Implementing Nursing Care: How to Master Nursing Practices

Implementing Nursing Care

Implementing nursing care is a vital phase of the nursing process where plans are transformed into action to promote health, prevent illness, and support recovery. This step goes beyond executing tasks; it involves a deep understanding of patient needs, critical thinking, and adaptability to ensure effective care.

By the end of this section, you should be able to:

• Standard Nursing Interventions 
• Critical Thinking in Implementation.
• Implementation Process.
• Direct Care.
• Indirect Care.

Let’s take a closer look at them.

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Standard Nursing Interventions

Facilitate quicker and more effective nursing responses to common health problems.

Ensure interventions are evidence-based, leading to better patient outcomes.

Allow nurses to individualize care plans while maintaining high standards of care.

Promote a consistent level of clinical excellence.

Types of Standardized Interventions

1. Clinical Practice Guidelines and Protocols: Systematically developed recommendations for specific clinical situations. Derived from evidence-based research to improve quality of care. And it is used with Individualized for each patient. Examples include guidelines for conditions like arthritis, wounds, and pain management. Sources: National Guidelines Clearinghouse (NGC) and MeSH terms from the National Library of Medicine. Organizations like the NIH and University of Iowa Hartford Center provide guidelines for geriatric nursing and acute conditions.
2. Advanced Practice Nurses (APNs): Follow diagnostic and treatment protocols for specific conditions (e.g., hypertension). Develop independent protocols in settings like long-term care (e.g., for incontinence, pressure ulcers). State Variability: Protocols and permitted interventions differ between states.
3. Standing Orders: Preprinted documents for routine therapies, monitoring, and diagnostics. Common Use: Acute and critical care settings where rapid intervention is needed. Community health settings where immediate provider contact isn’t possible. Example: Standing orders for medications like diltiazem for irregular heart rhythms. Legal Protection: Allows nurses to act in patients’ best interests under rapidly changing conditions.

Nursing Interventions Classification (NIC) in Implementing Nursing Care

Developed by the University of Iowa, the NIC system standardizes nursing practice by: Providing a consistent language for nursing interventions. Enhancing communication and outcome comparison across healthcare settings. Teaching nursing students about decision-making and patient care. Determining the costs of nursing services. Connecting with other health classification systems. The NIC system is often integrated into healthcare information systems.

Standards of Professional Nursing Practice in Implementing Nursing Care

Defined by the American Nurses Association (ANA). Include: Establishing professional, ethical, and caring relationships. Using evidence-based interventions and technologies. Providing holistic care across diverse groups and the lifespan. Ensuring patient safety and timely care. Reviewed regularly to maintain relevance and effectiveness.

Quality and Safety Education for Nurses (QSEN) Goal in Implementing Nursing Care

Prepare nurses to improve healthcare quality and safety. Core Competencies (KSAs): Provide patient-centered care with sensitivity to diversity. Initiate effective treatments for pain relief and symptom management. Resolve conflicts and build consensus in patient care contexts.

Clinical Practice Guideline: A set of recommendations developed by healthcare experts based on the best available research evidence. These guidelines assist healthcare professionals in making informed, consistent decisions regarding patient care, ensuring high-quality and evidence-based practice.

Standing Order: A written order or protocol from a physician that allows a nurse to carry out specific medical interventions without needing to contact the physician each time. Standing orders are typically used for routine or emergency situations where immediate action is needed.

Critical Thinking in Implementing Nursing Care

Involves making appropriate interpretations or conclusions about interventions for a patient’s health condition or life process. Requires: Modifying standard approaches. Improvising evidence-based solutions when necessary. Applying knowledge, experience, attitudes, and standards of care.

Framework for Implementation

1. Critical Thinking in Action: Decisions are influenced by: Patient knowledge: Understanding their unique condition and priorities. Social context: The dynamics of the healthcare unit. Interdisciplinary relationships: Collaboration with healthcare providers enhances decision-making.
2. Decision-Making Approaches: Reflect on the complexity of interventions and changing priorities. Assess the time and resources available for each situation.

