Chapter 20 Evaluation Evaluation is the final step of the nursing process. In this step you determine if your client’s condition or well- being has improved. Nurses conduct evaluation measures to determine if they have met expected client outcomes, not if their nursing interventions were complete. It is important to remember that the expected outcomes are the standards against which the nurse judges if goals have been met and care was successful.

Critical Thinking and Evaluation Evaluation is an ongoing process. If outcomes are met, client goals are met. Positive evaluations occur when nurses meet desired outcomes. Positive evaluations lead nurses to conclude that interventions were successful. Think about the sequence used during evaluations and the conclusions that can be drawn. Positive evaluations occur when desired outcomes occur, leading you to conclude that the nursing interventions effectively met the client’s goals. Unmet or undesirable outcomes indicate that interventions are did not minimize or resolve the actual problem or avoid a potential problem. An unmet outcome reveals the client has not responded to interventions as planned. When expected outcomes do not materialize, the nurse needs to change the plan of care by trying different therapies or changing the frequency or approach of existing therapies.

The Evaluation Process Includes five elements: Identify evaluative criteria and standards. Collect data. Interpret and summarize findings. Document findings and clinical judgments. Terminate, continue, or revise the care plan. To evaluate the nursing care plan, you need to know what to examine. The client's goals and expected outcomes give nurses the objective criteria needed to judge the client’s response to care. Ask students to define goal: the expected behavior or response that indicates resolution of a nursing diagnosis or maintenance of a healthy state. Remember goals are also based on standards of care or guidelines for minimal safe practice. Ask students to define expected outcomes: the expected favorable and measurable result of nursing care. It is important to remember that evaluation is not a description of the achievement of an intervention. Determining a client’s response to nursing care requires the use of evaluative measures, which are simply assessment skills and techniques. The intent of evaluation is to determine if known problems have remained the same, improved, worsened, or in any way changed. Next, you will need to interpret and summarize the findings. Acute changes occur frequently and chronic changes occur over a period of time and can be subtle. Table 20-2 presents examples of evaluative findings. Documentation and reporting are a most important part of the evaluative process. It will be important to describe the evaluative measures. This can be done via nursing progress notes, assessment flow sheets, and through shift reports. At this juncture, you will be able to adjust the plan of care or discontinue it. Unmet or partially met goals require you to continue the interventions. Your choices will be to discontinue or modify the plan of care. The question you will ask is, Do the goals and expected outcomes or interventions need to be modified?

Quality Improvement Quality improvement and performance improvement are interchangeable terms. An approach to the continuous study and improvement of the processes involved in providing health care services to meet the needs of clients and others (JCAHO, 2004). Health care facilities are continually looking at events which directly affect clients in the hospital, such as medication administration, fall prevention, skin and wound care, and discharge planning. Health care agencies are responsible for evaluating and improving the quality of client care services they provide. One method this can be achieved is through outcomes management. When nurses think in terms of outcomes management, their actions become more purposeful and focused on improving the condition of their client’s health.