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1. Implementing and Evaluating

2. ImpleImpleImplementingmenting
menting
Doing and documenting the activities
that are the specific nursing actions
needed to carry out interventions

3. Copyright © 2016, 2012, 2008
Pearson Education, Inc.
All Rights Reserved
Kozier & Erb's Fundamentals of Nursing, Tenth Edition
Audrey Berman | Shirlee Snyder | Geralyn Frandsen
Figure 14–1 Implementing—the fourth phase of the nursing process. In this phase the nurse implements the
nursing interventions and documents the care provided.

4. Implementing Skills
1- Cognitive (intellectual) skills
 Problem solving
 Decision making
 Critical thinking
 Creativity

5. 2- Interpersonal skills
 Verbal and nonverbal
 Effectiveness communicate.
 Therapeutic communication necessary
for caring, comforting, advocating,
referring, counseling, and supporting
 conveying knowledge, attitudes,
feelings, interest
 Appreciation of the client's cultural
values and lifestyle

6. 3- Technical skills
 Purposeful "hands-on" skills
 called tasks, procedures, or
psychomotor skills
 Psychomotor
• Physical actions that are controlled by
the mind, not by reflexes
 Require knowledge and manual
dexterity (‫براعه‬

7. Process of Implementing
1. Reassessing the client
2. Determining nurse's need for
assistance
3. Implementing nursing interventions
4. Supervising delegated care
5. Documenting nursing activities

8. Reassessing the client
 Reassess to make sure the intervention
is still needed
 Client's condition may have changed

9. Determining the nurse's need
for assistance
 Inability to implement the nursing
activity safely
 Assistance will reduce stress on the
client.
 Nurse lacks knowledge or skills to
implement a particular nursing activity

10. Implementing the nursing
interventions
 Base actions on scientific knowledge
 Clearly understand interventions
 Adapt activities to individual client
 Implement safe care
 Provide teaching, support, and comfort
 Be holistic
 Respect the dignity of the client and
enhance self-esteem
 Encourage active client participation

11. Supervising delegated care
 Nurse still responsible for client's overall
care
 Must validate and respond to any
adverse findings or client responses

12. Documenting nursing activities
 Record nursing interventions and client
responses
 Do not record in advance

13. Evaluating
• Judgment and appraisal
• Planned, ongoing, purposeful activity
• Determines client's progress,
effectiveness of care plan
• Continuous process
• Demonstrates nursing responsibility
and accountability for their actions

14. Copyright © 2016, 2012, 2008
Pearson Education, Inc.
All Rights Reserved
Kozier & Erb's Fundamentals of Nursing, Tenth Edition
Audrey Berman | Shirlee Snyder | Geralyn Frandsen
Figure 14–3 Evaluating—the final phase of the nursing process. In this phase the nurse determines the client's
progress toward goal achievement and the effectiveness of the nursing care plan. The plan may be continued,
modified, or terminated.

15. Relationship of Evaluating to Other
Nursing Process Phases
• Depends on effectiveness of preceding
steps
• Assessment data must be accurate and
complete.
• Desired outcome must be stated
concretely in behavioral terms to be useful
for evaluating.
• Without implementation/interventions,
there would be nothing to evaluate.
• Evaluating and assessing overlap.

16. Process of Evaluating Client Responses
1-Collecting data
 Some may require interpretation
2-Comparing data with desired outcomes
 Conclusions
• Goal was met
• Goal was partially met.
• Goal was not met.

17. 3- Relating nursing activities to outcomes
 Determine whether nursing activities
had any relation to the outcome without
assuming that the activity was the
cause or only factor of meeting a goal

18. 4- Drawing conclusions about problem status
 Actual problem has been resolved or potential
problem's risk factors no longer exist
 Potential problem is being prevented but risk
factors still exists
 Actual problem still exists even though some
goals are being met
 When goals partially met or not met:
• Care plan may need to be revised
• Client needs more time to achieve previously
established goals

19. 5- Continuing, modifying, or
terminating the care plan
 Critique each phase of the nursing
process
 Assessing
• Incomplete or inaccurate databases
influence all subsequent steps.
 Diagnosing
• If incomplete, add new diagnosis
statements
• If complete, analyze whether nursing
diagnoses relevant

20.  Planning: desired outcomes
• If inaccurate, goals/outcomes need
revision
• If accurate, goals/outcomes realistic and
obtainable
• Have priorities changed?
• Does client still agree with priorities?

21.  Planning: nursing interventions
• Relate to goal achievement
• Investigate whether best nursing
interventions were selected
 Implementing
• After modifications, begin nursing
process again