Nursing Process Information Part 2

Nursing Interventions:

A nursing intervention is any treatment based upon clinical judgement and knowledge that a nurse performs to enhance client/patient outcomes (NIC, 1996, p. xvii)

The Nursing Interventions Classification (NIC) differentiates between direct and indirect nursing interventions. A direct nursing intervention is any treatment that is performed through interaction with the client/patient. An indirect nursing intervention is an action performed away from the client/patient but on behalf of the client/patient, for example a case conference.

The N IC also differentiates between nurse initiated and physician initiated interventions. A Nurse Initiated intervention is a treatment initiated by a nurse in response to a nursing diagnosis. A Physician Initiated intervention is a treatment initiated by a physician in response to a medical diagnosis but carried out by a nurse in response to a physicians order. Some texts use the terms independent to refer to nurse-initiated interventions and collaborative or multidisciplinary  to refer to interventions initiated by physicians or other health care professionals.

Where to find research and/or theory based interventions:

• Standard Care Plan books, computer disks or CDROMS - there are many on reserve in the library and computer lab.
• Your textbook and other nursing textbooks
• The NIC
• Nursing Journal Articles
• Research Articles
• Speciality books and journals
• Agency for health policy and research web site.
• NIH and NIMH web sites
• Healthcare organization web sites.

Remember , the first three sources are like cookbooks they will provide guidance in planning care but you will have to adjust the seasoning to address the needs of your specific client. Just copying interventions from these lists is not enough. You must individualize the interventions so they fit the your specific patient.

". . .research based practice is a relative way of practicing, a way in which the practitioner makes and effort to integrate research findings into clinical thinking and decision-making while recognizing that effective health care is more than the mere application of scientific knowledge." (Brown, 1999, p.4).   So you must also use your intuition and your creative mind.

Individualizing Interventions

Each patient is a unique human being living in a unique set of circumstances. Care plans that do not reflect individual needs are useless. To individualize your care plans ask yourself these questions.

1. What are the desired outcomes of care for this problem? Which interventions will most likely achieve these outcomes?

For example: you may be caring for a patient who has a wound that is not ever expected to heal. Your desired outcomes may focus on patient comfort and prevention of systemic infection. From the standard care plan you need to select interventions that will achieve these goals.

2. Can the intervention be implemented in the setting where the client is being cared for? Are the personnel, equipment, knowledge and other resources available?

For example: The standard care plan may say that a client on bedrest must be turned every two hours. The caregiver may be a family member who can only turn the patient every 3 hours during the day and every 6 hours at night.

3. Is the client able to participate in the intervention?

For example: Early ambulation is listed in most post-operative care plans, but your client is quadrapelegic. How do you adapt the intervention to this situation.

4. Is the client willing to participate in or receive the intervention? Does the intervention violate the person's values, autonomy, dignity , etc.

For example: Visualization may be listed as a technique to help relieve pain. There may be adequate research evidence that it is effective in relieving pain. The patient may be able to learn the technique BUT the visualization may be contrary to the patient's religious beliefs.

5. Is the intervention within my scope of practice?

To determine this ask yourself:

• Do I possess the knowledge to carry out this intervention?
• Can I carry out this intervention competently? What kind of support do I need to be competent?
• Does the facility where I am practicing allow nurses to perform this intervention? Under what conditions? ( If you don't know check the policy/procedure manual).
• Does my instructor allow me to perform this intervention? Under what conditions?
• Is this an intervention that a reasonably prudent nurse would carry out under these circumstances?

If you answer NO or "I'm not sure" to any of these questions check with your instructor or supervisor before proceeding.

Will we write care plans in practice?

Probably not in most settings, but you must know how to think through the nursing process and use the steps in order to provide care, evaluate care plans and to pass your NCLEX exam. In most acute care settings Critical Pathways or Care Maps are used. An example of a Critical Pathway may be found on p. 240 in the Alfaro nursing process book. Other facilities use standard computerized care plans which are individualized. Some facilities use only medical plans. Regardless of what is used in your practice setting you must be able to assess, identify the nursing problem, identify outcomes, individualize interventions and implement them and evaluate the outcomes of your care. The care plans you complete this semester and next will help you learn to think like a nurse.

Nursing Process Session 2 & 3

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