Chapter 15: Evaluating

Structure evaluation

(or audit) Focuses on the environment in which care is provided. Standards describe physical facilities and equipment; organizational characteristics, policies, and procedures; fiscal resources; and personnel resources.

Performance improvement

Commitment to healthier patients, quality care, reduced costs, and making a difference; accomplished by discovering a problem, planning a strategy, implementing a change, and assessing the change to see if the goal is met.

Concurrent evaluation

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

Process evaluation

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

Outcome evaluation

Focuses on measurable changes in the health status of the patient or the end results of nursing care.

Nursing-sensitive quality indicators

Indicators that capture care or its outcomes most affected by nursing care.

Retrospective evaluation

May use postdischarge questionnaires, patient interviews (by telephone or face to face), or chart review (nursing audit) to collect data.

Criteria

Measurable qualities, attributes, or characteristics that identify skills, knowledge, or health states. Describe acceptable levels of performance by stating what is expected of the nurse or the patient.

Quality-assurance programs

Special programs that promote excellence in nursing. Range form small programs conducted by nurses on a small nursing unit to those developed for an entire institution, state, province, or country.

Quality improvement (QI)

The commitment and approach used to continuously improve every process in every part of an organization, with the intent of meeting and exceeding customer expectations and outcomes. Internally driven, focuses on patient care rather than organizational structure, focuses on processes rather than people, and has no end points.

Standards

The levels of performance accepted by and expected of nursing staff or other health team members. Established by authority, custom, or consent.

Evaluating

The nurse and patient together measure how well the patient has achieved the outcomes specified in the plan of care. Purpose is to allow the patient's achievement of expected outcomes and, when necessary, modifies the plan of care.

Evaluative statement

When a nurse makes and documents a judgment summarizing the findings, which is after the data have been collected and interpreted to determine patient outcome achievement.