Chapter 7

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Nursing Process: implementation and evaluation
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During implementation, you will:

perform or delegate planned interventions - meaning, carry out the care plan


How does implementation overlap with assessment?

Nursing use assessment data to individualize interventions for a specific person rather than just giving routine care


How does Implementation overlap with diagnosis?

Nurses use data discovered during implementation to identify new diagnoses or to revise existing ones.


How does implementation overlap with planning outcomes and interventions?

When the patient responses to interventions providing the data you need for revising the original goals and nursing goals


How does implementation overlap with evaluation?

You will compare the responses you observe during implementation to the existing goals


How can you prepare for implementation?

By checking your knowledge and abilities, organize your work, and prepare the patient.


How can you organize your work?

Establish feedback points, prepare supplies and equipment


What is to "establish feedback points"?

It is to get feedback from the patient (how the patient is responding to the activity) as you perform care


How can you prepare supplies and equipment?

Gather all the supplies and equipment you need before you go to the patient's room


How can you prepare the patient?

Check your assumptions, assess the patient's readiness and explain what you will do and what the patient will feel?


How can you check your assumptions?

Don't assume that an intervention is still needed simply because it is written on the care plan


How can you assess the patient's readiness?

A client must be physically and psychologically ready


Why should you explain what you will do and what the patient will feel?

Explaining will help it motivate the person and gives the patient the information they need to participate. Knowing what to expect helps to relieve anxiety, enables the person to cope with unpleasant or painful sensations and promotes a trusting relationship


How can you promote client participation and adherence?

Assess the client's knowledge, provide teaching, assess the client's supports and resources, be sensitive t the client's cultural, spiritual and other needs and view points, realize and accept that some attitudes cannot be changed, determine the client's main concerns, help the client to set realistic goals, talk openly and regularly about adherence.


Collaboration means:

working with patients and other caregivers


Coordination means:

putting together the bits and pieces of information to provide a holistic view of the person; you will need to read the reports of other professionals; help interpret the results for the patient and family and make rounds with other professionals to be sure that everyone sees the whole picture



the process of directing another person to perform a task or activity; a transfer of authority or responsibility


Delegating is:

not the same as assigning


You can delegate only:

the responsibility for performing a defined activity in a particular situation


What are the 5 rights of delegation?

Right circumstance, right person, right supervision, right communication, right task


Supervision is:

the process of directing, guiding and influencing the performance of the delegated task.



the final step of the nursing process; a planned, ongoing, systematic activity in which you will make judgments about: the client's progress toward desired health outcomes, the effectiveness of the nursing care plan, the quality of nursing care in the healthcare setting


Assessment data are collected:

before interventions are performed to determine initial or baseline health status and to make nursing diagnosis


Evaluation data are collected:

after interventions are performed to determine whether client goals were achieved.


Why is Evaluation essential to Full-spectrum nursing?

The patient is the nurse's first priority, evaluation helps nurses to conserve scarce resources, professional standards of practice require evaluation, the ANA code of ethics require evaluation, JACHO and professional standards review organizations require evaluation, evaluation helps demonstrate the value of nursing, evaluation demonstrates caring and responsibility.


Evaluation is categorized according to:

1. what is being evaluated 2. frequency and time of evaluation


What are the types of evaluation?

Structures, processes and outcomes


Structure evaluation focuses on:

the setting in which care is provided


Process evaluation focuses on:

the manner in which care is given - the activities performed by nurses


Outcomes evaluation focuses on:

observable or measurable changes in the patient's health status that result from the care given


Evaluation beings:

as son as you have completed the first nursing activity


Evaluation continues:

during each client contact until all goals are achieved or the client is discharged from nursing care


What determines how often you evaluate?

The client's status


An ongoing evaluation is performed:

while implementing, immediately after an intervention and at each patient contact


Intermittent evalution is performed:

at specificed times


Terminal evaluation describes:

the client's health status and progress toward goals at the time of discharge.


After giving care, you compare patient responses to:

the desired outcomes


You use the patient's responses to reflect critically on:

the care plan and each step of the nursing process as it applies to the patient


Reassessment are:

focused assessments


What are the types of goals achievement?

Achieved, partially achieved, not achieved


Achieved goal is:

the actual responses are the same as the desired outcomes


Partially achieved:

some, but not all, of the desired behaviors were observed, or the desired response occurs only some of the time


Not achieved:

the desired response did not occur


How can you record your evaluation statement?

Evaluative summary in the nursing notes or on the care plan; depends on the procedure specificed by the institution


An evaluation statement should include:

the conclusion about whether the goal was achieved, reassessment data to support the judgment


Variables that can affect the ability of an intervention to produce the desired outcome:

The client's ability and motivation to follow directions for treatment, availability and support from family and significant others, treatments and therapies performed by other health-care team members, client failure to provide complete information during assessment, client's lack of experience, knowledge or ability, staffing in the institution, nurse's physical and mental well-being


Goals met means:

if all goals for a nursing diagnosis have been met, you can discontinue the care plan for that diagnosis


Goals partially met:

if some outcomes are met and others not, you may revise the care plan for that problem; or you may continue with the same plan but allow more time for goal achievement


Goals not met:

if goals are not met, you should examine the entire plan and review all steps of the nursing process to decide whether to revise the care plan


How can you draw conclusions about problem status?

Depends on whether or not goals were met


How can you revise the care plan?

review each step of the nursing process; you cannot discontinue the ineffective interventions and try new ones