NURSING PROCESS

1. NURSING PROCESS Chapter 5 The Nursing Process: The Implementation Step: Putting the Plan of Care into Action

2. References • Doenges, M. E., & Moorhouse, M. F. (2008). Application of nursing process andnursing diagnosis: An interactive text for diagnostic reasoning(5th ed.). Philadelphia: F. A. Davis.

3. Competencies for Chapter 5, The Implementation Step: By the end of this unit the student will: • Describe the purpose of implementation • List 3 types of interventions • Discuss ethical and legal concerns of implementing • Identify factors that impact carrying out the plan of care • Describe delegation of nursing care

4. Implementing • Purpose of implementing: • Carry out planned nursing interventions to assist the client in achieving desired health goals • Types of interventions: • Nurse-initiated • Physician-initiated • Collaborative

5. Standard Interventions • Advantages for using standardized nursing interventions: • To standardize nomenclature • Expand nursing knowledge • Develop information systems • Teach decision making • Ensure appropriate reimbursement for nursing services • Allocate nursing resources • Communicate nursing to non-nurses

6. Variables that Influence Implementation of the Plan of Care • Patient variables (ability and willingness to participate) • Available resources (staff, equipment, supplies) • Nurse variables (creativity, expertise, critical thinking)

7. Variables that Influence Implementation of the Plan of Care(continued) • Standards of practice (legal criteria for nursing care) Protocols & standing orders expand scope of nursing practice • Protocols – written plans that detail nursing activities to be executed in specific situation • Standing orders – empower the nurse to initiate actions that ordinarily require the order or supervision of a physician • Research findings • Ethical and legal influences

8. Ethical and Legal Concerns • The plan of care must always reflect wishes of the client/family/significant others • One client desire or request does not negate the need for nurse to provide other types of care • See P. 106 Activity 5-2

9. Carrying out Plan of Care The nurse must: • Understand reason for doing intervention, expected effect, and potential hazards of intervention • Use knowledge and expertise to prioritize and carry out interventions • Review Plan of Care for outcomes • Provide appropriate environment • Determine need for assistance

10. Carrying out Plan of Care (cont.) • Consider which interventions must be combined, evaluated, reassessed • Promote self-care (teaching, counseling, advocacy) • Maintain flexibility (adapting to changing needs) • Assist patient to achieve health goals

11. Delegating Nursing Care Delegation-the transfer of responsibility for the performance of an activity to another individual while retaining accountability for the outcome: • The right task • The right person • The right communication • The right feedback • The right time

12. Data Collection • Monitor the patient to collect additional data • Use senses (touch, smell, hear, see) • Document findings • Verbally communicate to other healthcare members “Change of Shift Report”

13. Carrying out Plan of Care • Have prerequisite nursing skills • Understand • Review • Provide • Determine • Consider • Promote • Flexibility • Assist patient to

14. Delegating Nursing Care • Delegation- • The right • The right • The right • The right • The right

15. Summary • The nurse must prioritize client needs and interventions • Gather and review data to determine necessary interventions • Be aware that client care is an ongoing process • Know that changes can occur without notice