workshop on implementation

8/3/2019 Workshop on Implementation

1/13

Introduction:

Nursing is both a science and art. The nursing process provides an orderly, logical,

problem solving approach for administering nursing care so that the patients needs for

such care are met comprehensively and effectively.

The nursing process is a six step process. Implementation is the fourth step in the nursing

process.

Implementation is initiation and completion of action to accomplish the defined goals and

Optimal wellness of the client.

In theory, implementation of the nursing care plan follows the planning component of the

nursing process. However, in many health care settings it may begin directly after

assessment. Eg. In emergency situations such as cardiac arrest or sudden death of a loved

one.

Definition :

Implementation:

Implementation is a category of nursing behaviour in which the actions necessary for

achieving the goals and expected outcomes of nursing care initiated and completed.

- POTTER AND PERRY.

Nursing intervention :Nursing intervention is any action taken by the nurse to help the client move from present

health state to the health state described in the expected outcomes.

Implementation is both patient centered (Wholly compensatory, Partial compensatory,

supportive and educative) and functional or nurses centered (independent, dependent, and

collaborative actions ).

The implementation is in terms of needs of patient. The client may require intervention in

the form of support, medication, treatment for the current condition, client family

education or treatment to prevent future health problems.

The purpose of intervention is to render appropriate patient care by putting the nursing

care plan in to action.

Purposes of implementation :


2/13

1. Assist the patient in achieving desired health goals.

2. Promote health.

3. Prevent disease and illness, restore health and facilitate coping with altered

functioning.

Principles of implementation :

1. The implementation phase should be based on patients desires and environment.

2. Implementation should be aimed to achieve the health promotion, health

restoration and high levels of wellness.

3. Implementation should minimize all the potential capabilities of the client.

4. Nursing actions can be combined to achieve expected outcome.

5. Nursing implementation should aim therapeutic environment for the client.

6. Implementation should be based on nursing care plan, which is based on nursing

diagnosis and assessment.

7. Implementation should aim for achievement of goals and expected outcome.8. Implementation should be documented legibly and legally.

Types of nursing actions:

1. Independent Nursing actions.

2. Dependent Nursing actions.

3. Interdependent Nursing actions.

4. Protocols

5. Standing orders.

1. Independent Nursing actions : Are those actions that the nurse can performwithout directions from others. Eg. Providing back massage and turning a patient

every 2 hours etc.

2. Dependent Nursing actions : Are those actions prescribed by the physicians, are

carried out by the nurse. Eg. The nurse follows the orders while administering

medications, performing wound care and ordering diagnostic tests etc.

3. Interdependent Nursing actions : Are those actions that the nurse and other

health care personnel perform together. Eg. Counselling of a patient whose is

posted for surgery, Community health, involving sanitary inspector etc to give

health education

4. Protocols : A protocol is a written plan to indicate the procedures commonly

required for a particular group of clients or situations. Eg. Care of post-op client,

Protocols for admission and discharge, Pain management etc


3/13

5. Standing Orders: Standing order is a written document about policies, rules,

regulations or orders regarding client care. Standing orders give nurses the authority to

carryout specific action under circumstances in the absence of supervision of a physician.

Eg. Standing orders for narcotic overdoses that specify the agents the nurse is to

administer to reverse respiratory depression in an emergency, standing orders in

community health set- up, Standing orders for pain management, standing orders for

Obstetric and gynecological patients admission etc.

Implementation Process :

The implementation component of the nursing has seven steps.

1. Reassessing the client.

2. Reviewing and modifying the existing nursing care plan.

3. Organizing resources and care delivery.a. Equipment

b. Personnel

c. Environment

4. Anticipate and prevent complication.

5. Identifying areas of assistance.

6. Implementing nursing interventions.

7. Recording

1. Reassessing the client:

Assessment is a continous process, which may focus on only one dimension or

system. When a new data are gathered and new client need is identified, the nurse

modifies the care plan.

The reassessment phase of the implementation component thus provide a

mechanism for the nurse to determine whether the proposed nursing action is appropriate

for the clients level of wellness. Eg. The nurse may have planned to ambulate a client

following lunch, however, a reassessment reveals shortness of breath and increased

fatigue which require the client to return to bed.

2. Reviewing and modifying the existing nursing care plan.

Modification can occur in planned nursing care when there is change in the clients health

status. Before beginning care, the nurse reviews the care plan and compares it with

assessment data to validate the stated diagnosis and determine whether the nursing

interventions are the most appropriate for the clinical situation. If the clients status has


4/13

changed and the nursing diagnosis and related nursing interventions are no longer

appropriate, the nursing care plan needs to be modified.

Modification includes several steps. First data in the assessment column are revised to

reflect the clients current status. New data entered in the care plan should be dated to

inform other members of the health care team. Nursing diagnosis are revised. Then the

specific implementation methods are revised to correspond to the new nursing diagnosis

and client goals. Finally the nurse determines what methods of evaluation will be used.

