Nursing Process: Evaluation

1. Nursing Process: Evaluation George Ann Daniels, MS, RN

2. Evaluation Evaluation includes determining whether the desired outcomes have been met This in an on going process that determines how well the plan of care is working and if the plan of care needs to be modified What is the difference between assessment and evaluation When is discharge planning startedWhat is the difference between assessment and evaluation When is discharge planning started

3. A Time for reassessment Evaluation requires continued reassessment of the client�s condition, and determines Appropriateness of nursing actions Need to revise interventions Development of new client problems/needs Need to rearrange priorities to meet changing demands

4. How do you evaluate? Direct observation Client interview Review of records Progress notes, flow sheets, nursing notes

5. Components of evaluation expected outcomes Identification of expected outcomes Collect data related to expected outcomes Relate nursing actions to expected outcomes Draw conclusions about problem status Resolved Revised continue

6. Expected outcomes are either: Met Not met Partially met

7. EO: Met Document what client assessment findings show that the expected outcome is met How do you know as a nurse that this expected outcome is met? What has happened to prove the problem is resolved Which intervention can be terminated? How easily where the outcomes achieved? Can timelines be shortened

8. Actual problem resolved Nursing diagnosis is discontinued High risk problem resolved Risk factors no longer exist Nursing diagnosis is discontinues Problem still exists Revise interventions

9. EO: Partially Met Document the assessment findings that indicate that progress has been made, but there is still work to do. How do you know that progress has been made? What needs to be done to make continued progress?

10. EO: Not met Document what has been done that hasn�t worked so other HCP will be aware. How do you know that the client has not met the EO? What are the assessment findings that support this? What are you ideas for change?

11. If EO is not met ask these questions Were the outcomes realistic and appropriate? Was the client involved in setting the outcomes? Does the client believe the outcomes were important? Does the client know why the outcomes have not been met?

12. Have all of the interventions that were planned been carried out and in the timeframe specified? If not, why not? Were they too vague or misinterpreted? What variables may have affected achievement of the outcomes? Were new problems and adverse client responses detected early enough to make appropriate changes in the plan of care?

13. Modification of the plan of care When evaluation indicates a change in the plan of care is needed, �back up� through the nursing process to see where areas for change lie POC must be modified to reflect the changes outcome evaluation process handoutPOC must be modified to reflect the changes outcome evaluation process handout

14. How to write evaluations EO was met, partially met, or not met. Any new or additional data Any changes that were made in the intervention as a result of ongoing assessment How the interventions helped achieve the goal

15. ANA Standard VI Evaluation: The nurse evaluates the client�s progress toward attainment of outcomes 1. Evaluation is systematic ongoing, and criterion-based. 2. The client, family, and other healthcare providers are involved in the evaluation process as appropriate.

16. 3. Ongoing assessment data are used to revise diagnosis, outcomes, and the plan of care, as needed. 4. Revision in diagnoses, outcomes, and the plan of care are documented. 5. The effectiveness of interventions is evaluated in relation to outcomes. 6. The patient�s responses to interventions are documented.