Understanding SMART Objectives for Nursing School Care Plans

Something many students struggle with is understanding how to write SMART objectives for their nursing school care plans or clinical homework assignments. With this guide, you’ll soon be writing SMART objectives like a pro!

Align your objective with the patient’s problem

First of all, you must understand that the SMART objective doesn’t exist all on its own. It’s closely tied to the patient’s problems and the interventions you are utilizing to address those problems. Everything must be in alignment. For example, if your patient’s problem is a knowledge deficit, then your interventions are aimed at increasing their knowledge and evaluating their understanding. So, your SMART objective must be related to improving their knowledge deficit.

Let’s look at an example to drive this concept home. We’ll look at one example where all these components are in alignment and an example in which they are not.

Example 1: Not in alignment

Problem: Patient states he doesn’t understand when to take his blood pressure medication.

SMART Objective: Patient will maintain systolic blood pressure < 160 mmHg by next appointment in three months.

Interventions: Teach patient about medication, measure blood pressure, watch for adverse effects.

In this example, do you see how the objective and some of the interventions don’t align with the problem? Sure, they’re all about his blood pressure, but they’re not all related to his lack of understanding. 

Example 2: In alignment

Problem: Patient states he doesn’t understand when to take his blood pressure medication.

SMART Objective: Prior to discharge, patient will be able to state that his medication should be taken every night before bed.

Interventions: Assess the patient’s current understanding of his medication schedule, explain medication frequency to the patient, have the patient “teach-back” to demonstrate understanding.

In this example, see how everything aligns with the patient’s knowledge deficit? The patient doesn’t understand when to take his medication, so we’re going to set a goal (or objective) that he will understand when to take it, and we’ll intervene with effective teaching. When everything is in alignment, then you know you’re truly addressing your patient’s problems.

The components of a SMART objective

Each letter in SMART relates to a key component of your objective: 

• S: Specific
• M: Measurable
• A: Attainable
• R: Realistic
• T: Time-bound

Let’s go through a few examples so you can see SMART objectives in action! For these examples, I am using NANDA nursing diagnoses, but you can also just write the patient problems in plain language if that’s what your school teaches.

SMART objective example #1

Patient Problem: Risk for constipation related to opioid use as evidenced by hydrocodone administered four times on 3/24 and 3/25. 

SMART Objective: Patient will have at least one BM by 2300 today.

• S: Specific – Yes! We could have just said “patient will go to the bathroom” but we’ve been very specific about what we want him to do, which is to have a bowel movement.
• M: Measurable – Yes! We can measure “at least one” BM.
• A: Attainable – Yes! This, of course, depends on your interventions and what you are trying to accomplish. We’ll get to the interventions in just a moment.
• R: Realistic – Yes! Many times, if the goal is attainable, it is also realistic. Again, this depends on the interventions you are planning and also on the time-frame.
• T: Time-bound – Yes! This goal is time-bound. We want the patient to have a bowel movement by 2300 today.

Interventions: Remember, your interventions must be tied to the problem and help you achieve the objective you’ve set.

• Increase fluids
• Increase activity
• Administer laxatives as prescribed
• Administer enema as prescribed
• Provide prune juice

SMART objective example #2

Patient Problem: Activity intolerance related to fatigue, as evidenced by patient refusing physical therapy on 4/15 and 4/16 stating, “I’m too tired to get up.”

SMART Objective: Patient will ambulate 10 feet using a walker by 1400 today.

• S: Specific – Yes! We could have said, “The patient will increase activity” but that wouldn’t be specific since “activity” could mean a lot of different things.
• M: Measurable – Yes! We can definitely measure 10 feet.
• A: Attainable –  Yes! This is attainable because we’ve incorporated the use of an assistive device.
• R: Realistic – Yes! Again, realistic and attainable often go hand-in-hand. If we had said the patient was going to ambulate 60 feet after lying in bed for two days, that wouldn’t be very realistic. This definitely is. 
• T: Time-bound – Yes! The patient is going to reach this goal by 1400 today.

Interventions: Remember, your interventions must be tied to the problem and help you achieve the objective you’ve set.

• Encourage patient to participate in physical therapy, even if tired
• Assess for sleep disturbances and insomnia
• Balance activity with rest
• Utilize non-opioid pain management modalities
• Promote adequate nutrition

SMART Objective Example #3

Patient problem: Anxiety related to hospitalization as evidenced by the patient’s statement, “I don’t know who is going to take care of my kids while I’m here.”

SMART objective: Patient will rate anxiety about childcare at level 4 or lower on 0-10 scale by end-of-shift.

• S: Specific – Yes! We know that the patient’s anxiety is specifically related to her childcare situation. If we had just said, “Patient will feel better,” that could be interpreted a lot of different ways.
• M: Measurable – Yes! Using a 0-10 scale makes this subjective complaint very measurable.
• A: Attainable – Yes! This is, of course, reliant on the timeframe and the chosen interventions. 
• R: Realistic – Yes! Notice we didn’t say she’d rate her anxiety as a 0, as that’s not likely to happen. Yes, she’ll still have some anxiety about her childcare situation, but with solid interventions we’re aiming to get that anxiety level down to something more manageable.
• T: Time-bound – Yes! We’re going to help the patient reach this goal by the end of the shift.

Interventions:

• Obtain order for social work consult
• Provide therapeutic communication
• Help patient identify and reach out to one or two potential caregivers
• Provide iPad so patient can participate in video call with children
• Teach coping mechanisms

I hope this tutorial has helped you understand how to write your SMART objectives and align them with your patient’s plan of care. 

Looking for more help with nursing school? That’s why I created Crucial Concepts Bootcamp. In this program, I teach you key foundation concepts, study strategies, organizational skills, dosage calculations and soooo much more! Get all the details here.

Review SMART objectives on the go in episode 361 of the Straight A Nursing podcast wherever you get your podcast fix.

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Last Updated on November 3, 2024 by Maureen Osuna, MSN, RN