SRI DEVARAJ URS COLLEGE

OF NURSING -- Tamaka Kolar

SUBJECT– ADVANCED NURSING PRACTICE

TOPIC--- NURSING PROCESS, PLANNING , IMPLEMENTATION,

EVALUATION

YEAR- Ist Year M.sc nursing

Presented by:
Beneta V
SDUCON
TAMAKA KOLAR
WELCOME
 LEARNING OBJECTIVES
• AT THE END OF THE CLASS STUDENTS WILL BE ABLE TO KNOW ABOUT:

1. What Is Planning ?
2. Purposes Of Planning?
3. Types Of Planning ?
4. How To Develop A Nursing Care Plan?
5. Formats Of Nursing Care Plan ?
6. Process Of Planning ?
7. Types Of Goal?
8. What Is Nursing Intervention?
9. Types Of Nursing Intervention ?
10. Components Of Nursing Order?
11. What Is Implementation ?
12. Process Of Implementation?
13. What Is Evaluation?
14. Types Of Evaluation?
 INTRODUCTION

• Nursing process is a systematic problem solving approach used to identify prevent & treat

actual or potential health problems & promote wellness. A systematic way to plan implement

& evaluate care for individual families, groups & communities.

  DEFINE PLANNING

• Planning is the third phase of the nursing process,

•  Planning involves decision making and problem solving.

• It is the process of formulating client goals and designing the nursing interventions

required to prevent, reduce, or eliminate the client’s health problems.

 PURPOSES OF
PLANNING
1. Direct client care activities.

2. Promote continuity of care.

3. Focus charting requirements.

4. Allow for delegating of specific activities.

 TYPES OF PLANNING

Initial Discharge
Planning Planning

Ongoing
Planning
PATIENT INFORMATION'S

Name of the patient – Master Dinesh

Age :- 7 years
Sex – male
Ward- A43 ward
Classification – pre schooler
Date of admission – 30/8/21
Final diagnosis- myeloid leukemia
 MEDICAL HISTORY
PAST:- Master Dinesh is k/c/o myeloid leukemia from past 1 year on regular treatment

PRESENT :- came to hospital for platelet transfusion as platelet has decresed to less than 30,000
 TYPES OF PLANNING
1. Initial Planning : Planning which is done after the initial assessment
- cbc profile (platelets has decreased 27.000) / mm3 in client
normal value - 150 to 450 thousand mm cube platelets
2. Ongoing Planning : It is a continuous planning.
platelet transfusion and adequate fluid intake

3. Discharge Planning : Planning for needs after discharge

health education on prevention of infection and injuries, and frequent follow up and regular
medications.
 DEVELOPING NURSING CARE PLANS
• The end product of the planning phase of the nursing process is a formal or informal plan of
care:

Informal care Individualized Kardex care

plan care plan plan

Formal care Standardized

plan care plan
 AN INFORMAL CARE PLAN

• It is a plan of action that exists in the nurses mind.

• Eg: Nurse may think “ Master. Dinesh Asha is very tired, I will need to reinforce him for

teaching after he is rested”

 FORMAL CARE
PLAN
.

Is a written guide that organizes information

about the clients care
 STANDARDIZED CARE
PLAN
.

It specify the nursing care for group of clients with common needs

Eg: All patients with fever (Pyrexia)

 INDIVIDUALIZED CARE
PLAN
• .
These are tailored to meet the unique needs of a specific patients

Eg: A patient with myeloid leukemia

 KARDEX CARE PLAN
•  It is a name for a system in which client information & instruction for some of the clients
care are kept on a large card in a central file, making information quickly accessible:

• Example: The Kardex contains information about

• Diet

• Activity Level

• Self care/ Hygienic needs

• Treatments

• Procedure
 FORMATS FOR NURSING CARE
PLAN
• The care plan is organized into seven categories:

Assessmen Nursing Goal / Nursing

t Diagnosis Desired intervention Rationale
outcomes

Implementa
Evaluation
tion
 PROCESS OF PLANNING INCLUDES

• Setting priorities.

• Establishing client goals/desired outcomes.

• Selecting nursing interventions and activities.

• Writing individualized nursing interventions on care plans.

 SETTING
PRIORITIES
• The nurse begin planning by deciding which nursing diagnosis requires attention first, which

second, and so on.

• Nurses frequently use Maslow’s hierarchy of needs when setting priorities.

• Example: In this physiologic needs such as air, food and water are basic to life and receive

higher priority than the need for security or activity

 Nursing Diagnosis According To Priority

1. Risk for infection related to inadequate secondary defenses (alterations in mature WBC’S).

2. Activity intolerance related to insufficient physiologic or physiological energy to endure

or complete required or desired activity.

