Chapter 19

Implementing Nursing Care

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 Case Study

 Miranda is a nursing student who is assigned to Mr.

Bagley. Mr. Bagley is a 52-year-old Asian who was
admitted to the medical-surgical unit for management
of tuberculosis. Mr. Bagley travels internationally
because of his executive position with a global
company and most likely contracted tuberculosis
during his travels.
 Mr. Bagley’s current symptoms are shortness of
breath, night sweats, muscle pain, fatigue, and a
productive cough. Miranda reviews Mr. Bagley’s plan
of care to determine which interventions are to be
implemented first.
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 Standard Nursing Interventions

 Standardized interventions most often set a level

of clinical excellence for practice
 Nurse- and health care provider–initiated
standardized interventions are available in the
form of clinical guidelines or protocols,
preprinted (standing) orders, and Nursing
Interventions Classification (NIC) interventions
 American Nurses Association (ANA) standards
 Quality and Safety Education for Nurses (QSEN)
skill competencies
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 Standard Nursing
Interventions (Cont.)
 Clinical practice guidelines and protocols
 A systematically developed set of statements that
helps nurses, physicians, and other health care
providers make decisions about appropriate health
care for specific clinical situations
 Standing orders
 Preprinted document containing orders for the
conduct of routine therapies, monitoring guidelines,
and/or diagnostic procedures for specific patients with
identified clinical problem

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 Standard Nursing
Interventions (Cont.)
 Nursing interventions classification interventions
 Differentiates nursing practice from that of other
health care disciplines by offering a language that
nurses use to describe a set of actions in delivering
nursing care
 Standards of practice
 Used as evidence of the standard of care that
registered nurses (RNs) provide their patients
 Quality and safety education for nurses

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 Critical Thinking in Implementation

 Clinical judgment
 Includes making appropriate conclusions about
interventions to address a patient’s response to health
conditions or a life process
 Requires nurse to use or modify standard
approaches, sometimes improvise new ones

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 Critical Thinking in
Implementation (Cont.)

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 Critical Thinking in
Implementation (Cont.)
 Tips for making decisions during
implementation:
 Review the set of all possible nursing interventions for
a patient’s problem
 Review all possible consequences associated with
each possible nursing action
 Determine the probability of all possible
consequences
 Judge the value of the consequence to the patient

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 Implementation Process

 Reassessing a patient
 Continuous process with each patient interaction
 Reviewing and revising the existing nursing care
plan
 Allows you to validate a patient’s nursing diagnoses,
review the care plan, and determine whether the
nursing interventions remain the most appropriate for
the patient’s needs

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 Implementation Process (Cont.)

 Preparing for implementation

 Time management
 Equipment
 Personnel
 Environment
 Patient

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 Anticipating and
Preventing Complications
 Preventing complications
 Identify risks to the patient
 Adapt interventions to the situation
 Evaluate the relative benefit of a treatment vs. the risk
 Initiate risk-prevention measures
 Identifying areas of assistance
 Seek information about a procedure
 Collect all necessary equipment
 Ask another nurse provide assistance and guidance

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 Implementation Skills

 You are responsible for knowing when one type

of implementation skill is preferred over another
and for having the necessary knowledge and
skill to perform each.
 Cognitive skills
 Interpersonal skills
 Psychomotor skills

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 Quick Quiz!

1. Nurse-initiated interventions are

A. determined by state Nurse Practice Acts.
B. supervised by the entire health care team.
C. made in concert with the plan of care
initiated by the physician.
D. developed after interventions for the recent
medical diagnoses are evaluated.

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 Direct Care vs. Indirect Care
Direct Care
• Treatments performed
through interactions with
patients
Indirect Care
• Treatments performed
away from the patient but
on behalf of the patient or
group of patients

• Medication administration • Managing the patient’s

• Insertion of an environment (e.g., safety
intravenous (IV) infusion and infection control)
• Counseling during a time • Documentation
of grief • Interdisciplinary
collaboration

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 Case Study (Cont.)

 Miranda searches the hospital’s database for

additional information on tuberculosis.
 True or False: A clinical practice guideline is a
collection of institutional policies that assist
nurses, physicians, and other health care
providers in making decisions about appropriate
health care for specific clinical situations, such as
the management of tuberculosis.

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 Direct Care

 Activities of daily living (ADLs)

 Performed in the course of a day, including
ambulation, eating, dressing, bathing, and grooming
 Instrumental ADLs (IADLs)
 Skills such as shopping, preparing meals, house
cleaning, writing checks, and taking medications.
 Physical care techniques
 The safe and competent administration of nursing
procedures
 Lifesaving measures

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 Direct Care (Cont.)

 Counseling
 Teaching
 Controlling for
adverse reactions
 Preventive measures

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 Case Study (Cont.)

 Mr. Bagley’s plan of care calls for oxygen

therapy to improve his respiratory status.
 A preprinted document that contains orders for the
conduct of routine therapies, such as oxygen
therapy, is referred to as a __________
_____________.

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 Quick Quiz!
2. You are writing a care plan for a newly
admitted patient. Which one of these
outcome statements is written correctly?
A. The patient will eat 80% of all meals.
B. The nursing assistant will set the patient up
for a bath every day.
C. The patient will have improved airway
clearance by June 5.
D. The patient will identify the need to increase
dietary intake of fiber by June 5.

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 Indirect Care

 Indirect care measures are nursing actions that

manage the patient care environment and
interdisciplinary collaborative actions that
support the effectiveness of direct care
interventions
 Communicating nursing interventions
 Written or oral
 Delegating, supervising, and evaluating the work
of other staff members

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 Case Study (Cont.)

 Mr. Bagley is placed on Isolation Precautions.

 Isolation Precautions as a treatment intervention
are an example of which type of care?
A. Direct
B. Indirect
C. Prevention
D. Safety

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 Achieving Patient Goals

 Nurses implement care to meet patient goals.

 At times, multiple interventions may be needed.
 Priorities help nurses to anticipate and sequence
nursing interventions.
 Patient adherence means that patients and
families invest time in carrying out required
treatments.

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