Download Implementing

Implementing
Implementation
• nursing actions planned are carried out
• purpose: to assist the patient in achieving
valued health outcomes:
– promote health
– prevent disease and illness
– restore health
– facilitate coping with altered functioning
Advantages of Nursing
Interventions Classifications
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Standardizing nomenclature
Expanding nursing knowledge
Developing information systems
Teaching decision making
Ensuring appropriate reimbursement
Allocating nursing resources
Communicating nursing to non-nurses
Linking nursing content
Aims of NOC Research
• Identify, label, validate, and classify nursingsensitive 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
Types of Nursing Interventions
• Independent nursing actions
– Nurse-initiated interventions
• Protocols
• Standing orders
• Dependent
– Physician-initiated interventions
• Collaborative nursing actions
– Collaborative interventions
Question
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.
Answer
Answer: B. A nurse meets with the collaborative care
team to plan nursing measures for a patient.
Rationale:
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.
Implementing
Question
Tell whether the following statement is true or
false.
A nurse who follows the protocol for taking
vital signs following surgery is performing a
physician-initiated intervention.
A. True
B. False
Answer
Answer: B. False
A nurse who follows the protocol for taking
vital signs following surgery is performing a
nurse-initiated intervention.
Protocols
• written plans that detail the nursing activities
to be executed in specific situations
• routine nursing care
Standing Orders
• empower the nurse to initiate actions that
ordinarily require the order or supervision of a
physician
Implementing the Plan of Care
The nurse should:
1. determine the patient’s new or continuing
need for nursing assistance
2. promote self-care
3. assist the patient to achieve valued health
outcomes
Remember!
• To be sure that each nursing intervention is
supported by a sound scientific rationale, as
demanded by an evidence-based practice
• To 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
• To be sure that the nursing actions are safe for this
particular patient and individualized to his or her
preferences
• To clarify any questionable orders
Implementing the Care Plan
• Organize resources
• Anticipate unexpected outcomes/situations
• Promote self-care: teaching, counseling,
advocacy
• Assist patients to meet health outcomes
Implementing Guidelines
• Act in partnership with the patient/family.
• Reassess the patient and determine whether the
action is still needed
• Approach the patient competently - Know how to
perform the nursing action, why the action is being
performed, and potential adverse responses. Have all
equipment and supplies ready.
Implementing Guidelines
• Approach the patient caringly. Explain the nursing
action using language the patient understands.
Communicate genuine concern for what the patient
is experiencing.
Implementing Guidelines
• 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.
Implementing Guidelines
• Make sure that the nursing interventions selected
are consistent with standards of care and within legal
and ethical guides to practice.
• Always question that the nursing intervention
selected is the best of all possible alternatives.
– colleagues and literature for other possible approaches.
– Evaluate the effectiveness of the intervention selected,
noting any factors that positively or negatively influenced
the outcome.
Implementing Guidelines
• Develop a repertoire of skilled nursing
interventions. The more options one can
choose from, the greater the likelihood of
success.
Delegating Nursing Care
• reduce healthcare cost
• increase in demand for nursing services
Unlicensed Assistive Personnel
• trained to function in an assistive role to the
licensed RN
• supervised by the RN
Delegation
• the transfer of responsibility for the
performance of an activity to another
individual while retaining accountability for
the outcome
Guidelines for Delegating Nursing Care
• Factors to Consider:
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4)
patient’s condition
complexity of the activity
potential for harm
degree of problem-solving and innovation
necessary
Guidelines…cont.
6) level of interaction required with the patient
7) capabilities of the UAP
8) availability of professional staff to accomplish the
unit workload
Essentials of
Effective Delegation
• Know your state and institutional policies on
delegation (the policy and procedure manual is
available on each unit; for state policies, contact the
state nurse association).
• Be clear on the difference between nursing process
and nursing tasks.
Essentials of
Effective Delegation
• Know the training and background of the unlicensed
assistive personnel (UAP). (Administration must have
a standard and process to validate the UAP's
preparation.)
Essentials…cont.
• Know the patient's needs and what he or she 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.
Essentials…cont.
• 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.
5 Rights of Delegation
• Right Task – one that is delegable for a specific
patient
• Right Circumstances – appropriate patient
setting, available resources, and other
relevant factors considered
• Right Person – right person is delegating the
right task to the right person to be performed
on the right person
5 Rights of Delegation
• Right Direction/Communication – clear,
concise, description of the task, including its
objective, limits, and expectations
• Right Supervision – appropriate monitoring,
evaluation, intervention as needed and
feedback
Variables Influencing
Outcome Achievement
• Patient variables
– Developmental stage
– Psychosocial background
• Nurse variables
– Resources
– Current standards of care
– Research findings
– Ethical and legal guides to practice
Question
Which one of the following is an example of 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 at the
ER because a counselor is not available.
Answer
Answer: D. A rape victim does not receive counseling at
the ER because a counselor is not available.
Rationale:
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.
Common Reasons for
Noncompliance
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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
Question
Tell whether the following statement is true or
false.
When a patient fails to cooperate with the
plan of care despite the nurse’s best efforts, it
is time to reassign the patient to another
caretaker.
A. True
B. False
Answer
Answer: B. False
When a patient fails to cooperate with the
plan of care despite the nurse’s best efforts, it
is time to reassess the strategy.
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
Checklist for Organizing Student Clinical
Responsibilities
• Priorities for nursing care and special daily events
• Special teaching, counseling, or advocacy needs
• Special family needs