Implementation

Nursing process is dynamic state of cyclic process .And Implementation is one of the part of this process .

1. PRESENTED BY :- Ms. Truptimayee Das TUTOR,KINS

2. OUTLINE…… Introduction Definition Purposes of implantation Process of implementation Implementation skill Intervention types Major responsibilities in nursing care

3. Introduction Nursing process is action oriented , client centered and outcome directed . Based on assessment and diagno sis phases the nurse implements the interventions and evaluating the desired outcome . Implementing is the action phase in which the nurse performs the nursing interventions Consist of doing and documenting the activities .

4. Cont… Nursing intervention as any direct care treatment that a nurse performs on behalf of a client. These treatments includes nurse initiated treatments resulting from medical diagnosis and performances of the daily essential function for the client who that can not do these.

5. Definition A nursing intervention is any treatment based on clinical judgment and knowledge that a nurse performs to enhance patient outcomes (Bulechek et al., 2008). Implementation is a 4 th steps of the nursing process. It starts after the nurse develops a plan of care with based on clear & relevant nursing diagnosis .

6. Purposes of implementation 1.Standardization of the nomenclature (e.g., labeling, describing) of nursing interventions; standardizes the language nurses use to describe sets of actions in delivering patient care. 2.Expanding nursing knowledge about connections among nursing diagnoses, treatments, and outcomes; connections determined through the study of actual patient care using a database that the classification generates.

7. Cont.. 3.Developing nursing and health care information systems. 4.Teaching decision making to nursing students; defining and classifying nursing interventions to teach beginning nurses how to find out a patient’s need for care and to respond appropriately.

8. Cont ….. 5.Determining the cost of services provided by nurses. 6.Planning for resources needed in all types of nursing practice settings. 7.Language to communicate the unique functions of nursing. 8.Link with the classification systems of other health care providers.

9. PROCESS OF IMPLEMENTATON

10. Process……. 1.Reassessing the client Before implementing an intervention, the nurse must reassess the client to make sure the interventions still needed . Ex- the client who experience the pain may become quiet &withdraw external stimuli, the nurse can intervene , validate ,& assist the client to become more comfortable.

11. Process……. 2.Determining the nurses need for assistance When implementing some nursing interventions , the nurse may require assistance for one or more of the following reasons Assistance would reduce the stress on the client The nurse unable to implement the nursing activity safely or efficient alone The nurse lacks the knowledge or skills to implement a particular nursing activity

12. Process……. 3.Implementing the nursing interventions The nurses actions may be dependent or independent It is important to explain to the client what intervention will be done Ensure client privacy

13. Process……. Guidelines Basic nursing interventions on scientific knowledge , nursing research ,and professional standards of care (evidence based practice) when there exists . Clearly understand the interventions to be implemented and question any that are not understood . Adapt activities to the individual client Implement safe care

14. Process……. Guidelines Provide teaching, support and comfort Be holistic Respect the dignity of the client and enhance the client self esteem Encourage client participation in care

15. P r ocess … ………. 4.Supervising the delegated care If care delegated to other health care personnel, the nurse responsible for the clients overall care . Ensure that the activities have been implemented according to the plan of care .

16. P r ocess .. 5.Documenting the nursing activities Nurse complete the implementing phase by recording the interventions and client responses in the progress note Part of permanent client record Nursing actions are communicated through verbally as well as writing .

17. Imp l ementing skills Co g ni t i v e skill I n terpe r s o nal skills T e c h n ical skills

18. Skills …………. Cognitive skills Problem solving Decis ion making Critical thinking Inte r personal skills Verbal non verbal co mm unic a t i on Therapeutic co mm unic a t i on Technical skills Manipulating equipment Giving i n j e c t i o ns Bandaging Moving ,lifting and repositioning the client

19. TYPES OF INTERVENTION

20. The actions of nurse carries out in collaboration with other health team members, such as physical therapists, social workers, dietician & physician. COLLABORATIVE INTERVENTION

21. Dependent intervention These are activities carried out under the physicians orders or supervision . I t i s als o kn o w n a s p h y si c i a n initiated interventions Example – administer of Inj. Paracetamol for a patient with fever more than 101 F.

22. Independent intervention Nurses are licensed to initiate on the basis of their knowledge & skills They include physical care, ongoing assessment, emotional support & comfort, teaching, counseling. It is also known as Nurse Initiated interventions.

23. Major responsibilities in implementing nursing care:- Reviewing the planned interviews for appropriateness:- The first phase of implementation involves in reviewing the planed intervention . Develop intervention Select the best intervention

24. Cont.. Scheduling & organizing the intervention:- It requires the time management skill and involves in balancing the requirements of several people including patients and health care practitioner .

25. Cont.. Collaborating with other team members:- communication with collaboration among team members are essential . So that strengthened the nursing profession & also improves the quality nursing care .

26. Cont.. Supervising & delegating nursing care by other members of nursing teams:- The delegation of nursing care is based on 6 elements, as defined by the joint commission of Accreditation of Health care Organization. Complexity of the individuals condition & nursing care needs. Stability of persons status .

27. Cont.. 3 .Complexity of the assessment required to care for the person properly ,including knowledge & skills needed by nursing staff member , orderly to complete the assessment . 4. The type of technology or equipment employed in providing nursing care . 5.Degree of supervision required by nursing staff member based on nurses level of competence. 6 .Availability of supervision .

28. Cont.. Achievements of the organizational and client care goals :- The nursing team carries out the nursing order depends in the nursing plan of care . Nursing action planned to promote client goal or outcome achievement and the resolution of the health problem should be carefully executed .

29. Cont.. Direct nursing care :- Nursing intervention may be independent or interdependent . They may also be dependent which is carried out based on the physicians order e.g - provide IV fluids & medication administration .

30. Cont.. Counseling :- It helps the individuals with long-term chronic illness and disabilities to come to term with condition . Encourage the children to verbalize fear or concern by establishing a warm ,nonthreatening atmosphere .

31. Cont.. Involving the client in health care :- Enhance the client to acceptability of the outcomes and intervention . These required desirable condition have right to informed the client ,family members and involved in provision of nursing care .

32. Cont.. Teaching the client and family :- It is the vital part of implementing the care plan and promoting the change . Nurses assume the role of teacher when clients have identifiable learning and helps to develop self care abilities .

33. Cont.. Making the referral to the health care professional :- It’s a procedure simply transfer the information from one health care facility or department to another . Documentation :- After implementation of care nurse will record information in the medical record .

34. Example :- Infective airway clearance related to physiologic effects of pneumonia as evidenced by increased sputum, coughing, abnormal breath sounds, tachypnea, and dyspnea . Implementation Administering supplemental humidified oxygen via nasal cannula at the prescribed flow rate Positioning the patient Assessing vital signs and respiratory status Begin intravenous (IV) fluid Instruct client in coughing Gradually increase client's activity level, assessing client out of bed to the chair Continue monitoring vital signs and respiratory status every 4 hours or as indicated.

35. Scenario -1 Mrs. Sabita age of 29 yrs came to OPD with sign & symptoms: pain in lower abdomen burning sensation while urination, Cloudy, dark, bloody& odour urine . Fatigue Fever She is diagnosed with UTI .

36. THANK YOU