Generate Solutions
Key Points
- Generate Solutions is the fourth cognitive layer of the CJMM — selecting interventions that address the prioritized problem with expected outcomes.
- Nurses draw on evidence-based practice, clinical protocols, and patient-centered considerations to develop the care plan.
- Solution planning includes both current actual problems and likely potential problems, with “best-case” and “worst-case” forecasting.
- NGN items test whether nurses can match the most appropriate intervention to a specific clinical situation.
What It Means
Generating solutions involves identifying the best nursing actions and expected outcomes for the prioritized hypothesis. This goes beyond listing possible interventions — the nurse selects those most likely to be safe, effective, and appropriate for the specific patient’s context, preferences, and acuity level.
Solutions must be linked to measurable, realistic goals to support later evaluation.
Key Questions to Ask
- What nursing interventions directly address the priority problem?
- What does the evidence say about effective management of this condition?
- What are the expected outcomes if interventions are successful?
- What are the best and worst likely outcomes over the next care window?
- What patient-specific factors (allergies, comorbidities, preferences) affect solution selection?
- Are independent nursing actions sufficient, or does this require collaborative/provider-ordered interventions?
Nursing Application
- Select interventions based on clinical guidelines, scope of practice, and the patient’s acuity and context.
- Identify what must be addressed now (actual problem) versus what must be prevented next (potential problem).
- Classify candidate actions as indicated, contraindicated, or nonessential before finalizing the care plan.
- Distinguish independent nursing interventions (within nursing scope) from collaborative ones (requiring provider orders).
- Set SMART goals that are specific, measurable, attainable, relevant, and time-bound for this patient context.
- Build plans at least “two steps ahead” by pairing immediate interventions with contingency actions for deterioration.
- Consider patient and family input, cultural factors, and health literacy when tailoring solutions.
- Set goal timeframes collaboratively with the patient and team before implementation starts.
- Anticipate potential complications and include monitoring strategies within the care plan.
NGN Focus
Generate Solutions items ask nurses to select the most appropriate intervention or set of interventions for a given patient situation, or to identify expected outcomes. The best answer is evidence-based, prioritized, and patient-specific.
Types of Nursing Interventions
| Type | Description | Example |
|---|---|---|
| Independent | Within nursing scope, no order required | Repositioning, oral care, emotional support |
| Collaborative | Requires provider order or team coordination | Medication administration, diagnostic testing |
| Dependent | Carried out under physician direction | Specific treatments or procedures ordered |
| Action Priority Label | Meaning | Use in Planning |
|---|---|---|
| Indicated | Supported by cues and likely to improve outcomes | Prioritize first |
| Contraindicated | Likely unsafe or mismatched to current cues | Exclude and escalate if ordered |
| Nonessential | Not harmful but low-value for current priorities | Defer until higher risks are addressed |
Goal Timeframe Types
| Goal Horizon | Typical Time Window | Common Use |
|---|---|---|
| Short-term goal | Within a shift to about one week | Immediate stabilization, early skill demonstration, discharge-readiness checks |
| Long-term goal | Weeks to months | Rehabilitation progress, chronic-plan adherence, quality-of-life improvement |
Related Concepts
- prioritize-hypotheses - The prior stage: identifying which problem to address.
- take-action - The next stage: implementing the selected interventions.
- nursing-intervention-types-and-prioritization-in-implementation-phase - Framework for selecting and sequencing nursing actions.
- evidence-based-decision-making-in-nursing - Applying research evidence to clinical decisions.
- motivational-coaching-and-smart-goals-in-nursing-education - SMART goal-setting for nursing care plans.
Self-Check
- What makes a nursing intervention “evidence-based”?
- How does scope of practice affect which interventions a nurse can independently initiate?
- Why are measurable expected outcomes essential in the Generate Solutions stage?