Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc. Chapter 19 Implementing Nursing Care

2Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc. Nursing Intervention  A nursing intervention is any treatment based on clinical judgment and knowledge that a nurse performs to enhance patient outcomes.  Interventions include direct and indirect care measures aimed at individuals, families, and/or the community.

3Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc. Case Study  Miranda is a nursing student who is assigned to Mr. Bagley. Mr. Bagley is a 52 y/o Asian male admitted to the medical-surgical unit for management of tuberculosis. Mr. Bagley travels internationally because of his executive position with a global company and most likely contracted tuberculosis during his travels.  Mr. Bagley’s current symptoms are shortness of breath, night sweats, muscle pain, fatigue, and a productive cough. Miranda reviews Mr. Bagley’s plan of care to determine which interventions are to be implemented first.

4Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc. Critical Thinking in Implementation  Review the set of all possible nursing interventions.  Review all possible consequences associated with each possible nursing action.  Determine the probability of all possible consequences.  Make a judgment of the value of that consequence to the patient.

5Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc. Standard Nursing Interventions  Clinical practice guidelines and protocols  Standing orders  NIC interventions  ANA Standards of Professional Practice

6Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc. Protocols and Standing Orders Guidelines and ProtocolsStanding Orders Systematically developed set of statements that helps nurses, physicians, and other health care providers make decisions about appropriate health care for specific clinical situations A preprinted document containing orders for the conduct of routine therapies, monitoring guidelines, and/or diagnostic procedures for specific patients with identified clinical problems

7Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc. Implementation Process Reassessing the patient Reviewing and revising the existing nursing care plan Organizing resources and care delivery Anticipating and preventing complications

8Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc. Anticipate and Prevent Complications  Identify risks to the patient.  Adapt interventions to the situation.  Evaluate the relative benefit of a treatment vs. the risk.  Initiate risk prevention measures.

9Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc. Modification of an Existing Written Care Plan  Revise data assessment.  Revise the nursing diagnoses.  Revise specific interventions.  Determine how to evaluate whether you have achieved outcomes.

10Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc. Quick Quiz! 1.Nurse-initiated interventions are A. Determined by state Nurse Practice Acts. B. Supervised by the entire health care team. C. Made in concert with the plan of care initiated by the physician. D. Developed after interventions for the recent medical diagnoses are evaluated.

11Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc. Implementation Skills  Cognitive skills  Application of critical thinking in the nursing process  Interpersonal skills  Developing a trusting relationship, expressing a level of caring, and communicating clearly with a patient and his or her family  Psychomotor skills  Integration of cognitive and motor activities

12Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc. Direct Care vs. Indirect Care Direct CareIndirect Care Treatments performed through interactions with patients Examples: -Medication administration -Insertion of an intravenous (IV) infusion -Counseling during a time of grief Treatments performed away from the patient but on behalf of the patient or group of patients -Managing the patient’s environment (e.g., safety and infection control) -Documentation -Interdisciplinary collaboration

13Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc. Case Study (cont’d)  Miranda searches the hospital’s database for additional information on tuberculosis.  True or False: A clinical practice guideline is a collection of institutional policies that assist nurses, physicians, and other health care providers in making decisions about appropriate health care for specific clinical situations, such as the management of tuberculosis.

14Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc. Direct Care

15Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc. Direct Care (cont’d) Counseling Teaching Controlling for adverse reactions Preventive measures

16Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc. Case Study (cont’d)  Mr. Bagley’s plan of care calls for oxygen therapy to improve his respiratory status.  A preprinted document that contains orders for the conduct of routine therapies, such as oxygen therapy, is referred to as a __________ _____________.

17Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc. Quick Quiz! 2. You are writing a care plan for a newly admitted patient. Which one of these outcome statements is written correctly? A. The patient will eat 80% of all meals. B. The nursing assistant will set the patient up for a bath every day. C. The patient will have improved airway clearance by June 5. D. The patient will identify the need to increase dietary intake of fiber by June 5.

18Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc. Indirect Care  Communicating nursing interventions  Written or oral  Delegating, supervising, and evaluating the work of other health care team members

19Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc. Case Study (cont’d)  Mr. Bagley is placed on Isolation Precautions.  Isolation Precautions as a treatment intervention are an example of which type of care? A. Direct B. Indirect C. Prevention D. Safety

20Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc. Achieving Patient Goals  Nurses implement care to meet patient goals.  At times, multiple interventions may be needed.  Priorities help nurses to anticipate and sequence nursing interventions.  Patient adherence means that patients and families invest time in carrying out required treatments.