Implementing
knowledge, nursing research and
• Consists of doing and documenting the
activities that are the specific nursing
actions needed to carry out the
interventions.
Implementing skills
• Cognitive Skills (Intellectual Skills) include
problem solving decision making, critical
thinking, clinical reasoning and creativity.
They are crucial to safe, intelligent care
• Interpersonal Skills are all of the activities,
verbal and non verbal people use when
interacting directly with one another.
• Technical Skills are purposeful “hands-on”
skills such as manipulating equipment,
giving injections, bandaging, moving, lifting
and repositioning clients. These skills are
also called tasks, procedures, or
psychomotor skills.
Process of Implementing
• 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 reassesses the client to make
sure the intervention is still needed. Even
though an order is written on the care plan,
the client’s condition may have changed.
• New data may indicate a need change the
priorities of care or the nursing activities.
Determining the nurse’s need for assistance.
• The nurse is unable to implement the
nursing activity safely or efficiently alone.
• Assistance would reduce stress on the
client (turning a stroke patient)
• The nurse lacks the knowledge or skills to
implement a particular nursing activity
Implementing the nursing interventions.
• Base nursing interventions on scientific
professional standards of care
• Clearly understand the interventions to
be implemented and questions any that
are not understood
• Adapt activities to the individual client
• Implement safe care
• Provide teaching, support and comfort
• Be holistic
• Encourage clients to participate actively
in implementing the nursing
interventions
Supervising Delegated Care.
• If care has been delegated to other health
care personnel, the nurse responsible for
the client’s overall care must ensure that the
activities have been implemented according
to the care plan.
Documenting Nursing Activities.
• After carrying out the nursing activities, the
nurse completes the implementing phase by
recording the interventions and client
responses in the nursing progress notes.
Evaluating.
• To evaluate is to judge or to appraise.
Evaluating is the fifth phase. In this context,
evaluating is a planned, ongoing purposeful
activity in which the clients and health care
professionals determine the client’s
progress, the effectiveness of the nursing
care plan.
Process of evaluating client responses.
• Collecting data related to the desired
outcomes
• Comparing the data with desired outcomes
• Relating nursing activities to outcomes
• Drawing conclusions about problem status
• Continuing, modifying or terminating the
nursing care plan
Collecting Data.
• Using the clearly stated, precise and
measurable desired outcomes as a guide,
the nurse collects data so that conclusions
 can be drawn about whether goals have
been met. It is usually necessary to collect
both objective and subjective data.
Relating Nursing Activities to Outcomes.
• The third of the evaluating process is
determining whether the nursing activities
had any relation to the outcomes. It should
never be assumed that a nursing activity
was the cause of or the only factor in
meeting, partially meeting or not meeting
the goal.
Drawing conclusions about problem status.
• The actual problem stated in the nursing
diagnosis has been resolved or the potential
problem is being prevented and the risk
factors no longer exist.
• The potential problem stated in the nursing
diagnosis is being prevented but the risk
factors are still present
• The actual problem still exists even though
some goals are being met
Continuing, modifying or terminating the
nursing care plan.
• After drawing conclusions about the status
of the client’s problems, the nurse modifies
the care plan as indicated. Depending on
the agency, modification may be made by
drawing a line through portions of the care
plan, marking portions using a highlighting
pen, or indicating revisions as appropriate
for electronic charting systems. The nurse
may also write “Discontinued” “goal met” or
“problem solved” and the date
PLANNING
• The nurse collaborates with the patient and
the family and the rest of the health care
team to determine the urgency of identifies
problems and prioritizes patient needs
TYPES OF PLANNING
• INITIAL PLANNING
• ONGOING PLANNING
• DISCHARGE PLANNING
PRIORITY SETTING
• This is the ordering of nursing diagnoses or
patient problems using notions of urgency
and importance to establish a preferential
order for nursing interventions.
PLANNING PROCESS
• Setting Priorities
• Establishing client's goals
• Selecting nursing intervention
• Individualized Nursing Care Plan Writing
PRIORITY SETTING
• This is the ordering of nursing diagnoses or
patient problems using notions of urgency
and importance to establish a preferential
order for nursing interventions.
SETTING PRIORITIES
Factors to consider:
• Client’s Values and Beliefs- values
concerning health may be more important
to the nurse than to the client.
• Client’s Priorities- involving client in
prioritizing and care planning enhances
cooperation.
• Resources Available
• Urgency of Health problem
PRIORITY SETTING
HIGH- • If untreated, result in harm to patient or
others
• Consider Maslow’s Hierarchy of Needs
INTERMEDIATE- • Non-emergent, non-life
threatening needs of the patients.
LOW- may not always related to a specific illness
but affect the patient’s future well-being.
ESTABLISHING CLIENT’S GOAL
GOAL– ultimate outcome
OUTCOMES– measurable changes that must be
achieved to reach a goal
COMPONENTS OF GOAL/ DESIRED OUTCOME
STATEMENT
1. Subject- a noun ( client, any part of client)
2. Verb- specifies an action the client is to perform
3. Conditions/ Modifiers- added to verb to explain –
what, where, when, how?
 4. Criterion of Desired Outcome- level at which ERRORS IN WRITING INTERVENTION
client will perform specified behavior (time, speed,
accuracy, distance, quality) • Failure to precisely or completely indicate
nursing actions
• Patient will ambulate independently in 3 • Failure to indicate frequency
days • Failure to indicate quantity
• Patient ambulates in the hall 3 times a day • Failure to indicate method
by Friday
• Ambulate patient in the hall 3 times a day NURSING CARE PLAN
This includes nursing diagnoses, goals and/or
expected outcomes, specific nursing interventions,
and a section for evaluation findings so any nurse
is able to quickly identify a patient’s clinical needs
and situation. This may be subject to revision when
the patient’s status changes
FAILURE TO INDICATE METHOD- Apply
transparent dressing to skin tear site daily.
FAILURE TO INDICATE QUANTITY- Irrigate
wound with 100 ml normal saline until clear; once
every shift.
FAILURE TO INDICATE FREQUENCY- Administer
NURSING INTERVENTION is any treatment based
Mefenamic acid 500 mg as ordered by the
on clinical judgment and knowledge that a nurse
physician (3x a day or as necessary)
performs to enhance patient outcomes. Must be
evidenced-based. This includes direct and indirect FAILURE TO PRECISELY OR COMPLETELY
care measures aimed at individuals, families and/or INDICATE NURSING ACTIONS- Perform ROM for
community. flexion and extension of right knee; plantar flexion
and dorsiflexion of right ankle, 3x a day.
CATEGORIES OF NURSING INTERVENTIONS
TTROPAHIN
INDEPENDENT (Nurse-initiated)
Actions that a nurse can perform without
supervision or direction from others
DEPENDENT (health care provider-initiated)
Actions that require an order from the health care
provider (doctor),
INTERDEPENDENT (Collaborative)
These are therapies that require the combined
knowledge, skill and expertise of multiple health
care providers.
FACTORS IN CHOOSING INTERVENTION
1. Desired patient outcome
2. Characteristics of the nursing diagnosis
3. Research base knowledge for the intervention
4. Feasibility for doing the intervention
5. Acceptability to the patient
6. Nurse’s competency