RANZ PART Documentation - Documentation is any written or electronically generated information about a client that describes the care

or service provided to that client. Health records may be paper documents or electronic documents, such as electronic medical records, faxes, e-mails, audio or video tapes and images. Through documentation, nurses communicate their observations, decisions, actions and outcomes of these actions for clients. Documentation is an accurate account of what occurred and when it occurred. Directives for Documentation Requirements for documentation and the sharing, retention and disposal of this information are drawn from several sources: statutory regulations; Standards of Practice; agency policies and procedures; and legal principles. Statutory Regulation There are no laws stating specifically how and what nurses must document. Agencies generally develop documentation policies which reflect provincial and federal government statutes and/or other relevant documents. Examples of statutes and documents guide policy Statutes British Columbia Coroners Act Health Professions Act Child, Family and Community Service Act Hospital Act Controlled Drug and Substances Act (Federal) Health Care (Consent) and Facilities Act Electronic Transactions Act Limitation Act Evidence Act Medical Practitioners Act Freedom of Information and Protection of Privacy Act Mental Health Act Health Act

DOCUMENTATION FORMATS 1. Narrative Documentation - provides pertinent information written mainly in paragraph format. Narrative Example: Date: 3/3/04 Patient: John Smith Pt. RTC reporting no adverse effects from tx last visit or from HEP. He stated that he feels as though his wrist & ankle are moving a little better and the edema in the hand has _. He reports that he is able to shower (I) using a plastic chair in the tub and feels like he has improved c his ability to dress himself. AROM of the (L) wrist is as follows: flexion 30, extension 30, UD 15, RD 20, supination 45, and pronation 60; (L) knee: 0-135; (L) ankle DF-PF 5-45. Figure 8 wrist girth is 35.5 cm and ankle figure 8 girth is 43 cm on the (L). Pt. is ambulating household distances (I) c cx using (L) UE platform, PWB 50% on the (L) LE. (I) with all 2. SOAP Notes (subjective, objective, assessment, and plan) - is a method of documentation employed by health care providers to write out notes in a patient's chart, along with other common formats, such as the admission note. Example: Surgery Service, Dr. Jones S: No Chest Pain or Shortness of Breath. "Feeling better today." Patient reports flatus. O: Afebrile, P 84, R 16, BP 130/82. No acute distress. Neck no JVD, Lungs clear Cor RRR Abd Bowel sounds present, mild RLQ tenderness, less than yesterday. Wounds look clean. Ext without edema A: Patient is a 37 year old man on post-operative day 2 for laparoscopic appendectomy, recently passed flatus. P:

Recovering well. Advance diet. Continue to monitor labs. Prepare for discharge home tomorrow morning. 3. POMR (problem-oriented medical record) - Method of recording data about the health status of a patient in a problem-solving system. POMR preserves the data in an easily accessible way that encourages ongoing assessment and revision of the health care plan by all members of the health care team. Example: Case Signalment: K9 5 yo, f/s, Miniature Schnauzer "Tessa" Hx/PE: Tessa ate a pork chop 2 days ago. Approximately 8 hours ago, he became depressed and started vomiting. She has vomited a clear, yellow fluid 6 to 8 times. She is completely anorexic now. She has no previous medical illness or surgery except for spay after one litter at 3 years of age. She has had no known adverse drug reactions nor is there any history of trauma or toxin exposure. She is an indoor dog and current on vaccinations and heartworm preventative. She eats Kibbles and Bits free choice and some people food. No C/S/D/PUPD. PE: 10 kg. QAR, 7%deH2O, T=102.0, P=140, R=40, mm-pink, 1-2 sec 2cm SC soft mass on the right flank tense abdomen, resentful of palpation no other abnormal findings IPL: 1. Vomiting (ch by anorexia, deH2O, abdominal pain, depression) 2. Subcutaneous mass (right flank) (this is what you do after you've seen the patient in the exam room) PROBLEMS DxR/O DxPlans RxPlans CE 1. vomiting primary GI (eg. obstruction, inflammation, toxic) vs. secondary GI (pancreatic, renal, adrenal, hepatic) abdominal rads, pretx CBC, UA, chem panel w/ lipase NPO, IV LRS (700 cc replace, 600 cc maint., 100 cc ong. loss) need supportive care, minimal dx risk 2. subcutaneous mass inflammation; benign or malignant neoplasia, trauma FNA w/ cytology None pending results Signature ----------------- Source: http://vetsites.vin.com/kidney/POMR.html 4. Functional Outcome Reporting - Highlights how your clients injuries affect their daily lives and how your massage allows them to make progress towards resuming their regular activities. The assessment of client status, the interventions carried out and the impact of the interventions on client outcomes are organized under the headings of data, action and response. Example: Data: Subjective and/or objective information that supports the stated focus or describes the client status at the time of a significant event or intervention. Action: Completed or planned nursing interventions based on the nurses assessment of the clients status. Response: Description of the impact of the interventions on client outcomes. Piper, a postal carrier who can't walk more than 20 steps without severe pain and fatigue when she comes for her first massage session. After her third session, Piper can now walk 50 feet with moderate pain and fatigue and up to a 100 feet before feeling severe pain and fatigue. If you focus on pain, Piper is likely to report that she is still suffering severe pain and fatigue when walking and you

