THE NURSING PROCESS

OVERVIEW OF THE NURSING PROCESS

The use of the nursing process in clinical practice gained additional legitimacy in
1973 when the phases were included in the American Nurses Association (ANA)
Standards of Nursing Practice.
The Standards of Practice within the most current Scope and Standards of Nursing
Practice included the five phases of the Nursing Process:
(a) Assessment
(b) Diagnosis
(c) Planning
(d) Implementation
(e) Evaluation
CHARACTERISTICS OF THE NURSING PROCESS
The nursing process has distinctive characteristics that enable the nurse to respond
to the changing health status of the client.
These characteristics include its cyclic and dynamic nature, client centeredness,
focus on problem solving and decision making, interpersonal and collaborative
style, universal applicability and use of critical thinking.
A regularly repeated event or sequence of
events (a cycle) that is continuously
changing (dynamic) rather than staying the
same (static).
Client centered
An adaptation of problem solving and
systems theory
Decision making is involved in every phase
of the nursing process
The nursing process is interpersonal and
collaborative

Overview of the Nursing Process

PHASE & DESCRIPTION

PURPOSE

ACTIVITIES

ASSESSING
Collecting, organizing, validating and
documenting client data

To establish a database about

the clients response to health
concerns or illness and the
ability to manage health care
needs

Establish a database:

Obtain a nursing health history

Conduct a physical assessment
Review client records
Review nursing literature
Consult support persons
Consult health professionals

Update data is needed

Oraganize data
Validate data
Communicate/Document data

DIAGNOSING
Analyzing and synthesizing data

To identify client strengths and

health problems that can be

Interpret and analyze data.

Compare data against standards

prevented or resolved by
a collaborative and
independent nursing
interventions

Cluster or group data

Identify gaps and inconsistencies
Determine clien ts strengths, risks,
diagnoses and problems

To develop a list of nursing and

collaborative problems
Formulate nursing diagnoses and
collaborative problem statements
Document nursing diagnoses on the
care plan

PLANNING
Determining how to prevent, reduce, or
resolve the identified priority client
problems; how to support client
strengths; and how to implement
nursing interventions in an organized,

To develop an individualized
care plan that specifies client
goals/desired outcomes, and
related nursing interventions

Set priorities and goals/ outcomes in

collaboration with client
Write goals/desired outcomes
Select nursing strategies/interventions
Communicate care plan to relevant

individualized, and goal-directed

manner

health care providers

Reassess the client to update the
database.

IMPLEMENTING
Carrying out ( or delegating) and
documenting the planned nursing
interventions

To assist the client to meet

desired goals/outcomes;
promote wellness; prevent
illness and disease; restore
health; and facilitate coping
with altered functioning

Determine the nurses need for

assistance
Perform planned nursing intervention.
Communicate what nursing action were
implemented.
Document care and client
response to care
Give verbal reports as necessary

To determine whether to
continue, modify, or terminate
the plan of care

Collaborate with client and collect data

related to desired outcomes

EVALUATING
Measuring the degree to which the
goals/outcomes had been achieved and
identify the factors that positively or
negatively influence goal achievement

Judge whether goals/outcomes have

been achieved
Relate nursing actions to client
outcomes
Make decisions about problem status
Review and modify the care plan as
indicated or terminate nursing care

ASSESSMENT
The systematic and continuous collection, organization, validation and
documentation of data.
PURPOSE: to establish a database

Elements of the Assessment Process:

Data Collection
The process of gathering information about a clients health status
Data Verification
The information gathered during the assessment phase must be
complete, factual, and accurate. Validation is the act of doublechecking or verifying data that it is accurate and factual.
Data Organization
Uses a written format that organizes the assessment data
systematically. This is often referred to as a Nursing Health history,
nursing assessment, or nursing database form
Data Documentation
To complete the assessment phase, the nurse records client data.
Accurate documentation is essential and should include all data
collected about the clients health status.

