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iRubric: Nursing Care Plan Rubric
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Nursing Care Plan Rubric
Nursing Care Plan Rubric
Choose a patient that you had in clinical. Prepare a care plan based on relevant objective and subjective assessment data. The care plan will include nursing diagnosis, written in proper format and listed in order of priority for care, planning and goal statements which must be attainable and measureable, nursing interventions with researched rationales (reference sources), expectations for evaluation including what would constitute the goals being met, partially met, or unmet.
Rubric Code:
PX3WC5B
By
jjdavenport
Ready to use
Public Rubric
Subject:
Nursing
Type:
Assignment
Grade Levels:
Undergraduate
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Nursing Care Plan Rubric
Re-do
(N/A)
Fair
(N/A)
Good
(N/A)
Excellent
(N/A)
Assessment
Re-do
Assessment portion is incomplete or inacurate.
Fair
Assessment data is not well organized. Subjective and objective data are not identified. Assessment data is irrelevant or does not support nursing diagnosis.
Good
Identifies some significant, acurate and relevant data from more than one source. Does not consistently identify subjective and objective data correctly. Most assessment data supports nursing diagnosis.
Excellent
Utilizes multiple sources for data. Correctly identifies subjective and objective data which is clear, specific, and relevant. All data is clustered in a coherent manner and is related to a nursing diagnosis.
Diagnosis
Re-do
Diagnosis portion is incomplete or irrelevant.
Fair
Diagnosis are not NANDA approved, appropriate for patient or not prioritized. Diagnosis not clearly supported by assessment data.
Good
One or two diagnosis are identified that are appropriate for patient and are NANDA approved and clearly supported by assessment data. May not be listed in order of priority, or lack the proper format.
Excellent
Three or more diagnosis are identified and are clearly supported by assessment data, and reflect accurate clinical judgement. They are appropriate for patient, well prioritized, NANDA approved, and written in correct format.
Planning (Goal Setting)
Re-do
Goal portion is incomplete or completely unrelated to nursing diagnoses.
Fair
Goal statement are not relevant to nursing diagnosisis. Outcomes are consistently not client centered, measurable or have achievable target dates.
Good
Goal statements are identified that relate to the nursing diagnosis, and are patient focused. Criteria for measurement included but may not be clear or contain realistic time frame for evaluation.
Excellent
Short and long term goals are identified that clearly relate to the nursing diagnosis, are written in a patient focused manner, and are realistic. Each goal contains clear criteria for measurement and a time frame for evaluation.
Implementation
Re-do
Interventions portion is incomplete, not relevant to patient, or no rationales provided.
Fair
Interventions are unclear or do not clearly focus on the etiology of the nursing diagnosis or relate to patient goal outcomes.<BR>
Rationales provided do not demonstrate an understanding of the purpose of the interventions or no references are provided.
Good
Identifies three or less interventions for each goal that relate to the etiology of the nursing diagnosis. Not all interventions may be specific. Rationales included but may be weak, or references are incomplete or from sources that may not be reliable.
Excellent
Identifies at least 3-5 specific interventions for each outcome criteria in order to help the patient/family reach the desired goal. Interventions are specific in action and frequency, and include rationales which are researched and clearly referenced with very reliable sources.
Evaluation
Re-do
Evaluations portion is incomplete or does not relate to diagnosis, goal statement or interventions.
Fair
Evaluation portion does not consistently contain data that is listed as criteria in goal statement. May also not describe goal as met, partially met, or not met. May also not include revision or new evaluation date/time.
Good
Clearly states how each outcome would be evaluated. Able to correctly identify criteria for goal being met, partially met, or unmet. Identifies revisions for careplan but may not include acurate rationale for revision or references may be from sources that may not be reliable, or a new date is not provided for reevaluation.
Excellent
Evaluation portion contains data that is listed as criteria in goal statement and lists expectations for meeting the goal. Clear explanation of the criteria for goals being met, partially met, or not met. Includes plan for continuation or revision, clearly referenced rationale for revisions from reliable sources, and a new evaluation date/time.
Keywords:
Nursing, Care Plan
Subjects:
Nursing
Types:
Assignment
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