Robert J Pratt, Johan van Wijgerden, in Tuberculosis, 2009. One or two long, padded safety belts are placed at least 2 inches above the knees to prevent the buckling of the knees while in reverse Trendelenburg position. So it's a responsibility to ourselves as well as our patients, our colleagues, and the health care environment in general.” Nursing Interventions for a Self-Care Deficit. 1 College Circle As in the case of nursing diagnoses and outcomes, a comprehensive set of standardized nursing interventions, known as the Nursing Intervention Classification, has been developed,8 and is linked to both the NANDA-International diagnoses and the Nursing Outcomes Classification referred to earlier. In these examples, the measurement of outcomes includes behavioral indicators (in italics) as well as physiologic and organizational ones. The sequential compression device attached to the leg or foot compressors is turned on and checked. 2, Manuscript 1.DOI: 10.3912/OJIN.Vol21No02Man01Key Words: Nurse Sensitive Indicators, nursing outcomes, nursing process measures, quality assessment, quality metrics, quality measures, outcomes management, outcomes research, Minimum Nursi… Any Educate families that the patient is not suffocating. Phoebe D. Williams, Arthur R. Williams, in Encyclopedia of Social Measurement, 2005. Electrocardiogram electrodes, a pulse oximetry monitor, and an automatic blood pressure cuff (extra-large) are set up prior to anesthesia. Although medical and nursing care interventions would not usually be considered cognitive or behavioral treatments, they are included here because it is the behavioral assessment that is used to reveal the underlying etiology of negative affect or behavior problems that allows a medical or nursing intervention to relieve the condition. Another important function or purpose of nursing care plans is to provide consistency of care across time. If a nursing care plan is in place, nurses from different shifts or different floors can utilize this information to provide the same quality and type of interventions to care for patients, thus allowing patients to receive the most benefit from treatment. Brooten et al. Cluster care. 1. Priority setting involves ranking nursing diagnoses in order of importance. Of interest is the review by Brooten and Naylor of nursing studies that used experimental designs. not allowing a child to eat heated foods when they have certain illnesses), could be the acceptable practice of your patient’s culture. However, because of the risk of reflux and aspiration of gastric contents, do not maintain Trendelenburg position for more than a few minutes. The term describes any action nurses may take to improve the health and comfort of their patients. The implementation phase of the nursing process is the actual initiation of the nursing care plan. After a decade, these remain fundamental questions in nursing research. This can reassure to families and take away some of their angst. Although both are essential aspects of a nurse’s work, the practices are distinct. One year from baseline, as compared to the control group, significant positive outcomes of the nurse-led primary care were found on all outcome measures, except smoking cessation. Several of the unique contributions of these studies were their publication in both medical and nursing journals, their strong research design, and the attention paid to the relationship between outcomes and costs. Fluids build up in the tracheobronchial tree. For practicing nurses seeking to further develop their knowledge base, the RN to BSN online program at Husson University provides an exceptional curriculum designed to transform careers. 21, No. The first step to crafting a reasonable self-care plan is self-reflection and self-assessment. These reports were based on assessing the need for postoperative. Brian A. Williams, ... Christopher L. Wu, in Raj's Practical Management of Pain (Fourth Edition), 2008. These desired outcomes are more likely to occur when staffing is higher, higher educated nurses are employed, and nurses can devote more time to patients. For example, conclusions from research on organizational indicators of quality (e.g., total hours of nursing care provided and the RN “skill mix”) and patient outcomes have demonstrated that patients have fewer urinary tract infections, falls, pneumonias, and bedsores under a number of conditions. Research using nonexperimental designs, physiologic, and organizational indicators has demonstrated the value of nursing care, thus increasing the generalizability or external validity of outcomes research findings. There are currently 554 interventions in total. These actions can include: Because nursing interventions describe nearly every interaction nurses have with patients, a thorough system is used to identify and evaluate their work. Prompted voiding involves asking residents on a regular basis whether they need assistance with toileting. Nursing Intervention • A nursing intervention is any treatment based on clinical judgment and knowledge that a nurse performs to enhance patient outcomes (Bulechek et al., 2008). Introduction This essay is a reflective examination of a care episode in the domain of mental health nursing, in relation to the processes of nursing decision making, clinical reasoning, and processes associated with patient care planning and management. Implementation. The Nursing Interventions Classification (NIC) system is designed to categorize and describe every possible intervention a nurse might perform. Take the following steps to develop a plan for self-care: Step 1. With the varying paths of entry into nursing practice ranging from associate degree, to bachelors degree, to masters or doctorate, the difference in settings in which nurses practice and the varying needs of patients, the measurement of “nursing dose,” for example, has been elusive. This may shift enough of the secretions that air flows over the fluid without making a sound. The first level consists of seven broad domains: Within these domains are 30 classes, followed by lists of the interventions themselves. The more you look into nursing careers, the more you realize that a day in the life of a nurse is rarely boring. Importance of Nursing Care Plan- Introduction. Can we use website as a references. Therefore, interventions such as light therapy to improve sleep, pain management, reduction of discomfort by improved seating or positioning, and removal of physical restraints all have been associated with improvement in behavior. They identified four key questions in nursing research relative to changing patient outcomes. A behavioral approach may also guide nursing interventions directly in helping elderly persons to achieve maximal functional levels. Outcomes research done abroad also is mentioned. As a system that helps nurses both understand and improve the quality of care, nursing interventions are an occupational mainstay. It’s based on a ‘template’ which defines the areas the care plan covers. Because the program is offered fully online, working professionals can earn their degree in a format designed for their life. The components of secondary prevention measured at baseline and one year later included lifestyle measures such as engagement in physical activity, intake of dietary fat, and smoking as well as other clinical measures such as aspirin use, blood pressure management, and lipid management. Clinical judgment is an important nursing skill in this process because it enables an accurate identification of the nursing diagnosis. Nursing Interventions Classification (NIC) 6th Edition describes a number of uses for the system. The CNS care included a comprehensive discharge plan provided while the patient was in the hospital and during the first two weeks after discharge. Both types of protocols can be effective in reducing incontinence. Interventions that should be undertaken to support nursing judgments and demonstrate the depth of nursing judgment are built into the standardized nursing languages. Introduction. a process of shared decision-making between patients and healthcare professionals [3]. Secretions can also be cleared by postural drainage using Trendelenburg position. We are the great “multi-taskers” of the healthcare industry from executing doctors’ orders, granting patients’ requests, preparing a variety of medications, writing interventions to maintain an … Report pain control. © 2020 Husson University Online Copyright © 2020 Elsevier B.V. or its licensors or contributors. They found that compared to the routine care control groups, the E groups showed: higher patient satisfaction, higher infant immunizations, lower rehospitalizations, and health care cost reductions up to 38%. This essay is a reflective examination of a care episode in the domain of mental health nursing, in relation to the processes of nursing decision making, clinical reasoning, and processes associated with patient care planning and management. Examples of areas of patient care interventions include: Nurses may work in specialized settings (i.e. Similar research is being conducted of training families to cope with chronic care at home. Privacy Policy. Any task that a nurse does to or for a patient. Registered nurses (RN) deliver care to patients by applying validated interventions. One example is that of cognitive interventions that include cueing and task breakdown. The HoverMatt mattress is an effective and safe transfer device that is used in many hospitals. Two types of toileting protocols have been described. Updated On: Registered Nurse to Bachelor of Science in Nursing programs prepare ADN nurses for a higher level of clinical practice. What combinations of education, credentialing, and setting constitute valid and reliable measures of “dose?”. Planning and using nursing interventions based on good quality evidence of effectiveness is of importance to ensure that the desired outcomes of care are achieved. When secretions have reached the pharynx but are not clearing by repositioning, try oral suctioning. When these noises occur in the presence of other signs of the dying process, they are a strong predictor that death will occur within 96 hours.26 These noisy respirations, also known as the “death rattle,” occur in 23% to 92% of patients.27 They are most common in patients with lung and brain tumors, either primary or secondary.27. A- Nursing care plan- pain control. They include: According to the U.S. National Library of Medicine, the system contains several levels of classification. Home → Blog → Categorizing Care: A Guide to Nursing Interventions. Kostandinos Sideras, ... Charles L. Loprinzi, in Abeloff's Clinical Oncology (Fifth Edition), 2014. According to a WHO report, inadequate medication adherence averaged 