EVALUATION
Meaning:
Evaluation is the final phase of the Nursing
process in which the nurse determines the Clients progress toward goal/outcome
achievement and the effectiveness of the Nursing care plan.
The plan may be continued, modified or terminated.
PURPOSE OF EVALUATION:
It serves multiple purposes
·
To
evaluate the clients program towards meeting specified outcomes and
to direct future Nurse Client interactions.
·
To
Judge the effectiveness of the nursing process.
·
To design
and implementing accurate care plans and Judging the
effectiveness of their Nursing action
·
To
determine overall quality of care.
Steps
in evaluation
1. Reviewing patient goals and outcome
criteria
2. Collecting data
3. Measuring goal/outcome achievement
4. Recording judgments or measurements of
goal attainment
5. Revising or modifying patient's plan of
care.
1. Reviewing
patient goals and outcome criteria
·
Using
the clearly stated, measurable, desired outcomes that the nurse collect data so
that conclusions can be drawn about whether goals have been met.
·
They
evaluate patient goals and outcome criteria in various ways, including
·
observing
patient behaviors;
·
using
documentation of the patients responses to interventions
·
receiving
feedback from the patient, family members and other health care
2. Collecting
data
·
Subjective
data will be
collected from patient family members or significant others, nursing staff and
other healthcare team members
·
Objective
data from
·
observation
( posture, skin color, behavior)
·
Health
records (eg: Lab, pathology, cytology reports),
·
physical
assessment (eg: Breath sounds, strength of extremities) and
·
measurements
devices(eg. Blood pressure, temperature) are collected to judge the patient's
behavior.
·
Nurses
also use subjective data to evaluate the effectiveness of nursing care provided.
·
Eg.
Acute pain in a patient who has undergone surgery states the goal as patient
will state that the pain is relieved with in 10mts after repositioning
3. Measuring
goal/outcome achievement
·
Both
the nurse and client play an active role in comparing the clients actual
responses with the desired outcomes. eg. Did the client walk unassisted the
specified distance per day
·
When
determining whether a goal has been achieved, the nurse can draw one of three
possible conclusions
1. The goal was completely met
2. The goal was partially met
3. The goal was completely not met
4. New problem or nursing diagnoses have
developed.
· Evaluation statements
After determining whether a goal has been met , the nurse writes
an evaluative statement either in the care plan or in the nurses notes.
An evaluation statement consist of two parts:
1. Conclusion
2. Supporting data.
The conclusion is
a statement that the goal or desired outcome was met, partially met or not met.
Eg. Goal met: for a patient with fluid volume imbalance
·
oral
intake 300ml more than output,
·
skin
turgor good
·
mucus
membranes moist.
4. Record
judgment or measurement of goal attainment
·
The
nurse uses the judgments about goal achievement to determine whether the care
plan was effective in resolving, reducing or preventing client
problems.
·
When
goals have been met the nurse can draw one of the following conclusions
1. The actual problem has been resolved. The
risk problem is being prevented and the
2. The risk problem is being prevented, but
the risk factors are still present. In this case the nurse keeps the
problem on the care plan
3. the actual problem still exist even though
some goals are being met. Therefore the
When goals have been partially met or when goals have not been
met, two conclusions may be drawn
1. The care plan may need to be revised since the problem is only
partially resolved.
Or
2. The care plan does not need revision, because the client merely
needs more time to achieve the previously established goals.
5. Revise or Modify the Plan of Care
· After drawing conclusions about the status
of the clients problems the nurse modifies the care plan as indicated.
· Whether or not goals were met , a number
of decisions need to be made about continuing, modifying or terminating nursing
care for each problem.
· Before making individual decisions the
nurse must first determine why the plan as a whole was not completely effective.
· This requires a review of the entire care
plan and a critique of the nursing process steps involved in its development.
Types of Evaluation
1. Structure evaluation
2. Process evaluation
3. Outcome evaluation
Types of Evaluation
·
Structure
evaluation
·
It
deals with the environmental aspects that directly or indirectly influence the
quality of care provided.
·
Availability
of equipment, layout of physical facilities, nurse patent ratios,
administrative support and maintenance of nursing staff competence are some
areas of concern for structure evaluation.
·
Process
evaluation
·
Focuses
on nurses' performance and the nursing care provided was appropriate and
competent.
·
The
phases of nursing process are used as the framework for evaluation of nursing
care.
·
Outcome
evaluation
·
Focuses
on the patient and the patient's function. It determines the extent to which
the patient's behavioral response to nursing intervention reflects the desired
patient goal and outcome.
·
It
can be applied only when there is standards in the health care setting.
·
Examples
of objective evaluation and goal achievement
Evaluation may be ongoing, intermittent or terminal.
1. Ongoing evaluation
2. Intermittent evaluation
3. Terminal evaluation
·
Measurement
Criteria:
·
Evaluation
is systematic and ongoing.
·
Client's
responses to interventions are documented.
·
The
effectiveness of interventions is evaluated in relation to outcome.
·
Measurement
Criteria cont...
·
Ongoing
assessment data are used to revise diagnoses, outcomes, and the plan of care as
needed.
·
Revisions
in diagnoses, outcomes and the plan of care are documented.
· The client, significant others and health
care providers are involved in the evaluation process, when appropriate.
EVALUATING CLIENT RESPONSE:
1 The
evaluation process has six components.
2 Identifying
the expected outcomes that the nurse will use to measure client goal
achievement. (This is done in the Planning step).
3 Collecting
data related to the expected outcomes.
4 Comparing
the data with the expected outcomes and judging whether the goals have been
achieved.
5 Relating
Nursing actions to clients outcomes.
6 Drawing
conclusions about problem status.
7 Reviewing
and modifying the clients care plan if needed.
·
Identifying
expected outcomes:
o
The
expected outcomes formulated in the planning step are the criteria used to
evaluate the clients response to Nursing care.
·
Expected
outcomes serve two purposes.
·
They
are:
o
Establish
the kind of evaluative data that need to be collected and
o
Provide
standard against which the data are Judged.
·
Collecting
data
o
Using
the clearly stated, precise and measurable expected outcomes as a guide, the
nurse collects data.
·
Judging
goal achievement:
o
The
goal was met, that is, the client response is the same as the expected outcome.
o
The
goal was partially met, that is either a short-term goal was achieved, but the
long term goal was not of the expected outcome was only partially attained.
o
The
goal was not met.
·
Relating
nursing actions to client outcomes:
o
The
fourth aspect of the evaluating process is determining whether the Nursing
actions had any relation to the outcomes.
o
Drawing
conclusions about problem status:
o
The
actual problem stated in the Nursing diagnosis has been resolved or the
potential is being prevented, and risk factors no longer exist. In these
instances, the nurse documents that the goals have been met and discontinuous
the care for the problem.
o
Drawing
conclusions about problem status cont...
o
The
potential problem stated in the nursing diagnosis is being prevented, but the
risk factors are still present in this case the nurse keeps the problem on the
care plan.
o
Reviewing
and Modifying the Nursing care plan:
o
After
drawing conclusions about the status of the client's problems, the Nurse
modified the care plan as indicated.
o
EVALUATING
THE QUALITY OF NURSING CARE
o
Evaluating
the quality of nursing care is an essential part of professional
accountability. Other terms are used for this measurement are quality
assessment and quality assurance
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