Charting by Exception, or CBE, is a method of documentation used in healthcare, particularly in nursing, that focuses on documenting only significant or abnormal findings rather than recording every detail. This approach aims to streamline the documentation process, improve efficiency, and ensure that healthcare providers can quickly identify deviations from normalcy in patient assessments.
In CBE, healthcare professionals establish predefined standards of practice that define what constitutes...

Health promotion allows a person to control the determinants of health, resulting in an improved health status. It enhances the quality of life and reduces premature deaths. Health promotion and illness prevention programs help people make beneficial choices to reduce the risk of disease and disabilities. There are three health promotion and illness prevention levels: primary, secondary, and tertiary prevention.
In primary prevention, actions taken before disease onset prevent the disease from...

Problem-intervention-evaluation (PIE) is a systematic approach to documentation used in healthcare settings for clinical decision-making and patient care planning. It is a structured approach to organizing patient data based on problems, interventions, and evaluations. Here's a breakdown of its key features and considerations:

The levels of care describe the services provided in the healthcare system. Accordingly, there are six levels of the traditional healthcare system in the US: preventive, primary, secondary, tertiary, restorative, and continuing healthcare. A nurse must understand how the healthcare industry organizes and provides services within these levels of care.
The preventive healthcare service includes tests for screening. Preventive health care services include identifying and reducing disease risk...

Creating and executing a nursing diagnosis helps nurses plan care and guide patient, family, and community interventions. They are developed based on a patient's physical evaluation and support measuring the outcomes. It is not recommended to select random interventions throughout the planning process. Instead, consider the following six essential factors when choosing interventions:

Theories play an essential role in organizing patient care. Theories refer to a proposed or followed belief, policy, or procedure that is the basis for action. Nursing theories are knowledge-based concepts that guide nurses' actions, influence nursing education and practice, and allow nurses to care for their patients.
Theories provide a perspective to assess patients' conditions and organize data and methods. They also assist in analyzing and interpreting information. They represent a...