In: Nursing
Implementation, the fourth step of the nursing process, formally
begins after the nurse develops a plan of care. With a care plan
based on clear and relevant nursing diagnoses.
SOME IMPORTANT POINTS
Nursing Intervention
A nursing intervention is any treatment based on clinical judgment
and knowledge that a nurse performs to enhance patient outcomes
.
Ideally the interventions a nurse uses are evidenced based
,providing the most current, up-to-date, and effective approaches
for managing patient problems.
Interventions include direct and indirect care measures aimed at
individuals, families, and/or the community.
TYPES OF INTERVENTION
•Direct care
•Indirect care.
Domains of Nursing practice
• The Helping Role
• The Teaching-Coaching Function
• The Diagnostic and Patient-Monitoring Function
• Effective Management of Rapidly Changing Situations
• Administering and Monitoring Therapeutic Interventions and
Regimens
• Monitoring and Ensuring the Quality of Health Care
Practices
• Organizational and Work-Role Competencies
THE FIVE TASK OF IMPLIMENTATON PLANNING
• Before implementing a planned intervention, use critical thinking
to confirm whether the intervention is correct and still
appropriate for the patient’s clinical situation ((CRITICAL
THINKING IN IMPLEMENTATION)
• you have to exercise good judgment and decision making before
actually delivering each intervention
• Review the set of all possible nursing interventions for the
patient’s problem
• Review all possible consequences associated with each possible
nursing action
• Of all possible conditions determine the probability
sequences
STANDARD NURSING INTERVENTIONS
•Clinical Practice Guidelines and Protocols.
•Standing Orders
Purposes of implementation
1.Standardization of the nomenclature (e.g.,labeling, describing)
of nursing interventions; standardizes the language nurses use to
describe sets of actions in delivering patient care
2.Expanding nursing knowledge about connections among
nursingdiagnoses, treatments,and outcomes; connections determined
through the study of actual patient care using a database that the
classification generates
3.Developing nursing and health care information systems.
4.Teaching decision making to nursing students; defining and
classifying nursing interventions to teach beginning nurses how to
determine a patient’s need for care and to respond
appropriately
5.Determining the cost of services provided by nurses.
6.Planning for resources needed in all types of nursing practice
settings
7.Language to communicate the unique functions of nursing
8.Link with the classification systems of other health care
providers
Process of Implementation
• Reassessing the Patient
• Reviewing and Revising the Existing Nursing Care Plan
• Organizing Resources and Care Delivery
• Anticipating and Preventing Complications
• Identifying Areas of Assistance.
• Implementation Skills
Implementation
•Cognitive Skills
•Interpersonal Skills
•Psychomotor Skills
DIRECT CARE
• Activities of Daily Living
• Instrumental Activities of Daily Living
• Physical Care Techniques
• Lifesaving Measures
• Counseling
• Teaching
• Controlling for Adverse Reactions
• Preventive Measures
INDIRECT CARE
•Communicating Nursing Interventions
•Delegating, Supervising, and Evaluating the Work of Other Staff
Members
ACHIEVING PATIENT GOALS
• Regardless of the type of interventions, you implement nursing
care to achieve patient goals and outcomes. In most clinical
situations multiple interventions are necessary to achieve select
outcomes.
• Another way to achieve patient goals is to help them adhere to
their treatment plan
Key Points
• Implementation is the fourth step of the nursing process in which
nurses initiate interventions that are designed to achieve the
goals and expected outcomes of the patient’s plan of care.
• A direct-care intervention is a treatment performed through
interactions with a patient that can include nurse-initiated,
physician-initiated, and collaborative approaches.
• Always think first and determine if an intervention is correct
and appropriate and if you have the resources needed to implement
it.
• Clinical guidelines or protocols are evidence-based documents
that guide decisions and interventions for specific health care
problems.
• When preparing to perform an intervention, reassess the patient,
review and revise the existing nursing care plan, organize
resources and care delivery approaches, anticipate and prevent
complications, and implement the intervention.
• The implementation of nursing care often requires additional
knowledge, nursing skills, and personnel resources.
• Before beginning to perform interventions, make sure that the
patient is as physically and psychologically comfortable as
possible.
• Use good judgment and sound clinical decision making when
performing any intervention to ensure that no nursing action is
automatic.
• To anticipate and prevent complications, identify risks to the
patient, adapt interventions to the situation, evaluate the
relative benefit of a treatment versus the risk, and initiate risk
prevention measures.
• Methods used to ensure that you administer physical care
techniques appropriately include protecting you and the patient
from injury, using proper infection control practices, staying
organized, and following applicable practice guidelines.
• When you delegate aspects of a patient’s care, you are
responsible for ensuring that each task is assigned appropriately
and completed according to the standard of care.
• To complete any nursing procedure, you need to know the
procedure, its frequency, the steps, and the expected
outcomes.
Example
• Assessed the sign and symptoms of dehydration.
• Assessed the vital signs
• Hand washing is done
• Knowledge and explanation is given before and after every
procedure.
• Provided oral fluids
• Provided ORS
• Provided the IV Fluids
• Intake output chart is maintained
• Monitored the urine output .
• Monitored the bowel pattern
• Provided anti emetic medications according to the Doctor’s order
.
• Provided antidiarrheal according to the Doctor’s order
• Explained the patient and the family members about the present
condition