Nursing

STUDENT NAME:

FACILITY:

DATE:

Assessment &

Nursing Diagnostics

Planning Mutual &

Measurable Goals

Implementation

(Intervention)

Scientific Rationale w/

Documented Source for Each Function

Evaluation (Each goal met, unmet, partially met)

Assessment Data:

1. Subjective Data

2. Objective Data

Analyze Data

Nursing Diagnosis:

Short Term Goals:

1.

2.

Long Term Goals:

1.

2.

1. Independent Nursing Functions

a

b.

c.

d.

2. Collaborative Nursing Functions

a.

b.

c.

d.

1. Independent Nursing Functions

a

b.

c.

d.

2. Collaborative Nursing Functions

a.

b.

c.

d.

Short Term Goals:

1. Goal met…(Explain)

2. Goal met…(Explain)

Long Term Goals

1. Goal met partially…(If so, explain)

2. Goal met…(Explain)

Assessment &

Nursing Diagnostics

Planning Mutual &

Measurable Goals

Implementation

(Intervention)

Scientific Rationale w/

Documented Source for Each Function

Evaluation (Each goal met, unmet, partially met)

Assessment &

Nursing Diagnostics

Planning Mutual &

Measurable Goals

Implementation

(Intervention)

Scientific Rationale w/

Documented Source for Each Function

Evaluation (Each goal met, unmet, partially met)