Implementation begins after
the development of the Plan of Care.
Implementation includes
interventions designed to achieve goals and expected outcomes to support or improve the patient’s health status
Nursing Interventions
any rx based on clinical judgment and knowledge that a nurse performs to enhance patient outcomes.
Nursing interventions are
- evidence-based
- most up-to-date and effective approaches
- includes direct and indirect care measures
Direct Care Measures
-performed by directed interactions with patients.
Indirect Care Measures
-treatments performed away from the patient but on behalf of the patient
Direct Care Measures include
- medication administration
- insertion of an IV infusion
- counseling.
Indirect Care Measures include
- documentation
- interdisciplinary collaboration
- order entry
- managing safety and infection control measures
What are the intervention categories?
- independent
- dependent
- collaborative
independent interventions
patient teaching, monitoring therapeutic interventions
dependent interventions
MD orders
collaborative interventions
consultations, interdisciplinary conferences
Tips for Making Decisions: Implementation
- Review the set of all possible nursing interventions for the patient’s problem. (pain-positioning, pharmacology, relaxation techniques)
- Review all possible consequences associated with each possible nursing action. (each intervention may work, not work or cause adverse reactions)
- Determine the probability of all possible consequences. (pain medication has worked in the past with no adverse reactions - unlikely adverse reactions will occur)
- Make a judgement of the value of the consequence to the patient. (if the patient has a decreased pain level he/she will be less anxious and more receptive to therapeutic interventions (moving, instructions)
When you proceed with an intervention, consider:
- what you know about the intervention
- the steps in performing the intervention correctly
- the medical condition of the patient
- his/her expected response
- know the clinical standards of practice for your agency
With interventions, apply:
intellectual standards and critical thinking attitudes
Intellectual standards
relevant, clear, logical and complete
critical thinking attitudes
confidence (builds pt trust), creativity (reviewing & modifying interventions) and self-discipline (seek supervision as guide in the decision making process)
standardized interventions
make it quicker and easier of a nurse to intervene
standardized interventions are used in the form of:
- clinical guidelines
- protocols
- preprinted (standing) orders
- nursing intervention classification (NIC) interventions
- ANA Standards of Professional Nursing Practice- includes standards for the implementing step of the nursing process.
Clinical Guidelines/Protocols
- interventions for a specific health care problem or condition.
- seen as key tools for improving the quality of health.
Clinical Guidelines/Protocols are developed from
scientific literature and standard of practice
ex) rapid assessment protocols (stroke, STEMI), fall prevention, DVT, pressure ulcer, incontinence management, admission & discharge procedures.
Standing orders
a preprinted document (MD orders) containing conduct of routine therapies, monitoring guidelines, diagnostic procedures for a specific patient population.
Standing orders give the nurse
legal protection to intervene appropriately in the patient’s best interest.
ex) pt presenting to the ED w/ CP, abd pain and ortho c/o; critical care settings: pts w/ life threatening arrhythmias, BP
Nursing interventions classification (NIC)
- common interventions recommended for various NANDA nursing diagnoses.
- developed by University of Iowa: helps to differentiate nursing practice from other healthcare professionals.
- standardization to enhance communication of nursing care across settings and to compare outcomes.
ANA Standards of Professional Nursing Practice
The standard of care that registered nurses provide their patients
The standards of care that registered nurses provide include
- competencies for establishing professional and caring relationships
- using evidence-based interventions and technologies
- providing holistic care across the lifespan to diverse groups
- using community resources and systems
- implementing a timely plan following patient safety goals
QSEN
- Quality and Safety Education for Nurses
- Knowledge, Skills, Attitudes
Five Preparatory Activities:
- reassessing the patient
- review and revise the existing nursing care plan
- prepare for implementation
- anticipating and preventing complications
- implementation nursing interventions (cognitive, interpersonal, psychomotor)
Preparing for Implementation
- equipment: working, know how to use, availability
- time management
- personnel: delegation duties, collaborative
- environment: patient assist devices, lighting, safe environment
- patient: physical (toileting) and psychological comfort, level of endurance
Anticipating and Preventing Complications
- risks come from both illness and treatment
- evaluate benefit vs risk and take risk-prevention measures
Identifying Areas of Assistance
- do not hesitate to obtain assistance by seeking additional personnel, knowledge, and/or nursing skills
- do not take shortcuts if assistance is not immediately available: increases risk of injury to you and the patient.
When administering new medications, operating a new piece of equipment, or performing an unfamiliar procedure:
- review hospital policy and procedure
- collect all equipment necessary
- have another nurse/instructor provide assistance and guidance
Implementation Skills:
- cognitive skills
- interpersonal skills
- psychomotor skills
Cognitive skills
application of critical thinking in the nursing process:
- know the rationale for the therapeutic intervention
- know the normal and abnormal physical and psychological responses
Interpersonal Skills
Communication is critical.
- keep pts informed
- provide individualized pt teaching
- support pts emotional needs
- be perceptive of the pts verbal and nonverbal communication
Psychomotor Skills
cognitive and motor activities.
-good coordination and precision to perform a skill correctly.
Activities of Daily Living (ADLs)
- ambulation, grooming, bathing.
- is the pts need for assistance w/ ADLs temporary, permanent or rehabilitative?
Instrumental Activities of Daily Living (IADLs)
- shopping, preparing meals, house cleaning, writing checks, taking medications.
- home health nurses, occupational health therapists
Physical Care Techniques
safe patient handling, infection control practices, stay organized follow practice guidelines
Lifesaving Measures
emergency medications, resuscitation, intervening to protect a confused or violent patient
Counseling
- emotional, intellectual, spiritual, and psychological support to the pt and family.
- assess family caregivers for caregiver role strain and the possible need for respite (a break from providing care)
Teaching
- education key to patient-centered care
- focus on intellectual growth, acquisition of new knowledge or psychomotor skills
- know your patients health literacy level
Controlling for Adverse Reactions
- potential to follow any nursing intervention: medication administration, diagnostic test.
- anticipate and know which adverse reactions to expect.
Preventative Measures
- primary prevention
- secondary prevention
- tertiary prevention
primary prevention
health promotion including health education programs, immunizations and physical and nutritional fitness activities.
secondary prevention
- focuses on those who are experiencing health problems or illness and who are at risk for developing complications or worsening conditions.
- includes screening techniques and treating early stages of disease.
tertiary prevention
involves minimizing the effect of long-term illness or disability, including rehabilitation measures.
Indirect care can also
- support direct care interventions
- change of shift report
- may be managerial in nature: emergency cart maintenance, supply management
- consultation of interdisciplinary care plans
- delegation of care to CNA or NAP
Achieve Patient goals
- introduce interventions that patients are willing and able to follow.
- apply principles of care coordinations.
Principles of care coordinations include
- good time management
- organizational skills
- appropriate use of resources to ensure you deliver interventions effectively and meet desired outcomes.
- priority setting