50% among patients with a chronic disease [4] and represe… Patients are helped when they indicate such a need. While the ultimate goal of an assessment is to decide on a course of treatment, an intervention in many cases is the treatment. When a patient is unable to swallow, stop all oral intake. Qualified nurses helping patients that are in need of intensive care may have the titles NICU (neonatal intensive care unit) nurse, ICU nurse or trauma nurse. Citation: Jones, T., (May 31, 2016) \"Outcome Measurement in Nursing: Imperatives, Ideals, History, and Challenges\" OJIN: The Online Journal of Issues in Nursing Vol. Anything a nurse does that leads directly to a patient outcome. After the operation, the patient is moved to a hospital bed and is taken to the PACU for recovery. None of the studies reported that nursing theory-guided interventions as not useful. In scheduled or timed voiding toileting, patients are taken to the toilet either at fixed times (usually every 2 hours) or on a schedule that is based on their voiding pattern. Robert J Pratt, Johan van Wijgerden, in Tuberculosis, 2009. A footboard prevents the patient from sliding down the table. Before using medications, it is useful to try simpler nursing interventions, such as repositioning the patient, postural drainage, educating the family, and suctioning: Reposition the patient on the side or semi-prone. Practices that might be considered unethical to an autonomous American (e.g. Nursing interventions. It's indicated in patients with acute hypoxemia (PaO 2 less than 60 mm Hg or SaO 2 less than 90%) and those with symptoms of chronic hypoxemia or increased cardiopulmonary workload. Patient outcome/goals are achieved by he performance of the nursing interventions. Nursing interventions during labor and delivery of pregnant women Nursing Interventions for Normal Delivery: Some important nursing interventions for normal delivery have pointed out in the below: Promoting comfort by touching and reassurance as a basic nursing interventions. Oxygen is also given to help with the removal of loculated air in the chest, as you would see with pneumothorax or pneumomediastinum. Once outcomes have been developed and agreed, nursing interventions that facilitate their achievement are planned and implemented. These studies are important not only due to their immediate impact on nursing research in the United States, but their distinct differences in organizational and institutional setting provide possible opportunities for assessment of institutional and cross-cultural effects on outcomes. Bangor, ME 04401 What nurse dose works for which patient group? Although every nurse may not be familiar with every intervention, the concept remains universal across the field. Nursing practice, in addition to the interventions, treatments, and procedures, includes the use of observation skills and experience to make nursing judgments about patient care. Special considerations are necessary for knee surgery patients who present with preoperative baseline verbal pain scores of 3 out of 10 or higher,119,181 in that catheters may be indicated where single injections would have been originally planned (in the absence of preoperative pain). We use cookies to help provide and enhance our service and tailor content and ads. • Ideally the interventions a nurse uses are evidenced based ,providing the most current, up-to-date, and effective approaches for managing patient problems. report the results of a randomized trial of nurse-led primary care (the experimental group) in Scotland on the secondary prevention of coronary heart disease, CHD, and a usual care control group. Unfortunately, the use of experimental designs in such studies has been limited. By continuing you agree to the use of cookies. avoiding direct eye contact), or curious to a nutritionist (e.g. With prioritizing, the nurse can attend to the client's most important needs and organize ongoing care activities. A perinatal clinical nurse specialist or CNS provided instruction, counseling, home visits and daily on-call (telephone) availability for the experimental, E group. Nursing interventions are actions undertaken by a nurse to further the course of treatment for a patient. The nine simple interventions below will help you care for your patients’ spiritual needs. Medication adherence also implies the notion of concordance, i.e. For this, a multidisciplinary and networked effort is crucial. to ensure that the care given is recorded; to support the patient/client to identify, manage and, hopefully, solve his or her problems. Reflective evaluation of care interventions and clinical decision making. Identifying, appraising, and incorporating the best currently available research into evidence-based nursing practice promotes clinically effective quality care. In home health settings, studies have shown immediate and long-term effects on low-income families home visited by nurses that produced improved pregnancy outcomes and lessened child abuse and neglect. Planning and using nursing interventions based on good quality evidence of effectiveness is of importance to ensure that the desired outcomes of care are achieved. Brenda L. Hage, in A Comprehensive Guide to Geriatric Rehabilitation (Third Edition), 2014. The care plan is a written document (either electronic or paper-based) that is used and altered constantly throughout the