implementation chapter 14. 14-2 copyright 2004 by delmar learning, a division of thomson learning,...

Implementation

Chapter 14

14-2Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

Purposes of Implementation

The implementation phase of the nursing process begins with assessment and continually interacts with the other steps to reflect the changing needs of the client and the response of the nurse to those needs.


Requirements For Effective Implementation

Cognitive Skills Psychomotor Skills Interpersonal Skills


Cognitive Skills

Making appropriate observations Understanding the rationale for activities

performed Appreciating the differences among

clients


Cognitive Skills

Critical thinking is an important element within the cognitive domain.• Analyze data.• Organize observations.• Transfer previously learned knowledge to

current situations.


Psychomotor Skills

Safe and effective performance of nursing activities requires:• Handling technical equipment• Medication administration• Meeting mobility needs of the client


Interpersonal Skills

Effective communication with clients, families, and other health care personnel


Implementation Activities

Ongoing Assessment Establishing Priorities Allocating Resources Delegating Tasks



Ongoing Assessment• Validate the relevance of proposed

interventions. • Identify need to change expected outcomes

and interventions.



Establishing Priorities• Problems deemed most important by the

nurse, the client, and family or significant others

• Activities previously scheduled by other departments

• Available resources• Change-of-shift report



Allocating Resources • Determine if any activity that can be

performed independently by the client, with assistance from family, requires assistance of health care personnel.



Delegating Tasks• The RN is empowered to delegate selected

tasks to either licensed or unlicensed nursing personnel.

• The RN remains accountable for appropriate delegation and supervision of care.



Delegating Tasks• Decisions about delegation are guided by

the needs of the client, available personnel, and the nursing management system.

• Nurse practice acts dictate to some extent which tasks can be legally delegated.



Delegating Tasks• The registered nurse is held accountable to

delegate only such care that can safely be done by the other individual.

• The performance must be at the same level of competency and respect for state laws as would be evident in the nurse’s performance.



The registered nurse is responsible for delegating nursing tasks to other members of the health care team.



Types of Management Systems• Functional Nursing• Team Nursing• Primary Nursing• Total Client Care and Modular Nursing• Case Management


Types of Management Systems

Functional Nursing• Divides care into tasks.• Each staff member performs an assigned

task for each client.• Allows for more skilled personnel to be used

in areas for which they have special knowledge or skill.

• Can result in fragmented,depersonalized care, leading to omissions in care.



Team Nursing• RN responsible for supervision of the team.• Uses RNs for skilled observations and

interventions and direct care to acutely ill clients.

• Licensed Practical Nurses care for less acute ill.

• Cost-effective.• Provides more individualized care.



Primary Nursing• Primary nurse maintains full responsibility for

total client care for a small number of clients 24 hours a day.

• Continuity of care is inherent in the system.• Most effective with a total staff of RNs.



Total Client Care and Modular Nursing• A unit manager coordinates activities on the

unit.• Uses both registered nurses and licensed

practical nurses. • Responsibility for care changes from shift to

shift.• Ensures continuity of care.



Case Management• RN assumes responsibility for planning,

implementing, coordinating, and evaluating care for a given client.

• Often used when care is complex.• Development of a critical pathway.• Continuity of care and collaboration are

enhanced.


Nursing Interventions

Interventions must conform to standards of care.

The rationale for all interventions is based on scientific principles.

Nursing interventions are a blend of art (intuitive actions) and science (rational acts).


Types of Nursing Interventions

Standing Order• Standardized intervention• Written, approved, and signed by a health

care practitioner

Protocol• A series of standing orders to be followed

under specific conditions


Nursing Interventions Classification (NIC)

Standardized language system that describes nursing interventions performed in all practice settings

Offers standardized language for research on nursing interventions

Promising tool for determining reimbursement for nursing services


Nursing Intervention Activities

Activities of Daily Living (ADLs) Therapeutic Interventions Monitoring and Surveillance Client Education Discharge Planning Supervision and Coordination of

Personnel



Activities of Daily Living (ADLs) • Assistance with bathing, grooming,

ambulating, eating, and eliminating.• Ongoing assessment determines the

balance between ensuring safety and promoting independence.



A home health nurse assesses a client by gathering data while communicating with a client.



Therapeutic Interventions• Administration of medications and

treatments• Performance of skilled procedures• Provision of physical and psychological

comfort• Reassessment of the client



Monitoring and Surveillance• Vital signs• Cardiac monitoring• Recording of intake and output



Client Education • Therapeutic and side effects of medications• Self-monitoring of responses to care plan• Insight into the client’s knowledge base and

readiness to learn



Discharge Planning• Begins at time of admission• Consulting with other agencies for follow-up• Ensuring that teaching and other

interventions have been implemented before discharge



Supervision and Coordination of Personnel • Coordinates client activities among various

health care providers.• Ensures that standards of care are followed.• Scope varies with the management style

and type of facility.



Evaluating Interventions• The Nursing Intervention Classification (NIC)

links nursing activities to client outcomes.• The Nursing Outcomes Classification (NOC)

provides a common language for measuring client responses to nursing interventions.



Documentation of Interventions• Responsible for both written documentation

of the implementation process and verbal communication with other care providers.

• All communication must be objective, descriptive, and complete.


Documentation of Interventions

Communication between nurses generally occurs at the change of shift.


Documentation of Interventions

Verbal reports should include:• Activities completed and those remaining to

be completed• Status of current relevant problems• Any abnormalities or changes in assessment• Results of treatments• Diagnostic tests scheduled, or those

completed with the results

implementation chapter 14. 14-2 copyright 2004 by delmar learning, a division of thomson learning,...

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