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Related Concept Videos

Data Collection II01:29

Data Collection II

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The nursing history captures and records the patient's health status, so that a care plan evolves to meet the patient's individual needs. The nursing health history is a part of the initial assessment. A comprehensive history covers all health dimensions and plays a significant role in the assessment process. A comprehensive history includes the patient's biographical information, reasons for seeking health care, expectations, present and past health history, medications, and...
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Effective documentation is an integral part of nursing practice. Here are some essential guidelines to follow when documenting patient care:
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Introduction to Documentation and Reporting01:20

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Documentation is the systematic process of formally recording, maintaining, and communicating information.
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Guidelines and Strategies for Safe Computer Charting01:18

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Guidelines for Nursing Documentation I01:30

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Quality documentation and reporting share essential characteristics that ensure they are practical and valuable resources for those who use them. These characteristics are:
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Related Experiment Video

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Preserving nursing history

Anne Manchester

    Nursing New Zealand (Wellington, N.Z. : 1995)
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    PubMed
    Summary

    No abstract available in PubMed .

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