Key Concepts, Chapter 14, Implementing

During the implementing step of the nursing process, nursing actions planned in the

previous step are carried out. The purpose of implementation is to help the patient

achieve valued health outcomes: promote health, prevent disease and illness, restore

health, and facilitate coping with altered functioning.

In all nursepatient interactions, the nurse is concerned with the patients response to

health and illness and the patients ability to meet basic human needs. While other health

care professionals focus on selected aspects of the patients treatment regimen, nurses are

concerned with how the patient is responding to the plan of care in general.
One of nursings major contributions to the health care team is the role of coordinator.
Remember Alfaros Rule: assess, re-assess, revise, record: Assess patients before

performing nursing actions. Re-assess them to determine their responses after you

perform nursing actions. Revise your approach as indicated. Record patient responses and

any changes you made in the plan of care.

While nurses certainly need knowledge of best-practice interventions and technical skills

to implement the plan of care, it is also true that the nurses interpersonal competence to a

large degree determines how successfully the plan is implemented. If your patients and

team do not trust you, it will be difficult to motivate everyones best effort toward

achieving goals.
There are independent, dependent, and interdependent nursing actions.
When carrying out the plan of care, nurses use specialized abilities to (1) determine the

patients new or continuing need for nursing assistance, (2) promote self-care, and (3)

assist the patient to achieve valued health outcomes.

To implement the plan of nursing care, nurses need blended intellectual, interpersonal,

technical, and ethical/legal competencies as well as mastery of the Quality and Safety

Education for Nurses Competencies.

 Successful implementation of the plan of care requires a high degree of organization and

efficiency in todays hectic health care environments. Pay special attention to the patients

family and visitors, as well as your institutions equipment, environment, and personnel.

Although most people can independently meet their basic human needs, illness and the

stress of diagnostic and therapeutic measures may interfere with a persons usual practice

of self-care. The nurse assesses the patients abilities to meet ones human needs

independently.
If the plan of care is well constructed, carrying out its orders is the nurses most important

task and should receive top priority.

Nurses concerned about improving the quality of nursing care use research findings to

enhance their nursing practice. Reading professional nursing journals and attending

continuing education workshops and conferences are excellent ways to learn about new

nursing strategies that have proved effective.

To practice good nursing, be knowledgeable about the laws and regulations that affect

health care and the ethical dimensions of clinical practice.

An important nursing intervention is ongoing data collection. In every patient encounter,

be sensitive to both subtle and dramatic changes in the patients condition. Skilled nurses

monitor the patients responses to planned interventions to determine if the plan of care is

working. These assessment findings are used to update and revise the plan of care.
Remembering the legal truth, It wasnt done if it wasnt documented, each nurse

carefully documents all nursing interventions.

When a patient does not follow the plan of care despite your best efforts, it is time to

reassess strategy. The first objective is to identify why the patient is not following the

therapy. One possibility is that the plan of care may not be right for this patient.
Never has it been more important for nurses to critically identify which nursing

interventions require professional nurses and which can be safely delegated.

 Never attempt to perform interventions beyond your capacity without supervision, even if

instructed to do so by a staff nurse.

It is difficult for nurses to be sincerely attentive to patient needs if their own human needs

are not met. Because no one is perfectly healthy or whole all the time, it is important

that nurses preparing for professional practice spend time getting to know themselves.
As you begin to develop your expertise in implementing the plan of care, reflect on your

experiencessuccesses and failuresin order to improve your practice. How can you do

it better next time? What did you learn today that can help you tomorrow?