SoNM

NURSING PROCESS:
IMPLEMENTING/
EVALUATING
BY
DR FRANCISCA ACHALIWIE
 Implementing
SoNM

The nurse puts the nursing care plan into

action.
Consists of doing, delegating and recording.
The nurse carries out independent, dependent
and collaborative functions.
SoNM
Purpose
 To assist the patient meet desired
objectives / outcomes; promote wellness;
prevent illness and disease; restore health
and facilitate coping with altered functioning
SoNM
Successful implementing depends in part on
the quality of assessing, diagnosing and
planning.
Ongoing assessment occurs simultaneously
with implementing
Varying degrees of patient participation are
encouraged depending on health status.
 For successful implementation, the nurse
SoNM needs to have the following skills:
Cognitive: problem solving, decision
making, critical thinking and creativity for
safe nursing care.
Interpersonal: verbal and non-verbal
ways of interacting for effective care.
Technical: ‘hands-on’/ psychomotor skills
 Steps in Implementing
SoNM

Reassess the patient

Determine nurse’s need for assistance
Implement the nursing interventions
Supervise delegated care
Document nursing activities
SoNM
1. Reassessing the client

The nurse finds out whether the

intervention is still needed.
New data may indicate a need to change
priorities of care or the nursing activities
 2. Determining the Nurse’s need
SoNM for assistance
The nurse may need assistance for any of these
reasons:
Inability to implement a nursing activity safely
alone
To reduce stress on the patient
Lack of knowledge or skills to implement a
particular nursing activity.
 3. Implementing nursing
interventions
SoNM
Involves caring, communicating, helping,
teaching, counseling, leading and managing.
Explain interventions, sensations to expect,
patient’s role and expected outcome.
Ensure patient’s privacy.
Coordinate patient care.
 Guidelines for implementing
SoNM nursing strategies
Base nursing interventions on scientific
knowledge, nursing research and
professional standards of care.
Clearly understand interventions to be
implemented.
Adapt activities to the individual client and
be holistic.
SoNM
Implement safe care
Provide teaching, support and comfort.
Respect the dignity of the patient and
enhance self esteem.
Encourage patient to participate
actively in implementing nursing
interventions
 4. Supervising delegated care

SoNM
Nursing care are assigned and delegated to
other nurses where necessary.
The nurse responsible for the patient’s
overall care ensures that activities are
implemented according to the care plan.
 5. Documenting nursing activities
SoNM
Interventions and patient’s responses
are recorded in the nursing progress
notes.
Recording should be done after and
not before the activity is carried out.
Routine activities may be recorded
immediately after carrying them out or
at the end of shift.
SoNM
EVALUATING
 Evaluating
SoNM
Planned ongoing, purposeful activity to
determine client’s progress towards goal
achievement, and effectiveness of the
Nursing Care Plan.
Continues until the client/patient achieves
health care objectives/is discharged from
nursing care.
SoNM Purpose
 To determine whether to continue,
modify or terminate the plan of care
 Through evaluation, nurses
SoNM
demonstrate responsibility and
accountability for their actions
indicate interest in the results of their
activities
demonstrate a desire to adopt effective
actions
Effectiveness depends on preceding
steps
 Types of Evaluation
SoNM
• Ongoing:
Done while or immediately after
implementing a nursing intervention.
Helps the nurse to make on-the-
spot modifications in an intervention.
SoNM • Intermittent:
Performed at specific intervals
Shows extent of progress toward
achievement of objective
Enables the nurse to correct deficiencies and
modify care plan
SoNM
• Terminal:
Performed at discharge.
Determines status of goal achievement
Determines client’s self care abilities.
 Steps in Evaluating

SoNM
Collect data related to outcomes
Compare data with outcomes
Relate nursing actions to client
outcomes
Draw conclusions about problem status
Continue, modify or terminate nursing
care plan
 1. Collecting data related to
SoNM outcomes
The nurse uses the clearly stated,
precise and measurable outcomes as
guide.
Both subjective and objective data
are collected in order to make
conclusions about objective
achievement.
SoNM Subjective data requiring interpretation
could be validated with patient’s
statements / objective indicators.
Objective data requiring interpretation
could be substantiated by seeking the
views of colleagues.
Data must be recorded concisely and
accurately.
 2. Comparing data with outcomes
SoNM
Make judgments about objective
achievement
Write an evaluative statement i.e.
conclusion + supporting data.
Possible conclusions include:
 Objective fully met / partially met / not
met
Supporting data are the list of patient
responses that support the conclusion
 3. Relating nursing activities to
SoNM client outcomes
Determine whether nursing activities had
any relation to the outcomes.
It should never be assumed that a nursing
activity was the cause of / the only factor in
fully meeting, partially meeting or not
meeting an objective.
 4. Drawing conclusions about
SoNM problem status
The nurse uses judgment about client
outcome to decide whether the care
plan was effective in resolving,
reducing or preventing client
problems.
SoNM When objective is met, conclusion
may be:
Actual problem has been resolved /
potential problem has been prevented,
objective has been met and care is
discontinued; OR
 The potential problem is being
SoNM prevented but risk factors are still
present. The problem is kept on the
care plan; OR

