Nursing Process:

Implementation & Evaluation

Implementation

You will perform or delegate planned interventions---that is, carry out the care plan.

The implementation phase ends when you record the nursing actions on the chart; It evolves into evualtion as you record the resulting client responses.

How is Implementation related to other steps of the Nursing Process?

Nursing Process are interdependent.

Implementation overlaps with assessment.

Implementation overlaps with diagnosis

Implementation overlaps with planning outcomes

Implementation overlaps with evaluation

How should I prepare for Implementation?

In addition to "doing,delegating, and recording", implementation als involves some preparation.

You should do some more planning just before implementing the plan.

Check your Knowledge and Abilities

* You do not have the knowledge or skill needed to implement an order

eg. You may be unfamiliar with a medication

* You cannot perform the activinty safely alone.

eg. helping a heavy, weak patient to ambulate.

Performing the activity alone would cause undue stress for the patient.

eg. giving back care to a patient with multiple fractures.

Establish feedback Points

Establishing feedback points is a part of organizing your work.

You cannot assume you will be able to carry out a nursing order in exactly the way it was written.

feedback is not always verbal.

eg. it could change in vital signs,skin color, or lelvel of consciousness.

Feedback

(patient reponsnes to activity)

as you perform care.

Prepare Supplies and Equipment

Gather all the supplies and equipment you need before you go to the patients room.

Prevents stress to the patient when you leave them alone to go get something you have forgotten

Prepare the Patient

*Check your assumptions

*Check the patient readiness

*Explain what you will do and what the patient will feel.

*provide privacy

Implementing the plan:Doing or Delegating

During implementation you will coordinate and carry out both the nursing orders on the nursing are plan and the medical orders that relater to the patients medical treatment.

How can I promote client particiaption and adherences

* Assessing the clients knowledge.

*Assessing the cleints support

*Being sensitive to the cleints cultural,spiritual, and other needs and viewpoints.

*Realizing abd accepting that some attitude cannot be changed.

How can I promote client particiaption and adherences

(cont'd)

*Determining the client's main concerns.

*Helping the client to set realistic goals

Coordination

Care includes schedueling treatments and activities with other departments, but it is more than that.

eg. laboratory, physical therapy, radiology department

Delegation

The transfer to another person of the authority to perform a task in a sleelcted situation--the person delegating retains accountability for the outcome of the activity.

The five right's of delegation

* Right Task

*Right circumstances

*Right person

*Right direction/Communication

*Right Supervision

Evaluation: the final step of the nursing process

Evaluation- the final step of the nursing

process., is a planned. ongoing,systematic

activity in which you will make judgements about:

*the clients progress toward desired health outcomes.

*the effectiveness of the nursing care plan.

*the quality of nursing care in the helath care setting

Why is evaluation essential to full spectrum nursing?

*The patient is the nurses first prioty.

*Evalaution helps nurses to conserver scarce resources.

*Professional standards of practice require evaluation.

*The Ana code of ethics requires evaluation.

*The JCAHO  and professional standards review organizations require evaluation.

Why is evaluation essential to full spectrum nursing?

(cont'd)

* Evaluation helps ensure nursing survival

*Evlaution demosntrates caring and responsiblity.

How are standards and criteria Used in evalaution?

Criteria-Are measurable or observable characteristics, properties,attributing, or qualities.

Reliable- If it yields consistent results--the same results every time, regardless of who uses it.

Valid- It is really measured what it was intended to measure.

Types of Evalaution

Evlaution is categorized according to:

1. what is being evlauted(strucutres, processes, or outcomes)

2. Frequency and time of evaluation

Structure Evaluation

Focuses on the setting in which care is provided.

It explores the effect of orgnaizational characteristics on the qulatiy of care.

Requires standards and data about plocies, procedures, fiscal resources, physical facilites and euqipments.

Process evaluation

Focuses on demonstrable(measurable changes) in the patient's health status that result from the care given.

Ongoing evaluation

While implementing, immediatel;y after an intervention or each patient contact

Intermittent Evaluation

Performed at specified times.

It enables you to judge the progress toward goal acheivement and to modify the care plan as needed.

Terminal Evaluation

Describes the cleints health status and prgress toward goals at the time of discharge.

How is Evlaution related to other steps of the nursing process?

Teh patient outcomes stated in the planning outcomes stage must be concrete, observable and appropriate for the pt. in order to be useful as evaluation criteria.

evlaution overlaps greatly with the assessment step--both involve data collection.

Evlaution data are colelcted after intervention are perfromed to determine whether cleint goals were acheived.

Collect Reassessment data

To minimize confusion, assessments made for the purpose of evaluation are caleld reasessment.

Judge Goal achievement

*acheived

*Partially achieved

*Not acheived

Record the Evaluation Statement

Professional standards require that you record your evaluation.

An evaluation statment should include:

1. The conclusion about whether the goal was achieved.

2. Reassessment data to support the judgement.

Record the Evaluation Statement

(cont'd)

Evlaution statements are written exactly the same as goals, but the scale number descrines the patients actual status.

How do I evaluate Collborative Problems?

You will collect reassessment data the same as for nursing diagnoses.

compare the reassessment data to established norms and dtermine whether data are within an acceptable range

Evaluate and Revising the Care plan

(relate outcomes to interventions)

*The clients ability and motivation to follow directions for treatment.

*Avalaibility and support from family and significant others.

*Treatments and therapies performed by other healthcare team members

*Client fialure to provide complete information during assessment.

Evaluate and Revising the Care plan

(relate outcomes to interventions)

(cont'd)

*Clients lack of expereince, knowledge, or ability

*Staffing in the instituiton (ration of licensed to unlicnesed caregivers: number of patients for whom a nurse is responsible)

*Nurse's physical and mental well-being.

Draw Conclusion about problem status

Goals met: if all goals for a nursing diagnsoses have been met, you can discontinute the care plan for that diagnosis.

Goals partially met: If some outcomes are met and others not, you may revise the care plan for that problem.

Goals not met: If goals are not met, you should examine the entire plan and review all steps of the nursing process to decide whether to revise the care plan.

Revise the Care Plan

Review of assessment: review all initial and ongoing assessment data.

Review of diagnosis

Review of planning outcomes: if you had added data or revised it.

Review of planning interventions: you will probably need to modify nursing orders

Revise the Care Plan

(cont'd)

Review of implementaion: It could be that goals were not met because of failure to implement the nursing orders or because of the manner in which it was implemented.

Reflecting Critically about Evaluation

Inquiring

Noticing context

Analyzing assumption

Reflecting skeptically

Most common erros of evaluation are failure to : evaluate systematically; record the results; use the reassessment data to examine and modify care plan.

Evlauting the Quality of Care

Quality assurance programs

Are specially desigined programs to promote excellence in nursing.

Common Errors of Evaluation

* Failing toevaluate systematically.

*Failing to record results.

Failing to use reassessment data to re-examine and modify the care plan.

Evaluating Quality of Care in a Helath-care Setting

* Quality Assurance (QA) goal: to evaluate and improve care provided in the health-care setting.

QA involves evaluatin of: Structures, outcomes, and processes

The final step of implementation

Documentation

* record the nursing activities/interventions and the client repsonse to care