Chapter 15

Which example is a psychomotor outcome? A. A patient learns how to control his weight using the MyPyramid food guide. B. A patient is able to test for glucose levels and inject insulin as needed. C. A patient values his health enough to decide to quit smoking. D. A patient is able to ambulate the hallway following knee surgery.

A patient is able to test for glucose levels and inject insulin as needed. Rationale: Psychomotor outcomes involve the patient's achievement of a new skill, such as controlling diabetes. Cognitive outcomes involve an increase in patient knowledge (Answer A). Affective outcomes pertain to changes in patient values (Answer C). Physiologic outcomes target physical changes in the patient (Answer D).

Affective outcomes

Changed is the patients values, beliefs, and outcomes

What are the four types of outcomes?

Cognitive Psychomotor Affective Physiologic

How to Evaluate the different types of outcomes: Cognitive Psychomotor Affective Physciological

Cognitive: asking patient to repeat information or apply new knowledge Psychomotor: asking patient to demonstrate new skill Affective: observing patient behavior and conversation Physiologic: using physical assessment skill to collect and compare data

Evaluative Statements

Decide how well outcome was met (met, partially met, or not met). List patient data or behaviors that support this decision.

Evaluate patient achievement of desired outcomes. Review how the process is used. Revise the plan of care if necessary. Participate in quality-assurance programs.

Determining Adequacy of Evaluation Step

Four Steps Crucial to Improving Performance

Discover a problem. Plan a strategy using indicators. Implement a change. Assess the change and/or plan a new strategy if outcomes are not met.

Skilled communication True collaboration Effective decision making Appropriate staffing Meaningful recognition Authentic leadership

Elements of Healthy Work Environments

Allows achievement of outcomes Directs nurse-patient interactions Measures patient outcome achievement Identifies factors to achieve outcomes Modifies the plan of care, if necessary

Evaluating

T/F: Asking a patient to plan an exercise program to lower blood pressure based on information provided to the patient in an A/V presentation is an excellent method to evaluate a physiologic outcome.

False Rationale: Asking a patient to plan an exercise program to lower blood pressure based on information provided in an A/V presentation is an excellent method to evaluate a cognitive outcome.

Identifying evaluative criteria and standards Collecting data to determine if criteria and standards are met Interpreting and summarizing findings Documenting judgment Terminating, continuing, or modifying the plan What are these?

Five Classic Elements of Evaluation

Care based on continuous healing relationships Customization based on patient needs and values The patient as the source of control Shared knowledge and the free flow of information Evidence-based decision making Safety as a system priority The need for transparency Anticipation of patient's needs Continuous decrease in waste Cooperation among clinicians

IOM's 10 New Rules to Redesign and Improve Care

Peer review Quality-assurance programs Structure evaluations Process evaluations Outcome evaluations Quality improvement-continuous quality improvement (CQI) Patient satisfaction- HCAHPS: Hospital consumer assessment of healthcare providers & systems is the centers for Medicare & Medicaid services pt satisfaction program- surveys pts perspective of hospital care NDNQI: National database of nursing quality indicators- national database to house nurse sensitive indicators Nursing audit-chart review Concurrent and retrospective evaluations

Improving Professional Performance

Cognitive outcomes

Increases patients knowledge

Focus on organizational mission Continuous improvement Customer orientation Leadership commitment Empowerment Collaboration/crossing boundaries Focus on process Focus on data and statistical thinking

Major Premises of Quality Improvement (Schroeder, 1994)

What are the variables affecting Outcome Achievement

Patient For example, a patient gives up and refuses treatment Nurse For example, a nurse is suffering from burnout Health care system For example, inadequate staffing

Delete or modify the nursing diagnosis. Make the outcome statement more realistic. Increase the complexity of the outcome statement. Adjust time criteria in the outcome statement. Change nursing interventions.

Revisions in the Plan of Care

Broken rules Mistakes Lack of support Incompetence Poor teamwork Disrespect Micromanagement

Seven Crucial Conversations in Health Care

Which action should the nurse take when a patient has achieved each expected outcome in the plan of care? A. Terminate the plan of care. B. Modify the plan of care. C. Continue the plan of care.

Terminate the plan of care Rationale: The plan of care is terminated when the patient has achieved all of its goals. The plan of care is modified when there are difficulties achieving outcomes. The plan of care is continued if more time is needed to achieve the outcomes.

Actions Based on Patient Response to Plan of Care (terminate, modify, continue)

Terminate the plan of care when each expected outcome is achieved. Modify the plan of care if there are difficulties achieving the outcomes. Continue the plan of care if more time is needed to achieve the outcomes.

Psychomotor outcomes

The patients achievement of new skills

T/F: An outcome evaluation focuses on measurable changes in the health status of the patient or the end result of nursing care.

True

T/F: The purpose of evaluation is to allow the patient's achievement of expected outcomes to direct future nurse-patient interactions.

True

Peer review

evaluation of one staff member by another at the same level in the hierarchy

Structure evaluations

focuses on the environment: physical facility, equipment

Outcome evaluations

focuses on the measurable changes in the health status

Evaluating Standards

levels of performance accepted and expected by the nursing staff Established by authority, custom, or consent

Evaluating Criteria

measurable qualities, attributes, or characteristics that specify skills, knowledge, or health status Describe acceptable levels of performance by stating expected behaviors of nurse or patient

Process evaluations

nature & sequence of activities

Physiologic outcomes

physical changes in the patient

Quality-Assurance programs

special programs that promote excellence in nursing