1. Chapter 15
Evaluation

2. 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.
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3. Relationship of evaluation to the nursing process
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4. 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.
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5. 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.
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6. Components of Evaluation
Techniques
Sources of Data
Goals and Expected Outcomes
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7. 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.
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8. 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.
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9. 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.
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10. Methods of Evaluation
Evaluation is an orderly process consisting of eight steps.
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11. 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
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12. 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.
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13. Collecting Data
Evaluation data is collected to answer the question: Were the expected outcomes achieved?
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14. 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.

15. 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.
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16. 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.
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17. Reassessing the Client’s Status
The client’s health status is compared to baseline data.
Omissions or incomplete data are identified.
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18. 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
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19. 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.
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20. 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).
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21. Evaluation and Quality of Care
Appropriateness of Care
Clinical Outcomes
Client Satisfaction
Cost-Effectiveness
Access to Care
Availability of Resources
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22. Elements in Evaluating the Quality of Care
Organizational evaluation examines the agency’s overall ability to deliver quality care.
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23. Elements in Evaluating the Quality of Care
Structure Evaluation
Process Evaluation
Outcome Evaluation
Nursing Audit
Peer Evaluation
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24. Elements Within Each Type of Evaluation
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25. 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
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26. Structure Evaluation Sample question:
“Do staffing patterns reflect ability to meet acuity needs of clients?”
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27. Process Evaluation Examination of each phase of the nursing process.
Nursing interventions are measured for their effectiveness and efficiency.
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28. Process Evaluation Sample questions:
“Is the nursing care based on identified client needs?”
“Is the client’s response to the nursing actions documented?”
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29. Outcome Evaluation
Examines all direct care activities that affect the client’s health status.
Focuses on changes in the client’s health status.
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30. Outcome Evaluation Sample questions:
“Does the client demonstrate new knowledge and skills?”
“Is there documented evidence of client progress toward achievement of expected outcomes?”
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31. 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.
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32. 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.
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33. Influences affecting the nursing audit
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34. Nursing Audit Data examined include:
Interventions and client responses
Outcomes used as basis for interventions
Discharge planning
Client teaching
Adequacy of staffing patterns
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35. 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.
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36. 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.
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37. 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.
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38. Evaluation and Accountability
Nurses are accountable for:
Designing effective care plans
Implementing appropriate nursing actions
Judging the effectiveness of nursing actions
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39. Evaluation and Accountability
Nurses are accountable to:
Clients, families, and significant others
Colleagues
Employers
Society
The nursing profession
Themselves
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40. Evaluation and Accountability
Nurses demonstrate commitment by:
Participating in continuing education programs
Maintaining expertise in skills
Achieving and maintaining certification
Participating in peer evaluation
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41. 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.
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42. 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.