Evaluation, the fifth step in the nursing process, determines whether expected outcomes have been met, partially met, or not met at all. Evaluation is an ongoing process used to make necessary corrections as early as possible. The nurse remains sensitive to changes in the client’s physiological condition, emotional status, and behavior while evaluating.

The sources of data for evaluation are both subjective and objective. Subjective data provides information about how a client feels. Objective data consist of observable facts. The nurse uses both verbal and nonverbal communication to elicit evaluation data.

Evaluation involves establishing standards, collecting data, determining whether goals have been met, relating nursing actions to client status, judging the value of nursing interventions, reassessing the client’s status, modifying the plan of care, and critical thinking. Evaluation occurs at both the client level and the institutional level. Quality of care is enhanced when evaluation occurs on an ongoing basis. The areas that need to be evaluated in any evaluation are (1) the appropriateness of care, (2) clinical outcomes, (3) client satisfaction, (4) cost-effectiveness, (5) access to care, and (6) availability of resources. Evaluation is often a multidisciplinary activity.

The three types of evaluation are structure, process, and outcome evaluation. Structure evaluation involves determining whether the health care agency has the ability to provide services. The structures evaluated are the physical facilities, resources, equipment, staffing patterns, organizational patterns, and expectations of staff members. Process evaluation, the measurement of nursing actions by examination of each phase of the nursing process, is used to determine whether nursing care was effective and efficient. Outcome evaluation, the process of comparing the client’s current status with expected outcomes, focuses on changes in the client’s health status.

Nursing audits and peer evaluations are techniques to evaluate care at the institutional level. Nursing audits involve collecting and analyzing data to evaluate the effectiveness of nursing interventions. Nursing audits examine data related to safety, interventions, expected outcomes, discharge planning, client teaching, and adequacy of staffing patterns, to determine whether there are areas needing revision. Peer evaluation (peer review) is the process by which professionals provide their peers with critical performance appraisal and feedback geared toward corrective action. Peer evaluation is a component of self-governance, which insures professional and individual accountability.