00:01
Welcome to the implementation
phase of the ADPIE process.
00:05
So, if you recall,
we have five-steps
to that nursing process.
00:10
So the I piece of the pie
is our implementation phase.
00:13
I like to call this
the action phase,
because this is where,
as nurses,
we get to carry out
the functions
to help improve
our patient condition.
00:22
So when we're talking about
a nursing intervention,
just know that
this is any treatment
based on our clinical judgment
and our knowledge base,
this is going to help enhance
the outcomes of our patient.
00:33
And this could be
for a patient specifically,
it could be for a family,
or a group, for example.
00:40
Now, when we're talking
about implementation,
there's some critical thinking
that we need to do.
00:45
We've got to think about
the patient's medical condition,
possible outcomes that can occur
and expected response.
00:52
And all of these pieces
go into our implementation plan
for our patient.
00:58
So when we're talking about
an implementation plan,
we have certain
nursing interventions
that we can choose from.
01:04
Don't worry about this, guys,
you don't have to come up
with these on our own.
01:08
Here are some guidelines
for selection of interventions.
01:12
So, one of the
first and foremost
is clinical practice
guidelines or protocols.
01:17
So these are particularly from an
evidence based practice that shows
this type of intervention
is best for this specific condition
of a patient.
01:26
Here's a great example of that.
01:28
Let's say a patient comes
into the ER with a stroke,
for example.
01:32
We have specific protocols in how
we treat that stroke patient.
01:37
And we can follow
that same order set.
01:39
So those guidelines and those
interventions have been proven
to be effective
in that particular patient
like for stroke.
01:47
Next, we have standing orders.
01:49
Guys, nurses love this.
01:50
This helps us reduce our time
in calling the physician
many times
throughout our shift.
01:56
So when we talk about
a standing order,
this is something
that's on the patient's orders
that we may or
we may not use this,
Here's a great example.
02:05
Here's an example
of a standing order
that you may see
really commonly in your practice.
02:10
Maintain oxygen saturation
above 94%.
02:14
So as a nurse,
if we assess our patient
and see that the saturation
drops below this,
then we can intervene,
do that event,
because we have a standing order.
02:26
Because
with a standing order,
the physician has
already placed this
to where we can follow this
and we are not practicing
out of our scope of practice.
02:36
Next, we have interventions.
02:37
And of course,
we know lots about these.
02:39
These interventions
are outlined by NANDA,
but these are more
nurse driven.
02:44
So for example,
a patient will ambulate
three times a day.
02:47
We don't need an order for this.
02:49
This is something
that's nurse initiated.
02:53
And lastly, when we're
talking about interventions.
02:55
We've got to think
of what we call the ANA,
American Nurses Association.
03:00
They provide standards
of nursing practice.
03:04
It outlines what's ethical
and the minimum amount of care
that the patient has the right
to receive from their nurse.
03:10
So again, when you're
looking at interventions,
many times we're going
to have best practice
and protocols
for you to follow
depending on the diagnosis,
standing orders,
nurse initiated interventions,
and also ethical standards
that we have to go by.
03:28
Now, when we're talking about
implementation.
03:30
Of course,
we always need to go back
to assess and reassess
the patient and their needs.
03:36
Now, due to the
reassessment piece,
and we're about to intervene,
we may need to revise
the plan of care
to what's accurate and appropriate
at that time.
03:45
If we revise this care
appropriately,
we can organize our care,
and then limit the risk
of complications
when we perform our interventions
for our patients.
03:55
So, of course, when we're
talking about implementation,
the nurses has
the big piece of this, right?
because we're going to be
the one
that carries out
those interventions.
04:03
So as a nurse, we have skills
that are key for implementation.
04:08
One of those being
cognitive skills.
04:10
We have to apply
our critical thinking.
04:13
So this is important
because every intervention
is not appropriate
for every patient.
04:20
Even if they have
the same issue going on.
04:23
Okay, let me take a minute
and repeat that.
