Chapter 20

Evaluation

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Critical Thinking in Evaluation

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 Examine Results

 Reflection-in-action
 Once you deliver an intervention, you continuously
examine results by gathering subjective and objective
data from the patient, family, and health care team
members.
 At the same time you review knowledge regarding a
patient’s current condition, the treatment, and the
resources available for recovery.
 By reflecting on previous experiences caring for
similar patients, you are in a better position to know
how to evaluate your patient.

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 Evaluative Measures

 Evaluative measures
are assessment skills
and techniques
 Evaluating behavior
 Self-management
 Nursing Outcomes
Classification (NOC)

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 Compare Achieved Effect with Goals
and Outcomes
 Compare clinical data, patient behavior
measures, and patient self-report measures
collected before implementation with the
evaluation findings gathered after administering
nursing care.
 Evaluate whether the results of care match the
expected outcomes and goals set for a patient.

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Compare Achieved Effect with Goals
and Outcomes (Cont.)

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 Case Study

 Miyoko is a nursing student assigned to Mr.

Mashoud, a 48-year-old Arab admitted to the
hospital with kidney stones.
 Upon Mr. Mashoud’s admission to the
emergency department (ED) this morning, he
was experiencing excruciating pain.
 The treatment plan for Mr. Mashoud includes
keeping him in the hospital until he passes the
stones and adjusting his pain medication as
needed.
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 Case Study (Cont.)

 Miyoko evaluates Mr. Mashoud’s response to

the medication therapy to update his care plan.
Miyoko assesses Mr. Mashoud’s pain before
NSAID administration and then approximately
one hour after administration.
 Miyoko knows that evaluation is an ____________
process that occurs whenever contact with a patient
occurs.

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Interpreting and Summarizing Findings

 When you evaluate the effect of interventions,

you interpret or learn to recognize relevant
evidence about a patient’s condition
 Early detection is first line of defense
 Compare actual and expected findings
 Steps to objectively evaluate the degree of
success in achieving outcomes of care

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 Recognize Errors or
Unmet Outcomes
 Must have an open mind, actively pursue truth,
be patient and confident, and engage in self-
reflection
 Systematic use of evaluation
 Self-reflection and correction of errors

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 Care Plan Revision

 Discontinuing a care plan

 Modifying a care plan
 Reassessment
 Redefining diagnoses
 Goals and expected outcomes
 Interventions

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 Quick Quiz!

1. Your patient has met the goals set for

improvement of ambulatory status. You would
now:
A. modify the care plan.
B. discontinue the care plan.
C. create a new nursing diagnosis that states
goals have been met.
D. reassess the patient’s response to care and
evaluate the implementation step of the nursing
process.
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 Standards for Evaluation

 Nursing care helps patients

• Resolve actual health problems

• Prevent potential problems

• Maintain a healthy state

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 Standards for Evaluation (Cont.)

 American Nurses Association (ANA)

 Defines standards
 Competencies include:
 Being systematic
 Using criterion-based evaluation
 Collaborating
 Using ongoing assessment data to revise care plan
 Communicating results

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 Case Study (Cont.)

 Miyoko determines the patient outcomes for Mr.

Mashoud based on his reaction to the
medication regimen.
 Which of the following is an end result that translates
into observable patient behaviors that are measurable
and desirable?
A. Unexpected outcome
B. Expected outcome
C. Sensitive outcome
D. Accomplished outcome
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 Standards for Evaluation (Cont.)

 Collaborate and evaluate effectiveness of

interventions
 Family
 Health care team
 Document results

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 Case Study (Cont.)
Miyoko follows which steps to objectively evaluate the
degree of success in achieving outcomes of care for Mr.
Mashoud?
(Select all that apply.)
A. Identify the exact desired patient behavior.
B. Evaluate the patient’s actual behavior.
C. Compare the outcome criteria with the actual
behavior.
D. Assess the desired behavior and anticipated
outcome.
E. Judge the degree of agreement between the
outcome criteria and the actual behavior.
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 Quick Quiz!
2. You have finished with several nursing interventions.
To evaluate interventions, you need to examine the:
A. appropriateness of the interventions and the correct
application of the implementation process.
B. nursing diagnoses to ensure that they are not
medical diagnoses.
C. care planning process for errors in other health care
team members’ judgments.
D. interventions of each nurse to enable the nurse
manager to correctly evaluate performance.

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