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SOAPIER Documentation

SherieChristina Fundamentals of Nursing Inglés 10 fichas 3.716 visitas

Fichas del conjunto (10)

  1. 1SOAPIER DefinitionAn acronym for seven different aspects of charting. For notes on specific patient problems, only the necessary parts needed for completeness are used.
  2. 2SOAPIER (S)S:
    Subjective information is what the patient states or feels; only the patient can provide this information.
  3. 3SOAPIER (O)O:
    Objective information is what the nurse can measure or factually describe.
  4. 4SOAPIER (A)A:
    Assessment refers to an analysis or potential diagnosis of the cause of the patient's problem or need.
  5. 5SOAPIER (A)A:
    Assessment refers to an analysis or potential diagnosis of the cause of the patient's problem or need.
  6. 6SOAPIER (P)P:
    Plan is the general statement of the plan of care to be given or action to be taken.
  7. 7SOAPIER (I)I:
    Intervention or implementation is the specific care given or action taken.
  8. 8SOAPIER (E)E:
    Evaluation is an appraisal of the response and effectiveness of the plan.
  9. 9SOAPIER (R)R:
    Revision includes the changes that may be made to the original plan of care.
  10. 10SOAPE DefinititionThe briefer adaptation of the charting format for the POMR.

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Fundamentals of Nursing Fichas sobre SOAPIER Documentation, creado por SherieChristina el 15/05/2015.
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