day. Fewer people are needed to make the transfer and, because lifting the patient is unnecessary during lateral transfers, it reduces the potential for injury. What nurse dose is needed in a given health care environment to show a treatment effect? Medication adherence—defined as the extent to which patients take medication as prescribed by their healthcare professionals—is an important aspect of treatment efficacy, healthcare costs and patient safety [1, 2]. Family members are frequently disconcerted when their loved ones develop the “death rattle” because they are afraid the patient is suffocating or drowning when they hear the noise. In a Bachelor of Science in Nursing (BSN) program, nurses learn about evidence-based practice (EBP), which aids them in pinpointing care strategies that can help their patients.In recent decades, EBP has become a key component of exceptional patient care. As in most clinical disciplines, increasing attention is now being given to the “translation” (or application) of research findings into clinical practice. This website uses cookies to ensure you get the best experience. Nursing interventions also go beyond simply “fixing” a patient medically. Nursing interventions are often confused with nursing assessments. In several nations, professional nursing organizations have created complex classification systems for such interventions, creating a standardized system that can be used by all nurses to provide a high level of care. Outcomes of care and associated nursing interventions that have been developed in collaboration with the patient provide a clear structure for the effective audit of nursing practice, facilitate better patient adherence to therapeutic regimens, and keep the patient at the centre of the care process. have shown additionally that mortality rates for such patients can be substantially reduced. allowing a family member to speak for and dictate all medical care and decisions for an aging parent), or disrespectful/suspicious to a Caucasian (e.g. Compared to the routine care control group, the E group: (a) was discharged 11 days earlier and 2 weeks younger; (b) was equally as “safe” (that is, there was no difference in infant growth and development outcomes, acute care visits, or rehospitalizations; and maternal health and psychosocial measures); and (c) had lower cost (hospital charges were 27% less and MD charges were 22% less; hospital cost saving was $18,000 per infant). It helps to identify the unique role of nurses in attending the overall health and well-being of clients without having to rely entirely on a physician’s orders or interventions. Outside of clinical settings, true experimental designs have been used to test nursing interventions that have direct implications for clinical practice. Campbell et al. These reports were based on assessing the need for postoperative nursing interventions for parenteral analgesia after (1) a survey of 1200 outpatient knee surgery patients,93 (2) a survey of 948 outpatients undergoing ACL reconstruction,94 and (3) a prospective randomized trial involving 270 patients undergoing ACL reconstruction.119 The allocation scheme has been summarized in a review.180 To summarize, (1) patients in whom postoperative pain (exceeding a verbal pain score of 3 out of 10) in a specific nerve distribution is likely to last 24 hours or less, single-injection femoral with or without sciatic nerve blocks are recommended; and (2) patients in whom postoperative pain (exceeding a verbal pain score of 3 out of 10) in a specific nerve distribution is likely to last greater than 24 hours, femoral with or without sciatic nerve block catheters are recommended. Included in the plan are nursing actions to ensure the continuity of all prescribed medical treatments and other intervention modalities for the geriatric patient. Using the patient's bed eliminates transfer from operating room table to stretcher to hospital bed. Priorities are classified as high, intermediate, or low. Aiken et al. Published On: January 03, 2018. The effectiveness of nursing interventions in schizophrenia depends not only on patient performance, but also on the involvement of the entire family and society. In this position, gravity may draw fluids into the oropharynx, where they can be removed with a sponge, gauze on a stick, or oropharyngeal suction. Interventions are the backbone of nursing. Reflective evaluation of care interventions and clinical decision making. Crackling or gurgling noises are caused by the movement of air through or over these pooled secretions. An electrosurgical unit dispersive pad is applied to the thigh to ground the electrocautery unit. ScienceDirect ® is a registered trademark of Elsevier B.V. ScienceDirect ® is a registered trademark of Elsevier B.V. URL: https://www.sciencedirect.com/science/article/pii/B0123693985002681, URL: https://www.sciencedirect.com/science/article/pii/B9780702045882000814, URL: https://www.sciencedirect.com/science/article/pii/B978141603988400069X, URL: https://www.sciencedirect.com/science/article/pii/B9781416000891500546, URL: https://www.sciencedirect.com/science/article/pii/B9781455728657000436, URL: https://www.sciencedirect.com/science/article/pii/B9781437716191000238, URL: https://www.sciencedirect.com/science/article/pii/B0126574103007133, URL: https://www.sciencedirect.com/science/article/pii/B9780323041843500170, Phoebe