Nursing Process: Implementation Phase Overview

Implementation Phase of Nursing Process

• Overview

  • Fourth step in the nursing process

  • Execution of the nursing care plan developed during planning phase

  • Essential for accomplishing predetermined goals and specific outcomes

  • Requires clinical knowledge, careful planning, critical thinking, and judgment

  • Constantly interacts with other phases of the nursing process

Purpose of Implementation

• Directed towards fulfilling personal needs:

  • Health promotion

  • Illness prevention

  • Illness management

  • Health restoration

• Engages in:

  • Delegation of tasks

  • Documentation of nursing interventions

• Standards of practice defined by NMBA and NCNZ emphasize

  • Critical thinking and analysis in nursing practice

  • Planned nursing care to achieve identified outcomes

Requirements for Effective Implementation

• Cognitive Skills:

  • Make appropriate observations

  • Understand rationale behind nursing activities

  • Utilize critical thinking to analyze data

• Psychomotor Skills:

  • Competently handle medical equipment

  • Perform activities such as administering medications

• Interpersonal Skills:

  • Communicate effectively with patients, families, and health care professionals

  • Establish nurse-patient relationships through therapeutic communication

Implementation Activities

• Includes a variety of activities:

  • Ongoing assessment

  • Establishment of priorities based on assessments

  • Allocation of resources

  • Initiation of nursing interventions

  • Evaluation of interventions

  • Documentation of interventions and patient responses

Ongoing Assessment

• Essential to validate relevance of nursing interventions as conditions change

• Demonstrates adaptability in care based on patient feedback and condition

  • Example: Adjusting teaching methods if a patient has impaired vision

Establishment of Priorities

• Based on:

  • Patient and family input on important problems

  • Scheduled activities by other departments

  • Resources available

Allocation of Resources

• Reviewing interventions for appropriate delegation

  • Determine if activities can be performed independently, with family, or require professional help

  • Importance of safe delegation and maintaining accountability

Types of Nursing Management Systems

• Functional Nursing:

  • Tasks divided by staff skill levels

  • Efficient for large groups, but may lack continuity in patient care

• Team Nursing:

  • RN leads a team consisting of enrolled nurses and assistants, allowing for more individualized care

• Primary Nursing:

  • One nurse is responsible for total patient care, ensuring continuity

  • Most effective with a full staff of RNs, often costly

• Total Patient Care:

  • Responsibility for patient care shifts from nurse to nurse

• Case Management:

  • Oversees planning, implementing, coordinating, and evaluating care for complex situations

Nursing Interventions

• Defined as actions that help achieve desired outcomes in patient care

• Must adhere to professional standards of care

• Includes various types:

  • Independent: Nurse-initiated

  • Dependent: Requires a practitioner’s orders

  • Interdependent: Collaborative interventions

Implementation of Interventions

• Nursing interventions must consider:

  • What to do, how to do it, when to do it, who will do it, and for how long

• Ethical considerations involve patient rights and informed consent

Monitoring and Evaluation

• Ongoing monitoring is crucial to determine the success of interventions

  • Observations include vital signs and responses to treatment

• Evaluation addresses effectiveness and adjustments to care plans based on patient progress

Documentation

• Mandatory for all interventions and patient responses

• Should be detailed and accurate to provide continuity of care and legal protection

• Include observations relevant to patient status during nursing handovers