The fifth and final step of the nursing care plan is the evaluation phase. This is when it is evaluated if the desired result has been achieved during the shift. Evaluation, the final step in the nursing process, is crucial to determine if, after the application of the nursing process, the patient's condition or well-being improves. Apply everything you know about a patient and their condition and their experiences with previous patients to assess whether nursing care was effective.
You carry out evaluation measures to determine if your patients met the expected results, not if nursing interventions were completed. The expected outcomes established during planning are the standards by which the nurse judges whether the goals have been met and whether the care has been successful. Evaluation is an ongoing process that takes place every time you have contact with a patient. Once you perform an intervention, you collect subjective and objective data from the patient, family, and members of the healthcare team.
You also review knowledge about the patient's current condition, treatment, resources available for recovery and expected results. By consulting previous experiences caring for similar patients, you are in a better position to know how to evaluate your patient. You can anticipate what to evaluate. Apply critical thinking, attitudes, and standards to determine if care outcomes are achieved (Fig.
If the results are met, the patient's general objectives are also met. Compare the behavior and responses of the patients you evaluated before performing nursing interventions with the behavior and responses that occur after administering nursing care. Critical thinking directs you to analyze the findings of the evaluation (Fig. Has the patient's condition improved? Can the patient get better or are there physical factors that prevent recovery? To what extent does this patient's motivation or willingness to adopt healthier behaviors influence responses to therapies? During the evaluation, you make clinical decisions and continuously redirect nursing care.
For example, when Tonya evaluates Jacobs' learning, she applies her knowledge of patient education, the principles of patient education, and postoperative wound healing to interpret if learning has occurred and if more instruction is needed. Tonya knows that repetition is important in learning and therefore plans another instructional session with the family during a change of clothes the next day. The findings of the evaluation determine Tonya's next course of action. In the case of the Jacobs, Tonya knows that this is the first time that Mr.
Jacobs expressed concern about recognizing signs of infection. To learn about the results of the care, Tonya plans to talk about how the wound looks during normal healing and, specifically, about how signs of infection occur. She reinforces this explanation during the change of clothes, so Mr. Jacobs can re-examine the wound closely following Tonya's instructions.
Positive evaluations occur when the patient meets the desired results, leading to the conclusion that the nursing interventions were effective. For example, in the case study, Tonya points out that Ms. Jacobs identified three signs and symptoms of infection and Mr. Therefore, Tonya determines that the patient partially met the expected result of “describing the signs and symptoms of the wound infection”.
Unsatisfactory or unwanted outcomes, such as incorrect or incomplete knowledge, indicate that interventions are not effective in minimizing or solving the real problem or avoiding a risky problem. An unachieved result reveals that the patient has not responded to the interventions as planned. As a result, the nurse changes the care plan by trying different therapies or changing the frequency or focus of existing therapies. This sequence of critical evaluation and review of therapies continues until you and the patient successfully and adequately resolve the problems defined in nursing diagnoses.
Remember that the evaluation is dynamic and is constantly changing, depending on the patient's diagnoses and nursing conditions. As problems change, so do the expected results. A patient whose health status is constantly changing requires more frequent evaluation. In addition, priority diagnoses are evaluated first.
For example, Tonya continues to evaluate Mr. Jacobs' acute pain before evaluating the state of his deficient knowledge. You evaluate nursing care by knowing what to look for, as described in standards based on criteria that are included in the patient's goals and expected outcomes. Goals and outcomes are objective criteria needed to assess a patient's response to care.
A goal is the expected behavior or response that indicates the resolution of a nursing diagnosis or the maintenance of a healthy state. It is a summary statement of what will be achieved when the patient has achieved all the expected results. Jacobs Tonya selected the objective of: “The patient expresses his acceptance of the state of health on the day of discharge” for the diagnosis of anxiety by the nurse (see chapter 1). The successful achievement of this goal depends on Tonya carrying out interventions selected from the Classification of Nursing Interventions (NIC), including acceptance of health status and level of anxiety (see Nursing Care Plan, chapter 1).
The objectives are also often based on standards of care or established guidelines for a minimum safe practice. For example, the Society of Infusion Nurses (INS) has standards of care for the prevention of phlebitis, an intravenous (IV) complication (INS, 200). When a nurse treats a patient with a peripheral intravenous route, the goal of “keeping the intravenous site free of phlebitis” is established on the basis of sound practical standards. The INS phlebitis scale contains physical criteria for determining phlebitis (see chapter 4).
An expected outcome is an end result that is measurable, desirable and observable and that translates into observable patient behaviors (ANA, 20). It is a measure that indicates whether the interventions applied in patient care led to the successful achievement of the goals. When nurses apply the nursing process, a nursing-sensitive outcome is a measurable state, behavior, or perception of the patient or family, largely influenced by and sensitive to nursing interventions (Moorhead et al. Interventions must be within the scope of nursing practice and be an integral part of nursing care processes.
