Learning Objectives
By the end of this section, you will be able to:
- Explain how the evaluation phase reveals a patient’s progress
- Recognize how the evaluation phase provides a system for nurses to define, explain, and measure patient care
- Identify the evaluation phase’s role in promoting continuity of care
- Identify ways the nurse evaluates the plan of care
- Recognize how the nurse analyzes conclusions during the evaluation phase
In the nursing process, the evaluation phase follows the implementation phase, marking the final step. The systematic determination of a patient’s progress toward achieving the outcomes and goals set during the care-planning process is called evaluation. It is a dynamic and ongoing activity in which nurses assess whether the patient’s health status is improving, staying the same, or worsening in response to the nursing interventions. This phase is crucial because it determines the effectiveness of the nursing care provided, informs necessary changes to the care plan, and ensures that the patient’s health needs are adequately met (ANA, n.d.).
Determine the Patient’s Progress
Determining the patient’s progress is a fundamental step in the evaluation phase. In this phase, nurses compare the patient’s current status to the baseline data collected during the assessment phase and the expected outcomes established during the planning phase. Through careful analysis of data, nurses can determine whether the patient’s condition has improved, remained stable, or deteriorated since the initiation of care. They assess whether the patient is meeting the expected outcomes outlined in the care plan and identify any discrepancies or areas where adjustments may be needed.
The nurse will perform a comprehensive review of a patient’s current health status compared to the expected outcomes outlined in the care plan. They will assess various factors to gain insight into how well the interventions have worked and whether a patient is on track to meet goals. However, it is not just about noting improvements—the nurse also identifies areas where progress might be lagging or complications have developed.
Analyze Current Data
As described in Chapter 12 Assessment: Recognizing Cues, nurses are continually obtaining and analyzing data from their patients, and this includes during the evaluation phase (Lukey, 2023). To analyze current data, nurses review various sources of information, including objective data such as vital signs, laboratory results, and physical assessments, as well as subjective data provided by the patient or their family members regarding symptoms, comfort level, and overall well-being. Although tasks such as obtaining updated vital signs can be delegated to unlicensed assistive personnel (e.g., CNA), physical assessment and evaluating the data remain the responsibility of the nurse.
Clinical Judgment Measurement Model
Analyze Cues: Using Current Data to Determine Effectiveness of Interventions
Janieh, a registered nurse working in a pediatric unit, is caring for a 5-year-old child, Emily, who was admitted with a severe asthma exacerbation. Emily has been receiving nebulized bronchodilators and corticosteroids as prescribed, but her respiratory distress persists despite treatment. Janieh is tasked with assessing Emily’s response to the interventions and determining the next course of action.
- Recognize cues: Emily continues to exhibit audible wheezing and retractions, indicating ongoing respiratory distress. Emily’s respiratory rate remains elevated at thirty breaths per minute. Emily appears restless and irritable, with increased work of breathing noted.
- Analyze cues: Based on the cues observed, Janieh analyzes Emily’s response to the nursing interventions implemented thus far. Despite receiving nebulized bronchodilators and corticosteroids, Emily’s respiratory distress persists, as evidenced by the continued presence of wheezing, retractions, and elevated respiratory rate. Additionally, Emily’s restlessness and irritability suggest that she is experiencing discomfort and difficulty breathing, further highlighting the inadequate response to treatment.
Janieh concludes the current nursing interventions have not been effective in alleviating Emily’s respiratory distress. Despite receiving appropriate medications, Emily’s condition has not improved, and she continues to exhibit signs of respiratory compromise. By recognizing cues that suggest inadequate improvement in Emily’s condition despite treatment, Janieh can take proactive steps to reassess and modify the care plan to promote optimal patient outcomes.
To analyze current data, the nurse will utilize the patient’s medical records since the start of the implementation phase, including vital signs and other objective data that provide observable and measurable evidence of progress. Subjective data, such as a patient’s reports of pain and feelings about progress, are also crucial as they give the nurse a holistic view of the patient’s experience and recovery.
The team also evaluates the effectiveness of patient education by assessing a patient’s understanding and adherence to the care plan. This comprehensive analysis helps the nursing team make informed decisions about necessary adjustments to the care plan, ensuring it remains aligned with a patient’s health needs and goals.
