Presentation on theme: "RENI PRIMA GUSTY, SK.p,M.Kes"— Presentation transcript:
1 RENI PRIMA GUSTY, SK.p,M.Kes Nursing Process: Step 4- ImplementationBYRENI PRIMA GUSTY, SK.p,M.Kes
2 Class Objectives Describe direct and indirect nursing interventions Describe rationale for nursing protocols, standards of nursing care and standing ordersDiscuss importance of collaborating with client and others during intervention phaseDescribe what it means to have a personalized plan of care for clientsDiscuss how critical thinking is used during the implementation stage of careDiscuss implementation/associated rationale Discuss why/how nursing interventions/findings are communicated to other members of the health care team in common nursing care settings
3 Definition-Implementation 4th stage of the nursing processImplementation- actions that are required to attain goals and expected outcomes of nursing care.
4 Definition-Implementation Begins after the care plan has been designedIt is known as a category of nursing behaviorsRequires nursing interventions to perform, assist, or direct activities of daily living, provide direct care, delegate supervise, and evaluate staff work exchange and document information.
5 ImplementationEnsure you have the skills to carry out the prescribed care, that the patient is ready & you have everything you needCheck that you know what might go wrong, how to prevent it, and whether you can deal with a worst case scenarioCollaborate with patient and family/whanau & take all opportunities for providing educationDecide whether there is another (easier?) way to do thisCheck any policies or procedures you are not sure ofWrite rationale if changing care planComplete accurate documentationRemember that the outcome must measure the human response! So if you look at all these sample statements – they all measure the human response. So for example you would not say in your outcome statement that the patient would be supplied with equipment to change their colostomy bag because that is not a human response. However you may say that the patient will be independent with stoma management within a number of weeks because learning to care for the stoma/colostomy is a human response
6 IMPLEMENTATION Carry out the plan Assist person to meet goals; facilitate copingContinue to collect dataDocument care
7 Implementing Purpose, as applied to Problem solving: Communicate plans to everyone affected.Be sure plans, goals, and objectives are clearly identified.Maintain open, two-way communication with staff.Support and encourage compliance among all staff.The IMPLEMENTING phase should include:Effective communicationDelegationSupervision
8 Nsg Roles in Implementation: PractitionerEducatorCollaboratorCoordinatorAdvocateEvaluatorNote: when the client is involved in this process, the nursing role shifts to that of facilitator.Regardless of the role assumed by the nurse, the nurse must focus on the client, being constantly aware of the client’s response to the intervention.Cues from the client should direct the implementation. Ex- if the nurse is teaching a client how to change a surgical dressing and the client is experiencing pain, discontinuing the teaching plan temporarily to focus on controlling the pain would be a better action.
9 Direct and Indirect Nursing Interventions Direct Care Interventions -interventions that are treatments that are carried out through interaction with the client.Ex: medication administrationIndirect Interventions- are treatments that are performed away from the client but based on the client’s or group’s behalf.Ex: infection control- isolate a client to protect the other clients
10 Rationale for Nursing Protocols Protocols – provides a standard of care or clinical guideline that can be specifically designed for each patient depending upon how the organization wants it to be implemented.Ex: ER department- plan of care when a patient arrives with chest pain.
11 Protocols for Standing Orders Standing order – is a pre-printed document which includes orders for routine care, monitoring and or diagnostic tests. Must be approved and signed by the licensed prescribing physician or health care provider who is charge of the implementationEx: critical care unit, clients with burns.
12 Nursing Interventions REQUIRE:Nurses must have sound judgement and knowledge prior to implementation of nursing interventions.Need to use a research-based approachCareful selection of the best interventions and know the difference between the interventions of various disciplines.
13 Selection of Nursing Interventions Intervention selection may be difficult due to:-lack of objective data-nursing interventions may be administeredin collaboration with other disciplines.-absence of common language interventions
14 Implementation/Associated Rationale A) Reassess- determine whether the planned nursing action is appropriate.B) Review/ revise existing Nursing Care Plan- compare nursing assessment with nursing diagnosis and change accordingly, depending if the client’s condition changed.C) Organize resources and care delivery- Determine equipment, personnel and environment required to carry out the interventions.
15 Implementation/Associated Rationale D) Anticipate and prevent complications- Identify the risk and weigh the benefit of the treatment with the possible risks.E) Assess your knowledge , skill and qualifications-before implementation, review the plan of care to determine the need for assistance and type required.F) Identification of times when nurse requires support/assistance from others-provide assistance if necessary when performing a procedure, comforting a client and or preparing he/she for a procedure.Refer to Nursing Care Plans (Potter, Perry, Ross-Kerr & Wood, 2006, p.214 & 217).
16 Importance of Collaboration Collaboration with the client and other members of the health team is important for individualizing nursing interventionsNurse can examine previous clinical experiences and priorities to nursing interventions.
17 Personalized Plan of Care Document the care needed by clientCommunication toolIndividualizedProvides continuity of careOrganized so that information can be viewed quicklyCan be used for giving reportLong term needs of the clientExpected outcomesProvides direction
18 Types of Care PlansInstitutional Care Plans – Concise documents are part of the chart (Kardex)Kardex refers to a card-filing system that allows quick reference to a client’s needsStandard Care Plans- select a nursing diagnosis and then individualizes a plan of care from the selected items
19 Types of Care PlansCare Plans for Community-Based Settings- a more comprehensive health assessmentCritical Pathways- plan of care developed by nursing, medicine and other healthcare professionals such as pharmacy etc.Concept Maps- diagram of client problems, and interventions that shows the relationships to one another. Helps students in appraising their thinking process.
20 Critical Thinking is used to... Critical thinking helps nurses make decisions. Nurses form conclusions, make decisions and draw inferences about the client’ health needs. Also, a research approach is needed to plan the care and select interventions that are appropriate for the client’s condition.
21 Communication (HOW)Nursing interventions are communicated through written and oral modes.-Written communication occurs through documentation from all disciplines caring for the client in the careplan. Client’s responses are included as well as the time and detail of the intervention is included.-Oral communication occurs between nurses and other members of the health team. Information is communicated through discussion with other colleagues, at end of shift report, when transferring a client, or at discharge.
22 Communication (WHY)Nursing interventions are communicated because it is important to provide accurate and timely care, ensure that interventions are not duplicated unnecessarily, procedures delayed or interventions left undone.
23 Summary Direct and indirect nursing interventions Rationale for nursing protocols, standards of nursing care and standing ordersImportance of collaborating with client and others during intervention phasePersonalized plan of care for clientsDiscuss how critical thinking is usedImplementation/associated rationaleNursing interventions/findings are communicated to other members of the health care team