Evaluating patient outcomes

In this study, nurses effectively demonstrated that in addition to stating goals in observable outcomes, they could develop rating scales to measure a patient's progress toward goal attainment. An unexpected finding was that improvement in evaluation was accompanied by corresponding improvement in other components of the nursing process. For example, prior to the study period, nurses rarely listened to chest sounds or measured ventilatory volume to assess lung congestion, even though many had received training in physical assessment and a respirometer was available on the unit. During the study period, however, there was a flurry of auscultation and spirometric measurement activities for patients whose goals were to decrease lung congestion. When one such patient failed to progress as rapidly as the nurse anticipated, greater assistance was given to pulmonary physiotherapy and assistance with coughing. Although nursing has not given sufficient attention to the development of patient evaluation tools, recent legislation as well as consumers' demand for quality care are providing the impetus for developing such mechanisms in a scientific way. This fact may significantly contribute to refining clinical data for the objective evaluation of patient progress. Since most nurses receive some theoretical education in the evaluation process, the challenge may well be to provide nurses, in both educational and service settings, with practical experiences in developing and implementing evaluation techniques.