EVALUATION OF NURSING SERVICE
Introduction:
Evaluation is term used to describe the process of finding out whether what was expected, desired or aimed at has been achieved. It is an on-going process and an integral part of an organization. It is an intellectual activity, here the outcomes are compared with pre-determined standards and criteria, to know to the extent to which the goals or predetermined outcomes are achieved.
Definition:
Evaluation is a judgemental process and as such, it reflects the beliefs, values and attitudes of the participants of the programme.
Evaluation is a decision making process that leads to suggestions for actions to improve participants effectiveness and programme efficiency.
Purposes of Evaluation
Clarify and define education/programme objectives.
Facilitate the improvement of curriculum and instruction/programme.
Determine participant’s progress towards the achievement of the goals of the programme.
Facilitate the maintenance of strength and elimination of weakness on the part of participants.
Motivate the participants.
Provide sense of accomplishments (psychological security) for the participants and consumer.
Develop more reliable and valid instruments for measurement.
Determine the overall value (e.g. cost, efficiency) of undertakings for both participants and consumer immediately over long period.
Establish and maintain standards to meet legal, professional and academic credentials.
Principles of Evaluation
1.Objectivity: It is the degree to which the evaluation judgments are based on the facts, observed behaviour, and measurable aspects or the performance.
2.Feasibility: The methods techniques, and tools used for evaluation should not be too costly and time consuming.
3.Relevance: The criteria used for evaluation should be related to the important and critical aspects of services.
4.Validity: It is the degree to which the evaluation measures what it is intended to measure.
5.Reliability: It is the stability and consistency with which an evaluation should be acceptable not only to supervisors but also to the staff whose performance is evaluated.
6.Acceptability: The criteria for evaluation should be acceptable by all.
7.Achievable: The standards set for evaluation should be realistic and achievable with available resources.
Types of Evaluation
1. Summative evaluation serves traditionally for rank ordering students and justifying decisions regarding their passage to the following year or the obtaining degree. Usually it occurs at the and of the programme, course or unit and is concerned with whether the learner has mastered all designated behavioural objectives. It is a certifying evaluation used by the teacher to make a certifying judgment.
2. Formative evaluation occurs throughout the programme, course or unit, and through feedback enables teacher and students or authority and worker to diagnose learning needs or any specific needs to provide appropriate remedial strategies and pace the student or worker learning or equip according to needs and abilities. It is a diagnostic evaluation, which consists of evaluating the progress or the gains made by the participant and the programme.
Evaluation and Community Health Nursing Programme
Evaluation is the process of collecting data, presenting them in a convenient form and using them to form judgments to reach a decision about an activity on other type of process. A community health service is a process which starts with planning and ends with evaluation of that programme. The purposes of evaluation of community health programme are as follows.
1.The modification of the programme to be at par with the problem arising in the community or with the felt need of the community.
2.Ensuring objectives for the continuing education of the staff members for their develop­ment.
3.Serving as a basis for diagnosis of professional problems and potentialities.
4.Forming a basis for future plan of the programme.
5.Helping in research studies for innovation in community health nursing service
6.Providing a review of the standards of work for both the supervisor and staff.
An evaluation process has its own steps which include:
i.Setting objectives
ii.Establishing standards
iii.Allocation of resources
iv.Selection of appropriate methods
v.Comparison of output
vi.Replace if necessary.

For any programme the process of evaluation will be:
Programme input
Programme activity
Programme output
Impact on health structure
In forming health programme, the output is considered as target. The programme activities are planned according to the inputs (staff, supplies etc) available. Evaluation objectives are formed according to the performance objectives. The method of evaluation should be selected according to the level of evaluation, i.e.
Primary service units (individual, family, groups) · Administrative units (agency, community)
Supportive and co-ordinating units.
Criteria of Evaluation in Community Health Nursing
The criteria of evaluation in community health nursing can be categorised as follows.
1.Observable and objectively measurable evidences (incidences) of change of status, which include morbidity and mortality rates, e.g. IMR, MMR etc.
2.Subjective or judgmental evidences of change of status. Which means-these values of performances or work can be analysed against the standards formulated by the profession or agency.
3.Internal-introduction of change, based on the assumption that if a specific action is taken in specific way, specific outcome may be expected, e.g. promptness and home­ visits.
Methods of Evaluation in Community Health Nursing Practice
In community health nursing practice, the evaluation falls into two categories, i.e. evaluation of the individual job performance and evaluation of the programme or agency.
Evaluation of the individual job performance can be made on the basis of:
i.Observation of the staff in the field.
ii.Conference with the workers.
iii.Analysis of written reports.
iv.Maintenance of anecdotal records.
v.Maintenance of checklist.
Evaluation of the programme or agency can be made on the basis of:
1.Adult or review of programme or agency.
2.Field observation and discussion.
3.Community survey.
Sample of checklist to evaluate programme of field work Date
Name Position
Department
Evaluation
List of behaviours Satisfactory Non-satisfactory
I. Knowledge
Clinical knowledge
Nursing care needs
Needs of subordinates
II. Skills and ability
Teaching
Guiding and supervision
Communication Leadership
Reports and records.
III. Attitudes
Initiative
Dependability
Commanding
Teaching spirit
Reaction to supervisor
Professional ethics
Remarks Signature of Head
Evaluation of Employees
Usually the supervisory personnel have long been held responsible for mentally at least, evaluating the progress of their subordinates performance. These supervisors have been expected to communicate those in higher authority only information about their employees which should be used as basis for action. It may be written or unwritten report. But now it is very important and it is always better to use more carefully planned, organised written reports for evaluation of the strength and weakness for their subordinates.
