Chapter 20
Evaluation
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
Critical Thinking and Evaluation
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Evaluation is an ongoing process.
If outcomes are met, patient goals are met.
Positive evaluations occur when nurses meet
desired outcomes.
Positive evaluations lead nurses to conclude
that interventions were successful.
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
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Case Study
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Miyoko is a nursing student assigned to Mr.
Mashoud, a 48-year-old Arab male admitted
to the hospital with kidney stones.
Upon Mr. Mashoud’s admission to the
emergency department (ED) this morning, he
was experiencing excruciating pain.
The treatment plan for Mr. Mashoud includes
keeping him in the hospital until he passes
the stones and adjusting his pain medication
as needed.
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
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Case Study (cont’d)
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Miyoko evaluates Mr. Mashoud’s response to
the medication therapy to update his care
plan. Miyoko assesses Mr. Mashoud’s pain
before NSAID administration and then
approximately one hour after administration.
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Miyoko knows that evaluation is an ____________
process that occurs whenever contact with a
patient occurs.
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
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Standards for Evaluation
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Nursing care helps patients
Resolve actual health problems
Prevent potential problems
Maintain a healthy state
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
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Standards for Evaluation (cont’d)
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American Nurses Association (ANA)
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Defines standards
Competencies include:
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Being systematic
Using criterion-based evaluation
Collaborating
Using ongoing assessment data to revise care
plan
Communicating results
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
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Criterion-Based Standards
Criterion-based standards for evaluation are the
physiological, emotional, and behavioral
responses that are a
patient’s goals and expected outcomes.
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
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Criterion-Based Evaluation
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Goal = Expected behavior or response that
indicates resolution of a nursing diagnosis or
maintenance of a healthy state
Expected outcome = End result that is
measurable, desirable, and observable and
translates into observable patient behaviors
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Nursing-sensitive outcome
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
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Case Study (cont’d)
Miyoko determines the patient outcomes for Mr.
Mashoud based on his reaction to the
medication regimen.
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Which of the following is an end result that
translates into observable patient behaviors that
are measurable and desirable?
A. Unexpected outcome
B. Expected outcome
C. Sensitive outcome
D. Accomplished outcome
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
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Collaborate and Evaluate
Effectiveness of Interventions
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Collaborate with the
patient and family.
Use evaluative
measures.
Interpret and
summarize findings.
Document results.
Revise care plan.
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
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Objective Evaluation
1. Examine the outcome criteria.
2. Evaluate the patient’s actual response.
3. Compare the established outcome criteria with
the actual response.
4. Judge the degree of agreement between the
outcome criteria and the response.
5. If no or only partial agreement, what are the
barriers?
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
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Case Study (cont’d)
Miyoko follows which steps to objectively evaluate the
degree of success in achieving outcomes of care for Mr.
Mashoud?
(Select all that apply.)
A. Identify the exact desired patient behavior.
B. Evaluate the patient’s actual behavior.
C. Compare the outcome criteria with the actual
behavior.
D. Assess the desired behavior and anticipated
outcome.
E. Judge the degree of agreement between the
outcome criteria and the actual behavior.
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
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Revising a Care Plan
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Discontinuing a care plan:
Has the goal been met?
Does the patient agree?
Document the discontinued plan.
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
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Quick Quiz!
1. Your patient has met the goals set for
improvement of ambulatory status. You would
now
A. Modify the care plan.
B. Discontinue the care plan.
C. Create a new nursing diagnosis that states
goals have been met.
D. Reassess the patient’s response to care and
evaluate the implementation step of the nursing
process.
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
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Revising a Care Plan (cont’d)
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Modifying a care plan:
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Reassessment
Redefining diagnoses
Goals and expected outcomes
It sometimes becomes necessary to collect
evaluative measures over time to determine
whether a pattern of change exists.
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
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Revising a Care Plan (cont’d)
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Modifying a care plan: Interventions
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Appropriateness of the intervention
• Based on the standard of care
Correct application of the intervention
A patient’s nursing diagnoses, priorities, and
interventions sometimes change as a result
of evaluation.
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
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Quick Quiz!
2. You have finished with several nursing interventions.
To evaluate interventions, you need to examine the:
A. Appropriateness of the interventions and the correct
application of the implementation process.
B. Nursing diagnoses to ensure that they are not
medical diagnoses.
C. Care planning process for errors in other health care
team members’ judgments
D. Interventions of each nurse to enable the nurse
manager to correctly evaluate performance.
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
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Revising a Care Plan (cont’d)
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Modifying a care plan:
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Unmet patient needs
When a goal is not met, no matter what the
reason, repeat the entire nursing process
sequence for that nursing diagnosis to
identify necessary changes to the plan.
By consistently incorporating evaluation into
practice, you minimize errors and ensure that
the patient’s plan of care is appropriate and
relevant.
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
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