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Terms in this set (25)
Purposes of Implementation
vHelp the patient achieve valued health outcomes.
vPrevent disease and illness.
vFacilitate coping with altered functioning.
Tell whether the following statement is true or false.
One of the advantages of using Nursing Intervention Classifications in nursing practice is to ensure appropriate reimbursement for nursing services.
Aims of NOC Research
vIdentify, label, validate, and classify nursing-sensitive patient outcomes and indicators.
vEvaluate the validity and usefulness of the classification in clinical field testing.
vDefine and test measurement procedures for the outcomes and indicators.
Clinical Reasoning and Implementing
vReassess the patient for changes in status that might dictate a different set of interventions.
vBe sure that research supports the interventions you have selected and be open to better ways of addressing patient problems and issues.
vAlways monitor the patient's responses to your interventions so that you can modify the care plan if needed.
vAlfaro's rule: "assess, reassess, revise, record"
Checklist for Organizing Student Clinical Responsibilities
vPatient profile and name by which patient is addressed
vPatient's chief complaint and reason for admission
vPatient's current health status
vRoutine assistance to meet basic human needs
vPriorities for nursing care and special daily events
vSpecial teaching, counseling, or advocacy needs
vSpecial family needs
Implementing Guidelines #1
vAct in partnership with the patient/family.
vBefore implementing, reassess the patient to determine whether the action is still needed.
vApproach the patient competently.
vApproach the patient caringly.
vModify nursing interventions according to the patient's (1) developmental and psychosocial background, (2) ability and willingness to participate in the care plan, and (3) responses to previous nursing measures and progress toward goal/outcome achievement.
Implementing Guidelines #2
vCheck to make sure that the nursing interventions selected are consistent with standards of care and within legal and ethical guides to practice.
vAlways question that the nursing intervention selected is the best of all possible alternatives.
vDevelop a repertoire of skilled nursing interventions. The more options one can choose from, the greater the likelihood of success
Types of Nursing Interventions
vThose providing direct and indirect care
vThose aimed at individuals, family, and community
vThose for nurse-initiated and other provider-initiated treatments
Which one of the following nursing interventions is an indirect care intervention?
A. A nurse explains available birth control measures to a young couple.
B. A nurse meets with the collaborative care team to plan nursing measures for a patient.
C. A nurse prays with a patient prior to surgery.
D. A nurse administers pain medication to a patient with end-stage renal cancer.
-Carry out the plan
-Continue data collection and modify the plan of care as needed
Implementing the Care Plan #1
vDetermine the patient's new or continuing need for assistance.
vAssist the patient to achieve valued health outcomes.
Implementing the Care Plan #2
vReassessing the patient and reviewing the care plan
vClarifying prerequisite nursing competencies
vAnticipating unexpected outcomes/situations
vPreventing errors and omissions
vPromoting self-care: teaching, counseling, and advocacy
vAssisting patients to meet outcomes
Reassessing the Patient and Reviewing the Care Plan
vBe sure that each nursing intervention is supported by a sound scientific rationale, as demanded by an evidence-based practice.
vBe sure that each nursing intervention is consistent with professional standards of care and consistent with the protocols, policies, and procedures of the institution or agency.
vBe sure that the nursing actions are safe for this particular patient and individualized to the patient's preferences.
vClarify any questionable orders
Variables Influencing Outcome Achievement
oPsychosocial background and culture
oCurrent standards of care
oEthical and legal guides to practice
Which example illustrates a nurse variable influencing patient outcomes?
A. A patient in a nursing home refuses to take his medications.
B. A low-income family is unable to afford formula for their newborn infant.
C. An alcoholic patient is unwilling to participate in AA meetings.
D. A rape victim does not receive counseling in the emergency department because a counselor is not available.
Common Reasons for Noncompliance
vLack of family support
vLack of understanding about the benefits
vLow value attached to outcomes
vAdverse physical or emotional effects of treatment
vInability to afford treatment
vLimited access to treatment
Tell whether the following statement is true or false.
When a patient fails to cooperate with the care plan despite the nurse's best efforts, it is time to reassign the patient to another caretaker.
Five Rights of Delegation
vRight directions and communication
vRight supervision and evaluation
The activity falls within the delegatee's job description or is included as part of the established written policies and procedures of the nursing practice setting. The facility needs to ensure that the policies and procedures describe the expectations and limits of the activity and provide any necessary competency training.
The health condition of the patient must be stable. If the patient's condition changes, the delegatee must communicate this to the licensed nurse, and the licensed nurse must reassess the situation and the appropriateness of the delegation.
The licensed nurse along with the employer and the delegatee is responsible for ensuring that the delegatee possesses the appropriate skills and knowledge to perform the activity.
Right Directions and Communication
-Each delegation situation should be specific to the patient, the licensed nurse, and the delegatee.
-The licensed nurse is expected to communicate specific instructions for the delegated activity to the delegatee; the delegatee, as part of two-way communication, should ask any clarifying questions. This communication includes any data that need to be collected, the method for collecting the data, the time frame for reporting the results to the licensed nurse, and additional information pertinent to the situation.
-The delegatee must understand the terms of the delegation and must agree to accept the delegated activity.
-The licensed nurse should ensure that the delegatee understands that she or he cannot make any decisions or modifications in carrying out the activity without first consulting the licensed nurse.
Right Supervision and Evaluation
-The licensed nurse is responsible for monitoring the delegated activity, following up with the delegatee at the completion of the activity, and evaluating patient outcomes. The delegatee is responsible for communicating patient information to the licensed nurse during the delegation situation. The licensed nurse should be ready and available to intervene as necessary.
-The licensed nurse should ensure appropriate documentation of the activity is completed
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