The actual problem exists although

some objectives are being met.
Nursing interventions are therefore
continued.
 When objective is partially met or not
SoNM met, the conclusion may be:
The care plan may need to be revised in
the assessing, diagnosing, or planning
steps, as well as implementing OR
The care plan does not need revision,
the patient only needs more time to
achieve previously stated objectives.
 5. Continuing, Modifying or
SoNM
Terminating the Nursing Care Plan

After drawing conclusions about problem

status, the nurse modifies the care plan
as indicated.
SoNM Depending on the agency, a hi-liter is
used to mark/draw a line through portions
of care plan, or ‘discontinued’,
‘objective met’ or ‘problem resolved’ is
written and dated.
 Before modifying, the nurse determines
SoNM if the plan as a whole was not completely
effective.
A review of the entire care plan and a
critical look at each step of the nursing
process is done:
Assessing
Diagnosing
Planning
Implementing
 Summary: Scenario
SoNM
Justice Inkoom, 22yrs and a 2nd year
university student is admitted to the male
surgical ward after Laparotomy had been
performed O/A of Peritonitis 2o to typhoid
perforation.
On the morning of first day post-operation,
you met him with a temperature of 39.9oC,
nasogastric drainage of 740mls/24hrs,
sunken eyes, dry skin with poor turgor, and
he complains of pain at the wound site. He
 Patient’s problems include:
SoNM Patient has a surgical wound
Patient has high body temperature
(39.9oC)
Patient complains of abdominal pain
Patient is dehydrated
Patient is anxious
Patient has excessive gastric drainage
(780ml/24hrs)
 Nursing Care Plan
Date/ Nursing Objective / Nursing Orders Nursing Date/ Evaluation Sig
SoNM Time Diagnosis Outcome Interventions Time
Criteria
14/5/ Fluid volume Patient’s fluid .Assess degree of .Degree of 15/5/ Objective
12 deficit related volume will dehydration twice dehydration was 12 fully met.
10.45 to loss per be restored dly. assessed twice dly. 11am Patient’s skin
am NG drainage within 24hrs . Give patient IV . IV fluid 3L/24hrs and mucous
(740mls/24hr as evidenced fluid 3L/24hrs as was administered membranes
s) and fever by: ordered. as ordered. were
(39.9oC ) as . Nurse . Monitor and . Fluid intake and observed to
manifested observing record fluid intake output were strictly be moist and
by sunken patient has and output and monitored and had a good
eyes, dry moist skin report any recorded and skin turgor.
skin and poor and mucous abnormality. steady
skin turgor. membranes. . Check vital signs improvement
. Patient 4hrly and report noted.
observed to any abnormality. . Vital signs were
have good .Tepid sponge checked and
skin turgor. patient when recorded 4hrly
temperature is .Patient was tepid
above 38o C. sponged when
temperature read
above 38o C.
 Nursing Care Plan
Date/ Nursing Objective/ Nursing Nursing Date/ Evaluation Sig
SoNM Time Diagnosis Outcome Orders interventions Time
Criteria
14/5/ Pain (abd.) Patient’s pain .Assess pain .Pain intensity 17/5/ Objective
12 related to will be intensity using was assessed 12 fully met.
10.45 surgical relieved numeric rating using numeric 11am Patient
am intervention within 72hrs scale. rating scale 0-10 verbalized
as evidenced .Assist patient 12hrly relief of pain
by: into the most .Patient was and was
.patient comfortable assisted into low seen to be
verbalizing position. fowler’s position. cheerful
that pain is .Provide .Patient was
relieved diversional shown African
.nurse therapy e.g. movie of his
observing show TV choice for
that patient is programme of diversion
cheerful choice .IM Pethidine
.Serve analgesic 100mg 8hrly was
– IM Pethidine served as
100mg 8hrly ordered.
 Date/
Nursing Care Plan
Nursing Objective/ Nursing Orders Nursing Date/ Evaluation Sig
Time Diagnosis Outcome Interventions Time
Criteria
SoNM 14/5/ Anxiety Patient’s .Assess patient’s .Patient’s anxiety 16/5/ Objective fully
12 related to anxiety will be level of anxiety and level and physical 12 met.
11.55 acute nature relieved within physical reactions reactions were 12nn Patient said he
am of illness and 48hours as 6hrly. assessed 6hrly. was no more
unknown evidenced by: .Reassure patient .Patient was anxious and
outcome of .Nurse of the competence reassured of was observed
condition observing that of the health team. competence of the to be relaxed
patient has .Explain every health team. and interacting
relaxed facial procedure and .Every procedure/ with other
expression routines to be routine was inmates of the
.Patient carried out on explained in simple ward.
interacting with patient. language to patient.
other inmates .Encourage patient .Patient was
of the ward. to express his fears encouraged to
.Patient and concerns express his fears
verbalizing he .Introduce to him a and concerns
is no more patient who had .A patient who had
anxious been through similar surgery and
similar situation doing well was
and surgery and is introduced to him
doing well.
 Assignment
SoNM
Pick a patient in the ward, use the Nursing process to assess,
diagnose, plan and implement their care. Submit the care plan
with basic two-part diagnosis, three part and four-part diagnosis
each.

04/08/2025 School of nursing and midwifery 38