Implementing

Implementation

• nursing actions planned are carried out• purpose: to assist the patient in achieving

valued health outcomes:– promote health– prevent disease and illness– restore health– facilitate coping with altered functioning

Advantages of Nursing Interventions Classifications

• Standardizing nomenclature• Expanding nursing knowledge• Developing information systems• Teaching decision making• Ensuring appropriate reimbursement• Allocating nursing resources• Communicating nursing to non-nurses• Linking nursing content

Aims of NOC Research

• Identify, label, validate, and classify nursing-sensitive patient outcomes and indicators

• Evaluate the validity and usefulness of the classification in clinical field testing

• Define and test measurement procedures for the outcomes and indicators

Types of Nursing Interventions

• Independent nursing actions– Nurse-initiated interventions• Protocols• Standing orders

• Dependent – Physician-initiated interventions

• Collaborative nursing actions– Collaborative interventions

QuestionWhich one of the following nursing interventions is an indirect care intervention?A. A nurse explains available birth control measures to a young couple.B. A nurse meets with the collaborative care team to plan nursing measures for a patient.C. A nurse prays with a patient prior to surgery.D. A nurse administers pain medication to a patient with end-stage renal cancer.

AnswerAnswer: B. A nurse meets with the collaborative care team to plan nursing measures for a patient.Rationale: An indirect care intervention is treatment performed away from the patient but on behalf of a patient or group of patients, such as the example in answer B: consulting with the collaborative care team.The remaining answer options are direct care interventions or treatment performed through interaction with the patient.

Implementing

Question

Tell whether the following statement is true or false.A nurse who follows the protocol for taking vital signs following surgery is performing a physician-initiated intervention.A. TrueB. False

Answer

Answer: B. FalseA nurse who follows the protocol for taking vital signs following surgery is performing a nurse-initiated intervention.

Protocols

• written plans that detail the nursing activities to be executed in specific situations

• routine nursing care

Standing Orders

• empower the nurse to initiate actions that ordinarily require the order or supervision of a physician

Implementing the Plan of Care

The nurse should:1. determine the patient’s new or continuing

need for nursing assistance2. promote self-care3. assist the patient to achieve valued health

outcomes

Remember!• To be sure that each nursing intervention is supported by a

sound scientific rationale, as demanded by an evidence-based practice

• To be sure that each nursing intervention is consistent with professional standards of care and consistent with the protocols, policies, and procedures of the institution or agency

• To be sure that the nursing actions are safe for this particular patient and individualized to his or her preferences

• To clarify any questionable orders

Implementing the Care Plan

• Organize resources• Anticipate unexpected outcomes/situations• Promote self-care: teaching, counseling,

advocacy• Assist patients to meet health outcomes

Implementing Guidelines

• Act in partnership with the patient/family.• Reassess the patient and determine whether the

action is still needed• Approach the patient competently - Know how to

perform the nursing action, why the action is being performed, and potential adverse responses. Have all equipment and supplies ready.

Implementing Guidelines

• Approach the patient caringly. Explain the nursing action using language the patient understands. Communicate genuine concern for what the patient is experiencing.

Implementing Guidelines

• Modify nursing interventions according to the patient's (1) developmental and psychosocial background, (2) ability and willingness to participate in the plan of care,

and (3) responses to previous nursing measures and progress

toward goal/outcome achievement.

Implementing Guidelines• Make sure that the nursing interventions selected

are consistent with standards of care and within legal and ethical guides to practice.

• Always question that the nursing intervention selected is the best of all possible alternatives. – colleagues and literature for other possible approaches. – Evaluate the effectiveness of the intervention selected,

noting any factors that positively or negatively influenced the outcome.

Implementing Guidelines

• Develop a repertoire of skilled nursing interventions. The more options one can choose from, the greater the likelihood of success.

Delegating Nursing Care

• reduce healthcare cost• increase in demand for nursing services

Unlicensed Assistive Personnel

• trained to function in an assistive role to the licensed RN

• supervised by the RN

Delegation

• the transfer of responsibility for the performance of an activity to another individual while retaining accountability for the outcome

Guidelines for Delegating Nursing Care

• Factors to Consider:1) patient’s condition2) complexity of the activity3) potential for harm4) degree of problem-solving and innovation

necessary

Guidelines…cont.

6) level of interaction required with the patient7) capabilities of the UAP8) availability of professional staff to accomplish the

unit workload

Essentials of Effective Delegation

• Know your state and institutional policies on delegation (the policy and procedure manual is available on each unit; for state policies, contact the state nurse association).

• Be clear on the difference between nursing process and nursing tasks.

Essentials of Effective Delegation

• Know the training and background of the unlicensed assistive personnel (UAP). (Administration must have a standard and process to validate the UAP's preparation.)

Essentials…cont.

• Know the patient's needs and what he or she is at risk for.

• Know what clinical cues the UAP should be alert for and why.

• Assess which tasks can be safely delegated.• Have the UAP repeat your instructions to be sure you

have communicated them clearly.

Essentials…cont.

• Make frequent walking rounds to assess patients.• When talking with the patient, members of the

patient's family, or UAPs, listen for cues that indicate changes in the patient's condition.

• Take frequent mini-reports for the UAP.• Evaluate the UAP's performance and the patient's

response.

5 Rights of Delegation

• Right Task – one that is delegable for a specific patient

• Right Circumstances – appropriate patient setting, available resources, and other relevant factors considered

• Right Person – right person is delegating the right task to the right person to be performed on the right person

5 Rights of Delegation

• Right Direction/Communication – clear, concise, description of the task, including its objective, limits, and expectations

• Right Supervision – appropriate monitoring, evaluation, intervention as needed and feedback

Variables Influencing Outcome Achievement

• Patient variables– Developmental stage– Psychosocial background

• Nurse variables– Resources– Current standards of care– Research findings– Ethical and legal guides to practice

QuestionWhich one of the following is an example of a nurse variable influencing patient outcomes?A. A patient in a nursing home refuses to take his medications.B. A low-income family is unable to afford formula for their newborn infant.C. An alcoholic patient is unwilling to participate in AA meetings.D. A rape victim does not receive counseling at the ER because a counselor is not available.

AnswerAnswer: D. A rape victim does not receive counseling at the ER because a counselor is not available.Rationale:

Nurse variables that influence the plan of care include resources (Answer D), current standards of care, research findings, and ethical and legal guides to practice. The remaining answer options are patient variables, which include the patient’s changing ability and willingness to participate in the plan of care and personal responses to the nursing interventions implemented.

Common Reasons for Noncompliance

• Lack of family support• Lack of understanding about the benefits• Low value attached to outcomes• Adverse physical or emotional effects of

treatment• Inability to afford treatment

Question

Tell whether the following statement is true or false.When a patient fails to cooperate with the plan of care despite the nurse’s best efforts, it is time to reassign the patient to another caretaker. A. TrueB. False

Answer

Answer: B. FalseWhen a patient fails to cooperate with the plan of care despite the nurse’s best efforts, it is time to reassess the strategy.

Checklist for Organizing Student Clinical Responsibilities

• Patient profile and name by which patient is addressed

• Patient’s chief complaint and reason for admission• Patient’s current health status• Routine assistance to meet basic human needs

Checklist for Organizing Student Clinical Responsibilities

• Priorities for nursing care and special daily events• Special teaching, counseling, or advocacy needs• Special family needs