CH 19 P&P - IMPLEMENTING NURSING CARE

CH 19 P&P - IMPLEMENTING NURSING CARE

1. RELATIONSHIP OF IMPLEMENTATION TO THE NURSING DIAGNOSTIC PROCESS

   • 4th step of the nursing process
     • Begins after the development of a care plan
       • Nurse then initiates interventions that are designed to achieve patient goals and expected outcomes
   • 5 preparatory activities
     • Reassessing the patient
       • Reviewing and revising the existing nursing care plan
         • Organizing resources and care delivery
           • Anticipating and preventing complications
             • Implementing nursing interventions

2. ASSOCIATION BETWEEN CRITICAL THINKING & SELECTING NURSING INTERVENTION

   • Critical Thinking
     • Experience
       • Previous patient care experience. Knowledge of successful interventions (Potter & Perry, 2017).
       • Attitude
         • -Independent thinking -Responsibility -Authority -Creativity -Discipline (Potter & Perry, 2017)
         • Standards
           • 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).
           • Knowledge
             • -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
   • Nursing Intervention
     • Standardized Interventions
       • 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).

3. DIFFERENCE BETWEEN PROTOCOLS AND STANDING ORDERS

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

4. INFLUENCE OF ORGANIZATIONAL CULTURE ON INTERDISCIPLINARY COLLABORATION

5. THE VALUE OF THE NURSING INTERVENTIONS CLASSIFICATION SYSTEM IN DOCUMENTING NURSING CARE

6. STEPS FOR REVISING A PLAN OF CARE BEFORE PERFORMING IMPLEMENTATION

   • 1. Revise data in the assessment column to reflect the pt's current status. Date any new data to inform other members of the health care team of the time that the change occured
     • 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.
       • 3. Revise specific interventions that correspond to the new nursing diagnoses and goals. Be sure that revisions reflect the pt's present status.
         • 4. Choose the method of evaluation for determining whether the patient achieved his or her outcomes

7. 3 IMPLEMENTATION SKILLS

   • Cognitive Skills
     • Include the critical thinking and decision-making skills. Always use good judgement and sound clinical decision making when performing any intervention (Potter & Perry, 2017).
     • Interpersonal Skills
       • Develop a trusting relationship, express a level of caring, and communicate clearly with pt's and their families (Potter & Perry, 2017)
       • Psychomotor Skills
         • Requires the integration of cognitive and motor activities (Potter & Perry, 2017).

8. DIRECT & INDIRECT NURSING INTERVENTIONS

   • Indirect Care
     • Communicating Nursing Interventions
       • Any intervention that you provide for a pt is communicated in an electronic, written, or oral format (Potter & Perry, 2017).
       • Delegating, Supervising, and Evaluating the Work of Other Staff Members
         • 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.
   • Direct Care
     • ADLs
       • Instrumental ADLs
         • Physical Care Techniques
           • Lifesaving Measures
             • Counseling
               • Teaching
                 • Controlling for Adverse Rxns
                   • Taking the right precautions can prevent adverse rxns.  Anticipate for adverse rxns so that you are to better prepare for them.
                   • Preventative Measures
                     • Promote health and prevent illness to avoid the need for acute or rehabilitative health care

9. APPROPRIATE INTERVENTIONS FOR A PATIENT