Nursing Process – Evaluate

Evaluation. A-D-P-I-E. E is for evaluation. This is one of my favorite phases of the nursing process. That might make me sound like a bit of a nerd, but let me tell you guys why I love this. This is where we get to see if all the hard work we’ve done leading up to here worked. If it didn’t work, we get to cycle back and try again. Evaluation is so important and I want to make sure you guys love it and you do it every single time.

Evaluation is the final phase of our nursing process. It determines the effectiveness of our interventions and the nursing care plan. Please don’t skip this step.

Many times nurses will skip this step because we’re so busy. One of the reasons that I would get called for RRTs more than anything in the hospital was because insulin was given and then the patient was never checked on again until hours later in the next round, or the next time for medications and their blood sugars had plummeted down to the 50s, to the 30s, to the teens even. We’re called because the patient is unresponsive. We got to make sure … In that one they’ve implemented their insulin and then they were never evaluated until they went back to do another assessment. We skipped this whole step, this important step where we could’ve caught our patient’s blood sugars dropping before they actually got to a dangerous level.

Please don’t even skip this step. It’s so important that we’re evaluating the effectiveness of our interventions, okay? Questions that you need to ask during your intervention. Was the intervention successful? Did it work or did it not work? How effective was it? Did it do what we expected it to do? Did the patient progress or regress? Did the interventions have the outcomes … Or the outcomes caused the patient to move forward to going home, to regress, to getting worse, or was there no change at all? Then we need to know that, because that’s going to help us in our next phase of going back to assessment again. Now, does the plan of care need to change? If the patient’s progressing, great. Everything’s perfect. If the patient’s regressing, we better change our plan of care. We better make a change, try to get this patient progressing again.

If there’s no change at all, we also probably should change something, because we want our patients to be progressing. We want them to be getting better and we want them to be going home. All right. What is it that we need to be evaluating? First of all, we need to evaluate our interventions. The evaluation of all the care that we give to our patient, were they tolerated well? Did the things that we do work? We need to evaluate our goals. Do we have appropriate goals set for our patient? Were they achieved? Can we start changing our goals? Can we start making new goals for our patient? Then we need to evaluate our expected outcomes. When we walked into this … When we implemented, we had a theory about what was going to happen, right?

Remember, this is just a modified scientific theory. We had a theory of what was going to happen. Did it happen the way we expected it to happen? Did we get the outcome that we wanted or did something unexpected happen? Did we get the expected outcomes that we had walked into this implementation that we expected? That’s what we’re evaluating. All of our interventions, the goals that we had set, and did we get the outcomes that we wanted to see happen with our patient. Now, if the goal isn’t met, we need to know why. Now, sometimes if goals aren’t met, remember it’s not necessarily your fault. It’s important to understand why sometimes goals might not be met. Sometimes it’s the orders. There’s a delay in orders, or we don’t get the orders that the patient needs, etc.

Sometimes it’s time. Sometimes there’s time restraints, such as another patient gets sick, so maybe we were supposed to give our patient their Protonix at 6AM, but the patient next door just fell out of bed. Well, we’re probably not going to get that Protonix on time because we have a big issue with our patient over here who just fell out of bed and so we just didn’t get time to get both of those done. Sometimes it’s patient compliance and communication. A lot of times when patients come to hospitals they’re used to taking the blue pill at home. We got the red pill. Same medication, but they’re not willing to take it because it looks different than their pill at home, so they’re not going to comply. Maybe it’s communication. Maybe we didn’t explain ourselves clearly, or the patient doesn’t understand what we’re talking about.

Sometimes it could be equipment and supplies. Maybe there’s not a walker ready, or a wheelchair ready to get the patient downstairs to the car. Or what can happen a lot of times is pharmacy is understaffed. Pharmacy doesn’t have the medication available. They aren’t able to get that medication to us, so we can’t do what we need to do because it’s not available. We can’t do anything. Then sometimes the patient condition. Occasionally patients’ conditions change, which deters us from our goals. We set these goals and then the patient has a change in their condition and we’re not able to do anything, okay? Now listen, there may be reasons why goals aren’t achieved, but there’s never justification for not meeting a goal and then just letting it sit.

If nothing is achieved, the goal isn’t achieved, we need to go back and reassess. We can’t just sit there and not do anything. How do we reassess? We go back to our assessment phase, right? We did A, D, P, I. Here we are in our evaluation phase. We got to go back and reassess. “Okay, this didn’t work. All the stuff we did, this didn’t work. Let’s go back to our reassessment phase.” Not all interventions are going to work. All right. If interventions do not work, evaluate why by reassessing. We talked about that before. You guys know how to assess now. Some of the nursing concepts you’re going to see with this are professionalism and clinical judgment. Remember, we’re on the clinical floor we got to use our clinical judgment and that’s following the nursing process.
I hope by now you guys are in love with the nursing process, you understand it’s important, and you’re excited to implement all these new things that you’ve learned. If following these steps doesn’t work, you’re going to go back and evaluate and reassess and try to get the nursing process to work for you. What is it? Evaluation is determining if interventions worked. We evaluate our goals, and we evaluate our interventions, and we evaluate the expected outcomes that we wanted to see. Sometimes goals aren’t met because of outside factors. Things like orders, time, or supplies being available.

We got to reassess our patients always, always, always. Please don’t miss this. This is so important. Not all interventions work, but you must identify why they don’t work. Then never skip ever, ever, ever the evaluation phase. It’s so important to evaluate. It’s a necessary last step before starting over. We can’t get a real assessment if we don’t know what we just evaluated, if it worked for the patient or not. Please always make sure you’re in there evaluating the care that you give to a patient. It’s so important. I know you guys are going to do that and I know you’re going to do a great job with it.

Make sure you check out all the other resources attached to this lesson and go out and be your best selves today. Happy nursing.