Evaluation: Two components
- examination of a condition or situation
2. judgement as to whether change has occurred (did the patient meet expected outcomes? was care successful?)
Once you deliver an intervention, you must:
- gather subj. & obj. data from pt, family & healthcare team members
- review knowledge regarding pts current condition, treatment, resources available for recovery, and expected outcomes
- refer to previous experience caring for similar patients - anticipate what to evaluate
- apply critical thinking attitudes & standards to determine if outcomes are achieved
- compare pt behavior and responses that you assessed before and after delivering nursing interventions.
Points to ponder
- has pt’s condition improved?
- is pt able to improve or are there physical factors preventing recovery?
- to what degree does this pt’s motivation or willingness to pursue healthier behaviors influence responses to therapies?
Nurse Indicators to Evaluating Care include
- examine results according to clinical data collected
- compare achieved effect w/ goals and expected outcomes
- recognize errors or unmet outcomes
- understand pt situation participate in self-reflection, and correct errors
Care Plan Revisions
- discontinuing a care plan
2. modifying a care plan
Steps for Modifying a Care Plan
- reassessment
- redefining a diagnoses
- reviewing expected goals and outcomes
- review interventions for accuracy
Steps for Discontinuing or Modifying a Care Plan
- evaluate in conjunction w/ the patient if goals have been met or not met and identify the factors that interfered with their achievement.
- reassess the pt to determine accuracy of the nursing diagnosis.
- establish new goals and expected outcomes and select new interventions.
At times, lack of goal achievement may result from
an error in nursing judgement or failure to follow each step of the nursing process
Modifying a Care Plan: Reassess
- compare new data about the patient’s condition.
- using past experience helps direct the reassessment process.
Modifying a Care Plan: Redefine Diagnoses
as the pt condition changes, the diagnoses also changes.
Modifying a Care Plan: Goals and Expected Outcomes:
- review the goals and expected outcomes for necessary changes.
- clearly document the new goals and outcomes. All team members need to be aware.
Modifying a Care Plan: Interventions
Were they appropriate? Were the interventions applied correctly?
Interventions
adjusted according to the patient’s actual response to therapy and your previous experience with similar patients.
Appropriateness of interventions are based on
the standard of care for a patient’s health problem
Standard of Care
- is the minimum level of care accepted to ensure high quality of care to patients
- defines the types of therapies typically administered to patients with defined problems or needs.
Consulting with other nurses often yields
suggestions for improving the care delivery
The American Nurses Association (ANA)
defines standards of professional nursing practice, which include standards for the evaluation step of the nursing process.
Competencies for evaluation include:
- Being systematic and using criterion-based evaluation
- Collaboration with patients and other professionals
- Using ongoing assessment data to revise the plan
- Communicating results to patients and families
- Ensure the responsible and appropriate use of interventions to minimize unwarranted or unwanted treatment
The patient and/or family must
be actively involved in the evaluation process
Proper evaluation
determines the effectiveness of nursing interventions.
When doing an evaluation, the nurse should ask
- what is the patient’s response to nursing care?
- was the therapy effective in improving the patient’s physical or emotional health?
- have the patient’s expectations been met?
Evaluation measures
- determine if the known problems have remained the same, improved, worsened or otherwise changed.
- pt specific based on behavior, physical status and reaction to caregivers
What is the patient’s first line of defense?
early detection of problems
Evaluation of Outcomes
objectively evaluating the degree of success in achieving outcomes of care.
Steps to Evaluating Outcomes of Care
- examine the outcome criteria to determine the exact desired pt behavior or response.
- evaluate the pt’s actual behavior or response.
- compare the established outcome criteria w/ the actual behavior or response.
- judge the degree of agreement between outcome criteria and actual behavior or response
- if no agreement, or partial agreement: What is/are the barriers? Why did they not agree?
Documentation of Results
accurate info needs to be present in the pt’s medical record and shared during handoff communication.
The use of standardized languages
improves the quality, consistency and accuracy of what is documented
Federal and state regulations determine the standards for evaluation are to be
shared with patients and their families
