nursing process Evaluation


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nursing process Evaluation

  1. 1. Evaluation
  2. 2. INTRODUCTION. Evaluation, the final step of the nursing process, is crucial to determine whether, after application of the nursing process, the client’s condition or well-being improves. The nurse applies all that is known about a client and the client’s condition, as well as experience with previous clients, to evaluate whether nursing care was effective. The nurse conducts evaluation measures to determine if expected outcomes are met, not the nursing interventions.
  3. 3. The expected outcomes are the standardsagainst which the nurse judges if goals havebeen met and thus if care is successful.Providing health care in atimely, competent, and cost-effectivemanner is complex and challenging. Theevaluation process will determine theeffectiveness of care, make necessarymodifications, and to continuously ensurefavorable client outcomes.
  4. 4. DEFINITIONEvaluation is defined as the judgment of the effectiveness of nursing care to meet client goals; in this phase nurse compare the client behavioral responses with predetermined client goals and outcome criteria. {CRAVEN 1996}
  5. 5. Nursing Diagnosis : Impaired skin integrity related to physicalmobilityExpected Outcomes : The patient will be able to get recovery of pressuresore.Planning Rationale Evaluation Wound healing•Pressure sore dressing, Cleansing the was observed area will prevent (tissues were further infection red, healthy)•Back care It will promote blood circulation•Change the position frequently It will put little pressure on the sore site•Encourage the patient to ambulate•Take protein rich diet Protein helps in repair of tissues
  6. 6. PURPOSES1. Determine client’s behavioral response to nursing interventions.2. Compare the client’s response with predetermined outcome criteria.3. Appraise the extent to which client’s goals were attained.
  7. 7. 4. Assess the collaboration of client and health care team members.5. Identify the errors in the plan of care.6. Monitor the quality of nursing care.
  8. 8. ACTIVITIES IN EVALUATION PHASE Identifying criteria and standards Collecting evaluating data Interpreting & summarizing findings
  9. 9. Documenting findings Care plan revision
  10. 10. • Identifying criteria and standard Nurses evaluate the nursing care by knowingwhat to look for. A client’s goals & expectedoutcome give the objective criteria needed aclient’s response to care.
  11. 11. • Collecting Evaluative Data Evaluating a client’s response to nursingcare requires the use of evaluativemeasures, which are simply assessment, skill &techniques, (Eg. Auscultation of lungsounds, observation of client’s skillperformance, discussion of the client’sfeeling, and inspection of the skin.) Infact, evaluative measures are thesame as assessment measures, but nurses performthem at the time of care when theymake, decission about the client’s status andprogress.
  12. 12. • Interpreting & Summarizing Findings Using evidence, nurses make judgementabout a client condition. To develop clinicaljudgement, match the result of evaluative measureswith expected outcomes to determine if a client’sstatus is improving or not. 1. Examine the goal statement to identify the exact desired client behavior or response. 2. Assess the client for the presence of that behavior or response.
  13. 13. 3. Compare the established outcome criteria with the behavior or response.4. Judge the degree of agreement between outcome criteria and the behavior or response.5. If there is no agreement (or only partial agreement ) between the outcome criteria and the behavior or response, what is/are the barriers? Why did they not agree?.
  14. 14. •Documenting Findings: Documentation and reporting are an importantpart of evaluation. Written nursing processnotes, assessment flow sheets and information sharedbetween nurses during changes of shift reportscommunicate a client’s progress toward meetingexpected outcomes and goals for the nursing plan ofcare.
  15. 15. •Care Plan Revision: Evaluate expected outcomes anddetermine if the goals of care have been met Then decide the need to adjust the planof care. If goal met successfully, discontinuethat portion of the care plan.
  16. 16. COMPONENTS OF EVALUATION1. Collecting the data related to the desired outcomes2. Comparing the data with outcomes3. Relating nursing activities to outcomes4. Drawing conclusion about problem status5. Continuing, modifying, or terminating the nursing care plan
  17. 17. Collecting the data: The nurse collects the data so thatconclusion can be drawn about whether goalshave been met. It is usually necessary to collectboth subjective & objective data. Data must berecorded concisely and accurately to facilitate thenext part of the evaluating process.
  18. 18. Comparing the data with outcomes: If the first part of the evaluationprocess has been carried out effectively , it isrelatively simple to determine whether a desiredoutcome has been met. Both the nurse and clientplay an active role in comparing the client’sactual responses with the desired outcomes.
  19. 19. Relating nursing activities to outcomes The third aspect of theevaluating process is determined whether thenursing activities had any relation to theoutcome.
  20. 20. Drawing conclusion about problem status: The nurse uses the judgement aboutgoal achievement to determine whether thecare plan was effective in resolving, reducingor preventing client problems. When goalshave been met the nurse can draw one thefollowing conclusions about the status of theclient’s problem.
  21. 21. •The actual problem stated in the nursing diagnosishas been resolved , or the potential problem is beingprevented and the risk factors no longer exist. Inthese instances , the nurse documents that the goalshave been met and discontinues the care for theproblem.• The potential problem is being prevented, but therisk factors still present. In this case , the nurse keepsthe problem on the care plan.• The actual problem still exists even though somegoals are being met. In this case the nursinginterventions must be continued.
  22. 22. Continuing , modifying , or terminatingthe nursing care plan: After drawing conclusion about thestatus of the client’s problems , the nursemodifies the care plan as indicated. Whetheror not goals were met, a number of decisionneed to be made aboutcontinuing, modifying or terminatingnursing care for each problem.
  23. 23. Before making individualmodification, the nurse must first determinewhy the plan as a whole was not completelyeffective. This require a review of the entireplan.
  25. 25. FACTORS AFFECTING GOALATTAINMENT Family Members Health Team Factors Affecting NurseMembers Goal Attainment
  26. 26. EVALUATION SKILL REQUIRED FORNURSES1. Nurse must know the hospital policies, procedure and protocols of interventions and recording.2. Nurse must have up to date knowledge and information of many subject.
  27. 27. 3. Nurse must have intellectual and technical skill to monitor the effectiveness of nursing interventions.4. Nurse must have knowledge and skill of collecting subjective data and objective data.
  28. 28. THANK YOU