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Chapter 14

Implementing

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• Restore health. • Promote health. • Facilitate coping with altered functioning.Purposes of Implementation • Help the patient achieve valued health outcomes. • Prevent disease and illness. Copyright © 2015 Wolters Kluwer • All Rights Reserved .

validate. • Evaluate the validity and usefulness of the classification in clinical field testing. and classify nursing-sensitive patient outcomes and indicators.Aims of NOC Research • Identify. label. • Define and test measurement procedures for the outcomes and indicators. Copyright © 2015 Wolters Kluwer • All Rights Reserved .

record” Copyright © 2015 Wolters Kluwer • All Rights Reserved . • Always monitor the patient’s responses to your interventions so that you can modify the plan of care if needed. reassess. • “Assess. • Be sure that research supports the interventions you have selected and be open to better ways of addressing patient problems and issues.Clinical Reasoning and Implementing • Reassess the patient for changes in status that might dictate a different set of interventions. revise.

community programs • Those aimed at individuals. interdisciplinary collaboration.Types of Nursing Interventions • Those providing direct – Physiological or psychosocial • Those which provide indirect care – Management of the patient’s environment. and community • Those for nurse-initiated and other provider-initiated treatments Copyright © 2015 Wolters Kluwer • All Rights Reserved . family.

staff • Anticipating unexpected outcomes/situations – Monitor for complications • Preventing errors and omissions • Promoting self-care: teaching. and advocacy • Assisting patients to meet outcomes Copyright © 2015 Wolters Kluwer • All Rights Reserved .Implementing the Plan of Care • Reassessing the patient and reviewing the plan of care – Utilize evidence based practice • Clarifying prerequisite nursing competencies • Organizing resources – Environment. equipment. counseling.

and procedures of the institution or agency.Reassessing the Patient and Reviewing the Plan of Care • Be sure that each nursing intervention is supported by a sound scientific rationale. policies. • Clarify any questionable orders. • Be sure that the nursing actions are safe for this particular patient and individualized to the patient’s preferences. • Be sure that each nursing intervention is consistent with professional standards of care and consistent with the protocols. as demanded by an evidencebased practice. Copyright © 2015 Wolters Kluwer • All Rights Reserved .

• Approach the patient competently. • Approach the patient caringly. reassess the patient to determine whether the action is still needed. • Before implementing.Guidelines for Interventions • Act in partnership with the patient/family. Copyright © 2015 Wolters Kluwer • All Rights Reserved . • Modify nursing interventions according to the patient’s – 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.

• Always question that the nursing intervention selected is the best of all possible alternatives.Implementing Guidelines (cont.) • Check to make sure that the nursing interventions selected are consistent with standards of care. • Develop a repertoire of skilled nursing interventions. The more options one can choose from. the greater the likelihood of success. Copyright © 2015 Wolters Kluwer • All Rights Reserved .

Variables Influencing Outcome Achievement • Patient variables – Developmental stage – Psychosocial background • Nurse variables • Resources • Current standards of care • Research findings • Current evidence based practice • Ethical and legal guides to practice Copyright © 2015 Wolters Kluwer • All Rights Reserved .

Common Reasons for Noncompliance • Lack of family support • Lack of understanding about the benefits • Low value attached to outcomes • Adverse physical or emotional effects of treatment • Inability to afford treatment • Limited access to treatment Copyright © 2015 Wolters Kluwer • All Rights Reserved .

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 Copyright © 2015 Wolters Kluwer • All Rights Reserved .

• Know what clinical cues the UAP should be alert for and why. Copyright © 2015 Wolters Kluwer • All Rights Reserved .Essentials of Effective Delegation • Know your state and institutional policies on delegation. • Know the patient’s needs and what the patient is at risk for. • Know the training and background of the unlicensed assistive personnel. • Be clear on the difference between nursing process and nursing tasks. • Assess which tasks can be safely delegated.

• Take frequent mini-reports for the UAP.) • Have the UAP repeat your instructions to be sure you have communicated them clearly. • Make frequent walking rounds to assess patients. listen for cues that indicate changes in the patient’s condition. members of the patient’s family. • Evaluate the UAP’s performance and the patient’s response. Copyright © 2015 Wolters Kluwer • All Rights Reserved . • When talking with the patient.Essentials of Effective Delegation (cont. or UAPs.

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. or advocacy needs • Special family needs Copyright © 2015 Wolters Kluwer • All Rights Reserved . counseling.