CH 14 Implementing CH 15 Evaluating

Implementing

Advantages of Nursing Interventions Classifications Helps demonstrate the impact that nurses have on the system of healthcare delivery Standardizes and defines the knowledge base for nursing curricula and practice Facilitates appropriate selection of a nursing intervention Facilitates communication of nursing treatments to other nurses and other providers Enables researchers to examine the effectiveness and cost of nursing care Assists educators to develop curricula that better articulate with clinical practice

Advantages of Nursing Interventions Classifications (cont.) Facilitates the teaching of clinical decision making to novice nurses Assists administrators in planning more effectively for staff and equipment needs Promotes the development of a reimbursement system for nursing services Facilitates the development and use of nursing information systems Communicates the nature of nursing to the public (McCloskey Dochterman, & Bulechek, 2008)

Relationship of Implementation to other Phases of the Nursing Process Preceding phases provide the basis for implementation Implementation informs evaluation, the final phase Implementation is individualized through the assessment Some interventions are assessments It’s all intertwined and the process flows…

Implementing Skills Cognitive skills Interpersonal skills Critical thinking Interpersonal skills Therapeutic communication techniques Professional interpersonal skills Self-awareness and sensitivity Technical skills Practice makes perfect

Process of Implementing Reassess the client Determine need for assistance Implementing or supervising delegated care Explain to patient, ensure privacy, coordinate care Document/communicate the nursing activities and the patient’s response

Delegation as part of Implementation Legal authority to delegate given by Nurse Practice Act UAP’s/LPN’s RN can never delegate the Nursing Process UAP’s can assist with parts of assessment and implementation Only RN’s can diagnose or plan Student role

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 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.

Essentials of Effective Delegation (cont.) 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 from the UAP. Evaluate the UAP’s performance and the patient’s response.

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

Evaluating Step Allows achievement of outcomes Directs nurse–patient interactions Measures patient outcome achievement Identifies factors to achieve outcomes Modifies the plan of care, if necessary

Evaluating Outcomes Evaluation data depends on the type of outcome identified Types of outcomes: Cognitive Psychomotor Affective Physiologic Making VERY SPECIFIC goals/outcomes makes evaluation easier. Taylor, p. 309, gives examples to explain this.

Question Which one of the following examples is a psychomotor outcome? A. A patient learns how to control his weight using the MyPyramid Food Guide. B. A patient is able to test for glucose levels and inject insulin as needed. C. A patient values his health enough to decide to quit smoking. D. A patient is able to ambulate the hallway following knee surgery.

Answer Answer: B. A patient is able to test for glucose levels and inject insulin as needed. Rationale: Psychomotor outcomes involve the patient’s achievement of a new skill, such as controlling diabetes. Cognitive outcomes involve an increase in patient knowledge (Answer A). Affective outcomes pertain to changes in patient values (Answer C). Physiologic outcomes target physical changes in the patient (Answer D).

Evaluating

Documenting Outcomes include timeframe and evaluation must be done to meet that criteria Outcomes are stated in evaluation: Outcome (or goal) met Outcome partially met Outcome not met Then support your judgment! Important to include narrative about interventions and patient response.

Modifying the Plan of Care Must be done when goal not met or partially met. Possible revisions include: Change the diagnosis Make the outcome more realistic or fine-tune it Adjust the time frame Add or subtract interventions In some situations, when goal is met, plan must be modified If goal was “walk to the BR X 2,” tomorrow the goal might be “Ambulate in the hall.”

Evaluation of care on an institutional level Performance improvement Discover a problem Plan a strategy Implement a change Evaluate the outcome Peer review Quality assurance programs Nursing audits Patient satisfaction surveys

Workbook application exercises Complete quizzes (handouts) by using your text to look up answers prn. Please work in groups of 2-3 to answer the following—without looking in the back of the book until you are done! CH 15—Implementing Matching, p.80 Correct the false statements, p.81 CH 16—Evaluating Criteria-Standard Matching p.86-87 Short answer, # 1 and #6 only.