4 - Nursing Process Part 2/Implementation and evaluation (SLOs 8-15)

What are the 3 parts of a nursing diagnosis?

1. Diagnostic label 2. Related to 3. Defining characteristics

SLO #9 Explain what occurs in the implementation step of the nursing process. What are the two steps?

1. identifying the best interventions for the patient 2. implementation of these interventions

SLO #13 Differentiate between a nursing care plan and a concept map - Difference between nursing care plan and a concept map?

Concept maps are a WAY of visually presenting the nursing care plan that can also be used for other purposes

Writing an evaluation - What should it include?

Evaluation statement should include: - Date, time of evaluation - Whether goal was MET, PARTIALLY met, NOT met - Supporting statement, giving results of how patient did/did not achieve goal - Recommendation (terminate, change, continue)

SLO #8 Differentiate between the following types of nursing interventions: Dependent/Independent/Collaborative Independent

- Activities that nurses are licensed to do/initiate within their scope of practice based on their sound judgement/skills - Examples: > Ambulating > Anything that can be done without an order > Physical care > Ongoing assessment > Emotional support and comfort > Teaching > Counseling > making referrals to other healthcare professionals

SLO #12 Describe how evaluation leads to discontinuation, revision or modification of a plan of care. - Modifying the evaluation

- Based on the evaluation statement, what changes need to be made? - Assess whether nursing diagnoses were relevant, accurate, supported by data? - Revise patient goals if goals were unrealistic, if priorities have changed, or if time frame was insufficient - Revise or write new nursing diagnosis Consider: - Selecting new nursing interventions > May not have been best to achieve goal > New ones may reflect changes in amount of care needed - Methods of implementation > May have interfered with goal achievement > May not have been carried out properly

SLO #8 Write a correctly stated nursing intervention/rationale - What are some tips for writing a nursing intervention?

- Begin with an action verb - One action per intervention - Should have qualifiers of HOW, WHEN, WHERE,TIME,FREQUENCY, AMOUNT - Patient-centered, specific, concise - Realistic, relevant - Should provide rationale

SLO #12 Describe how evaluation leads to discontinuation, revision or modification of a plan of care. - Developing an evaluation

- Collect objective and subjective data - If goal was written properly, you should be able to determine whether it was met - Once you know if goal was met, one of three possible conclusions possible: > Goal met: Patient response same as desired outcome > Goal partially met: such as short-term goal achieved, but long-term goal not achieved or desired outcome only partially achieved > Goal not met: within the time frame

SLO #13 Differentiate between a nursing care plan and a concept map - What is a nursing care plan/plan of care?

> ADPIE > written/electronic guidelines that organizes ino about an individual's or family's care > Begins on admission > Reassessed every shift and updated throughout stay (in response to changes in conditions or goal achievements) > The nursing process in ACTION > Basically: A write up that requires a nurse to apply each step of the nursing process in an individualized way

SLO #13 Differentiate between a nursing care plan and a concept map - What are the guidelines for a concept map?

> Follow sequence of nursing process phases > Simple > Creativity to individualize > Do not get caught up in artistic

When goals have been partially met or not mat then the nurse should:

> Relook at the entire care plan including GOAL (planning) and INTERVENTION (implementation) > Revise all or parts of the plan of care **Do not revise if patient just needs more time

SLO #13 Differentiate between a nursing care plan and a concept map - Why should nurses use care plan? Purpose?

> To communicate what needs to be done with/for the client > Provides: - Continuity of care through comm with all providers involved - Informs nurse about which specific observations and actions need to be documented - Documentation for insurance - Guide when assigning staff to care for patient

What is evaluation?

A planned, ongoing, purposeful activity in which the client's progress towards the achievement of goals or desired outcomes, and the effectiveness of the nursing care plan/plan of care. - collect data related to outcomes - compare data with outcomes - relate nursing actions to patient goals/outcomes - draw conclusions about problem status - continue, modify, or terminate the patient's care plan

SLO #8 Differentiate between the following types of nursing interventions: Dependent/Independent/Collaborative Dependent

Activities carried out under the physician's orders/supervision or protocols

SLO #8 Write a correctly stated nursing intervention/rationale - What is a rationale? How do you add this to intervention?

