Application of goal attainment theory
• Assessing the patient’s condition using various methods explained by nursing theory • Identifying the patient’s needs • Demonstrating effective communication and interaction with the patient
• Choosing a theory for application based on the patient’s needs • Applying the theory to solve the patient’s identified problems • Evaluating the extent to which the process was fruitful
• King’s theory sheds light on nurses’ interactions with individuals and groups in the workplace.
• It emphasizes the importance of client involvement in decisions affecting care and focuses on both the process of nurse-client interaction and the outcomes of care.
Mr.sy (74 years old) was admitted to the l3 ward of…hospital for a herniorrhaphy on… for his left indirect inguinal hernia and was scheduled to be discharged… In his nursing process, he applied goal attainment theory.
• King indicates that assessment occurs during interaction in the nursing process. The nurse brings special knowledge and skills to this interaction, whereas the client brings knowledge of self and perception of problems of concern.
• During the assessment, the nurse collects data about the client (his/her growth and development, perception of self and current health status, roles, and so on).
• •perception is the foundation for data collection and interpretation; communication is required to verify perception accuracy, as well as for interaction and transaction.
The first step in the nursing process is for the nurse to meet the patient and communicate and interact with him. The assessment process begins with gathering data about the patient based on relevant concepts.
Mr. Sy is 74 years old and married. He was admitted to the l3 ward of…hospital on March 27, 2008, with a diagnosis of indirect inguinal hernia and underwent herniorraphy with prolene mesh on March 30, 2008. The following areas were targeted for data collection.
What does the patient think about the situation?
“I had hernia surgery,” the patient explains. “the wound is healing, I have no other problems” “I have pain in the area of surgery when moving” “I’ve been taking hypertension medications from here for the last 7 years” I had surgery for my right eye about ten years ago.”
What are my thoughts on the situation?
On March 30, the patient underwent herniorahaphy surgery for an indirect inguinal hernia that had gone untreated for 35 years. The patient is experiencing difficulties with health maintenance. The patient is at risk of becoming infected. The patient is in pain as a result of the surgical incision. In the future, the patient may develop hypertension-related complications.
What other information do I require to help this patient achieve health?
Particulars of identification
Mr. Sy is 74 years old, married, male, studied up to 7th grade, owns a business, and is a practicing Muslim. He was admitted to l3 ward of…hospital on 27/03/08 with a diagnosis of indirect inguinal hernia and underwent herniorraphy with prolene mesh on 30/03/08.
Present illness history of abdominal swelling for 35 years, with difficulty performing activities and occasional abdominal pain He has been suffering from hypertension for seven years. The swelling remained stable with uncomplicated progression, increasing in size when standing for long periods of time and reducible with pressure no h/o severe pain but increasing in size for the last few years relived after pressing the swelling back into position and taking rest and applying pressure
Previous medical history Patient had cataract surgery about ten years ago while being treated for hypertension and had no other significant illnesses.
Ancestral history The patient’s next elder brother and next younger brother both had inguinal hernias and were operated on. The elder brother had three hernia surgeries.
Socioeconomic status high economic status per month >rs.20000/-
Non-vegetarian lifestyle, no smoking or alcoholism Knowledgeable about health-care facilities
Physical exam alert, conscious, and oriented moderately built, adequate nourishment, with bmi of 22 vital signs – normal except bp 140/90 mmhg general head-to-foot examination reveals normal findings except for right eye vision difficulty and healing surgical wound on the left inguinal region Subjective issues pain at the surgical wound site, inability to urinate for two days, and a review of relevant systems
Inspection of the Gi system: healing wound, no infection, no redness, no swelling
• Auscultation: normal bowel sounds • Palpation: no pain, normal abdominal organs
• Percussion: no dull sound indicating fluid collection or ascitis Genito-urinary system • Inspection: testicles in position, no infection, no swelling or enlargement. • Palpation: no c/o pain, no prostate enlargement.
• Fbs – 91 mg/dl • Na (130-143meq/dl) – 134 meq / dl • K+ (3.5-5 mg/dl) – 3.5 meq / dl • Urea (8-35mg/dl) – 29 mg / dl • Sr. Cr (0.6-1.6 mg/dl) – 1 mg/ dl
• Electrocardiogram (ECG) ant. Fascicular block, left atrial enlargement, and normal axis
What does this information mean in this context?
• Patient ignored a health problem for 35 years; • Patient has acute pain at the site of surgical wound; • Patient has a family history of inguinal hernia and a risk of recurrence; • Patient has a risk of recurrence due to constipation; • Patient has a risk of infection due to inadequate knowledge and age; and • Patient requires education regarding health maintenance.
What is the patient’s conclusion (judgment)?
• The patient’s pain must be managed.
