Chapter 7 Nursing Process: Implementation & Evaluation

Standards and criteria used in evaluation

ANA standards include a set of criteria to help describe the standard Criteria: measurable characteristics, properties, attributes, or qualities. Must be reliable (yields consistent results) and valid (if it is really measuring what it is intended to measure)

Preparing for implementation

Doing or delegating Check your knowledge and abilities Organize your work - establish feedback points (how the patient is responding to the activity) - prepare supplies and equipment Prepare your client

Common errors of evaluation

Failing to evaluate systematically Failing to record results Failing to use reassessment data to re-examine and modify the care plan

Types of Evaluation: Outcomes evaluation

Focuses on observable or measurable changes in the patient's health status that result from the caregiving Most important aspect is improvement in patient health status

Types of Evaluation: Process evaluation

Focuses on the manner in which care is given - The activities performed by nurses and other personnel. Explores whether the care was relevant to patient needs, appropriate, complete, and timely It does not describe the results of your activities (example: washes hands before each patient contact

Types of Evaluation: Structure evaluation

Focuses on the setting in which care is provided Explores the effect of organizational characteristics on the quality of care Requires standards and dad about policies, procedures, physical resources, physical at the Sellitti's and equipment, and number and qualifications of personnel

Reflecting critically about evaluation

Inquiring, noticing content, analyzing assumptions, reflecting skeptically

Types of Evaluation: Frequency and time of evaluation

ONGOING: done while implementing, immediately after an intervention, and at each patient contact INTERMITTENT: performed at specific times TERMINAL: describes the clients health status and progress towards goals at the time of discharge

Evaluating quality of care in a healthcare setting

Quality Assurance (QA) goal - to evaluate and improve care provided in the health care setting QA involves evaluation of structures, outcomes, and processes

Evaluating and revising the care plan

Relate outcomes to interventions - use critical reflection to identify factors that might have supported or interfered with the effectiveness of an intervention Draw conclusions about problem status - goals met/partially met/not met Revise the care plan - review each step of the nursing process: assessment, diagnosis, planning outcomes, planning interventions, implementation

Evaluating client progress

Review outcomes Collect reassessment data - client responses to interventions Judge goal achievement - are the actual outcomes the same as the expected or desired outcomes? Record the evaluative statement - right and evaluate if summary in the nursing notes or on the care plan depending on the procedure specified by the institution. Should include the conclusion about whether the goal was achieved and reassessment data to support the judgment

The five rights of delegation: Right circumstance

Right circumstance - if the client is very ill or if the results of the task RN predictable, the task should probably not be delegated

The five rights of delegation: Right communication

Right direction/communication - explain exactly what the task is; include specific times and methods for reporting; explain the purpose or objective of the task; describe the expected results or potential complications to expect; be specific in your instructions.

The five rights of delegation: Right person

Right person - only a professional nurse can evaluate an LPN or NAP's ability to perform a nursing task

The five rights of delegation: Right supervision

Right supervision - Monitor the work, intervene if necessary, obtain and provide feedback from the worker, evaluate client outcomes, ensure proper documentation

The five rights of delegation

Right task Right circumstance Right person Right communication Right supervision

The five rights of delegation: Right task

Right task - you are signing staff members to a task, not to a. Does it fall within your scope of practice? Is the activity within the scope of practice of the person you are delegating it to? Is it in accordance with agency policy? Is it performed within an established set of steps? Does this occur frequently in the daily care of patients? Does it usually have a predictable results?

Documentation

The final step of implementation Records the nursing activities and the client's response

Evaluation

The final step of the nursing process; overlaps with the assessment step - both involve data collection Evaluate: - The clients progress towards goals - effectiveness of nursing care plan - Quality of care in the healthcare setting

Delegation and supervision

Transferring responsibility while retaining accountability Include supervision You CANNOT delegate ANY intervention that requires independent, specialized nursing knowledge, skill, or judgment

Implementing the plan

Use cognitive, interpersonal, and psychomotor skills Promote client participation Collaborate and coordinate care

Implementation related to the other steps of nursing process

Without the assessment, diagnosis, and planning steps, implementation would reflect only dependent functions, such as carrying out policies, protocols, and medical orders. The autonomous nursing activities performed during the implementation are built on the nurses reasoning in the previous three steps. Implementation overlaps in someway with every other phase of the nursing process