Implementation By Patricia M. Dillon Updated Spring 2010 Prof. Unn Hidle.

ImplementationImplementationBy Patricia M. Dillon

Updated Spring

2010

Prof. Unn Hidle

Copyright 2002 by Delmar, a division of ThomsoCopyright 2002 by Delmar, a division of Thomson Learningn Learning

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Review of the Nursing ProcessReview of the Nursing Process

ASSESSMENTASSESSMENT ANALYSISANALYSIS PLANNINGPLANNING IMPLEMENTATIONIMPLEMENTATION EVALUATIONEVALUATION


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ImplementationImplementation

Implementation is the Implementation is the fourth step of the fourth step of the nursing process. It nursing process. It involves the execution involves the execution of the nursing plan of of the nursing plan of care derived during the care derived during the planning phase of the planning phase of the nursing process.nursing process.


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Purposes of ImplementationPurposes of Implementation

Fulfilling client needs which results in Fulfilling client needs which results in health promotion, prevention of illness, health promotion, prevention of illness, illness management, or health restorationillness management, or health restoration

Delegate tasks to staff members and Delegate tasks to staff members and assistive personnelassistive personnel

Document specific activities executed by Document specific activities executed by the nurse and the client’s responses to the nurse and the client’s responses to these activities to maintain these activities to maintain communication among team members.communication among team members.


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Requirements For Requirements For Effective ImplementationEffective Implementation

Cognitive skills Cognitive skills Psychomotor skillsPsychomotor skills Interpersonal skills Interpersonal skills


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Implementation ActivitiesImplementation Activities

Ongoing assessmentOngoing assessment Necessary to validate the Necessary to validate the

relevance of proposed relevance of proposed interventionsinterventions

Allows for adaptations to be Allows for adaptations to be made to better individualize made to better individualize carecare


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PrioritiesPriorities

Establishment of priorities is Establishment of priorities is based onbased on Which problems are deemed Which problems are deemed

most important by the nurse, most important by the nurse, the client, and family or the client, and family or significant otherssignificant others

Activities previously scheduled Activities previously scheduled by other departments by other departments

Available resourcesAvailable resources


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Allocation of resources

Delegation of tasksDelegation of tasks Types of management Types of management

systemssystems Functional nursingFunctional nursing Team nursingTeam nursing Primary nursingPrimary nursing Total patient care nursing Total patient care nursing Case managementCase management


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Initiation of Initiation of nursing nursing interventionsinterventions An action or actions performed An action or actions performed

by the nurse that help the client by the nurse that help the client to achieve the results specified to achieve the results specified by the goals and expected by the goals and expected outcomesoutcomes

Nursing Interventions


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Types of Nursing InterventionsTypes of Nursing Interventions

Independent interventionsIndependent interventions:: Involve carrying out nurse-prescribed orders Involve carrying out nurse-prescribed orders

written on the nursing plan of care, and any written on the nursing plan of care, and any other actions that nurses initiate without the other actions that nurses initiate without the direction and supervision of another health direction and supervision of another health care professional. These actions are the care professional. These actions are the result of their assessment of patient needs.result of their assessment of patient needs.

Dependent interventionsDependent interventions:: Involve carrying out physician-prescribed Involve carrying out physician-prescribed

orders. orders. Nurses are accountable for the dependent Nurses are accountable for the dependent

orders they implement and are thus orders they implement and are thus responsible for the clarification of any responsible for the clarification of any questionable order.questionable order.

Collaborative (interdependent) interventionsCollaborative (interdependent) interventions:: Those performed jointly by nurses and other Those performed jointly by nurses and other

members of the healthcare team.members of the healthcare team.


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Protocols and Standing OrdersProtocols and Standing Orders

ProtocolsProtocols: : Written plans that detail the nursing Written plans that detail the nursing

activities to be executed in specific activities to be executed in specific situations.situations.

Standing ordersStanding orders: : Empower the nurse to initiate actions Empower the nurse to initiate actions

that ordinarily require the order or that ordinarily require the order or supervision of a physician. supervision of a physician.