Written reports are have more value than unwritten ones, and are more advantageous. It requires supervision to observe all employees in regard to certain required types of achievements instead of looking only for attributes to which specific supervisor might attach great weight. It gives administrative personnel a routine time when they can see the evaluated strengths and weaknesses of their employees. It provides objective evidence and can be used to give unmistakable warning when an employee is in danger of being terminated on the basis of unsatisfactory achievement. It can help those planning the in-service education programme to see where the greatest training needs lie and most important it can serve as a basis for a progress of periodic progress interviews where an employee can learn how his achievements are being rated and where he can make improvements.
Principles of Performance Evaluation
To fair and accurate evaluation of the subordinates', job performance, certain principles must be followed.
1.Assess performance in relation to behaviourally stated work goals Evaluation of the employee should be based on behaviourally stated performance standards for the position occupies, e.g. a nurse's job performance should be evaluated with reference to progress towards those work goals.
2.Observe a representative sample of employees total work activities An adequate, representative sample of the nurse's job behaviour should be observed to provide a basis for evaluation. Care should be taken to be evaluated nurse's usual or consistent job behaviour and to avoid undue attention to a single, typical instance of superior or incept behaviour.
3.Compare supervisor’s evaluation with employees self evaluation The nurse should be given a copy of her or his job description, performance standards, and performance evaluation form to review before the evaluation conference, so that the nurse and supervisor can approach their discussion from the same frame of reference.
4.Cite specific examples of satisfactory and unsatisfactory performance While documenting nurse's performance, the supervisor should indicate areas of performance that are satisfactory and the areas that need improvement or that are unsatisfactory with evidence.
5.Indicate which job areas have highest priority for improvement When served areas of job performance need improvement, the supervisor should specify which areas are to be given highest priority.
6.Evaluation conference should be held in good atmosphere For which the evaluation conference should be scheduled at a time convenient for nurse and supervisor, and should be held in pleasant surroundings, and should allow adequate time for discussion.
7.The purpose of evaluation is to improve work performance and job satisfaction The goal of evaluation process should be improve employee performance and satisfaction, rather than to threaten or punish the employee for performance inadequacy. An employee can withstand strong criticism from supervisor who is considerate of the employee’s feelings and offers to coach her/him towards improved performance.
HINTS OF PERFORMANCE APPRAISAL
The employee performance appraisal is a sensitive and important part of the management process, requiring much skill. In performance appraisal, actual performance should be evaluated; this helps the employees know where they stand and what is expected of them.
The following points are to be kept in mind for apprising fairer and more accurate assessment.
1.The appraiser should develop an awareness of his or her own biases and prejudices.
2.Consultation should be sought frequently.
3.Information should be gathered appropriately.
4.Information should be written down and not trusted to memory.
5.Collected assessment should contain positive example of growth and achievement and areas where development is needed.
6.The appraiser needs to guard against the three common pitfalls of assessment-halo effect, horn effect and central tendency.
The "halo effect" occurs when the appraiser lets one or two positive aspects of assessment or behaviour of the employee unduly influence all other aspects of the employee's performance.
The "horn effect" occurs when the appraiser allows some negative aspects of the employee’s performance influence the assessment to such an extent, that other levels of job performance are not accurately recorded.
The manager who falls into the central tendency trap is resistant to risk true assessment and therefore, reties all the employees as average. These appraisal behaviours lead employees to discount the entire assessment of their work.
7.Some efforts must be made to include the employees own appraisal of his or her work.
Tools of Performance Appraisal
1.Trait rating scales (TRS) A rating scale is a method of rating an individual against a set standard, which may be the job description, desired behaviours, or personal traits. The rating scale is probably the most widely used one.
2.Job dimension scales (JDS) The technique that a rating scale be constructed fot each job classification. The rating factors are taken from the context of the written job description.
3.Behaviourally anchored rating scales (BARS) It is also called behavioural expectation scale, that overcome some of the weakness of the rating system. As in JDS, the BARS technique requires that a separate rating form be developed for each job classification.
4.Checklists There are several types of checklist appraisal tools. The weighted scale is composed of many behavioural statements that represent desirable job behaviours. Each of these behaviour statements has a weighted score attached to it. Score is based on employees behaviour or attributes.
The forced checklist requires that supervisor select an undesirable and desirable behaviour for each employee. Both have quantitative values and employee gains ends up with total score.
The simple checklist is composed of numerous words or phrases describing various employees’ behaviours or traits, e.g. assertiveness or interpersonal skill etc.
5.Essays This method is often referred to as the "free from review". Here, the appraiser describes in narrative form, the employee strengths and area where improvement or growth is needed.
6.Self appraisals.
7.Management by objectives.
8.Per review-performance carried out by peers.
Conclusion
Regular evaluation of all aspects of the total college programme is necessary in order to keep up with the changes; technological, social, scientific and advancement in knowledge in the particular discipline. Evaluation by accrediting agencies is a means of keeping up standards of education.
Bibliography:
1)B.T. Basavanthappa, Nursing administration 1st ed., Jaypee brothers; New Delhi: 2005 p
2)TNAI Nursing administration 1st ed. Academy press: Noida: 2000 p
3)Sr. Lucita, Nursing administration, 1st ed. Bharat Publishers: Jabalpur: 2002: p.
4)Patricia. Text book of administration, 3rd ed. Jaypee brothers: New Delhi: 2004: p.