IMPLEMENTATION
Introduction:
Implementation is initiation and completion of action to
accomplish the defined goals and optimal wellness of the client.
IMPLEMENTING
•
Reassess
the client
•
Determine
the nurse's need for assistance
•
Implement
the nursing interventions
•
Supervise
delegated care
•
Document
nursing activities
Definition
Implementation is a category of nursing behavior in which the
actions necessary for achieving the goals and expected outcomes of nursing care
initiated and completed.
POTTER AND PERRY.
Nursing intervention
Nursing intervention is any action taken by the nurse to help
the client move from present health state to the health state described in the
expected outcomes
Implementation is both
patient centered ( Wholly compensatory, Partial
compensatory, supportive and educative) and functional or nurses centered ( independent, dependent, and collaborative actions
).
Purposes of
implementation
•
Assist
the patient in achieving desired health goals.
•
Promote
health.
•
Prevent disease and
illness, restore health and facilitate coping with altered functioning.
Principles of
implementation
•
The
implementation phase should be based on patient's desires and environment.
•
Implementation
should be aimed to achieve the health promotion, health restoration and high
levels of wellness.
•
Implementation
should minimize all the potential capabilities of the client.
•
Nursing
actions can be combined to achieve expected outcome.
•
Nursing
implementation should aim therapeutic environment for the client.
•
Implementation
should be based on nursing care plan, which is based on nursing diagnosis and
assessment.
•
Implementation
should aim for achievement of goals and expected outcome.
•
Implementation
should be documented legibly and legally.
Types of nursing action
1.
Independent Nursing actions.
2.
Dependent Nursing actions.
3.
Interdependent Nursing actions
4.
Protocols
5.
Standing orders
Independent nursing
action
Are those actions that the nurse can perform without
directions from others.
Dependent nursing action
Are those actions prescribed by the physicians, are
carried out by the nurse.
Interdependent Nursing
Action
Are those actions that the nurse and other health care
personnel perform together.
Protocol
A protocol is a written plan to
indicate the procedures commonly required for a particular group of clients or
situations.
Standing orders
Standing order is a written document about policies, rules,
regulations or orders regarding client care. Standing orders give nurses the
authority to carryout specific action under circumstances in the absence of
supervision of a physician.
Implementation Process
The implementation component of the nursing has 5 steps.
1. Reassessing the client.
2.
Reviewing and
modifying the existing nursing care plan.
3. Organizing resources and care
delivery.
·
Equipment
·
Personnel
·
Environment
·
Patient
and patient visitors
4. Anticipate and prevent complication.
Identifying areas of assistance.
6. Implementation skills
·
Cognitive
skills
·
Interpersonal
skills
·
Psychomotor
skills
1. Reassessing the client
The reassessment phase of the
implementation provide a mechanism for the nurse to determine whether the
proposed nursing action is appropriate for the client's level of wellness.
2. Reviewing and modifying existing nursing care plan
·
If the
client's status has changed and the nursing diagnosis and related nursing
interventions are no longer appropriate, the nursing care plan needs to be
modified.
·
Modification
includes several steps.
·
First
data in the assessment column are revised to reflect the client's current
status.
·
New
data entered in the care plan should be dated.
·
Inform
other members of the health care team.
·
Nursing
diagnosis are revised.
·
Specific
implementation methods are revised to correspond to the new nursing diagnosis
and client goals.
·
Nurse
determines what methods of evaluation will be used.
3.
Organizing Resources and Care
Delivery
·
Organization
of equipment and personnel make efficient, skilled client care possible.
·
The
nurse Prepares the necessary supplies and decides on the time and provide of
care.
·
Preparation
of care delivery also involves preparing the environment and client for nursing
intervention.
Equipment- should be in working order
Personnel- competencies, model of care delivery
Patient and patient
visitors(family)-
Gaining patient cooperation, developing care giving skills of family member.
Equipment
Most nursing procedures require some equipment or supplies.
The nurse analyzes each planned interventions for needed item and provider of
care. Equipment should be in working order to ensure safe use.
Personnel
As the nurse prepares to intervene, he or she must consider
the competencies of personnel available and model of care delivery being used.
Environment
Environment factors influence the delivery of care.
The surroundings in which nursing activities occur should be
of safe and conducive to the implementation of the therapy.
Privacy promotes relaxation, when body parts are exposed.
Patient
and patient visitors
Patient should be prepared well (physically and mentally)
before implementing any intervention In order to gain his co-operation
Visitors can be allowed during performing of certain
procedures in order to make them develop care giving skills at home.
4. Anticipating and preventing complications
Risks to the client arises from both the illness and
treatment.
The nurse must identify these risks, evaluate and relative
benefit of the treatment versus the risk and initiate risk prevention measures.
