1. Chapter 36 Implementing and Evaluating Care

2. Aspects of Nursing Implementation
After collecting data, identifying nursing diagnoses, developing goals, and writing a nursing care plan, the next step is to implement the care plan.
Implementation of a nursing care plan may also be referred to as providing nursing interventions. It involves:
Performance of nursing actions
Continued data collection
Communication with healthcare team
Documentation

3. Nursing Implementation
Dependent actions
Actions that carry out a physician’s orders regarding medication or treatments
Interdependent actions
Actions that you perform collaboratively with other care providers
Independent actions
Actions that do not require a physician’s orders

4. Nursing Accountability
The nurse is responsible for all actions performed, whether they are dependent, interdependent, or independent.
This responsibility is also called accountability, an important aspect of the legal requirements of nursing practice.

5. Skills Used in Implementing Nursing Care
Intellectual skills
Knowing and understanding essential information before caring for clients; critical thinking
Interpersonal skills
Believing, behaving, and relating to others
Technical skills
Changing a sterile dressing or administering an injection, requires safe and competent performance

6. Communication
Solid communication techniques and client encounters that promote the development of a trusting relationship are interpersonal skills that every nurse should possess.
Client planning conference or discharge planning conference
The nurse gives both verbal and written information to those attending to ensure that the plan of care is not only coordinated with those of other healthcare providers, but also evaluated by them.

7. Question Which of these is not a step in nursing implementation?
a. Putting the nursing care plan into action
b. Continuing the collection of data
c. Communicating care with the healthcare team
d. Identifying strengths and problems
e. Documenting care

8. Answer d. Identifying strengths and problems
Nursing implementation includes the following steps: Putting the nursing care plan into action, continuing the collection of data, communicating care with the healthcare team, and documenting care.
Strengths and problems are identified in the assessment stage.

9. Evaluation Evaluation
Measures the effectiveness of assessing, diagnosing, planning, and implementing
The client is the focus of the evaluation.
Steps in the evaluation of nursing care are:
Analyzing the client’s responses
Identifying factors contributing to success or failure
Planning for future care

10. Evaluation (cont’d)
Means to evaluate the effectiveness of nursing care:
Client
The primary source of evaluation
Team conference
Helps to plan, evaluate, and design a discharge plan
Community health agencies
Who are in touch with clients after they leave the facility

11. Question
Which of these are steps of the evaluation stage of the nursing process?
a. Modify goals and interventions
b. Collect data
c. Plan future care
d. Document care
e. Recognize data clusters

12. Answer a. Modify goals and interventions c. Plan future care
Modifying goals and interventions and planning future care are steps of the evaluation stage of the nursing process.
Collecting data and recognizing data clusters are part of the nursing assessment stage.
Documenting care is an essential part of the nursing implementation stage.

13. Discharge Planning Discharge planning
Process by which the client is prepared for continued care outside the healthcare facility or for independent living at home
Planning for discharge is ongoing throughout the client’s plan of care.
The discharge plan is individualized.
Healthcare team usually holds a discharge conference with the client to set new goals.

14. Question Is the following statement true or false?
Discharge planning begins on admission of the client into the facility.

15. Answer
True
The client and family cannot be expected to remember a large amount of teaching at one time, especially just as the client is leaving the facility.
Discharge planning may include written instruction, skills demonstration, and/or verbal teaching. The client, the family, and one or more significant persons may be included in the discharge planning.

16. Components of Discharge Planning
Equipment needed at home
Dietary needs: Special diet
Medications to be taken at home
Resources
Emergency response: Danger signs
Activity
Summary

17. End of Presentation