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Chapter 15
Implementing
Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins
Advantages of Nursing
Interventions Classifications
• 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
Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins
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
Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins
Outcomes for “Caregiver
Home Readiness”
• Willing to assume caregiving role
• Knowledge about caregiver role
• Demonstration of positive regard for care recipient
• Participation in home care decision
• Confidence in ability to manage care at home
• Knowledge of where to obtain needed equipment
Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins
Types of Nursing Interventions
• Independent nursing actions
– Nurse-initiated interventions
• Protocols
• Standing orders
• Collaborative nursing actions
– Physician-initiated interventions
– Collaborative interventions
Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins
Implementing
Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins
Implementing the Care Plan
• Organize resources
• Anticipate unexpected outcomes/situations
• Promote self-care: teaching, counseling, advocacy
• Assist patients to meet health outcomes
Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins
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
Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins
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
Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins
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
Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins
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.
Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins
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.
Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins
Question
Tell whether the following statement is true or false.
One of the advantages of using Nursing Intervention
Classifications in nursing practice is to ensure appropriate
reimbursement for nursing services.
A. True
B. False
Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins
Answer
Answer: A. True
One of the advantages of using Nursing Intervention
Classifications in nursing practice is to ensure appropriate
reimbursement for nursing services.
Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins
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.
Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins
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.
Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins
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
Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins
Answer
Answer: B. False
A nurse who follows the protocol for taking vital signs
following surgery is performing a nurse-initiated
intervention.
Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins
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
Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins
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.
Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins