Chapter. 19
Chapter 19: Implementing Nursing Care
Nursing Process: Implementation
Key Steps: Overview of nursing process stages in implementation.
Implementation: Taking action based on nursing plans.
Evaluation: Assessing outcomes of implemented interventions.
Assessment: Recognizing cues based on patient data.
Clinical Decision Making: Analyzing cues and prioritizing solutions.
Nursing Interventions Scope of Practice
Types of Interventions
Direct Care Interventions: Hands-on patient care.
Indirect Care Interventions: Administrative and supportive actions.
Sources of Initiation
Nurse-initiated: Actions based on nursing judgment.
Health care provider-initiated: Orders from physicians or other providers.
Other provider-initiated: Actions suggested by interdisciplinary team members.
Examples of Interventions
Patient Monitoring and Management:
Vital sign monitoring during changes.
Blood glucose testing and oxygen saturation measurement.
Pressure injury prevention.
Conducting care plan conferences and discharge planning.
Skills Utilized
Teaching and Coaching: Educating patients on self-management and providing emotional support.
Monitoring: Ensuring quality health practices through data collection and assessments.
Standard Nursing Interventions
Clinical Practice Guidelines
Provide evidence-based recommendations for managing patient conditions.
Standard Nursing Interventions and Clinical Practice Guidelines
Standard nursing interventions are specific actions nurses take to help patients based on Clinical Practice Guidelines (CPGs)—evidence-based recommendations for safe and effective care. These guidelines help nurses make the right decisions for managing common conditions.
Example:
For diabetic patients, standing orders may allow nurses to give insulin when blood sugar is high, without waiting for a doctor’s approval. Other examples include giving oxygen for breathing problems or turning patients to prevent bedsores.
Standing Orders
Pre-written instructions from doctors that let nurses act without waiting for approval (for example, giving insulin if a patient’s blood sugar is high).
Clinical guidelines ensure patients get the best care quickly and safely.
Nursing Interventions Classification (NIC)
A system for standardizing interventions to improve communication and outcome comparison across settings.
Regular reviews to ensure timely responses to patient safety goals.
Quality and Safety Education for Nurses (QSEN)
Focuses on competencies in knowledge, skills, and attitudes for ensuring quality and safety in nursing practice.
Prepares nurses to enhance healthcare systems.
Critical Thinking in Implementation
Importance of Critical Thinking
Essential for delivering effective nursing interventions.
Involves adapting to changing priorities and available time.
Knowledge and Attitudes
Knowledge Base: Understanding physiology, interventions, and patient assessment.
Attitudes Required: Independent thinking, responsibility, creativity, and confidence.
Environmental Factors
Influenced by time pressures, task complexity, and the care delivery model.
Consideration of health care resources and standards in practice.
Implementation Process
Steps to Avoid Adverse Events
Reassess patient before procedures.
Ensure nursing care plan is current.
Organize resources effectively.
Anticipate complications.
Implement interventions correctly.
Nursing Process: Implementation
Standard Nursing Interventions
Clinical Practice Guidelines: Evidence-based care instructions for managing specific conditions.
Standing Orders: Pre-approved medical orders (e.g., insulin sliding scale).
Nursing Interventions Classification (NIC): Standardizes nursing care and outcomes across settings.
Quality and Safety Education for Nurses (QSEN): Prepares nurses to improve patient safety and care quality.
Direct Care
Activities of Daily Living (ADLs) – Basic self-care tasks:
Ambulating, toileting, eating, dressing, bathing
Instrumental Activities of Daily Living (IADLs) – Everyday tasks:
Grocery shopping, cooking, cleaning, banking
Physical Care Techniques – Hands-on care to treat patients.
Lifesaving Measures – Emergency care when a patient’s life is at risk.
Counseling – Emotional, spiritual, and psychological support.
Teaching – Educating patients about their care.
Preventative Interventions – Health promotion and illness prevention (education, vaccinations, health screenings).
Controlling Adverse Reactions – Prevent and manage complications.
Indirect Care
Communicating Nursing Interventions: Documentation, charting, care plans.
Delegating, Supervising, and Evaluating Staff: Ensures tasks are done correctly and timely.
Achieving Patient Outcomes
Implement interventions on time.
Manage time and prioritize tasks.
Use resources efficiently.
Coordinate care to help patients meet their goals.
Ensure patients understand and follow interventions