A.

Definition of Nursing Interventions

Nursing interventions are actions designed to assist clients in moving

from the current level of health to the desired level in the expected results
(Gordon, 1994). Nursing orders are all actions of care that the nurse takes on
behalf of the client. These actions include interventions initiated by nurses,
doctors, or collaborative interventions (McCloskey & Bulechek, 1994).

Intervention (planning) is an activity in nursing which includes;

putting the center of goals on the client, setting the results to be achieved, and
choosing nursing interventions to achieve the goals (Potter and Perry, 1997).
The planning phase provides opportunities for nurses, clients, families and the
closest people of the client to formulate a nursing action plan to address the
problems experienced by the client. This plan is a written guide that
accurately illustrates the plan of nursing action taken against the client
according to his needs based on the nursing diagnosis.

The planning stage can be referred to as the core or main point of the
nursing process because planning is an initial decision that gives direction to
the goals to be achieved, things to be done, including how, when, and who
will carry out nursing actions. Therefore, in preparing a nursing action plan
for clients, family and the closest people need to be involved maximally.

This planning phase has several important objectives, including as a

means of communication between fellow nurses and other health teams;
increase the sustainability of nursing care for clients; and document the
process and criteria for nursing care outcomes to be achieved.The most
important element at this stage of planning is prioritizing the order of nursing
diagnoses, formulating goals, formulating evaluation criteria and formulating
nursing orders.

B. Type of intervention

There are three categories of nursing interventions, namely

interventions initiated by nurses, doctors and collaborative interventions.
Selection categories are based on client needs. One client may need all of the
three categories, while another client may only require interventions initiated
by nurses and doctors.

1. Nurse Intervention

Nurse intervention is the nurse's response to the client's health

care needs and nursing diagnoses. This type of intervention is "An act of
autonomy based on scientific rationale carried out for the benefit of the
client in a predictable manner related to nursing diagnoses and client
goals" (Bulechek & McCloskey, 1994). This intervention does not
require supervision or direction from others. For example, interventions
to increase client knowledge about adequate nutrition or daily activities
related to hygiene are independent nursing actions.

Nurse intervention does not require doctor's instructions or other

professions. Doctors often in their written instructions include
independent nursing interventions. However, under the laws of nursing
practice in most states, nursing actions relating to activities of daily
living, health education, health promotion, and counseling are in the
domain of nursing practice.

2. Doctor's Intervention

The doctor's intervention is based on the doctor's response to

medical dioagnosa, and the nurse completes the doctor's written
instructions (Bulechek & McCloskey, 1994). Providing medication,
implementing an invasive procedure, changing the dressing and
preparing the client for a diagnostic check are examples of these
interventions. This intervention is not always within the legal practice of
nursing for nurses to prescribe or instruct these actions, but such
interventions are in nursing practice for nurses to complete these
instructions and to specialize approaches to action.
 For example, the doctor instructs to replace the dressing twice a
day, intravenous medication every 6 hours, and bone scan for Tn. D. The
nurse integrates each of these instructions into the care plan D so that
these instructions are carried out safely and efficiently. Each doctor's
intervention requires specific nursing responsibilities and knowledge of
specific nursing techniques. When administering drugs, the nurse is
responsible for knowing the classification of the drug, its physiological
work, normal dosage, side effects, and nursing interventions related to
the action of the drug or its side effects. Nursing interventions relating to
the administration of medication are based on the doctor's written
instructions.

3. Collaborative Intervention

Collaborative intervention is a therapy that requires knowledge,

skills and expertise from a variety of health care professionals.

For example, Mr. J is a 78-year-old man who has hemiplegia due

to a stroke and also has a long history of dementia. His cognitive function
is limited, he is at risk of experiencing problems related to sensational
damage and mobility, and is unable to independently complete the
activities of daily life. With the aim that Mr. To maintain his current
health level, he needs specific nursing interventions to prevent pressure
sores; physical therapy interventions to prevent musculoskeletal changes
due to immobility; and occupational therapy interventions for food and
hygiene needs. This client care requires coordination of collaborative
interventions from various health care professionals all of which are
directed towards the long-term goal of maintaining the health level of
Mr. J at this time.

Thus, nurse intervention, doctor intervention, and collaborative

intervention require critical nursing assessment and decision making.
When facing a doctor's intervention or collaborative intervention, the
 nurse does not automatically implement therapy, but must determine
whether the requested intervention is appropriate for the client.

C. Intervention steps

Following are the steps in making an intervention:

1. Date and sign the plan.

The date the plan is written is important for evaluation, review and
future plans. Nurses' signatures indicate accountability towards patients
and the nursing profession because the effectiveness of nursing actions can
be evaluated.

2. Use the category heading "Nursing Interventions" and include an

evaluation date for each goal.
3. Use medical symbols or standard language and keywords, not complete
sentences to convey your idea.

For example, write "Change position and correct q2h position" instead of
"Change position and correct patient position every 2 hours".

4. Specific

Nurses now work in sif for different lengths of time, some work in
sif 12 hours and in sif 8 hours, so it is important to specify the specific
time of intervention expected.

5. Refer to the procedure book or other source of information, not include all
the steps in the written plan.For example "See the unit procedures book for
tracheostomy care".
6. Adjust the plan to the characteristics of the patient unit by ensuring that
the patient's choices, such as choices about the time of treatment and the
method used, are included.
7. Ensure that the nursing plan combines aspects of health prevention and
maintenance as well as aspects of recovery.
8. Ensure that the plan contains interventions for continuous patient
assessment (eg inspection of q8h incision).
9. Include collaborative and coordinating activities in the plan.

For example, nurses can write programs to ask nutritionists or physical

therapists about specific aspects of patient care.

10. Include patient discharge plans and home care needs.Nurses need to
consult and make arrangements with community care, social service
officers, and specialized institutions that provide information and
equipment needed by patients.