Chapter 15 Evaluating Dr. James Pelletier The Swain Department of Nursing

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

Evaluating

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.

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

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

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

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

Variables Affecting Outcome Achievement Patient For example, a patient gives up and refuses treatment Nurse For example, a nurse is suffering from burnout Health care system For example, inadequate staffing

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

Revisions in the Plan of Care Delete or modify the nursing diagnosis. Make the outcome statement more realistic. Increase the complexity of the outcome statement. Adjust time criteria in the outcome statement. Change nursing interventions.

IOM’s 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

IOM’s 10 New Rules to Redesign and Improve Care (cont.) 8. Anticipation of patient’s needs 9. Continuous decrease in waste 10. Cooperation among clinicians

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.

Improving Professional Performance Peer review Quality-assurance programs Structure evaluations Process evaluations Outcome evaluations Quality improvement Nursing audit Concurrent and retrospective evaluations

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

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.

Elements of Healthy Work Environments Skilled communication True collaboration Effective decision making Appropriate staffing Meaningful recognition Authentic leadership

Seven Crucial Conversations in Health Care Broken rules Mistakes Lack of support Incompetence Poor teamwork Disrespect Micromanagement