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  2. SOAP note - Wikipedia

    en.wikipedia.org/wiki/SOAP_note

    The four components of a SOAP note are Subjective, Objective, Assessment, and Plan. [1] [2] [8] The length and focus of each component of a SOAP note vary depending on the specialty; for instance, a surgical SOAP note is likely to be much briefer than a medical SOAP note, and will focus on issues that relate to post-surgical status.

  3. Nursing assessment - Wikipedia

    en.wikipedia.org/wiki/Nursing_assessment

    Nursing assessment is the gathering of information about a patient's physiological, psychological, sociological, and spiritual status by a licensed Registered Nurse. Nursing assessment is the first step in the nursing process. A section of the nursing assessment may be delegated to certified nurses aides.

  4. SAMPLE history - Wikipedia

    en.wikipedia.org/wiki/SAMPLE_History

    SAMPLE history is a mnemonic acronym to remember key questions for a person's medical assessment ... Signs/Symptoms (Symptoms are important but they are subjective ...

  5. Kolcaba's theory of comfort - Wikipedia

    en.wikipedia.org/wiki/Kolcaba's_Theory_of_Comfort

    Kolcaba's theory successfully addresses the four elements of nursing metaparadigm. [3] Providing comfort in physical, psychospiritual, social, and environmental aspects in order to reduce harmful tension is a conceptual assertion of this theory. [3] When nursing interventions are effective, the outcome of enhanced comfort is attained. [2]

  6. Review of systems - Wikipedia

    en.wikipedia.org/wiki/Review_of_systems

    A review of systems (ROS), also called a systems enquiry or systems review, is a technique used by healthcare providers for eliciting a medical history from a patient. It is often structured as a component of an admission note covering the organ systems, with a focus upon the subjective symptoms perceived by the patient (as opposed to the objective signs perceived by the clinician).

  7. Caregiver burden - Wikipedia

    en.wikipedia.org/wiki/Caregiver_burden

    The concept of caregiver burden was introduced in the 1960s, distinguishing between objective and subjective aspects of caregiving. Objective burden arises from specific caregiving tasks, while subjective burden typically stems from the emotional strain caused by the excessive demands and potential embarrassment associated with caring for recipients.

  8. Gordon's functional health patterns - Wikipedia

    en.wikipedia.org/wiki/Gordon's_functional_health...

    The following areas are assessed through questions asked by the nurse and medical examinations to provide an overview of the individual's health status and health practices that are used to reach the current level of health or wellness. [1] [2] Health Perception and Management; Nutritional metabolic

  9. Objective structured clinical examination - Wikipedia

    en.wikipedia.org/wiki/Objective_structured...

    An objective structured clinical examination (OSCE) is an approach to the assessment of clinical competence in which the components are assessed in a planned or structured way with attention being paid to the objectivity of the examination which is basically an organization framework consisting of multiple stations around which students rotate and at which students perform and are assessed on ...