Chapter 18 - Evaluating

National Database of Nursing Quality Indicators (NDNQI)

ANA-funded database of nursing-sensitive quality indicators aimed at promoting and facilitating the standardization of information submitted by hospitals across the United States on nursing quality and patient outcomes

A nurse manager is conducting peer reviews of the staff on the critical care unit. Which person would the nurse manager select to evaluate a registered nurse who is certified in critical care?

Another registered nurse with critical care certification

A client is administered an anxiolytic. Which nursing action demonstrates the nurse evaluating the client?

Asking whether the client feels less anxious 30 minutes after administering the medicine

A client comes into the clinic for a routine postoperative visit. While the nurse is assessing the level of pain, the client states that there is occasional discomfort but that pain levels have improved daily since returning home from the hospital. What should the nurse's response be regarding the client's plan of care?

Continue the plan of care

The nurse works as a client advocate for an older adult client admitted with hyponatremia. Which action can the nurse take to help the client advocate for oneself?

Encourage the client to ask questions

Quality by inspection focuses on finding opportunities for improvement and fosters an environment that thrives on teamwork.

FALSE

The following would be considered an example of a psychomotor outcome: "Before discharge, patient will verbalize the need to quit smoking cigarettes."

FALSE

Quality improvement in care delivery requires which components? Select all that apply. Leadership commitment Continuous improvement Total client care by the nursing unit Focus on data collection Focus on the mission of the organization

Leadership commitment Continuous improvement Focus on data collection Focus on the mission of the organization

The nursing staff on a hospital unit uses peer review to improve professional performance. Who performs the review?

Nurses

A national study of more than 1,700 health care professionals found that the majority of physicians and nurses surveyed had seen coworkers take shortcuts that could have been dangerous to patients.

TRUE

A client has been recently diagnosed with diabetes after receiving emergency treatment for a hyperglycemic episode. Which of the client's actions indicates that the client has achieved a cognitive outcome in the management of this new health problem?

The client is able to explain when and why the client needs to check the blood glucose level

A nurse evaluates clients prior to discharge from a hospital setting. Which action is the most important act of evaluation performed by the nurse?

The nurse evaluates the client's goal/outcome achievement

The client identifies three strategies for minimizing leakage of an ileostomy bag. This is an example of:

a cognitive outcome

evaluative statement

a judgment summarizing the nurse's findings after data have been collected and interpreted to determine patient outcome achievement

A new mother is having difficulty breastfeeding a newborn. A goal was established stating that the infant would be nursing every 2 to 3 hours by age 1 week. The mother presents to the follow-up center at 1 week and reports having discontinued breastfeeding 4 days ago. The nurse evaluates the original goal as:

completely unmet

In the nursing process, evaluative criteria are the patient _______ developed during the planning step.

outcomes

The evaluation of one staff member by another staff member on the same level in the hierarchy of an organization is known as ________ review.

peer

A mother brings an infant into the clinic. The infant is 2 months old and has not been gaining weight appropriately. The outcome statement on the plan of care states, "The infant will double birth weight by 6 months of age." This is an example of which type of outcome statement?

physical changes

nursing-sensitive quality indicators

indicators specific to nursing that identify structures of care and care processes that influence care outcome

evidence-based practice

nursing care provided that is supported by sound scientific rationale

The nurse is caring for a postoperative client who reports ineffective pain management with pain rated a 7 on a 0-10 rating scale. Based on the information provided by the client, which step should the nurse take first to modify the care plan?

Evaluate the use of current pain relief measures.

An older adult client who is recovering from a stroke is scheduled to be transferred to the rehabilitation unit in the morning. The client is tearful and reports feeling lonely and abandoned in the hospital unit. The family visits daily, and flowers and cards are in the room. Documentation in the chart indicates that the client's pastor has been by twice in the past week to visit. Which nursing diagnosis and outcome criteria need to be addressed immediately for this client?

Ineffective Coping; verbalizes support systems

Evaluative criteria are measurable qualities, attributes, or characteristics that specify skills, knowledge, or health status.