D. Williams, Arthur R. Williams, in, A Comprehensive Guide to Geriatric Rehabilitation (Third Edition), Nursing care of patients with tuberculosis, Nursing Care of the Bariatric Surgery Patient, The goals of intraoperative care as stated by McEwan are as follows: “Skilled perioperative, Kostandinos Sideras, ... Charles L. Loprinzi, in, Abeloff's Clinical Oncology (Fifth Edition), reported improved pain management in patients undergoing radiation therapy for head and neck cancer with a daily, oral intake. also tested the “transitional care model” as provided by a CNS to another population: elderly patients with congestive heart failure and their family caregivers, the E group. The nursing care plan incorporates specific nursing interventions and activities to treat specific nursing diagnoses or deal with problem areas such as changes in food intake, impaired capacity for personal care, risk for accidental injuries due to general weakness and mild dementia, grief unrelated to the health problem and other needs of the geriatric patient and the caregiver. Findings showed that compared to the routine care group, the E group had fewer total days in hospital, fewer re-admissions, lower re-admission charges, and lower total charges for healthcare services. Oxygen therapy is the term we use for the clinical use of supplemental oxygen. further tested the “model of transitional care” as provided by a CNS similar to the above in randomized clinical trials on three high risk, high volume, high cost groups of patients, namely those with unplanned Caesarean section births, pregnant women with diabetes, and post-hysterectomy women. This is extremely important in the recovery process. Nursing students learn about applying evidence-based research, critical thinking and scientific knowledge to the delivery of healthcare. Summary/ evaluation how the NCP assisted in caring for the client and outline the” whole picture”. Bachelor of Science in Business Administration, Bachelor of Science in Business Administration – Management, Bachelor of Science in Business Administration – Marketing Management, Bachelor of Science in Business and Liberal Studies, Bachelor of Science in Healthcare Administration and Public Health, Bachelor of Science in Integrated Technology – Software Development, Graduate Certificate in Business Analytics. According to the Journal of Nursing Education, nursing interventions can be described as one of two ideas: These tasks may be general or specific and direct or indirect. Other causes of noisy respirations in a dying patient are respiratory infections or pulmonary edema. Most patients gained at least one effective component of secondary prevention; future cardiovascular events and mortality were reduced by up to one-third. They are how medical personnel gain information about a patient’s symptoms and ailments. Nursing intervention and outcomes research using true experimental designs are mentioned briefly below. Williams and associates have provided detailed insights on the allocation of femoral with or without sciatic nerve blocks, also considering the selection of single-injection techniques versus continuous nerve blocks, for outpatient knee surgery (Table 14-5). You recently came across the term nursing intervention, which sounds like even more drama than the TV shows “Grey’s Anatomy” and “Intervention” combined!. ICU, oncology, pediatrics), which may require knowledge of specific interventions unnecessary in other areas. Use analgesics appropriately. The physician promptly changed the prescribed analgesic regimen when the patient's symptoms changed. Another example involves toileting management protocols. A random sample of 19 general practices in the northeast was used; 1173 participants were under 80 years old, diagnosed with CHD, but not house bound nor with terminal illness or dementia. An important part of this phase is documentation. Related: 7 Important Elements Of An Inspiring Nursing Career Before using medications, it is useful to try simpler, Cognitive and Behavioral Interventions for Persons with Dementia, Postoperative Pain and Other Acute Pain Syndromes, Brian A. Williams, ... Christopher L. Wu, in, Raj's Practical Management of Pain (Fourth Edition), ). Nursing intervention is the third step, and considered the core, of the nursing care process.Every nurse knows that this is the phase where the appropriate actions are selected and carried out to provide care … ( My Nursing Diagnosis is Altered Tissue Perfusion: Cerebral related to CVA as evidenced by Motor deficits / impaired mobility of arms & hands. It suspends the patient's body by providing a frictionless pillow of air underneath the patient, which results in a very smooth and comfortable transfer. You don’t even have to say anything; you can connect with the patient by being silent and trying to understand what he or she is experiencing. A temperature-regulating blanket is placed over the patient's chest and arms to prevent the hypothermia that tends to develop with abdominal surgery. Condition of external body areas such as the skin, Condition of internal systems such as cardiovascular, pulmonary or musculoskeletal, Coordinating nursing care and conducting status reports, Standardized communication regarding care. During the phase the nurse continues to assess the patient to determine whether interventions are effective. Janjan and colleagues123 reported