Implementation in nursing care is the action phase of the patient management cycle. During this stage, the nurse systematically puts the individualized care plan into practice. This translates abstract goals and chosen interventions into concrete activities performed for and with the patient. Implementation requires technical skill and continuous assessment to ensure actions are appropriate and timely for the patient’s current condition.
Where Implementation Fits in Nursing Care
The framework for structured patient care is the Nursing Process, commonly remembered by the acronym ADPIE. This process begins with Assessment and Diagnosis, followed by Planning, where measurable outcomes and specific interventions are selected. Implementation follows Planning, serving as the necessary bridge before the final phase of Evaluation. The nurse must have a formally established plan before any implementation activities begin. This sequential structure ensures all actions are purposeful, evidence-based, and directly linked to established patient goals.
Categorizing Nursing Actions
Nursing actions during implementation are categorized based on the scope of practice and the need for external authorization.
Independent Interventions
Independent nursing interventions are activities a registered nurse initiates based solely on their own license and professional judgment. Examples include providing patient education on medication side effects, initiating comfort measures like repositioning, or applying non-pharmacological pain relief techniques.
Dependent Interventions
Dependent nursing interventions require a direct order or prescription from a licensed healthcare provider, such as a physician or nurse practitioner. These actions include administering prescribed medications, initiating blood transfusions, or inserting a urinary catheter. The nurse executes the order safely while applying professional judgment regarding timing and patient readiness.
Collaborative Interventions
The final category is collaborative, or interdependent, interventions, which involve working with other members of the healthcare team. These actions require the expertise of different disciplines to achieve complex patient outcomes. Examples include consulting a physical therapist for mobility improvement or coordinating with a dietitian for specialized nutritional support.
The Procedure of Executing Care Plans
Executing the care plan requires a systematic procedural approach, regardless of the intervention type. Before performing any action, the nurse must re-assess the patient’s immediate status and readiness for the procedure. This check confirms the intervention is still safe and necessary, such as verifying blood pressure before administering anti-hypertensive medication.
The next step involves preparing the environment and necessary equipment to ensure efficiency and sterility. This preparation includes gathering supplies, ensuring proper lighting, and confirming the patient’s privacy and comfort. Following preparation, the nurse performs the intervention using safe, skillful, and evidence-based techniques, prioritizing patient safety and dignity.
When appropriate, certain tasks may be assigned to other qualified personnel through delegation. The nurse maintains accountability for the outcome and must supervise the delegated staff member to ensure the task is performed correctly. The final, non-negotiable step is immediate and accurate documentation of the intervention. This record must include the time, the specific action taken, and the patient’s initial response for communication continuity and later evaluation.
Influences on Implementation Success
The ultimate success of the implementation phase is influenced by a complex interplay of internal and external factors. Patient-specific factors heavily affect outcomes, including their willingness to participate and their physical or psychological ability to comply with instructions. A motivated patient who understands their role in the treatment regimen is more likely to achieve the intended results.
External resource factors also significantly impact the ability to implement care plans effectively and safely. These factors include the availability of trained staff, the time allocated for complex procedures, and immediate access to necessary supplies and functioning equipment. A shortage in any of these areas can delay or compromise the quality of the intervention.
The competence of the nurse performing the action is a major determinant of success. This encompasses the nurse’s technical skill in executing procedures and their ability to think critically and adapt the plan when unexpected patient responses occur. Continuous professional development and strict adherence to established protocols help ensure high-quality implementation.