Learning Objectives
By the end of this section, you will be able to:
- Evaluate nursing actions to determine if they were effective in achieving patient outcomes
- Describe how to modify nursing plans of care to more effectively achieve optimal patient outcomes
Imagine you have set a goal for yourself: to run a marathon. It is a challenging objective, requiring not just determination but also a strategic plan. Your plan will likely include a detailed training schedule, a balanced diet, and regular health checkups to monitor your fitness levels. However, creating this plan is just the beginning. The next crucial step is implementation: putting your plan into action. This means adhering to your training schedule, running regularly, gradually increasing your distance, eating according to your diet plan, and consistently monitoring your health. Each of these actions is a step toward your goal, bringing you closer to being marathon-ready.
Yet, the process does not end with implementation. The final phase is possibly even more important. Despite your best efforts, suppose that on the day of the marathon you are unable to complete the 26.2 mi (42.2 km). This is where you need to evaluate your plan by analyzing what went wrong and identifying areas for improvement. Did you train sufficiently? Were there nutritional gaps in your diet? Did you give your body enough time to recover between training sessions? Addressing these questions will help you understand the shortcomings of your initial plan and make necessary adjustments for your next attempt.
This process of planning, implementing, and evaluating is not just relevant for personal goals such as running a marathon. It is also a fundamental approach in various fields, including nursing. Nurses plan and implement care plans and then evaluate outcomes, ensuring that patient care is continuously improved and adapted to achieve the best possible outcomes.
Evaluating Outcomes
The systematic determination of a patient's progress toward the achievement of outcomes and goals set during the care-planning process is called evaluation. Looking at the CJMM, the evaluation phase follows the phase of taking action, marking the final step. Evaluation is a dynamic and ongoing activity in which nurses assess whether the patient's health status is improving, staying the same, or perhaps worsening in response to the nursing interventions. This phase is crucial as 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 being met adequately (American Nurses Association, n.d.).
Let us revisit Mr. Silva, whose case we have been following throughout the implementation phase following his knee replacement surgery. The nursing team has diligently executed the planned interventions for Mr. Silva’s postoperative care, including managing his pain, assisting with mobility exercises, and educating him about his condition. As we enter the evaluation phase, it is time to critically assess the outcomes of these interventions. Did they improve Mr. Silva's condition as expected? Are there any aspects of the care that need adjusting? This module will guide us through the systematic approach to evaluating Mr. Silva's progress, employing the essential tools and criteria nurses use to analyze and measure the effectiveness of the care provided (Cleveland Clinic, 2023).
Determine Patient Progress
In the evaluation phase, determining the patient's progress is a fundamental step. For Mr. Silva, who has been recovering from knee surgery, this involves a comprehensive review of his current health status compared to the expected outcomes outlined in his care plan. The nursing team assesses various factors, such as the reduction in pain levels, improvement in mobility, and adherence to postoperative instructions. This step is crucial as it provides an insight into the effectiveness of the interventions and whether Mr. Silva is on track with his recovery. This step is not only about noting improvements but also identifying any areas where progress might be lagging or any complications that may have arisen.
Analyze Current Data
Nurses are continually obtaining and analyzing data from their patients, and the evaluation phase is no different (Lukey, 2023). To analyze Mr. Silva's current data, the nursing team reviews his medical records since the start of the implementation phase, including vital signs, pain assessment scores, and progress in physical therapy sessions. These objective data provide measurable, observable evidence of Mr. Silva’s recovery progress. For instance, a decrease in pain scores and an increase in the range of motion in his knee indicate positive responses to pain management strategies and physiotherapy.
Furthermore, the team considers subjective data, such as Mr. Silva’s own reports of pain and his feelings about the progress he is making. This type of information is crucial as it provides a holistic view of the patient's experience and recovery. The team also evaluates the effectiveness of patient education by assessing Mr. Silva’s understanding of and adherence to postoperative care instructions, such as medication schedules and exercise routines. This comprehensive analysis helps the nursing team make informed decisions about any necessary adjustments to the care plan, ensuring it remains aligned with Mr. Silva's health needs and recovery goals.
Modifying Nursing Care Plans
After determining patient progress and analyzing current data, the nursing team should have a good idea about whether patient goals were met. This information is essential for guiding the next steps in patient care, whether the team continues with successful strategies or reevaluates and modifies the care plan to address challenges. This modification is based on the conclusions drawn from the evaluation data and can take several forms, depending on the patient’s progress and current needs. For Mr. Silva, who is recovering from knee surgery, the nursing team faces decisions on whether to continue, revise, or terminate certain aspects of his care plan, depending on his recovery status and response to the interventions.
If the nursing team concludes that Mr. Silva is progressing well and meeting the recovery goals as expected, the decision may be to continue with the current plan. For instance, if Mr. Silva’s pain levels are well-managed and he is showing steady improvement in mobility, the existing pain management strategies and physical therapy exercises would be continued. Continuing a care plan is appropriate when the patient is responding positively to the interventions and the goals are being progressively met.
Should the evaluation reveal that Mr. Silva’s recovery is not progressing as anticipated, or if he encounters new challenges, the nursing team may decide to revise the care plan. This could involve altering his pain management regimen if his pain is not adequately controlled or introducing different physical therapy techniques if his mobility is not improving as expected. Revising a care plan is necessary when the current interventions are not fully effective or when the patient’s condition changes.