3. Organizing resources and care delivery :

A facilitys resources include equipment and skilled personnel. Organization of

equipment and personnel make efficient , skilled client care possible. The nurse Prepares

the necessary supplies and decides on the time and provide of care.

Preparation of care delivery also involves preparing the environment and client for

nursing intervention.

a. Equipment.

b. Personnel.

c. Environment.

d. Patient and patient visitors

1. Equipment : Most nursing procedures require some equipment or supplies. The

nurse analyzes each planned interventions for needed item and provider of care.

Preparation of care delivery also involves preparing the environment and clientfor nursing intervention .Equipment should be in working order to ensure safe

use.Eg. Catheterization.

2. Personnel: As the nurse prepares to intervene, he or she must consider the

competencies of personnel available and model of care delivery being used. The

most common types of nursing delivery systems are functional, team, total client

care, primary nursing and care management.

3. Environment: Environment factors influence the delivery and reception care.

The surroundings in which nursing activities occur should be of safe and

conducive to the implementation of the therapy. Privacy promotes relaxation,

when body parts are exposed.

4. patient and patient visitors

Patient should be prepared well (physically and mentally) before implementing any

intervention in order to gain his co-operation


5/13

Visitors can be allowed during performing of certain procedures in order to make

them develop care giving skills at home.

5. Anticipating and preventing complications :

Risks to the client arises from both the illness and treatment. The nurse must identify

these risks, evaluate and relative benefit of the treatment versus the risk and initiate risk

prevention measures. The nurse needs to be aware of potential complication and institute

Precautionary measures. Eg. Diabetic patient- preventing complications.

5. Identifying areas of assistance :

Some nursing situation requires the nurse to acquire assistance by seeking additional

personnel, knowledge and nursing skills. Assistance may be needed in performing a

procedure, comforting a client or preparing the client for a procedure. Eg. Pre-op

counseling for a client posted for surgery.

6. Implementing nursing interventions:

A variety of interventions can be selected by the nurse in administering care. The nurse

selects from the following intervention methods to achieve goals of nursing care.

a. Performing, assisting or directing the performance of activities of daily

living.

b. Counseling and evaluating the client and family.

c. Providing direct nursing care.

d. Supervising and evaluating the work of other staff members.Nursing practice is composed of cognitive, interpersonal and psychomotor skills. These

skills are needed to implement interventions.

7. Documentation

Record serves as a communication tool and a resource to aid in determining the

effectiveness of care and to assist in setting priorities for ongoing care

Competencies essential to nursing practice

a. cognitive competencies

b. technical competencies

c. interpersonal competencies

d. ethical competencies

Cognitive competencies


6/13

Knowledge of what information you need to implement the nursing interventions that

effectively meet the nursing needs of the client

Knowledge pertinent to the standards of care and agency and institutional policies

Ability to think critically about how to respond to the patients need for nursing

Technical competencies

Ability to use equipment and techniques competency that are specified by the patients plan of care.

Interpersonal competencies

Ability to establish a trusting nurse patient relationship

Ability to communicate to the patient that you are more concerned about the patient and

his wellbeing than about the role implementation of the plan of care or accomplishment of tasks

Ability to work collaboratively with the member of the care giving team to implement the

interdisciplinary plan of care

Ethical/legal competencies

Commitment to implementing successfully the plan of care with in the scope of your

legal practice

Ability to be a trusted and effective patient advocate

Consistent use of appropriate legal safeguards while implementing the plan of care

Implementation methods

The nurse carries the nursing care plan by using several implementation methods. A client with impairedphysical mobility may require assistance in daily activities. The client with ineffective coping related

fear of hospitalization may require counseling. For each diagnosis the nurse identifies appropriate

interventions, each which requires specific theoretical knowledge and clinical skills.

The implementation methods are

a. assisting with activities of daily living

b. counseling

c. teaching

d. providing direct nursing care

e. delegating, supervising and evaluating the work of other staff members

f. recording

a. Assisting with activities of daily living

activities of daily living usually performed in the course of a normal day they include ambulating,

eating, dressing, bathing and grooming etc. conditions resulting in the need for assistance with ADLS

can be acute, chronic, temporary assistance with ADLS, the client needs assistance during a specific

period. A client with total self care deficit related to an irreversible injury has a permanent need for


7/13

assistance. The client can be taught new ways to perform ADLS, thus becoming more independent and

better able to perform self care.

b. Counseling

Counseling is an implementation method that helps the client use a problem solving process to recognize

and manage stress and that facilitates interpersonal relationship among the client, family and health care

team. Counseling is emotional, intellectual, spiritual and psychological support that helps the client

accept or impending changes resulting from stress. Clients needing counseling include

Persons who must adjust lifestyle patterns

Clients coping with chronic or disabling diseases.

