Week 5 Implementation BlackBoard - Tagged.pdf

Nursing Process: Implementation  COURSE OUTCOME Describe principles of safe, patient-centered, evidence-based nursing care to adults at the basic level, guided by the Caritas philosophy. Discuss critical thinking and clinical reasoning strategies that are needed to provide quality patient care....

Nursing Process: Implementation  COURSE OUTCOME Describe principles of safe, patient-centered, evidence-based nursing care to adults at the basic level, guided by the Caritas philosophy. Discuss critical thinking and clinical reasoning strategies that are needed to provide quality patient care. Describe effective communication with patients and the interprofessional collaborative practice members. COMPETENCY Describe the elements of the nursing process. Discuss critical thinking strategies used when making clinical judgments. Discuss the use of critical thinking to prioritize basic elements of patient care when implementing the nursing process. Discuss the roles of inter-professional collaborative practice members CONCEPT Clinical Decision Making: A process used to examine and determine the best actions to meet desired goals; requires anticipating, recognizing and organizing patient problems to respond with urgency and/or importance in a preferential order to avoid or minimize adverse changes in a patient’s condition Concept Collaboration: Process in which the interprofessional healthcare team works toward as common goal by combining their skills, knowledge, and resources to improve client outcomes while avoiding duplication of effort. UNIT OUTCOMES Describe the association between critical thinking and safe implementation of nursing interventions. Identify members of the interprofessional team and the professionals' major scope of practice.  Clinical Experience as a Student Nurse Patients expect your care to be as competent as the RNs on the unit Student nurse practices in the skills lab to improve and master nursing skills Important to repeat … Student nurse demonstrates competent clinical practice with patients that is equal to the knowledge, skill and attitudes of the RN. Student Nurse in Clinical LCC Student: Must only provide care they have been educated on through Lakeland Community College, Nursing Program. Implementation Action phase of the nursing process Use the information from the prior three phases to determine Nursing interventions Nursing interventions: treatments or actions based on clinical judgment and knowledge that nurses’ perform to meet patient outcomes Patients expect the Nurse to: ◦ Know the scientific rationale/evidence-base for the intervention ◦ Possess the necessary psychomotor and interpersonal skills ◦ Be able to function within a setting to use health care resources effectively Implementati on * Initiate actions most likely to achieve the desired goal and patient outcome * Support or improve the patient’s overall health * Should be evidenced based, scientific knowledge, current best practice to solve patient problems Implementation: Implement Interventions Interventions are actions that can be direct and indirect. Direct: interventions performed through interaction with the patient Indirect: intervention performed away from the patient, but on behalf of the patient.  A nursing intervention is any treatment based on clinical judgment that a nurse performs to Reminder: enhance patient Nursing outcomes. Interventio n Caring for individuals, families, and/or the community. Types of Interventions 1. Nurse initiated ◦ Independent—Actions that a nurse initiates ◦ In the scope of practice ◦ (activities of daily living, health education, health promotion, counseling) 2. Physician initiated ◦ Dependent—Require an order from a physician or other health care professional 3. Collaborative Another term for a collaborative intervention is Interdependent Interprofessional interventions ◦ Require combined knowledge, skill, and expertise of interprofessional health care providers. Types of Nursing Interventions 3. Collaborative interventions Includes dependent interventions, done by the nurse in accordance with physician orders. Actions by the nurse carried out in collaboration with other health care disciplines. Example: Physical therapy Assist with crutch walking Examples What would be some actions that would be considered direct interventions? What would be some actions that would be considered indirect interventions? Critical thinking: Implementation Critical thinking is at every stage of the nursing process Implementation ◦ Consider all possible interventions ◦ Consider the purpose of the intervention Review all possible consequences and safety considerations with each intervention ◦ Consider the probability of consequences ◦ Make a judgment about the value of the intervention ◦ Making decisions about interventions is complex Practice Scenario Patient has an IV in their right arm. You are to take a blood pressure as a component of a collaborative intervention. What are all the possible interventions? Review the consequences of each intervention Determine probability of consequence Make a judgement base on the consequences. How do we know what interventions are available? ANA STANDARDS OF CLINICAL PRACTICE GUIDELINES PROFESSIONAL PRACTICE Standards of nursing practice Health care organizations offer guidelines for the selection develop their own facility of interventions. standard of practice guidelines in an effort to improve their standard of care. Policies and procedures of the clinical facility, school, or agency Implementing Nursing Interventions 1. Based on science, evidence, standards 2. Be sure to fully understand the intervention be for implementing 3. Individualize/adapt to individual patient 4. SAFETY ALWAYS in every intervention 5. Always share the intention and purpose with the patient. Encourage participation as able. 6. Respect patients rights, dignity, autonomy, culture Implementing Nursing Interventions During the implementation of the intervention, continually reassessing the patient. Modify care based on the reassessment/feedback Anticipate and prevent complications Identify risks Implementing Nursing Interventions Consider protecting yourself from injury Consider infection control measures Consider privacy Consider all safety measures Follow practice standards and guidelines Organize the process Implementation Process Reviewing and Organizin Anticipating revising g and Reassessing the resources preventing the patient existing and care complication nursing delivery s care plan Modification of an Existing Written Care Plan Revise data assessment. Revise the nursing diagnoses. Revise specific interventions. Determine how to evaluate whether you have achieved outcomes. The NURSE modifies the care of the patient based on current assessment data Implementation: Skills Needed Cognitive skills ◦ Application of critical thinking in the nursing process Interpersonal skills ◦ Developing a trusting relationship, expressing a level of caring, and communicating clearly with a patient and his or her family Psychomotor skills ◦ Integration of cognitive and motor activities Direct Care Interventions: You may be providing Activities of Daily Instrumental Living Activities of Daily (ADLs) Living (IADLs) Physical care Lifesaving measures techniques CPR Activities of Daily Living Activities of daily living (ADLs) are activities performed in the course of a normal day including ambulation, eating, dressing, bathing, and grooming. NURS 1090 Physical Care Techniques Physical care techniques are the activities that nurses perform while rendering care. Including performing tasks such as urinary catheter insertion, naso-gastric tube insertion, intravenous catheter insertion. IADL: Instrumental Activities of Daily Living Include the day-to-day activities a person performs such as shopping, preparing meals, writing checks to pay the bills, and taking medications. Activities needed for independent living Lifesaving measures include CPR Implementing Care: To Achieve Patient Goals Nurses implement care to meet patient goals. Priorities: Deciding what is most important will help nurses to anticipate and sequence nursing interventions. Patient adherence means that patients and families invest time in carrying out recommended care and treatments. Question s?