2. INTRODUCTION
As a part of professional accountability,
nurses are answerable to themselves as
practitioners, to individuals and significant
others, to physicians and others who
participate in giving care, to agencies in
which they practice, and to the community.
The use of evaluation helps fulfill the nurse‘s
duty to act in a professionally responsible
way.
3. DEFINITION
To evaluate is TO JUDGE or TO APPRAISE.
Evaluation is a planned, ongoing, purposeful activity, in
which client and health care professionals determine –
1) The client‘s progress toward goal achieve
2) The effectiveness of nursing care plan.
4. Evaluation is defined as the judgment of the
effectiveness of nursing care to meet client goals
based on the client‘s behavioral responses.
This phase involves a thorough, systematic review of
the effectiveness of nursing interventions and a
determination of client goal achievement.
5. Nurses use a variety of skills to judge the
effectiveness of nursing care.
These skills include knowledge of standards of care,
normal client responses, and conceptual models and
theories of nursing; ability to monitor the
effectiveness of nursing interventions; and awareness
of clinical research. Critical appraisal of goal
attainment is determined jointly by the nurse and the
client.
6. DIFFERENCE BETWEEN
ASSESSMENT AND EVALUATION
• Assessment involves data gathering for the purposes
of deriving a nursing diagnosis and forming a plan.
• Therefore, the assessment phase consists of gathering
information about the existing problems and
strengths of the person.
• The evaluation step of nursing process uses your
knowledge and skills to make a clinical judgment
about the achievement of outcomes.
7. • During Evaluation, you compare the current status of
the person with the expected outcomes..
• When you evaluate the person, you make a decision
about how well the person achieved the outcomes
and whether the plan of care should be continued,
modified, or discontinued
8. PURPOSES
• To collect the objective and subjective data to make judgments about
nursing care delivered.
• To examine the client‘s behavioral responses to nursing interventions.
• To compare the client‘s behavioral responses with predetermined outcome
criteria.
• To appraise the extent to which client goals were attained or problems
resolved.
• To appraise involvement and collaboration of the client, family members,
nurses, and healthcare team members in healthcare decisions.
• To provide a basis for the revision of the nursing plan of the care evaluation.
• To monitor the quality of nursing care and its effect on the client‘s health
status.
9. TYPES
There are three types of evaluation:-
• Structure Evaluation: Structure evaluation focuses on the
attributes of the setting or surroundings where healthcare is
provided. It deals with the environmental aspects that
directly or indirectly influence the quality of care provided.
Availability of equipment, layout of physical facilities, nurse-
client ratios, administrative support, and maintenance of
nursing staff competence are some areas of concern for
structure evaluation.
10. • Process Evaluation: Process evaluation focuses on the nurse‘s
performance and whether the nursing care provided was appropriate
competent. The phases of the nursing process are used as the framework
for the evaluation of nursing care. Areas of concern for this type of
evaluation include the type of information obtained by interview and
physical assessment, the validity of the nursing diagnostic statements,
the nurse‘s technical competence.
• Outcome Evaluation: Outcome evaluation, which focuses on the client
and the client‘s function. Outcome evaluation determines the extent to
which the client‘s behavioral response to nursing intervention reflects the
desired client goal and outcome criteria. Outcome evaluation can take
place only after standards have been developed. An example of an
outcome evaluation is to establish standards of care for a specific
diagnosis and then compare actual client outcome with that standard.
11. EVALUATION MAY ALSO BE ONGOING,
INTERMITTENT, OR TERMINAL:
•I. Ongoing Evaluation: Ongoing evaluation is
done while or immediately after implementing a
nursing order; it enables the nurse to make on
the spot modifications in an intervention.
12. • II. Intermittent Evaluation: It is performed at specified intervals
(e.g. Once a week), shows the extent of progress toward goal
achievement and enables the nurse to correct any deficiencies
and modify the care plan as needed. Evaluation continues
(either ongoing or intermittently) until the client achieve the
health goals or is discharged from nursing care.
• III. Terminal Evaluation: It indicates the client‘s condition at the
time of discharge. It includes the status of goal achievement
an evaluation of the client‘s self care abilities with regard to
follow-up care. Most agencies have a special discharge record
for the terminal evaluation.
14. Review Client Goals and Outcome Criteria:
• Measuring goal attainment starts by reviewing the client goals and
outcome criteria, written in measurable terms that were developed
each nursing diagnosis.
• Nurses‘ review expected client behavior by examining the time frames
and methods of measurement of goal fulfillment.