Types of Assessment
TYPE

TIME PERFORMED

PURPOSE

Initial Assessment

Performed within the

specified time after
admission to a health care
facility

To establish a complete
database for problem
identification, reference,
and future comparison

Problem-Focused
Assessment

Ongoing process
integrated within nursing
care

To determine the status of

a specific problem
indentified in an earlier
assessment

Emergency Assessment

During any physiologic or

psychologic crisis of the
client

Time- lapsed Assessment

Several months after initial To compare the clients

assessment
current status to baseline
data previously obtained

EXAMPLE
Nursing admission
assessment

Hourly assessment of a
clients fluid intake and
urinary output

Rapid assessment of a
To identify life-threatening persons airway, breathing
problems
status, and circulation
To identify new or
during a cardiac arrest
overlooked problems
Reassessment of a clients
functional health patterns
in a home care or
outpatient setting or, in a
hospital, at shift change

METHODS OF ASSESSMENT
1. CEPHALOCAUDAL APPROACH
Head-to-toe assessment
2. PROXIMODISTAL APPROACH
Running from the center of the body out towards the distal ends of
appendages
3. SYSTEMIC APPROACH
By System Assessment

COLLECTION OF DATA
TYPES OF DATA
SUBJECTIVE DATA
Apparent only to the person affected and can be described or verified
only by that person
ex. Symptoms (Covert Data)

OBJECTIVE DATA
Detectable by an observer or can be measured or tested against an
accepted standard
ex. Signs (Overt Data)

EXAMPLES:

Subjective

Objective

I feel weak all over when I exert

myself

Blood pressure 90/50

Apical pulse 104
Skin pale and diaphoretic

Client states he has a cramping pain in

his abdomen. States, I feel sick to my
stomach.

Vomited 100 ml green-tinged fluid

Abdomen firm and slightly distended
Active bowel sounds auscultated in all
four quadrant

Im short of breath

Lung sounds cleat bilaterally;

diminished in right lower lobe

Wife states: He doesnt seem so sad

today. (subjective and secondary
source data)

Client cried during interview

I would like to see the chaplain before

surgery

Holding open bible

Has small silver cross on bedside table

Data Collection Method

INTERVIEW
A planned communication or a conversation with a purpose.
Ex: get or give information, identify problems, evaluate change, teach,
provide support

2 Approaches
Directive Interview highly structured and elicits specific information. The
nurse establishes the purpose of the interview and controls the
interview.
o Frequently used when time is limited
Nondirective Interview (Rapport-building interview) the nurse allows the
client to control the purpose, subject matter and pacing

Types of Interview Questions

Open Ended Questions Invite the client to discover and explore,
elaborate, clarify or illustrate their thoughts and feelings.
It is useful at the beginning of an interview or to change
topics and to elicit attitudes
Open-Ended questions may start with what or how
Closed Questions are restrictive and generally require only yes or no
or short factual answers giving specific information
Closed questions often begin with when, where,
who, what, do(did,does) or is(are,was)

The highly stressed person and the person who has

difficulty communicating will find closed questions easier to
answer.

OBSERVATION
To gather data with the use of senses, use of units of measure,
physical examination techniques, interpretation of lab results.

SOURCES OF DATA
PRIMARY- patient/client; The best source of data
SECONDARY family members, significant others, patients record/ chart

DIAGNOSING
NANDA NURSING DIAGNOSES
To use the concept of nursing diagnoses effectively in generating and completing a
nursing care plan, the nurse must be familiar with the terms used, the types and the
components of nursing diagnoses.

Definitions
The term diagnosing refers to the reasoning process, whereas the term diagnosis is
a statement or conclusion regarding the nature of the phenomenon.
PURPOSE:
to identify the clients health care needs and to prepare diagnostic statements

TYPES OF NURSING DIAGNOSES

1. Actual Diagnosis a client problem that is present at the time of the nursing
assessment.
Examples: Ineffective Breathing pattern and Anxiety
An actual nursing diagnosis is bases on the presence of
associated signs and symptoms.
2. Risk Nursing Diagnosis a clinical judgment that a problem does not exist,
but the presence of risk factors indicates that a problem is likely
to develop unless nurses intervene.
Examples: Risk for Infection
3. Wellness Diagnosis Describes the human responses to levels of wellness
in an individual, family or community that have a readiness for
enhancement
Examples: Readiness for enhanced Spiritual well-being or Readiness

for enhanced family coping.

