ImplementationDeblina Roy M.Sc Nursing 1st YearK.G.M.U. Institute of Nursing

INTRODUCTION• Implementation, the fourth step of the nursing process,

formally begins after the nurse develops a plan of care. With a care plan based on clear and relevant nursing diagnoses.

Nursing Intervention

• A nursing intervention is any treatment based on clinical judgment and knowledge that a nurse performs to enhance patient outcomes (Bulechek et al., 2008).

• Ideally the interventions a nurse uses are evidenced based ,providing the most current, up-to-date, and effective approaches for managing patient problems. Interventions include direct and indirect care measures aimed at individuals, families, and/or the community.

TYPES OF INTERVENTION

•Direct care •Indirect care.

Domains of Nursing practice• The Helping Role• The Teaching-Coaching Function • The Diagnostic and Patient-Monitoring

Function • Effective Management of Rapidly Changing

Situations • Administering and Monitoring Therapeutic

Interventions and Regimens• Monitoring and Ensuring the

Quality of Health Care Practices • Organizational and Work-Role

Competencies

CRITICAL THINKING IN IMPLEMENTATION • Before implementing a planned intervention, use critical

thinking to confirm whether the intervention is correct and still appropriate for the patient’s clinical situation

• you have to exercise good judgment and decision making before actually delivering each intervention

• Review the set of all possible nursing interventions for the patient’s problem

• Review all possible consequences associated with each possible nursing action

• of all possible conditions determine the probability sequences

STANDARD NURSING INTERVENTIONS

•Clinical Practice Guidelines and Protocols.

•Standing Orders

Purposes of implementation

1.Standardization of the nomenclature (e.g.,labeling, describing) of nursing interventions; standardizes the language nurses use to describe sets of actions in delivering patient care

2.Expanding nursing knowledge about connections among nursing diagnoses,

treatments, and outcomes;connections determined through the study of actual patient care using adatabase that the classificationgenerates

3.Developing nursing and healthcare information systems 4.Teaching decision making to nursing students; defining and classifying nursing interventions to teach beginning nurses how to determine a patient’s need for care and torespond appropriately

5.Determining the cost of services provided by nurses

6.Planning for resources needed in all types of nursing practice settings

7.Language to communicate the unique functions of nursing

8.Link with the classification systems of other health care providers

Process of Implementation

• Reassessing the Patient • Reviewing and Revising the Existing

Nursing Care Plan • Organizing Resources and Care

Delivery • Anticipating and Preventing

Complications • Identifying Areas of Assistance. • Implementation Skills

Implementation

•Cognitive Skills• Interpersonal Skills•Psychomotor Skills

DIRECT CARE • Activities of Daily Living • Instrumental Activities of Daily Living • Physical Care Techniques• Lifesaving Measures • Counseling• Teaching• Controlling for Adverse Reactions • Preventive Measures

INDIRECT CARE

•Communicating Nursing Interventions•Delegating, Supervising, and

Evaluating the Work of Other Staff Members

ACHIEVING PATIENT GOALS

• Regardless of the type of interventions, you implement nursing care to achieve patient goals and outcomes. In most clinical situations multiple interventions are necessary to achieve select outcomes.• Another way to achieve patient goals is to help

them adhere to their treatment plan

Key Points• Implementation is the fourth step of the nursing process in

which nurses initiate interventions that are designed to achieve the goals and expected outcomes of the patient’s plan of care.

• A direct-care intervention is a treatment performed through interactions with a patient that can include nurse-initiated, physician-initiated, and collaborative approaches.

• Always think first and determine if an intervention is correct and appropriate and if you have the resources needed to implement it.

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• Clinical guidelines or protocols are evidence-based documents that guide decisions and interventions for specific health care problems.

• When preparing to perform an intervention, reassess the patient, review and revise the existing nursing care plan, organize resources and care delivery approaches, anticipate and prevent complications, and implement the intervention.

• The implementation of nursing care often requires additional knowledge, nursing skills, and personnel resources.

• Before beginning to perform interventions, make sure that the patient is as physically and psychologically comfortable as possible.

• Use good judgment and sound clinical decision making when performing any intervention to ensure that no nursing action is automatic.

• To anticipate and prevent complications, identify risks to the patient, adapt interventions to the situation, evaluate the relative benefit of a treatment versus the risk, and initiate risk prevention measures.

• Methods used to ensure that you administer physical care techniques appropriately include protecting you and the patient from injury, using proper infection control practices, staying organized, and following applicable practice guidelines.

• When you delegate aspects of a patient’s care, you are responsible for ensuring that each task is assigned appropriately and completed according to the standard of care.

• To complete any nursing procedure, you need to know the procedure, its frequency, the steps, and the expected outcomes.

Example• Assessed the sign and symptoms of dehydration.• Assessed the vital signs• Hand washing is done • Knowledge and explanation is given before and after every procedure.• Provided oral fluids • Provided ORS• Provided the IV Fluids • Intake output chart is maintained • Monitored the urine output .• Monitored the bowel pattern• Provided anti emetic medications according to the Doctor’s order .• Provided antidiarrheal according to the Doctor’s order• Sent the stool for RE• Explained the patient and the family members about the present condition .

Thank You