Evidence-Based Practice and Interdisciplinary Teamwork

PICO Question: How does interdisciplinary teamwork compare with multidisciplinary models in improving patient care delivery?

Findings: Teamwork is essential, but organizational culture impacts collaboration. Effective teamwork merges the strengths of all disciplines to improve outcomes. Beginning nurses play a critical role in interdisciplinary collaboration through: Competency in clinical care. Building trust via clear communication. Understanding the contributions of other providers.

Critical Thinking in Practice

1. Confirm Intervention Appropriateness: Understand the patient’s condition. Monitor for changes in response and adjust interventions as needed.
2. Reflect-in-Action: Continuously assess how the patient responds during interventions and adjust accordingly.
3. Multitasking and Organization: Maintain strong time management skills to address multiple patients with varying needs and changing priorities.

Steps for Making Decisions During Implementation

Review all possible interventions for the problem. Evaluate potential consequences of each intervention: Effectiveness. And Risk of adverse effects. Assess probability of outcomes: For example, if analgesics relieve pain and side effects are minimal, continue treatment. If anxiety persists, consider alternative interventions. Judge the intervention’s value for the patient: E.g., Effective pain relief may improve readiness for postoperative instructions.

Preparation for Interventions in Implementing Nursing Care

Purpose of the intervention. Steps to perform it correctly. Patient’s current condition and expected response. With experience: Recognize patterns in patient responses. Refine approaches based on past successes or failures.

Role of QSEN in Evidence-Based Practice

Competency in Evidence-Based Practice: Use current evidence to select interventions effectively. For example: Is a prn medication optimal for pain management? Are evidence-based relaxation exercises available? Apply intellectual standards: Ensure interventions are clear, logical, and relevant. Demonstrate critical thinking attitudes: Show confidence and responsibility. Seek assistance when unsure.

Tips for Effective Implementation

1. Build trust by demonstrating confidence and competence.
2. Use creativity and self-discipline to adapt and refine interventions.
3. Seek supervision and consult policies when needed.

Implementation Process

To ensure safe, efficient, and effective care delivery. Activities: Reassess the Patient: Confirm that chosen interventions remain appropriate for the patient’s current condition. Review/Revise the Care Plan: Validate or update the nursing diagnosis, interventions, and goals to align with the patient’s evolving status. Organize Resources: Allocate time, equipment, personnel, and adjust the environment for optimal care. Anticipate Complications: Identify risks based on the patient’s condition and tailor interventions to minimize potential issues. Implement Interventions: Deliver direct or indirect care using cognitive, interpersonal, and psychomotor skills.

Reassessing the Patient

Reassessment involves continuous evaluation during every interaction. Focus is placed on the most relevant nursing diagnosis or system (e.g., cardiovascular, comfort level). Example: Tonya reassesses Mr. Lawson’s anxiety about work-related activity restrictions and modifies her approach to address his concerns more effectively.

Reviewing and Revising the Care Plan in Implementing Nursing Care

Modify the plan when the patient’s condition or goals change. Steps: Update the assessment data, nursing diagnoses, and goals with dates. Remove outdated diagnoses or interventions. Align interventions with the patient’s current condition and care priorities. Establish evaluation methods to measure goal attainment. Example: Tonya adjusts Mr. Lawson’s pain management strategy and incorporates Mrs. Lawson as a coach for relaxation exercises.

Preparation Components

1. Time Management: Balance physical, psychological, and organizational demands for timely and individualized care.
2. Equipment: Ensure supplies are available, functioning, and prepared for the intervention.
3. Personnel: Delegate tasks appropriately, seek assistance for complex interventions, and collaborate effectively with colleagues.
4. Environment: Create a safe, distraction-free setting conducive to care and teaching.
5. Patient Readiness: Address physical and emotional comfort to enhance participation in interventions.

