CHAPTER 18

 IMPLEMENTING NURSING CARE

Mosby items and derived items © 2005 by Mosby, Inc.

Implementation
 Types of nursing interventions
 Direct – treatments performed on the pt.
 Indirect – performed on behalf of the pt but
away from the pt
 Protocols-written plan specific to procedures
provided in client care
 Standing orders- preprinted document with
Dr.’s orders for routine care of specific pts
with specific problems

Mosby items and derived items © 2005 by Mosby, Inc.

TYPES OF NURSING INTVENTIONS
 Independent – nurse initiated
 Dependent- doctor initiated
 Collaborative – team responsibility,
ex.) critical pathways or care maps

Mosby items and derived items © 2005 by Mosby, Inc.

Nursing Interventions

 Critical thinking and selection of nursing interventions

 Nursing diagnosis-dictates what actions will be
taken
 Expected outcomes-determines when to continue
or stop
 Evidence based-proven practice guidelines
 Feasibility- cost effectiveness; impact on other
interventions
 Acceptability-client participation & affect on pt.
 Nurse competencies-knowledge & skill

Mosby items and derived items © 2005 by Mosby, Inc.

Implementation Process
 Reassessing the client-is the
intervention still necessary?
 Reviewing and revising the existing care
plan:
 Modification may be necessary
 Revision reflects the client’s current status

Mosby items and derived items © 2005 by Mosby, Inc.

Implementation Process (cont'd)
 Organizing resources and care delivery
 Equipment- cost! Be prepared
 Personnel- delegate appropriately
 Environment-SAFETY, privacy
 Client- prep the pt.
 Anticipating and preventing complications-
Identify risks, preventative measures
 Identifying areas of assistance-personnel,
knowledge (meds, technology)

Mosby items and derived items © 2005 by Mosby, Inc.

Implementation Skills
 Cognitive skills-application of
nursing knowledge
 Interpersonal skills- therapeutic
nurse/client relationship
 Psychomotor skills- safe
performance of skills is necessary!

Mosby items and derived items © 2005 by Mosby, Inc.

Mosby items and derived items © 2005 by Mosby, Inc.
Direct Care Measures
 Activities of daily living (ADLs)-assess & preference
 Instrumental activities of daily living- independence in society
 Physical care techniques-safety for both nurse & pt.
 Counseling-assists the pt accept changes r/t problem
 Teaching- increase the knowledge of the pt.
 Controlling for adverse reactions-reduce or counteract the
reaction.
 Preventive measures- promote health & prevent illness in all
ages and circumstances

Mosby items and derived items © 2005 by Mosby, Inc.

Indirect Care Measures
 Communicating nursing interventions
 Care plans
 Shift reports
 Delegating, supervising, and evaluating the work
of other staff members
 Scope of Practice – Texas BNE
 Competency of Assistive personnel
 Responsible for task completion according to standard
of care

Mosby items and derived items © 2005 by Mosby, Inc.