Evaluation is the fourth step of the NP and is used to determine the effectiveness of the Care plan establishing if outcomes have been met, whether they should be continued or changed (Kozier et al 2008). .Lynda Juall (2009) states that, evaluation may be the most difficult stage of the NP. Describing evaluation as a step may be incorrect, since evaluation should be a continues process, mentally taking notes and evaluating throughout the implementation stage.