Examples of nursing-sensitive outcomes include reducing the frequency of pain, the incidence of pressure sores, and the incidence of falls (Box 20-. By comparison, medical outcomes are largely influenced by medical interventions. Examples include patient mortality, surgical wound infection, and hospital readmissions. The results are statements of progressive and gradual physical, emotional, or behavioral responses that the patient must meet to achieve the goals of care.
When results are obtained, factors related to nursing diagnosis generally no longer exist. Two of the expected results for Mr. Jacobs' objective is: “The patient expresses his acceptance of the state of health on the day of discharge”, it is: “The patient describes the results of the surgery in a conversation with the surgeon within 24 hours” and “the patient shares his concerns with his wife before the day of discharge”. Tonya evaluates Mr.
Jacobs observing behaviors that reflect anxiety and discussing what the patient has learned from the surgeon and what he has discussed with his wife. The related factor of “uncertainty about recovery” no longer exists if Mr. Jacobs can relate the surgical results discussed with the surgeon and the reports of having a conversation about those results with his wife. The current climate in healthcare aims to increase the responsibility of healthcare organizations for the quality of the care they provide (Loan et al.
Nursing-sensitive outcomes provide reference points for hospitals to assess the quality of their care. The use of nursing-sensitive outcomes, such as the prevalence of pressure sores, the frequency of symptoms (pain, nausea, fatigue), errors in medication administration, and the incidence of injuries from falls and falls, offers hospitals the opportunity to compare their performance with specificity (Brown et al. In addition, these outcome measures offer a way to measure staff effectiveness (Loan et al. Application to nursing practice: Evaluation is not a description of the achievement of an intervention.
Jacobs doesn't involve looking at your ability to perform relaxation exercises for your anxiety. The evaluation involves observing the patient's behavior (facial expression) during conversations about their recovery. A valuable resource for selecting outcomes is the Nursing Outcomes Classification (NOC) (see chapter 1). It offers a language for the evaluation stage of the nursing process.
The purposes of the NOC are (to identify, label, validate and classify) the outcomes of patients sensitive to nurses; (to test in the field and validate the classification); and (to define and test the procedures for measuring results and indicators) using clinical data (Moorhead et al. Within the NOC taxonomy, you can select specific outcomes for nursing interventions related to nursing diagnoses. The NOC project complements the work of NANDA International (NANDA-I) and the NIC project. The NOC classification provides nursing-sensitive results for NANDA-I nursing diagnoses (Table 20-.
For each outcome, specific evaluation indicators are recommended (i.e.,. Links between the classification of nursing outcomes and nursing diagnoses An important aspect of patient-centered care and evaluation is collaboration. A nurse must respect the patient and their family as core members of the healthcare team, which means that the patient and their family must be actively involved in the evaluation process. When you develop patient care goals and the expected results with a patient, he or she becomes an important resource to tell you if the results are being met.
For example, a patient knows better if the pain has lessened or if breathing is easier. The same is true for the family, who can often recognize changes in the patient's behavior before you because of their familiarity with the patient. Members of the healthcare team who contribute to patient care also collect evaluative findings. Evaluating a patient's response to nursing care requires the use of evaluative measures, which are evaluation skills and techniques (for example,.
In fact, evaluative measures are the same as evaluation measures, but they are performed at the point of care when decisions are made about the patient's condition and evolution. The intention of the evaluation is to identify what problems exist, if any. The intention of the evaluation is to determine if the known problems remain the same, have improved, worsened, or changed in any way. After a patient diagnosed with pneumonia finishes a course of antibiotics, the health care provider usually asks him to return to the office for a chest X-ray to determine if the pneumonia has gone away.
A nursing care planning (NCP) design team began meeting in January 2001 to design an approach that would integrate care planning in the CIS and, simultaneously, develop a cognitive infrastructure that would promote critical thinking. However, when interventions do not help the patient move toward the expected results, the nursing care plan must be revised to more effectively address the patient's needs. The structured questions that are asked to staff are designed to determine if the limitations of the previous worklists of the previous care planning system have been eliminated. Syndrome: a group of nursing diagnoses that occur following a pattern or that can all be addressed through the same nursing intervention or with similar nursing interventions.
The initial step was to incorporate the sets of nursing orders into the computerized patient record to facilitate nursing care planning. Initially, you'll find that most care plans will have ongoing goals that can be met within a few days or may take weeks. Evaluation is defined as the judgment about the effectiveness of nursing care in meeting the client's goals; in this phase, the nurse compares the client's behavioral responses with the client's predetermined goals and outcome criteria. The purpose of the evaluation is to determine the usefulness and integrity of the NCP system and whether the limitations of the previous care planning system have been overcome.
Evaluating a patient's response to nursing care requires the use of evaluative measures, which are evaluation skills and techniques (p. The evaluation addresses the usability and integrity of order sets for planning and directing nursing care. The integration of the nursing care planning function into the Nebraska Health System (NHS) clinical information system (CIS) was implemented in March 2003.
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