NURSING
PROCESS:
IMPLEMENTATION
& EVALUATION
NURS 2051: Nursing Concepts
Mrs. Leolin Castillo
OBJECTIVES
At the end of this lecture, students will be able to:
1. Define the terms, implementation, and evaluation.
2. Describe skills necessary to implement the nursing interventions.
3. Discuss the five (5) activities of the implementing phase.
4. Identify how evaluating relates to other phases of the nursing process.
5. Describe the five components of the evaluation process.
6. Describe the steps involved in reviewing and modifying the client’s care plan.
7. Describe three components of quality evaluation: structure, process, and outcomes
Differentiate quality improvement from quality assurance.
COMPONENTS OF THE PHASES
Implementation
• Take action
• giving nursing care
• Using support systems and available resources
• Document nursing activities
Evaluating
• Collect data related to outcomes
• Compare data with outcomes
• Relate nursing actions to clients’ goals/outcomes
• Draw conclusions about the problem status
• Continue, modify, and terminate the client’s care plan (revise the plan of care)
D E F I N I T I O N O F T E R M S & I N T E R R E L AT I O N O F P H A S E S
Implementing: this is the action phase in which the nurse
performs the nursing interventions.
Evaluation: 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.
4 T H PHASE: IMPLEMENT
Action-oriented, client-centered,
and Outcome-directed.
Definition: consists of doing and
documenting the activities that are
specific nursing actions needed to
carry out the intervention.
• Action-oriented
IMPLEMENTING
• The nurse performs or delegates the nursing activities.
• The degree of participation depends on the client’s health status.
Implementing Skills
Need Cognitive, Interpersonal, & Technical Skills
Cognitive: includes problem-solving, decision-making, critical
thinking, and creativity.
Interpersonal: Verbal and non-verbal
technical Skills: “Hands-on” skills like manipulating equipment,
giving injections and bandaging, moving, lifting, and repositioning.
PROCESS OF IMPLEMENTING
There are five activities involved in the process of
implementation.
1. Reassess the client.
2. Determining the nurse’s need for assistance.
3. Implementing nursing interventions.
4. Supervising delegate care.
5. Documenting nurses’ activities
REASSESSING THE CLIENT
Before implementing the nurse must reassess the client: to ensure
the intervention is still needed
Even if an order is written, the client’s condition may be changed.
• E.g. disturbed sleeping pattern related to anxiety and unfamiliar
surroundings.
During the rounds, the nurse discovers that the patient is sleeping
and defers the back massage that has been planned as a relaxation
strategy.
New data may indicate a need to change the priorities of care or
the nursing activities
DETERMINING THE NURSE’S NEED FOR
ASSISTANCE
When implementing some nursing interventions, the nurse may
require assistance for one of the following reasons
the nurse is unable to implement the nursing activity safely alone.
Assistance would reduce stress on the client
The nurse lacks the knowledge or skills to implement a
particular nursing activity
I M P LEM EN TI N G TH E N U R S I N G I N TERV EN TI O N S
Use the following guidelines:
a. Base nursing intervention on scientific knowledge, nursing
research, and professional standards of care(evidence base
practice) when they exist.
• The nurse must be aware of the scientific rationale of all
interventions.
Example: The client taking her medication after meals when she
should be taking it before meals due to absorption
IMPLEMENTING THE NURSING INTERVENTIONS
b. Clearly understand the intervention to be implemented and question any
that are not understood.
c. Adapt activities to the individual client.
d. Implement safe care
e. Provide teaching, support, and comfort
f. Be holistic
g. Respect the dignity of the client and enhance the client’s self-esteem.
h. Encourage clients to participate actively in implementing the nursing
interventions.
S U P E R V I S I N G D E L E G AT E D C A R E & D O C U M E N T I N G N U R S I N G A C T I V I T I E S
Supervising delegated care
If care has been delegated to other healthcare personnel, the nurse
responsible for all the client’s care must ensure that the activities
have
been implemented according to the care plan.