Also known as a scientific explanation (underlying reasons for which the nursing intervention was chosen for the NCP) - Must include the reference resource - Evidence-based

SLO #11 Explain how evaluation relates to each of the other four steps in the nursing process. - Why it is important

An important aspect of the nursing process because: - Conclusions drawn from this step determining whether the nursing intervention (implementation) should be terminated, continued, or changed - Includes evaluating the entire plane of care

SLO #8 Differentiate between the following types of nursing interventions: Dependent/Independent/Collaborative

Are actions that the nurse carries out in collaboration with other health team members such as physicians, NP/PAs, social workers, dietitians, and therapists

Writing an evaluation - Example?

Goal: patient will have a clear airway and O2 sat above 92% by discharge Interventions: - Auscultate breath sound every four hours and PRN - Monitor O2 sat levels every four hours and PRN - Encourage patient to use incentive spirometer 10 times per hour while awake Evaluation statements: - 12/25 1430: Goal met. Auscultated clear lungs sounds and O2 sat 95% on RA. Plan of care, problem resolved and patient to be discharged today. - 12/25 1430: Goal partially met. Auscultated occasional wheezed in bilateral upper airways with O2 sat on 95% on RA. Continue with plan of care more time needed to achieve goal. - 12/25 1430: Goal not met. Auscultated wheezes in bilateral upper airways and O2 desaturation while ambulating. Patient not using incentive spirometer 10 times per hour. Continue with plan of care with some changes to the nursing interventions.

SLO #8 Write a correctly stated nursing intervention/rationale - Example of nursing interventions with correlating rationale

Goals: Client will maintain a blood glucose reading above 70 mg/dL and less than 180 mg/dL before meals - Nursing intervention: Monitor blood glucose levels prior to meals and at bedtime - Rationale: Blood glucose is checked prior to meals and bedtime for bolus insulin coverage. Data to support hyper, or hypoglycemia.

SLO #10 Explain the types of indirect care measures that nurses carry out during the implementation step of the nursing process citing specific examples.

Intervention performed away from, on behalf of the patient Example: - Delegating tasks to the NAI/UA - Calling the doctor - Charting

SLO #10 Explain the types of direct care measures that nurses carry out during the implementation step of the nursing process citing specific examples.

Intervention performed through interacting with the patient Examples: - ROM - Bathing - Medication administration

SLO #13 Differentiate between a nursing care plan and a concept map - Describe a concept map

Patterned Diagram which represents the connection b/n a clients actual and perceived health problems. > Visual way to organize thoughts and make connections between ideas > Visual representation of nursing plan of care but can be applied for other purposes as well (like for studying) > Enhances clinical reasoning by "showing" how phases of nursing process relate to each other > Can take many different forms > Helps view patient and problems holistically > Creates ability to look at entire concept on one page

SLO #15 Using a patient scenario, develop a plan of care to include the following: 1. Subjective and objective data 2. Nursing diagnosis 3. Patient-centered goal 4. Nursing interventions 5. Evaluation

Practice!!!

SLO #12 Describe how evaluation leads to discontinuation, revision or modification of a plan of care. - Drawing conclusions You will need to 1. Draw conclusions 2. Develop an evaluation 3. Modify, discontinue, or continue the plan

The evaluation phase means that the nurse will look at: - Actual problem solved - Potential problems prevented with no risk factors - Risk problems being prevented but risk factors still present - Actual problems still existing even through some part of goal is being met Say: goal met or not met, then why or why not, then the plan for modification.

SLO #9 Explain what occurs in the implementation step of the nursing process.

This is putting the plan into action Nurses take data from the first three phases (assessment/diagnosis/planning) to determine appropriate interventions It is a two-step process 1. identifying the best interventions for the patient 2. implementation of these interventions textbook planning: - reassess the patient - determine the nurses' need for assistance (collab) - implement the nursing interventions - supervise delegated care - document nursing activities

Nursing Interventions:

are used to plan evidence-based interventions to treat or prevent the identified nursing diagnoses 1. Monitor health status & response to treatment 2. Reduce risks 3. Resolve, prevent, or manage a problem 4. Promote independence with ADLs 5. Promote optimum sense of physical, psychological, and spiritual well being 6. Give pts. the information they need to make informed decisions and be independent

•Nursing interventions should be:

•Safe and appropriate for the client's age, health, and condition. •Achievable with the resources and time available. •Incorporate the client's values, culture, and beliefs. •Respect the dignity of the patient, and enhance patient self-esteem •Support prescriptions (orders) and other therapies. •Based on nursing knowledge and experience - Evidence Based. •Within established standards of care determined by state laws, professional associations, facility policies/protocols. •Patient Centered, encourage patient participation