improved pain management in patients undergoing radiation therapy for head and neck cancer with a daily nursing intervention consisting of instructions on the use of mouthwashes and a three-step analgesic protocol consisting of acetaminophen, acetaminophen with codeine suspension, and liquid morphine for relief of mild, moderate, and severe pain, respectively. These can impact practice in the United States. Nursing care is implemented according to the care plan, so continuity of care for … The following are the purposes and importance of writing a nursing care plan: Defines nurse’s role. Naylor et al. According to AMN (American Mobile Nurses) Healthcare Education Services, there are four types of possible assessments: During assessments, nurses may gather information about: Nursing interventions are informed by the results of nursing assessments. Brooten et al. This system is constantly used, evaluated and updated. The roles of the scrub and circulating nurses (or operating room physician's assistant) are geared to the procedure to be performed and, of course, entail the use of the special equipment needed for bariatric surgery. Daily review of a symptom survey by a radiation oncology nurse combined with a well-defined strategy for mouth care and analgesics appeared to improve pain management of radiation-induced oropharyngeal mucositis because of prompt attention to patient needs. Once outcomes have been developed and agreed, nursing interventions that facilitate their achievement are planned and implemented. Use non analgesic relief measures. Although the sheer number of interventions may seem daunting, it is important to remember that most nurses do not need to be familiar with or use all the interventions. This “translational research” is a growth area in nursing and medicine. Nurses are the ones who are in the hospital 24 hours a day and 7 days a week. completed a well-known “true experiment” to test a model of early hospital discharge and transitional care (as compared to a routine care control group) for very low birth weight infants (< 1500 Gm). The patient's arms are secured on padded armboards, palm upward, to protect the ulnar nerve. High-priority nursing diagnoses are those that if untreated, could result in harm to the client. Warn families and caregivers of the risks of aspiration and asphyxiation. For those considering advancement in the field, nursing interventions are a crucial concept to master. Effective communication is an important part of the therapy. 2. B Nursing intervention and rational; Observe for nonverbal cause of discomfort to plan appropriate intervention. Importance of Care in Nursing. Frank D. Ferris, ... Arthur Siegel, in Palliative Care (Second Edition), 2011, In the last hours of life, as the patient dies, weakness and decreased neurologic function present as difficulty swallowing and coughing and loss of the gag reflex. 1 Be there Your mere presence is meaningful when you intentionally focus on the patient. In the operating room, the team helps to get the patient onto the table. What outcomes should be measured? Promote comfort by cool, damp wash cloths on the women’s face. Overall, nursing theory-guided interventions improved all of studied outcomes in 26 studies and at least one outcome in nine studies. Jiska Cohen-Mansfield, in Encyclopedia of Applied Psychology, 2004. According to the Journal of Nursing Education, nursing interventions can be described as one of two ideas: 1. Observe for the sign of increasing increased intracranial pressure (ICP) to avoid treatment delay and … Similarly, the provision of eyeglasses or hearing aids can be an important intervention for treating sensory deprivation and loneliness as well as the ensuing depressed affect and problem behaviors. Eligible patients were stratified by age, gender, and general practice, and randomized (by individual) using a table of random numbers. High quality nursing research has been done outside the United States. Clustering care is a vital part of every shift, not only for the patient, but for you as the … Patients who received a daily nursing intervention reported fewer days of moderate and severe pain, had less pain throughout the day, and noted less disturbance in sleep, eating, and energy level. It can be highly stimulating and painful to an otherwise peaceful patient and may cause distress to family members who are watching. Katherine Mary Fox R.N., M.P.H., in Surgical Management of Obesity, 2007, The goals of intraoperative care as stated by McEwan are as follows: “Skilled perioperative nursing interventions afford patients safe and comfortable positioning during surgery, ensure optimal exposures of surgical sites, and prevent postoperative complications (e.g., pressure injuries, neuropathies, cardiovascular and respiratory compromises).”10. Warn families and caregivers of the risks of aspiration and asphyxiation. Avoid deep suctioning whenever possible. The nursing care to be delivered is determined during the outcomes or planning phase of the nursing process, where assessment data, diagnoses, and measurable goals drive intervention … Assessments may be done by both nurses and physicians. What “nurse dose” (i.e., what nurse intervention in what amount) is needed to show an effect? Suctioning is less effective when secretions remain beneath the pharynx and are difficult to get to with typical suctioning maneuvers.