Anticipating and Preventing Complications

Recognize and mitigate risks associated with the patient’s condition or treatments. Use knowledge of pathophysiology and past experiences to predict potential complications. Example: Administering analgesics before repositioning an obese patient to prevent pressure ulcers.

Implementation Skills in Implementing Nursing Care

Cognitive Skills: Use critical thinking to ensure interventions are evidence-based and individualized. Interpersonal Skills: Build trust, communicate effectively, and support emotional needs. Psychomotor Skills: Execute interventions with precision and confidence to build patient trust.

Case Application in Implementing Nursing Care

Tonya implements strategies to address Mr. Lawson’s specific needs: She reassesses his anxiety and pain levels, modifies teaching methods to ensure understanding, and engages his wife as a support system. Her actions reflect an integration of cognitive, interpersonal, and psychomotor skills to ensure the effectiveness of her interventions. By adhering to these principles, nurses can deliver care that is not only clinically effective but also empathetic and responsive to patient needs.

Direct Care

Nurses provide direct care through patient interactions, where sensitivity to clinical conditions, experiences, expectations, and cultural views is essential. Always practice competently and safely, using a caring approach for effective outcomes.

Activities of Daily Living (ADLs)

Routine tasks like ambulation, eating, dressing, bathing, and grooming. Types of Needs: Temporary: Assistance needed for short periods, e.g., after surgery or injury. Permanent: For irreversible conditions, e.g., spinal cord injuries. Rehabilitative: Aimed at regaining independence, often supported by occupational and physical therapists. Key Principles: Respect patient preferences and allow family assistance if culturally appropriate. Encourage independence to boost self-esteem. Plan care based on the patient’s condition and preferences, involving them in decision-making.

Instrumental Activities of Daily Living (IADLs)

Skills needed for independence in society, e.g., shopping, preparing meals, housekeeping, managing finances, and taking medications. Support: Nurses, occupational therapists, family, and friends can help adapt these activities. In acute care, assess how illness affects IADLs and make referrals for necessary resources at home.

Physical Care Techniques in Implementing Nursing Care

Procedures like positioning, inserting feeding tubes, administering medications, and providing comfort measures. Key Points: Protect patients and yourself from injury using proper techniques and infection control. Know the procedure’s risks, assessments required, and desired outcomes. Always evaluate the patient’s response before, during, and after procedures. Seek help or further knowledge when performing unfamiliar procedures.

Lifesaving Measures

Emergency interventions to restore physiological or psychological stability. Examples: CPR, emergency medication, handling violent patients, or obtaining immediate counseling. Action Steps: Stay with the patient and call for experienced assistance if inexperienced.

Counseling

A direct care method to support patients in managing stress and adapting to changes. Scope: Provides emotional, psychological, and spiritual support. Helps patients and caregivers adjust to challenges, e.g., terminal illnesses or caregiving roles. Key Goals: Foster decision-making by helping patients explore alternatives. Promote growth and a sense of control.

Teaching in Implementing Nursing Care

Importance: Vital for patient-centered care, enabling patients to manage their health problems. Key Elements: Use interpersonal skills to educate patients about procedures, health status, and expected outcomes. Tailor education to the patient’s literacy level, cultural background, and preferences. Encourage questions to address concerns and reinforce understanding. HCAHPS Survey: A standardized measure of hospital care quality highlights the importance of patient education on procedures, symptoms, and medication side effects.

Controlling Adverse Reactions

Harmful effects from medications, tests, or procedures. Prevention and Management: Anticipate potential reactions and monitor the patient during interventions. Take timely action, such as stopping a harmful drug or applying countermeasures (e.g., using diphenhydramine for an allergic reaction). Example: Avoid skin burns from heat compresses by assessing and monitoring skin condition during application.

Preventive Measures

Actions to promote health and prevent illness or complications. Types: Primary Prevention: Health education, immunizations, fitness activities. Secondary Prevention: Early disease detection and treatment. Tertiary Prevention: Rehabilitation to minimize effects of long-term illness or disability.

