CH 18 Evaluating

Seven Crucial Conversations in Health Care

-Broken rules (nurse not washing hands) -Mistakes (administering wrong meds to patient) -Lack of support (Nobody to help, or refuses to help) -Incompetence (Not knowledgable but continues with a proceedure anyway) -Poor teamwork (not working together) -Disrespect (physician speaking poorly to nurse) -Micromanagement (taking over proceeedures when teaching someone how to do it)

Four Types of Outcomes

-Cognitive: increase in patient knowledge -Psychomotor: patient's achievement of new skills -Affective: changes in patient values, beliefs, and attitudes -Physiologic: physical changes in the patient

Revisions in the care plan

-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.

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.

Determining Adequacy of Evaluation Step

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

Five Classic Elements of Evaluation

-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

Evaluating Step

-Nurse and patient together measure how well the patient has achieved the outcomes specified in the care plan. -The nurse identifies factors that contribute to the patient's ability to achieve expected outcomes and, when necessary, modifies the care plan. -The purpose of evaluation is to allow the patient's achievement of expected outcomes to direct future nurse-patient interactions

Improving Professional Performance

-Peer review -Quality-assurance programs -Structure evaluations -Process evaluations -Outcome evaluations -Quality improvement -Nursing audit -Concurrent and retrospective evaluations

Elements of Healthy Work Environments

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

Actions Based on Patient Response to Care Plan

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

IOM's (Institute of Medicine) 10 New Rules to Redesign and Improve Care

1.Care based on continuous healing relationships 2.Customization based on patient needs and values 3.The patient as the source of control 4.Shared knowledge and the free flow of information 5.Evidence-based decision making 6.Safety as a system priority 7.The need for transparency Anticipation of patient's needs 9. Continuous decrease in waste 10. Cooperation among clinicians

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

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

Tell whether the following statement is true or false. An outcome evaluation focuses on measurable changes in the health status of the patient or the end result of nursing care. A. True B. False

Answer: A. True Rationale: An outcome evaluation focuses on measurable changes in the health status of the patient or the end result of nursing care.

Tell whether the following statement is true or false. The purpose of evaluation is to allow the patient's achievement of expected outcomes to direct future nurse-patient interactions. A. True B. False

Answer: A. True Rationale: The purpose of evaluation is to allow the patient's achievement of expected outcomes to direct future nurse-patient interactions.

Which example is a psychomotor outcome? A. A patient learns how to control his weight using the Choose MyPlate 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.

Answer: B. 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).

Tell whether the following statement is true or false. 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. A. True B. False

Answer: B. 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.

physiologic example?

At 1 month postpartal telephone interview, 3/4/20 (by parents report) the baby will demonstrate adequate: weight gain (birth weight, 7 lb 6 oz) sleep wakefulness patterns comfort level indicating adequate parenting

Affective example?

Before discharge, parents will verbalized decreased anxiety in regard to caring for son

cognitive example?

By 2/6/20, parents will report appropriate action if questions or problems arise after discharge: name and number of primary nurse name and number of pediatrician

Evaluating Outcomes

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.

Standards?

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

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

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

Quality and Safety Education for Nurses (QSEN) Project Goals

The overall goal of the QSEN Institute initiatives is to prepare nurses with the knowledge, skills, and attitudes (KSAs) necessary to continuously improve the quality and safety of their health care systems.

Psychomotor example?

before discharge patient will demonstrate confidence in: holding baby, diapering dressing baby, bathing baby. feeding baby