NURSING PROCESS IMPLEMENTATION PHASE

IMPLEMENTATION

The next step in Nursing Process is Implementation, which involves the execution of the nursing plan of care derived during the planning phase of the nursing process.

It involves completion of nursing activities to accomplish predetermined goals and to make progress toward achievement of specific outcomes.

The execution of the implementation phase of the nursing process, as with the other phases of the process, requires a broad base of clinical knowledge, careful planning, critical thinking and analysis, and judgment on the part of the nurse.

SKILLS NEEDED FOR EFFECTIVE IMPLEMENTATION

• Cognitive Skills: Cognitive skills enable nurses to make appropriate observations, understand the rationale for the activities performed, and appreciate the differences among individuals and how they influence nursing care. Critical thinking is an important element within the cognitive domain because it helps nurses to analyze data, organize observations, and apply prior knowledge and experiences to current client situations.
• Psychomotor Skills: Proficiency with psychomotor skills is necessary to safely and effectively perform nursing activities. Nurses must be able to handle medical equipment with a high degree of competency and to perform skills such as administering medications and assisting clients with mobility needs (e.g., positioning and ambulating).
• Interpersonal Skills: The use of interpersonal skills involves communication with clients and families as well as with other health care professionals. The nurse-client relationship is established through the use of therapeutic communication that helps ensure a beneficial outcome for the client’s health status. Interaction between members of the health care team promotes collaboration and enhances holistic care of the client.

STRATEGIES FOR IMPLEMENTING PLAN OF CARE

• Ongoing Assessment: 
  • The nursing plan of care is based on the initial assessment data collected by the nurse and the nursing diagnoses derived from those data. Because a client’s condition can change rapidly, or new data may become available through interaction with the client, ongoing assessment is necessary to validate the relevance of proposed interventions. Goals, expected outcomes, and interventions may need to be altered as new data are collected or progress toward outcomes is evaluated
• Setting Priorities: 
  • Following ongoing assessment and review of the problem list, priorities are determined for implementation of care. Priorities are based on:
  • Which problems are deemed most important by the nurse, the client, and family or significant others.
  • Activities previously scheduled by other departments (e.g., surgery, diagnostic testing)
  • Available resources.
• Allocation of Resources:
  • Before implementing the nursing plan of care, the nurse reviews proposed interventions to determine the level of knowledge and the types of skills required for safe and effective implementation. The assessment provides data for determining if an activity can be performed independently by the client, can be completed with assistance from family, or requires assistance of health care personnel.
• Initiation of Nursing Interventions:
  • After reviewing the client’s current condition, verifying priorities, and examining resources, the nurse should be ready to initiate nursing interventions. A nursing intervention is an action performed by the nurse that help the client to achieve the results specified by the goals and expected outcomes. All interventions must conform to standards of care.
  • Nurses should understand the reason for any intervention, the expected effect, and any potential problems that may result. Understanding the reason for a nursing intervention is the hallmark of a professional nurse, in that the nurse is using logic and/or scientific reasoning as the basis of practice.
  • Nursing interventions are a blend of science (rational acts) and art (intuitive actions). It is important for novice nurses to identify the rationale (the fundamental principle) of all interventions in order to implement theory-based practice.
• Documentation:
  • Communication concerning implementation of interventions must be provided through written documentation and should also be verbally conveyed when responsibility of the client’s care is transferred to another nurse.
  • The nurse is legally required to record all interventions and observations related to the client’s response to treatment.
  • This not only provides a legal record but also allows valuable communication with other health care team members for continuity of care and for evaluating progress toward expected outcomes. In addition, written documentation provides data necessary for reimbursement for services and tracking of indicators for continuous quality improvement.