Implementing

Implementing guidelines

Act in partnership with the patient/family. Before implementing, reassess the patient to determine whether the action is still needed. Approach the patient competently. Approach the patient caringly. Modify nursing interventions according to the patient's (1) developmental and psychosocial background, (2) ability and willingness to participate in the plan of care, and (3) responses to previous nursing measures and progress toward goal/outcome achievement. Check to make sure that the nursing interventions selected are consistent with standards of care. Always question that the nursing intervention selected is the best of all possible alternatives. Develop a repertoire of skilled nursing interventions. The more options one can choose from, the greater the likelihood of success.

Which one of the following nursing interventions is an indirect care intervention? A. A nurse explains available birth control measures to a young couple. B. A nurse meets with the collaborative care team to plan nursing measures for a patient. C. A nurse prays with a patient prior to surgery. D. A nurse administers pain medication to a patient with end-stage renal cancer.

B. A nurse meets with the collaborative care team to plan nursing measures for a patient. An indirect care intervention is treatment performed away from the patient but on behalf of a patient or group of patients, such as the example in answer B, consulting with the collaborative care team. The remaining answer options are direct care interventions or treatment performed through interaction with the patient.

Reassessing the patient and reviewing the plan of care

Be sure that each nursing intervention is supported by a sound scientific rationale, as demanded by an evidence-based practice. Be sure that each nursing intervention is consistent with professional standards of care and consistent with the protocols, policies, and procedures of the institution or agency. Be sure that the nursing actions are safe for this particular patient and individualized to the patient's preferences. Clarify any questionable orders.

Which example illustrates a nurse variable influencing patient outcomes? A. A patient in a nursing home refuses to take his medications. B. A low-income family is unable to afford formula for their newborn infant. C. An alcoholic patient is unwilling to participate in AA meetings. D. A rape victim does not receive counseling in the emergency department because a counselor is not available.

D. A rape victim does not receive counseling in the emergency department because a counselor is not available. Nurse variables that influence the plan of care include resources (answer D), current standards of care, research findings, and ethical and legal guides to practice. The remaining answer options are patient variables, which include the patient's changing ability and willingness to participate in the plan of care and personal responses to the nursing interventions implemented.

Implementing the care plan

Determine the patient's new or continuing need for assistance Promote self-care Assist the patient to achieve valued health outcomes Reassessing the patient and reviewing the plan of care Clarifying prerequisite nursing competencies; need blending intellectual, interpersonal, technical and ethical/legal competencies Organizing resources; patient and visitors- make sure they are physically and psychological prepared; equipment- anticipate all equipment you'll need; environment; personnel- can you carry out plan of care alone or do you need assistance Anticipating unexpected outcomes/situations Preventing errors and omissions Promoting self care- teaching, counseling and advocacy Assisting patients to meet outcomes

Aims of NOC research

Identify, label, validate and classify nursing-sensitive patient outcomes and indicators Evaluate the validity and usefulness of the classification in clinical field testing Define and test measurement procedures for the outcomes and indicators

Essentials of effective delegation

Know your state and institutional policies on delegation. Be clear on the difference between nursing process and nursing tasks. Know the training and background of the unlicensed assistive personnel. Know the patient's needs and what the patient is at risk for. Know what clinical cues the UAP should be alert for and why. Assess which tasks can be safely delegated. Have the UAP repeat your instructions to be sure you have communicated them clearly. Make frequent walking rounds to assess patients. When talking with the patient, members of the patient's family, or UAPs, listen for cues that indicate changes in the patient's condition. Take frequent mini-reports for the UAP. Evaluate the UAP's performance and the patient's response.

Common reasons for noncompliance

Lack of family support Lack of understanding about the benefits Low value attached to outcomes Adverse physical or emotional effects of treatment Inability to afford treatment Limited access to treatment

Checklist for organizing student clinical responsibilities

Patient profile and name by which patient is addressed Patient's chief complaint and reason for admission Patient's current health status Routine assistance to meet basic human needs Priorities for nursing care and special daily events Special teaching, counseling, or advocacy needs Special family needs

Variables influencing outcome achievement

Patient variables Developmental stage Psychosocial background- consider and respect the patients socioeconomic background and culture Nurse variables Resources- adequate staff, equipment and supplies Current standards of care Research findings Ethical and legal guides to practice

Clinical reasoning and implementing

Reassess the patient for changes in status tha tight distaste a different set of interventions Be sure that research supports the interventions you have selected and be open to better ways of addressing patient problems and issues Always monitor the patient's responses to your interventions so that you van modify the plan of care if needed Alfaro's rule: assess, reassess, revise, record; assess before performing, reassess to determine response, revise as needed and record response and changes

Purpose of implementation

Step of nursing process actions are planned and carried out Purposes: Help the patient achieve valued health outcomes Promote health Prevent disease and illness Restore health Facilitate coping with altered functioning

Types of nursing interventions

Those providing direct and indirect care; direct care include physiologic and physiosocial nursing actions and include bother actions that are "laying of hands" and supportive; indirect actions aimed at management of patient care environment and interdisciplinary collaboration; supports effectiveness of direct care Those aimed at individuals, family and community; community targeted to promote and preserve health of populations Those for nurse-initiated and other provider-initiated treatments

One of the advantages of using Nursing Intervention Classifications in nursing practice is to ensure appropriate reimbursement for nursing services.

True One of the advantages of using Nursing Intervention Classifications in nursing practice is to ensure appropriate reimbursement for nursing services.