Evaluation of the Nursing Process

by Samantha Rhea, MSN, RN

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    00:01 Welcome to the evaluation phase of the ADPIE process otherwise known as the nursing process.

    00:08 This is the piece to figure out, did our plan of care work? Do we need to revise it? Or was it effective for our patients? So when we're talking about evaluation, sometimes it works out great, and it's positive, sometimes it does not.

    00:22 So we're talking about a positive desired evaluation at the end of our plan of care.

    00:28 This occurs when our desired outcomes or our SMART goals were met.

    00:32 Also, our interventions were successful here, and it was effective for our patients treatment.

    00:37 But sometimes we can have unmet or undesired evaluations where of course, our SMART goals or desired outcomes were not met, and those interventions were not successful.

    00:50 Here are five things that are recommended from the AMA or American Nurses Association in regard to evaluation with our plan of care.

    00:58 So we need to make sure we communicate the results of that plan of care, and use criterion-based evaluation measures.

    01:05 We need to collaborate with others and be systematic in the way we evaluate.

    01:11 And of course, we need to reassess and if that plan of care was ineffective, we need to revise the care plan as needed for patient.

    01:20 So when we're talking about evaluation, we're looking at two big things.

    01:24 We're looking at the patient's goal and the expected outcome.

    01:27 So we're talking about a patient's SMART goal.

    01:30 This is a specific statement that we create that describes a desired change in a patient's condition.

    01:37 Then we're going to look at the expected outcome.

    01:39 This is what we create as an end result that is measurable, desirable, and we want to observe this.

    01:46 So an evaluation, we're going to look at the goal and the expected outcome.

    01:49 Did we meet it, or did we not? So we're evaluating the effectiveness of those interventions.

    01:56 We have to make sure in that evaluation, and even during this process, we're collaborating with the patient in the family.

    02:04 We're using those evaluative measures, then we're going to interpret and summarize those findings and of course, document the results.

    02:11 Now, upon evaluation, we've got to remember, was this effective? Did we reach those goals, or did we not? And we need to revise the care plan as needed.

    02:21 As you can imagine, the patient condition can change, priorities in the patient treatment can change as well.

    02:27 So again, be flexible here and revise as needed.

    02:31 Now, we're talking about evaluating outcomes.

    02:34 Here are a couple of steps that we need to think about.

    02:37 So first, on the top of this list, we've got to look at our desired outcomes.

    02:41 We're going to review these.

    02:42 If you remember, going back to those outcomes.

    02:45 So an example of this is, we hope that the patient's O2 sat is going to be above 90% on room air.

    02:52 So we've got to review the actual outcome, not our desired.

    02:56 So when we assess our patient, the actual outcome was the O2 saturation was 86% on room air.

    03:04 Now, we're going to compare the both the desired of what we set, and what actually is occurring.

    03:10 So here you can see the actual outcome of the oxygen saturation was 86%.

    03:16 If it did not meet our goal, our desired outcome of 90% on room air.

    03:22 So now we're looking at these discrepancies saying "Okay, well, the patient's oxygen saturation is too low when they're on room air.

    03:31 And lastly, we've got to identify any barrier and revise that care plan as needed.

    03:36 So because the patient's oxygen saturation was low, maybe we were trying to get them to use their incentive spirometer for breathing.

    03:43 But we've looked at and see the barrier that maybe the patient can't use that incentive spirometer because of delirium, or confusion.

    03:51 So of course, this isn't going to work for our patients.

    03:54 So we've got to revise our pair plan for a patient.

    03:57 So when we're talking about evaluation, if it was effective, we can discontinue a care plan.

    04:03 That is good news for us as nurses.

    04:05 This means the patient goal was met successfully and the patient agreed to that plan of care.

    04:10 Then we document that discontinued plan of care.

    04:15 Now, sometimes, again, like we've talked about throughout this presentation, we've got to modify that a bit.

    04:20 That could mean because priorities have changed.

    04:24 Patient needs have changed.

    04:25 Or those interventions were not effective, and they're no longer appropriate.

    04:31 If this is the case, we've got a document that we'd have to modify or revise that care plan for our patient.

    About the Lecture

    The lecture Evaluation of the Nursing Process by Samantha Rhea, MSN, RN is from the course Nursing Process – Assessment, Diagnosis, Planning, Interventions, and Evaluation.

    Included Quiz Questions

    1. The client walked two lengths of the hallway unassisted on Thursday.
    2. The client walked three lengths of the hallway unassisted on Friday.
    3. The client walked one length of the hallway with assistance on Saturday.
    4. The client refused to walk in the hallway with the physiotherapist.
    1. “I know I need to compare the desired outcomes with the actual outcomes.”
    2. “My client had difficulties engaging with the physiotherapy team due to their diagnosis of dementia. I will have to revise the plan of care because of this.”
    3. “My desired outcome for my client was to walk two lengths of the hallway unassisted within the week. They only walked half a length of the hallway within the week, which means I do not need to revise the plan of care.”
    4. "I only need to review the desired outcomes, not the actual outcomes."

    Author of lecture Evaluation of the Nursing Process

     Samantha Rhea, MSN, RN

    Samantha Rhea, MSN, RN

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