Patient’s

Patient’sname:
name:________________________________________
________________________________________ Age:
Age: Sex:
Sex:__________
__________ Room/Bed
Room/BedNo.
No.____________
____________
Diagnosis:
Diagnosis:_____________________________________________
_____________________________________________ Date
Dateof
ofimplementation:
implementation:_______________
_______________ Shift:
Shift:_______________________
_______________________ 8

Prepared
Preparedby:
by:__________________________________
__________________________________ Supervisor/CI:
Supervisor/CI:_________________________
_________________________

CUES
CUES NURSING
NURSING ANALYSIS
ANALYSIS PLAN
PLANOFOFCARE
CARE INTERVENTION
INTERVENTION RATIONALE
RATIONALE EVALUATION
EVALUATION
DIAGNOSIS
DIAGNOSI
Subjective Either of the S Scientific Analysis Goal Nursing roles Reference-based Outcome evaluation
assessment
Subjective two ways:
Either of the (reference-based):
Scientific Analysis Based
Goal on the identified Independent
Nursing roles explanation of
Reference-based Aligned
Outcome with the intervention,
evaluation
(Verbatim) Analysis on the nursing problem Dependent interventions write if the
assessme a.2-part
two ways: (reference-based): Based on the identified
(Short-term goal for Independent explanation of Aligned withmeasures indicated is
the intervention,
nt statement (for anatomical
Analysis on physiological
the nursing problem
acute care settings;
Collaborative
Dependent interventions either
write ifMET
the or
measures indicated is
a.2-part changes (Short-term goal for NOT MET.
(Verbatim) risk problems) anatomical physiological Long-term goal for long Collaborative either MET or
Objective statement (for acute care settings; Focus
Problem + Situational
changes Analysis term care settings) Process
NOT MET.evaluation
assessment risk problems) Long-term goal for long Developmental-
Etiology (Client-specific): Analyze term care settings) Focus After analyzing whether it is met
(Biophysical Situational Analysis Supplemental Process evaluation
Objective Problem + what happened to the Objectives Developmental- or not met. Write a statement of
measures, b.3-part (Client-specific): Analyze Facilitative
assessme Etiology patient and the incidents a.Objectives
What to address: Supplemental After
the analyzing
reason why whether
it was metit is
ormet
not
laboratory statement what happened to the
nt
Problem
b.3-part
that lead to the
patient and the a.1.What
Etiology
to address: Facilitative or notReason
met. met. Write
should a statement
be based on of
tests, 2.Cognitive, Other consideration:
(Biophysic
+Etiology+
statement
occurrence of the
incidents that lead to 1. Etiology Psycho- the reason why
effectiveness it was met
efficiency, or not
adequacy,
radiologic
al disease which includes motor and affective evidence-based
Other met. Reason should
Signs and
Problem the occurrence of the 2.Cognitive, Psycho- appropriateness andbe based on
acceptability.
tests, etc)
measures, but not limited to risks b. Way to write intervention
consideration: effectiveness efficiency, adequacy,
symptoms disease which includes motor and affective
+Etiology+
laboratory
Signs and
factors based on client
but not limited to risks b.objectives: SMART
Way to write evidence-based appropriateness and acceptability.
tests, history. Specific, Measurable,
objectives: SMART intervention
symptoms factors based on client
radiologic Health Attainable,
Specific,Realistic,
history.implication:
tests, etc) What may happen if the Time-bounded
Measurable,
Health implication:
client’s nursing problem (align objectives with
Attainable, This format was developed by FEU Nursing Science Team 2020
2020
What
is not may happen if the
addressed intervention, rationale
Realistic, and
Time-
client’s nursing problem evaluation)
bounded