1. CH 14 Implementing CH 15 Evaluating

2. Implementing

3. 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

4. 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)

5. 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…

6. 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

7. 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

8. 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

9. 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.

10. 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.

11. 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

12. 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

13. 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.

14. 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.

15. 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).

16. Evaluating

17. 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.

18. 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.”

19. 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

20. 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.