System for Nurses to Define, Explain, and Measure
The evaluation stage in the nursing process is a systematic approach for nurses to define, explain, and measure the effectiveness of patient care. This stage enables nurses to concretely define the outcomes of their interventions, explain the reasons behind the success or failure of these interventions, and measure the extent to which patient care goals have been met. By defining specific criteria for success and measuring a patient’s progress against these benchmarks, the team can objectively evaluate the quality and efficacy of the care provided.
Verify the Quality of Nursing Care
Nurses assess the quality of care provided to patients by comparing actual outcomes to predetermined standards and benchmarks. Verifying the quality of nursing care involves a detailed assessment of the care provided against established standards and guidelines. They must confirm that interventions were implemented correctly, adherence to evidence-based practice guidelines was maintained, and patient outcomes met the established criteria for success. By verifying quality, nurses ensure that patients receive safe, effective care aligned with best practices.
Analyze Nursing Interventions
Nurses analyze the effectiveness of interventions implemented during the care process to determine their effect on patient outcomes. They examine the patient’s response to treatment, assess changes in their condition over time, and identify any factors that may have influenced the effectiveness of interventions. Through this analysis, nurses gain valuable insights into which interventions are most beneficial for specific patient populations, allowing for continuous improvement in care delivery. In analyzing the nursing interventions, the nursing team critically evaluates each action and its outcome. This detailed analysis can involve both objective and subjective data from the patient.
Patient Conversations
Discussing Intervention Effectiveness
Nurse: Good morning, Mr. Silva. How are you feeling today?
Patient: Morning, Nurse. I’m feeling okay, just a bit sore from the surgery.
Nurse: That’s understandable after knee replacement surgery. Let’s talk about how you’re doing with the interventions we’ve implemented. First, let’s discuss your pain management. How has your pain management been since we started administering medication every four hours?
Patient: It’s not as bad. The pain is much more manageable now.
Nurse: I’m glad to hear that. It’s important that we keep your pain at a tolerable level so you can participate in rehabilitation exercises. Have you experienced any side effects from the medication, or is there anything else you’re experiencing?
Patient: Not really, no. I’ve been a bit drowsy, but that’s about it.
Nurse: Good to know. Now, let’s talk about your mobility. How have you been finding the physical therapy sessions?
Patient: They’re challenging, but I can already feel some improvement in my knee’s flexibility.
Nurse: That’s great progress. What has been your experience with the at-home exercises? Are the exercises we showed you for at-home practice clear and manageable?
Patient: Yes, I’ve been doing them every day. They help with the stiffness.
Nurse: Excellent. How are you feeling about the self-care instructions we went over, such as wound care and the signs of infection to watch for? Is there anything you’re unsure about?
Patient: Yes, those instructions are clear. The wound seems to be healing well, no redness or swelling.
Nurse: Perfect. It’s crucial to monitor the wound for any changes.
Patient: I understand.
Nurse: That’s great. Your feedback is valuable in helping us evaluate and adjust our care plan. Is there anything else you’d like to discuss or any questions you have about your ongoing care or what we’ve talked about today?
Patient: No, I think I’m good for now. Thank you for taking the time to go through everything with me.
Nurse: Of course, Mr. Silva. We’re here to support you every step of the way. Keep up the good work with your recovery!
Promote Accountability among Nurses
Nurses hold themselves and other members of the healthcare team accountable for the care provided to patients. They ensure that interventions are documented accurately, responsibilities are fulfilled, and communication among team members is clear and effective. By promoting accountability, nurses foster a culture of transparency, professionalism, and collaboration, ultimately enhancing the quality and safety of patient care. Promoting accountability in a patient’s care requires each nurse to reflect on their individual contributions and understand their effect on the patient’s experience and outcomes. This self-assessment and accountability ensure that each nurse takes ownership of their part in a patient’s care, fostering a responsible and reflective practice environment that prioritizes patient well-being.
Promote Continuity of Care
As discussed earlier in this chapter in Providing Continuity of Care, continuity of care is a vital aspect of the nursing process, ensuring patients receive consistent, uninterrupted support throughout their healthcare journey (Regis College, 2023). During the evaluation phase, nurses play a crucial role in promoting continuity of care, especially as patients transition between various stages of recovery. The nurse continuously assesses a patient’s progress and adjusts the care plan based on these evaluations. These coordinated efforts may occur between hospital staff, home healthcare providers, and the patient’s family, all with the overall goal of maintaining the quality and effectiveness of care across each setting.
