Evaluation & Evaluate Outcomes
The American Nurses Association (ANA) links the evaluation standard of professional nursing practice to which related competencies? Select all that apply. Holistic Sporadic Individual Systematic Criterion based
Holistic The ANA identifies evaluation as a holistic practice. Systematic The ANA states that evaluation is a systematic process. Criterion based The ANA identifies evaluation as a criterion-based process. WRONG: Sporadic The ANA states that evaluation should be continual, not sporadic. Individual The ANA states that evaluation is a collaborative, not individual, process involving the patient and additional members of the health care team.
Match the step of the Plan-Do-Study-Act (PDSA) improvement model to the nursing action that takes place during each step. Consider what the data show, and revise the plan of care if needed State the objective and develop a plan Review results Implement interventions Study Plan Do Act
onsider what the data show, and revise the plan of care if needed Act State the objective and develop a plan Plan Review results Study Implement interventions Do
When providing care for a patient whose goal is to lose weight, which evaluative measure would the nurse utilize to evaluate the patient's expectations of care? Weigh the patient to obtain a current measurement. Evaluate the patient's nausea using a numeric rating scale. State, "Name three principles of weight management in your plan of care." Conduct a patient interview to determine the patient's perspective related to care. NOT SURE
Conduct a patient interview to determine the patient's perspective related to care. Conducting a patient interview can provide information about the patient's expectations of care. WRONG: Weigh the patient to obtain a current measurement. Patient weight should be a component of the plan of care and included in outcomes; however, it does not provide information about the patient's expectations of care. Evaluate the patient's nausea using a numeric rating scale. The scenario does not state that the patient is experiencing nausea, and evaluating nausea does not gather information regarding expectations of care. State, "Name three principles of weight management in your plan of care." Teach-back (asking the patient to repeat the content learned) is an effective tool in patient education; however, it does not provide insight into the patient's expectations of care.
Which activities related to evaluation did the American Nurses Association (ANA) identify as a standard competency for professional nursing practice? Select all that apply. Continual process Collaboration with the patient Resolution of patient problems Documentation of results Use of assessment data to revise plan
Continual process Holistic, systematic, continual, and criterion-based evaluation is a competency related to the standard of evaluation identified by the ANA. Collaboration with the patient The ANA evaluation-related competencies state that the nurse will collaborate with the patient and other members of the health care team. Documentation of results Documentation of results is an evaluation-related competency identified by the ANA standards. Use of assessment data to revise plan The ANA identified utilization of ongoing assessment data to revise the plan of care as a competency for the evaluation standard of nursing practice. WRONG: Resolution of patient problems Resolution of patient problems, prevention of potential problems, and maintenance of the highest possible level of wellness and health are primary functions of nursing. They are not competencies defined by the ANA related to the standard of evaluation.
According to The Joint Commission requirements, which time frame describes when the nurse would evaluate the plan of care? Daily Every shift Continuously Only if the patient's condition changes
Continuously The Joint Commission requires patient care plans to be evaluated on a continual basis. Making modifications to care plans as a patient's status changes is a necessary component of providing safe patient care. WRONG: Daily Daily is not often enough to evaluate patient care plans. Every shift In many individual agencies, nurses are expected to evaluate outcomes at least once during every shift. However, The Joint Commission has a different standard. Only if the patient's condition changes It is not enough to evaluate the patient's care plan only when the patient's condition changes.
Once a patient meets a goal, which action would the nurse take? Discontinue the goal. Discontinue the plan of care. Revise the entire plan of care. Decide whether to continue or discontinue the goal.
Decide whether to continue or discontinue the goal. When a goal is met, the nurse decides whether the goal should be continued or discontinued, based on patient preference and the nurse's clinical judgment. WRONG: Discontinue the goal. The nurse and patient may decide to continue a goal for sustained improvement even after the goal has been met. Discontinue the plan of care. When a goal is met, the plan of care remains active. It is not discontinued. Revise the entire plan of care. When a goal is met, the plan of care may be partially revised, but the entire plan does not need to be revised.
Which activity occurs during step 6 of the Clinical Judgment Measurement Model (CJMM)? Identification of hypotheses Priority ranking of hypotheses Develop a patient plan of care Determine effectiveness of interventions
Determine effectiveness of interventions During the sixth and final step of the CJMM, the nurse evaluates outcomes by comparing actual outcomes with expected outcomes to determine the effectiveness of nursing interventions. WRONG: Identification of hypotheses During step 2 of the CJMM (analyze cues), the nurse considers what the patient cues could mean by identifying hypotheses and potential or actual patient problems. Priority ranking of hypotheses Prioritization of hypotheses occurs during step 3 of the CJMM (prioritize hypotheses). Develop a patient plan of care The nurse develops a plan of care, including outcomes and potential interventions, during step 4 of the CJMM (generate solutions).
