05.05 Nursing Process – Implement

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Overview

  1. Implementation
    1. Phase Information
    2. Interventions

Nursing Points

General

  1. Phase Information
    1. Fourth Phase
    2. Begins after planning
  2. Implementation
    1. Execute Care
      1. Actual delivery of the care or intervention
    2. Deliver care
      1. The first two phases of the nursing process prepares for implementation, in addition to solid knowledge base
      2. Be confident in how you deliver your car.  You have the knowledge to back up what you’re doing, so go in as if you’ve done that intervention hundreds of times.
      3. Monitor for safety before, during and after interventions
        1. Requires reassessment, changing plan of care if necessary
      4. Continuous, cyclical process
        1. Always assessing, analyzing and changing care plans if necessary
    3. Sometimes interventions do not work
      1. Not a sign of a bad nurse
      2. Maybe a better intervention is available
      3. Follow up with resources available to you
        1. Charge nurse
        2. Veteran nurses
        3. Physicians

Nursing Concepts

  1. Professionalism
  2. Clinical Judgment

Reference Links

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Video Transcript

The implementation phase is the fourth step in the nursing process. I’m not gonna beat a dead horse here too much guys, this is where you do it, this is where you do the interventions that you have planned.

Let’s talk about it really quick though, like I said it’s the fourth phase of the nursing process, this begins right after we plan our care. The RN is gonna evaluate the interventions and if they worked in the next phase. What we do here guys is we basically execute our care, we do our planned interventions. One thing I want you to keep in mind here guys is that you need to be confident.

All right what can happen here is during this first phase of the nursing process the assess, diagnose, this planning, all these different phases we’ve been gathering all this data, we’ve collected all this information, and now it’s time for us to go do what we need to do. You need to do these things confidently, don’t walk in there scared, don’t walk in there timid, walk in there confident. You’ve made your decision go in there and perform your care as if you’ve done it 100 times. Your patient doesn’t want to see you walk in there all scared, they want to see you walk in there confident, comfortable in what you’re doing so have confidence of this phase. You’ve collected the data, you’ve made your decision, now go in there and do it.

Sometimes these things that we plan to do, these things that we implement they just don’t work. That doesn’t mean that you’re a bad nurse, you’re not a bad nurse if your interventions don’t work. Okay sometimes world class athletes trip on a hurdle in the Olympics, that doesn’t mean that they’re bad runners or they’re slow, that means it just didn’t work that time. Okay? An intervention might not be available, the patient might have an unexpected reaction to something we didn’t know about, so if it doesn’t work that doesn’t reflect poorly on you, the patient might be dehydrated, you might not be able to get a vein, nobody might be able to get a vein, so just be easy on yourself during this phase especially if interventions don’t work.

You can follow up with people if they aren’t working, follow up with your charge nurse first, you can follow up with other veteran nurses who maybe have more experience on the floor or who have done this before, you can follow up with other providers or physicians. If you say you know this is what we planned to do and it just didn’t work and here’s all the data I’ve gathered and this is why I did this and it just didn’t seem to work follow up with these people and they’re gonna be willing to help you, we all want the patient to be good, we all want the patient to get healthy, so follow up with these people they’re gonna help you out. Now the nursing concept you need to keep in mind here are professionalism and clinical judgment. Again using your judgment, using all this data, all this information that you’ve gathered to then go implement the care that you have determined is best for your patient.
The key points out here guys, biggest thing is just do it. Right? Just do it, don’t tell Nike, I don’t want them to sue me. But once you’ve decided what you’re gonna do go do it, that’s as easy as it is. Deliver the care with confidence, the first thing here guys is you need to know your stuff. Learn all that you can, practice all that you can, and then when these interventions arise for you on the floor go in there and do your stuff. Then be humble, sometimes the interventions don’t work, that doesn’t mean you’re a bad nurse sometimes things just don’t work, sometimes there might be a different option or something might work better for a patient.

One thing to keep in mind here guys as you’re taking NCLEX questions what should the nurse do next doesn’t always mean implementation, make sure that you’re following the nursing process don’t just jump to action means implement. Your first action might be an assessment or something like that so don’t get caught in that NCLEX trap, we do talk about that in the test taking course.

All right guys I hope that helps. Dive into the other lessons here and just realize and what I want you to keep in mind here is have confidence when you implement, talk to your patient clearly, talk to them cleanly, and then go in and just do it and be humble if things don’t work. You guys can do this, I know you can, go out and be your best selves today. Happy nursing.

Read more

  • Question 1 of 10

A nurse is caring for an 86-year-old client receiving enteral nutrition through an NG tube. The client continues to pull at the tube in an attempt to take it out. The client has had wrist restraints on and off for the past two days while in the hospital and the nurse is considering what options could be implemented instead. Which of the following should the nurse consider for alternatives to using wrist restraints?

  • Question 2 of 10

A nurse is discharging a client to home following abdominal surgery. The client has a history of diabetic neuropathy and the nurse is providing discharge instructions. Which of the following instructions should the nurse give to this client to best prevent an injury at home as a result of peripheral neuropathy symptoms?

  • Question 3 of 10

A pediatric nurse is caring for a 2-year-old child who suffered a femur fracture. The child has a cast on the leg and has been placed in Bryant’s traction. Which of the following considerations must the nurse implement when working with a child who uses this traction?

  • Question 4 of 10

While caring for a patient who is dying of cancer, the nurse tries to control the patient’s pain. The nurse uses the WHO ladder to determine how much pain medicine to give. Which best describes implementation of this ladder?

  • Question 5 of 10

A nurse has started working in a clinic where many of the clients do not speak English. While the nurse has some working knowledge of a couple of other languages beyond English, the nurse is not fluent enough to easily communicate with most of the clients. Which actions would best represent the nurse’s attempts to implement cross-cultural care in this practice setting? Select all that apply.

  • Question 6 of 10

A client has been diagnosed with antisocial personality disorder and becomes very angry with the nurse and is starting to become aggressive. Which principle of management would most likely be implemented in this situation?

  • Question 7 of 10

A nurse in a long-term care facility has many clients who have difficulties with urinary incontinence and immobility. Which methods could the nurse implement that would most likely reduce moisture content on the skin of these clients? Select all that apply.

  • Question 8 of 10

The nurse is caring for a client who has returned to the floor from the PACU after an appendectomy. Based on this surgical procedure, the nurse knows to implement which of the following interventions for this client?

  • Question 9 of 10

A nurse is caring for a 12-month old child who is recovering from surgery. Which of the following principles should the nurse implement when managing pain in a patient who cannot communicate with words? Select all that apply.

  • Question 10 of 10

A nurse is caring for a client who has been sexually abused. Which of the following interventions should the nurse implement to establish rapport and to demonstrate safety?

Module 0 – Fundamentals Course Introduction

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