Documenting Nursing Activities
The nurse completes the implementing phase by recording the
interventions and the client’s responses in the nursing notes.
DOCUMENTING NURSING ACTIVITIES
Documenting Nursing Activities
The nurse may record routine or recurring activities such as mouth
care in the client record at the end of the shift, while some actions
are recorded in special worksheets according to the agency’s
policy.
Immediate recording helps safeguard the client to prevent double
actions.
EVALUATION
WHEN IS EVALUATION NECESSARY?
1. Evaluation is continuous
2. Done immediately after implementation to make on-the-spot modifications
of an intervention
3. Evaluation can be performed at specific intervals
4. Evaluation continues until the client achieves the health goal or is
discharged from nursing care
5. It includes goal achievements and self-care abilities
6. Through evaluation the nurses demonstrate responsibility and
accountability for their actions.
7. Evaluation indicates the nurse’s interest in the results of the nursing
activities and demonstrates a desire to adopt effective interventions.
PROCESS OF EVALUATING CLIENT
RESPONSES
The evaluation phase has five components
Collecting data related to the desired outcomes (NOC indicators)
Comparing the data with desired outcomes
Relating nursing activities to outcomes
Drawing conclusions about the problem status
Continuing, modifying, or terminating the nursing care plan
COLLECTING THE DATA
• The nurse collects data so that conclusions can be
drawn about whether goals have been met. It is usually
necessary to collect both objective and subjective data.
Data must be recorded concisely and accurately to
facilitate the next part of the evaluation process.
COMPARING THE DATA
When determining whether a goal has been achieved,
the nurse can draw one of three possible conclusions:
1. The goal was met; that is, the client’s 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
R E L AT I N G N U R S I N G A C T I V I T I E S TO O U T C O M E S
• 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 the meeting, partially meeting, or not
meeting a goal.
EVALUATION STATEMENT
• After determining whether or not a goal has been met, the nurse
writes an evaluation statement.
• Statement can be written on the care plan or nurses’ notes
• Consist of two parts: a conclusion (goal met, partially or not
met) and supporting data (list of client responses).
• E.G. Goal met: Client had uninterrupted sleep for 4 hours x 2 in
12 hours
D R AW I N G C O N C L U S I O N S A B O U T P R O B L E M S TAT U S
• The nurse uses the judgments about goal achievement to
determine whether the care plan was effective in resolving,
reducing, or preventing client problems.
• When goals have been met, the nurse can draw one of the
following conclusions about the status of the client’s problem:
G O A L M E T: C O N C L U S I O N D R AW N
• Problem was resolved, Potential problem is being prevented or
Risk factor no longer exists
• Potential problem is prevented, risk factor still present (nurse
keeps the problem on the care plan)
• Actual problems still exist even though some goals are met.
E.G. client will drink 2000 mL of fluids daily (which she did)
but oral mucosa remains dry (nursing intervention must be
continued even though this goal was met).
GOAL PARTIALLY MET OR NOT MET
• When goals have been partially met or when goals have not
been met, two conclusions may be drawn:
• The care plan may need to be revised: during the assessing,
diagnosing, or planning phases, as well as implementation.
OR
• The care plan does not need revision, because the client
merely needs more time to achieve the previously established
goal(s).
CONTINUING, MODIFYING, OR TERM IN ATING THE
NURSING CA RE PLA N
• After drawing a conclusion about the status of the client’s
problems, the nurse modifies the care plan as indicated.
• Whether or not goals were met, a number of decisions
need to be made about continuing, modifying, or
terminating nursing care for each problem.
• Before making individual modifications, the nurse must
first determine why the plan as a whole was not
completely effective. This requires a review of the entire
plan.
REFERENCES
Berman, A., Snyder, S.J. (2012) Kozer & Erb’s
Fundamentals of nursing: Concepts, process, & practice.
(8th ed.). New Jersey: Pearson Education
Potter, P.A. & Perry. A.G. (2005). Fundamentals of nursing. (6th
ed.). MO: Mosby.