3. Risk for deficient fluid volume related to decreased fluid intake.

4. Deficient knowledge related to lack of exposure to resources.

ESTABLISHING CLIENT GOALS/DESIRED
OUTCOMES
• It is a specific and measurable behaviour or response that reflects a clients highest possible
level of wellness and independence in function After establishing priorities the nurse set goals
for each nursing diagnosis.

• Goals may be short term or long term.

 TYPES OF GOALS
.

Short term goal Long term goal

 SHORT TERM GOAL

• It is an objective that is expected to achieved / with in a short time, usually less than a week.

• Risk for infection related to inadequate secondary defenses (alterations in mature WBC’S).

• Example: identify actions to prevent / reduce risk of infection.

 LONG TERM GOAL

• It is an objective that is expected to believe over a longer time frame, usually over weeks or

months.

• Example: Demonstrate techniques, life style changes to promote safe environmental

and achieve timely healing

 EXAMPLE- 2 OF SHORT AND LONG
TERM GOALS
• Activity intolerance related to insufficient physiologic or physiological energy to endure or complete

required or desired activity.

• Short term goals :

• Child will report a measurable increase in activity tolerance

• Long term goals:

Participate in activities of daily living to the level of ability.

 NURSING
INTERVENTIONS &
ACTIVITIES
• A nursing intervention & activities are the action a nurse performs to improve patient’s
health.
 TYPES OF NURSING INTERVENTION
• .
Independent
interventions 

TYPES OF
NURSING
INTERVENTI
ON
Dependent Collaborative
interventions interventions
 INDEPENDENT INTERVENTIONS

.
They include
Are those
physical
activities that
care, ongoing It is also
nurses are
assessment, known as
licensed to
emotional nurse
initiate on the
support & initiated
basis of their
comfort, intervention
knowledge
teaching,
and skills.
counselling
 NURSING INTERVENTIONS :
Activity intolerance related to insufficient physiologic or physiological energy to endure or
complete required or desired activity.

1. INDEPENDENT INTERVENTION:-
• Evaluate reports of fatigue and observing the inability to participate in activities.
• Encourage to keep a dairy of daily routines & energy levels and observing the activities that
increases fatigue.
 DEPENDENT INTERVENTIONS
• .

These are Example:

activities administer inj.
It is also
carried out paracetamol
known as
under the for the
physician
orders or patients with
initiated
supervision of fever more
intervention
a licensed than 101
physician. degree F
 DEPENDENT INTERVENTIONS
• Activity intolerance related to insufficient physiologic or physiological energy to endure or
complete required or desired activity.

Dependent interventions

• 1. Provide supplemental oxygen As advised by the physician

 COLLABORATIVE
INTERVENTIONS
• .
Are actions the nurse
carries out in
collaboration with
other health team
members such as
physical therapist,
social workers,
dietician, &
physician
 COLLABORATIVE
INTERVENTIONS
• Activity intolerance related to insufficient physiologic or physiological energy to endure or
complete required or desired activity.

• Collaborative interventions:-

• Recommended small nutritious high protein meals and healthy snacks through out the day
 WRITING INDIVIDUALIZED NURSING
ORDERS
• After choosing the appropriate nursing interventions, the nurse writes them on the care plan.

• Nursing care plan is a written or computerized information about the client’s care.
COMPONENTS OF NURSING
Date ORDERS
Signature

Action verb

Time
element

Content
area
 COMPONENTS OF NURSING ORDERS
• DATE: Nursing orders are dated when they are written and reviewed regularly at intervals
that depends on the individuals need.

• ACTION VERB: The verb starts the orders and must be precise Example: Check the
temperature of the patient Explain the action of Tablet. Paracetamol.

• CONTENT AREA :The content is the where and the what of the order.

• TIME ELEMENT: The time element answers when, how long or how often the nursing
action is to occur

• SIGNATURE: of the nurse prescribing the order shows the nurse’s accountability and has
legal significance
 EXAMPLE
DATE ACTION CONTENT TIME SIGNATURE
• . AREA ELEMENT

20/03/2021 Palpate Abdomen for Hourly once Mrs. Manju

firmness
 IMPLEMENTATION

• It is the fourth phase of the nursing process

• Implementation consists of doing and documenting the activities.

• The process of implementation includes

Implementing the Documenting nursing

nursing interventions activities
 IMPLEMENTING THE NURSING INTERVENTIONS

• To implement the care plan successfully, nurses need following three skills. They are:

Cognitive Interpersonal Technical

Skills Skills Skills
 COGNITIVE SKILLS

• It include problem solving, decision making, critical thinking and curative thinking.