These orders are typically seen in These orders are typically seen in critical care and emergency situations critical care and emergency situations where the nurse must act quickly to save where the nurse must act quickly to save a life.a life.


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Coordination of CareCoordination of Care Carrying Out the Plan of Care Utilizing Carrying Out the Plan of Care Utilizing

therapeutic interventionstherapeutic interventions Determining the need for assistanceDetermining the need for assistance Delegation of care (supervision)Delegation of care (supervision) Responsibility and AccountabilityResponsibility and Accountability Promoting self care (teaching & discharge Promoting self care (teaching & discharge

planning) planning) Communication (verbal & written)Communication (verbal & written)

Monitoring and surveillance of response to care Monitoring and surveillance of response to care (evaluation)(evaluation)

Nursing intervention activities


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Nurse as CoordinatorNurse as Coordinator

One of nursing's major contributions to the One of nursing's major contributions to the healthcare team is that of healthcare team is that of coordinatorcoordinator. Care can . Care can easily become fragmented when patients are seen easily become fragmented when patients are seen by numerous people. by numerous people.

Patients may complain that no one really knows Patients may complain that no one really knows them and can talk with them about what is going them and can talk with them about what is going on with them. Also, the orders of different on with them. Also, the orders of different specialists may conflict with one another and be specialists may conflict with one another and be counterproductive. counterproductive.

Therefore, it is important for nurses to make Therefore, it is important for nurses to make rounds with other healthcare professionals and to rounds with other healthcare professionals and to read the results of consultations that patients read the results of consultations that patients have had with various members of the healthcare have had with various members of the healthcare team. team.

The nurse is in an ideal position to serve as liason The nurse is in an ideal position to serve as liason between the patient and members of the between the patient and members of the healthcare team.healthcare team.


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Determining the Need Determining the Need for Assistancefor Assistance

Although most people are capable of independently Although most people are capable of independently meeting basic human needs, illness and the stress meeting basic human needs, illness and the stress of diagnostic and therapeutic measures may of diagnostic and therapeutic measures may interfere with a person's usual practice of self-care. interfere with a person's usual practice of self-care. A careful nursing assessment of the A careful nursing assessment of the patient’s patient’s abilities to independently meet human needs is abilities to independently meet human needs is indicatedindicated. .

Nursing has often failed patients by doing too much Nursing has often failed patients by doing too much for them and by encouraging negative, sick role for them and by encouraging negative, sick role behaviors.behaviors.

Conversely, there is a time and a place for the Conversely, there is a time and a place for the "tender loving care" that says to a patient "tender loving care" that says to a patient "I know "I know you may be able to do this for yourself, but just this you may be able to do this for yourself, but just this once, how about if I do it and we'll talkonce, how about if I do it and we'll talk".".


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Delegating Nursing CareDelegating Nursing Care

Delegation is the transfer of responsibility for Delegation is the transfer of responsibility for the performance of an activity from one the performance of an activity from one individual to another individual to another while still retaining while still retaining accountability for the outcomeaccountability for the outcome..

With current pressure to reduce healthcare With current pressure to reduce healthcare costs, many employers are increasing their costs, many employers are increasing their utilization of utilization of unlicensed assistiveunlicensed assistive personnel personnel (UAP), or "nurse extenders". Delegated care (UAP), or "nurse extenders". Delegated care can range from taking vital signs (temperature, can range from taking vital signs (temperature, pulse, respiration, blood pressure) to simple pulse, respiration, blood pressure) to simple assessments to a variety of skills and assessments to a variety of skills and procedures. Never has it been more important procedures. Never has it been more important for nurses to critically identify which nursing for nurses to critically identify which nursing interventions require professional nurses and interventions require professional nurses and which can be safely delegated.which can be safely delegated.


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Before delegating any nursing service, a Before delegating any nursing service, a

number of factors should be considered:number of factors should be considered:

Patient's condition (if the patient is in critical or unstable Patient's condition (if the patient is in critical or unstable condition, it may be best for the nurse to carry out the condition, it may be best for the nurse to carry out the care).care).

