Chapter 16
Evaluating
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Evaluating Step
• Allows achievement of outcomes
• Directs nurse–patient interactions
• Measures patient outcome achievement
• Identifies factors to achieve outcomes
• Modifies the plan of care, if necessary
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Evaluating
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Action Based on Outcome Achievement
• Terminate plan of care
• Modify plan of care
• Continue plan of care
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Four Types of Outcomes
• Cognitive—increase in patient knowledge
• Psychomotor—patient’s achievement of new skills
• Affective—changes in patient values, beliefs, and
attitudes
• Physiologic—physical changes in the patient
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Evaluating Outcomes
• Cognitive—asking patient to repeat information or apply
new knowledge
• Psychomotor—asking patient to demonstrate new skill
• Affective—observing patient behavior and conversation
• Physiologic—using physical assessment skill to collect
and compare data
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Five Classic Elements of Evaluation
• Identifying evaluative criteria and standards
• Collecting data
• Interpreting and summarizing findings
• Documenting judgment
• Terminating, continuing, or modifying the plan
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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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Variables Affecting Outcome Achievement
• Patient
– e.g., a patient gives up and refuses treatment
• Nurse
– e.g., a nurse is suffering from burn-out
• Healthcare system
– e.g., inadequate staffing
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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
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Revisions in the Plan of Care
• Delete or modify the nursing diagnosis
• Make the outcome statement more realistic
• Adjust time criteria in outcome statement
• Change nursing interventions
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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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Improving Professional Performance
• Peer review
• Quality assurance programs
• Structure evaluations
• Process evaluations
• Outcome evaluations
• Quality improvement
• Nursing audit
• Concurrent and retrospective evaluations
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Major Premises of Quality Improvement
(Schroeder, 1994)
• 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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Standards for Establishing and Sustaining
Health Work Environments
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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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Questions to Ensure a Firm
Commitment to Evaluation
• What are the patient’s outcomes?
• What are nursing’s values?
• How can these values be formalized in standards and
evaluative criteria?
• What data exist to determine whether criteria are met?
• How can these data best be collected, analyzed, and
interpreted?
• To what courses of actions do the findings lead?
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Question
Tell whether the following statement is true or false.
The purpose of evaluation is to allow the patient’s
achievement of expected outcomes to direct future
nurse-patient interactions.
A. True
B. False
Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins
Answer
Answer: A. True
The purpose of evaluation is to allow the patient’s
achievement of expected outcomes to direct future
nurse-patient interactions.
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Question
Which of the following actions should the nurse take
when a patient has achieved each expected outcome in
the plan of care?
A. Terminate the plan of care
B. Modify the plan of care
C. Continue the plan of care
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Answer
Answer: A. Terminate the plan of care
Rationale:
The plan of care is terminated when the patient has
achieved all of its goals.
The plan of care is modified when there are difficulties
achieving outcomes.
The plan of care is continued if more time is needed to
achieve the outcomes.
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Question
Which one of the following examples is a psychomotor
outcome?
A. A patient learns how to control his weight using the
MyPyramid Food Guide.
B. A patient is able to test for glucose levels and inject
insulin as needed.
C. A patient values his health enough to decide to quit
smoking.
D. A patient is able to ambulate the hallway following
knee surgery.
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Answer
Answer: B. A patient is able to test for glucose levels and
inject insulin as needed.
Rationale:
Psychomotor outcomes involve the patient’s achievement
of a new skill, such as controlling diabetes.
Cognitive outcomes involve an increase in patient
knowledge (Answer A).
Affective outcomes pertain to changes in patient values
(Answer C).
Physiologic outcomes target physical changes in the
patient (Answer D).
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Question
Tell whether the following statement is true or false.
Asking a patient to plan an exercise program to lower
blood pressure based on information provided to him in
an A/V presentation is an excellent method to evaluate a
physiologic outcome.
A. True
B. False
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Answer
Answer: B. False
Asking a patient to plan an exercise program to lower
blood pressure based on information provided to him in
an A/V presentation is an excellent method to evaluate a
cognitive outcome.
Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins
Question
Tell whether the following statement is true or false.
An outcome evaluation focuses on measurable changes
in the health status of the patient or the end result of
nursing care.
A. True
B. False
Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins
Answer
Answer: A. True
An outcome evaluation focuses on measurable changes
in the health status of the patient or the end result of
nursing care.
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