During which step of the nursing process would the nurse review the patient's plan of care and determine whether a goal was met? Planning Evaluation Assessment Implementation NOT SURE
Evaluation Evaluation involves the nurse reviewing the patient's achievement of goals established in the patient's plan of care. WRONG: Planning Planning involves creating the plan of care and goals for the patient. Assessment Assessment involves gathering of patient data to select nursing diagnoses. Implementation Implementation involves carrying out the interventions.
Place in order the steps the nurse uses to compare observed outcomes with expected outcomes. Examine outcome criteria to determine expected outcomes. Consider the degree to which results match expected outcomes and goals (met, partially met, unmet). Compare actual outcomes with expected outcomes. Determine actual outcomes following nursing actions. Determine the nurse's next action. Review evaluative measures of data collected before the nurse implements interventions.
Examine outcome criteria to determine expected outcomes. Review evaluative measures of data collected before the nurse implements interventions. Determine actual outcomes following nursing actions. Compare actual outcomes with expected outcomes. Consider the degree to which results match expected outcomes and goals (met, partially met, unmet). Determine the nurse's next action. The nurse compares observed outcomes with expected outcomes by following these steps: examining outcome criteria to determine expected outcomes; reviewing evaluative measures of data collected before implementing interventions; determining actual outcomes following nursing actions; comparing actual outcomes with expected outcomes; considering the degree to which results match expected outcomes and goals (met, partially met, unmet); and determining the nurse's next action.
A patient sets a goal to quit smoking within the next 30 days. After 30 days, the patient has not quit but reports that their smoking is reduced by 50%. The goal for the next 30 days is revised. Which outcome would the nurse document regarding goal attainment? Goal met Goal unmet Goal partially met Goal unattainable
Goal partially met "Goal partially met" would be documented because the patient was able to make positive steps toward meeting the goal. WRONG: Goal met Documentation of "goal met" would occur if smoking cessation was successful. Goal unmet The goal is not unmet because the patient was able to make changes toward the original goal. Goal unattainable "Goal unattainable" is not an appropriate documentation for the evaluation statement because it is not a legitimate option for evaluation of outcomes (goal met, goal unmet, goal partially met).
The patient's goal states, "Patient will demonstrate decreased respiratory distress by the end of the shift." The expected outcome states, "The patient will demonstrate improved breathing within 4 hours (decreased dyspnea, oxygen saturation greater than 94%, and respiratory rate of no more than 16)." Patient findings include decreased dyspnea, oxygen saturation of 93% on 3 L of oxygen via nasal cannula (up from 90% on room air), respiratory rate of 18 (down from 26), and lung sounds clearing (crackles in lower lobes only, instead of in all lobes). Which phrase describes the patient's level of goal attainment? Goal met Goal unmet Goal partially met Goal not appropriate NOT SURE
Goal partially met The evaluative measures reflect that the goal (improved breathing) was partially met within the 4-hour time frame stated (although there was decreased dyspnea, oxygen saturation and respiratory rate outcomes were not met). However, the patient problem is not alleviated, so the current goal could be extended. WRONG: Goal met The evaluative measures reflect that the goal was partially met. There was decreased dyspnea, but oxygen saturation and respiratory rate outcomes were not met. Goal unmet The evaluative measures reflect that the goal was partially met. Goal not appropriate The goal is appropriate for the patient experiencing respiratory distress.
Arrange actions in each of the six steps of the Clinical Judgment Management Model (CJMM) in the order of occurrence. Determine where the nurse should concentrate efforts by ranking hypotheses by priority. Decide which actions are the most appropriate to take and implement them. Identify what is most important among the patient cues collected during assessment. Determine whether actions taken were effective and helped the patient. Consider what the cues could mean by identifying hypotheses, potential or actual patient problems. Consider what the nurse can do by developing a plan of care, including outcomes and potential interventions. NOT SURE
Identify what is most important among the patient cues collected during assessment. Consider what the cues could mean by identifying hypotheses, potential or actual patient problems. Determine where the nurse should concentrate efforts by ranking hypotheses by priority. Consider what the nurse can do by developing a plan of care, including outcomes and potential interventions. Decide which actions are the most appropriate to take and implement them. Determine whether actions taken were effective and helped the patient. Each of the six steps of the CJMM includes specific actions: (1) recognize cues, (2) analyze cues, (3) prioritize hypotheses, (4) generate solutions, (5) take action, and (6) evaluate outcomes.