Establish Patterns of Continuous Care
Establishing patterns of continuous care is essential for patients transitioning between healthcare settings. This process involves meticulous planning to ensure each care setting is equipped to meet the diverse needs of patients. For instance, a patient moving from a hospital to home care may require arrangements for home healthcare services, whereas a patient transitioning to a rehabilitation facility might need specialized rehabilitation plans. Nurses coordinate care transitions by preparing detailed discharge plans, facilitating communication between healthcare providers, and ensuring seamless access to a patient’s medical history. This coordinated approach aims to maintain the quality of care, regardless of the setting—whether it’s a patient’s home, another hospital, or a long-term care facility.
Patient and Family Involvement
Involving patients and their families (if the patient permits) in the continuity of care process is crucial for successful health outcomes. Educating patients and families about postdischarge care, such as medication management, wound care, and the importance of follow-up appointments, is a key responsibility of the nursing team. This education empowers family members to actively participate in a patient’s care and decision-making. Encouraging family members’ input in care planning ensures that their preferences and concerns are considered and fosters a collaborative approach to health management. This supportive involvement enhances adherence to treatment plans and provides emotional support, as patients and their families feel more in control and informed about their healthcare journey (Agency for Healthcare Research and Quality, 2012).
Evaluate Data
Evaluating data is a pivotal aspect of the nursing evaluation phase. Nurses systematically review collected data to assess the effectiveness of nursing interventions and the patient’s overall progress. This process involves examining various types of data, including vital signs, lab results, pain assessments, and patient feedback. By examining data, nurses can determine whether the patient’s health outcomes align with the goals set in the care plan. The evaluation of data is also crucial for ensuring high-quality patient care, as it informs any necessary changes or adjustments to the care plan. It helps the nurse identify trends, understand the patient’s response to treatment, and make evidence-based decisions. Thorough evaluation ensures that care remains patient-centered and is continuously adapted to meet the patient’s evolving needs.
Compare Activities to Identified Outcomes
When comparing activities to identified outcomes, nurses carefully assess the interventions implemented during patient care and evaluate their contribution to achieving the desired goals and outcomes. They review the care plan to identify specific objectives and measurable criteria established for each patient’s condition or situation.
Then, nurses systematically compare the activities performed during care delivery to the identified outcomes to determine whether progress has been made toward achieving the desired goals. For example, if the goal is to improve mobility in a postoperative patient, the nurse will assess whether interventions, such as ambulation exercises and physical therapy sessions, have led to increased mobility and independence. Comparing provides nurses with valuable insights into the effectiveness of interventions, helps them identify areas for improvement, and empowers them to make informed decisions about modifying the care plan to better meet a patient’s needs and goals.
Analyze Conclusions
The final part of the evaluation phase involves analyzing the conclusions drawn from the data assessment (Table 14.5). This crucial step determines the future course of the patient’s care plan. Nurses analyze whether the care provided has achieved the desired outcomes or if there are areas where the goals have not been met.
| Evaluation | When to Make the Decision | Actions to Take | Rationale |
|---|---|---|---|
| Goal met | Patient’s condition or situation aligns with expected outcomes defined in the care plan. | Continue with current plan of care. | Interventions are effective and patient is progressing toward desired outcomes. No need to modify current strategies unless the patient’s condition changes or new goals emerge. |
| Goal unmet | Patient’s condition does not improve as expected, new issues arise, or goals are not met. | Reassess patient’s condition, review interventions, consult with healthcare professionals, and revise the care plan. | Current interventions may not be fully effective, patient’s condition may have changed, or new challenges may have arisen. Modifying interventions, setting new goals, or exploring alternative approaches can optimize care delivery and improve outcomes. |
| Terminate | Interventions are no longer relevant, feasible, or effective in achieving desired outcomes. | Discontinue specific interventions, focus on other interventions, or adjust the care plan to remove irrelevant aspects. | Terminating interventions can be appropriate when specific goals are not met, certain treatments are no longer beneficial, or the patient’s condition or preferences have changed. |
This analysis is foundational in deciding whether to continue with the current care plan, make revisions for better outcomes, or terminate interventions that are no longer necessary. The ability to make these determinations is a key component of nursing judgment and ensures that patient care is both effective and adaptable.