Evaluation: 5th Phase of the Nursing Process

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What is Evaluation?

Evaluation is the last phase of the nursing process.

It includes two main activities:

  • examination of the client’s condition or situation
  • judgement on whether change has occurred

In the evaluation phase, the nurse discovers the reason behind the success or failure of the client’s plan of care.

What is the purpose of evaluation?

The purpose of evaluation is to determine client’s achievement of expected outcomes and the effectiveness of the nursing care plan in achieving client goals.

What are the classic elements of evaluation?

These are the five classic elements of evaluation:

  1. identification of evaluative criteria
  2. collection of data to check whether criteria were met
  3. interpretation and summary of findings
  4. documentation
  5. termination, continuity or modification of the plan of care

identification of evaluative criteria

The nurse goes back to the outcome criteria identified during the planning phase. Such information serves as criteria and standards for evaluation.

collection of data to check whether criteria were met

This is similar to the assessment phase but rather than collecting data on the client’s health problems, the nurse identifies whether there is outcome achievement.

interpretation and summary of findings

The nurse interprets findings to make sure there was achievement of outcomes. It is necessary to determine whether the data  is  a one-time or a consistent incident.

documentation

The nurse summarizes findings through documentation. It is usually written in a two-part evaluative statement which include the following information:

  1. decision on how well the outcome was met 
  2. supportive data and behaviors that support this decision

Documentation allows all members of the health care team to identify client’s progress.

termination, continuity or modification of the plan of care

Nursing Process Evaluation
Nursing Process Evaluation

Termination of the plan of care is done when each expected outcome is achieved.

Continuation of the plan of care is done if more time is needed to achieve expected outcomes.

Modification of the plan of care is done if difficulties in achieving the outcomes are identified.

When is evaluation done?

Evaluation is a continuous process. It can be done:

  • during or after implementing nursing activities allowing timely modification of the plan of care
  • at specified intervals, for example once a week
  • after discharge to determine need for home care

What else is done during evaluation?

Apart from evaluation of the achievement of client’s outcomes, the nurse also evaluates quality of care rendered to clients. This is important to improve future client care. Factors to be considered in evaluating the quality of nursing care include:

  • the effect of the setting on the quality of care
  • how care was given
  • changes in client’s health status as a result of nursing care

This type of evaluation can be done by the nurse personally or by the health care agency as a whole.

Key Points

  • The purpose of evaluation is to determine client’s achievement of expected outcomes and the effectiveness of the nursing care plan.
  • Documentation allows all members of the health care team to identify client’s progress.
  • The nurse can either terminate, modify or continue plan of care depending on the results identified during evaluation.

Implementation: 4th Phase of the Nursing Process

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What is Implementation?

Implementation is the action phase of the nursing process.

During this phase, the nurse performs or delegates nursing activities formalized during the planning phase.

After carrying out the specific nursing interventions, the nurse records what were done and the client’s responses to the nursing activities.

How is implementation related to other phases of the nursing process?

Assessment, Diagnosis and Planning serve as basis for the nursing activities carried out during Implementation.

Responses of the client to the nursing activities done during the Implementation phase are the factors to be examined during the Evaluation Phase.

What processes are involved in implementation?

Nursing Process - Implementation
Nursing Process – Implementation

These are the processes involved during implementation:

  • Reassessing the client. Client must be reassessed prior to the performance of nursing activities because his or her status may have improved voiding the need to perform planned nursing activities.
  • Determining the nurse’s need for assistance. The nurse is not the Jack of All Trades in the care of the client. Sometimes, assistance may be need in order to perform the planned nursing activities efficiently and safely.
  • Implementing the nursing interventions. Nursing activities to be performed to the client must be based on professional standards of care. Explain to the client what procedures will be done, what sensations to expect, activities to be done when expected sensations are felt and what the expected result is.
  • Supervising the delegated care. The nurse is responsible for the overall well-being of the client during the implementation of the nursing activities. Hence, delegated activities must be monitored to ensure they are appropriately carried out.
  • Documenting nursing activities. After nursing activities are performed, the nurse must document what was done and the client’s response. This record forms part of the client’s permanent record which serves as communication tool among all professionals involved in the care of the patient.

Key Points

  • Implementation is the actual carrying out of planned nursing interventions.
  • All nursing activities to be performed must be  properly explained to the client. Explanation includes what procedures will be done, what sensations to expect, recommendations to deal with expected sensations and what the expected result is.
  • The implementation phase always ends with a documentation of the nursing activities and the client’s responses.

 

Planning: 3rd Phase of the Nursing Process

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What is Planning?

Planning is the third phase of the nursing process.

During planning, the nurse sets measurable and achievable short term and long term goals for the client based on the assessment and diagnosis previously made.

The product of the planning phase is a nursing care plan.

The nursing care plan lists down the assessment data, diagnosis, goals and steps needed to reach set goals.

What is the purpose of planning?

The purpose of planning is to set priorities and develop patient goals and outcomes that when met results in the prevention, reduction, resolution of client’s health problems and attainment of client’s health expectations.

What are the nursing activities involved in planning?

Diagram of Nursing Process Planning
Diagram of Nursing Process Planning

These are the processes involved in planning:

Diagnosis Prioritization

After coming up with a list of problem areas, the nurse prioritizes which nursing diagnosis to focus on.

Client must be involved in this process. If the client does not agree with the priorities set by the nurse, there won’t be any motivation to work toward the goals.

Consultation with other health professionals involved in the care of the client must be done to differentiate nursing problems from those that can be managed by other health care providers.

Goals and Outcomes Setting

Once nursing diagnoses are prioritized, the nurse identifies the patient goals and outcomes.

Goals vs. Outcomes

Goals are broad statements of what needs to be accomplished. They stem from the problem statement of the nursing diagnosis. It is crucial to establish both short term and long term client goals.

Outcomes are concrete and specific statements that are useful to evaluate whether the goal is met. They are derived from the defining characteristics of the nursing diagnosis.

Selecting Nursing Interventions

Once goals are set, the nurse plans the important steps to be done to reach the goals. This must be done in coordination with other health care professionals

Documentation

An individualized nursing care plan is then formalized. The care plan lists down assessment data, diagnosis, goals and outcome statements and related nursing interventions aiming to meet the set client goals.

What are the characteristics of an outcome?

Appropriate outcome statements must be SMART:

SSpecific. It must be precisely identify what the client must achieve.

MMeasurable. It must use measurable and observable verbs that can be quantified for easy evaluation.

AAchievable. Outcome statements must be realistic for the client to achieve.

RResults Oriented. They must be aimed at attaining the set goals.

TTime Limited. They must be bound by a certain time frame.

KEY POINTS

  • Effective planning depends upon the quality and comprehensiveness of assessment.
  • It crucial to prioritize client’s most immediate health needs before planning care.
  • Outcomes must be SMART (specific, measurable, achievable, results oriented and time limited).
  • The Planning phase aims to achieve prevention, reduction, resolution of client’s health problems and attainment of client’s health expectations.