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Nursing Process: Implementation and Evaluation

5 min read

Reference:

  1. Lecturer (Tuiza)

Implementation

The action phase in which the nurse performs nursing interventions. The client is reassessed to make sure the interventions are still valid, then care is provided. Requisite assistance is obtained for the procedure. During provision, supervision is imperative for delegated care. All nursing activities are documented.

  1. Reassessing the client is done prior to care to determine if intervention is still required. This applies to independent and dependent actions, and the nurse exerts their clinical judgment as necessary.
  2. Determining the need for assistance is done to perform care best provided collaboratively. This enhances safety and efficiency, especially in the case of a nurse who is not yet experienced in practice.
  3. Supervising delegated or assigned care is a legal and ethical obligation under the doctrine of respondeat superior. All care activities must be implemented according to the care plan.

Respondeat Superior is a doctrine of law to "let the principal be held responsible", extending the liability of subordinates to their superiors.

  1. Documenting Nursing Activities: completion of the implementation phase occurs after recording the interventions and client responses in the nursing progress notes. This is done immediately after implementation, and never in advance.

Good Characteristics of Nursing Interventions

  • Adaptable: care is individualized to patient health status, beliefs, environment, etc.
  • Based on professional standards: scientifically rational, with proper considerations and education on side effects and complications to watch out for.
  • Clear and understandable; any questionable interventions are clarified and revised if erroneous.
  • Dignified. The client’s self-esteem is preserved as much as possible.
  • Encouraging for the patient, especially in exercising independence, control, and active participation in their care.
  • Holistic. It should be safe and applied with teaching, support, and comfort.

Evaluation

The final phase of the nursing process. Conclusions are drawn whether or not the nursing interventions should be terminated, continued, or changed. There are five components of evaluation:

ComponentQuestion
Collecting DataHas the client’s condition improved or deteriorated since the last evaluation?
Comparing DataWhat improvements have been made in client care?
Relating Nursing ActivitiesWere the nursing interventions able to attain the planned outcomes?
Drawing ConclusionsWhich outcomes have been attained?
Continuation, Modification, or TerminationAre there any changes necessary in the plan of care to attain the desired outcomes?
  1. Collecting Data: assessment of the client for the effects of implemented care. This follows the same principles as applied in the assessment phase.
  2. Comparing Data: the re-assessment is compared to the data for desired outcomes. This is generally divided into three phrases in documentation: Goal met, Goal partially met (i.e., not all desired outcomes were reached), and Goal not met. These are followed by the assessment data supporting such a declaration.
  3. Relating Nursing Activities: the interventions are correlated to the outcomes to determine their role in reaching goals. This determines if interventions are necessary, appropriate, effective, or efficient.
  4. Drawing Conclusions: the previous steps compile into this final output. It concludes whether interventions should be continued, revised, or discontinued:
StatusFurther Action
Goal Met: the problem has been resolved and its risk factors are no longer presentCare is discontinued
Goal Met: the problem has been resolved but its risk factors remain presentThe care plan is kept for use when necessary.
Goal Partially Met: the problem remains, but some goals have been metContinue nursing intervention, consider revisions
Goal Partially Met or Goal Not MetThe care plan may need to be revised, or has not yet been able to exert its full effect.

Agency SOP

Agencies have differing standards for NCP modifications. In some, modifications may be made via strikethrough (like this) for the care plan, highlighting, or indicating revisions as appropriate for electronic charting systems. Writing “Discontinued”, “Goal Met”, or “Problem Resolved” may also be appropriate.

Evaluation Checklist

Below is a simple guideline for evaluating whether the stages of the nursing process were performed adequately:

  • Assessing:
    1. Are data complete, accurate, and validated?
    2. Do new data require changes in the care plan?
  • Diagnosing:
    1. Are nursing diagnoses relevant and accurate?
    2. Are nursing diagnoses supported by the data?
    3. Has problem status changed (i.e., potential, actual, risk)?
    4. Are the diagnoses stated clearly and in the correct format?
    5. Have any nursing diagnoses been resolved?
  • Planning (Desired Outcomes):
    1. Do new nursing diagnoses require new goals?
    2. Are goals realistic?
    3. Was enough time allowed for goal achievement?
    4. Do the goals address all aspects of the problem?
    5. Does the client still concur with the goals?
    6. Have client priorities changed?
  • Planning (Nursing Interventions):
    1. Do nursing interventions need to be written for new nursing diagnoses or new goals?
    2. Do the nursing interventions seem to be related to to stated goals?
    3. Is there a rationale to justify each nursing order?
    4. Are the nursing interventions clear, specific, and detailed?
    5. Are new resources available?
    6. Do the nursing interventions address all aspects of the client’s goals?
    7. Were the nursing interventions actually carried out?
  • Implementing:
    1. Was client input obtained at each step of the nursing process?
    2. Were goals and nursing interventions acceptable to the client?
    3. Did the caregivers have the knowledge and skill to perform the interventions correctly?
    4. Were explanations given to the client prior to implementing?

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