# Situation: The nurse works on an acute psychiatric unit that uses milieu therapy, attitude therapy, and planned activity groups. Each client has an individual plan of care with measurable outcomes. A 30-year-old man with schizophrenia attends social skills training. His outcome reads: "Starts a conversation with a peer at least twice daily on 3 consecutive days by day 14." Before day 12 he had started no conversations with peers. The nurse's records show: Day 12: started 2 conversations with peers and 1 with staff Day 13: started 1 conversation with a peer and 2 with staff Day 14: started 2 conversations with peers and 0 with staff How should the nurse evaluate this outcome?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=630015  
> language: ko  
> subject: Nursing Practice V — Care of Clients with Maladaptive Patterns of Behavior; Care of Clients with Life-Threatening Conditions, Acute Multi-Organ Problems, High Acuity and Emergency Situations

## 문제

Situation: The nurse works on an acute psychiatric unit that uses milieu therapy, attitude therapy, and planned activity groups. Each client has an individual plan of care with measurable outcomes.

A 30-year-old man with schizophrenia attends social skills training. His outcome reads: "Starts a conversation with a peer at least twice daily on 3 consecutive days by day 14." Before day 12 he had started no conversations with peers. The nurse's records show:
Day 12: started 2 conversations with peers and 1 with staff
Day 13: started 1 conversation with a peer and 2 with staff
Day 14: started 2 conversations with peers and 0 with staff
How should the nurse evaluate this outcome?

## 보기

1. Not met, since on one day only one conversation was with a peer **✔ 정답**
2. Met, since he started at least two conversations every day
3. Met, since he started five conversations with peers in 3 days
4. Met, since he started two peer conversations on day 14, the deadline

**정답: 1**

## 해설

An outcome is evaluated against every element of its criterion: who (a peer), how often (at least twice daily), and for how long (3 consecutive days) by the deadline. Day 13 had one peer conversation, so the outcome is not met even though his total contacts rose. A total count is not the measure the outcome sets.

## 심화 해설

Evaluate against every element of the criterion
The outcome reads: "Starts a conversation with a peer at least twice daily on 3 consecutive days by day 14." Each part is a separate requirement: who the conversation is with, how often it happens each day, and how many consecutive days it must be sustained, all by the deadline. On day 12 he started 2 peer conversations, on day 13 only 1, and on day 14 2. Because day 13 had only one conversation with a peer, the daily minimum was not met on 3 consecutive days, so the outcome is not met.

| Day | Peer conversations | Staff conversations | Meets daily minimum (2 with peers)? |
| --- | --- | --- | --- |
| 12 | 2 | 1 | Yes |
| 13 | 1 | 2 | No |
| 14 | 2 | 0 | Yes |

Why the other evaluations are wrong
Counting conversations with staff gives at least two every day, but the outcome specifies peers, so staff contacts do not count toward it. Adding up five peer conversations over 3 days uses a total, but the criterion is a daily minimum on consecutive days, not a total over the period. Judging only by day 14, the deadline, ignores the requirement that the behavior be sustained on 3 consecutive days. Each of these errors partly reads the outcome but drops one of its elements.

Writing and evaluating measurable outcomes
A well-written outcome is specific, measurable, achievable, relevant, and time-bound. It names the behavior, the condition, the criterion, and the time frame, as this one does. Evaluation then compares the client's actual behavior with each element and concludes whether the outcome is met, partially met, or not met. When it is not met, the nurse reviews the plan, for example by adding more structured opportunities for peer contact in social skills groups, and may revise the time frame.

Watch out! His progress is real: he went from no peer conversations to several. Progress is documented, but the outcome as written is still not met. Evaluation is judged against the criterion, not against effort or improvement alone.

Exam takeaway
Key point! An outcome is met only when every element of its criterion is met: who, how often, how long, and by when. Watch for distractors that substitute totals for daily minimums or include the wrong people.

## 임상 시나리오

Evaluating a Measurable OutcomeSocial skills training in schizophrenia
The outcome requires conversations with a peer, at least twice daily, on 3 consecutive days, by day 14.

Day 13 had only 1 peer conversation, so the outcome is not met, even though his total contacts rose.

Document his progress, review the plan, and add structured opportunities for peer contact; revise the time frame if needed.

CautionStaff conversations and totals over the period do not count toward a daily peer criterion.

## 핵심 개념

- **Expected outcome** — A measurable statement of the client behavior expected, with criteria and a time frame.
- **Evaluation** — The phase of the nursing process that compares actual client behavior with the expected outcome.
- **Social skills training** — A structured therapy that teaches and rehearses interpersonal skills, often used in schizophrenia.
- **SMART outcome** — An outcome that is specific, measurable, achievable, relevant, and time-bound.

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