Critical Thinking- Implementation



Implementation is initiation and completion of action to accomplish the defined goals and optimal wellness of the client.
         Reassess the client
         Determine the nurse's need for assistance
         Implement the nursing interventions
         Supervise delegated care
         Document nursing activities
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.
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.


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
Environment- safe and conducive
Patient and patient visitors(family)- Gaining patient cooperation, developing care giving skills of family member.


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.


As the nurse prepares to intervene, he or she must consider the competencies of personnel available and model of care delivery being used.


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 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 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.
Providing direct nursing care
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



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item Critical Thinking- Implementation
Critical Thinking- Implementation
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