ch 19 evaluating

the evaluative statement includes what (2 part)

-includes decision about how well the outcome was met along with pt data or behaviors that support decision -outcomes may have been met, partially met, or not met -ex: 1/12/25--- outcome met. Pt reports 1 week of no tobacco use. N. O'Brien, RN

quality assurance programs

-special programs that promote excellence in nursing

what are the 3 options for plan of care when evaluating?

-terminate the plan of care when each expected outcome is achieved -modify the plan of care if there are difficulties achieving the outcomes -continue the plan of care if more time is needed to achieve the outcome

4 steps to improving performance

1. Discover a problem 2. Plan a strategy using indicators 3. Implement a change 4. evaluate a change

five elements of evaluation in order

1. identifying evaluative criteria and standards (what the nurse looks for during evaluation, that is expected pt outcomes) 2. collecting data to determine whether these criteria and standards are met 3. interpreting and summarizing findings 4. documenting your judgement 5. terminating, continuing, or modifying the plan

Which nursing action reflects evaluation?

The nurse assesses urine output following administration of a diuretic.

Which action should the nurse take during the evaluation phase of the nursing process? a. document reassessment of pain after medication administration b. provide the client with a follow up appt after discharge c. have the client give input into a plan of care at admission d. d/c the indwelling catheter pre drs instructions

a

A nurse writes the outcome for a patient who is trying to lose weight: "The patient will explain the relationship between weight loss, increased exercise, and decreased calorie intake." This outcome reflects which domain of learning? a. Cognitive b. Psychomotor c. Affective d. Physical changes

a because cognitive demonstrates the pt increase in knowledge

standards

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

criteria

acceptable level of performance -Measurable qualities, attributes, or characteristics that identify knowledge or health status

For a client with a self-care deficit, the long-term goal is that the client will be able to dress oneself by the end of the 6-week therapy. For best results, when should the nurse evaluate the client's progress toward this goal?

as soon as possible -doing this will encourage client to continue working toward their goal

The nurse performs discharge teaching for a client. How would the nurse best evaluate the effectiveness of the discharge teaching?

ask client to repeat how care will be done at home

the nurse manager of a unit with an excellent safety record meets with staff to present the findings of a recent audit. the manager states, were doing well but i believe we can do better. whos got an idea to foster increased pt well being and satisfaction? this leader has demonstrated they value which process? a. quality assurance b. quality improvement c. process evaluation d. outcome evaluation

b

As part of a hospital-wide quality-assurance program, an electronic medical record review for the last 6 months reveals a higher incidence of falls on a specific unit. The nurse authoring the study refers to the review as what type of evaluation? a. Quality by inspection b. Retrospective evaluation c. Concurrent study d. Quality by indicator

b.

retrospective evaluation

may be used post discharge questionnaires, pt interviews, or chart review to collect data -ex: The nurse devises a postdischarge questionnaire to evaluate client satisfaction.

A plan of care for a patient with a low potassium level includes providing information about the effect of medications and dietary intake of foods high in potassium. How would a nurse measure achievement of an outcome for this plan? a. physical assessment b. health history c. laboratory data d. pt statements

c

a nurse is evaluating an established plan of care. after identifying the evaluative criteria standards, what must the nurse do next a. interpret and summarize findings b. document his or her judgment c. collect data abt pt responses d. formulate a new plan of care

c

a nurse is writing nursing outcomes in the affective domain for a pt who is trying to stop smoking. which outcome statement will the nurse include in care plan? a) the pt will state the relationship between smoking and CAD b) after the teaching session, the pt will redemonstrate the proper application of a nicotine patch c) the pt will state they value a healthy body sufficiently to stop smoking prior to discharge d) the pt will state that any changes in cough should be reported to health care provider

c) remember AFFECTIVE is changing VALUES

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

nurses

A nurse in a community health center has been having regular meetings with a woman who wants to stop smoking. Which of the following outcome decision options wouldthe nurse document if the womanhas not smoked for 3 months?

outcome met

"The client will verbalize appropriate cast care on discharge" represents which type of outcome?

cognitive -pts increase in knowledge

which of the following would not be part of the nurses decision abt care after evaluating the pts responses to the plan of care a. terminate plan of care b. modify plan of care c. continue plan of care d. begin plan of care

d

after reviewing the admission SBAR and plan of care, the nurse begins to evaluate pt outcomes. which statement reflects a clear evaluation of the pts primary problem? S. pt with profound wheezing, tachycardia, and anxiety B. pt has a history of asthma, she uses an inhalers A. pulse ox 89%, cyanosis of lips, dyspnea R. admit to telemetry unit, add IV a) pt states they were terrified when they were fighting to breathe and wheezing would not stop b) nurse determines the pts strengths include adherence to their medication regimen c) care plan includes the health problem of impaired gas exchange, etiology, bronchospasms d) at 10am, no wheezing on auscultation, pulse ox is 94%, pt reports no anxiety; outcome has been met

d) its a 2 part evaluative statement that includes if outcome has been met

What is evaluated when conducting a nursing audit?

pt records

Ahospital is evaluating its policies andprocedures. What type of evaluation is the hospital conducting?

structure

A nurse has developed a plan of care for the nursing diagnosis Risk for Loneliness for a recently widowed man. When evaluating the plan, the man tells the nurse new information about his active social life. What wouldthe nurse do next?

delete nursing diagnosis

concurrent evaluation

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

Why are quality-assurance programs important in nursing?

enable nursing to be accountable for quality of care

quality by inspection

focuses on finding deficient workers and removing them -ex:The nurse manager observes one of the unit nurses failing to wash hands on entering a client room. Hospital protocol is to wash hands before and after entering a client room

Quality as opportunity

focuses on finding opportunities for improvement and fosters an environment that thrives on teamwork, with people sharing the skills and lessons they have learned

Quality Improvement (QI)

systematic and continuous actions that lead to measurable improvement in health care services and the health status of targeted patient groups -focus on systems and PROCESSES -has no end points -focuses on data and statistical thinking -ex: The nurse manager observes one of the unit nurses failing to wash hands on entering a client room. Hospital protocol is to wash hands before and after entering a client room.

what is evaluating?

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

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 clients admission to hospital

The nurse has performed multiple evaluations on the hospital unit. What evaluation would the nurse identify as a structure evaluation?

tracking nurse-pt ratios on various shifts

The health care team has convened to discuss the care of an end-of-life client who is not able to achieve an acceptable level of comfort. The health care provider asks for the nurse's perspective of the situation. Which standard for establishing and sustaining healthy work environments does this action represent?

true collaboration