Key Concepts, Chapter 15, Evaluating

In the fifth step of the nursing process, evaluating, the nurse and patient together measure

how well the patient has achieved the outcomes specified in the plan of care. When

evaluating patient outcome achievement, the nurse identifies factors that contribute to the

patients ability to achieve expected outcomes and, when necessary, modifies the plan of

care.

The purpose of evaluation is to allow the patients achievement of expected outcomes to

direct future nursepatient interactions. Based on the patients responses to the plan of

care, the nurse decides to (1) terminate the plan of care when each expected outcome is

achieved, (2) modify the plan of care if there are difficulties achieving the outcomes, or

(3) continue the plan of care if more time is needed to achieve the outcomes.

Nurses measure patient outcome achievement; how effectively nurses help targeted

groups of patients to achieve their specific outcomes; the competence of individual

nurses; and the degree to which external factors, such as different types of health care

services, specialized equipment or procedures, or socioeconomic factors, influence health

and wellness. The patient, however, is always the nurses primary concern.

The five classic elements of evaluation are (1) identifying evaluative criteria and

standards (what you are looking for when you evaluate, e.g., expected patient outcomes),

(2) collecting data to determine whether these criteria and standards are met, (3)

interpreting and summarizing findings, (4) documenting your judgment, and (5)

terminating, continuing, or modifying the plan. Each element requires the nurse to think

critically about how best to evaluate the patients progress toward valued health

outcomes.
 Although the terms criteria and standards are often used interchangeably in reference

to the evaluation step, they are different. Criteria are measurable qualities, attributes, or

characteristics that identify skills, knowledge, or health states. They describe acceptable

levels of performance by stating what is expected of the nurse or the patient. Standards

are the levels of performance accepted by and expected of nursing staff or other health

team members. They are established by authority, custom, or consent.

Nurses write expected outcomes during the planning phase of the nursing process. The

type of patient data collected to support the evaluation of outcome achievement depends

on the nature of the outcome. The data collected to determine the degree of outcome

achievement are recorded in evaluative statements. In addition to knowing what type of

data to collect to determine outcome achievement, the nurse needs to know when to

collect the data.

The most common mistake nurses make when evaluating in acute care settings is waiting

until the day the patient is to be discharged before evaluating outcome achievement. At

that point, it is too late to revise the plan of care.

After data have been collected and interpreted to determine patient outcome achievement,

the nurse makes and documents a judgment summarizing the findings. This is termed the

evaluative statement. The two-part evaluative statement includes a decision about how

well the outcome was met, along with patient data or behaviors that support this decision.

Outcomes may have been met, partially met, or not met.

When evaluation reveals that the patient has made little or no progress toward outcome

achievement, the nurse needs to re-evaluate each preceding step of the nursing process to

try to identify the contributing factors causing problems with the plan of care.
 Each nurse must decide how to respond when compromised patient care has been

identified. Nurses committed to healthier patients, quality care, reduced costs, and the

personal satisfaction of knowing that they are actually making a difference versus merely

wishing things were different value performance improvement.

The prevalent culture of poor communication and collaboration among health

professionals is significantly related to continued medical errors and staff turnover.

Quality-assurance programs arespecial programs that promote excellence in nursing. The

ANA model quality-assurance program consists of seven steps: (1) identify values; (2)

identify structure, process, and outcome standards and criteria; (3) measure the degree of

attainment of criteria and standards; (4) make interpretations about strengths and

weaknesses based on such measurements; (5) identify possible courses of action; (6)

choose a course of action; and (7) take action.

Quality improvement is the commitment and approach used to continuously improve

every process in every part of an organization, with the intent of meeting and exceeding

customer expectations and outcomes (Schroeder, 1994, p. 3). Unlike quality assurance,

quality improvement is internally driven, focuses on patient care rather than

organizational structure, focuses on processes rather than people, and has no end points.
An evaluative program that focuses on patient satisfaction is a powerful tool for patients

and families who want to know what care will be like before choosing a health care

facility.
Nursing-Sensitive Quality Indicators capture care or its outcomes most affected by

nursing care. The goals of the National Database of Nursing Quality Indicators

(NDNQI) are to promote and facilitate the standardization of information submitted by

hospitals across the United States on nursing quality and patient outcomes

(www.nursingworld.org).

The cultivation of evaluation as a critical component of the nursing process helps ensure
 nursings continued success in achieving desired changes in patient health status. Nursing

actions are far too valuable and costly to be haphazardly implemented. Evaluation that is

carefully planned and executed can direct and redirect these actions to maximize the

patients benefit. This is the outcome and challenge of nursing evaluation.

Perhaps the most important question to reflect on is this: Are your patients and their

families better for having had you share in the critical responsibility of partnering with

them to evaluate the development and implementation of the plan of care?