Overview Of Evaluation

[Pennie 26]

Overview of Evaluation

 

Define the Area (or Scope) to be Measured

Cognitive: Executive Function, language Skills, attention Span, Orientation, Judgement, Memory, Coping Skills, and Academic

Physical: Gross Motor Coordination, strength/Endurance, Sight/Vision, Cardiovascular Functioning, Bowel & Bladder, Upper Extremity Manipulation, Eye Hand coordination, hearing, Ambulation

Social: Reaction to others, Social Interest, Cooperation, Style of Group Interaction, Reaction to Environment, Competition

Emotional: self-confidence, Mental Sharpness/Dullness, and Expression of Hostility, Moods, Caring/Energy Investment, Sense of Humor

 

The first step is to estimate what norms or expectation seem to be not met. Developing a general understanding of what area(s) of performance or attitude/feelings are enough "off: to need to be measured is important. Why spend time taking exact measurements of the resident's ability to walk when, on close observation, the resident has no trouble walking? Better to spend time measuring the resident's ability to remember where his/her room is if s/he has a problem with memory. It would be the memory impairment and not the locomotion skills, which limit the resident's participation in-group activities. By using the scope it will help the professional to see what areas are norms or expectations.

The professional gains experience, s/he develops the skill to know which areas of the regular scope need a more in-depth measurement based on the resident himself/herself.

 

WHAT DO I NEED TO KNOW? Be sure that the information gathered is a true reflection of the actual status. A sample should be drawn which facilitates the truthful answers to the "What do I need to know" question. The two most common types of samples used in activities are the skip & the focus group.

 

Need to know: Are residents' initial assessments being done on time?

Possible Sample: Select charts of Residents admitted since a given date (e.g., within past 8 months). Roll a dice & use any given number above "3" This is your "skip" number. If you rolled a "5" you take the chart of every 5th resident admitted until you get the number of charts you need to review (e.g. 20).

 

FOCUS GROUP

Do residents on bedfast: Have appropriate programming which addresses their bedrest status?

Select charts of residents: Who had orders for bedrest between 2 Specific dates (e.g. Nov.6 to Jan 24th.)

 

Skip sample selection is when the professional uses a simple math equation to decide which subjects (e.g., charts, residents) to evaluate & which ones to ignore (skip). This works best when the skip number is unknown to everyone until just before the evaluation. That prevents staff from performing "better" in situations where the sample is known before the evaluation.

 

DATA: The data can be collected by interviewing the resident, family members &/or through observation.

You need to gather data: In many ways this is the hardest part. It requires the acceptance of "facts" just as they are. No allowance is made for "maybe the person meant this" or "this mark could mean ---." If the element being measured would not be obviously clear to at least 5 different individuals - it is not counted Data collection has no interpretation associated with it!

Example:

3. Is descriptive enough to be able to distinguish the resident from a group of other residents.

4. Is descriptive enough to clearly define abilities & weakness

5. Is summarized in a manner, which clearly reflects the use of clinical decision making prioritize the residents' needs

 

Question: Does the initial assessment provide enough description about the resident's abilities & weaknesses to be clear to others that read the assessment?

 

Subject Quotes taken from subjects initial assessment met/not met

Res.#1 Res. has history of progressive disorientation problems not met

 

Res#2 Res. has total paralysis on right side of body met

 

Res#3 Res. has hearing loss not met

 

Res#4 Res. is able to walk 20' independently w/o walker met

 

Res#5 Res. is able to recognize his own name met

 

Res#6 Res. enjoys engaging independently & frequently in his met Favorite activity - bird watching

Res#7 Res. has left neglect met

 

Res#8 Res. misses family not met

 

Res#9 Res. physically strikes out at staff when asked to stand met

 

Res#10 Res. can play 3 different card games met

 

JUDGEMENT: is the process of comparing what is normal & expected to what has been measured & making a decision about weather action is required. Review the data collected to determine 2 things:

1. If the data collected shows something different then what would be considered a norm &

2. If any difference is significant enough to warrant a change.

This requires knowledge & expertise. Determine what caused the substance performance. Educated guesses are made about why the problem showed up. Review the data again to see if a clear cause emerges. If a clear cause is not found, future evaluation is significant enough to warrant change.

When you have determined that the problem has been found decide if the problem is sever enough to warrant trying to change what is happening. Consider if the problem is bad enough that it would result in the facility being out of compliance during survey, whether the care being given to the residents or participates could be significantly improved.

 

The 3 parts of the evaluation are;

1. The identification of the norms & expectations

2. The measurement of actions & the recording of attitudes/feelings &

3. The use of the professional's judgement to state, what, if any, important difference were found between the desired (norms & expectations) & the measured performance.

 

COMPONETS OF EVALUATION:

 

I. Norms & Exceptions - which state what is desired versus what is considered inappropriate

Set by:

 Governments,

 Credentialling organizations,

 Professional organizations,

 Results of scientific research,

 Management at facilities,

 Professionals & their department or work group & expectations set by the residents

II. Measurements - which show how close something is to what is desired

 Scope - identifying issues & areas to be measured

 Criteria - developing a general understanding of the areas to be measured & identifying/developing criteria as to what should be found

 Data - establishing the exact method to be used to collect information & then actually collecting the information (data)

III Judgement - which states what, if any, important difference were found between the desired (norms & expectations) & the measurement (performance)

 Determine if the data collected is different from the norms & exceptions

 Determine if any difference seen is significant & warrants a change.