4. Possible Nursing Diagnosis- one in which evidence about a health problem
is incomplete or unclear. A possible diagnosis requires more
data either to support or to refute it.
Example: an elderly widow who lives alone id admitted to the
hospital. The nurse notices that she has no visitors and is
pleased with attention and conversation from the nursing staff.
Until more data are collected, the nurse may write a nursing
diagnosis of Possible Social Isolation related to unknown
etiology.
5. Syndrome Diagnosis a diagnosis that is associated with a cluster of
diagnoses
Examples: Risk for Disuse Syndrome may be experienced by longterm bedridden clients
Clusters of diagnoses associated with this syndrome include:
Impaired Physical Mobility
Risk for Impaired Tissue Integrity
Risk for Activity Intolerance
Risk for Constipation
Risk for Infection
Risk for Injury
Risk for Powerlessness
Impaired Gas Exchange, and so on

Components of a NANDA Nursing Diagnosis

A nursing diagnosis has three components:

(1) The problem and its definition
(2) The etiology
(3) The defining characteristics
FORMAT:
PES
P problem
E- etiology
S- Signs and Symptoms

PROBLEM RELATED ETIOLOGY

TO

Ineffective
Airway
Clearance

Related to

AS
EVIDENCE
D BY

Tracheobronchial As Evidenced
infection
by

SIGNS/
SYMPTOMS

Adventitious
breath sounds
and copious
green sputum
production

Basic Two-part Diagnostic statement

PROBLEM

RELATED TO

ETIOLOGY

Ineffective Airway
Clearance

Related to

Tracheobronchial infection

Basic Three-part Diagnostic statement

STEPS IN DEVELOPING A NURSING DIAGNOSIS
1. Data cues are collected from the assessment phase
2. Data cues are validated and examined

3. Data cues are interpreted and assigned a meaning through the use of critical
thinking
4. Data are grouped into clusters
5. The NANDA list is consulted
6. The first part of the nursing diagnosis statement is written
7. Related to (RT) factors are identified
8. Phrases from steps 6 and 7 are combined to form a two-part nursing
diagnosis

FORMULATING NURSING DIAGNOSES

Example:
FUNCTIONAL
HEALTH
PATTERN

CLIENT CUE
CLUSTERS

Nutritional/
Metabolic

No Appetite since
having cold has
not eaten today; last
fluids at noon today
Nauseated x 2 days

INFERENCES

Imbalanced
Nutrition: less
than body
Requirements

FORMULATING
DIAGNOSTIC
STATEMENTS

Imbalanced
Nutrition: Less
than Body
Requirements
related to decreased
appetite and nausea
and increased
metabolism

Guidelines for Writing a Nursing Diagnostic Statement

GUIDELINE

CORRECT STATEMENT

INCORRECT STATEMENT

1. State in terms of a problem,

not a need

Deficient Fluid Volume (problem)

related to fever

Fluid Replacement (need) related to

fever

2. Word the statement so that it

is legally advisable

Impaired Skin Integrity related to

immobility (legally acceptable)

Impaired Skin Integrity related to

improper positioning (implies legal
liability)

3. Use nonjudgmental statements Spiritual Distress related to inability

to attend to church services
secondary to immobility
(nonjudgmental)

Spiritual Distress related to strict

rules necessitating church attendance
(judgmental)

4. Make sure that both elements Risk for Impaired Skin Integrity
of the statement do not say the related to immobility
same thing

Impaired Skin Integrity related to

ulceration of sacral area (response
and problem cause are the same)

