Evaluation

Notes

Introduction
  • Evaluation, the final step of the nursing process, is crucial to determine whether, after application of the nursing process, the client’s condition or well-being improves. The nurse applies all that is known about a client and the client’s condition, as well as experience with previous clients, to evaluate whether nursing care was effective. The nurse conducts evaluation measures to determine if expected outcomes are met, not the nursing interventions.
  • The expected outcomes are the standards against which the nurse judges if goals have been met and thus if care is successful.Providing health care in a timely, competent, and cost-effective manner is complex and challenging. The evaluation process will determine the effectiveness of care, make necessary modifications, and to continuously ensure favorable client outcomes.
Definition
  • Is assessment the client’s response to nursing interventions and then comparing that response to predetermined standards or outcome criteria.

Evaluation is defined as the judgment of the effectiveness of nursing care to meet client goals; in this phase nurse compare the client behavioral responses with predetermined client goals and outcome criteria. –CRAVEN 1996

Sample Case Study

Nursing Diagnosis : Impaired skin integrity related to physical mobility

Expected Outcomes : The patient will be able to get recovery of pressure sore.

Planning:

  • Pressure sore dressing
    • Rationale: Cleansing the area will prevent further infection
  • Back care
    • Rationale: It will promote blood circulation
  • Change the position frequently
    • Rationale: It will put little pressure on the sore site
  • Encourage the patient to ambulate
    • Rationale: It will put little pressure on the sore site
  • Take protein rich diet
    • Rationale: Protein helps in repair of tissues

Evaluation : Wound healing was observed (tissues were red, healthy)

Purposes
  1. Determine client’s behavioral response to nursing interventions.
  2. Compare the client’s response with predetermined outcome criteria.
  3. Appraise the extent to which client’s goals were attained.
  4. Assess the collaboration of client and health care team members.
  5. Identify the errors in the plan of care.
  6. Monitor the quality of nursing care.

Components of Evaluation
  1. Collecting the data related to the desired outcomes
  2. Comparing the data with outcomes
  3. Relating nursing activities to outcomes
  4. Drawing conclusion about problem status
  5. Continuing, modifying, or terminating the nursing care plan
Collecting the data
  • The nurse collects the data so that conclusion can be drawn about whether goals have been met. It is usually necessary to collect both subjective & objective data. Data must be recorded concisely and accurately to facilitate the next part of the evaluating process.
Comparing the data with outcomes
  •  If the first part of the evaluation process has been carried out effectively , it is relatively simple to determine whether a desired outcome has been met. Both the nurse and client play an active role in comparing the client’s actual responses with the desired outcomes.
Relating nursing activities to outcomes
  • The third aspect of the evaluating process is determined whether the nursing activities had any relation to the outcome.
Drawing conclusion about problem status
  • The nurse uses the judgement 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 the following conclusions about the status of the client’s problem.
    • The actual problem stated in the nursing diagnosis has been resolved , or the potential problem is being prevented and the risk factors no longer exist. In these instances , the nurse documents that the goals have been met and discontinues the care for the problem.
    • The potential problem is being prevented, but the risk factors still present. In this case , the nurse keeps the problem on the care plan.
    • The actual problem still exists even though some goals are being met. In this case the nursing interventions must be continued.
Continuing , modifying , or terminating the nursing care plan

After drawing conclusion about the status of the client’s problems , the nurse modifies the care plan as indicated. Whether or not goals were met, a number of decision need to be made about continuing, modifying or terminating nursing care for each problem.

Before making individual modification, the nurse must first determine why the plan as a whole was not completely effective. This require a review of the entire plan.

Factors Affecting Goal Attainment
  1. Family Members
  2. Health Team Members
  3. Nurse
Evaluation Skill Required for Nurses
  1. Nurse must know the hospital policies, procedure and protocols of interventions and recording.
  2. Nurse must have up to date knowledge and information of many subject.
  3. Nurse must have intellectual and technical skill to monitor the effectiveness of nursing interventions.
  4. Nurse must have knowledge and skill of collecting subjective data and objective data.

 

Exam

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