Chapter 18

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.

2Answer: 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).

Evaluating Step

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

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.

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.

Seven Crucial Conversations in Health Care

Broken rules Mistakes Lack of support Incompetence Poor teamwork Disrespect Micromanagement

Ways to Evaluate 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

Four Steps Crucial to Improving Performance

Discover a problem Plan a strategy using indicators Implement a change Assess

Five Classic Elements of Evaluation Identifying

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

Variables Affecting Outcome Achievement

Patient Example: a patient gives up and refuses treatment Nurse Example: a nurse is suffering from burnout Health care system Example: inadequate staffing

Elements of Healthy Work Environments

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

Actions Based on Patient Response to Plan of Care

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

Affective Outcome

changes in patient values, beliefs, and attitudes

Cognitive Outcome

increase in patient knowledge

Psychomotor Outcome

patient's achievement of new skills

Physiologic Outcome

physical changes in the patient