8.6: Nursing Implementation

Implementation is the execution of the nursing care plan developed during the planning phase.

The five steps to implementing effective nursing care include reassessing the patient, reviewing and revising the existing nursing care plan, organizing the resources and care delivery, anticipating and preventing complications, and implementing nursing interventions.

1. The first step is reassessing the client, a continuous process every time a nurse interacts with a patient, obtains new data, identifies a new patient need, and modifies the care plan. A reassessment aims to gather more information to ensure the treatment plan is effective. It helps to decide if the proposed nursing actions are still appropriate for the patient's level of wellness.
2. The second step is to ensure the validity of nursing diagnoses and the appropriateness of nursing treatments, review the care plan and compare assessment results. If the patient's status changes and the nursing diagnosis and accompanying nursing interventions are no longer suitable, the nursing care plan is modified. An outdated or inadequate care plan compromises quality nursing care. Reviewing and modifying the care plan enable timely nursing interventions to best meet the patient's needs.
3. Organizing resources and providing care involves assembling a team of experts and equipment. The proper organization of equipment and personnel makes the ability to provide timely, efficient, and quality patient care. The patient and the environment must be ready before nursing intervention can begin.
4. The fourth step includes anticipating and preventing complications arising from the patient's illness or treatment. The nurse should recognize the risks and select appropriate interventions according to the situation.
5. The fifth step includes implementing skills that integrate cognitive, psychomotor, and interpersonal activities.

Nursing requires cognitive, interpersonal, and psychomotor (technical) abilities. Nurses need each type of skill to implement direct and indirect nursing interventions. Direct care entails the application of cognitive skills (critical thinking, reflection, clinical judgment, creativity, and so on); interpersonal skills (caring, communication, comforting, advocacy, and counseling, among others); and technical or psychomotor abilities (lifting, giving injections, repositioning, etc.).

For indirect care, the treatments are performed through client interactions, such as medication administration. Likewise, indirect care includes treatments performed away from the client but on behalf of the client. Examples include communication of patient care with other healthcare providers, making referrals, advocating, and managing the environment.