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It makes the process of nursing assessment visible through what is presented in the documentation content. [4] During nursing assessment, a nurse systematically collects, verifies, analyses and communicates a health care client's information to derive a nursing diagnosis and plan individualized nursing care for the client. [5]
The information contained in the medical record allows health care providers to determine the patient's medical history and provide informed care. The medical record serves as the central repository for planning patient care and documenting communication among patient and health care provider and professionals contributing to the patient's care.
Modern concerns include the degree of disclosure to insurance companies, employers, and other third parties. The advent of electronic medical records (EMR) and patient care management systems (PCMS) have raised new concerns about privacy, balanced with efforts to reduce duplication of services and medical errors .
PICOT formatted questions address the patient population (P), issue of interest or intervention (I), comparison group (C), outcome (O), and time frame (T). Asking questions in this format assists in generating a search that produces the most relevant, quality information related to a topic, while also decreasing the amount of time needed to produce these search results.
Another ethical challenge of therapeutic privilege which is discussed by Finnerty, is the question of who is qualified to judge the effect of non-disclosure on a patient which is critical consideration for a decision, ‘Insofar as it could be, what was clear from the case law was that it is the medical professional’s judgement of the effect ...
Peer review in nursing is the process by which practicing registered nurses systematically access, monitor, and make judgments about the quality of nursing care provided by peers as measured against professional standards of practice. In Nursing, as in other professions, peer review applies professional control to practice, and is used by ...
The first scholarly textbook for nursing is generally accepted as Text-Book of the Principles and Practice of Nursing by Bertha Harmer, a Canadian nurse and early nurse educator. Virginia Henderson is regarded as one of the earliest nurse educators to expand the scholarly writings of nursing into textbooks for use in schools and colleges of ...
Nursing Times has regularly run campaigns on issues affecting nurses including most recently Time Out for Training (2008), A Seat on the Board (2010–2011), Speak Out Safely (2013–2014) and Covid-19: Are You OK (2020–). In 2018, Nursing Times was inducted into the International Academy of Nursing Editors’ Nursing Journal Hall of Fame. It ...