Nursing Evaluation Gail Ladwig, RN, MSN, CHTP Mosby items and derived items © 2011 by Mosby, Inc., an affiliate of Elsevier Inc.

2 Evaluation  Step 5 of the Nursing Process

3 Mosby items and derived items © 2011 by Mosby, Inc., an affiliate of Elsevier Inc. Definition: Nursing Process  The nursing process is an organizing framework for professional nursing practice.  The process is used in nursing to identify and treat the nursing diagnoses (problems) of a client.

4 Mosby items and derived items © 2011 by Mosby, Inc., an affiliate of Elsevier Inc. Critical Thinking  Process information that is gathered while performing the steps of the nursing process  Decision making for and with the client

5 Mosby items and derived items © 2011 by Mosby, Inc., an affiliate of Elsevier Inc. Nursing Process: Steps  Use the acronym ADPIE  Assessment  Diagnosis  Planning  Implementation  Evaluation

6 Mosby items and derived items © 2011 by Mosby, Inc., an affiliate of Elsevier Inc. Step One Assessment

7 Mosby items and derived items © 2011 by Mosby, Inc., an affiliate of Elsevier Inc. Definition: Assessment  Initial step of the nursing process  Collection of information about the client  Holistic and detailed  Supports critical thinking  Determines problems and strengths  Ongoing during all phases of nursing process

8 Mosby items and derived items © 2011 by Mosby, Inc., an affiliate of Elsevier Inc. Step Two Nursing Diagnosis

9 Mosby items and derived items © 2011 by Mosby, Inc., an affiliate of Elsevier Inc. Definition: Nursing Diagnosis  Clinical judgment  Individual, family, or community  Response to actual or potential health problems or life processes  Basis for outcomes and interventions  The nurse is accountable (North American Nursing Diagnosis Association-International, )

10 Mosby items and derived items © 2011 by Mosby, Inc., an affiliate of Elsevier Inc. Step Three Planning

11 Mosby items and derived items © 2011 by Mosby, Inc., an affiliate of Elsevier Inc. Definition: Planning  Follows the nursing diagnosis  This phase consists of writing measurable client outcomes and nursing interventions to accomplish the outcomes  These outcomes and interventions are designed to change the client’s nursing diagnosis/problem

12 Mosby items and derived items © 2011 by Mosby, Inc., an affiliate of Elsevier Inc. Step Four Implementation

13 Mosby items and derived items © 2011 by Mosby, Inc., an affiliate of Elsevier Inc. Definition: Implementation  Initiation of the nursing care plan  Performing the nursing interventions  Delegation of appropriate nursing interventions  Using skills  Psychomotor  Interpersonal  Cognitive  Performing continuous assessment

14 Mosby items and derived items © 2011 by Mosby, Inc., an affiliate of Elsevier Inc. Step Five Evaluation

15 Mosby items and derived items © 2011 by Mosby, Inc., an affiliate of Elsevier Inc. Definition: Evaluation  Although evaluation is listed as the last phase of the nursing process, it is actually an integral part of each phase and something that is done continually.  Clients’ outcomes are evaluated to see if they were met.  If the outcomes were not met, then the nursing process is begun again, with assessment to determine the reason that the outcomes were not met.

16 Mosby items and derived items © 2011 by Mosby, Inc., an affiliate of Elsevier Inc. Evaluation: Critical Thinking  Check the client outcomes.  Were the outcomes met or not met?  Is an additional assessment needed?  Were the outcomes attainable?  Was the correct nursing diagnosis selected?  Does the nursing care plan need to be modified?

17 Mosby items and derived items © 2011 by Mosby, Inc., an affiliate of Elsevier Inc. Evaluation: Critical Thinking (continued)  When using EBN, it is at this point that it is determined whether the practice that was followed was effective.  Necessary revisions may be made at this time.

18 Mosby items and derived items © 2011 by Mosby, Inc., an affiliate of Elsevier Inc. Sample: Case Scenario  A 73-year-old man has been admitted to the unit with an admitting medical diagnosis of COPD (chronic obstructive pulmonary disease). He states that he has “difficulty breathing when walking short distances” (RR = 26). He also states that his “heart feels like it is racing” (HR = 120) at the same time. He states that he is “tired all the time,” and while talking to you, he is continually wringing his hands and looking out the window.

19 Mosby items and derived items © 2011 by Mosby, Inc., an affiliate of Elsevier Inc. Outcomes and Nursing Diagnosis  Nursing diagnosis: Activity Intolerance

20 Mosby items and derived items © 2011 by Mosby, Inc., an affiliate of Elsevier Inc. Individualized Outcome  Activity tolerance improved  As evidenced by (AEB):  Client will walk in hall three times a day for 5 minutes.  Client’s heart rate (HR) will be >100 beats/min and respiratory rate (RR) >20 breaths/min after activity.  Client will state positive subjective feelings after activity.

21 Mosby items and derived items © 2011 by Mosby, Inc., an affiliate of Elsevier Inc. Critical Thinking  Did the client walk in the hall three times a day for 5 minutes?  What were his HR and RR after activity?  What statement did he make regarding the activity?

22 Mosby items and derived items © 2011 by Mosby, Inc., an affiliate of Elsevier Inc. Critical Thinking (continued)  Compare the answers to these questions with the desired client outcomes.  Were the outcomes met?  Are there any changes that need to be made?

23 Mosby items and derived items © 2011 by Mosby, Inc., an affiliate of Elsevier Inc. Evaluation of Outcomes Example

24 Mosby items and derived items © 2011 by Mosby, Inc., an affiliate of Elsevier Inc. Critical Thinking: Evaluation of Outcomes  Activity Intolerance improved  AEB:  Client states, “I do not feel tired all the time anymore.” HR was 90 beats/minute after walking in hall for 5 minutes HR was 90 beats/minute after walking in hall for 5 minutes  Client states, “My heart isn’t racing anymore.” RR was 18 breaths/minute after walking in hall for 5 minutes RR was 18 breaths/minute after walking in hall for 5 minutes  Client states, “My breathing is easier.”

25 Mosby items and derived items © 2011 by Mosby, Inc., an affiliate of Elsevier Inc. Critical Thinking  In this example, all of the client outcomes were met.  If they had not been met, then you would proceed to the first step of the nursing process and reassess the client.

26 Mosby items and derived items © 2011 by Mosby, Inc., an affiliate of Elsevier Inc. Reevaluate  Ask:  Was more assessment information needed?  Was the correct nursing diagnosis made?  Were the outcomes correct?  Were the outcomes relevant and realistic?  Were the right interventions selected?  Were the interventions based on EBN (evidence- based nursing)?  Were the interventions prioritized and timely?

27 Mosby items and derived items © 2011 by Mosby, Inc., an affiliate of Elsevier Inc. Summary  You have now completed all the steps of the nursing process: 1.Assessment 2.Diagnosis 3.Planning 4.Implementation 5.Evaluation

28 Mosby items and derived items © 2011 by Mosby, Inc., an affiliate of Elsevier Inc. Congratulations  Using the steps of the nursing process and standardized nursing language, you have provided excellent holistic nursing care for your client.