CHAPTER 6 Implementation and Evaluation

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CHAPTER 6 Implementation and Evaluation
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Implementing Care

• Implementing care follows assessment, nursing
  diagnosis, and planning.
• The phase of the nursing process in which nursing
  actions (or orders) are carried out
• Reason and rationale should be identified before
  carrying out interventions.
• Change-of-shift report should give clues as to
  the priority of each action to be implemented.
• (Contd)

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Implementing Care

• (Contd)
• Some interventions may require an independent
  nursing action (not requiring a physicians
  order).
• Check the facilitys policy
• The care plan is not part of the patients chart
  if a clinical pathway is being used as the guide
  to patient care.
• (Contd)

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Implementing Care

• (Contd)
• Considerations for care delivery
• The reason for the intervention
• The rationale for the intervention
• The standard of care (refer to the facilitys
  nursing policy and procedure manual see Table
  6-1)
• The expected outcome
• Potential dangers

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Collaborative Care

• Some agencies use clinical pathways, care maps,
• or care paths to guide care
• Interdisciplinary approach to managing patient
  care
• An outgrowth of managed care
• Still uses the nursing process
• Usually standardized to a medical diagnosis and
  customized to each patient

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Long-Term Care

• In long-term care facilities, most routine care
  is delegated to nursing assistants
• Exercise interventions usually performed by
  physical therapy aides or restorative aides
• Medications may be administered by LVNs/LPNs or
  nursing assistants with certification in
  medication administration (in some states).
• The nurse performs any invasive or sterile
  procedure.

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Home Health

• In home health, the family may be implementing
  the interventions.
• The nurse making home visits does teaching to
  enable the family to
• Administer medications
• Change dressings
• Perform range of motion exercises
• Perform treatments

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Documentation

• Each nursing intervention performed must be
  documented in the patients chart.
• Examplesmedications administered, dressings
  changed, vital signs measured
• Procedures not documented are considered not
  performed
• Routine items such as baths, ambulation,and
  eating may be documented on a checklist

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Evaluation

• ANA Standard VIEvaluation
• Once interventions have been implemented, they
  must be evaluated for effectiveness in reaching
  the patients goals or outcomes
• If goals/outcomes are not being reached, the plan
  must be revised (a continuous process)
• If goals are reached and the problem is resolved,
  it is evaluated, signed off in the nurses notes
  as met, and removed from the plan of care.
• (Contd)

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Evaluation

• (Contd)
• Interventions resulting in expected outcomes
  require nursing documentation supporting the
  outcome.
• Expected outcomes not being met require revision
  of the plan of care and documentation of the
  change.

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Quality Improvement

• Outcome-based quality improvement is carried out
  to determine whether outcomes are effective.
• Usually involves agency-wide evaluation of care
  delivered by all departments against standards
  set for each department
• Audits are carried out at predetermined intervals.

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Constructing a Nursing Care Plan

• Collect patient data for a database.
• Analyze the database for potential problems.
• Choose appropriate nursing diagnosis
• Rank the nursing diagnosis in order of priority.
• Plan the care by defining goals and expected
  outcomes.
• (Contd)

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Constructing a Nursing Care Plan

• (Contd)
• Plan nursing care by choosing appropriate nursing
  interventions.
• Implement the nursing interventions.
• Evaluate the actual outcomes of each nursing
  intervention determine whether progress toward
  achieving expected outcomes has been made.