Nurse needs to be aware of potential complication and
institute precautionary measures.
5. Identifying areas of assistance
Some nursing situation requires the nurse to acquire
assistance by seeking additional personnel, knowledge and nursing skills.
Assistance may be needed in performing a procedure,
comforting a client or preparing the client for a procedure.
6. Implementation skills
A variety of interventions can be selected by the nurse in
administering care.
The nurse selects from the following intervention methods to
achieve goals of nursing care.
Performing, assisting or directing the performance of
activities of daily living.
Counseling and evaluating the client and family.
Providing direct nursing care.
Supervising and evaluating the work of other staff members.
Cognitive skills: involve application of critical
thinking in the nursing process.
Interpersonal skills: are essential for effective nursing
action. Good interpersonal communication is critical for keeping patient
informed, individualized and effective.
Psychomotor skills: psychomotor skills require the
integration of cognitive and motor activities
7. Recording
Documentation describes the actions implemented by the nurse,
client or others in terms of the nursing diagnosis.
The clients responses to the implementation of the plan is
also recorded. (responses consist of physical, psychological, social and
spiritual behaviors).
Competencies Essential to Nursing Practice
1. Cognitive competencies
2. Technical competencies
3. Interpersonal competencies
4. Ethical competencies
Cognitive Competencies
Knowledge of what information need to implement the nursing
interventions that effectively meet the nursing needs of the client.
Knowledge pertinent to the standards of care, agency and
institutional policies.
Ability to think critically about how to respond to the
patients need.
Technical competencies
Ability to use equipment and techniques competency that are
specified by the patient's plan
of care.
Interpersonal competencies
Ability to establish a trusting nurse patient relationship.
Ability to communicate to the patient that nurse is more
concerned about the patient and his wellbeing.
Ability to work collaboratively with the member of the care
giving team to implement the interdisciplinary plan of care.
Ethical/ legal competencies
Commitment to implement successfully the plan of care with in
the scope of legal practice.
Ability to be a trusted and effective patient advocate.
Consistent use of appropriate legal safeguards while
implementing the plan of care.
Implementation Methods
·
Assisting
with activities of daily living
·
counseling
·
teaching
·
providing
direct nursing care
·
delegating,
supervising and evaluating the work of other staff members
·
recording
Assisting with activities of daily
living
Activities of daily living usually performed in the course of
a normal day they include ambulating, eating, dressing, bathing and grooming
etc.
Conditions resulting in the need for assistance with ADLS can
be acute, chronic, temporary assistance with ADLS.
The client needs assistance during a specific period. A
client with total self care deficit related to an Irreversible injury has a
permanent need for assistance.
Counseling
Counseling is an emotional, intellectual, spiritual and
psychological support that helps the client to accept changes resulting from
stress.
Clients needing counseling include-
Persons who must adjust lifestyle patterns
Clients coping with chronic or disabling diseases
Clients with life threatening illness to cope with
possibility of death.
Teaching
Teaching involves use of communication skills to effect a
change in the client.
The main focus of teaching is intellectual growth or the
acquisition of new knowledge or psychomotor skills.
Teaching is an important implementation method used to
present correct principles, procedures and techniques of health care to the
clients and to inform clients about their health status
The nurse is responsible for assessing the learning needs of
clients and is accountable for the quality of education delivered.
To achieve the therapeutic goals for the client, the nurse
initiates interventions to compensate
for adverse reactions.
Uses precautionary or preventive measures in providing care.
Applies correct techniques in administering care and
preparing the client for special procedures and initiates life long measures in
emergency situations.
Compensation for adverse reactions
An adverse reaction is a harmful or unintended effect of a
medication, diagnostic test or therapeutic intervention.
Nursing actions that compensates for adverse reactions reduce
or counteract that reaction.
Preventive measures
These actions are directed at promoting health and preventing
illness to avoid the need for acute or rehabilitative health care.
Prevention includes
·
assessment
and promotion of the client's health
·
immunizations,
·
health
teaching,
·
early
diagnosis and treatment.
Delegating, supervising
and evaluating the work of other staff members
·
The
nurse assigning tasks is responsible for ensuring that each task is
appropriately assigned and is completed according to the standard of care.
·
She
will supervise and evaluate the work of other staff members.
·
Factors
affecting implementation
·
Poor
levels of nursing staff
·
Ambiguous
job description
·
Lack
of resources- man, money, material
·
Unrealistic
expectation from colleagues
·
No
financial/other incentives
·
Conflict
with nursing managers
·
Being
used for non nursing responsibility
·
Incomplete
protocols
·
Non-acceptance
of role
·
Lack
of family support
·
Adverse
physical or emotional effects of treatment
COMMENTS