implementation

• Implementation


  Involves the execution of the nursing plan of care derived during the planning phase of the nursing process
• Implementation


  • Involves completion of nursing activities to accomplish predetermined goals and to make progress toward achievement of specific outcomes
• Implementation

  • Putting nursing care plan into ACTION!
  • To help client attain goals and achieve optimal level of health
  • Requires: Knowledge, Technical skills, Communication skills, Therapeutic Use of Self
• Something that is not written is considered as not done
• Requirements for effective implementation

  • Cognitive (intellectual) skills
  • Psychomotor (technical) skills
  • Interpersonal skills
• Cognitive skills


  • Enable nurses to make appropriate observations, understand the rationale for the activities performed, and appreciate the differences among individuals and how they influence nursing care
• Critical thinking


  • An important element within the cognitive domain because it helps nurses to analyze data, organize observations, and apply prior knowledge and experiences to current client situations
• Psychomotor skills


  • Necessary to safely and effectively perform nursing activities
  • Nurses must be able to handle medical equipment with a high degree of competency and to perform skills such as administering medications and assisting clients with mobility needs
• Interpersonal skills


  • Involves with clients and families as well as with other health care professionals
  • The nurse-client relationship is established through the use of therapeutic communication that helps ensure a beneficial outcome for the client's health status
• Implementation activities

  • Ongoing assessment
  • Establishment of priorities
  • Allocation of resources
  • Initiation of nursing interventions
  • Documentation of interventions and client response
• Prior to implementation, it is necessary to determine

  • What is to be done
  • How it is to be done
  • When it should be done
  • Who will do it
  • How long it should be done
• Standing Orders - Physician's Orders


  • Clear liquid supper evening prior to test
  • 16 oz citrate of magnesia 6 PM
  • Ducolax tabs iii at 8 PM
  • NPO after midnight
  • Enemas until clear AM of test
  • Milk of magnesia 30 ml PO following test
• Protocol


  • A series of standing orders or procedures that should be followed under certain specific conditions
  • They define what interventions are permissible and under what circumstances the nurse is allowed to implement the measures
• Types of nursing interventions

  • Nurse-initiated
  • Health care practitioner-initiated
  • Derived from collaboration with other health care professionals
• Categories of nursing interventions

  • Independent
  • Dependent
  • Interdependent
• Nursing intervention activities

  • Assisting with ADL
  • Delivering skilled therapeutic interventions
  • Monitoring and surveillance of response to care
  • Teaching
  • Discharge planning
  • Supervising and coordinating nursing personnel
• Activities of Daily Living (BATTED)

  • Bathing
  • Ambulation
  • Toileting
  • Transfers
  • Eating
  • Dressing
• Instrumental Activities of Daily Living (SCUM)

  • Shopping
  • Cooking/cleaning
  • Using telephone/transportation
  • Managing money/medications
• Nurse's role


  • Determine the extent of assistance needed and to provide support for ADL while at the same time fostering independence
  • Ongoing assessment is important for determining the appropriate balance between ensuring safety and promoting independence
• Therapeutic nursing interventions

  • Administration of medications and treatments
  • Performing skilled procedures
  • Providing physical and psychological comfort
• Written orders must be verified before implementing interventions requiring prescriptive authority
• Reassessment of the client is also needed to determine if the intervention remains appropriate
• Typical monitoring activities


  • Observations such as vital signs measurement
  • Cardiac monitoring
  • Recording of intake and output
• Teaching


  • A key element in health promotion and illness management is the counseling of clients to help them modify their behaviors in response to potential health risks and actual health alterations
  • Nurses must also discuss the rationales for the interventions that are included in the care
• Discharge planning


  • Preparation for discharge begins at the time of admission to a health care facility
  • Expected outcomes dictate the type of planning required and the interventions necessary to attain the desired outcomes
• Interventions directed towards discharge planning

  • Teaching and consultation with other agencies
  • Teaching related to any changes in diet, medications, or lifestyle
  • Resolving any barriers or problems in the home environment before discharge
• Supervision and coordination of personnel


  The management style and type of facility, as well as the needs of the client, determine the scope of interventions associated with supervision and coordination of client care