Question
Back to the basics, but what components should an ideal goal have?
Answer
Goals should have the following components:
· Participant -- Person who will perform the skill
· Behavior -- What the person will do
· Condition -- Requirements or circumstances necessary to perform the activity
· Measurement -- Objective measure of progress.
· Product or Functional Outcome -- The functional result of performance
The participant should be listed as they are the person who will perform the skill. That seems easy. However, I still read goals that state, “Therapist will administer the Berg Balance Assessment to the patient within one week”, etc. Your participant should never be the therapist. It should be your patient or in certain cases where it would not be the patient, it might be the caregiver or staff person.
Behavior is what the patient will do. We want the patient to walk or transfer or stand or climb stairs.
Conditions are the requirements or circumstances necessary to perform the activity. We want them to “sit at the edge of the bed with good balance”. We want them to “climb three stairs reciprocally with no posterior loss of balance”. We want them to “walk X number of feet with adequate toe clearance during the swing phase of gait”. What are the conditions with a specific range of motion, within a certain amount of time, without loss of balance, with a certain number of verbal or tactile cues, etc.? The reality is that the more conditions you put into your goal, the longer you will be able to work on that goal. You can have a ton of really small incremental goals. You can make one goal that would encompass all of them. I do not think there is a right or wrong way to make those goals.
The goal also has to be measurable. This is min, mod, or max, a certain level of distance, a pain rating scale, etc. The one thing I do not like to see in goals, and reviewers do not like to see either, is a goal that states that the patient will score X, Y, Z, on this standardized test. While we think that the standardized test, such as the Berg or the Tinetti, is a great test and will tell you whether or not the patient continues to have fall risk or balance or gait deficits, that score alone does not tell you anything functional about that patient. Having the objective measurement is fabulous. It belongs in your note. It does not belong in your goal. Let’s say your goal is for balance or for gait, you would say, “Balance at X, Y, Z level with fair/good/no loss of balance” or “less than two tactile cues to maintain balance.”
The next thing a goal should have is functional outcome or product. This can include stating, “in order to” do something specific such as stand at the sink, transfer to the wheelchair, or to attend meals in the dining room independently. This list can go on and on. It always has to be functional. Ideally, we want those measurements, but they should not be part of our goal.
An example would be “Resident will ambulate 100 feet using a rolling walker with equal step length and heel strike and less than two loss of balances requiring min assist or less to correct with contact guard assist in order to attend meals in the dining room.” That is a lengthy goal, but it has every component. I can look at that goal and know for sure what it is that you are working on. You will be doing gait training, because you are working on step length and heel strike. We do not want any loss of balance, so I know you are probably going to be doing some sort of neuromuscular re-education or balance retraining with this patient. With contact guard assist, you are going to be doing some sort of therapeutic activity with this patient. I know what you will be focusing on as it clearly states what you are doing in your plan of care.
