for post-operative pain-

1. Diagnosis: Acute pain related to surgical incision.
2. Priority: High (Pain interferes with the patient’s ability to breathe deeply and move).
3. Goal (SMART): Patient will report a pain level of 3/10 or less within 30 minutes of receiving analgesic medication.
4. Interventions:
   1. Administer prescribed pain medication.
   2. Assist patient in finding a comfortable position using pillows for support.
   3. Use distraction techniques (e.g., television or breathing exercises).