Nursing 1160A/B Lecture Notes - Lecture 4: Soap Note, Alternative Medicine
28 Feb 2016
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Thinking like a nurse tools used to make clinical. Used while listening to the patient"s story: theory of validation, in order to answer questions. Pcc health care team must all work in partnership with client to achieve goals. Helps us organize things to deal with circumstances in a logical way. Cognitive thinking process that is systematic used in any setting and level of intervention. Overlapping: occurs when there is an assessment/observation that the planned intervention is not, occurs when assessment is conducted during an implementation (ex. bathing) working. Collect: performing assessments and interviews with client and family, lab results, etc, speaking with hc team, done during all activities should always be observing. Soap note: includes info about client"s strengths and challenges, considers the patient"s reality . Sort, cluster, and analyze the data: identify from nursing perspective what actions can be taken to help the client. Plan nursing actions: not to be confused with medical diagnosis.
