Chapter 15 Evaluation

Evaluation Evaluation, the fifth step in the nursing process, is a planned, systematic process that compares the client’s health status with the desired expected outcomes. Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

Relationship of evaluation to the nursing process Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

Evaluation Determines if the stated outcomes have been met, partially met, or not met. Determines the effectiveness of nursing care in helping clients achieve the expected outcomes. Determines the overall quality of care provided. Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

Evaluation of Client Care Determines the need to modify the client’s plan of care during any phase of the nursing process. Promotes nursing accountability. Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

Components of Evaluation Techniques Sources of Data Goals and Expected Outcomes Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

Components of Evaluation Techniques Therapeutic communication is used to yield data about the accuracy of planned outcomes and interventions. Observation skills are used to identify subtle changes in the client’s physical condition, emotional status, and behavior. Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

Components of Evaluation Sources of Data The nurse’s nonjudgmental attitude will allow the client and family to be open and honest in providing subjective data. Objective data consist of observable facts, including the client’s behavior. Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

Components of Evaluation Goals and Expected Outcomes Provide direction for plan of care. Serve as measurements for client progress. Are realistic with regard to client strengths and limitations. Include the time frame for achievement. Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

Methods of Evaluation Evaluation is an orderly process consisting of eight steps. Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

Methods of Evaluation Establishing Standards Collecting Data Determining Goal Achievement Relating Nursing Actions to Client Status Judging the Value of Nursing Interventions Reassessing the Client’s Status Modifying the Plan of Care Critical Thinking and Evaluation Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

Establishing Standards Specific criteria is established before nursing action is implemented. Evaluation of criteria examines the presence of any changes, direction of change, and whether the changes were expected or unexpected. Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

Collecting Data Evaluation data is collected to answer the question: Were the expected outcomes achieved? Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

Determining Goal Achievement Data are analyzed to determine whether client behaviors indicate goal achievement. Data include physiological or psychosocial responses. Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

Relating Nursing Actions to Client Status Nursing interventions are examined to determine their relevance to the client’s needs and nursing diagnoses. Efficient nursing actions prove to be primary factors in helping clients resolve problems. Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

Judging the Value of Nursing Interventions Critical thinking skills are utilized to determine the contribution of nursing actions to the client’s improved status. Opportunities for revision are identified. Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

Reassessing the Client’s Status The client’s health status is compared to baseline data. Omissions or incomplete data are identified. Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

Modifying the Plan of Care Indicated when there is a lack of progress toward outcome achievement Formulation of more appropriate nursing diagnoses, and new or revised outcomes Implementation of different nursing actions, or repetition of specific actions Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

Critical Thinking and Evaluation Evaluation is much more complex than merely answering questions. Evaluation involves analysis and making judgments. Nurses use juxtaposing throughout evaluation activities by comparing client responses to expected behaviors. Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

Evaluation and Quality of Care Quality and evaluation are closely related. Evaluation is performed at the individual and institutional levels. Quality management involves constant, ongoing evaluation (monitoring of activities). Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

Evaluation and Quality of Care Appropriateness of Care Clinical Outcomes Client Satisfaction Cost-Effectiveness Access to Care Availability of Resources Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

Elements in Evaluating the Quality of Care Organizational evaluation examines the agency’s overall ability to deliver quality care. Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

Elements in Evaluating the Quality of Care Structure Evaluation Process Evaluation Outcome Evaluation Nursing Audit Peer Evaluation Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

Elements Within Each Type of Evaluation Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

Structure Evaluation Examination of physical facilities, resources, staffing patterns, organizational patterns, and agency’s qualifications for staff Review of policy and procedure manuals to check for compliance with legal parameters Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

Structure Evaluation Sample question: “Do staffing patterns reflect ability to meet acuity needs of clients?” Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

Process Evaluation Examination of each phase of the nursing process. Nursing interventions are measured for their effectiveness and efficiency. Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

Process Evaluation Sample questions: “Is the nursing care based on identified client needs?” “Is the client’s response to the nursing actions documented?” Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

Outcome Evaluation Examines all direct care activities that affect the client’s health status. Focuses on changes in the client’s health status. Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

Outcome Evaluation Sample questions: “Does the client demonstrate new knowledge and skills?” “Is there documented evidence of client progress toward achievement of expected outcomes?” Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

Nursing Audit An nursing audit is the process of collecting and analyzing data to evaluate the effectiveness of nursing interventions. An audit can focus on implementation of the nursing process, client outcomes, or both. Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

Nursing Audit Audits are based on components such as institutional policies, governmental regulations, accreditation standards, and professional standards. Corrective action plans are developed in accordance with the audit results. Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

Influences affecting the nursing audit Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

Nursing Audit Data examined include: Interventions and client responses Outcomes used as basis for interventions Discharge planning Client teaching Adequacy of staffing patterns Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

Peer Evaluation Process by which professionals provide to their peers critical performance appraisal and feedback geared toward corrective action. Peer review promotes both professional and individual accountability. Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

Peer Evaluation Constructive peer review in nursing is positive feedback that improves the quality of care. Destructive peer review in nursing undermines morale and cohesiveness. Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

Evaluation and Accountability Accountability means assuming responsibility for one’s actions. Evaluation enhances accountability by providing a mechanism for assisting the nurse to define, explain, and measure the results of nursing actions. Accountability is increased by ongoing evaluation. Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

Evaluation and Accountability Nurses are accountable for: Designing effective care plans Implementing appropriate nursing actions Judging the effectiveness of nursing actions Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

Evaluation and Accountability Nurses are accountable to: Clients, families, and significant others Colleagues Employers Society The nursing profession Themselves Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

Evaluation and Accountability Nurses demonstrate commitment by: Participating in continuing education programs Maintaining expertise in skills Achieving and maintaining certification Participating in peer evaluation Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

Multidisciplinary Collaboration in Evaluation Multidisciplinary evaluation helps promote a continuum of care for the client from the preadmission phase to discharge planning and follow-up care. Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

Multidisciplinary Collaboration in Evaluation Health care providers, clients, and families share responsibility and interest in the outcomes of evaluation. Other parties interested in the outcomes of evaluation are both public and private reimbursement organizations. Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.