1. Chapter 14
Implementation

2. Purposes of Implementation
The implementation phase of the nursing process begins with assessment and continually interacts with the other steps to reflect the changing needs of the client and the response of the nurse to those needs.
Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

3. Requirements For Effective Implementation
Cognitive Skills
Psychomotor Skills
Interpersonal Skills
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4. Cognitive Skills Making appropriate observations
Understanding the rationale for activities performed
Appreciating the differences among clients
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5. Cognitive Skills
Critical thinking is an important element within the cognitive domain.
Analyze data.
Organize observations.
Transfer previously learned knowledge to current situations.
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6. Psychomotor Skills
Safe and effective performance of nursing activities requires:
Handling technical equipment
Medication administration
Meeting mobility needs of the client
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7. Interpersonal Skills
Effective communication with clients, families, and other health care personnel
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8. Implementation Activities
Ongoing Assessment
Establishing Priorities
Allocating Resources
Delegating Tasks
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9. Implementation Activities
Ongoing Assessment
Validate the relevance of proposed interventions.
Identify need to change expected outcomes and interventions.
Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

10. Implementation Activities
Establishing Priorities
Problems deemed most important by the nurse, the client, and family or significant others
Activities previously scheduled by other departments
Available resources
Change-of-shift report
Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

11. Implementation Activities
Allocating Resources
Determine if any activity that can be performed independently by the client, with assistance from family, requires assistance of health care personnel.
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12. Implementation Activities
Delegating Tasks
The RN is empowered to delegate selected tasks to either licensed or unlicensed nursing personnel.
The RN remains accountable for appropriate delegation and supervision of care.
Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

13. Implementation Activities
Delegating Tasks
Decisions about delegation are guided by the needs of the client, available personnel, and the nursing management system.
Nurse practice acts dictate to some extent which tasks can be legally delegated.
Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

14. Implementation Activities
Delegating Tasks
The registered nurse is held accountable to delegate only such care that can safely be done by the other individual.
The performance must be at the same level of competency and respect for state laws as would be evident in the nurse’s performance.
Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

15. Implementation Activities
The registered nurse is responsible for delegating nursing tasks to other members of the health care team.
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16. Implementation Activities
Types of Management Systems
Functional Nursing
Team Nursing
Primary Nursing
Total Client Care and Modular Nursing
Case Management
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17. Types of Management Systems
Functional Nursing
Divides care into tasks.
Each staff member performs an assigned task for each client.
Allows for more skilled personnel to be used in areas for which they have special knowledge or skill.
Can result in fragmented,depersonalized care, leading to omissions in care.
Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

18. Types of Management Systems
Team Nursing
RN responsible for supervision of the team.
Uses RNs for skilled observations and interventions and direct care to acutely ill clients.
Licensed Practical Nurses care for less acute ill.
Cost-effective.
Provides more individualized care.
Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

19. Types of Management Systems
Primary Nursing
Primary nurse maintains full responsibility for total client care for a small number of clients 24 hours a day.
Continuity of care is inherent in the system.
Most effective with a total staff of RNs.
Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

20. Types of Management Systems
Total Client Care and Modular Nursing
A unit manager coordinates activities on the unit.
Uses both registered nurses and licensed practical nurses.
Responsibility for care changes from shift to shift.
Ensures continuity of care.
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21. Types of Management Systems
Case Management
RN assumes responsibility for planning, implementing, coordinating, and evaluating care for a given client.
Often used when care is complex.
Development of a critical pathway.
Continuity of care and collaboration are enhanced.
Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

22. Nursing Interventions
Interventions must conform to standards of care.
The rationale for all interventions is based on scientific principles.
Nursing interventions are a blend of art (intuitive actions) and science (rational acts).
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23. Types of Nursing Interventions
Standing Order
Standardized intervention
Written, approved, and signed by a health care practitioner
Protocol
A series of standing orders to be followed under specific conditions
Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

24. Nursing Interventions Classification (NIC)
Standardized language system that describes nursing interventions performed in all practice settings
Offers standardized language for research on nursing interventions
Promising tool for determining reimbursement for nursing services
Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

25. Nursing Intervention Activities
Activities of Daily Living (ADLs)
Therapeutic Interventions
Monitoring and Surveillance
Client Education
Discharge Planning
Supervision and Coordination of Personnel
Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

26. Nursing Intervention Activities
Activities of Daily Living (ADLs)
Assistance with bathing, grooming, ambulating, eating, and eliminating.
Ongoing assessment determines the balance between ensuring safety and promoting independence.
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27. Nursing Intervention Activities
A home health nurse assesses a client by gathering data while communicating with a client.
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28. Nursing Intervention Activities
Therapeutic Interventions
Administration of medications and treatments
Performance of skilled procedures
Provision of physical and psychological comfort
Reassessment of the client
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29. Nursing Intervention Activities
Monitoring and Surveillance
Vital signs
Cardiac monitoring
Recording of intake and output
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30. Nursing Intervention Activities
Client Education
Therapeutic and side effects of medications
Self-monitoring of responses to care plan
Insight into the client’s knowledge base and readiness to learn
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31. Nursing Intervention Activities
Discharge Planning
Begins at time of admission
Consulting with other agencies for follow-up
Ensuring that teaching and other interventions have been implemented before discharge
Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

32. Nursing Intervention Activities
Supervision and Coordination of Personnel
Coordinates client activities among various health care providers.
Ensures that standards of care are followed.
Scope varies with the management style and type of facility.
Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

33. Implementation Activities
Evaluating Interventions
The Nursing Intervention Classification (NIC) links nursing activities to client outcomes.
The Nursing Outcomes Classification (NOC) provides a common language for measuring client responses to nursing interventions.
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34. Implementation Activities
Documentation of Interventions
Responsible for both written documentation of the implementation process and verbal communication with other care providers.
All communication must be objective, descriptive, and complete.
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35. Documentation of Interventions
Communication between nurses generally occurs at the change of shift.
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36. Documentation of Interventions
Verbal reports should include:
Activities completed and those remaining to be completed
Status of current relevant problems
Any abnormalities or changes in assessment
Results of treatments
Diagnostic tests scheduled, or those completed with the results
Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.