1.

3: EVALUATION

Evaluation is the measurement of the degree to which objectives are achieved.  "Evaluation is a
planned, systematic process... that compares the client's health status with the desired expected
outcomes."
PURPOSES OF EVALUATION
 * To determine the client's progress or lack of progress toward achievement of expected outcomes
 * To determine the effectiveness of nursing care in helping the clients achieve the expected
outcomes
 * To determine the overall quality of care provided
 * To promote nursing accountability 
Evaluation is done primarily done to determine whether a client is progressing == that is, experiencing
an improvement in health status. 
Evaluation is not an end to the nursing process, but rather an ongoing mechanism that assures
quality interventions. 
Effective evaluation is done periodically, not just prior to termination of care. Evaluation is relatively
related to each of the other stages of nursing process.  The plan of care can be modified during any
phase of the nursing process, when the need to do so is determined through evaluation.  Client goals
and expected outcomes provide the criteria for evaluation of care.
EVALUATION as a STANDARD COMPONET OF CARE: ANA Standards

Standard VI: Evaluation

The nurse evaluates the client’s progress toward attainment of outcomes.
Guidelines
Evaluation must:
 Be performed as a systemic process
 Occur on an ongoing basis
 Lead to revision of the plan of care when needed
 Involve the client, significant others, and other members of the health care team
 Be documented

Evaluation is a fluid process that is dependent on all the other components of the
nursing process.
As shown in Figure 10-1, evaluation affects, and is affected by, assessment, diagnosis,
outcome identification and planning, and implementation of nursing care.
Table 10-1 shows how evaluation is woven into every phase of the nursing process.
Ongoing evaluation is essential if the nursing process is to be implemented
appropriately.

As Alfaro-LeFevre (1998) states: When we evaluate early, checking whether our

information is accurate, complete, and up-to-date, we’re able to make corrections early.
We avoid making decisions based on outdated, inaccurate, or incomplete information.
Early evaluation enhances our ability to act safely and effectively. It improves our
efficiency by helping us stay focused on priorities and avoid wasting time continuing
useless actions.

There are specific criteria to be used in the process of evaluation. The evaluation
criteria must be planned, goal-directed, objective, verifiable, and specific (that is,
strengths, weaknesses, achievements, and deficits must be considered).
 Methods of Evaluation

The nurse who successfully evaluates nursing care uses a systematic approach that ensures
thorough, comprehensive collection of data. Evaluation is an orderly process consisting of ⭐seven
steps, which are explained here.

⭐Establishing Standards
Specific criteria are used to determine whether the demonstrated behavior indicates goal
achievement. Standards are established before nursing action is implemented. Evaluation of criteria
examines the presence of any changes, direction of change (positive or negative), and whether the
changes were expected or unexpected.
⭐Collecting Data
Assessment skills are used to gather data pertinent to goals and expected outcomes. The nurse must
be proficient in assessment skills for effective, comprehensive evaluation to occur. Evaluation data
are collected to answer the following question: Were the treatment goals and expected outcomes
achieved?
⭐Determining Goal Achievement
Data are analyzed to determine whether client behaviors indicate goal achievement. This process is
validated through analysis of the client’s response to the specific nursing interventions that are
developed in the plan of care.
For example, these data can take the form of either physiological responses (such as the client’s
being able to cough productively in order to promote effective breathing patterns) or psychosocial
responses (such as the client’s being able to verbalize concerns about an impending surgical
procedure in order to alleviate anxiety).
⭐Relating Nursing Actions to Client Status
Nursing interventions are examined to determine their relevance to the client’s needs and nursing
diagnoses. Efficient nursing actions are those that address pertinent client needs and are proven to
be primary factors in helping clients appropriately resolve actual or potential problems.
⭐Judging the Value of Nursing Interventions
Critical-thinking skills are employed to determine the degree to which nursing actions have
contributed to the client’s improved status. These skills enable the nurse to apply an analytical focus
to the client’s responses to the nursing interventions and thus to evaluate the benefits of those
actions and identify additional opportunities for change.
⭐Reassessing the Client’s Status
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.
⭐Modifying the Plan of Care
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). See the Nursing Checklist for guidelines
for evaluating effective application of the nursing process to client care.
Evaluation is performed by every nurse, regardless of the practice setting. For example, the home
health nurse evaluates the care provided regularly throughout the client’s relationship with the
agency.
Evaluation of the home care client is carried out in order to deter-mine whether the care was
delivered in an effective and efficient manner, to modify the plan of care as needed, and to decide
when the client is ready for discontinuation of home care services. The accompanying display
provides an example of evaluation performed by the home health care nurse.
Nursing Checklist
Evaluating Nursing Care
Following are guidelines useful in analyzing the application of the nursing process:
- Assessment was thorough and accurate
- Nursing diagnoses were relevant.
- Client and family participated in goal setting
- Goals were specific, measurable, and realistic
- Nursing actions addressed client’s problems
- Client and family participated in evaluation
- Evaluation was ongoing and resulted in a revised plan of care as the client’s status changed
- Plan of care was revised according to the client’s needs.
- Documentation reflected the client’s status, including responses to nursing interventions.

Critical Thinking and Evaluation

Evaluation is a critical thinking activity. It is a deliberate mechanism used to analyze and make
judgments. Nurses need to remain objective when evaluating client care in order to modify care
based on reason rather than emotion. One critical thinking strategy, juxtaposing, is described as
“putting the present state condition next to the outcome state in a side-by-side contrast”
Nurses use juxtaposing throughout evaluative activities by comparing client responses to expected
behaviors. They make conclusions about whether expected outcomes have been met. In order to
make such conclusions, assessment data is needed to determine client progress toward achievement
of objectives. Evaluation involves analysis and is much more complex than merely answering
questions.