CH 14 Implementing
CH 15 Evaluating
Implementing
Advantages of Nursing
Interventions Classifications
• Helps demonstrate the impact that nurses have
on the system of healthcare delivery
• Standardizes and defines the knowledge base for
nursing curricula and practice
• Facilitates appropriate selection of a nursing
intervention
• Facilitates communication of nursing treatments
to other nurses and other providers
• Enables researchers to examine the effectiveness
and cost of nursing care
• Assists educators to develop curricula that better
articulate with clinical practice
Advantages of Nursing
Interventions Classifications (cont.)
• Facilitates the teaching of clinical decision making to novice
nurses
• Assists administrators in planning more effectively for staff
and equipment needs
• Promotes the development of a reimbursement system for
nursing services
• Facilitates the development and use of nursing information
systems
• Communicates the nature of nursing to the public (McCloskey
Dochterman, & Bulechek, 2008)
Relationship of Implementation to other Phases
of the Nursing Process
• Preceding phases provide the basis for
implementation
• Implementation informs evaluation, the final
phase
• Implementation is individualized through the
assessment
• Some interventions are assessments
• It’s all intertwined and the process flows…
Implementing Skills
• Cognitive skills
– Critical thinking
• Interpersonal skills
– Therapeutic communication techniques
– Professional interpersonal skills
– Self-awareness and sensitivity
• Technical skills
– Practice makes perfect
Process of Implementing
• Reassess the client
• Determine need for assistance
• Implementing or supervising delegated care
– Explain to patient, ensure privacy, coordinate care
• Document/communicate the nursing activities
and the patient’s response
Delegation as part of Implementation
• Legal authority to delegate given by Nurse
Practice Act
• UAP’s/LPN’s
• RN can never delegate the Nursing Process
– UAP’s can assist with parts of assessment and
implementation
– Only RN’s can diagnose or plan
• Student role
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 patient’s needs and what he or she is at risk
for.
• Know what clinical cues the UAP should be alert for
and why.
• Assess which tasks can be safely delegated.
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 patient’s family, or UAPs, listen for cues
that indicate changes in the patient’s
condition.
• Take frequent mini-reports from the UAP.
• Evaluate the UAP’s performance and the
patient’s response.
Checklist for Organizing Student Clinical
Responsibilities
• Patient profile and name by which patient is
addressed
• Patient’s chief complaint and reason for admission
• Patient’s 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
Evaluating Step
•
•
•
•
•
Allows achievement of outcomes
Directs nurse–patient interactions
Measures patient outcome achievement
Identifies factors to achieve outcomes
Modifies the plan of care, if necessary
Evaluating Outcomes
• Evaluation data depends on the type of outcome
identified
• Types of outcomes:
–
–
–
–
Cognitive
Psychomotor
Affective
Physiologic
• Making VERY SPECIFIC goals/outcomes makes
evaluation easier.
• Taylor, p. 309, gives examples to explain this.
Question
Which one of the following examples is a
psychomotor outcome?
A. A patient learns how to control his weight
using the MyPyramid Food Guide.
B. A patient is able to test for glucose levels and
inject insulin as needed.
C. A patient values his health enough to decide to
quit smoking.
D. A patient is able to ambulate the hallway
following knee surgery.
Answer
Answer: B. A patient is able to test for glucose
levels and inject insulin as needed.
Rationale:
Psychomotor outcomes involve the patient’s
achievement of a new skill, such as controlling
diabetes.
Cognitive outcomes involve an increase in patient
knowledge (Answer A).
Affective outcomes pertain to changes in patient
values (Answer C).
Physiologic outcomes target physical changes in
the patient (Answer D).
Evaluating
Documenting
• Outcomes include timeframe and evaluation
must be done to meet that criteria
• Outcomes are stated in evaluation:
– Outcome (or goal) met
– Outcome partially met
– Outcome not met
• Then support your judgment! Important to
include narrative about interventions and
patient response.
Modifying the Plan of Care
• Must be done when goal not met or partially
met.
• Possible revisions include:
–
–
–
–
Change the diagnosis
Make the outcome more realistic or fine-tune it
Adjust the time frame
Add or subtract interventions
In some situations, when goal is met, plan must be
modified
If goal was “walk to the BR X 2,” tomorrow the goal
might be “Ambulate in the hall.”
Evaluation of care on an institutional
level
• Performance improvement
–
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–
–
•
•
•
•
Discover a problem
Plan a strategy
Implement a change
Evaluate the outcome
Peer review
Quality assurance programs
Nursing audits
Patient satisfaction surveys
Workbook application exercises
• Complete quizzes (handouts) by using your text to look
up answers prn.
• Please work in groups of 2-3 to answer the following—
without looking in the back of the book until you are
done!
– CH 15—Implementing
• Matching, p.80
• Correct the false statements, p.81
– CH 16—Evaluating
• Criteria-Standard Matching p.86-87
• Short answer, # 1 and #6 only.