Activities of Daily Living (ADLs): Basic self-care tasks that individuals perform daily, such as bathing, dressing, grooming, toileting, eating, and mobility. These activities are essential for maintaining personal independence and assessing a person’s overall health.

Adverse Reaction: An undesirable, unintended, and harmful response to a medication, therapy, or procedure. Adverse reactions can range from mild to severe and may require treatment adjustments or discontinuation of the therapy.

Counseling: A process where a nurse or healthcare professional offers guidance and support to help patients and their families understand medical conditions, make informed decisions, cope with illness, and improve mental or emotional well-being.

Direct Care: Hands-on care provided directly to a patient by healthcare professionals, such as administering medications, performing assessments, providing wound care, or assisting with personal hygiene. Direct care is essential for the immediate health and well-being of patients.

Implementation: The phase in the nursing process where the planned interventions are carried out to address patient care needs and achieve desired health outcomes. It involves applying nursing skills, knowledge, and judgment to provide the necessary care.

Instrumental Activities of Daily Living (IADLs): More complex daily tasks that support independent living, such as managing finances, shopping, meal preparation, housekeeping, and using transportation. IADLs are necessary for an individual’s quality of life but are not as essential for basic survival as ADLs.

Lifesaving Measure: An intervention that is essential for preserving a patient’s life. Lifesaving measures include emergency treatments, such as CPR, defibrillation, or urgent surgical procedures, performed when a patient’s life is at risk.

Indirect Care

Nursing actions that manage the patient care environment and interdisciplinary collaboration to support direct care interventions. Examples of Indirect Care Activities: Documentation (electronic or written). Delegation of care activities to Nursing Assistive Personnel (NAP). Medical order transcription. Infection control measures (e.g., handling supplies, protective isolation). Environmental safety management (e.g., ensuring patient room safety). Telephone consultations with physicians and health care providers. Hand-off reports and communication with the care team. Transporting patients and collecting/labeling specimens.

Communicating Nursing Interventions in Implementing Nursing Care

Interventions are documented electronically, in writing, or verbally to ensure continuity of care. Records should include: Assessment findings. Specific interventions. Patient responses. Importance: Validates procedures performed. Provides critical information for subsequent caregivers. Effective communication prevents errors, delays, and duplication of tasks, ensuring care is coordinated. Miscommunication is a leading cause of adverse events; timely and accurate communication is essential.

Delegating, Supervising, and Evaluating Work

Nurses delegate care tasks to NAP or other team members based on clinical judgment. Effective delegation ensures the right person performs the right task. Approaches to Delegation: Unit-Based Scenario: NAP works independently with minimal direction; limited interaction with RNs. Pairing: RN and NAP/LPN work together for a shift but may not consistently collaborate long-term. Partnering: RN and NAP/LPN consistently work together, fostering trust and collaboration. Responsibilities in Delegation: Assign tasks appropriately based on competence. Ensure tasks are completed to the standard of care. Document and evaluate all delegated tasks. Delegated activities often include noninvasive, repetitive tasks like hygiene, ambulation, and vital sign monitoring for stable patients.

Achieving Patient Goals in Implementing Nursing Care

Requires multiple, coordinated interventions to meet patient goals and outcomes. Adapt interventions as patient conditions change. Care Coordination: Good time management, organization, and resource utilization are critical. Prioritize nursing interventions based on patient needs and diagnoses. Patient Adherence: Engage patients and families to invest time in their treatment plans. Smooth transitions between care settings (e.g., hospital to home) are essential. Individualize discharge planning and education to align with patient beliefs, culture, and lifestyle. Reinforce patient successes to encourage continued adherence to the care plan.

Indirect Care: Nursing actions that support and enhance patient care but do not involve direct contact with the patient. Examples include documentation, delegation, managing the environment, coordinating care, and consulting with other healthcare professionals.

Patient Adherence: The extent to which a patient follows prescribed healthcare instructions, such as taking medications, attending follow-up appointments, and adhering to lifestyle changes. Patient adherence is crucial for the effectiveness of treatment and recovery.

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