FUNDAMENTAL OF NURSING-II

IMPLEMENTATION
&
EVALUATION
Younas Bhatti 1
Nursing Instructor
Bahria Town School of Nursing

Implementation and Evaluation 10/22/2019

By the end of this unit the students will be able to,
1. Understand the implementation and evaluation and the
process of implementation.
2. Review the skills used for the implementation process
3. Describe the evaluation and its importance
4. Enlist the types of the evaluation

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 Implementing consists of doing and documenting the activities
that are the specific nursing actions needed to carry out the
interventions.
 Three of the implementation substandard apply to all
registered nurses: coordination of care, health teaching and
health promotion, and consultation.
Implementing Skills:
 To implement the care plan successfully, nurses needthe
following three skills,
1) Cognitive
2) Interpersonal,
3) Technical skills.

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 Cognitive skills
 These are known as the intellectual skills and include, Problem
solving, decision making, critical thinking, clinical reasoning,
and creativity.
Interpersonal skills
 These include the communication skills. All of the activities,
verbal and nonverbal, people use when interacting directly
with one another.
 The effectiveness of a nursing action often depends largely on
the nurse’s ability to communicate with others.
 Interpersonal skills include conveying knowledge, attitudes,
feelings, interest, and appreciation of the client’s cultural values
and lifestyle.

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 Technical skills are purposeful “hands-on” skills such as
manipulating equipment, giving injections, bandaging, moving,
lifting, and repositioning clients.
 These skills are also called tasks, procedures, or psychomotor
skills.
 The term psychomotor refers to physical actions that are
controlled by the mind, not by reflexes.

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The process of implementing normally includes the following:
 Reassessing the client
 Determining the nurse’s need for assistance
 Implementing the nursing interventions
 Supervising the delegated care
 Documenting nursing activities.
Reassessing The Client:
 Just before implementing an intervention, the nurse must
reassess the client to make sure the intervention is still needed.
 The reassessing process changes the priorities and decisions
which are being made by the nurses to implement the
interventions.

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 Reassessing The Client:
 For example, a nurse begins to teach a client who has diabetes
how to give himself insulin injections.
 Shortly after beginning the teaching, the nurse realizes that he
is not concentrating on the lesson.
 Subsequent discussion reveals that he is worried about his
eyesight and fears he is going blind.
 Realizing that the client’s level of stress is interfering with his
learning, the nurse ends the lesson and arranges for a primary
care provider to examine the client’s eyes.
 The nurse also provides supportive communication to help
alleviate the client’s stress.

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 Determining The Nurse’s
Need For Assistance
 Whenever implementing some nursing interventions, the nurse
may require assistance for one or more of the following reasons:
 When the nurse is unable to implement the nursing activity safely
or efficiently alone
For example: ambulating an unsteady obese client.
 The Presence of the assistance will reduce the stress on the client.

For example turning a person who experiences acute pain when

moved.
 When the nurse lacks the knowledge or skills to implement a
particular nursing activity
 For example a nurse who is not familiar with a particular model of
traction equipment needs assistance the first time it is applied.
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 Implementing The Nursing Interventions
 It is very important to explain to the client what interventions will
be done, what feelings to expect, what the client is expected to do,
and what the expected outcome will be.
 For many nursing activities it is also important to ensure the client’s
privacy, for example, by closing doors, pulling curtains, or
covering the client.
 Other than direct or independent nursing interventions the nurses
also work in coordination.
 Nurses also coordinate client care. This activity involves
scheduling client contacts with other departments (e.g., laboratory
and x-ray technicians, physical and respiratory therapists) and
serving as a liaison (connection or association) among the
members of the health care team.

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 The Nursing interventions are always based on Scientific
knowledge, Nursing Research and Evidence based Practices.
 For example, a client has been taking an oral medication after
meals; however, this medication is not absorbed well in the
presence of food.
 Therefore, the nurse will need to explain why this practice
needs to be altered.
 The nurse must always view the client as a whole and consider
the client’s responses in that context.
 Encourage clients to participate actively in implementing the
nursing interventions.
 Active participation enhances the client’s sense of
independence and control.

