Kozier Ch 14( Evaluation) Unit 3 The Nursing Process - Fundamentals Of Nursing + Nclex Review? (Elisa)

Front 1

Evaluation is ?

Back 1

-Judgment and appraisal
-Planned, ongoing, purposeful activity
-Continuous process
(Slide 28.)

Front 2

Evaluation Determines?

Back 2

- client’s progress, effectiveness of care plan
(Slide 28.)

Front 3

Evaluation Demonstrates?

Back 3

- nursing responsibility and accountability for their actions
(Slide 28.)

Front 4

What is the Relationship of Evaluating to Other Nursing Process Phases ?(5 things)

Back 4

-Depends on effectiveness of preceding steps
-Assessment data must be accurate and complete
-Desired outcome must be stated concretely in behavioral terms to be useful for evaluating
-Without implementation/interventions, there would be nothing to evaluate
-Evaluating and assessing overlap
(Slide 29.)

Front 5

What are the 5 basic Components of the Evaluation Process ?

Back 5

-Collect data related to the desired outcomes
-Compare the data with outcomes
-Relate nursing activities to outcomes
-Draw conclusions about problem status
-Continue, modify, or terminate the nursing care plan
(Slide 30.)

Front 6

During the Evaluation phase how do we determine if we are Continuing, Modifying, or Terminating the Care Plan?

Back 6

-Critique each phase of the nursing process
(Slide 31.)

Front 7

How is Assessment important to Evaluation?

Back 7

-Incomplete or inaccurate databases influence all subsequent steps
(Slide 31.)

Front 8

Why is Diagnosis important to Evaluation?

Back 8

-If incomplete – add new diagnosis statements
-If complete - analyze whether nursing diagnoses relevant
(Slide 31.)

Front 9

How does Planning play a role in Evaluation?(5 things)

Back 9

-If inaccurate - goals/outcomes need revision
-If accurate - goals/outcomes realistic and obtainable
-Have priorities changed? Does client still agree with priorities?
-Relate to goal achievement
-Investigate whether best nursing interventions were selected
(Slide 32.)

Front 10

Why is Implementing an important step to evaluation?

Back 10

-After modifications, begin nursing process again
(Slide 32.)

Front 11

Quality Assurance is an Ongoing, systematic process what 3 things does it evaluate?

Back 11

-Evaluates and promotes excellence in provision of health care
-May evaluate level of care provided
-May evaluate performance of a nurse or agency or country
(Slide 33.)

Front 12

What are the Three components of Quality Assurance ? (3 focuses)

Back 12

-Structure evaluation - focuses on setting
-Process evaluation- focuses on care given
-Outcome evaluation - focuses on demonstrable changes in client’s health status as result of nursing care
(Slide 33.)

Front 13

Who oversees Quality Improvement ?

Back 13

Joint Commission Mission
(Slide 34.)

Front 14

What is the mission of the Joint Commission Mission?

Back 14

“To continuously improve the safety and quality of care provided to the public the provision of health care accreditation and related services that support performance improvement in health care organizations.”
(Slide 34.)

Front 15

What does the Joint Commission Mission place Great emphasis on?

Back 15

-sentinel events
(Slide 34.)

Front 16

What are sentinel events?

Back 16

Unexpected occurrence involving death or serious physical or psychological injury or the risk thereof
(Slide 34.)

Front 17

Over all the Joint Commission Focuses on?

Back 17

- process
(Slide 34.)
-Uses a systematic approach to improve quality of care
-Often focuses on identifying and correcting a system’s problems
(Slide 35.)

Front 18

Quality Assurance is Also known as…

Back 18

-Continuous quality improvement (CQI)
-Total quality management (TQM)
-Performance improvement (PI)
-Persistent quality improvement (PQI)
(Slide 35.)

Front 19

What is the National Quality Forum?

Back 19

-12 nursing-sensitive care measures to evaluate quality of nursing care
-(SREs)
(Slide 36. )

Front 20

What is (SREs)?

Back 20

- Serious reportable events or “never events”
-Facility may not be paid for care if SRE has occurred
(Slide 36. )

Front 21

What is(NDNQI) ?

Back 21

- National Database of Nursing Quality Indicators (NDNQI) - ANA database
(Slide 36. )

Front 22

What does(NDNQI) do?

Back 22

- Consistently gather data to evaluate quality of nursing care
(Slide 36. )

Front 23

The primary purpose of the evaluating phase of the care planning process is to determine whether:

A. Desired outcomes have been met.
B. Nursing activities were carried out.
C. Nursing activities were effective.
D. Client’s condition has changed.
(Slide 37.)

Back 23

*A. Correct. The desired outcomes and indicator statements are the parameters by which success is measured.
B. The goal can be met even if nursing activities are not carried out.
C. The goal can be met even if nursing activities are ineffective.
D. Although the desired outcome, by definition, indicates a change in the client’s condition (behavior, knowledge, or attitude), only specific changes (desired outcomes) reflect the success of the care plan. (Slide 38.)

