Chapter 18- Evaluating
When recording or documenting outcome attainment in the chart, nurses are to be very clear with the descriptions used. Which term is appropriate?
"Demonstrated steps" Explanation: Written documentation of the subjective and objective data gathered and the judgment made about goal attainment is required on the client's health record. Judgments about goal attainment are written clearly and concisely. Avoid ambiguous terminology, such as "inadequate," "good," or "extremely well," which can be interpreted differently by different people.
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. Explanation: Availability of equipment, layout of physical facilities, nurse-client ratios, administrative support, and maintenance of nursing staff competence are some areas of concern for structure evaluation. Process, outcome, goal, and subjective evaluation address those respective categories.
One of the outcomes that has been identified in the care of a client with a new suprapubic catheter is that he will demonstrate the correct technique for cleaning his insertion site and changing his catheter prior to discharge. When should this outcome be evaluated?
throughout the client's hospital admission Explanation: It is important to evaluate client outcomes early and frequently. Reserving evaluation for the time of discharge or after discharge is inappropriate, even if the designated time criteria for the outcome specifies "by time of discharge."
Which is a psychomotor client goal?
By 18AUG2015, the client will demonstrate improved motion in the left arm. Explanation: Psychomotor client goals refer to the client's achievement of new skills, such as demonstrating improved motion in the left arm. Valuing health by quitting smoking is an example of an affective goal. Listing three foods low in salt is a cognitive goal. Learning exercises to strengthen leg muscles is an affective goal.
A group of nurses on the orthopedic floor of a hospital wish to improve their clinical performance. The nurse manager suggests a program in which the nurses will evaluate each other and provide feedback for improved performance. This program is termed:
Peer review Explanation: Peer review is a process by which one nurse evaluates the performance of another to improve professional performance. QSEN has as its goal the preparation of nurses with the knowledge, skills, and attitudes necessary to improve the quality and safety of health care systems. AACN strives to provide safe work environments. HCAHPS measures client satisfaction with health care
Which nursing action reflects evaluation?
The nurse assesses the client's response to pain medication. Explanation: Examples of evaluation include assessing the client's response to pain medication. The focus of diagnosing is recognition of a client health problem that can be prevented or resolved by independent nursing intervention, such as a wound infection. Setting an anxiety rating with the client is an example of planning. Performing colostomy irrigation is an example of implementation.
The client identifies three strategies for minimizing leakage of an ileostomy bag. This is an example of:
a cognitive outcome. Explanation: Cognitive outcomes demonstrate increases in client knowledge, such as strategies for minimizing leakage of an ileostomy bag. An affective outcome involves changes in the client's values, beliefs, and attitude. Physiologic outcomes are physical changes in the client. Psychomotor outcomes describe the client's achievement of new skills.
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 Explanation: Evaluation allows the nurse to determine whether the client has met the goal. By analyzing the client's response to the anxiolytic, the nurse determines the effectiveness of the nursing care. The other actions demonstrate other parts of the nursing process: assessment (collecting data about the client's history with anxiety), diagnosis (assigning the client a new nursing diagnosis based on the client's controlled anxiety), and planning (devising a plan for the client to practice anti-anxiety exercises at home).
Which action should the nurse take during the evaluation phase of the nursing process?
Document reassessment of pain after medication administration. Explanation: The evaluation phase includes documenting a reassessment of pain following an intervention such as the administration of pain medication. Providing a client with an appointment and discontinuing an indwelling urinary catheter are interventions. Having a client give input into a plan of care is part of the planning process.
A new mother is having difficulty breastfeeding a newborn infant. A goal was established stating that the baby 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. The nurse evaluates the original goal as:
completely unmet. Explanation: After collecting data and evaluating the client's behavioral responses, the nurse makes a judgment about goal attainment by comparing the client's actual behavioral responses with the predicted responses or predetermined outcome criteria developed in the planning phase. In this case the mother abandoned breastfeeding, which represents a complete failure to meet the collaborative goal established. If the mother reported breastfeeding the baby every 4 to 5 hours, the nurse could consider the goal partially met. There is no evidence that the goal was inappropriately chosen for the client.
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. Explanation: Evaluation using the functional health approach provides a framework for organizing and evaluating data allowing the nurse to modify the client care plan. Evaluation has no influence upon meeting accreditation standards, implementation of medical orders, or the need for health care consultations.
Which statement regarding quality improvement or quality assurance is correct?
Quality improvement focuses on processes, data, and statistical thinking. Explanation: Quality improvement focuses on processes, data, statistical thinking, and client satisfaction and promotes empowerment and collaboration. Quality assurance focuses on organization structure and individuals and is externally driven.
A nurse manager tends to use the quality by inspection method of ensuring quality on the unit. Which actions, taken by this manager, are evidence of use of this technique? Select all that apply.
