Week 5- Ch. 14- Implementing

Airgas templateChapter 14
Purposes of Implementation
Promote health.
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Aims of NOC Research
Identify, label, validate, and classify nursing-sensitive patient outcomes and indicators.
Evaluate the validity and usefulness of the classification in clinical field testing.
Define and test measurement procedures for the outcomes and indicators.
Clinical Reasoning and Implementing
Reassess the patient for changes in status that might dictate a different set of interventions.
Be sure that research supports the interventions you have selected and be open to better ways of addressing patient problems and issues.
Always monitor the patient’s responses to your interventions so that you can modify the plan of care if needed.
“Assess, reassess, revise, record”
Types of Nursing Interventions
Management of the patient’s environment, interdisciplinary collaboration, community programs
Those aimed at individuals, family, and community
Those for nurse-initiated and other provider-initiated treatments
Implementing the Plan of Care
Reassessing the patient and reviewing the plan of care
Utilize evidence based practice
Clarifying prerequisite nursing competencies
Assisting patients to meet outcomes
Reassessing the Patient and Reviewing the Plan of Care
Be sure that each nursing intervention is supported by a sound scientific rationale, as demanded by an evidence-based practice.
Be sure that each nursing intervention is consistent with professional standards of care and consistent with the protocols, policies, and procedures of the institution or agency.
Be sure that the nursing actions are safe for this particular patient and individualized to the patient’s preferences.
Clarify any questionable orders.
Guidelines for Interventions
Act in partnership with the patient/family.
Before implementing, reassess the patient to determine whether the action is still needed.
Approach the patient competently.
Approach the patient caringly.
developmental and psychosocial background
ability and willingness to participate in the plan of care
responses to previous nursing measures and progress toward goal/outcome achievement.
Implementing Guidelines (cont.)
Check to make sure that the nursing interventions selected are consistent with standards of care.
Always question that the nursing intervention selected is the best of all possible alternatives.
Develop a repertoire of skilled nursing interventions. The more options one can choose from, the greater the likelihood of success.
Variables Influencing
Outcome Achievement
Patient variables
Developmental stage
Psychosocial background
Nurse variables
Common Reasons for Noncompliance
Lack of family support
Low value attached to outcomes
Adverse physical or emotional effects of treatment
Inability to afford treatment
Limited access to treatment
Delegation as an RN
Delegation is the transfer of responsibility for the completion of a task to another person while keeping responsibility for the outcome
Delegation is not the same as assignment
Delegation may be made to UAPs or LPNs
LPNs are responsible for patients that are stable and predictible
Essentials of Effective Delegation
Know your state and institutional policies on delegation.
Be clear on the difference between nursing process and nursing tasks.
Know the training and background of the unlicensed assistive personnel.
Know the patient’s needs and what the patient is at risk for.
Know what clinical cues the UAP should be alert for and why.
Assess which tasks can be safely delegated.
Essentials of Effective Delegation (cont.)
Have the UAP repeat your instructions to be sure you have communicated them clearly.
Make frequent walking rounds to assess patients.
When talking with the patient, members of the patient’s family, or UAPs, listen for cues that indicate changes in the patient’s condition.
Take frequent mini-reports for the UAP.
Evaluate the UAP’s performance and the patient’s response.
Checklist for Organizing Student Clinical Responsibilities
Patient profile and name by which patient is addressed
Patient’s chief complaint and reason for admission
Patient’s current health status
Routine assistance to meet basic human needs
Priorities for nursing care and special daily events
Special teaching, counseling, or advocacy needs
Special family needs

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Week 5- Ch. 14- Implementing