What first comes to mind when you think of a “nursing intervention?” For many, especially newer nurses, administering medication or evaluating vital signs may come to mind. However, nursing interventions encompass the holistic nature of the nursing profession. Defining what a nursing intervention is important to empower nurses to work at their full professional scope.
The agreed-upon definition of a nursing intervention is “any treatment, based upon clinical judgment and knowledge, that a nurse performs to enhance patient/client outcomes.” 1
This definition comes from Bulechek’s Nursing Interventions Classification (NIC) book, which includes no less than 565 interventions that are mapped to over 13,000 nursing activities. These interventions include basic and complex physiological interventions, behavioral, safety, family, health system, and community interventions. Clearly nursing interventions are far more complex and far-reaching than simply carrying out a doctor’s orders.
What is a Nursing Care Plan?
Nursing interventions are an important component of a nursing care plan. Without the other steps of a care plan in place, nursing interventions are unlikely to be as effective. Nursing care plans have six components which include: assessment, diagnosis, expected outcomes, interventions, rationale, and evaluation.2 Interventions should be performed only after appropriate assessment and expected outcomes are defined by the nurse. Depending on if the intervention is solely nurse-initiated, the diagnosis may be a nursing diagnosis or a diagnosis given by another care team member, such as a physician. Even if the nurse is not creating the formal diagnosis, they must understand the patient’s diagnosis and its implications. Further, before the intervention is carried out, there must be a clear rationale for the intervention. The rationale for the nursing intervention should include answers to the following questions.
- What is the desired outcome?
- Is there a relevant nursing/medical diagnosis that explains the need for this intervention?
- Is the intervention evidence-based?
- Is it feasible to perform this intervention given the care context?
- Is this an intervention that is acceptable to the patient?
- Does the nurse have the skills necessary to perform the intervention?1
What is a Nursing Consideration?
Although not a separate step in the nursing care plan, nursing considerations are the implications of the interventions a nurse is providing. Nursing considerations may take the form of assessments that must be done before an intervention can be performed. They may also include outcomes or complications to watch for as a result of an intervention. Commonly, the nursing intervention of administering medication may include nursing considerations for a drug being given. For instance, before administering a beta blocker, the nurse must know to assess for the current heart rate.
Types of Nursing Interventions
Nursing interventions can be broken down into three broad categories of independent, dependent and collaborative or interdependent interventions.3
Independent
Independent nursing interventions can also be classified as nurse-initiated activities. When an intervention is independent, the nurse does not require another team member to initiate, perform, and evaluate the intervention. What actions can be carried out independently depends on an individual nurse’s knowledge and skill, local regulations, and employer policy. For instance, while some independent activities are legally allowed under the scope of a registered nurse, the individual may need extra training or certification to initiate the intervention independently.
Dependent
Dependent nursing activities cannot be carried out without another member of the care team. Usually, this is a legal requirement that does not allow the nurse to perform the task independently. For instance, in most jurisdictions, nurses have little prescribing authority (not including nurse practitioners). Therefore, to carry out an intervention that includes medication administration, a prescription is needed, making the intervention dependent. There may also be local or employer policy or licensing body regulations that depend on whether a nurse needs a physician’s order to complete a task. For instance, there is no legal requirement that a physician’s order is necessary to discontinue a foley catheter. Some hospitals require that nurses have a physician’s order, but for some, this is an activity nurses can perform independently.
Interdependent/Collaborative
Interdependent or collaborative nursing interventions are performed in a team setting. There is some crossover between independent and dependent nursing interventions and collaborative interventions. This is particularly true with the shift to team-based care in acute and outpatient care settings. Interdependent nursing interventions are present when interdisciplinary team members collaborate on a shared care plan for a patient. Interdependent nursing interventions may also be carried out in collaboration with other interdisciplinary team members, such as social workers or physiotherapists.
Nursing Intervention Examples
Independent Nursing Intervention Example
During personal care, the nurse notices redness around the coccyx area. The patient is usually a mobile person from a nursing care home, but they were recently admitted after a fall and are no longer walking. They have also had episodes of delirium of an unknown cause and have been experiencing some incontinence. The nurse recognizes this patient is at risk for further skin breakdown, so they initiate a care plan that includes scheduled toileting and turns for the patient every two hours. This is communicated in a written care plan and during reports to their colleagues. This is an independent intervention because no other health professionals need to be involved in this intervention.
Dependent Nursing Intervention Example
A nurse works in an outpatient heart failure clinic and is on a regularly scheduled phone check-in with a patient. This patient records their blood pressure measurements daily and alerts you that they’ve been trending higher than usual for the last few weeks. The nurse suspects that the blood pressure medications need to be titrated. However, they need the doctor to adjust the prescription. They communicate this finding to the doctor who prescribes a higher dose of medication for the patient. The nurse then calls the patient back to review the possible side effects and risks of the medication. This action could not be carried out without the participation of the physician, making it a dependent intervention.
Interdependent Nursing Intervention Example
There is a quality improvement project underway in an ICU to reduce the incidence of ventilator-associated pneumonia. One method to reduce ventilator-associated pneumonia is limiting mechanical ventilation to only when necessary.4 While discontinuing ventilation requires a physician’s order, ICU-trained nurses can initiate ventilator weaning to stop mechanical ventilation as soon as possible. Nurses may also work with other members of the care team, such as a respiratory therapist, to optimize ventilation to reduce the risk of pneumonia. These interventions are interdependent because the nurse works with other interprofessional team members for a common goal.
References
- Bulechek GM. Nursing Interventions Classification (NIC). 6th ed. Elsevier/Mosby; 2013. https://go.exlibris.link/1jtrWDVg
- Ballantyne H. Developing nursing care plans. Nursing standard. 2016;30(26):51. doi:10.7748/ns.30.26.51.s48
- Wisconsin Technical College. OPEN RESOURCES FOR NURSING (OPEN RN). 4.6 Planning. Accessed December 15, 2022. https://wtcs.pressbooks.pub/nursingfundamentals/chapter/4-6-planning/#footnote-117-4
- Micik S, Besic N, Johnson N, Han M, Hamlyn S, Ball H. Reducing risk for ventilator associated pneumonia through nursing sensitive interventions. Intensive and Critical Care Nursing. 2013;29(5):261-265. doi:10.1016/j.iccn.2013.04.005
