CH 19 P&P - IMPLEMENTING NURSING CARE

1. Begins after the development of a care plan
   1. Nurse then initiates interventions that are designed to achieve patient goals and expected outcomes

1. Reassessing the patient
   1. Reviewing and revising the existing nursing care plan
      1. Organizing resources and care delivery
         1. Anticipating and preventing complications
            1. Implementing nursing interventions

1. Experience

   Nota:

   • Previous patient care experience. Knowledge of successful interventions (Potter & Perry, 2017).
   1. Attitude

      Nota:

      • -Independent thinking -Responsibility -Authority -Creativity -Discipline (Potter & Perry, 2017)
      1. Standards

         Nota:

         • Standards of practice (e.g. ANA, subspecialty) and evidence-based practice guidelines (e.g. AHRQ, APS) Agency's policies/procedures for guidelines of nursing practice and delegation Intellectual standards Patient's expected outcomes (Potter & Perry, 2017).
         1. Knowledge

            Nota:

            • -Expected effects of interventions -Techniques used in performing interventions -Nursing Interventions Classification -Role of other health care disciplines -Health care resources (e.g. equipment, personnel) -Anticipated patient responses to care -Interpersonal skills -Counseling theory

1. Standardized Interventions

   Nota:

   • Standardized interventions most often set a level of clinical excellence for practice. Nurse-and-health care provider-initiated standardized interventions are available in the form of clinical guidelines or protocols, preprinted (standing) orders, and Nursing Interventions Classification inteventions (Potter & Perry, 2017).

Nota:

• Preprinted document containing orders for routine therpies, monitoring guidelines, and/or diagnostic procedures for specific patients with identified clinical problems (Potter & Perry, 2017).

Nota:

• A systemically developed set of statements that help nurses, physicians, and other health care providers make decisions about appropriate health care for specific clinical situations (Potter & Perry, 2017).

1. 2. Revise the nursing diagnosis. Delete nursing diagnosis that are no longer relevant and add and date any new diagnoses. Revise related factors and the pt's goals, outcomes, and priorities. Date any revisions.
   1. 3. Revise specific interventions that correspond to the new nursing diagnoses and goals. Be sure that revisions reflect the pt's present status.
      1. 4. Choose the method of evaluation for determining whether the patient achieved his or her outcomes

Nota:

• Include the critical thinking and decision-making skills. Always use good judgement and sound clinical decision making when performing any intervention (Potter & Perry, 2017).

1. Interpersonal Skills

   Nota:

   • Develop a trusting relationship, express a level of caring, and communicate clearly with pt's and their families (Potter & Perry, 2017)
   1. Psychomotor Skills

      Nota:

      • Requires the integration of cognitive and motor activities (Potter & Perry, 2017).

1. Communicating Nursing Interventions

   Nota:

   • Any intervention that you provide for a pt is communicated in an electronic, written, or oral format (Potter & Perry, 2017).
   1. Delegating, Supervising, and Evaluating the Work of Other Staff Members

      Nota:

      • RNs work closely with LPNs and NAPs.  It is important to have effective and good communication skills with the staff members we work closely with and the ones whom work under our supervision.

1. ADLs
   1. Instrumental ADLs
      1. Physical Care Techniques
         1. Lifesaving Measures
            1. Counseling
               1. Teaching
                  1. Controlling for Adverse Rxns

                     Nota:

                     • Taking the right precautions can prevent adverse rxns.  Anticipate for adverse rxns so that you are to better prepare for them.
                     1. Preventative Measures

                        Nota:

                        • Promote health and prevent illness to avoid the need for acute or rehabilitative health care