Chapter 20: Evaluation

Question 1

Evaluation: Two components

Answer 1

1. examination of a condition or situation

2. judgement as to whether change has occurred (did the patient meet expected outcomes? was care successful?)

Question 2

Once you deliver an intervention, you must:

Answer 2

1. gather subj. & obj. data from pt, family & healthcare team members
2. review knowledge regarding pts current condition, treatment, resources available for recovery, and expected outcomes
3. refer to previous experience caring for similar patients - anticipate what to evaluate
4. apply critical thinking attitudes & standards to determine if outcomes are achieved
5. compare pt behavior and responses that you assessed before and after delivering nursing interventions.

Question 3

Points to ponder

Answer 3

• has pt’s condition improved?
• is pt able to improve or are there physical factors preventing recovery?
• to what degree does this pt’s motivation or willingness to pursue healthier behaviors influence responses to therapies?

Question 4

Nurse Indicators to Evaluating Care include

Answer 4

1. examine results according to clinical data collected
2. compare achieved effect w/ goals and expected outcomes
3. recognize errors or unmet outcomes
4. understand pt situation participate in self-reflection, and correct errors

Question 5

Care Plan Revisions

Answer 5

1. discontinuing a care plan

2. modifying a care plan

Question 6

Steps for Modifying a Care Plan

Answer 6

• reassessment
• redefining a diagnoses
• reviewing expected goals and outcomes
• review interventions for accuracy

Question 7

Steps for Discontinuing or Modifying a Care Plan

Answer 7

• evaluate in conjunction w/ the patient if goals have been met or not met and identify the factors that interfered with their achievement.
• reassess the pt to determine accuracy of the nursing diagnosis.
• establish new goals and expected outcomes and select new interventions.

Question 8

At times, lack of goal achievement may result from

Answer 8

an error in nursing judgement or failure to follow each step of the nursing process

Question 9

Modifying a Care Plan: Reassess

Answer 9

• compare new data about the patient’s condition.

- using past experience helps direct the reassessment process.

Question 10

Modifying a Care Plan: Redefine Diagnoses

Answer 10

as the pt condition changes, the diagnoses also changes.

Question 11

Modifying a Care Plan: Goals and Expected Outcomes:

Answer 11

• review the goals and expected outcomes for necessary changes.
• clearly document the new goals and outcomes. All team members need to be aware.

Question 12

Modifying a Care Plan: Interventions

Answer 12

Were they appropriate? Were the interventions applied correctly?

Question 13

Interventions

Answer 13

adjusted according to the patient’s actual response to therapy and your previous experience with similar patients.

Question 14

Appropriateness of interventions are based on

Answer 14

the standard of care for a patient’s health problem

Question 15

Standard of Care

Answer 15

• is the minimum level of care accepted to ensure high quality of care to patients
• defines the types of therapies typically administered to patients with defined problems or needs.

Question 16

Consulting with other nurses often yields

Answer 16

suggestions for improving the care delivery

Question 17

The American Nurses Association (ANA)

Answer 17

defines standards of professional nursing practice, which include standards for the evaluation step of the nursing process.

Question 18

Competencies for evaluation include:

Answer 18

• Being systematic and using criterion-based evaluation
• Collaboration with patients and other professionals
• Using ongoing assessment data to revise the plan
• Communicating results to patients and families
• Ensure the responsible and appropriate use of interventions to minimize unwarranted or unwanted treatment

Question 19

The patient and/or family must

Answer 19

be actively involved in the evaluation process

Question 20

Proper evaluation

Answer 20

determines the effectiveness of nursing interventions.

Question 21

When doing an evaluation, the nurse should ask

Answer 21

• what is the patient’s response to nursing care?
• was the therapy effective in improving the patient’s physical or emotional health?
• have the patient’s expectations been met?

Question 22

Evaluation measures

Answer 22

• determine if the known problems have remained the same, improved, worsened or otherwise changed.
• pt specific based on behavior, physical status and reaction to caregivers

Question 23

What is the patient’s first line of defense?

Answer 23

early detection of problems

Question 24

Evaluation of Outcomes

Answer 24

objectively evaluating the degree of success in achieving outcomes of care.

Question 25

Steps to Evaluating Outcomes of Care

Answer 25

1. examine the outcome criteria to determine the exact desired pt behavior or response.
2. evaluate the pt’s actual behavior or response.
3. compare the established outcome criteria w/ the actual behavior or response.
4. judge the degree of agreement between outcome criteria and actual behavior or response
5. if no agreement, or partial agreement: What is/are the barriers? Why did they not agree?

Question 26

Documentation of Results

Answer 26

accurate info needs to be present in the pt’s medical record and shared during handoff communication.

Question 27

The use of standardized languages

Answer 27

improves the quality, consistency and accuracy of what is documented

Question 28

Federal and state regulations determine the standards for evaluation are to be

Answer 28

shared with patients and their families