• The patient understands the importance of addressing health risks and agrees to work on these issues.
What is the patient’s conclusion (judgment)?
Based on the assessment, nursing diagnoses, i.e. clinical judgment about the patient’s actual and potential problems, were developed.
Nursing diagnosis • The assessment data is used to make nursing diagnoses in the nursing process.
• As part of the goal-achievement process, the nurse identifies the problems, concerns, and disturbances for which the person seeks assistance.
1. Acute pain from a surgical incision
2. Infection risk associated with surgical incision
3. Constipation risk associated with bed rest, pain medication, and npo or soft diet
4. Inadequate knowledge of treatment and home care
5. Inefficient health-care maintenance
• Following diagnosis, interventions to solve the problems are planned. Goal attainment planning is represented by setting goals and making decisions about and agreeing on the means to achieve goals. • This part of the transaction is encouraged, and client participation in making decisions on the means to achieve the goals is encouraged.
Identifying goals and making plans to achieve them (this step is congruent with planning in the traditional nursing process)
What objectives do I believe will be most beneficial to the patient?
1. The client will feel more comfortable, as evidenced by: • a decrease in pain rating, • the ability to rest and sleep comfortably
2. The client will be infection-free, as evidenced by a normal temperature and vital signs.
3.the client’s bowel elimination will be improved, as evidenced by: • stool elimination without straining
4. The client will gain sufficient knowledge about the treatment and home care.
5.The client will address health issues as soon as possible.
What are the patient’s objectives?
The patient’s objectives are as follows: • Pain relief • Rapid healing • Adequate bowel movement
• gaining adequate knowledge about his health problems
Are the patient’s and professional goals in sync?
What are the top priorities?
Pain relief • Infection prevention • Adequate bowel movement • Increased knowledge of health conditions • Prompt attention to health problems
What does the patient believe is the most effective way to achieve goals?
• Collaborating with health professionals • Learning • Sharing adequate information about health problems
Is the patient willing to put in the effort?
Yes, what do I believe is the best way to achieve the objectives?
Goal 1: Assess the characteristics of pain; administer prescribed medication; monitor responses to drug therapy; provide a calm, efficient manner that reassures the client and minimizes anxiety; and provide a comfortable position as requested by the client.
Goal 2: • monitor vital signs • administer antibiotics as directed • use aseptic techniques when changing dressings • keep the surgical wound site clean • report any early signs of infection to the surgeon
Goal 3: Ensure that the client’s diet contains adequate bulk and fluid intake; instruct the client on how to avoid straining and valsalva maneuvers; and consult the treating physician about medications.
• Explain the treatment measures and their benefits to the patient in simple, understandable language.
• Explain and demonstrate home care.
• Clarify the patient’s doubts, as the patient may present with some important issues.
• Reinforce learning by repeating information as needed.
Goal 5: Provide health education on the following topics:
• 6 months of no heavy weight lifting (more than 20kg) • Any additional management that may be required
• Control of his hypertension through diet
• Rehabilitation measures to encourage healthier living
• For regular examination of the site for hernia recurrence.
Are the objectives short-term or long-term?
Goals are set for both the short and long term.
What changes are required based on mutuality?
• Pain is tolerable for the patient and does not necessitate sos medication; • Constipation is not severe enough to warrant medication; and • Other interventions are mutually acceptable.
• In the nursing process, implementation entails the actual activities to achieve the goals.
• Transactions are completed as a result of this step.
• Transactions take place as a result of perceiving the other person and the situation, making judgments about those perceptions, and acting in response.
• Reactions to action result in transactions that reflect a shared perspective and commitment.
• This step reflects the traditional nursing process’s implementation.
Is this what the patient and I agreed on?
What actions am I carrying out?
In accordance with the goals established, on a mutually acceptable basis.
When am I going to carry out the action?
A few interventions require immediate attention based on priority.
Other interventions are carried out during the hospitalization period until April 5th.
Why am I performing the action?
The patient’s condition necessitates the use of a nursing car.
Is it reasonable to expect that carrying out the action will result in the achievement of the identified goals?
• It entails determining whether or not goals have been met.
• In King’s description, evaluation refers to goal attainment and the effectiveness of nursing care.
Are my actions assisting the patient in achieving mutually agreed-upon objectives?
How well are objectives met?
Prior to hospital discharge, short-term objectives are met.
Because the patient is motivated to continue receiving home care, long-term goals are expected to be met.
What are the ineffective actions?
What is the patient’s reaction to my actions?
My actions have pleased the patient.
Are there any other factors impeding goal achievement?
The patient’s age is a barrier to achieving health maintenance goals.
How should the plan be altered to achieve the desired results?
Health education can be tailored to the developmental stage of the child.
Involvement of a family member in the patient’s care.