Complexity of the activity (more difficult tasks should be Complexity of the activity (more difficult tasks should be performed by professional staff)performed by professional staff)

Capabilities of the UAP (when you work with unlicensed Capabilities of the UAP (when you work with unlicensed personnel on a regular basis you become familiar with personnel on a regular basis you become familiar with their abilities and sense of responsibility. You should their abilities and sense of responsibility. You should not delegate care when you are uncertain about the not delegate care when you are uncertain about the UAP’s abilities).UAP’s abilities).

Availability of professional staff to accomplish the work Availability of professional staff to accomplish the work (never delegate care so that you can take a break or ‘take (never delegate care so that you can take a break or ‘take it easy’. If there is professional staff available, the work it easy’. If there is professional staff available, the work should be done by the licensed personnel).should be done by the licensed personnel).


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Responsibility & AccountabilityResponsibility & Accountability

It is the RN who is responsible It is the RN who is responsible and accountable for nursing and accountable for nursing practice. Assistive personnel practice. Assistive personnel should work in a should work in a supportivesupportive role role to the RN and together they will to the RN and together they will deliver safe, effective care to deliver safe, effective care to patients. patients.


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Written CommunicationWritten Communication

Documentation of InterventionsDocumentation of Interventions

The nurse is legally required to The nurse is legally required to record all interventions and record all interventions and observations related to the client’s observations related to the client’s response to treatment in the response to treatment in the patient’s medical record.patient’s medical record.

The recording of information can The recording of information can be in the form of checklists, flow be in the form of checklists, flow sheets, or narrative summaries.sheets, or narrative summaries.


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LegalitiesLegalities

The rule of thumb in healthcare is:The rule of thumb in healthcare is: "If you didn't chart it, you didn't do it.""If you didn't chart it, you didn't do it." In legal situations it is extremely important In legal situations it is extremely important

for all of your nursing actions to be for all of your nursing actions to be accurately and completely recorded. accurately and completely recorded.

Most facilities have flow sheets for Most facilities have flow sheets for simplifying some of the routine measuressimplifying some of the routine measures

Each facility has policies for what will Each facility has policies for what will be charted, when, and where.be charted, when, and where. Charting (documentation) can be Charting (documentation) can be focused focused

notenote, , narrativesnarratives, , SOAPSOAP, , SOAPIE,SOAPIE, or other or other as determined by the agency.as determined by the agency.

More and more charthing is now done More and more charthing is now done electronicallyelectronically..


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Verbal interaction among health care Verbal interaction among health care providers is essential for providers is essential for communicating current information.communicating current information.

Formal reports are given between Formal reports are given between shifts; informal reports are given shifts; informal reports are given constantly to other nurses, members constantly to other nurses, members of the healthcare team, doctors, of the healthcare team, doctors, families (i.e. breaktimes). families (i.e. breaktimes).

Oral Communication


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Basic patient identification information (age, sex, diagnosis)Basic patient identification information (age, sex, diagnosis)

Status of current relevant problemsStatus of current relevant problems

Any abnormalities or changes in assessmentAny abnormalities or changes in assessment

Results of treatmentsResults of treatments

Diagnostic tests scheduled, or those completed with the Diagnostic tests scheduled, or those completed with the resultsresults

Needed activities completed and those remaining to be Needed activities completed and those remaining to be completedcompleted

What should be included in verbal reports?


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SUMMARYSUMMARY

IMPLEMTATION INCLUDES:IMPLEMTATION INCLUDES: Execution of the nursing plan of care Execution of the nursing plan of care

(Interventions/nursing actions)(Interventions/nursing actions)

Fulfilling client needs which results in health Fulfilling client needs which results in health assessment, promotion, prevention of illness, assessment, promotion, prevention of illness, illness management, or health restorationillness management, or health restoration

Delegate tasks as necessaryDelegate tasks as necessary

Teaching, encouraging self care activitiesTeaching, encouraging self care activities

Proper communication & documentationProper communication & documentation

Monitoring clients response to nursing actionsMonitoring clients response to nursing actions

THE ENDTHE END

Implementation By Patricia M. Dillon Updated Spring 2010 Prof. Unn Hidle.

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Transcript of Implementation By Patricia M. Dillon Updated Spring 2010 Prof. Unn Hidle.