1. Evaluating

2. Evaluation the nurse and the patient together measure how well the patient has achieved the outcomes specified in the plan of care allow the patient’s achievement of expected outcomes to direct future

3. 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

4. Evaluating

5. 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

6. Answer Answer: A. True The purpose of evaluation is to allow the patient’s achievement of expected outcomes to direct future nurse-patient interactions.

7. Action Based on Outcome Achievement Terminate plan of care Modify plan of care Continue plan of care

8. 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

9. 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.

10. 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

11. 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.

12. 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).

13. 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

14. 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

15. 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.

16. Five Classic Elements of Evaluation Identifying evaluative criteria and standards Collecting data Interpreting and summarizing findings Documenting judgment Terminating, continuing, or modifying the plan

17. 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

18. 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

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

20. 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

21. 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

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

23. 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

24. 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.

25. 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

26. Standards for Establishing and Sustaining Health Work Environments

27. 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?

28. 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