Front 24

The client has a high-priority nursing diagnosis of Risk for Impaired Skin Integrity related to the need for several weeks of imposed bed rest. The nurse evaluates the client after 1 week and finds the skin integrity is not impaired. When the care plan is reviewed, the nurse should perform which of the following?

A. Delete the diagnosis since the problem has not occurred.
B. Keep the diagnosis since the risk factors are still present.
C. Modify the nursing diagnosis to Impaired Mobility.
D. Demote the nursing diagnosis to a lower priority.
(Slide 39.)

Back 24

A. There is no reason to delete the nursing diagnosis since risk factors are still present.
*B. Correct. The risk factors are still present so the diagnosis is still valid.
C. There is no reason to modify the nursing diagnosis since risk factors are still present.
D. There is no reason to demote this to a lower priority because risk factors are still present.
(Slide 40.)

Front 25

What type of action evaluates the length of time clients must wait for a nurse response to a need reported over the intercom on each shift?

A. Structure evaluation
B. Process evaluation
C. Outcome evaluation
D. Audit
(Slide 41.)

Back 25

. A. A structure evaluation would focus on the setting (e.g., how well equipment functions).
*B. Correct. A process evaluation focuses on how care is provided.
C. Outcome evaluations focus on changes in client status (e.g., whether reported satisfaction levels vary with type of person who answers the call light).
D. An audit would be a chart or document review.
(Slide 42)

Front 26

When evaluating, if an objective is not met what should you do first?

A. Identify factors responsible for the failure.
B. Modify the nursing orders.
C. Schedule a client-care conference.
D. Rewrite the objective.
(slide 43.)

Back 26

Answer: A– Identify factors responsible for the failure.

Rationale: Resist the temptation to modify nursing orders without a complete review of the nursing process steps. Likewise, you cannot assume a client-care conference is needed or that the objective is faulty. You must first find out why the objective was not met. If it was unrealistic, then you would rewrite it; if the nursing order was ineffective, you would rewrite that; and so forth.
(Slide 44.)

Front 27

What is the first step in evaluating?

A. Identify outcome criteria.
B. Gather data related to the goals.
C. Determine whether goals were met.
D. Modify the patient’s plan of care.
(Slide 45.)

Back 27

Answer: A – Identify outcome criteria

Rationale: The goals you set in the Planning stage serve as your evaluation criteria in the Evaluation stage. You must know what the goals are before you can gather data related to them to determine whether or not the goals have been met. You should not modify the plan of care until you determine whether goals have been met.
(Slide 46.)

Front 28

Which approach to evaluation focuses on the organization of the client care system?

A. Structure
B. Process of care
C. Outcomes of care
D. Retrospective
(Slide 47.)

Back 28

Answer: A – Structure

Rationale: Structure evaluation focuses on the setting in which care is given. It asks the question, what effect do environmental and organizational characteristics have on the quality of
care? Process of care evaluation focuses on the nurse’s actions. Outcomes of care focuses on the
client’s health status or responses. Retrospective evaluation is an “approach” to evaluation. It simply means something related to a past event.
(Slide 48.)

Front 29

The following statement appears on a nursing care plan: “After the first teaching session the patient will correctly demonstrate use of the glucose meter.” For which type of
evaluation would this be used as a criterion?

A. Outcome
B. Structure
C. Process
D. Audit
(Slide 48.)

Back 29

Answer: A – Outcome

Rationale: Outcome evaluation measures patient behaviors/responses against behavioral objectives written in the planning outcomes stage of the nursing process. It focuses on client health status. Structure evaluation focuses on the environment in which care is given: equipment, policies, and so on. Process evaluation focuses on nursing activities and the manner in which they are done. An audit is not a type of evaluation. It is a method of obtaining evaluation data.
(Slide 50.)

Front 30

. Which activity occurs in the evaluation stage of the nursing process?

A. Writing nursing orders
B. Comparing actual to predicted outcomes
C. Charting nursing actions
D. Formulating patient goals
(Slide 51)

Back 30

Answer: B – Comparing actual to predicted outcomes

Rationale: Nursing orders are written in the planning stage. Charting nursing actions occurs in the implementation stage. Formulating patient goals is done in the planning stage.
(Slide 52.)

Front 31

What is the primary focus of the evaluation stage of the nursing process? To

A. Assess the quality of care provided
B. Determine whether patient goals were met
C. Collect comprehensive patient data
D. Establish that policies were followed
(Slide 53.)

Back 31

Answer: B – Determine whether patient goals were met

Rationale: Assessing the quality of care is the primary focus of a quality assurance program.
Although the nurse collects data to determine whether goals were met, data collection is not the primary focus of evaluation. Data collection is the primary focus of the assessment stage.
Establishing that policies have been followed is one purpose of quality assurance.
(Slide 54.)