4- Implementing (413)
Intervention
Implementing
*Implementation
During the step of implementation we:
*Carry out the plan of care
*Continue data collection
*Modify the plan of care as needed
*Document the care
The Purposes of Nursing Implementation
1-Help the patient in achieving valued health outcomes
2-Promote health
3- Prevent disease & illness
4-Restore health and
5-Facilitate coping with altered functioning.
Unique Focus of Nursing Implementation
• In all nurse-patient interactions, the nurse is
concerned with the patient's response to
health and illness and the nurse's ability to
meet basic human needs.
• Whereas other health care professionals focus
on selected aspects of the patient’s treatment
regimen.
Clinical Reasoning and Implementing
As you implement the plan of care, you are
constantly engaging in clinical reasoning about
what you are doing.
• Since patient conditions can change dramatically in
minutes you must reassess the patient for changes
in health status that might dictate a different set of
interventions.
• You also want to be sure that research support
your interventions. (EBP Evidence-Based-Practice)
Implementing & Interpersonal Competence
• Nurses always working with patients, families,
communities and other nurses and other
health care professionals.
• So you need to build a trust relationship with
the patient to practice the intervention on
him/her successfully.
Types of Nursing Interventions
• Nursing Intervention is any treatment based
upon clinical judgment and knowledge that a
nurse performs to enhance patient/ client
outcomes.
1-Direct Care Interventions
A treatment performed through interaction with the patient (s)
• Direct care interventions include:
Physiological and psychological nursing actions
and include both ‘ laying of hands’ actions and those
that are more supportive and counseling in nature.
2-An Indirect Care Intervention:
• Is a treatment performed away from the patient
but on behalf of a patient or group of patients.
-Indirect Nursing Interventions Include:
Nursing actions aimed at a management of the
patient care environment and interdisciplinary
collaboration.
These actions support the effectiveness of direct
care interventions.
*-Protocols & Standing Orders expand the scope of
nursing in practice in certain clearly defined
situations.
Protocols are written plans that detail the nursing
activities to be executed in specific situations
*Other protocols include Standing Orders that
empower the nurse to initiate actions that
ordinarily require the order or supervision of a
physician example of standing order is giving the
medications .
*Implementing The Plan of Care
When carrying out the plan of care, nurses use
specialized abilities:
1-Determine the pt’s new or continuing need for nursing
assistance.
2-Promote self – care.
3-Assist the patient to achieve health goals.
(1)Reassessing The Patient & Reviewing The Plan of Care
*The patient's status is changed during time
So it is critical to check his/her status
continuously in order to change the
intervention accordingly.
*It is also important for each nurse
implementing the plan to do the following:
1-To be sure that each nursing intervention is
supported by a sound scientific rationale
(evidence- based practice).
2-Nursing intervention is consistent with
professional standard of care or policies and
protocols.
3-Nursing actions are safe for this particular patient
4-Clarification of any questionable order.
2)Clarifying Prerequisite Nursing Skills
To implement the plan of nursing, nurses need:
-Intellectual
-Interpersonal
-Technical and
-Ethical or legal skills
3)Organizing Resources
Successful implementation of the plan of care
requires a high degree of organizing and
efficiency in today's hectic healthcare
environment.
*Patient and patient visitors
*Equipments
*Environment
*Personnel
4)Anticipating Unexpected Outcomes/ Situations
• Sometimes some problems appear in
performing interventions, the nurse must
expect for these adverse reactions to happen.
• The skilled nurse knows what might happen if
an intervention "goes wrong" and is prepared
to deal with the new challenge.
5)Preventing Errors and Omissions
• The goal is to catch possible errors and
omissions early.
6)Promoting Self- Care: Teaching,
Counseling, and Advocacy
• Some people can independently meet their
basic human needs, illness and the stress of
diagnostic and therapeutic measures may
interfere with a person's usual practice of self-
care.
• The nurse must encourage the patient to
perform the care himself.
7)Assisting Patient to Meet Health
Outcomes
• The nursing teams carries out the nursing
orders detailed in the nursing plan of care
• If the plan of care is well constructed, carrying
out its order is the nurse's most important
task and should receive top priority.
Variables that influence outcome
achievement
1-Patient variables such as:
*Developmental stage
*Psychosocial background.
2-Nurse's variables such as:
*level of expertise
*Creativity
*Willingness to provide care
*Available time.
3-Resources such as:
*Adequate staff
*Equipments
*Supplies
4-Current standards of care:
*The actions must be consistent with the
standards of practice.
5-Research findings:
*Follow up the newly researches and
articles to be up to date with science.
6-Ethical and legal guides to practice:
*To know the laws and regulations
in treating the patients.
Continue Data Collection & Risk Management
• It is important to be sensitive to both subtle
and dramatic changes in the patient's
condition.
• Skilled nurses monitor the patient's responses
to planned interventions to determine if the
plan of care is working
*Documenting Nursing Care
• The legal truth ( it wasn't done, if it wasn't
documented).
• Each nurse carefully documents all nursing
interventions.
• When the patient does not cooperate with
the plan of care:
• When the patient does not follow the plan of
care despite the nurse's best effort, it is time
to reassess strategy.
Common Reasons for Noncompliance
1-Lack of family support
2-Lack of understanding about the benefits of
compliance
3-Low value attached to outcomes or related
interventions
4-Adverse physical or emotional effects of
treatment (such as pain or fatigue)
5-Inability to afford treatment
6-Limited access to treatment.
Delegation Nursing Care
Many employers of nurses have increased their
use of unlicensed assistive personnel o" nurse
extenders"
• Unlicensed assistive personnel: are individuals
who are trained to function in an assistive role
to the licensed registered nurse (RN) in the
provision of patient activities as delegated by
and under the supervision of RN.
Delegation
• It is the transfer of responsibility for the
performance of an activity to another
individual while retaining accountability
for the outcome.
Delegating & The Student Nurse
• Student nurses may find themselves the
recipient of delegated care that they cannot
safely perform.
• Whenever you are asked by a staff nurse to
perform an intervention for which you lack
training, you should consult with your
instructor to see if you can safely perform it
with supervision.
The End