Implementing Care

This essay describe the nursing processes, with implementing as the fourth phase in the nursing process, or intervention phase through the use of Roper, Logan and Tierney (1996), models of nursing which is based to the priority nursing actions or interventions performed to accomplish a specified goal stated in the holistic assessment and planning care of my client.

The use of a pseudonym John is also going to be used as a way of protecting client confidentiality as required by the Nursing and Midwifery Council (2004).

I will focus on Mr John care implementing in return to the activities of living that I had used during assessment and planning which was breathing. I will try to implement the nursing care plan follows the planning component of the nursing process and diagnosis, which I had established the priority of care to identify the nursing interventions that I will provide to John with the help of my Mentor and the Multidisciplinary team. The actions are also selected after goals are established.

However, to implement these actions occurs during the phase of implementation of 7the nursing process. Synder (1985) proposes that nursing intervention is a model of decision making.

Implementation is the delivery of nursing care, including the initiation and completion of the actions necessary for achieving the set goals: which means to perform, assist, or direct the performance of the twelve activities of daily living. According to Heath (1995), Implementation begins after the care plans has been developed, and focus on the initiation of nursing interventions to achieve the goals of care.

A nursing intervention is any act that a nurse do to implement the nursing care plan or any specific objective of the plan. Roper et al (1996) suggest that a patient or client may require intervention in the form of support, medication, treatment for the current condition or treatment to prevent future health problems of the patient or client.

I will use the steps of implementing nursing care, by focusing on the initiate nursing intervention to achieve the goals of nursing care of my client, by assisting him to solve or alleviate actual problems in the respiratory system, cardiovascular system or any combination of these. To prevent solved problems from recurring, counselling and educating him, the nurse’s role is to be as a health educator as it has been acknowledged in the Health of the Nation (Department of Health, 1991) by providing care to achieve therapeutic goals, and giving care to facilitate the attainment of the goals. Heath (1995) states that nursing intervention is composed of cognitive skills which means that the nurse must know the rationale for each intervention, understand physiological and psychological aspect of nursing, so the nurse could recognise the need for preventive and compensatory nursing actions.

Interpersonal skills are also essential to effective nursing action. The nurse must communicate clearly with the patient, family, and other member of the health care team. So that counselling and teaching must be done to the level of the patient understanding.

I know how effectively and efficiently decisions are implemented, and I know when plans worked out in practice will have a great deal to do with a success or failure, which is associated of being confident, decisive and courageous in carrying through an action plan. According to Thompson et al (2000), several factors are involved in effective and efficient implementation of practical decisions; which include a responsible monitoring of progress or failure of the action taken to achieve defined objectives.

Before implementing to be effective, multidisciplinary team should be involved and worked together as a team as Alexander et al (2000) described that nurses, doctors and the health team personal should work cooperatively to a proper nursing intervention and care as part of a collaborative team approach, so the realistic goals planned during the nursing plan to be achieved.

Mr John assessment and planning shows he was suffering from shortness of breath. I referred him to a specialist nurse, to solve actual problems in the respiratory and cardiovascular systems which have caused the shortness of breath.

I gave full explanation and reassurance to John about the implementation of his nursing care intervention, so he could participate on his treatment, and to have any information related to his care. In the Nursing and Midwifery Code of Professional Conduct (2004) states that any time to obtain patient consent before you give any treatment, and to respect the patient as an individual. The Code means that you have to explain and gain consent to any patient before undertaken any procedure, or treatment, and to treat the patient explanation and declaration confidential. The implementation of care should involve John, so that he would be aware of why such care is needed, but also the member of the multidisciplinary team who have a stake in helping John to get back his health.

Thompson et al (2001) suggested that nurses should always consult the patient before to carry out any procedure which is part of his treatment, and to explain to him everything that has been decided. I thought that is very important to encourage patients to be independent and to involve their relatives in their care. The Code of Professional Conduct (UKCC 1998) in Clause 5 define that this clause emphasises the importance of involving patients in their own care. Any patients have the right to take part of any of their treatment, which is part of the Human Right Act (1998).

I implemented his problem and health needs first, so I could achieve the goals set during planning, to minimize potential and actual complications. My nursing intervention for his shortness of breath, I promoted the record and monitoring his pulse and blood pressure as his condition indicates and his oxygen saturation. Referring from his assessment and planning, John was complaining about chest pain, had pyrexia because of high temperature, query of Urine Tract Infection due to the presence of protein and ketone in his urine, his oxygen saturation on air was very low. Then, I did a risk assessment chart and fluid chart.

For my nursing intervention, I decided to take his temperature, so I could monitor the fluctuations of his temperature. Pulse, blood pressure more often and to record his oxygen saturations, and respiration rate, which is important. An individual should be observed for rate, depth and pattern of breathing, so you could detect if tachypnoea as occurred which is an increased respiratory rate. According to Mallet et al (2000) respiratory rate could increase when the person is suffering from pneumonia. Bradypnoea occur when the respiratory rate decreased.

