NURSING PROCESS EVALUATION PHASE

EVALUATION

• Evaluation is the final step in the Nursing Process & is a measure of the degree to which the patient has mastered the learning objectives
• The Nurse monitors the performance level of the patient so that changes can be made as needed.
• The Nurses assesses and finds out whether the client’s goals are achieved
• However, if certain goals are not achieved, the Nurse may need to reassess the patient & alter the plan of care
• If further needs are identified on the client, the Nurse then plans new objectives, content & Interventions

TYPES OF EVALUATION

• Short Term Evaluation:
  •  Short term Evaluation are used to quickly evaluate the patient’s skills or behavior change & mastery over their health.
• Long Term Evaluation: 
  • Long term Evaluation requires follow up evaluation in the out-patient clinic or outside agency.
  • The Nurse’s role is to explain to the patient the positive outcomes associated with regular care & re-evaluation by some one familiar with client’s Needs.
  • The Nurse should set up a schedule of visits for the patient before he/ she leaves the hospital/ clinic or refer the client to proper Agencies.

TECHNIQUES TO EVALUATE THE OUTCOME OF CARE

• Observe the Client Directly:
  • By observation the Nurse determines if a task has been mastered by the client or if further Instructions are needed or if the client is ready for a new or additional Knowledge.
  • E.g. Show Me how you’ll Changed the Dressing.
• Observe for verbal & Non-verbal Cues:
  • If the patient asks the Nurse to repeat Instructions, asks Questions, shakes the head, looses eye contact, slumps or droops in the chair or bed, becomes restless or expresses doubts about understanding, the client may be indicating that further Instructions is needed or alternative approach should be taken
• Ask Direct Questions: 
  • Open ended Questions will provide more information about the patient’s understanding than closed ended Questions that require “Yes” or “No” answer.
  • E.g. What are the Major food groups? How often should you change the dressing?
• Talk with Client's Caregiver:
  • Because the Nurse at times cannot be with the client 24 hours a day use other people who are with the client for evaluation.
  • E.g. Is he eating regularly? Is he taking medicines regularly?
• Seek Patient's self Evaluation of progress: 
  • By seeking out a client’s opinion the Nurse is allowing the client’s Input into the evaluation process.
  • E.g. Which evidence shows the client’s objective are met? Is the client confidence that goals are met?

REVIEW & MODIFY

• Review: 
  • The client’s health status is reevaluated through use of assessment and observation skills.
  • Evaluation focuses on the client’s health status and compares it with baseline data collected during the initial assessment.
  • Omissions or incomplete data within the database are identified so that an accurate picture of the client’s health status is obtained.
• Modify:
  • If the evaluation data indicate a lack of progress toward goal achievement, the plan of care is modified.
  • These revisions are developed through the following process:
  • - Reassessment of the client;
  • - formulation of more appropriate nursing diagnoses;
  • - development of new or revised goals and expected outcomes; and
  • - implementation of different nursing actions or repetition of specific actions to maximize their effectiveness (for instance, client teaching).

DOCUMENTATION & REPORTING

• Documentation provides evidence that the Nursing practice standards related to the Nursing process have been maintained during care of the patient.
• Assessment, Diagnosis, outcomes, interventions, & evaluation of the patient’s response to care are a critical part of the patient’s record.
• Many documentation methods and formats are used depending on the personal preference, agency policy & regulatory standards by the Accreditation Agencies

E.gs. Of Documentation charts that address the Nursing process are:-

-SOAP- Subjective, objective, Assessment & Plan Charting,

- PIE - Problem, Intervention & Evaluation Charting,

-DAR (Focus)- Data Action Response charting &

- charting by Exemption (CBE)

• Every method of charting is designed to document the assessment of patient’s status, the implementation of Interventions & the outcome of Interventions.