Document Code No.

CHS/BSN-CURR -RLEFORM-002j
Revision No. Effective Date Page No.
00 02.24.2023 1 of 3

NURSING CARE PLAN

Identified Problem:
Nursing Diagnosis:
Definition: May refer to NANDA in determining when and when not to use each nursing diagnostic Defining Characteristics:
category, both the definition and defining characteristics should be compared with the client’s set of data
(cues) to make sure that the correct diagnoses are chosen for the client.

CUES OBJECTIVES INTERVENTIONS RATIONALE EVALUATION

Subjective: Short term:

Objective: Long term:

 Document Code No.
CHS/BSN-CURR -RLEFORM-002j
Revision No. Effective Date Page No.
00 02.24.2023 2 of 3
 Document Code No.
CHS/BSN-CURR -RLEFORM-002j
Revision No. Effective Date Page No.
00 02.24.2023 3 of 3

EVALUATION TOOL: NURSING CARE PLAN RUBRIC

Nursing Diagnosis
Risk factors/ Subjective and
Objective Cues
STO and LTO
Nursing Intervention
Evaluation/ Expected Outcome
UNACCEPTABLE SATISFACTORY
(1) (3)
Main Problem is not listed or identified; Identified problem but not the priority
need of the patient;
Assessment data are not listed or inadequate to Correct assessment data but lacking
support nursing diagnosis important factors to support nursing
diagnosis
Objectives do not solve/target the identified problem STO and LTO are not SMART
Intervention/s are not appropriate for the patient and Correct Intervention/s but lacking (5-8
does not solve the main problem (<5 interventions) interventions)
Evaluation or expected outcomes do not measure Evaluation or expected outcomes
the STO and LTO. measure LTO but not the STO.
EXCEPTIONAL
REMARKS
(5)
Main Problem is listed or identified
with correct related factor
Listed all pertinent assessment
data more than enough to support
the nursing diagnosis
STO and LTO are SMART
Intervention/s (>8 interventions)
are correct and appropriate for the
patient.
Evaluation or expected outcomes
measure and target the STO and
LTO.
Total ___/25