SRepublic of the Philippines

CAMARINES SUR POLYTECHNIC COLLEGES

Nabua, Camarines Sur

BACHELOR OF SCIENCE IN NURSING

College of Health Sciences
1ST SEMESTER S/Y 2021-2022
NURSING PROCESS
Module 5:EVALUATION
Learning Outcomes:
After completing this module, you will be able to:
1. Explain how evaluating relates to other phases of the nursing process.
2. Describe five components of the evaluation process.
3. Describe the steps involved in reviewing and modifying the client’s care plan.
4. Describe three components of quality evaluation: structure, process, and outcomes.

Introduction
Evaluating is the fifth phase of the nursing process. In this context, evaluating is a planned, ongoing, purposeful
activity in which clients and health care profession also determine
(a) the client’s progress toward achievement of goals/ outcomes and
(b) the effectiveness of the nursing care plan.
Evaluation is an important aspect of the nursing process because conclusions drawn from the evaluation
determine whether the nursing interventions should be terminated, continued, or changed. Evaluation is continuous.
Evaluation done while or immediately after implementing a nursing order enables the nurse to make on the-spot
modifications in an intervention. Evaluation performed at specified intervals (e.g., once a week for the home care
client) shows the extent of progress toward achievement of goals/outcomes and enables the nurse to correct any
deficiencies and modify the care plan as needed.

Process of Evaluating Client Response

Before evaluation, the nurse identifies the desired outcomes (indicators) that will be used to measure client goal
achievement. (This is done in the planning step.)

The evaluation phase has five components:

 Collecting data related to the desired outcomes
 Comparing the data with desired outcomes
 Relating nursing activities to outcomes
 Drawing conclusions about problem status
 Continuing, modifying, or terminating the nursing care plan.
Collecting Data
Using the clearly stated, precise, and measurable desired outcomes as a guide, the nurse collects data so that
conclusions can be drawn about whether goals have been met. It is usually necessary to collect both objective and
subjective data. Some data may require interpretation.
Some data may require interpretation.
 Examples of objective data requiring interpretation are the degree of tissue turgor of a
dehydrated client or the degree of restlessness of a client with pain.
 Examples of subjective data needing interpretation include complaints of nausea or pain by the
client.
When interpreting subjective data, the nurse must rely on either:
(a) the client’s statements (e.g., “My pain is worse now than it was after breakfast”) or
(b) objective indicators of the subjective data, even though these indicators may require further
interpretation (e.g., decreased restlessness, decreased pulse and respiratory rates, and relaxed facial
muscles as indicators of pain relief)
Comparing Data with Desired Outcomes
f the first two parts of the evaluating process have been carried out effectively, it is relatively simple to
determine whether a desired outcome has been met. When determining whether a goal has been achieved, the
nurse can draw one of three possible conclusions:
 The goal was met; that is, the client response is the same as the desired outcome.
 The goal was partially met; that is, either a short-term outcome was achieved but the long-term
goal was not, or the desired goal was incompletely attained.
 The goal was not met.
After determining whether or not a goal has been met, the nurse writes an evaluation statement (either
on the care plan or in the nurse’s notes). An evaluation statement consists of two parts: a conclusion and
supporting data. The conclusion is a statement that he goal/desired outcome was met, partially met, or not met.
The supporting data are the list of client responses that support the conclusion, for example:

Goal met: Oral intake 300 mL more than output; skin turgor resilient; mucous membranes moist

Relating Nursing Activities to Outcome

The third phase of the evaluating process is determining whether the nursing activities had any relation to
the outcomes. It should never be assumed that a nursing activity was the cause of or the only factor in meeting,
partially meeting, or not meeting a goal.

For example, a client was obese and needed to lose 14 kg (30 lbs.). When the nurse and client drew up a care plan,
one goal was “Lose 1.4 kg (3 lbs.) in 4 weeks.” A nursing strategy in the care plan was “Explain how to plan and
prepare a 1,200-calorie diet.” Four weeks later, the client weighed herself and had lost 1.8 kg (4 lbs.). The goal had
been met—in fact, exceeded. It is easy to assume that the nursing strategy was highly effective. However, it is
important to collect more data before drawing that conclusion. On questioning the client, the nurse might find any
of the following: (a) The client planned a 1,200-calorie diet and prepared and ate the food; (b) the client planned a
1,200-calorie diet but did not prepare the correct food; (c)  the client did not understand how to plan a 1,200-
calorie diet, so she did not bother with it.

Drawing Conclusions about Problem Status

The nurse uses the judgments about goal achievement to determine whether the care plan was effective
in resolving, reducing, or preventing client problems.

When goals have been met, the nurse can draw one of the following conclusions about the status of the client’s
problem:
 The actual problem stated in the nursing diagnosis has been resolved, or the potential problem is being
prevented and the risk factors no longer exist.
 The potential problem stated in the nursing diagnosis is being prevented, but the risk factors are still
present. In this case, the nurse keeps the problem on the care plan.
 The actual problem still exists even though some goals are being met.

For example, a desired outcome on a client’s care plan is “Will drink 3,000 mL of fluid daily.” Even though
the data may show this outcome has been achieved, other data (dry oral mucous membranes) may
indicate that the nursing diagnosis Deficient Fluid Volume is applicable. Therefore, the nursing
interventions must be continued even though this one goal was met.

When goals have been partially met or when goals have not been met, two conclusions may be drawn:
 The care plan may need to be revised, since the problem is only partially resolved. The revisions may need
to occur during the assessing, diagnosing, or planning phases, as well as implementing.
 The care plan does not need revision, because the client merely needs more time to achieve the
previously established goal(s).
 Continuing, Modifying or Terminating the Nursing Care Plan
After drawing conclusions about the status of the client’s problems, the nurse modifies the care plan as
indicated. Whether or not goals were met, a number of decisions need to be made about continuing, modifying,
or terminating nursing care for each problem.

Prepared by:
Jocyl Darrel B. Abinal, R.M, R.N, MAN
Clinical Instructor

Source: Kozier and Erb’s FUNDAMENTALS OF NURSING, concept, process and practice 10th edition Unit 3, Chapter 14