The manager threatens to "write up" a nurse if the nurse is late to work again. The nurse requests transfer off the unit for a nurse who has made three medication errors in three months. Explanation: Quality by inspection focuses on finding deficient workers and removing them. Quality as opportunity focuses on finding opportunities for improvement and fosters an environment that thrives on teamwork. Holding education sessions regarding problem-prone procedures reflects this technique. Not participating in celebrations and making client rounds are not related to either quality style.
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 Explanation: Physical changes are related to actual body changes in the infant. Psychomotor outcomes are those that are related to new skill attainment. Cognitive outcomes are related to achieving greater knowledge. Affective outcomes are related to feelings and attitudes.
A client with a new diagnosis of diabetes will be discharged on insulin therapy. Which client psychomotor outcome does the nurse expect after client education?
The client demonstrates administration of insulin. Explanation: Psychomotor outcomes describe the client's achievement of new skills, such as demonstration of administration of insulin. An affective outcome involves changes in the client's values, beliefs, and attitudes, such as testing blood sugar before meals. Cognitive outcomes demonstrate increases in client knowledge, such as signs and symptoms of hypoglycemia and correct injection sites.
A nurse on the unit fails to help a colleague ambulate a client even though there is time to do so. Which are appropriate responses by the nurse who required assistance with the client? Select all that apply.
"We all have to work together as a team to provide quality care for our clients." "This client is in need of our assistance, and everyone who is free should come together for improved client outcomes." "Please come and help and work together with me as a team." Explanation: The nurse who requested assistance with a client should address rather than ignore (as seen in the response, "Never mind, I will get someone else to help") the failure of the other nurse to work together with the first nurse as a team. The nurse is not in a position to tell the other nurse go home, nor would this be an appropriate response, in any case. The other choices are all appropriate responses that address the concern of the nurse needing assistance.
"The client will verbalize appropriate cast care on discharge" represents which type of outcome?
Cognitive Explanation: This is an example of a cognitive outcome. Cognitive outcomes are related to achieving greater knowledge. Psychomotor outcomes are those that are related to new skill attainment. Affective outcomes are related to feelings and attitudes. Physical changes are related to actual body changes in the individual.
Which statement related to the evaluation of outcome attainment for a client is correct?
Collecting data related to outcome attainment requires the nurse to know when to collect the data, based upon established time criteria. Explanation: In addition to knowing what type of data to collect to determine outcome achievement, it is important to know when to collect the data based upon established time criteria. It is important for the nurse to evaluate client outcome achievement as early as possible and not wait until discharge, when the plan of care cannot be modified. Evaluation of the client's attainment of outcome goals is determined by the nurse, client, and the client's family. Celebrating outcome attainment with the client usually helps encourage the client and leads to further outcome achievement.
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. Explanation: By encouraging the client to ask questions about one's care, the nurse teaches the client about self-advocacy. Providing skin care is a maintenance intervention undertaken to allow the client to preserve function and reduce the incidence of complications but does not help to promote self-advocacy. Acting in the advocacy role, the nurse would coordinate client activities. Incorporating therapeutic use of self in the care enables the nurse to be supportive of the client.
All of the activities listed are related to evaluation, but which activity is the priority concern for nurses?
Meeting the care needs of clients Explanation: The priority concern for nurses should always be related to meeting the care needs of clients. The other choices are all activities related to evaluation that serve this priority.
The nursing staff on a hospital unit uses peer review to improve professional performance. Who performs the review?
Nurses Explanation: Peer review is the evaluation of one staff member by another staff member on the same level of the hierarchy of the organization. Peer review is not done by the unit manager, clients, or visitors
A group of nurses on the orthopedic floor of a hospital wish to improve their clinical performance. The nurse manager suggests a program in which the nurses will evaluate each other and provide feedback for improved performance. This program is termed:
Peer review Explanation: Peer review is a process by which one nurse evaluates the performance of another to improve professional performance. QSEN has as its goal the preparation of nurses with the knowledge, skills, and attitudes necessary to improve the quality and safety of health care systems. AACN strives to provide safe work environments. HCAHPS measures client satisfaction with health care.
Prior to the first visit following gastrectomy, the client will have a weight loss of 10 lb (4.5 kg). This is an example of which type of evaluative statement?
Physical changes Explanation: Physical changes are related to actual body changes in the individual, represented here by the 10-lb (4.50-kg) weight loss. Psychomotor outcomes are related to new skill attainment. Cognitive outcomes are related to achieving greater knowledge. Affective outcomes are related to feelings and attitudes.
The Joint Commission is conducting an accreditation visit at the hospital. What is the focus of the evaluation being conducted?
Quality assurance Explanation: Accreditation by the Joint Commission evaluates quality assurance. Quality assurance is an externally driven process, demonstrating nursing excellence by meeting professional standards of care. Quality improvement is an internally driven, continuous process focusing on the processes of client care. Peer review is a process whereby individual nurses improve their professional performance through the evaluation of one staff member by another staff member on the same level of the hierarchy. Magnet status is awarded by the American Nurses Credentialing Center, recognizing health care organizations for their excellence in nursing.
Which of the following best summarizes the evaluation step of the nursing process?
