Quality of Nursing Documentation and its Effect on Continuity of patients’ care

Abstract

Background: Nursing documentation is defined as the record of nursing care that is planned and given to individual patients and clients by qualified nurses or other caregivers under the control of a qualified nurse. Purpose of the study: Assess the relation between quality of nursing documentation system and the continuity of patient care at Tanta university hospitals. Study design: Descriptive correlational design was utilized to conduct this study. Study setting: The study was conducted at Tanta University Hospitals affiliated to Ministry of Health. Study sample: A convenient sample of 80 nurse supervisors and simple random sample of 80 staff nurses in intensive care units. Data collection instruments: Data was collected using two instruments adapted by the investigator. The first instrument was a quality of nursing documentation questionnaires. The second instrument was Auditing continuity of patient care checklist. Results: The present study showed that the most of studied samples resulted in accepted level of nursing documentation quality and the majority of total studied samples resulted in average level of continuity of patient care. Conclusion: There was a highly statistically significant positive correlation between quality of nursing documentation and continuity of patient care. Recommendations: Encourage nurses to comply with standard of nursing documentation at intensive care units.

Machine-learning Algorithms for Ischemic Heart Disease Prediction: A Systematic Review

“…This systematic review was guided by the Preferred Reporting Items as the best-recommended methods for Systematic Reviews and Meta-Analyses (PRISMA) guidelines [ 7 ].…”

“…The goal of Electronic Health Records (EHRs) is to improve the efficiency of health management, raise the bar of treatment, and streamline workflow processes in healthcare settings [ 6 ]. Making an accurate diagnosis of cardiac disorders depends on several contributing risk factors and laboratory findings [ 7 ]. In this enormous dataset, it is beneficial to find patterns that can be used to forecast individuals who are at high risk of developing diseases of the heart [ 8 ] using machine-learning algorithms and computers.…”

Persepsi Perawat tentang Penerapan Dokumentasi Keperawatan di Rumah Sakit A

“…Pencatatan dan pelaporan dokumentasi keperawatan tidak hanya bermanfaat untuk kepentingan pasien melainkan untuk kepentingan perawat dan tim kesehatan lain. Dokumentasi kepearawatan menjadi bukti administrasi, medis, hukum, keuangan, penelitian pendidikan, akreditasi, statistik, komunikasi (Hidayat, 2021) dan penjaminan mutu (Abd El Rahman, Ibrahim, & Diab, 2021), sehingga penting untuk disikapi dan dilaksanakan dengan baik oleh perawat.…”

“…Permasalahan terkait dokumentasi keparawatan yang belum optimal secara kualitas dilakukan perawat menjadi hal umum dan global di setiap rumah sakit (Abd El Rahman et al, 2021) termasuk di Indonesia (Togubu et al, 2019) (Kamil, Rachmah, & Wardani, 2018). Hasil penelitian Tasew et al, (2019) menunjukkan bahwa praktik dokumentasi asuhan keperawatan yang dilakukan perawat masih kurang memadai dan lebih dari 50% perawat tidak mendokumentasikan asuhan keperawatan mereka dengan baik (Tasew et al, 2019).…”