Online Companion: Fundamentals of Nursing Standards and Practice 2E

Chapter Summary

This chapter focuses on the fifth step of nursing process: evaluation. In this step the nurse determines whether the client goals have been met, partially met, or are still unmet. The purposes of evaluation include: determining the client's progress toward achievement of expected outcomes, determining the effectiveness of nursing care in helping clients to achieve expected outcomes, determining the overall quality of care provided to the client, and promoting nursing accountability. The nurse does ongoing evaluation by weaving this step into every phase of nursing process. For instance, during the assessment phase, the nurse evaluates the completeness and methods of data collection. Evaluation during the planning phase examines for realistic and achievable outcome statements. The components of effective evaluation are these: objective and verifiable criteria, accurate use of communication and observation techniques, honest feedback from client and family and clear goals and outcomes to serve as measurements of progress. Using these methods, the nurse develops a systematic approach that incorporates seven steps. Standards are first established and then data is collected to determine if treatment goals were achieved. Data on the client's response to nursing interventions is analyzed and the effectiveness of specific nursing interventions is determined. In the fifth step, the nurse uses critical thinking to determine the degree to which nursing actions have contributed to the client's improved status. The client's health status is then reevaluated against baseline data. If evaluation data do not indicate progress toward the goals, the plan of care is revised. The chapter includes a checklist that offers concise guidelines for evaluating nursing care.

Another use of the evaluation process is to determine the quality of care provided at the institutional level. For this scope of evaluation, three types of evaluation formats are used. Structure evaluation examines the health care agency's ability to provide the services offered to its client population. It examines the physical facilities, resources, staffing and agency's organization. Process evaluation measures each phase of nursing process to determine whether nursing care was adequate, appropriate, efficient and effective. Outcome evaluation compares the client's current status with expected outcomes. It focuses on changes in the client's health status. The nursing audit and peer evaluation are two methods commonly used to evaluate quality of nursing care within an institution. Accountability is closely related to evaluation and is a hallmark of professional nursing practice. Nurses are involved with consumers of health care, third-party payers and other health care professionals in monitoring and evaluating care in a multidisciplinary setting.