might conclude that she hasn't made any progress. If you focus on her activities of daily living, you'll notice that she can now walk around her house, and therefore is making progress. Source:http://www.wincityinc.com/products/massagesoapnotes/1.1/prod01_massageso apnotes_functionalreporting.htm 5. Focus Charting - Method of documentation, the nurse identifies a focus based on client concerns or behaviors determined during the assessment. Example: Data: Subjective and/or objective information that supports the stated focus or describes the client status at the time of a significant event or intervention. Action: Completed or planned nursing interventions based on the nurses assessment of the clients status. Response: Description of the impact of the interventions on client outcomes. Source: https://www.crnbc.ca/Standards/Lists/StandardResources/151NursingDocumen tation.pdf

Tools for Documentation 1. Worksheets and kardexes - Nurses use worksheets to organize the care they provide, and to manage their time and multiple priorities. Kardexes are used to communicate current orders, upcoming tests or surgeries, special diets or the use of aids for independent living specific to an individual client (College of Nurses of Ontario, 2002). If a paper format is used, entries may be erasable as long as the assessment, nursing interventions carried out and the impact of these interventions on client outcomes are documented in the permanent health record. When the kardex is the only documentation of the clients care plan, it is kept as part of the permanent record. 2. Client care plans - Care plans are outlines of care for individual clients and make up part of the permanent health record. Care plansare written in ink (unless electronic), upto-date and clearly identify the needs and wishes of the client. 3. Flow sheets and checklists - Flow sheets and checklists are used to document routine care and observations that are recorded on a regular basis (e.g., activities of daily living, vital signs, intake and output). Flow sheets and checklists are part of the permanent health record, and can be used as evidence in legal proceedings (College of Nurses of Ontario, 2002). Symbols (e.g., check marks) may be used on flow sheets or checklists as long as it is clear who performed the assessment or intervention and the meaning of each of the symbols is identified in agency policy. 4. Care maps and clinical pathways -Care maps and clinical pathways outline what care will be done and what outcomes are expected over a specified time frame for a usual client within a case type or grouping. Nurses individualize care maps and clinical

pathways to meet clients specific needs (e.g., by making changes to items that are not appropriate). If the status of clients varies from that outlined on the care map or clinical pathway at a particular time period, the variance is documented, including the reasons and action plan to address it. 5. Monitoring strips -Monitoring strips (e.g., cardiac, fetal or thermal monitoring; blood pressure testing) provide important assessment data and are included as part of the permanent health record.

JANILEYS PART Use of Technology 1.Electronic Documentation - A clients electronic health record is a collection of the personal health information of a single individual, entered or accepted by health care providers, and stored electronically, under strict security. 2. Fax Transmission - convenient and efficient method for communicating information between health care providers. Protection of client confidentiality is the most significant risk in fax transmission and special precautions are required when using this form of technology. 3.Electronic Mail - The use of e-mail by health care organizations and health care professionals is becoming more widespread as a result of its speed, reliability, convenience and low cost. Unfortunately the factors that make the use of e-mail so advantageous also pose significant confidentiality, security and legal risks. 4. Telenursing - Nurses who provide telephone care are required to document the telephone interaction. Documentation may occur in a written form (e.g., log book or client record form) or via computer. Standardized protocols that guide the information obtained from the caller and the advice given are useful in both providing and documenting telephone nursing care.