• They evaluate client goals and outcome criteria in a variety of ways,
including observing client behaviors, using documentation of the
responses to interventions, and receiving feedback from the client,
family members, and other healthcare providers, if appropriate.
• This review helps nurses focus on data they need to assess the
and realistic nature of goals and outcome criteria.
15. Collect Data:
• Systematic data collection is required to determine goal achievement.
• Subjective data are collected from any sources: the client, family
or significant others, nursing staff, and other healthcare team members.
Objective data from observation (e.g. posture, skin, color, and behavior),
health records (e.g. laboratory results, reports from other health care
members), physical assessment (e.g. breath sounds, strength of
extremities) and measurement devices (e.g. blood pressure, temperature)
are collected to judge the client‘s behavioral responses to nursing
interventions.
• Nurses also use subjective data to evaluate the effectiveness of nursing
care provided. E.g. a client with a nursing diagnosis of Acute Pain related
to a recent surgical procedure may have as a goal, ―Client will state that
pain is relieved within 10 minutes after repositioning.
• The client‘s subjective statement would be needed to judge whether this
goal has been achieved.
16. Measure Goal/Outcome Achievement:
• After collecting data, nurses form a comprehensive picture of the client‘s
behavioral responses to nursing interventions.
• The next activity is to make a judgment about goal attainment by
comparing the client‘s actual behavioral responses to the predicted
responses or predetermined outcome criteria developed in the planning
phase.
• When possible, the client is involved. The four possible judgments that
may be made are as following:
• The goal was completely met.
• The goal was partially met.
• The goal was completely unmet.
• New problems or nursing diagnosis have developed.
• The fourth judgment can exist simultaneously with any of first three.
the judgment about the attainment or lack of attainment of outcome
criteria is made, the plan of care is revised.
17. Assess Facilitators of Goal Attainment:
• Clients, family members, significant others and other
healthcare team members are invaluable in facilitating or
helping with goal attainment.
• Occasionally, only those closest to the client can identify the
subtle or elusive factors that helped or hindered goal
achievement.
• Examples of facilitators include audiovisual materials,
handouts, repetition of material, and easily assessable and
interested nursing staff.
18. Assess Barriers to Goal Attainment:
• Several barriers to goal attainment have been identified.
• Barriers may involve the client, family members or significant others, and the
nurse or other healthcare team members. Examples of how goal attainment
be blocked include providing incorrect information, withholding information,
having an unexpected reaction to treatment (e.g. allergic response to therapy),
possessing inadequate coping ability, and experiencing a worsened underlying
pathologic condition.
• Family members also may act as barriers to goal achievement in many ways.
their lack of understanding the plan of care, lack of interest in the client etc.
• Nurses may unwittingly block goal achievement. E.g. by neglecting to collect
pertinent assessment data, delegating nursing care to inappropriate nursing
members.
• Other healthcare team members also may be barriers. They may lack
communication among themselves, be unable to work together as a team. The
evaluation phase identifies the barriers that are interfering with the client‘s
advancement towards goal achievement.
19. Record Judgment or Measurement of Goal Attainment:
• Written documentation of the subjective and objective data
gathered and the judgment made about goal attainment is
required on the client‘s health record.
• Judgment about goal attainment is written clearly and
20. Revise or Modify the Nursing Care Plan:
• Revision or modification of the nursing plan of care is part of evaluation
phase.
• It provides a feedback mechanism that starts the entire chain of events
again.
• Nursing diagnoses that are resolved require no further nursing
intervention and may be removed from the nursing plan of care.
• To maintain the client‘s Problem- free status, a nursing plan of care is
developed that incorporates potential for wellness and other health
promoting nursing diagnosis and focuses nursing actions towards
functioning.
• The levels of functioning and health status changes are periodically
reassessed to determine whether new problems or nursing diagnosis
developed.
21. MODIFICATION
Some client goals are partially met or completely unmet.
Modification begins with a complete client reassessment. Changes
in client goals, client outcome criteria, and nursing interventions
are required. If new problems have arisen, new nursing diagnosis
must be identified and a nursing plan of care written.
23. FUNCTIONAL APPROACH TO
EVALUATION
Evaluation using the functional health approach requires a specific
perspective.
In addition to measuring attainment of client goals, the client‘s
functional status for each health pattern is established.
After implementing the nursing plan of care, the nurse ascertains
the client‘s functional status based on data from the evaluation
phase.
24. Subjective and Objective data are used to determine the client‘s
movement toward improved function.
Evaluation using the functional health approach provides a
framework for organizing and evaluating data for revision or
modification of the nursing plan of care.