Which information would the nurse include in an evaluation statement? Select all that apply. Level of goal attainment Revisions needed in the plan of care Date when the goal will be reevaluated The name of the person evaluating the goal Factors contributing to goal achievement
Level of goal attainment Evaluation statements include level of goal attainment (goal met, partially met, or unmet). Revisions needed in the plan of care Evaluation statements include revisions needed in the plan of care. Factors contributing to goal achievement Evaluation statements include evidence of factors contributing to the goal being met, partially met, or unmet. WRONG: Date when the goal will be reevaluated The date when the goal will be reevaluated is not included in the evaluation statement. The name of the person evaluating the goal The name of the person evaluating the goal is not included in the evaluation statement.
Consider the goal: Patient will ambulate 50 ft twice daily with assistance. Match the level of goal attainment with the evaluation statement. Patient is consistently ambulating 50 ft twice daily. Patient is ambulating between 20 and 50 ft twice daily. Patient is on bed rest due to the development of a pulmonary embolus. Goal is unmet. Goal is met. Goal is partially met.
Patient is consistently ambulating 50 ft twice daily. Goal is met. Patient is ambulating between 20 and 50 ft twice daily. Goal is partially met. Patient is on bed rest due to the development of a pulmonary embolus. Goal is unmet.
Which process occurs when the nurse uses data and specific methods to systematically increase the quality of patient care? Planning Evaluation Nursing process Quality improvement
Quality improvement Quality improvement involves the use of data to monitor outcomes and improvement methods to implement change, with the ultimate goal of continuously improving the quality of patient care and health care systems. WRONG: Planning Planning is a step in the nursing process that involves the development of patient goals and outcomes. Evaluation Evaluation is the final step of the nursing process and determines if the patient's goals have been met. Nursing process The nursing process is a systematic way for nurses to collect and analyze data about a patient.
Which process occurs when the nursing staff of a small emergency department implements a process to reduce wait times? Evaluation Patient satisfaction Quality improvement Evidence-based practice
Quality improvement Quality improvement is a formal way to look at patient and treatment outcomes to determine what can be done differently. WRONG: Evaluation Evaluation is the fifth and final step of the nursing process and involves the use of critical thinking to determine whether a patient's short- and long-term goals were met and whether patient outcomes were achieved. Patient satisfaction Patient satisfaction will likely increase with this quality improvement plan. Evidence-based practice Implementing evidence-based guidelines is a component of quality improvement.
Which action would the nurse take when the patient's goal states, "Skin will remain intact while in the hospital" and the nurse notices a new stage 2 pressure injury? Document the goal as being met. Delete the goal and write a new one. Reflect on factors that prevented goal achievement. Document the goal as being met once the skin has healed.
Reflect on factors that prevented goal achievement. The nurse and patient should consider underlying causes as to why the goal was not met to determine whether to continue, revise, or discontinue the goal. WRONG: Document the goal as being met. The nurse should document the patient's level of goal attainment. This goal has not been met. Delete the goal and write a new one. Goals should never be deleted. They are documented as met, partially met, or unmet. Document the goal as being met once the skin has healed. The nurse should document that the goal was not met and write a new goal to address the skin breakdown.
Which nursing actions reflect critical thinking as the nurse evaluates outcomes during step 6 of the Clinical Judgment Measurement Model? Select all that apply. Quickly assess patient stability. Reflect on the patient's condition. Examine results of nursing care. Recognize ineffective treatments. Compare actual outcomes with expected outcomes.
Reflect on the patient's condition. To evaluate outcomes effectively the nurse must apply critical thinking skills to understand the patient's condition, reflect on the situation, and adjust the plan of care to correct errors. Examine results of nursing care. Critical thinking skills allow the nurse to examine the results of care according to collected patient cues. Recognize ineffective treatments. The nurse uses critical thinking to recognize that the patient is not responding as expected to a treatment. Compare actual outcomes with expected outcomes. Comparison of actual outcomes with expected outcomes requires critical thinking skills. WRONG: Quickly assess patient stability. Evaluation of outcomes requires more than a quick check of a patient to assess whether the patient is stable. Evaluating outcomes requires a systematic approach to determine if nursing actions effectively influenced a patient's condition or circumstances.
Sequentially arrange the steps taken by nurses to implement the quality improvement process in nursing. Make changes in nursing practice. Review data about nursing care. Determine factors contributing to positive patient results.
Review data about nursing care. Determine factors contributing to positive patient results. Make changes in nursing practice. Quality improvement is the process of making nursing care safer and better for patients. It is a formal way to look at patient and treatment outcomes and to determine what can be done differently to yield positive results in given situations.
