7 Evaluate Outcomes

Compare findings with the goal

Evaluation is an ongoing part of care: after an intervention, gather current information and compare the patient's response with the expected result. In the NCSBN Clinical Judgment Measurement Model, evaluating outcomes is the final of six clinical-judgment functions, and the findings inform what happens next.

Use the indicators named in the goal, such as a symptom rating, vital signs, assessment findings, laboratory results, or the patient's ability to perform a task. Check them at the specified time, and consider both the patient's report and objective findings. Compare current findings with the patient's baseline and the care-plan goal.

Ask whether the expected result was met, partly met, or not met; whether the patient is improving, unchanged, or worsening; and whether the planned interventions were carried out as intended. Note any new findings or barriers that could affect the response.

Takeaway: Compare relevant findings with the specific goal, not with a general impression that the patient seems better.

Use specific, measurable goals

A useful goal names an observable result and a timeframe. For example: within 45 minutes of the prescribed intervention, the patient will report pain at 3 or less on a 0-to-10 scale. At the appropriate time, reassess pain and compare the reported rating with that target.

A goal that cannot be checked against specific indicators or a timeframe is difficult to evaluate. Continue evaluation as the patient's condition and care needs change.

Takeaway: Use the same indicators in the goal and the reassessment, and check them at the stated time.

Choose the next action

The evaluation finding guides the next nursing action:

• Goal met and response safe and sustained: Continue appropriate parts of the plan and needed monitoring. Update goals or interventions as the patient's needs change; discontinue a completed goal when it is no longer needed.

• Goal partly met or not met, and the patient is stable: Reassess the patient and the original problem. Check whether the intervention was completed as intended and whether the goal and timeframe remain appropriate. Consider new findings or barriers, revise interventions or goals as indicated, communicate with the care team, and evaluate again.

• The patient worsens or develops an urgent warning sign: Do not wait for a routine reassessment time. Reassess promptly, take appropriate actions within role and protocol, and escalate to the responsible clinician or emergency response system according to the patient's condition and facility policy. Continue monitoring and document the response.

An unmet goal does not, by itself, show that an intervention was ineffective. The patient's condition may have changed, the intervention may not have been carried out, or the goal may need reconsideration. Reassessment helps distinguish these possibilities.

Example: A patient reports incisional pain at 8 on a 0-to-10 scale. The goal is a rating of 3 or less within 45 minutes of the prescribed intervention. At reassessment, the patient reports a rating of 3, is alert, and has no concerning change in breathing or other status. The outcome is met; continue appropriate care and monitoring. If the rating remains 7, reassess, check whether the intervention was given as ordered, consider new or worsening findings, and collaborate with the care team to revise the plan and reassess. If the patient becomes difficult to arouse or develops respiratory deterioration, treat the change as urgent and escalate rather than focusing only on the pain rating.

Takeaway: Continue a safe, effective plan; reassess and revise when progress is inadequate; and promptly escalate deterioration or urgent warning signs.

• Evaluate outcomes

• measurable outcome