Chapter 14 Implementing Dr. James Pelletier Swain Department of Nursing The Citadel

Purposes of Implementation Help the patient achieve valued health outcomes. Promote health. Prevent disease and illness. Restore health. Facilitate coping with altered functioning.

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.

Clinical Reasoning and Implementing Reassess the patient for changes in status that might dictate 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 can modify the plan of care if needed. Alfaro’s rule: “assess, reassess, revise, record”

Types of Nursing Interventions Those providing direct and indirect care Those aimed at individuals, family, and community Those for nurse-initiated and other provider-initiated treatments

Implementing

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.

Implementing the Plan of Care Reassessing the patient and reviewing the plan of care Clarifying prerequisite nursing competencies Organizing resources Anticipating unexpected outcomes/situations Preventing errors and omissions Promoting self-care: teaching, counseling, and advocacy Assisting patients to meet outcomes

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.

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

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

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.

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 for the UAP. Evaluate the UAP’s performance and the patient’s response.

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.

Implementing Guidelines (cont.) 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.