Online Companion: Fundamentals of Nursing Standards and Practice 2E
The fourth step of the nursing process, implementation, is the major topic of Chapter 9. The step begins with assessment and continually interacts with other steps of the nursing process. The purposes of implementation include fulfilling client needs for health promotion and illness management, delegating tasks to staff members and assistive personnel and documenting activities done for the client and the client's response to these. The nurse needs competencies in cognitive, psychomotor and interpersonal skills to be effective in implementing care. Five implementation activities are identified: ongoing assessment, establishing priorities, allocating resources, initiating nursing interventions and documenting interventions and client's response.
While the registered nurse is legally responsible for all nursing care given, some aspects of client care may be delegated to other licensed or unlicensed personnel. Health care agencies develop management systems for delivering care. The moist common systems currently used include functional nursing, team nursing, primary nursing, total patient care, modular nursing and case management.
Chapter 9 discusses the types of nursing interventions that are ordered in the care plan. The intervention may be nurse-initiated, physician-initiated or derived from collaboration with the health care team. Two types of standardized orders: the standing order or the protocol can be used to implement interventions. A standardized language for research on the effectiveness of nursing interventions has been developed in the University of Iowa's Nursing Interventions Classification (NIC) project. Six classes of nursing intervention activities are discussed in the chapter: assisting with Activities of Daily Living (ADL's), delivering skilled therapeutic interventions, monitoring of responses to care, teaching, discharge planning and supervising nursing personnel. The need to consider client rights and the ethical and legal implications associated with providing care is very important during implementation. The nurse is legally required to record all interventions and observations related to the client's response to treatment. Verbal communication about the client's condition is shared with other nurses at the shift report. The nurse also communicates with assistive personnel and the client's physician. This communication is confidential information and must be descriptive, objective and complete in written or verbal reports.