Class ObjectivesClass Objectives Describe direct and indirect nursing interventionsDescribe direct and indirect nursing interventions Describe rationale for nursing protocols, standards of Describe rationale for nursing protocols, standards of

nursing care and standing orders nursing care and standing orders Discuss importance of collaborating with client and others Discuss importance of collaborating with client and others

during intervention phaseduring intervention phase Describe what it means to have a personalized plan of Describe what it means to have a personalized plan of

care for clientscare for clients Discuss how critical thinking is used during the Discuss how critical thinking is used during the

implementation stage of careimplementation stage of care Discuss implementation/associated rationale Discuss Discuss implementation/associated rationale Discuss

why/how nursing interventions/findings are communicated why/how nursing interventions/findings are communicated to other members of the health care team in common to other members of the health care team in common nursing care settingsnursing care settings

Definition-ImplementationDefinition-Implementation

44thth stage of the nursing process stage of the nursing process ImplementationImplementation- actions that are required to attain goals - actions that are required to attain goals

and expected outcomes of nursing care. and expected outcomes of nursing care.

Definition-ImplementationDefinition-Implementation Begins after the care plan has been designedBegins after the care plan has been designed It is known as a category of nursing behaviorsIt is known as a category of nursing behaviors Requires Requires nursing interventionsnursing interventions to perform, assist, or to perform, assist, or

direct activities of daily living, provide direct care, direct activities of daily living, provide direct care, delegate supervise, and evaluate staff work exchange delegate supervise, and evaluate staff work exchange and document information.and document information.

ImplementationImplementation Ensure you have the skills to carry out the prescribed Ensure you have the skills to carry out the prescribed

care, that the patient is ready & you have everything you care, that the patient is ready & you have everything you needneed

Check that you know what might go wrong, how to Check that you know what might go wrong, how to prevent it, and whether you can deal with a worst case prevent it, and whether you can deal with a worst case scenarioscenario

Collaborate with patient and family/whanau & take all Collaborate with patient and family/whanau & take all opportunities for providing educationopportunities for providing education

Decide whether there is another (easier?) way to do thisDecide whether there is another (easier?) way to do this Check any policies or procedures you are not sure ofCheck any policies or procedures you are not sure of Write rationale if changing care plan Write rationale if changing care plan Complete accurate documentationComplete accurate documentation

IMPLEMENTATIONIMPLEMENTATION

Carry out the planCarry out the planAssist person to meet goals; facilitate Assist person to meet goals; facilitate

copingcopingContinue to collect dataContinue to collect dataDocument careDocument care

ImplementingImplementingPurpose, as applied to Problem solving:Purpose, as applied to Problem solving:

Communicate plans to everyone Communicate plans to everyone affected.affected.

Be sure plans, goals, and objectives are Be sure plans, goals, and objectives are clearly identified.clearly identified.

Maintain open, two-way communication Maintain open, two-way communication with staff.with staff.

Support and encourage compliance Support and encourage compliance among all staff.among all staff.

Nsg Roles in Implementation:Nsg Roles in Implementation:

PractitionerPractitionerEducatorEducatorCollaboratorCollaboratorCoordinatorCoordinatorAdvocateAdvocateEvaluatorEvaluator

Note: when the client is involved in this Note: when the client is involved in this process, the nursing role shifts to that of process, the nursing role shifts to that of facilitator.facilitator.

Direct and Indirect Nursing Direct and Indirect Nursing InterventionsInterventions

Direct Care Direct Care InterventionsInterventions - -interventions that are interventions that are treatments that are treatments that are carried out through carried out through interaction with the interaction with the client. client.

Ex: medication administration Ex: medication administration

Indirect Interventions-Indirect Interventions- are treatments that are treatments that are performed away are performed away from the client but from the client but based on the client’s based on the client’s or group’s behalf.or group’s behalf.

Ex: infection control- isolate a Ex: infection control- isolate a client to protect the other client to protect the other clientsclients

Rationale for Nursing ProtocolsRationale for Nursing Protocols

Protocols Protocols – provides a standard of care or – provides a standard of care or clinical guideline that can be specifically clinical guideline that can be specifically designed for each patient depending upon designed for each patient depending upon how the organization wants it to be how the organization wants it to be implemented. implemented.

Ex: ER department- plan of care when a patient arrives Ex: ER department- plan of care when a patient arrives with chest pain.with chest pain.

Protocols for Standing OrdersProtocols for Standing Orders

Standing orderStanding order – – is a pre-printed is a pre-printed document which includes orders for document which includes orders for routine care, monitoring and or diagnostic routine care, monitoring and or diagnostic tests. Must be approved and signed by the tests. Must be approved and signed by the licensed prescribing physician or health licensed prescribing physician or health care provider who is charge of the care provider who is charge of the implementationimplementation

Ex: critical care unit, clients with burns.Ex: critical care unit, clients with burns.

Nursing InterventionsNursing Interventions

REQUIREREQUIRE:: Nurses must have sound judgement and Nurses must have sound judgement and

knowledge prior to implementation of nursing knowledge prior to implementation of nursing interventions.interventions.

Need to use a research-based approachNeed to use a research-based approach Careful selection of the best interventions and Careful selection of the best interventions and

know the difference between the interventions of know the difference between the interventions of various disciplines.various disciplines.

Selection of Nursing Selection of Nursing InterventionsInterventions

Intervention selection may be Intervention selection may be difficultdifficult due due to:to:

-lack of objective data-lack of objective data

-nursing interventions may be administered-nursing interventions may be administered

in collaboration with other disciplines.in collaboration with other disciplines.