Source: https://www.crnbc.ca/Standards/Lists/StandardResources/151NursingDocumen tation.pdf

ALISSAS PART Evaluation As defined by the American Evaluation Association evaluation involves assessing the strengths and weaknesses of programs, policies, personnel, products, and organizations to improve their effectiveness. Evaluation is the systematic collection and analysis of data needed to make decisions, a process in which most well-run programs engage from the outset. Evaluation is the systematic collection and analysis of data needed to make decisions, a process in which most well-run programs engage from the outset. Here are just some of the evaluation activities that are already likely to be incorporated into many programs or that can be added easily:


Pinpointing the services needed for example, finding out what knowledge, skills, attitudes, or behaviors a program should address Establishing program objectives and deciding the particular evidence (such as the specific knowledge, attitudes, or behavior) that will demonstrate that the objectives have been met. A key to successful evaluation is a set of clear, measurable, and realistic program objectives. If objectives are unrealistically optimistic or are not measurable, the program may not be able to demonstrate that it has been successful even if it has done a good job Developing or selecting from among alternative program approaches for example, trying different curricula or policies and determining which ones best achieve the goals

Tracking program objectives for example, setting up a system that shows who gets services, how much service is delivered, how participants rate the services they receive, and which approaches are most readily adopted by staff Trying out and assessing new program designs determining the extent to which a particular approach is being implemented faithfully by school or agency personnel or the extent to which it attracts or retains participants.

Rossi and Freeman (1993) define evaluation as "the systematic application of social research procedures for assessing the conceptualization, design, implementation, and utility of ... programs." There are many other similar definitions and explanations of

"what evaluation is" in the literature. Our view is that, although each definition, and in fact, each evaluation is slightly different, there are several different steps that are usually followed in any evaluation. It is these steps which guide the questions organizing this handbook. An overview of the steps of a "typical" evaluation follows.

The Goals of Evaluation The generic goal of most evaluations is to provide "useful feedback" to a variety of audiences including sponsors, donors, client-groups, administrators, staff, and other relevant constituencies. Most often, feedback is perceived as "useful" if it aids in decision-making. But the relationship between an evaluation and its impact is not a simple one -- studies that seem critical sometimes fail to influence short-term decisions, and studies that initially seem to have no influence can have a delayed impact when

more congenial conditions arise. Despite this, there is broad consensus that the major goal of evaluation should be to influence decision-making or policy formulation through the provision of empirically-driven feedback.

NARCIS PART Evaluation Strategies 'Evaluation strategies' means broad, overarching perspectives on evaluation. They encompass the most general groups or "camps" of evaluators; although, at its best, evaluation work borrows eclectically from the perspectives of all these camps. Four major groups of evaluation strategies are discussed here. Scientificexperimental models are probably the most historically dominant evaluation strategies. Taking their values and methods from the sciences -- especially the social sciences -they prioritize on the desirability of impartiality, accuracy, objectivity and the validity of the information generated. Included under scientific-experimental models would be: the tradition of experimental and quasi-experimental designs; objectives-based research that comes from education; econometrically-oriented perspectives including costeffectiveness and cost-benefit analysis; and the recent articulation of theory-driven evaluation. The second class of strategies are management-oriented systems models. Two of the most common of these are PERT, the Program Evaluation and Review Technique, and CPM, the Critical Path Method. Both have been widely used in business and government in this country. It would also be legitimate to include the Logical Framework or "Logframe" model developed at U.S. Agency for International Development and general systems theory and operations research approaches in this category. Two management-oriented systems models were originated by evaluators: the UTOS model where U stands for Units, T for Treatments, O for Observing Observations and S for Settings; and the CIPP model where the C stands for Context, the I for Input, the first P for Process and the second P for Product. These management-oriented systems models emphasize comprehensiveness in evaluation, placing evaluation within a larger framework of organizational activities. The third class of strategies are the qualitative/anthropological models. They emphasize the importance of observation, the need to retain the phenomenological quality of the evaluation context, and the value of subjective human interpretation in the evaluation process. Included in this category are the approaches known in evaluation as naturalistic or 'Fourth Generation' evaluation; the various qualitative schools; critical theory and art criticism approaches; and, the 'grounded theory' approach of Glaser and Strauss among others. Finally, a fourth class of strategies is termed participant-oriented models. As the term suggests, they emphasize the central importance of the evaluation participants, especially clients and users of the program or technology. Client-centered and stakeholder approaches are examples of participant-oriented models, as are consumeroriented evaluation systems. Types of Evaluation Process (also called "methods")

