Chapter 15

Evaluating

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Benefits of Evaluation

Allows achievement of outcomes

Directs nursepatient interactions
Measures patient outcome achievement
Identifies factors to achieve outcomes
Modifies the plan of care, if necessary

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Actions Based on Patient Response to

Plan of Care
Terminate the plan of care when each expected outcome
is achieved.
Modify the plan of care if there are difficulties achieving
the outcomes.
Continue the plan of care if more time is needed to
achieve the outcomes.

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Five Classic Elements of Evaluation

Identifying evaluative criteria and standards
Collecting data to determine if criteria and standards are
met
Interpreting and summarizing findings
Documenting judgment
Terminating, continuing, or modifying the plan

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Types of Outcomes and Methods of

Evaluation
Cognitive:
increase in patient knowledge
asking patient to repeat information or apply new knowledge
Psychomotor:
patients achievement of new skills
asking patient to demonstrate new skill
Affective:
changes in patient values, beliefs, and attitudes
observing patient behavior and conversation
Physiologic:
physical changes in the patient

using physical assessment skill to collect and compare data

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Evaluative Criteria vs. Standards

Criteria: measurable qualities, attributes, or
characteristics that specify skills, knowledge, or health
status
Describe acceptable levels of performance by stating
expected behaviors of nurse or patient
Standards: levels of performance accepted and expected
by the nursing staff
Established by authority, custom, or consent

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Evaluative Statements
Decide how well outcome was met (met, partially met,
or not met).
List patient data or behaviors that support this
decision.
Outcomes may be met, partially met, or not met

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Revisions in the Plan of Care

After evaluating outcomes which have not been
accomplished, the nurse should:
1.Delete or modify the nursing diagnosis.
2.Make the outcome statement more realistic.
3.Increase the complexity of the outcome statement.
4.Adjust time criteria in the outcome statement.
5.Change nursing interventions.

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Variables Affecting Outcome Achievement

Patient
For example, a patient gives up and refuses
treatment, physical change in condition
Nurse
For example, a nurse is suffering from burnout, lack
of experience or knowledge
Health care system
For example, inadequate staffing, equipment
available, specialty units

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Determining Adequacy of Evaluation Step

Evaluate patient achievement of desired outcomes.
Review how the process is used.
Revise the plan of care if necessary.
Participate in quality-assurance programs.

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IOMs 10 New Rules to Redesign and

Improve Care
1. Care based on continuous healing relationships
2. Customization based on patient needs and values
3. The patient as the source of control
4. Shared knowledge and the free flow of information
5. Evidence-based decision making
6. Safety as a system priority
7. The need for transparency

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IOMs 10 New Rules to Redesign and

Improve Care (cont.)
8. Anticipation of patients needs
9. Continuous decrease in waste
10. Cooperation among clinicians

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Four Steps Crucial to

Improving Performance
Discover a problem.
Plan a strategy using indicators.
Implement a change.
Assess the change and/or plan a new strategy if
outcomes are not met.

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Seven Crucial Conversations in Health

Care
Broken rules
Mistakes
Lack of support
Incompetence
Poor teamwork
Disrespect
Micromanagement

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Elements of Healthy Work Environments

Skilled communication
True collaboration
Effective decision making
Appropriate staffing
Meaningful recognition
Authentic leadership

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Improving Professional Performance

Peer review- evaluation by an equal
Quality-assurance programs May be punitive or the chance for improvement
Structure evaluations- physical environment and organization
Process evaluations- examines a process
Outcome evaluations- measures result
Quality improvement- continuous observation and review
Patient satisfaction surveys
Nursing audit- standardized quality guidelines
Concurrent and retrospective evaluations
Direct observation or post-care review and questionnaires
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Major Ideas of Quality Improvement

Focus on organizational mission
Continuous improvement
Customer orientation
Leadership commitment
Empowerment
Collaboration/crossing boundaries
Focus on process
Focus on data and statistical thinking

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