Which statements describe the process utilized by nurses to evaluate patient outcomes? Select all that apply. Review of evaluative measures Determination of whether goals were met Decision regarding the nurse's next action Comparison of anticipated outcomes with expected outcomes Assessment only when a patient condition's changes
Review of evaluative measures The nurse reviews evaluative measures of data collected before the nurse implements interventions and compares them to actual outcomes following nursing actions, or interventions. Determination of whether goals were met The nurse evaluates outcomes, comparing observed and expected outcomes to determine if goals were met and to what degree they were met (met, partially met, unmet). Decision regarding the nurse's next action After the nurse compares outcomes, the nurse determines the next appropriate action. WRONG: Comparison of anticipated outcomes with expected outcomes The nurse compares actual or observed outcomes with expected outcomes. Anticipated and expected outcomes are the same. Assessment only when a patient condition's changes The nurse continually assesses the patient to evaluate the patient's progress.
Which statement explains the importance of making modifications to the plan of care when a patient's status changes? Plan modification enhances communication among health care providers. The Joint Commission requires modification to the plan of care. Revision is a necessary component of providing safe patient care. The hospital can be reimbursed for interventions provided when revision occurs.
Revision is a necessary component of providing safe patient care. Modifying the patient's care plan when the patient's status changes is a necessary component to providing safe patient care. WRONG: Plan modification enhances communication among health care providers. The care plan is a tool used to communicate with other health care providers; however, the primary reason to modify the care plan is not health care provider communication. The Joint Commission requires modification to the plan of care. The Joint Commission requires care plan evaluation on a continual basis. The hospital can be reimbursed for interventions provided when revision occurs. Reimbursement to the hospital based on interventions provided due to care plan modification is not why care plan modification is important.
A patient appears restless, turning frequently and moaning in the postoperative care unit. Their blood pressure is stable and heart rate has increased (92 beats/min compared with preoperative rate of 72 beats/min). The health care provider prescribed an analgesic for pain, but the nurse has not administered the medication. Which finding would the nurse associate with the assertion that interventions are not effective? Delay in administration of pain medication Patient's blood pressure trend Symptoms reflecting restlessness Patient recovering as expected NOT SURE
Symptoms reflecting restlessness Turning frequently, moaning, and increased heart rate suggest that the patient is restless. The nurse should gather additional data (e.g., use a pain rating scale), review the plan of care to make modifications, or administer medications as appropriate. WRONG: Delay in administration of pain medication Delayed administration of pain medication alone might not be concerning without recognition of signs and symptoms of pain or discomfort. Patient's blood pressure trend Evaluative measures reveal the patient's blood pressure is stable, so it does not reveal ineffective interventions. Patient recovering as expected The patient is not recovering as expected, evidenced by signs of discomfort (turning frequently, moaning, increased heart rate).
Which statement describes the evaluation step of the nursing process? Evaluation is not a collaborative process. Evaluation is the fourth step of the nursing process. This step facilitates the selection of nursing diagnoses. The nurse determines whether the goals were achieved.
The nurse determines whether the goals were achieved. During evaluation the nurse determines whether the patient's goals were achieved. WRONG: Evaluation is not a collaborative process. Evaluation of goal attainment is a collaborative process involving the patient and sometimes family members and additional health care professionals. Evaluation is the fourth step of the nursing process. Evaluation is the fifth and final step of the nursing process. This step facilitates the selection of nursing diagnoses. Selection of nursing diagnoses occurs during the analysis step and is supported by the data collected during the assessment stage.
Which statement describes the process used by the nurse to evaluate outcomes in step 6 of the Clinical Judgment Measurement Model (CJMM)? Nurses collect patient cues to determine problems or potential problems. The original assessment allows the nurse to focus on whether identified problems have changed. Reporting is not a component of the process nurses use to evaluate outcomes. The patient interview is one technique nurses use as an evaluative measure.
The patient interview is one technique nurses use as an evaluative measure. Evaluative measures include techniques such as observation, patient interview, review of measurements collected during physical examination, and implementation of different types of measurement scales (e.g., pain rating scale). WRONG: Nurses collect patient cues to determine problems or potential problems. The original assessment during step 1 of the CJMM involves identification of problems or potential problems. The evaluation stage focuses on the collected data to determine if the problems have changed. The original assessment allows the nurse to focus on whether identified problems have changed. The original assessment occurs in step 1 of the CJMM (recognize cues) and focuses on identifying the patient's problems or potential problems. Reporting is not a component of the process nurses use to evaluate outcomes. Documentation and reporting of evaluative measures and findings are essential nursing functions to ensure the accurate and timely communication of information about a patient's status and progress.
Match each issue that negatively influences patient outcomes with a potential cause. Treating patients with similar conditions with an identical plan of care Recognizing that planned interventions did not occur Understanding the patient is not reacting as expected to an intervention Judgment error Omission error Ineffective treatment
Treating patients with similar conditions with an identical plan of care Judgment error Recognizing that planned interventions did not occur Omission error Understanding the patient is not reacting as expected to an intervention Ineffective treatment