The nurse and client measure achievement of planned outcomes of care. Explanation: In evaluation, which is the fifth step of the nursing process, the nurse and client together measure how well the client has achieved the outcomes specified in the plan of care. Establishing a health assessment is the first stage of the nursing process. Identifying nursing diagnosis is the second stage and implementation of care is the fourth stage. When the client no longer needs care, the relationship is terminated.
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. Explanation: The ability to describe the rationale and technique for blood glucose monitoring indicates that the client has achieved a cognitive outcome. Demonstration of the technique constitutes a psychomotor outcome, whereas the expression of a desire for change is an affective outcome. The maintenance of healthy blood glucose levels is a physiologic outcome.
Which are cognitive client outcomes? Select all that apply.
The client lists the side effects of digoxin. The client describes how to perform progressive muscle relaxation. The client identifies signs and symptoms of hypoglycemia. Explanation: Cognitive outcomes demonstrate increases in client knowledge, such as listing side effects of medications, identifying signs and symptoms of hypoglycemia, and describing progressive muscle relaxation. Psychomotor outcomes describe the client's achievement of new skills, such as correct ambulation with a walker. An affective outcome involves changes in the client's values, beliefs, and attitude, such as the client's report of cycling.
Which characteristic is the most important indicator of high-quality nursing practice?
The nurse considers the individual needs of clients. Explanation: The personal, compassionate, caring side of a nurse is the most important indicator of quality nursing care. Considering the individual needs of the clients demonstrates the nurse's belief in the importance of the client. Being organized and efficient, following policies and procedures, and ensuring accurate medication administration are important parts of nursing care but are mainly task oriented.
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. Explanation: The priority is to evaluate the client's goal/outcome achievement. This determines if the nursing diagnosis has been resolved. If the client's goal/outcome had not been met the nurse should then begin evaluating all aspects of the plan of care. It is not the responsibility of the nurse to evaluate the competence of nurse practitioners. The nurse can evaluate services available to the client but this is not the purpose of the evaluation phase of the nursing process.
What outcome does the nurse hope to achieve by evaluating the plan of care of a client who is being discharged?
To direct future nurse-client interactions Explanation: The purpose of evaluation is to allow the client's achievement of expected outcomes and, when necessary, to modify the plan of care to direct future nurse-client interactions. The plan of care encompasses more than the relationship between the nurse and the client. It is important to evaluate the achievements by the client. The nurse develops nursing diagnoses during the diagnosis phase of the nursing process, not the evaluation phase. Medical prescriptions are physician interventions, not nursing interventions, and thus would not be included in the nursing plan of care. The purpose or outcome of evaluating the plan of care is not to terminate the nurse-client relationship.
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 Explanation: Outcome evaluation focuses on measurable changes in the health status of the client or the end results of nursing care, such as an expedited discharge of the client based on the client recovering more quickly due to an intervention. The focus of a process evaluation is the nature and sequence of activities carried out by nurses implementing the nursing process. A structure evaluation or audit focuses on the environment in which care is provided. Cost-effectiveness is not a type of evaluation identified by the American Nurses Association.
While auscultating a client's lung sounds, the nurse notes crackles in the left lower lobe, which were not present at the start of the shift. The nurse is engaged in which type of nursing intervention?
Surveillance Explanation: Surveillance interventions include detecting changes from baseline data and recognizing abnormal response. Nurses rely on the senses to detect changes, such as observing the appearance and characteristics of clients and hearing by auscultation, pitch, and tone. Nurses use these surveillance activities to determine the current status of clients and changes from previous states. Educational interventions require instruction, demonstration, and return demonstration of knowledge or a skill set. Psychomotor interventions involve the nurse physically working with the client. Maintenance interventions involve the nurse assisting the client with performing routine activities of daily living.
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. Explanation: Standards are the levels of performance accepted and expected by the nursing staff and other health team members, such as institutional policies and procedures. The nurse preceptor providing feedback to the new graduate nurse after 6 weeks of orientation is an example of peer review. The nurse manager providing the staff nurse feedback regarding job performance for the previous year is typical of an annual employee review. The nurse seeking input from the UAP on a family's response to education is inappropriate, as the nurse may not delegate evaluation to the UAP.
A nurse manager attempts to achieve performance improvement in the emergency department of a busy inner-city hospital. Which nursing actions follow Haase and Miller's recommended steps in performance improvement? Select all that apply.
The nurse discovers that there is a problem with the triage system that is in place in the emergency department. The nurse calls a meeting of the emergency department interdisciplinary team to effect change in the triage process. The nurse organizes a task force to implement change in the triage process of a busy emergency department. The nurse meets with the emergency department staff to assess changes made to the triage process. Explanation: Nurses committed to healthier clients, quality care, reduced costs, and the personal satisfaction of knowing that they are actually making a difference (versus merely wishing things were different) value performance improvement. The four steps, according to Haase & Miller, that are crucial in improving performance include:1. Discover a problem.2. Plan a strategy using indicators.3. Implement a change.4. Assess the change; if the outcome is not met, plan a new strategy.
