Make Sure All Nursing Interventions Are Carried Out As Planned. Research Paper Sample

Implementation

“Consists of doing and documenting activities that are specific nursing actions needed to carry out nursing orders” (Jacob, 2008 p.35).

Outcomes
Promote Wellness
Restore Health
Disease Prevention
Help client meet desired outcomes/goals
Make altered functioning easier
Activities
Assign/Perform Planned Nursing Interventions
Decide whether there is a need for nursing assistance
Inform about the implemented nursing actions:
report verbally (if required)
document client responses to care and provided care
make sure goals are met
collaborative/ physician initiated/ nurse initiated

Implementing Skills:

Cognitive (decision-making, problem-solving, creativity, & critical thinking – to comfort, care, advocate, refer, counsel, support client)
Interpersonal (ability to communicate with others-verbal & non-verbal)
Technical (psychomotor skills-hands-on skills, e.g. manipulate equipment)
e.g. when inserting a urinary catheter, the nurse needs (1) cognitive knowledge of steps & principles of the procedure, (2) interpersonal skills to have the patient informed & reassured, and (3) technical skills to manipulate articles & drape client (Jacob, 2008).

Process of Implementing

(e.g. when directive-back message for client’s nursing diagnosis of Disturbed Sleeping Pattern and the nurse sees the client sleeping, she defers the back message, asking to change nursing activities/care priorities).

Decide Whether The Nurse Requires Assistance

(e.g. ambulating an obese, unsteady client-nurse is unable to implement the nursing activity safely alone or lacks skills/knowledge).

Implement The Nurse Interventions

base nursing intervention on evidence-based practice
aware of scientific rationale & potential complications of interventions
clearly understands the order nursing & medical plans of care are to be implemented
adapts client-focused activities that don’t affect a nursing action’s success (e.g. client’s age, beliefs, health status, environment)
provide support/teaching/comfort as needed
make the implementation & plan holistic
encourage the client to make their own decisions & participate in the nursing interventions’ implementations

Monitor The Assigned Care (ensure activities are implemented according to the care plan & responds to client’s responses/adverse findings)

Report Nursing Activities (record client responses & interventions in the nursing progress notes immediately)
(Jacob, 2008)

EVALUATION

“It is the way by which nurses determine whether a client has reached a goal [] by analyzing the client’s response, evaluation helps to determine the effectiveness of nursing care” (Timby, 2009 p.25)

Measure the degree to which outcomes/goals (not interventions) are met.

Identify factors that affect reaching goals (positively or negatively)
OUTCOME
Determine whether a plan of care requires continuation, modification or termination.
ACTIVITIES
Collaborate with the client to help relate client outcomes to nursing actions.
Determine whether outcomes/goals have been met.
Re-evaluate
Data (was all/correct data collected?)
Diagnosis (was information analyzed accurately?)
Etiology (accuracy?)
Outcome (is it realistic, measurable & patient-centered?)
Interventions (are they doable & realistic?)
Care plan (does it need modifications /revisions?)
Evaluation & Other Processes
Evaluation is dependent on all other preceding processes to be successful.
Evaluation & Assessment - data must be complete & accurate so appropriate diagnosis & desired outcomes are formulated)
Evaluation & Desired Outcomes - to evaluate client responses outcomes should be reported in behavioral terms)
Evaluation & Implementation- without a plan put in action (implementation process), evaluation could not occur (Timby, 2009).
Collection of Data (Objective & Subjective)
During assessment, nurse collects data to help make diagnosis.
During evaluation, nurse collects data to evaluate the effectiveness of nursing care (Jacob, 2008).
Evaluative measures (techniques, skill, & assessment) are required to evaluate a client’s response to nursing care (e.g. discussion of the client’s feeling).

PROCESS OF EVALUATING

Define the outcomes that will measure the client’s goal accomplishment.
Collect data associated with the desired outcomes.
Compare data collected with desired outcomes.
Associate outcomes with nursing activities.
Identify errors and reach a conclusion in regards problem status.
Monitor the quality of care (Decide whether the nursing care plan will be continued, terminated or modified) (Timby, 2009).
INTERPRETING FINDINGS
Nurse makes clinical judgment about the condition of the client and decides whether the client’s status has improved or not, using evidence - results of evaluative measures with desired outcomes (Potter & Perry, 2008).

Identify the expected client response/behavior, by goal statement analysis.

Assess the client for the desired response/behavior as per the goal statement analysis.
Compare the response/behavior with the set outcome criteria.
Critically evaluate the degree to which the client’s response/behavior matches the outcome criteria.
Evaluate the criteria, in case of partial or complete disagreement between the client’s response/behavior & outcome criteria (Potter & Perry, 2008).
DOCUMENTATION & REPORTING
A client’s progress as per the established outcomes & goals for the nursing care plan is communicated by:
Nursing progress notes (written)
Information shared between nurses during shift change (Timby, 2009).

References:

Jacob, Annamma (2008). A Comprehensive Textbook of Midwifery. Jaypee Brothers Publishers.
Potter, P., & Perry, A. (2008). Fundamentals of Nursing (7th Edition). St. Louis: Elsevier Mosby.
Timby, Barbara (2009). Fundamental Nursing Skills and Concepts. Lippincott Williams & Wilkins.