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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.
14-3Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Requirements For Effective Implementation
Cognitive Skills Psychomotor Skills Interpersonal Skills
14-4Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Cognitive Skills
Making appropriate observations Understanding the rationale for activities
performed Appreciating the differences among
clients
14-5Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Cognitive Skills
Critical thinking is an important element within the cognitive domain.• Analyze data.• Organize observations.• Transfer previously learned knowledge to
current situations.
14-6Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Psychomotor Skills
Safe and effective performance of nursing activities requires:• Handling technical equipment• Medication administration• Meeting mobility needs of the client
14-7Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Interpersonal Skills
Effective communication with clients, families, and other health care personnel
14-8Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Implementation Activities
Ongoing Assessment Establishing Priorities Allocating Resources Delegating Tasks
14-9Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Implementation Activities
Ongoing Assessment• Validate the relevance of proposed
interventions. • Identify need to change expected outcomes
and interventions.
14-10Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Implementation Activities
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
14-11Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Implementation Activities
Allocating Resources • Determine if any activity that can be
performed independently by the client, with assistance from family, requires assistance of health care personnel.
14-12Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Implementation Activities
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.
14-13Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Implementation Activities
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.
14-14Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Implementation Activities
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.
14-15Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Implementation Activities
The registered nurse is responsible for delegating nursing tasks to other members of the health care team.
14-16Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Implementation Activities
Types of Management Systems• Functional Nursing• Team Nursing• Primary Nursing• Total Client Care and Modular Nursing• Case Management
14-17Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
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.
14-18Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Types of Management Systems
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.
14-19Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Types of Management Systems
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.
14-20Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Types of Management Systems
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.
14-21Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Types of Management Systems
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.
14-22Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
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).
14-23Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
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
14-24Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
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
14-25Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Nursing Intervention Activities
Activities of Daily Living (ADLs) Therapeutic Interventions Monitoring and Surveillance Client Education Discharge Planning Supervision and Coordination of
Personnel
14-26Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Nursing Intervention Activities
Activities of Daily Living (ADLs) • Assistance with bathing, grooming,
ambulating, eating, and eliminating.• Ongoing assessment determines the
balance between ensuring safety and promoting independence.
14-27Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Nursing Intervention Activities
A home health nurse assesses a client by gathering data while communicating with a client.
14-28Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Nursing Intervention Activities
Therapeutic Interventions• Administration of medications and
treatments• Performance of skilled procedures• Provision of physical and psychological
comfort• Reassessment of the client
14-29Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Nursing Intervention Activities
Monitoring and Surveillance• Vital signs• Cardiac monitoring• Recording of intake and output
14-30Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Nursing Intervention Activities
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
14-31Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Nursing Intervention Activities
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
14-32Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Nursing Intervention Activities
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.
14-33Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Implementation Activities
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.
14-34Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Implementation Activities
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.
14-35Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Documentation of Interventions
Communication between nurses generally occurs at the change of shift.
14-36Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
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