Clients with life threatening illness to cope with possibility of death.

c. Teaching

Teaching involves use of communication skills to effect a change in the client. The main focus ofteaching is intellectual growth or the acquisition of new knowledge or psychomotor skills. Teaching is

an important implementation method used to present correct principles, procedures and techniques of

health care to the clients and to inform clients about their health status. The nurse is responsible for

assessing the learning needs of clients and is accountable for the quality of education delivered.

d. Providing direct nursing care

To achieve the therapeutic goals for the client, the nurse initiates interventions to compensate for

adverse reactions. Uses precautionary or preventive measures in providing care, applies correct

techniques in administering care and preparing the client for special procedures and initiates life long

measures in emergency situations.

Compensation for adverse reaction

An adverse reaction is a harmful or unintended effect of a medication, diagnostic test or therapeutic

intervention. Nursing actions that compensates for adverse reactions reduce or counteract that reaction

Preventive measuresThese actions are directed at promoting health and preventing illness to avoid the need for acute or

rehabilitative health care.

Prevention includes assessment and promotion of the clients health potential, application of prescribed

measures such as immunizations, health teaching, and early diagnosis and treatment.

e. Delegating, supervising and evaluating the work of other staff members


8/13

Some activities may be delegated to other members of health care team and co-coordinated by the nurse.

When a nurse delegates aspects of a clients care to another staff member, the nurse assigning tasks is

responsible for ensuring that each task is appropriately assigned and is completed according to the

standard of care. She will supervise and evaluate the work of other staff members.

f. Recording

Documentation of the implementation component involves the use of written record, the health care

record and the care plan is accurately becoming a permanent part of the health care record in many

agencies.

Documentation describes the actions implemented by the nurse, client or others in terms of the nursing

diagnosis, the clients responses to the implementation of the plan is also recorded responses consist of

physical, psychological, social and spiritual behaviors.

It helps the other shift nurses to quickly see what is to be done and if any intervention was omitted. It

serves as a legal document.

Factors affect implementation

inadequate nursing staff

lack of family support

lack of resources-man, money, material

unrealistic expectation from colleagues

no financial/other incentives

conflict with nursing managers

being used for non nursing responsibility incomplete protocols

non-acceptance of role


9/13

Self-

care

Self-

care

agency

Self-

care

deficit

Self-

care

deman

d

Nursing

system

It is the totality ofself care action to be

performed self carerequisites by using

valid methods &

related sets of operation & action

each persons

therapeutic demandvaries throughout

life.

Self care agents are providers of self

care . agents arethose who can/have

take care of

themselves, - power to regulate

factors that affect

their own function

The goal of nursing agency is to help

people meet their dependant others

therapeutic self

Three components of nursing agency are,

1.help client accomplish theureuutic self-

care.2. Help the client to increaseindependence steadily decline self-care, adjust

interruption.3.hel family members in providing

client care.


10/13

Self care

agency

Self care

agency

Self care

agency

Self care

agency

Self care

agency

Age.gender.

Socioculturalorientation.

development

stauts.health status.

health caresystem factors.

Environmental

factors.Resource

adequacy &availability

DOROTHEA. E. OREM

SELF CARE MODEL


11/13

Self-

care

Self-

care

agency

Self-

care

deficit

Nursing

system

Self-

care

deman

d

Mr.Ramesh aged 28years maintains

sufficient air, I feel difficult to pass themotion, I dont feel like eating, I have

severe body pain. He is prone to get

hazards, as he is restless, needs medicalhelp for health promotion.

Mr. Ramesh needsadjustment with body

change. Due to fracture.

-pain due to fracture,-confined to bed, constipation.

-altered elimination.-imbalanced nutritional status.

-prone to injury & complications.-altered body image.

As Mr. Ramesh isconfined to bed due to

traction, so nursing

personnel are neededto provide care

-acute pain related tofracture.

- impaired physicalmobility r/t confinementin traction.

-impaired skin integrityr/t inability to change

the position secondary totraction.

-self care deficit r/ttraction.

-imbalanced nutritionalstatus less body

requirement r/t less

intake.

-risk for injury r/ttraction.-knowledge deficit r/t

exercise, diet, follow up.

Conditioning factors.Name: Mr. Ramesh.Age : 28 years.

Sex : male.Occupation : students.

Family : good support.Health status : moderately

built.

Diagnosis : Right femur &ulnar fracture (traction)

Wholly compensatory, supportive educativesystem


12/13

Accomplishes clients therapeutic self care

Supports and protects.

Compensates for clients inability to engage

self care.

Performs some self care measures

Assists client as required

Compensates for self care limitation of client.

Perform some self care measures for client.

Accepts care and assistance for nurse.

Accomplishes self care.

Regulates self care agency

PARTLY

COMPENSATORY

SUPPORTIVE-

EDUCATIVE SYSTEM

Regulates the exercise and development ofself care agency.

WHOLY

COMPENSATORY

BASIC NURSING SYSTEM


13/13

workshop on implementation

Documents