18.1 Measurable Outcomes, Coordination & Delegation

Turn a problem list into an individualized plan

A plan of care should connect an assessment finding to an achievable outcome and an intervention that can change it. Measurable outcomes describe what the child or caregiver will demonstrate, how it will be assessed, and when reassessment will occur. They should reflect developmental ability, baseline function, family priorities, and the expected clinical course. A generic statement such as patient will improve is too vague to guide action.

Distinguish the outcome from the task. Administer prescribed analgesia describes an intervention; the child's reassessed pain, alertness, breathing, and ability to participate in a needed activity describe outcomes. A completed checklist can coexist with an ineffective or harmful result. Specify both benefit and safety measures so that relief achieved through excessive sedation is not mistaken for success.

Write useful goals

Do not invent a physiological target when the clinical context requires a prescribed range. Oxygen goals in a child with a particular congenital heart lesion may differ from routine targets. Establish the correct individualized goal, document it, and reassess trends. The nurse must distinguish a known baseline from a new deterioration rather than forcing every patient into an adult or generic normal range.

Coordinate across disciplines

A child with poor growth and feeding difficulty may need the primary team, nursing, nutrition, speech or feeding specialists, pharmacy, and case management. Define each consultation question: assess feeding safety is more actionable than see patient. Integrate recommendations into one coherent plan and resolve contradictions. The family should not receive incompatible feeding instructions from separate teams.

During rounds, invite the child and caregiver to describe the main concern and explain what has changed. Confirm who will communicate results and pending decisions. If the family reports that a proposed plan is not feasible at home, bring that information back into the plan rather than treating it as an inconvenience. Interprofessional work succeeds when the agreed recommendation can actually be implemented.

A transition needs named responsibility

Before transfer, communicate current condition, baseline differences, treatments already given, medications due, access devices, safety risks, pending tests, and contingency actions. Use a structured handoff and confirm the receiving person's understanding. A test result expected after transfer must have an identified clinician or team responsible for review. Saying the result is pending does not assign responsibility for acting on it.

Discharge planning begins before the last hour of the admission. Determine whether equipment, medicines, transport, school accommodations, follow-up, and caregiver training will be available. A medically stable child who needs a new feeding pump cannot safely use that plan without the device and a capable caregiver. Escalate barriers early to the team that can resolve them.

Delegate within the real scope of practice

Delegation depends on the jurisdiction, institutional policy, worker role, demonstrated competence, task, supervision, and patient stability. The RN does not delegate nursing judgment or assume that a familiar task is appropriate for every patient. Routine measurement may be delegated in an appropriate situation, but interpretation and the response to abnormal findings remain nursing responsibilities.

Give explicit instructions: what to do, when to report, which findings require immediate communication, and how completion will be confirmed. For an unstable child, the RN may need to perform the assessment directly rather than waiting for delegated routine observations. Reassess after the task and provide feedback. Delegation is not complete when a request is sent; the result must reach the responsible nurse and inform care.

Prioritize competing needs

Imagine the RN is preparing a stable child for discharge when another child's breathing changes. Address the potentially unstable child and call for appropriate support. A competent team member may help with suitable routine discharge logistics while the RN retains clinical assessment, teaching evaluation, and final readiness decisions. Prioritization uses urgency, stability, time sensitivity, and available resources rather than simply completing tasks in the order received.

Communicate delays and coverage clearly. Time management must preserve reassessment, infection precautions, accurate medication checks, and essential family communication. An apparent efficiency gain that omits the next assessment can delay recognition of deterioration. If workload prevents safe care, escalate through the appropriate chain rather than silently lowering the plan's standards.

Evaluate and revise

At the agreed reassessment time, compare the observed result with the goal. Classify it as met, partially met, or unmet using actual findings, then determine why. The intervention may need adjustment, the diagnosis may need reconsideration, or a resource barrier may remain. Document the revised plan and communicate it to the team and family. The nursing process continues until a safe and realistic plan is in place.

ANCC current PED-BC outline identifies outcomes, coordination, and delegation as tested skills. The examples here are independent teaching scenarios.