• It is also known as intellectual skills

 INTERPERSONAL
SKILLS
• These are all the activities, verbal & non verbal, people use when communicating directly

with one another.

 TECHNICAL
SKILLS
These are “hands on” skills such as manipulating equipment, giving injecting and bandaging,

moving, lifting and repositioning clients.

PROCESS OF IMPLEMENTATION

Reassessing the
client

Determining the
Communicating
nurses need for
the nursing actions
assistance

Delegating & Implementing the

Supervising nursing orders
 REASSESSING THE CLIENT

• Just before implementing an order, the nurse must reassess the client to make sure the

intervention is still needed.

• Even though an order is written on the care plan, the clients condition may have changed
 DETERMINING THE NURSES NEED
FOR ASSISTANCE
When implementing the some nursing care the nurse may require assistance for one of the

following reasons :

The nurse is unable to implement the nursing care safely alone.

Eg: turning an obese patient in the bed.

 IMPLEMENTING NURSING
ORDERS
• It is important to explain to the client what will be done, what sensations to expect and what

the client is expected to do.

 GUIDELINES FOR
IMPLEMENTING NURSING
ORDERS
• Nursing actions should be based on scientific knowledge, nursing research and professional standards of

care.

• Nurses should understand clearly the orders to be implemented and question any that are not understood.

• Nursing actions should be adopted to the individual client.

• Nursing actions should always be safe

Nursing actions often require teaching support and comfort
.

Nursing actions should be holistic

Nursing actions should respect the dignity of the client & enhance the
patients self esteem

Client should be encouraged to participate actively in implementing

the nursing actions
 DELEGATING AND
SUPERVISING
• The nurse has two responsibilities in making work assignments:

• Appropriate delegation of duties

• Adequate supervision of personnel

• The RN can assign some nursing care duties to an unlicensed person but cannot assign
responsibility for total nursing care

• Example: Assistive personnel may perform task such as measuring intake & output, but the RN
is responsible for analysing the data, planning care & evaluating outcomes
 DOCUMENTING NURSING ACTION OR
COMMUNICATING
• After carrying out the nursing orders, the nurse completes the implementing phase by

recording the interventions and client responses in the nursing progress notes
 EVALUATION

• It is the fifth and last phase of the nursing process

Evaluation is a planned, ongoing, purposeful activity in which the nurse determines:

The client’s progress

The effectiveness of
toward achievement
the nursing care plan
of goals/outcomes
 TYPES OF
EVALUATION
• .
Ongoing

Terminal Intermittent
 ONGOING EVALUATION

• It is done while or immediately after implementing a nursing order. It enables the nurse to

make on the spot modification in an intervention.

• Example :- whether the child is able to perform daily activities.

 INTERMITTENT
EVALUATION
• It is performed at specified intervals ( Eg. Once a week), shows the extent of progress

toward goal achievement & enables the nurse to correct any deficiencies and modify the care

plan as needed

• Example :- whether the infections is reduced

platelet counts are increased

 TERMINAL
EVALUATION
• It indicates the clients condition at the time of discharge. It includes the status of goals

achievement and evaluation of the clients self care abilities with regard to follow up care.

• Example :- platelet counts at the time of discharge.

 COMPARING DATA WITH OUTCOMES
• The nurse should compare the collected data with outcomes.
• When determining whether a goal has been achieved, the nurse can draw one of three
possible conclusions:
• The goal was met
• The goal was partially met
• The goal was not met
 DRAWING CONCLUSIONS ABOUT
PROBLEM STATUS
• It nurse uses the judgments about goal achievement to determine whether the care plan was

effective in resolving, reducing or preventing client problems.

• Example: child mother was able to understand and follow the infection control

measures by redemostrating the measures of hand washing

SUMMARIZATION
 CONCLUSION

• The nursing process and standardized nursing languages has improved the quality of patients

care and also the image of the nursing profession.

• As nurse professionals, we must identify ourselves with this awesome breakthrough of the

nursing profession and begin to utilize standardized nursing language in the care of our

patients.
 REFERENCES

• Shebeer P Basheer S.Yaseen “A concise text book of Advanced nursing practice “ second
edition 2017 published by Emmess medical publishers pgno – 487- 504.

• Kozier, Barbara , (2004) assessing , fundamentals of nursing concepts, process & practice 2nd
edition , page no 261-265.

• Potter & Perry (2005) fundamentals of nursing 6th edition st lowis Mo: Elsevier Mosby.