-absence of common language interventions-absence of common language interventions

Implementation/Associated Implementation/Associated RationaleRationale

A) Reassess- determine whether the planned nursing action A) Reassess- determine whether the planned nursing action is appropriate.is appropriate.

B) Review/ revise existing Nursing Care Plan- compare B) Review/ revise existing Nursing Care Plan- compare nursing assessment with nursing diagnosis and change nursing assessment with nursing diagnosis and change accordingly, depending if the client’s condition changed. accordingly, depending if the client’s condition changed.

C) Organize resources and care delivery- Determine C) Organize resources and care delivery- Determine equipment, personnel and environment required to carry out equipment, personnel and environment required to carry out the interventions.the interventions.

Implementation/Associated Implementation/Associated RationaleRationale

D) Anticipate and prevent complications- Identify the risk and weigh D) Anticipate and prevent complications- Identify the risk and weigh the benefit of the treatment with the possible risks. the benefit of the treatment with the possible risks.

E) Assess your knowledge , skill and qualifications-before E) Assess your knowledge , skill and qualifications-before implementation, review the plan of care to determine the need for implementation, review the plan of care to determine the need for assistance and type required.assistance and type required.

F) Identification of times when nurse requires support/assistance F) Identification of times when nurse requires support/assistance from others-provide assistance if necessary when performing a from others-provide assistance if necessary when performing a procedure, comforting a client and or preparing he/she for a procedure, comforting a client and or preparing he/she for a procedure.procedure.

Refer to Nursing Care Plans (Potter, Perry, Ross-Kerr & Wood, Refer to Nursing Care Plans (Potter, Perry, Ross-Kerr & Wood, 2006, p.214 & 217).2006, p.214 & 217).

Importance of CollaborationImportance of Collaboration

Collaboration with the client and other Collaboration with the client and other members of the health team is important members of the health team is important for for individualizing nursing interventionsindividualizing nursing interventions

Nurse can Nurse can examine previous clinical examine previous clinical experiences and priorities to nursing experiences and priorities to nursing interventions. interventions.

Personalized Plan of CarePersonalized Plan of Care Document the care needed by clientDocument the care needed by client Communication toolCommunication tool IndividualizedIndividualized Provides continuity of careProvides continuity of care Organized so that information can be viewed Organized so that information can be viewed

quicklyquickly Can be used for giving reportCan be used for giving report Long term needs of the clientLong term needs of the client Expected outcomesExpected outcomes Provides directionProvides direction

Types of Care PlansTypes of Care Plans

Institutional Care PlansInstitutional Care Plans – Concise – Concise documents are part of the chart (Kardex)documents are part of the chart (Kardex)

KardexKardex refers to a card-filing system that allows quick refers to a card-filing system that allows quick reference to a client’s needsreference to a client’s needs

Standard Care Plans-Standard Care Plans- select a nursing select a nursing diagnosis and then individualizes a plan of diagnosis and then individualizes a plan of care from the selected itemscare from the selected items

Types of Care PlansTypes of Care Plans

Care Plans for Community-Based Settings-Care Plans for Community-Based Settings- a a more comprehensive health assessmentmore comprehensive health assessment

Critical Pathways-Critical Pathways- plan of care developed by plan of care developed by nursing, medicine and other healthcare nursing, medicine and other healthcare professionals such as pharmacy etc. professionals such as pharmacy etc.

Concept Maps- diagram of client problems, Concept Maps- diagram of client problems, and interventions that shows the and interventions that shows the relationships to one another. Helps relationships to one another. Helps students students in appraising their thinking process. in appraising their thinking process.

Critical Thinking is used to...Critical Thinking is used to...

Critical thinking helps nurses make Critical thinking helps nurses make decisions. Nurses form conclusions, make decisions. Nurses form conclusions, make decisions and draw inferences about the decisions and draw inferences about the client’ health needs. Also, a research client’ health needs. Also, a research approach is needed to plan the care and approach is needed to plan the care and select interventions that are appropriate select interventions that are appropriate for the client’s condition. for the client’s condition.

Communication (HOW)Communication (HOW)

Nursing interventions are communicated Nursing interventions are communicated through through writtenwritten and and oral modesoral modes..

--Written communication occurs through documentation Written communication occurs through documentation from all disciplines caring for the client in the careplan. from all disciplines caring for the client in the careplan. Client’s responses are included as well as the time and Client’s responses are included as well as the time and detail of the intervention is included.detail of the intervention is included.

-Oral communication occurs between nurses and other -Oral communication occurs between nurses and other members of the health team. Information is members of the health team. Information is communicated through discussion with other colleagues, communicated through discussion with other colleagues, at end of shift report, when transferring a client, or at at end of shift report, when transferring a client, or at discharge.discharge.

Communication (WHY)Communication (WHY)

Nursing interventions are communicated Nursing interventions are communicated because it is important to provide accurate because it is important to provide accurate and timely care, ensure that interventions and timely care, ensure that interventions are not duplicated unnecessarily, are not duplicated unnecessarily, procedures delayed or interventions left procedures delayed or interventions left undone. undone.

SummarySummary Direct and indirect nursing interventionsDirect and indirect nursing interventions Rationale for nursing protocols, standards of nursing Rationale for nursing protocols, standards of nursing

care and standing orders care and standing orders Importance of collaborating with client and others during Importance of collaborating with client and others during

intervention phaseintervention phase Personalized plan of care for clientsPersonalized plan of care for clients Discuss how critical thinking is used Discuss how critical thinking is used Implementation/associated rationale Implementation/associated rationale Nursing interventions/findings are communicated to Nursing interventions/findings are communicated to

other members of the health care team other members of the health care team