The evaluation component rounds out the Standards of Practice and the six elements of nursing process: assessment, diagnosis, outcomes identification, planning, implementation, and evaluation. Evaluation, the component of interest in this chapter, is defined as “the process of determining the progress toward attainment of expected outcomes, including the effectiveness of care” (ANA, 2010, p. 65). Evaluation is accomplished through direct observation; through interviews with the healthcare consumer, family, and/caregiver; and through reviews of record documentation including progress notes, flow sheets, and results and reports from other departments. In Standard 3, Outcomes Identification, the registered nurse (RN) identifies expected outcomes for a plan individualized to the healthcare consumer or situation. Nurses must create a collective system of accountability by evaluating outcomes through constant evaluation and re-evaluation and adjustment in collaboration with others. Those outcomes may be related to the standards of care, the process of care, or the outcomes of care. Benner, Sutphen, Leonard, and Day (2010) tell us that nurses must ask the right questions, find the right information to answer those questions, and make the best decision on the basis of that information through clinical reasoning. Without the ability to appropriately
evaluate, the RN is simply following orders and can potentially cause a breakdown in the entire system of care.

Practice imperatives were established as early as 2001, when the Institute of Medicine (IOM) published Crossing the Quality Chasm: A New Health System for the 21st Century. This book called for safe, effective, patient-centered, timely, efficient, and equitable care. The RN and the advanced practice registered nurse (APRN) are critical to the evaluation of those patient outcomes.

The RN provides a systematic, criterion-based evaluation of outcomes prescribed by the plan of care and within the specified time frame. The RN conducts the evaluation in partnership with the healthcare consumer and his or her family or caregivers. The RN also collaborates with other healthcare providers involved with the plan of care to evaluate whether nursing interventions are appropriate and affecting outcomes. During the evaluation, the nurse assesses whether the patient’s outcomes have been achieved. The outcomes are met, partially met, or not met at all, and conclusions are drawn about the status of the problem to see if problems are resolved, revised, or continue. The nurse determines if the original diagnoses were correct, if they need to be revised, or if the priorities need to be revisited to meet changing demands. This ongoing assessment determines how well the plan of care is working, if the interventions are effective, if new data are necessary to make the correct evaluation, and if the plan of care needs to be modified. The evaluation depends on all other phases of the nursing process.

The graduate-level prepared specialty nurse and the APRN are expected to evaluate systems more broadly to “determine the effect of the plan on healthcare consumers, families, groups, communities, and institutions” (ANA, 2010, p. 46). Therefore, the advanced practice nurse must evaluate the accuracy of the diagnoses and outcomes demonstrated. Synthesis for those advanced nurses includes a focus on population that includes families, communities, organizations, and systems. Results at this advanced level often focus on policy, process, or protocol revision to affect the larger population of patients or consumers.