Implementing nursing care

Introduction The nursing process is action oriented , client centered, and goaldirected. After developing a plan of care based on the assessing and diagnosing phases, the nurse puts the plan into effect and evaluates the results. Definition Implementation is the step of the nursing process where nurses provide care to patients .The nurse initiate and complete actions or interventions necessary for achieving the goals and expected outcomes of nursing care. Types of Nursing interventions 1. Direct care 2. Indirect care Direct care: Direct care interventions are treatments performed through interaction with the client For eg :a client may require direct intervention in the form of medication administration ,insertion of an intravenous infusion to support circulatory function. Indirect care: Interventions are treatments performed away from the client but on behalf of the client or group of clients . Eg: of indirect care include actions aimed at managing the clients environment.(safety and infection control) Nursing interventions are performed or developed and organized on the basis of protocols or preprinted orders . Protocols and standing orders A protocol is a written play specifying the procedures to be followed during care of clients with a select clinical condition or situation ,such as the care of post soperative clients

A standing order is a preprinted document containg orders for the conduct of routine therapies , monitoring guidelines , and /or diagnostic procedures for specific clients with identified clinical problems Eg: lidocaine or propranolol for an irregular heart rhythm . Implementing skills: To implement the care plan successfully nurses need good cognitive , interpersonal and technical skills . Cognitive skills Include problem solving ,decision making , critical thinking and creative thinking , they are safe , intelligent nursing care Interpersonal skills They are all the activities , verbal and non verbal, people use when communicating directly with one another .They include verbal and non verbal activities .The effectiveness of a nursing action often depends largely on the nurses ability to communicate with others . Technical skills Hands- on skills such as manipulating equipment, giving injections and bandaging , moving , lifting and repositioning clients. Guidelines for implementing nursing strategies: 1. Nursing actions should be based on scientific knowledge, nursing research and professional standards of care. 2. Nurse should understand clearly the orders to be implemented and question any that are not understood . 3. Nursing actions should be adapted to the individual client. 4. Nursing actions should always be safe . 5. Nursing actions should respect the dignity of the client and enhance the clients self esteem. 6. Clients should be encouraged to participate actively in implementing the nursing actions. Process of implementing : The process of implementing normally includes: Re-assess the client Determine the nurses need for assistance Implement the nursing orders

 Delegate and supervise Document nursing actions Reassessing the client: Assessment is a continuous process that occurs each time a nurse interact with a client .Before implementing an order , the nurse must re-assess the client to make sure the intervention is still needed. Even though an order is written on the care plan. Determining the Nurses need for assistance. When implementing some nursing strategies , the nurse may require assistance for one of the following reasons. 1. The nurse is unable to implement the nursing strategies safely alone. 2. Assistance would reduce stress on the client 3. The nurse lacks the knowledge or skills to implement a particular nursing activity. 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. Delegating and Supervising: Delegating is another activity that occurs during the planning phase of the nursing process, while choosing nursing interventions and writing nursing orders on the client s care plan , the nurse must also determine who should actually perform the activity The nurse has two responsibilities in making work assignment. 1. Appropriate delegation of duties 2. Adequate supervision of personnel Documenting Nursing actions After carrying out the nursing orders the nurse completes the implementing phase by recording the interventions and client responses in the progress note. It is important to record a nursing action immediately after it is implemented .immediate recordings helps safeguard that client for example from receiving a second dose of medication

Conclusion: The implementation of nursing care may require additional knowledge ,nursing skills and personnel resources. Successful implementation of nursing interventions requires the nurse to use appropriate cognitive , interpersonal and psychomotor skills. Bibliography Kozier Barbara ,et, al:fundamentals of nursing,6th edition,2003,pearson Education publication Singapore, Pp no:329-333. Poter and perry, fundamentals of nursing 6th edition 2006,published by Elsevier New delhi, Pp340-353.