04:26
So, this may seem
a little confusing,
but every intervention isn't
appropriate for the same problem.
04:32
So we as a nurse have to use
our critical thinking skills
and decide
is this appropriate for a patient?
And also, when we're
carrying out interventions,
there's some interpersonal skills
that must be established.
04:45
We've got to develop
trust with our patients,
we've got to communicate
effectively,
because if we don't,
the patient's compliance for
treatment may not be so good
if we don't communicate
with our patient
and have a good
working relationship.
04:59
And lastly,
we have psychomotor skills
that we have to perform.
05:03
So we've got to integrate
that cognitive and motor activity,
because many of the
treatments that we do
take hands on nursing skills
when we're talking about
nursing interventions.
05:14
So we're talking about
implementation.
05:16
This can come
in a number of ways.
05:19
So this can be direct care,
or indirect care.
05:23
Now,
what I mean by this
is when we're providing direct care,
or direct nursing interventions.
05:28
These are treatments
that are performed through
interactions with our patients.
05:32
So directly with the patient.
05:34
And sometimes our interventions
can even include indirect care.
05:39
Meaning we're going to
perform treatments
that are away from
the actual patient's bedside,
but it's on behalf of the patient.
05:45
So let me show you
what I mean by those.
05:49
So here's a great example.
05:50
If you're looking at this
long list here on this slide,
we've got the direct care piece.
05:56
So notice, this is the stuff
we do hands-on with a patient.
05:59
Like our assessment,
med administration,
we're going to help them
participate in therapy, etc.
06:06
Now, when we're talking about
indirect care,
this is again, more stuff away
from more patient.
06:11
So this can just mean
us documenting that care
to communicate with
other providers,
just direct communication
with the healthcare team
about our patients problem,
coordinating care,
evaluating,
and working with
interdisciplinary systems as well.
06:27
So just know when you're talking
about direct and indirect care,
all of this is part of
the implementation phase
for our patients.
06:36
So when we're talking about
implementation of care,
sometimes we need to think about
teamwork.
06:41
And we also need
to think about delegation
when it's appropriate.
06:45
So I want to orient you
to this arrow here.
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When you're looking at
the green piece down here,
all the way to the red
on the arrow,
the green is pretty safe here
for delegation, for example.
06:56
Such as activities of daily living,
where maybe the patient needs help
bathing, or dressing, or eating,
all the way
to increase in complexity
to those life saving measures.
07:07
Now, this can include
giving invasive drugs.
07:10
There's a whole list of this
that we have to consider
in regard to delegation.
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Is it safe, or is it not?
So we have to consider the personnel
that we're going to delegate to.
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Also think about from the red,
if you move closer
to the green side,
these are pieces that were more
safely able to delegate.
07:30
So especially again,
those activities of daily living.
07:34
And you've got to remember,
as a nurse,
when you delegate
aspects of a patient's care,
this is a really
important point, guys.
07:42
You are responsible for every task
that you delegate to someone
because it affects your patient.
07:49
Here's a great example of that.
07:50
Let's say, I need a blood pressure
taken on a patient.
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And I delegate
my nursing aid.
07:56
Well, if I get a reading
and I medicate off of that,
then I have to ensure that that
manual blood pressure that was taken
was done appropriately
and accurately,
because I'm going to provide
treatment based on that result.
08:12
Now, when we're talking
about implementation, again,
we're trying to work
with our patient
to meet our goals.
08:17
So if you take a look here
on this bridge,
we're starting with our
treatment plan as a nurse.
08:23
We've created multiple interventions
that may be needed
to reach our patient's goal.
08:27
We also need
to remember that
there's lots of priorities
along the way.
08:32
And we maybe need to help
to anticipate
the sequence
of those nursing interventions.
08:37
And also, you've got to remember
to invest in the time
to make sure
the patient understands,
you've included them
in that plan of care,
because
this is going to matter
when they're carrying out
required treatments
for that patient.
08:50
And again, all of these should align
with your patients goal.