CHAPTER 19

 EVALUATION

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 Evaluation
Final Step of the Nursing Process
Determines whether after nursing
care, the client’s condition improves!

It is on-going! See Figure 19-1, p 356.

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 Success of Goals
 Examine the goal statement-indicates behavior or
response desired, (resource-NOC), Table 19-2, p.
358.
 Assess (evaluate) the client- same actions,
different time in the NP cycle & different reason for
gathering info; data is collected after
interventions!
 Compare the expected outcome with client
behavior or response, not the nursing intervention
 Judge the degree of agreement between outcome
and client response – ex. Critical pathway, Fig. 19-
2, p. 359-360.
 Determine reasons for no agreement or partial
agreement

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 Process
 Identify evaluative criteria and standards
specific to the goal.
 Collecting data (Pt’s Response), to determine if
criteria or standards are met
 Types of Outcome can be – cognitive,
psychomotor, affective, body function &
appearance;
 Client satisfaction – sources are pt, family, health care
team
 Evaluative measures – assessment skills, Table 19-3,
p. 362.
 Complete over specific period of time

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 Process Continued:
 Interpreting and summarizing findings –
leads to Clinical Decision Making
 Judge degree of agreement between outcome
criteria and client response, Table 19-4, p.
362
 Documenting findings – Communicates
progress towards the goal.
 Objective data & Subjective data
 Share with health team
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 Care Plan Revision
 Terminating, continuing, or revising the
care plan – determined by clients
response
 Discontinue – Expected outcome was met
and document.
 Modify – Goal not met; Identify variables
and adjust changes to meet the goal

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 Care Plan Revision
 Modifying – Critical Thinking!
 Reassessment-complete review; compare
new data to old; review cultural beliefs, values,
& practices.
 Nursing diagnosis -check for accuracy
 Client goals and outcomes -one problem may
affect another; be realistic; client centered.

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 Care Plan Revision – Cont.
 Nursing interventions -check for
appropriateness & correct application
 Standard of Care – minimum level of care
 Frequency of interventions – Increase or
decrease
 Consider the level of care provided
 Consult with other nurses
 Occasional unmet needs should be
anticipated.

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 Quality Improvement
 Purpose-continuous study & improvement of
providing healthcare
 Nursing practice-begins at staff level:
 Med admin
 Diet management
 Wound care
 Discharge planning
 Outcome management-result of prescribed
treatment
 Professional outcomes-measures care givers
performance
 Client outcomes-client status after receiving care

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 OUTCOMES MANAGEMENT
 National initiative:
 Reduce health care cost
 Identify & use best practices
 Health risk appraisal
 Quality Accreditation and Advocacy
Organizations, Table 19-5, p. 366

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Example of a Goal, Outcome, and
Evaluative Measure
 Goal: client’s pressure ulcer will heal
within 7 days
 Outcome: erythema will be reduced in 2
days
 Evaluative measure: inspect color,
condition, and location of pressure ulcer

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