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 Supervising Delegated Care:
 The nurse is responsible for the overall care even when it is
delegated.
 The nurse responsible for the client’s overall care must ensure that
the activities have been implemented according to the care plan.
 The nurse validates and responds to any adverse findings or client
responses. This may involve modifying the nursing care plan.
Documenting Nursing Activities:
 After carrying out the nursing activities, the nurse completes the
implementing phase by recording the interventions and client
responses in the nursing progress notes.
 These are a part of the agency’s permanent record for the client.

 Nursing care must not be recorded in advance because the nurse

may determine on reassessment of the client that the intervention
should not or cannot be implemented.

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 The evaluation means to judge or to review
 It is the fifth step of the nursing process and it is very crucial
 It is to determine whether, after application of the nursing
process, the patient’s condition or well-being improves.
 Evaluation is an ongoing process that occurs whenever Nurse
has contacted with a patient.
 Once the nurse delivers an intervention, she/he gathers
subjective and objective data from the patient, family, and
health care team members
 Evaluating is a planned, ongoing, purposeful activity in which
clients and health care professionals determine
(a) The client’s progress toward achievement of goals/ outcomes
and
(b) The effectiveness of the nursing care plan.

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 Successful evaluation depends on the effectiveness of the steps
that precede it.
 The evaluating and assessing phases overlap
 During the assessment phase the nurse collects data for the
purpose of making diagnoses.
 During the evaluation step the nurse collects data for the
purpose of comparing it to preselected goals/outcomes and
judging the effectiveness of the nursing care.
Process of Evaluating Client Responses
 Before evaluation, the nurse identifies the desired outcomes
(indicators) that will be used to measure client goal
achievement.

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 Desired outcomes serve two purposes:
 They establish the kind of evaluative data that need to be
collected
 These provide a standard against which the data are judged.
For example,
 Given the following expected outcomes, any nurse caring for
the client would know what data to collect:
 Daily fluid intake will not be less than 2,500 mL.
 Urinary output will balance with fluid intake.
 Residual urine will be less than 100 mL

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 The evaluation phase has five components
1) Collecting data related to the desired outcomes
2) Comparing the data with desired outcomes
3) Relating nursing activities to outcomes
4) Drawing conclusions about problem status
5) Continuing, modifying, or terminating the nursing care plan.
Collecting Data
 Using the clearly stated, precise, and measurable desired
outcomes as a guide, the nurse collects data so that conclusions
can be drawn about whether goals have been met.

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 Some data may require interpretation.
 Examples of objective data requiring interpretation are the degree
of tissue turgor of a dehydrated client or the degree of restlessness
of a client with pain.
 Examples of subjective data needing interpretation include
complaints of nausea or pain by the client. When interpreting
subjective data, the nurse must rely on either
(a) the client’s statements (e.g., “My pain is worse now than it was
after breakfast”)
(b) objective indicators of the subjective data, even though these
indicators may require further interpretation (e.g., decreased
restlessness, decreased pulse and respiratory rates, and relaxed
facial muscles as indicators of pain relief).
 Data must be recorded concisely and accurately to facilitate the
next part of the evaluating process.

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 Comparing Data With Desired Outcomes
 If the first two parts of the evaluating process have been
carried out effectively, it is relatively simple to determine
whether a desired outcome has been met or not.
1. The goal was met; that is, the client response is the same as
the desired outcome.
2. The goal was partially met; that is, either a short-term
outcome was achieved but the long-term goal was not, or the
desired goal was incompletely attained.
3. The goal was not met.
Relating Nursing Activities To Outcomes
 The third phase of the evaluating process is determining
whether the nursing activities had any relation to the outcomes.
 It should never be assumed that a nursing activity was the
cause of or the only factor in meeting, partially meeting, or not
meeting a goal.

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 Drawing Conclusions About Problem Status

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