Fundamentals of Nursing (Chap 15 Evaluating)

What expected client outcomes are examples of psychomotor outcomes?

safely ambulating using a walker, accurately drawing up insulin

Quality assurance programs-

special programs that promote excellence in nursing

This nurse is using criteria to determine expected standards of performance-

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

evaluating-

the nurse & pt together measure how well the pt has achieved the outcomes specified in the plan of care

What nursing action reflects evaluation?

the nurse assesses urine output following administration of a diuretic

Evaluative statement-

the nurse makes and documents a judgement summarizing the findings

The pt is always-

the nurse's primary concern

Nursing-sensitive quality indicators-

those indicators that capture care or its outcomes most affected by nursing care

Cognitive outcomes-

an increase in client knowledge and are evaluated by asking the client to repeat information or perform a skill

An example of planning-

setting an anxiety rating with the client

An example of implementation-

performing tracheostomy care

A hospital is evaluating its policies and procedures. What type of evaluation is the hospital conducting?

structure evaluation

Time criteria-

(ex: by 7/8/15, the pt will walk the length of the hallway with support of a walker)

7 crucial conversations in healthcare-

1. broken rules (colleague fails to wash hands) 2. mistakes (nurse administers wrong med to wrong pt) 3. Lack of support nurses refuse to help a colleague move a pt, etc. 4. incompetence (nurse fails to correctly administer dialysis) 5. poor teamwork (encouraging the behavior of a difficult family member and rewarding favoritism among staff 6. disrespect (when student asks physician if she has time to answer a few questions for her pt, the physician screams at her) 7. micromanagement (a student asks her clinical preceptor, "will you walk me through this procedure before I do it since it's my first time?", the preceptor takes over doing it for the student)

Possible revisions to any plan of care include-

1. delete or modify the nursing dx, 2. make the outcome statement more realistic, 3. adjust time criteria in outcome statement, 4. change nursing interventions

5 classic elements of evaluation-

1. identifying evaluative criteria and standards (what you are looking for when you evaluate expected pt outcomes) 2. collecting data to determine whether these criteria and standards are met, 3. interpreting & summarizing findings, 4. documenting your judgment, 5. terminating, continuing, or modifying the plan

How to distinguish the different types of evaluation in quality assurance-

1. structure- implies building or facilities, 2. process- implies action or activities, 3. outcome- implies changes in health

Which nursing action reflects the evaluation stage?

1. the nurse determined that the client didnot lose the expected 2 lbs. 2. the nurse documents the clients response to suctioning

Performance improvement-

4 steps are crucial in improving performance: 1. discover a problem, 2. plan a strategy using indicators, 3. implement a change, 4. address the change; it the outcome is not met, plan a new strategy

What best summarizes the evaluation step of the nursing process?

the client & family have met healthcare goals and no longer need and help

What client outcome is an example of a cognitive outcome?

the client identifies 3 strategies for minimizing the leakage of a ileostomy bag

A client has recently been diagnosed with diabetes after receiving emergency tx for a hyperglycemic episode, what shows that the client has received a cognitive outcome in the management of his new health problem?

the client is able to explain when and why he needs to check his blood sugar

Psychomotor outcomes-

the client's achievement of a new skill

Evidence based practice-

the goal is to design and deliver nursing care that evidence supports as likely to produce the expected pt outcomes

Peer review-

evaluation of one staff member by another staff member on the same level in the hierarchy of the organization, is an important mechanism nurses can use to improve their professional performance

Outcome evaluation-

focuses on measurable changes in the heath status of the pt or the end results of nursing care

Structure evaluation (or audit)-

focuses on the environment in which care is provided

The nurse is collecting data on a client presenting to the medical short stay unit for a colonoscopy. A client reported to the nurse that he quit smoking 6 mos. ago after being dx with lung cancer. The nurse recognizes this kind of behavior as what type of outcome?

affective outcome

Quality improvement (QI)-

aka continuous quality improvement (CQI) or total quality management (TQM) is the commitment and approach used to continuously improve every process in every part of an organization

QSEN (quality and safety education for nurses)-

an important resource for nurses committed to performance improvement. The overall goal of QSEN is to is to prepare nurses with knowledge, skills, and attitudes (KSA's) necessary to continuously improve the quality & safety of their healthcare system

A nurse observes a colleague enter an isolation room without any PPE, which type of crucial conversation category is this an example of?

broken rules

Focusing on the process of quality care is-

quality improvement

Our goal as nurses-

quality improvement

The focus of diagnosing is-

recognition of a client health problem that can be prevented or resolved by independent nursing intervention

Affective outcome-

changes in client values, beliefs, and attitudes and are more complex to evaluate

When the nurse prepares to discharge a client and evaluate the effectiveness of the nursing care, the nurse should determine whether the-

client's goals have been achieved

What 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

Identifying the kind and amount of nursing services required is a possible solution for-

inadequate staffing

Standards-

levels of performance accepted by and expected of nursing staff or other health care members

Retrospective evaluation-

may use post discharge questionnaires, pt interviews (by phone of face-to-face), or chart review (nursing audit) to collect data

Criteria-

measurable qualities, attributes, or characteristics that identify skills, knowledge, or health states

Process evaluation-

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

4 types of outcomes-

nurses write outcomes during the planning phase of the nursing process 1. cognitive 2. psychomotor 3. affective 4. physiologic

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

other nurses

The focus of a hospital's current quality assurance program is a comparison between the healthcare status of clients upon the time of admission and the time of discharge. This form of quality assurance is characteristic of-

outcome evaluation

Physiologic outcomes-

physical changes resulting in physical assessment

The goals of the National Database of Nursing Quality Indicators (NDNQI)-

promote and facilitate standardization of information submitted by hospitals across the US on nursing quality & pt outcomes (www.nursingworld.com)

Accreditation by the Joint Commission evaluates-

quality assurance

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 (it is important to evaluate the client early and frequently, even if outcome time specifies "by time of discharge")

Concurrent evaluation-

using direct observation of nursing care, pt interviews, and chart review to determine whether the specified evaluative criteria are met