Chapter 14

Implementing

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Purposes of Implementation
Help the patient achieve valued health outcomes.
Promote health.
Prevent disease and illness.
Restore health.
Facilitate coping with altered functioning.

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Aims of NOC Research

Identify, label, validate, and classify nursing-sensitive
patient outcomes and indicators.
Evaluate the validity and usefulness of the classification
in clinical field testing.
Define and test measurement procedures for the
outcomes and indicators.

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Clinical Reasoning and Implementing

Reassess the patient for changes in status that might
dictate a different set of interventions.
Be sure that research supports the interventions you
have selected and be open to better ways of addressing
patient problems and issues.
Always monitor the patients responses to your
interventions so that you can modify the plan of care if
needed.
Assess, reassess, revise, record

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Types of Nursing Interventions

Those providing direct

Physiological or psychosocial
Those which provide indirect care
Management of the patients environment,
interdisciplinary collaboration, community programs
Those aimed at individuals, family, and community
Those for nurse-initiated and other provider-initiated
treatments

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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, staff
Anticipating unexpected outcomes/situations
Monitor for complications
Preventing errors and omissions
Promoting self-care: teaching, counseling, and advocacy
Assisting patients to meet outcomes
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Reassessing the Patient and Reviewing

the Plan of Care
Be sure that each nursing intervention is supported by a
sound scientific rationale, as demanded by an evidencebased practice.
Be sure that each nursing intervention is consistent with
professional standards of care and consistent with the
protocols, policies, and procedures of the institution or
agency.
Be sure that the nursing actions are safe for this
particular patient and individualized to the patients
preferences.
Clarify any questionable orders.

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Guidelines for Interventions

Act in partnership with the patient/family.
Before implementing, reassess the patient to determine
whether the action is still needed.
Approach the patient competently.
Approach the patient caringly.
Modify nursing interventions according to the patients
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.
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Implementing Guidelines (cont.)

Check to make sure that the nursing interventions
selected are consistent with standards of care.
Always question that the nursing intervention selected is
the best of all possible alternatives.
Develop a repertoire of skilled nursing interventions. The
more options one can choose from, the greater the
likelihood of success.

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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
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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

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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

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Essentials of Effective Delegation

Know your state and institutional policies on delegation.
Be clear on the difference between nursing process and
nursing tasks.
Know the training and background of the unlicensed
assistive personnel.
Know the patients needs and what the patient is at risk
for.
Know what clinical cues the UAP should be alert for and
why.
Assess which tasks can be safely delegated.

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Essentials of Effective Delegation (cont.)

Have the UAP repeat your instructions to be sure you

have communicated them clearly.
Make frequent walking rounds to assess patients.
When talking with the patient, members of the patients
family, or UAPs, listen for cues that indicate changes in
the patients condition.
Take frequent mini-reports for the UAP.
Evaluate the UAPs performance and the patients
response.

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Checklist for Organizing Student Clinical

Responsibilities
Patient profile and name by which patient is addressed
Patients chief complaint and reason for admission
Patients current health status
Routine assistance to meet basic human needs
Priorities for nursing care and special daily events
Special teaching, counseling, or advocacy needs
Special family needs

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