5.4.6: FRAME 6- Evaluate Outcomes
- Page ID
- 90264
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CORRECT Answer
Question Type: Multiple Response Select All That Apply
Scoring: +/-
NCSBN Item Type and Scoring: https://www.ncsbn.org/public-files/p...main_stage.pdf
The nurse is pleased to review Jacklyn’s Progress journal and goals. As the nurse, determine which of the goals created by the client demonstrates a lack of understanding and needs follow-up.
| Goal Statement | |
|---|---|
| \(\bigcirc\) | Discuss cardiac rehab schedule with son for transportation needs. |
| \(\bigcirc\) | Try to make it to every session |
| \(\bigcirc\) | Talk to my boss about job responsibilities, see if there is another position that does not require as much lifting and pulling |
| \(\bigcirc\) | Try to find support outside of my son. Join the support group of fellow patients and caregivers who have recovered from heart-related events |
| \(\bigotimes\) | Walk 2 miles by the end of the month |
RATIONALE
Comparing observed outcomes against expected outcomes is an essential nursing action prior to discharge. This will help the nurse collaborate with the client to identify improving/declining/unchanged status, and evaluate the client’s knowledge on their disease process, recovery, medications, restrictions, prior to discharge. As the nurse reviews Jacklyn’s Milestone Journal, it is evident Jacklyn is in a better mental and emotional state than she was a few days ago. She articulates signs of hope and continued progress for the future. The nurse would want to further discuss the timeframe for Jacklyn’s goal of walking 2 miles by the end of the month, knowing Jacklyn is being discharged on July 28.
It is also important for the nurse to realize that when clients are discharged, they are leaving a controlled environment and entering a more uncontrolled environment that is heavily influenced by SDOH. Allowing for the client to identify barriers they will face upon discharge will assist the nurse in identifying possible resources, guidance, and tools to assist in the client in forward progression and avoid readmission to the hospital. Varied teaching strategies can be used by the nurse when assessing the client’s understanding. Spending valuable time assessing the effectiveness of the education will help the nurse understand ways to improve health literacy and client understanding prior to discharge to avoid readmission back to the hospital.
FOCUSED GUIDE
Major opportunities for integrating SDoH into clinical healthcare can be found in standardizing electronic health recordbased tools for SDoH assessments, facilitating panel management to identify and direct outreach to high-risk clients, and tailoring clinical decisions to address environmental factors like housing conditions and health literacy.
Depression in the United States is increasing across all races and ethnicities and is attributed to multiple SDOH (Yelton et al., 2022). Healthy People 2030 aims to ensure “healthy, thriving lives and well-being free of preventable disease, disability, injury, and premature death” and acknowledges the need to achieve health equity through structural and behavioral intervention. Health People 2030 categorized SDOH into five domains Economic Stability, Education Access and Quality, Health Care Access and Quality, Neighborhood and Built Environment, and Social and Community Context. Within these domains are several potential risk and protective factors for mental health outcomes relating to access, quality, and safety of material, social, educational, occupational, civic, and health-related resources (Yelton et al., 2022). Systemic racism, implicit bias, reluctance to refer, segregation, inequity for protective factors for specific groups or communities can contribute to adverse SDOH outcomes and depression/depressive symptoms.
Social change and action to increase equity and provide a voice to populations who otherwise voices are not heard can be influenced by the nurse’s advocacy, engagement in the legislative process, and participatory research promoting dialogue that shares stories about important issues affecting rural and other marginalized individuals or groups.