5. Be sure that cause and effect

are correctly stated

Pain: Severe Headache related to

fear of addiction to narcotics

Pain related to headache

Impaired Oral Mucous Membrane

Impaired Oral Mucous Membrane

6. Word the diagnosis

specifically and precisely to

provide direction for planning
nursing intervention

related to decreased salivation

secondary to radiation of neck
(specific)

related noxious agent (vague)

7. Use nursing Terminology

rather than medical
terminology

Risk for Ineffective Airway

Risk for Pneumonia (medical
Clearance related to accumulation of terminology)
secretions in lungs

8. Use nursing terminology

rather than medical
terminology to describe the
probable cause of clients
response

Risk for Ineffective Airway

Clearance related to accumulation
of secretions in lungs (nursing
terminology)

Risk for Ineffective Airway

Clearance related to emphysema
(medical terminology)

PLANNING
Planning is a deliberative, systematic phase of the nursing process that involves
decision making and problem solving.
Planning begins with the first client contact and continues until the nurse-client
relationship ends.
The Nurse refers to the clients assessment data and diagnostic statements for
direction in formulating client goals and designing the nursing interventions
required to prevent, reduce or eliminate the clients problem.

TYPES OF PLANNING
Initial Planning
The nurse who performs the admission assessment usually
develops the initial comprehensive plan of care
Should be initiated as soon as possible after the initial
assessment

Ongoing Planning
Done by all nurses who work with the client
Occurs at the beginning of a shift as the nurse plans the care to
be given that day
The nurse carries out daily planning for the following purposes:
(1) To determine whether the clients health status has changed
(2) To set priorities for the clients care during the shift
(3) To decide which problems to focus on during the shift
(4) To coordinate the nurses activities so that more than one
problem can be addressed at each client contact

 Discharge Planning
The process of anticipating and planning for needs after
discharge
A crucial part of comprehensive health care and should be
addressed in each clients care plan

DEVELOPING CARE PLANS

The end product of the planning phase of the nursing process is a formal or
informal plan of care
Informal Nursing Care Plan a strategy for action that exists in the nurses
mind.
Ex: Mrs. Phan is very tired. I will need to reinforce her health
teaching after she has rested

Formal Nursing Care Plan a written or computerized guide that organizes

information about the clients care.
Provides for continuity of care

Standardized Care Plan formal plan that specifies the nursing care for
groups of clients with common needs
(e.g. all clients with Myocardial Infarction)

Individualized Care Plan tailored to meet the needs of a specific client

needs that are not addressed by the standardized
care plan.

GUIDELINES FOR WRITING NURSING CARE PLANS

The nurse should use the following guidelines when writing care plans:
(1) Date and Sign the plan
- Essential for evaluation, review and future planning
- The nurses signature demonstrates accountability to the client and
to the nursing profession
(2) Use category headings
- Nursing Diagnoses, Goals/Desired Outcomes, Nursing
Interventions, and Evaluation
(3) Use standardized/approved medical or English symbols and key words
rather than complete sentences to communicate your ideas
- Ex: Turn and reposition q2h rather than Turn and reposition the
client every two hours.
(4) Be Specific
- Nurses are working shifts of different lengths, some working
12hour shifts some 8 hour shifts, it is more important to be specific
about expected timing of an intervention.
- Writing down specific times during the 24 hour period will help
clarify
(5) Refer to procedure books or other sources of information rather than
including all the steps on a written plan
- Ex: See unit procedure book for tracheostomy care
(6) Tailor the plan to the unique characteristic of the client by ensuring that the
clients choices are included
- Reinforces the clients individuality and sense of control.
- Ex: Nursing Intervention Provide prune juice at breakfast rather
than other juice, indicates that the client was given a choice of
beverages.
(7) Ensure that the nursing plan incorporates preventive and health
maintenance aspects as well as restorative ones

