1. Implementation Chapter 14

2. 14-2 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. 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.

3. 14-3 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Requirements For Effective Implementation  Cognitive Skills  Psychomotor Skills  Interpersonal Skills

4. 14-4 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Cognitive Skills  Making appropriate observations  Understanding the rationale for activities performed  Appreciating the differences among clients

5. 14-5 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Cognitive Skills  Critical thinking is an important element within the cognitive domain. Analyze data. Organize observations. Transfer previously learned knowledge to current situations.

6. 14-6 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Psychomotor Skills  Safe and effective performance of nursing activities requires: Handling technical equipment Medication administration Meeting mobility needs of the client

7. 14-7 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Interpersonal Skills  Effective communication with clients, families, and other health care personnel

8. 14-8 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Implementation Activities  Ongoing Assessment  Establishing Priorities  Allocating Resources  Delegating Tasks

9. 14-9 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Implementation Activities  Ongoing Assessment Validate the relevance of proposed interventions. Identify need to change expected outcomes and interventions.

10. 14-10 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. 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

11. 14-11 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. 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.

12. 14-12 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. 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.

13. 14-13 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. 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.

14. 14-14 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. 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.

15. 14-15 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Implementation Activities  The registered nurse is responsible for delegating nursing tasks to other members of the health care team.

16. 14-16 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Implementation Activities  Types of Management Systems Functional Nursing Team Nursing Primary Nursing Total Client Care and Modular Nursing Case Management

17. 14-17 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. 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.

18. 14-18 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. 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.

19. 14-19 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. 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.

20. 14-20 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. 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.

21. 14-21 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. 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.

22. 14-22 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. 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).

23. 14-23 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. 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

24. 14-24 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. 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

25. 14-25 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Nursing Intervention Activities  Activities of Daily Living (ADLs)  Therapeutic Interventions  Monitoring and Surveillance  Client Education  Discharge Planning  Supervision and Coordination of Personnel

26. 14-26 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. 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.

27. 14-27 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Nursing Intervention Activities  A home health nurse assesses a client by gathering data while communicating with a client.

28. 14-28 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Nursing Intervention Activities  Therapeutic Interventions Administration of medications and treatments Performance of skilled procedures Provision of physical and psychological comfort Reassessment of the client

29. 14-29 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Nursing Intervention Activities  Monitoring and Surveillance Vital signs Cardiac monitoring Recording of intake and output

30. 14-30 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. 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

31. 14-31 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. 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

32. 14-32 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. 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.

33. 14-33 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. 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.

34. 14-34 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. 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.

35. 14-35 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Documentation of Interventions  Communication between nurses generally occurs at the change of shift.

36. 14-36 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. 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