Implementing and Evaluating

ImpleImpleImplementingmentingmenting

Doing and documenting the activities that are the specific nursing actions needed to carry out interventions

Copyright © 2016, 2012, 2008Pearson Education, Inc.

All Rights ReservedKozier & Erb's Fundamentals of Nursing, Tenth EditionAudrey Berman | Shirlee Snyder | Geralyn Frandsen

Figure 14–1 Implementing—the fourth phase of the nursing process. In this phase the nurse implements the nursing interventions and documents the care provided.

Implementing Skills

1- Cognitive (intellectual) skills Problem solving Decision making Critical thinking Creativity

2- Interpersonal skills Verbal and nonverbal Effectiveness communicate. Therapeutic communication necessary for

caring, comforting, advocating, referring, counseling, and supporting

conveying knowledge, attitudes, feelings, interest

Appreciation of the client's cultural values and lifestyle

3- Technical skills Purposeful "hands-on" skills called tasks, procedures, or

psychomotor skills Psychomotor• Physical actions that are controlled by

the mind, not by reflexes Require knowledge and manual

dexterity (براعه

Process of Implementing

1. Reassessing the client2. Determining nurse's need for

assistance3. Implementing nursing interventions4. Supervising delegated care5. Documenting nursing activities

Reassessing the client

Reassess to make sure the intervention is still needed

Client's condition may have changed

Determining the nurse's need for assistance

Inability to implement the nursing activity safely

Assistance will reduce stress on the client.

Nurse lacks knowledge or skills to implement a particular nursing activity

Implementing the nursing interventions

Base actions on scientific knowledge Clearly understand interventions Adapt activities to individual client Implement safe care Provide teaching, support, and comfort Be holistic Respect the dignity of the client and

enhance self-esteem Encourage active client participation

Supervising delegated care

Nurse still responsible for client's overall care

Must validate and respond to any adverse findings or client responses

Documenting nursing activities

Record nursing interventions and client responses

Do not record in advance

Evaluating

• Judgment and appraisal• Planned, ongoing, purposeful activity• Determines client's progress,

effectiveness of care plan• Continuous process• Demonstrates nursing responsibility

and accountability for their actions

Copyright © 2016, 2012, 2008Pearson Education, Inc.

All Rights ReservedKozier & Erb's Fundamentals of Nursing, Tenth EditionAudrey Berman | Shirlee Snyder | Geralyn Frandsen

Figure 14–3 Evaluating—the final phase of the nursing process. In this phase the nurse determines the client's progress toward goal achievement and the effectiveness of the nursing care plan. The plan may be continued, modified, or terminated.

Relationship of Evaluating to Other Nursing Process Phases

• Depends on effectiveness of preceding steps

• Assessment data must be accurate and complete.

• Desired outcome must be stated concretely in behavioral terms to be useful for evaluating.

• Without implementation/interventions, there would be nothing to evaluate.

• Evaluating and assessing overlap.

Process of Evaluating Client Responses

1-Collecting data Some may require interpretation

2-Comparing data with desired outcomes Conclusions• Goal was met• Goal was partially met.• Goal was not met.

3- Relating nursing activities to outcomes Determine whether nursing activities

had any relation to the outcome without assuming that the activity was the cause or only factor of meeting a goal

4- Drawing conclusions about problem status Actual problem has been resolved or potential

problem's risk factors no longer exist Potential problem is being prevented but risk

factors still exists Actual problem still exists even though some

goals are being met When goals partially met or not met:• Care plan may need to be revised• Client needs more time to achieve previously

established goals

5 -Continuing, modifying, or terminating the care plan

Critique each phase of the nursing process

Assessing• Incomplete or inaccurate databases

influence all subsequent steps. Diagnosing• If incomplete, add new diagnosis

statements• If complete, analyze whether nursing

diagnoses relevant

Planning: desired outcomes• If inaccurate, goals/outcomes need

revision• If accurate, goals/outcomes realistic and

obtainable• Have priorities changed?• Does client still agree with priorities?

Planning: nursing interventions• Relate to goal achievement • Investigate whether best nursing

interventions were selected Implementing• After modifications, begin nursing

process again