Process evaluation examines the procedures and tasks involved in implementing a program. This type of evaluation also can look at the administrative and organizational aspects of the program. Process evaluation monitors the program to ensure feedback during the course of the program. Impact (also called "outcome objectives") Impact evaluation is the most comprehensive of the four evaluation types. It is desirable because it focuses on the long-range results of the program and changes or improvements in health status as a result. However, impact evaluations are rarely possible because they are frequently costly and involve extended commitment. Also, the results often cannot be directly related to the effects of an activity or program because of other (external) influences on the target audience, which occur over time. Information obtained from an impact study may include: Changes in morbidity and mortality Changes in absenteeism from work Long-term maintenance of desired behavior Rate or recidivism Outcome (also called "bridging objectives") Outcome evaluation is used to obtain descriptive data on a project and to document short-term results. Task-focused results are those that describe the output of the activity (e.g., the number of public inquiries received as a result of a public service announcement). Short-term results describe the immediate effects of the project on the target audience (e.g., percent of the target audience showing increased awareness of the subject). Information that can result from an outcome evaluation includes: Knowledge and attitude changes Expressed intentions of the target audience Short-term or intermediate behavior shifts Policies initiated or other institutional changes made Formative Formative evaluation, including pre-testing, is designed to assess the strengths and weaknesses or materials or campaign strategies before implementation. Formative research tailors the program to the target audience. Messages or products are tested by a small group before they are implemented on a large scale. This type or evaluation permits necessary revisions before the full effort goes forward. Its basic purpose is to maximize the change for program success before the activity starts. Summative Any combination measurements and judgments that permit conclusions to be drawn about impact, outcome, or benefits of a program or method. Three Levels of Evaluation Project-Level Evaluation Project-level evaluation is the evaluation that project directors are responsible for locally.The project director, with appropriate staff and with input from board members and other relevant stakeholders, determines the critical evaluation questions, decides whether to use an internal evaluator or hire an external consultant, and conducts and guides the project-level evaluation.The Foundation provides assistance as needed. The primary goal of project-level evaluation is to improve and strengthen Kellogg-funded projects. the consistent, ongoing collection and analysis of information for use in decision making. Consistent Collection of Information If the answers to your questions are to be reliable and believable to your projects stakeholders, the evaluation must collect information in a consistent and thoughtful way.This collection of information can involve individual interviews, written surveys,

focus groups, observation, or numerical information such as the number of participants.While the methods used to collect information can and should vary from project to project, the consistent collection of information means having thought through what information you need, and having developed a system for collecting and analyzing this information. The key to collecting data is to collect it from multiple sources and perspectives, and to use a variety of methods for collecting information.The best evaluations engage an evaluation team to analyze, interpret, and build consensus on the meaning of the data, and to reduce the likelihood of wrong or invalid interpretations. Use in Decision Making Since there is no single, best approach to evaluation which can be used in all situations, it is important to decide the purpose of the evaluation, the questions you want to answer, and which methods will give you usable information that you can trust. Even if you decide to hire an external consultant to assist with the evaluation, you, your staff, and relevant stakeholders should play an active role in addressing these questions.You know the project best, and ultimately you know what you need. In addition, because you are one of the primary users of evaluation information, and because the quality of your decisions depends on good information, it is better to have negative information you can trust than positive information in which you have little faith. Again, the purpose of project-level evaluation is not just to prove, but also to improve. People who manage innovative projects have enough to do without trying to collect information that cannot be used by someone with a stake in the project. By determining who will use the information you collect, what information they are likely to want, and how they are going to use it, you can decide what questions need to be answered through your evaluation. Project-level evaluation should not be a stand-alone activity, nor should it occur only at the end of a program. Project staff should think about how evaluation can become an integrated part of the project, providing important information about program management and service delivery decisions. Evaluation should be ongoing and occur at every phase of a projects development, from preplanning to start-up to implementation and even to expansion or replication phases. For each of these phases, the most relevant questions to ask and the evaluation activities may differ.What remains the same, however, is that evaluation assists project staff, and community partners make effective decisions to continuously strengthen and improve the initiative.