TRUE

The focus of a process evaluation is the nature and sequence of activities carried out by nurses who are implementing the nursing process.

TRUE

Which nurse is using criteria to determine expected standards of performance?

The new graduate nurse consults the policies and procedures of the institution prior to skill implementation

performance improvement

commitment to healthier patients, quality care, reduced costs, and making a difference; accomplished by discovering a problem, planning a strategy, implementing a change, and assessing the change to see if the goal is met

Evaluation that is conducted by using direct observation of nursing care, patient interviews, and chart review to determine whether the specified evaluative criteria are met is known as ___________ evaluation.

concurrent

peer review

evaluation at the closest point to the patient and an ongoing tool to use for professional growth

outcome evaluation

evaluation that focuses on measurable changes in the health status of the patient or the end results of nursing care

structure evaluation

focuses on the environment in which care is provided; also known as an audit

Evaluating

measurement of the extent to which the patient has achieved the goals specified in the plan of care; factors that positively or negatively influence goal achievement are identified, and the plan of care is terminated or revised

quality assurance program

ongoing evaluation program designed and implemented to secure the excellence of health care; may involve an assessment of structure, process, and outcome standards

The nursing supervisor is evaluating how many clients each of the department nurses has been assigned for the shift. This type of evaluation would be considered:

structure

concurrent evaluation

the evaluation of nursing care and patient outcomes while the patient is receiving care, conducted by using direct observation of nursing care, patient interviews, and chart review to determine whether the specified evaluative criteria are met

The nurse determines that a client has not met the goal of consuming at least 80% of each meal served by a designated date. Which response(s) by the nurse would be appropriate regarding this lack of goal attainment? Select all that apply. "Do you think it is possible that you will be able to eat 80% of the food served here?" "What kinds of things have we been doing to increase your appetite?" "Maybe it would be better if we delete this goal and work on something else." "Do you think you could meet the goal if we check on it in one week or so?" "Are you trying as much as possible to eat 80% of each meal?"

"Do you think it is possible that you will be able to eat 80% of the food served here?" "What kinds of things have we been doing to increase your appetite?" "Do you think you could meet the goal if we check on it in one week or so?"

The nurse in a burn intensive care unit (BICU) is caring for a 3-year-old child who was burned with scalding hot water. The client has burns covering 75% of the body. The client's condition is critical but stable. At 1000, the nurse reassesses the client and finds that the client is agitated and pulling at the endotracheal tube. Which is the nurse's priority intervention for this client at this time?

Ensuring that the endotracheal tube is secure

process evaluation

evaluation focusing on the nature and sequence of activities carried out by nurses implementing the nursing process

retrospective evaluation

evaluation of nursing care and patient outcomes after the patient has been discharged using postdischarge questionnaires, patient interviews, or chart review to collect data

The documentation of a judgment summarizing data interpretation and patient outcome achievement is an _____________ statement.

evaluative

The nurse is caring for a client with congestive heart failure. The nurse manager informs the nurse that the client was enrolled in a clinical trial to assess whether a 10-minute walk, 3 times per day, leads to expedited discharge. Which type of evaluation best describes what the researchers are examining?

outcome

The primary purpose for evaluating data about a client's care according to a functional health approach is to:

revise or modify the client care plan

standards

rules or guidelines that allow nurses to carry out professional roles, serving as protection for the nurse, the patient, and the institution where health care is given

criteria

specified behavior; for example, the measurable criteria in a patient goal specifies how the patient must perform the desired behavior

A _____________ of nursing practice is established by authority, custom, or consent, and reflects a level of performance accepted by and expected of nursing staff.

standard

"The levels of performance accepted by and expected of nursing staff or other health team members" defines:

standards

Quality Improvement (QI)

the commitment and approach used to continuously improve every process in every part of an organization, with the intent of meeting and exceeding customer expectations and outcomes—also known as continuous quality improvement (CQI) or total quality management (TQM)