Ch 14 - Implementation And Evaluation - Nur 312 - Craven

Front 1

Implementation

Back 1

the action phase of the nursing process in which nursing care is provided. It is the actual initiation of the plan and recording of nursing actions. Its purpose is to provide technical and therapeutic nursing care required to help the client achieve an optimal level of health.

Front 2

Activities of Implementation

Back 2

* Reassessing
* Setting priorities
* Performing nursing interventions
* Recording nursing actions

Front 3

Implementation Skills

Back 3

*Intellectual - problem solving, decision making, teaching, ask questions, discuss alternatives, open to new ideas
*Interpersonal - non/verbal communication
*Technical - able to use equipment, machines and supplies in a particular specialty

Front 4

Reassess

Back 4

During each encounter with clients, nurses assess function, ensuring prompt attention to emerging problems. Because a client's condition can change quickly and dramatically, astute nurses remain alert to subtle cues and inferences.

Front 5

Important Factors when Setting Priorities

Back 5

* The client's condition
* New information from reassessment
* Time and resources available for nursing interventions
* Feedback from the client, family, and healthcare staff
*The nurse's experience in assessing situations and setting priorities

Front 6

Top Priorities

Back 6

ABC's
- esp with a patient with multiple trauma

Front 7

Intervention for Collaborative Problems

Back 7

nurses use both Nurse and Physician prescribed interventions
- "is this a problem that a nurse can legally treat w/o an order from a physician?"

Front 8

Referrals

Back 8

nurses may make referrals to other health care providers

-some referrals are within the scope of independent nursing practice

Front 9

Nursing Intervention Classification
(NIC)

Back 9

assists in defining the role of the professional nurse by listing direct and indirect treatments performed within the nursing role

Front 10

Educational Interventions

Back 10

develop teaching plans and provide instruction about health promotion or specific healthcare problems and their management

Front 11

Cognitive Interventions

Back 11

Educational
Supervisory

Front 12

Supervisory Interventions

Back 12

include ensuring that other members of the nursing team carry out specified aspects of the plan of care, and that those involved with the client or family show return demonstration of skills

Front 13

Interpersonal Interventions

Back 13

Coordinating
Supportive
Psychosocial

Front 14

Technical Interventions

Back 14

Maintenance
Surveillance
Psychomotor

Front 15

Coordinating Interventions

Back 15

*client activities
*involves acting as a client advocate
*making referrals for follow-up care
*collaborating with other healthcare team members
*ensuring that the client's schedule is therapeutic

Front 16

Supportive Interventions

Back 16

emphasize use of communication skills, relief of spiritual distress, and caring behaviors.
- combo of good communication and caring provides comfort and promotes a healthy response to health problems

Front 17

Psychosocial Interventions

Back 17

focus on resolving emotional, psychological, or social problems.
- humor, individual or group therapy, role-modeling social skills, and exploring feelings
- individual or group therapy

Front 18

Maintenance Interventions

Back 18

basic hygiene, skin care, & other routine N activities
- allow clients to preserve function and reduce the chance of developing complications

Front 19

Surveillance Interventions

Back 19

detecting changes from baseline data and recognizing abnormal responses
- N's can rely on sensed to detect changes
- N's often detect subtle changes in C's condition and communicate them to the Physician to minimize problems

Front 20

Psychomotor Interventions

Back 20

require technical expertise
- inserting, removing, changing, applying, administering, cleaning
- care of equipment, supplies, treatments, procedures

Front 21

Evaluation

Back 21

the sixth phase of the nursing process, follows implementation of the plan of care. Evaluation is defined as the judgment of the effectiveness of nursing care to meet client goals based on the client's behavioral responses. This phase involves a thorough, systematic review of the effectiveness of nursing interventions and a determination of client goal achievement.

Front 22

Evaluation Skills

Back 22

knowledge of standards of care, normal client responses, and conceptual models and theories of nursing; ability to monitor the effectiveness of nursing interventions; and awareness of clinical research

Front 23

Foundation for Evaluation

Back 23

Plan of care

Front 24

Purposes for carrying out Evaluation

Back 24

# To collect subjective and objective data to make judgments about nursing care delivered
# To examine the client's behavioral responses to nursing interventions
# To compare the client's behavioral responses with predetermined outcome criteria
# To appraise the extent to which client goals were attained or problems resolved
# To appraise involvement and collaboration of the client, family members, nurses, and healthcare team members in healthcare decisions
# To provide a basis for the revision of the plan of care evaluation
# To monitor the quality of nursing care and its effect on the client's health status

Front 25

Activities during Evaluation Phase

Back 25

* Reviewing client goals and outcome criteria
* Collecting data
* Measuring goal attainment
* Recording judgments or measurements of goal attainment
* Revising or modifying the client's plan of care

Front 26

Standards of Care

Back 26

authoritative statements made by nursing organizations, that describe the responsibilities of the nursing profession, against which its practitioners are held accountable

Front 27

Ability to Monitor the Effectiveness of Nursing Interventions

Back 27

Nurses Need:
- interviewing techniques
- physical & functional assessment skills
- knowledge and skill when using measuring devices & interpreting laboratory data

Front 28

Awareness of Clinical Research

Back 28

Journal clubs
Reviews of Clinical Research

Front 29

Types of Evaluation

Back 29

Structure - environmental aspects
Process - N's performance and appropriateness of care
Outcome - how client's response matches client outcome criteria/goal

Front 30

Evaluation Activities

Back 30

*Collect Data - Ob/Subjective
*Measure Goal/Outcome Achievement
-the goal was completely/partially met/unmet /and/or new problems developed
*Record Judgment or Measurement of Goal Attainment
*Revise or Modify Plan of Care

Front 31

Assess Facilitators or Barriers of Goal Attainment

Back 31

Client
Family Members
Significant Others
the Nurse
Other Healthcare Team Members

Front 32

Quality Improvement Programs

Back 32

mechanisms for healthcare organizations to assess and improve care

Front 33

Peer Review

Back 33

evaluation and judgment of a N's performance by other nurses

Front 34

Nursing Monitor

Back 34

- nursing audit
- a review by a nurse of the client's care or records to determine the extent to which that care or records meet established standards