RAINIERS PART EVALUATION TOOLS Evaluation Matrix Although by all appearances, the "Evaluation Matrix" is a very simple tool, it has a powerful purpose. It helps you to consider a wider range of data collection methods than you might otherwise consider in relation to each of the questions addressed by your evaluation. Evaluators sometimes get into the habit of using one or other data collection method, e.g., an end-of-training questionnaire, without considering the advantages of alternative

methods. This tool prompts you to consider each evaluation question and to decide which of the many data collection options have the greatest potential for providing the desired information. Anecdotal Record Form Evaluation data does not have to be reported as "cold hard statistics." Often you will want to tell the "human story" involved in your development or implementation project. One way of capturing those important stories and critical incidents that provide the human story is the "Anecdotal Record Form." Participants in an interactive multimedia design project can use this instrument to describe a noteworthy event and to offer their own interpretation of its relevance. It is very important to try to complete an Anecdotal Record Form as soon as possible after a critical event has occurred so as not to forget critical information. It is equally important to separate your description of the incident from your interpretation of it! Expert Review Checklist Expert review is one of the primary evaluation strategies used in both formative (How can this multimedia program be improved?) and summative (What is the effectiveness and worth of this multimedia program?) evaluation. It is often a good idea to provide experts with some sort of instrument or guide to insure that they critique all of the important aspects of the IMM program that you want reviewed. This "Expert Review Checklist" has been designed for use by an instructional design expert. You would employ different sorts of Expert Review Checklists with different types of experts such as a content expert or a human computer interface expert. Focus Group Protocol Focus groups are a powerful means of collecting data about learner or instructor reactions to a new interactive multimedia program. However, focus groups need to be carefully planned so that you get the kind and quality of information you are seeking. This "Focus Group Protocol" is a brief example of a list of questions that might be addressed during a focus group regarding an interactive multimedia program. Formative Review Log The "Formative Review Log" is a simple instrument that can be used by anyone you have asked to review your program in its formative stages. The instrument has three columns, the first for recording the screen or format sheet number that the person is reviewing, the second for writing down observations (e.g., errors, confusing points, or ideas), and the third for recording what actions have been taken in reaction to the feedback provided by members of the project team. Using an instrument like this with many different types of users will probably have the greatest pay-off for formative evaluation throughout the life of the project. Implementation Log It is one thing to plan and develop a good interactive multimedia program. It is entirely another thing to implement it as planned. Many training innovations have failed because implementation factors (such as instructor motivation) were not considered. It is essential to make every effort to collect information regarding the actual use of an interactive multimedia program as compared to the planned use. The "Implementation Log" tool has been designed to make that comparison a little more systematic. Interview Protocol Interviews are a powerful means of collecting data about learner or instructor reactions to a new interactive multimedia program. However, interviews need to be

carefully planned so that you get the kind and quality of information you are seeking. This "Interview Protocol" is a brief example of a list of questions that might be addressed during an interview regarding an interactive multimedia program. Questionnaire Questionnaires are undoubtedly the single most frequently used type of evaluation instrument. Poorly designed questionnaires are often administered at the close of a course or training session as a "smilometer" or "happiness indicator." They are also often distributed to users of interactive multimedia programs. If the only thing you find out about your interactive multimedia program with a questionnaire is whether the trainees liked it, you are not making good use of this strategy. As shown in the "Questionnaire," a wealth of information can be provided by a well-designed instrument. User Interface Rating Form The "User Interface" of an interactive instructional product, e.g, a multimedia program, is a critical element of the product that must be carefully evaluated. If the user interface is not well-designed, learners will have little opportunity to learn from the program. This rating form includes ten major criteria for assessing the user interface for an interactive program, such as "ease of use" and "screen design." Not all of the criteria may be relevant to the particular program you are evaluating, but most of them will. You may need to add additional criteria to the list. Novice users of interactive instructional products are generally not good candidates for using this form. The people rating the user interface should be experienced users of the type of program you are asking them to rate. Even better, they could be experienced designers of interactive programs. Evaluation Report Sample The "Evaluation Report Sample" presents one way of structuring an evaluation report. Evaluation reports are notorious for being weighty volumes that few people read. Not surprisingly, lengthy reports have little effect on decision-makers. This tool illustrates a strategy for dividing an evaluation report into two-page sections that each include four parts: 1) an attention-getting headline, 2) a description of the major issues related to the headline, 3) a presentation of data related to the issues, and 4) a bottom-line recommendation or summary of the findings. People who receive a report in this format can take two or three sections at a time and make them agenda items for their team meetings. In this way, the evaluation findings are much more likely to have an impact on practical decisions.