Technical skills require knowledge and, frequently, manual dexterity. The number of technical skillsexpected of a nurse has greatly increased in recent years because of the pervasive use of technology,especially in acute care hospitals.
Process of Implementing
The process of implementing (see Figure 14-1) normally includes the following:
Reassessing the client
Determining the nurse's need for assistance
Implementing the nursing interventions
Supervising the delegated care
Documenting nursing activities
Reassessing the Client
Just before implementing an intervention, the nurse must reassess the client to make sure theintervention is still needed. Even though an order is written on the care plan, the client's conditionmay have changed. For example, a client has a nursing diagnosis of
Disturbed Sleep Pattern
related toanxiety and unfamiliar surroundings. During rounds, the nurse discovers that she is sleeping andtherefore defers the back massage that had been planned as a relaxation strategy. New data may indicate a need to change the priorities of care or the nursing activities. For example, anurse begins to teach a client who has diabetes, how to give himself insulin injections. Shortly after beginning the teaching, the nurse realizes that he is not concentrating on the lesson. Subsequentdiscussion reveals that he is worried about his eyesight and fears he is going blind. Realizing that theclient's level of stress is interfering with his learning, the nurse ends the lesson and arranges for a primary care provider to examine the client's eyes. The nurse also provides supportive communicationto help alleviate the client's stress.
Determining the Nurse's Need for Assistance
When implementing some nursing interventions, the nurse may require assistance for one or more of the following reasons:
The nurse is unable to implement the nursing activity safely or efficiently alone (e.g., ambulating anunsteady obese client).
Assistance would reduce stress on the client (e.g., turning a person who experiences acute pain whenmoved).
The nurse lacks the knowledge or skills to implement a particular nursing activity (e.g., a nurse whois not familiar with a particular model of traction equipment needs assistance the first time it isapplied).
Implementing the Nursing Interventions
It is important to explain to the client what interventions will be done, what sensations to expect, whatthe client is expected to do, and what the expected outcome is. For many nursing activities it is alsoimportant to ensure the client's privacy, for example by closing doors, pulling curtains, or draping theclient. The number and kind of direct nursing interventions are almost unlimited. Nurses alsocoordinate client care. This activity involves scheduling client contacts with other departments (e.g.,laboratory and x-ray technicians, physical and respiratory therapists) and serving as a liaison amongthe members of the health care team.