Nursing documentation : legal focus across practice settings

著者

書誌事項

Nursing documentation : legal focus across practice settings

[edited by] Sue E. Meiner

Sage Publications, c1999

  • : cloth
  • : paper

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注記

Includes bibliographical references (p. 269-277) and index

内容説明・目次

内容説明

This book is intended to meet the needs of students and clinicians in determining how they should be recording their practice and what the legal implications of these records may be. The authors first examine the realm of nursing documentation, including the legal implications of current methods of recording. In Part II the book presents the basis for liability in terms of nursing negligence and risk management. The third section explores documentation and its legal implications with respect to the delegation of patient care and across the range of in-patients and outpatient settings.

目次

PART ONE: COMMUNICATIONS IN NURSING PRACTICE Introduction to Documentation, Liability and Nursing Practice - Sue E Meiner Current Approaches in Charting - Sue E Meiner Computer-Based Patient Records - Elizabeth C Mueth Common Problems of Recording in the Medical Record - Sue E Meiner Issues Requiring Reporting and Recording - Sue E Meiner with Linda Steele Reporting Health and Safety Issues - Sue E Meiner PART TWO: THE BASIS FOR LIABILITY Nursing Negligence Issues - Alice G Rini Risk Management and Claims Prevention - Alice G Rini PART THREE: DOCUMENTATION IN PRACTICE SETTINGS Staffing and Delegation of Patient Care - Robyn Levy and Sue E Meiner Recording Patient Care in the Emergency Department - Sue E Meiner Recording Patient Care in the Critical Care Unit - Sue E Meiner Recording Patient Care in the Obstetric Unit - Sue E Meiner Recording Patient Care in the Pediatric Unit - Sue E Meiner Recording Patient Care in Perioperative Nursing - Linda L Zinser-Eagle and Sue E Meiner Recording Patient Care in Psychiatric/Mental Health Nursing - Sue E Meiner Communications in Community and Home Health Care Nursing - Sue E Meiner with Nancy Kuhrick and Marilee Kuhrick Documentation in Extended and Long-Term Care Nursing - Sue E Meiner Advanced Practice Nursing Issues - Linda Steele with Sue E Meiner Nursing Educators, Administration, and Nursing Education - Alice G Rini Managed Care - Sue E Meiner PART FOUR: A NATIONAL HEALTH INFORMATION SYSTEM FOR THE 21ST CENTURY Dialogue for a National Health Information System - Sue E Meiner and Elizabeth C Mueth

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