RENI PRIMA GUSTY, SK.p,M.Kes Nursing Process: Step 4- Implementation BY RENI PRIMA GUSTY, SK.p,M.Kes

Class Objectives Describe direct and indirect nursing interventions Describe rationale for nursing protocols, standards of nursing care and standing orders Discuss importance of collaborating with client and others during intervention phase Describe what it means to have a personalized plan of care for clients Discuss how critical thinking is used during the implementation stage of care Discuss implementation/associated rationale Discuss why/how nursing interventions/findings are communicated to other members of the health care team in common nursing care settings

Definition-Implementation 4th stage of the nursing process Implementation- actions that are required to attain goals and expected outcomes of nursing care.

Definition-Implementation Begins after the care plan has been designed It is known as a category of nursing behaviors Requires nursing interventions to perform, assist, or direct activities of daily living, provide direct care, delegate supervise, and evaluate staff work exchange and document information.

Implementation Ensure you have the skills to carry out the prescribed care, that the patient is ready & you have everything you need Check that you know what might go wrong, how to prevent it, and whether you can deal with a worst case scenario Collaborate with patient and family/whanau & take all opportunities for providing education Decide whether there is another (easier?) way to do this Check any policies or procedures you are not sure of Write rationale if changing care plan Complete accurate documentation Remember that the outcome must measure the human response! So if you look at all these sample statements – they all measure the human response. So for example you would not say in your outcome statement that the patient would be supplied with equipment to change their colostomy bag because that is not a human response. However you may say that the patient will be independent with stoma management within a number of weeks because learning to care for the stoma/colostomy is a human response

IMPLEMENTATION Carry out the plan Assist person to meet goals; facilitate coping Continue to collect data Document care

Implementing Purpose, as applied to Problem solving: Communicate plans to everyone affected. Be sure plans, goals, and objectives are clearly identified. Maintain open, two-way communication with staff. Support and encourage compliance among all staff. The IMPLEMENTING phase should include: Effective communication Delegation Supervision

Nsg Roles in Implementation: Practitioner Educator Collaborator Coordinator Advocate Evaluator Note: when the client is involved in this process, the nursing role shifts to that of facilitator. Regardless of the role assumed by the nurse, the nurse must focus on the client, being constantly aware of the client’s response to the intervention. Cues from the client should direct the implementation. Ex- if the nurse is teaching a client how to change a surgical dressing and the client is experiencing pain, discontinuing the teaching plan temporarily to focus on controlling the pain would be a better action.

Direct and Indirect Nursing Interventions Direct Care Interventions -interventions that are treatments that are carried out through interaction with the client. Ex: medication administration Indirect Interventions- are treatments that are performed away from the client but based on the client’s or group’s behalf. Ex: infection control- isolate a client to protect the other clients

Rationale for Nursing Protocols Protocols – provides a standard of care or clinical guideline that can be specifically designed for each patient depending upon how the organization wants it to be implemented. Ex: ER department- plan of care when a patient arrives with chest pain.

Protocols for Standing Orders Standing order – is a pre-printed document which includes orders for routine care, monitoring and or diagnostic tests. Must be approved and signed by the licensed prescribing physician or health care provider who is charge of the implementation Ex: critical care unit, clients with burns.

Nursing Interventions REQUIRE: Nurses must have sound judgement and knowledge prior to implementation of nursing interventions. Need to use a research-based approach Careful selection of the best interventions and know the difference between the interventions of various disciplines.

Selection of Nursing Interventions Intervention selection may be difficult due to: -lack of objective data -nursing interventions may be administered in collaboration with other disciplines. -absence of common language interventions

Implementation/Associated Rationale A) Reassess- determine whether the planned nursing action is appropriate. B) Review/ revise existing Nursing Care Plan- compare nursing assessment with nursing diagnosis and change accordingly, depending if the client’s condition changed. C) Organize resources and care delivery- Determine equipment, personnel and environment required to carry out the interventions.

Implementation/Associated Rationale D) Anticipate and prevent complications- Identify the risk and weigh the benefit of the treatment with the possible risks. E) Assess your knowledge , skill and qualifications-before implementation, review the plan of care to determine the need for assistance and type required. F) Identification of times when nurse requires support/assistance from others-provide assistance if necessary when performing a procedure, comforting a client and or preparing he/she for a procedure. Refer to Nursing Care Plans (Potter, Perry, Ross-Kerr & Wood, 2006, p.214 & 217).

Importance of Collaboration Collaboration with the client and other members of the health team is important for individualizing nursing interventions Nurse can examine previous clinical experiences and priorities to nursing interventions.

Personalized Plan of Care Document the care needed by client Communication tool Individualized Provides continuity of care Organized so that information can be viewed quickly Can be used for giving report Long term needs of the client Expected outcomes Provides direction

Types of Care Plans Institutional Care Plans – Concise documents are part of the chart (Kardex) Kardex refers to a card-filing system that allows quick reference to a client’s needs Standard Care Plans- select a nursing diagnosis and then individualizes a plan of care from the selected items

Types of Care Plans Care Plans for Community-Based Settings- a more comprehensive health assessment Critical Pathways- plan of care developed by nursing, medicine and other healthcare professionals such as pharmacy etc. Concept Maps- diagram of client problems, and interventions that shows the relationships to one another. Helps students in appraising their thinking process.

Critical Thinking is used to... Critical thinking helps nurses make decisions. Nurses form conclusions, make decisions and draw inferences about the client’ health needs. Also, a research approach is needed to plan the care and select interventions that are appropriate for the client’s condition.

Communication (HOW) Nursing interventions are communicated through written and oral modes. -Written communication occurs through documentation from all disciplines caring for the client in the careplan. Client’s responses are included as well as the time and detail of the intervention is included. -Oral communication occurs between nurses and other members of the health team. Information is communicated through discussion with other colleagues, at end of shift report, when transferring a client, or at discharge.

Communication (WHY) Nursing interventions are communicated because it is important to provide accurate and timely care, ensure that interventions are not duplicated unnecessarily, procedures delayed or interventions left undone.

Summary Direct and indirect nursing interventions Rationale for nursing protocols, standards of nursing care and standing orders Importance of collaborating with client and others during intervention phase Personalized plan of care for clients Discuss how critical thinking is used Implementation/associated rationale Nursing interventions/findings are communicated to other members of the health care team

THANK YOU FOR YOU ATTENTION