I implemented a short term goal to achieve, so that he would comfortable and pain free within 20 minutes, to promote his well-being.

I implemented a long term goal to achieve, so that he would feel in control of you’re his pain within 12 hours, to ensure chest expansion, coughing and pain free movement has been achieved by John, as he stated of feeling sharp pain along his ribs.

I referred him to physiotherapist as it has been required by the multidisciplinary team, and has been also send for chest x-ray. If the pain continued within the 20 minutes, I will decide another achievement, to give him a correct analgesia with the right route, dose and the right time.

For the potential and actual risk of infection, the goal I intend to achieve is the short term goal first which is to detect and treat infection. So, I make sure John is comfortable, I applied a fan therapy, and requested paracetamol from my Mentor to stabilise his temperature to normal.

I took a urine sample, and send it to the microbiology for test if he had Urine Tract Infection (UTI); so that the doctor could prescribed some antibiotics for the infection, because testing urine could provide a great deal of information about their state of health.

I decided for the doctor to prescribe oxygen therapy, to implement and maintain adequate oxygen saturation range between 96 to 100%, so I would be able to prevent him from chest infection and complication. The goal of the oxygen therapy is to prevent or relieve Hypoxia, as John oxygen saturation was low, and a lack of oxygen in the blood which is (Hypoxaemia) is obviously the reason for administering oxygen to prevent lack of oxygen in the tissues. According to Heath (1995) states that Oxygen is not a substitute for other treatment, however, in the case of my patient, it should be used only when indicated, as it should be treated as a drug. Kenworthy et al (2002) suggested that cells can manage with a limited supply of oxygen as their energy chemical requirement activities is much diminished by a reduction in oxygen.

In implementing, to maintain fluid and electrolyte balance, is to prevent John from dehydration during his stay on the ward.

I implemented to measure again John’s weight and height so I could calculate his body mass index, as follow: BMI (weight in kg divided by height m2). To prevent him from any risk of pressure sore, and to identify if he is underweight or overweight, and Jarvis (2004) suggested that to measure weight, height, and body mass index (BMI) should be recorded on the patient’s notes.

I implemented a fluid chart, to monitor the amount of fluid taken in and excreted out from the body with the help of my Mentor and the Multidisciplinary team. Because it is a very important indicator of health, if more fluid is excreted than the intake, then the patient could became dehydrated. That is why the intake and output is measured by keeping a record of the volume of fluids in and out, which I recorded on a fluid chart. Nolan (2002) describe that in order to keep an accurate record of input and output of fluid, and all the fluid which the patient takes through the mouth or through an intravenous drip, must be measured.

I implemented to check his blood glucose level appropriately as John has a past medical history of diabetes, and also is a requirement under the ward policy to check any patient blood glucose admitted on the ward.

I put two wrist bands on John’s arms, one with his name, date of birth, and hospital unit number. The second wrist band would indicate that he is allergic to penicillin, and has been also recorded on his nursing notes.

For his nutritional implementation, I recorded and inform the team about the essential nutrients he required as he is diabetic, as Alexander et al (2000) as described that food analysis and dietary planning are important. Then I referred him to the dietician. I informed the housekeepers that he was vegetarian, and I documented everything on his notes.

In implementing John’s anxiety, I did a one to one counselling, to explain them about all the treatment and expected cause of being at the hospital, because during assessment and the planning, his was worried about how long he will stay in the hospital. Because illness is a disrupting psychological event for anyone and could presents more challenges to the ill person, when is compounded by the family’s reactions to it. That is why I had a discussion with John’s wife, so she could visited him more often without pressurising her, so she could help him to overcome his worries. Barry (1996) believes that the important part of a person is social function. To function socially, a person must interact with others, so that he will have the opportunity to be well and not at risk of any psychological problems.

The discharge plan I implemented is to achieve what I plan for his discharge during admission which was he could be discharge in two weeks time.

The discharge plan I did is to provide a smooth transition from hospital to home for continued care, as Victor et al (1993) suggested that the nurse in charge should take responsibility for coordinating discharge plans.

I referred John with the help of my Mentor, to a community rehabilitation nurse one week prior to discharge, to give him advice and information on the following as appropriate: breathing exercise, alcohol consumption and anxiety.

After doing the nursing implementation of John, I documented all the agreed nursing interventions and outcomes on the appropriate notes, with the help of my Mentor and the Multidisciplinary team. Kenworthy et al (2002) believed that nursing documentation is not only to provide care of a person but also to communicate with the other members of the team. According to Heath (1995) the recording of client’s medical needs or record is an important part of nursing process, it establishes a mechanism for communication among the members of the health care team and facilitated the evaluation of the individual and creates a permanent legal record of the care provided to the client.

This essay has highlighted the nursing models and the process of implementing nursing care. I have also brought the concepts of care and methods of implementing through reflection and description I did about John holistic assessment and planning of care, by identifying his problems and needs, and trying to achieve the goals. During the process of implementing, I had always kept the patient focus about his treatment. I also give the reasons for the importance of documentation in nursing process.

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