NURSING PROCESS

1. NURSING PROCESS Chapter 6 The Nursing Process: The Evaluation Step: Determining Whether Desired Outcomes Have Been Met

2. Reference • Doenges, M. E., & Moorhouse, M. F. (2008). Application of nursing process andnursing diagnosis: An interactive text for diagnostic reasoning(5th ed.). Philadelphia: F. A. Davis.

3. Competencies for Chapter 6, The Evaluation Step: • By the end of this unit the student will: • Compare and contrast evaluation and assessment • Describe the purpose of evaluation • Describe 3 nursing actions in response to evaluation • Define and describe the 3 components of evaluation • Differentiate between the 3 types of goals

4. Evaluation • A continuous process • Based on reviewing client responses • Determines effectiveness of care plan in meeting client needs • Essential in assuring quality and appropriateness of care

5. Evaluation Purpose: • To allow patient’s achievement of expected outcomes to direct future nurse-patient interaction Based on patient’s response nurse decides: • Terminate plan of care as goals achieved • Modify plan of care • Continue plan of care

6. Evaluation step’s 3 components: • Reassessment • Modification of the Plan of Care • Termination of Services

7. Reassessment Ongoing process of measuring, monitoring, and evaluating: • Patient’s response to care • Progress or lack of progress toward desired outcomes

8. Reassessment Outcomes may be evaluated by: • Direct Observation • Client Interview • Review of Records

9. Reassessment Evaluation of data determines: • Appropriateness of nursing actions • Need to revise interventions • Development of new client needs • Referral to other resources • Rearrange priorities to meet the changing demands of care

10. Modification of Plan of Care When evaluating outcomes and modifying plan of care: • Was there a change that was or was not expected? • Is a change in treatment approach needed? • Are basic needs are being met? • If so, can care progress to higher-level concerns? • If not, identify reasons, document, and revise outcomes or write new ones • Are outcomes met? • Any interventions not met? • Which interventions can be terminated? • Can timeframes be shortened/lengthened?

11. Modification of Plan of Care To help with modification of plan of care: • Client care conference • Consultation with another colleague or resource person with special knowledge Remember: • address the changing needs of the client’s health status, environment, and therapeutic regimen

12. Termination of Services When desired outcomes have been achieved and broader goals met, termination of care is planned • Focus is now on how will the patient manage on their own • Not all outcomes will be achieved by the time of discharge • Goals/outcomes not met need to be reviewed and reasons why not met documented

13. Types of Goals • Cognitive goals • Psychomotor goals • Affective goals • Physical changes

14. Termination of Services • Discharge planning begins at time of admission • Discharge information to include: • Written or verbal instructions • Signs/symptoms to report • Referral/contact phone numbers • Follow-up appointments • Copy of nursing discharge summary (depending on facility) • Teaching • Copy of doctor’s discharge orders (depending on facility)

15. Enhancing Delivery of Quality of Care • Client care evaluated on an individual basis • Comparing overall outcomes and effectiveness of specific interventions for selected groups of clients is bases for research and improving care for groups • Key in refining standards of care and determining protocols, policies and procedures for quality nursing care • Standards – levels of performance accepted and expected by the nursing staff or other health team members

16. Performance improvement • Discover a problem • Plan a strategy using indicators • Implement a change • Assess the change

17. Quality Assurance • Range from small programs on a nursing unit to those developed for an entire institution • Enables the nurse to be accountable to society for the quality of nursing care

18. Summary • During this phase nurse monitors and reports on the status of identified needs and outcomes • Involves patient and family/caregivers • Determined if needs/outcomes met • Decision made to continue, modify, or terminate care