Critical Thinking- Evaluation


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.
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 provider.
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.
The supporting data are the list of client responses that support the conclusion.
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 about the status of the client problem.
1.   The actual problem has been resolved. The risk problem is being prevented and the risk factors no longer exist. In these instances the nurse discontinues the care for the problem.
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 nursing interventions must be continued.
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.
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.
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 is an essential part of professional accountability. Other terms are used for this measurement are quality assessment and quality assurance



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Critical Thinking- Evaluation
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