THE RIGHT TOOL FOR THE JOB

CONNIE DAVIS

J ust as there is more than one way to do anything, there is more than one way to evaluate what's

been done. The evaluation tool may be a

checklist, a rating scale, a graphic scale, ora test. But it isn't always easy to decide what the most effective and informative tool will be.

Checklists, for example, are effi- cient and simple but do not allow for a variety of responses. A rating scale, by contrast, overcomes this draw- back by describing a range of achievement to choose from. Graph- ic scales describe behaviors but do not assign numeric values to the de- scriptors.

These are but three ofthe most ba- sic evaluation formats possible-- how do you decide which is best suited to your intent?

1. Choose the Target Activity

It is not possible to evaluate every activity a nurse or nursing assistant performs, so the evaluator must choose a critical skill as an indicator

~of performance. At the Aurora- Edwards Nursing Home, we needed a tool to evaluate how well our certi- fied nursing assistants were provid- ing care.

We chose morning care for the tar- get activity because the CNA's ability to quickly, neatly, and efficiently give morning care sets the tone of the day for the aide and the resident. Ex- cellent morning care is immediately apparent upon entering a long-term care facility: The residents are clean, well groomed, and appropriately dressed.

2. Relate to a Standard

After deciding on the focus of the tool, identify the standards pertain- ing to that staff function. For exam-

ple, we based our tool on the Ameri- can Nurses' Association Standards of Gerontological Nursing Practice, published in 1976. Facility standards of care also may be used.

3. State the Expected Behavior

Next, describe the ideal perfor- mance of the skill in question. Our director of nursing and the assistant director of nursing detailed the fol- lowing expectations of morning care:The night-shift CNA carries out morning care. • S/he assists each assigned resident with getting out of bed and going to the toilet or commode as described in the resident's nursing care plan. • S/he assists each resident with per- sonal hygiene as described in the resi- dent's care plan. • S/he assists each resident with grooming as described in the resi- dent's care plan. • S/he assists each resident with dressing as described in the nursing care plan. • S/he leaves all patient rooms with beds made, commodes and denture cups emptied, and soiled linen in ei- ther the washing machine or hamp- ers as outlined in the facility policy and procedure manual. • S/he demonstrates respect for the resident while performing morning care. • S/he completes morning care by 7:00 A~I. (Late sleepers could be ac- commodated in the patient care plans.)

4. Choose a Format

Keep in mind who will be using the tool and provide appropriate direc- tions for its use. Keep it as simple, neat, and straightforwardas possible, but make sure there is enough infor- mation for different raters to come to the same conclusion with the tool. Our rating scale consists of six areas

for assessment and descriptors for at- tainment of each level of care.

After a rough draft of the tool is ready, share it with colleagues and consider their ideas. Refine the tool so it is ready to be used.

5. Put the Tool to Work

Present the evaluation tool to the staff who will be evaluated with it. We offered CNAs an inservice pro- gram on personal care, then gave each a copy of the tool. We encour- aged them to critique the tool and help refine and/or revise it. (They suggested changes in some wording to make it clearer.)

6. Evaluate the Evaluator

We assessed the construct validity of our tool by having the director o f nursing, several nurses who had worked in nursing homes, and a nursing home consultant review the tool Their suggestions were incorpo- rated into the final form.

Another method of evaluation is to use the new tool to score a CNA classified by previous performance evaluations as an expert. Our most experienced CNA achieved a perfect score when evaluated by the new method. Stability of the tool could be determined by retesting this CNA.

The method should never be con- sidered perfect or set in stone. The nursing care staff using the tool should participate in evaluation by sharing their comments on the tool's usefulness and accuracy. All staff comments are then considered in further editions of the tool. Flexibili- ty is key to keeping the method o f evaluation fair and responsive to the facility's needs.

Connie Davis, RN, C, MN, is director of resi- dent care at Kenney Presbyterian Home, Seat- tle, WA. She was assistant director of nursing at the Aurora-Edwards Nursing Home, Ed- monds, WA, when this tool was developed,

194 Geriatric Nursing July/August 1989

A S S E S S M E N T : M O R N I N G C A R E OF THE N U R S I N G H O M E R E S I D E N T

Scoring: Circle all of the observed behaviors listed under the numbers. Use the column under Comments to explain why s portion was not done or is not appro- priate, or to praise excellent care. The score for each item is the number above the lowest circled item. For example, ff the person being saored did all the correct behaviors under Personal Hygiene Put forgot the soap, the overall score would

be 2. Each nurse's aide must achieve a score of 3 in Mobility Assistance. Any score of 1 indicates the need for f~rther training or supervision. NCP = nursing care plan P/P = policy and procedure manual

1. SOCIAL CARING 0 1 2 not seen by spoke with harsh voice, spoke intermittently, evaluator did not speak, spoke briefly

teased patient in unfriendly way, exposed patient

3 smiled, greeted patient, guided patient through care with verbal cues, used pleasant tone of voice, kept curtains drawn around patient

COMMENTS

2. MOBIL ITY ASSISTANCE 0 1 not seen by did not get patient to toilet in time, evaluator did not lock bed or chair wheels,

gripped patient too tightly, did not assist ambulation per NCP, did not provide cane or walker

2 transferred with difficulty, patient uncomfortable during transfer, used some but not all needed equipment

3 patient got to toilet when needed, all proper safety equipment used, handled patient firmly but gently, used proper body mechanics, assisted ambulation as indicated in NCP

COMMENTS

3. GROOMING 0 1 not seen by did not comb hair, evaluator patient not ready for breakfast

2 did not shave patient or apply cosmetics as described in NCP for breakfast

3 hair combed, patient shaved or cosmetics applied, patient ready for breakfast

COMMENTS

4, PERSONAL HYGIENE 0 1 not seen by did not wash patient evaluator

2 washed patient but did not use warm water, did not use soap, did not do skin care as indicated in NCP

3 gave incontinent care as described in P/P, used warm washcloth, washed face, hands, and bottom, rinsed off soap, applied proper amount and type of lotion as indicated in NCP

COMMENTS

5. DRESSING 0 not seen by evaluator

1 put tom clothing on patient, gave too little help, dressed in PJs instead of street clothes when it was not bath day, forgot hearing aid, forgot dentures, forgot glasses

2 patient dressed but clothing mismatched, clothes not tucked in, gave too much help

3 patient dressed in appropriate clothes, clothing matches and is in good repair, assisted patient as described in NCP, patient has all necessary appliances (hearing aid, braces, glasses, dentures)

COMMENTS

6. PA TIENT ROOM 0 1 not seen by laundry on floor or on bed, evaluator bed not made,

commode not emptied

2 denture cup not emptied, grooming items not put away

3 items put away, commode empty, laundry in proper places as described in P/P

COMMENTS

TOTAL SCORE (ADJUST FOR ALL UNOBSERVED ITEMS):. 16-18 excellent care 12-15 adequate care 11 or less: needs further training or supervision

Gcriatric Nursing July/August 1989 195