- Ex: Nursing Intervention Provide active assistance ROM exercise

to affected limbs q2h prevents joint contractures and maintains
muscle strength and mobility
(8) Ensure that the plan contains interventions for ongoing assessment of the
client
- E.g. (Inspect incision q8h)
(9) Include collaborative and coordination activities in the plan
- Ex: The nurse may write interventions to ask a nutritionist of
physical therapist about specific aspects of the client care
(10)Include plans for the clients discharge and home care needs
- The nurse begins discharge planning as the client has been admitted
- Add teaching and discharge plans as addenda if they are lengthy and
complex
THE PLANNING PROCESS
In the process of developing client care plans, the nurse engages in the following
activities:
o
o
o
o

Setting Priorities
Establishing client goals/desired outcomes
Selecting nursing interventions
Writing individualized nursing interventions on care plans

Setting Priorities
The process of establishing a preferential sequence for addressing nursing
diagnoses and interventions
Nurses frequently use Maslows Hierarchy of needs when setting priorities
Priorities change as the clients responses, problems, and therapies change.
The nurse must consider a variety of factors:
Clients health values and beliefs

 Values concerning health may be more important to the nurse

than to the client
When ther is difference in opinion, the client and nurse should
discuss it openly to resolve any conflict
In life-threatening situation the nurse usually must take the
initiative
Clients priorities
The clients perception of what is important conflicts with the
nurses perception of what is important
The nurse aware of potential complications needs to inform the
client and carry out necessary interventions
Resources available to the nurse and client
If the necessary resources are not available, the solution to the
problem might need to be postponed, or the client may need a
referral
Urgency of the health problem
Situations that affect the integrity of the client, those that could
have a negative or destructive effect on the client, also have
high priority
Medical treatment plan
The priorities for treating health problems must be congruent
with the treatment by other health professionals
Ex: a high priority for the client might be to become ambulatory
; however if the primary care providers therapeutic regimen
calls for extended bed rest, then ambulation must assume a
lower priority.

DERIVING DESIRED OUTCOMES FOR NURSING DIAGNOSES

Nursing Diagnosis

Opposite Healthy Responses

(Goals)

Desired Outcomes
The Client will:

Impaired Physical Mobility: inability Improved mobility

to bear weight on left leg, related to Ability to bear weight on left leg
inflammation of knee joint

Ambulate with crutches by the end

of the week

Ineffective Airway Clearance related Effective Airway Clearance

to poor cough effort, secondary to
incision pain and fear of damaging
sutures

Have lungs clear to auscultation

during entire postoperative period
Have no skin pallor or cyanosis by
12 hours postoperation
Within 24 hours after surgery,
demonstrate god cough effort.

TYPES OF NURSING INTERVENTIONS

Nursing Interventions are identified and written during the planning step of the
nursing process.
Independent Intervention
o Activities that nurses are licensed to initiate on the basis
of their knowledge and skills.
o They include: physical care, ongoing assessment,
emotional support and comfort, teaching, counseling,
environmental management.

Dependent Interventions
o Activities carried out under the physicians orders or
supervision, or according to specified routines

Collaborative Interventions
o Actions the nurse carries out in collaboration with other
health team members, such as physical therapists, social
workers, dieticians and physicians

NURSING CARE PLAN

NURSING DIAGNOSIS: Ineffective Airway Clearance Related to Viscous secretions and Shallow Chest
Expansion secondary to Deficient Fluid Volume, Pain, and Fatigue
DESIRED OUTCOMES

NURSING INTERVENTIONS

RATIONALE

Respiratory Status: Gas Exchange as

evidenced by
Absence of pallor and
cyanosis (skin and
mucous membrane)
Use of correct
breathing/coughing
technique after
instruction
Productive cough
Symmetric chest
excursion of at least
4cm

Monitor respiratory status q4h: rate,

depth, effort, skin color, mucous
membranes, amount and color of
sputum
Monitor result of blood gases, chest
x-ray studies and incentive
spirometer volume as available
Monitor level of consciousness.
Auscultate lungs q4h.
Vital signs q4h (TPR, BP, pulse
oximetry)

To Identify progress toward or

deviations from goal. Ineffective
Airway Clearance leads to poor
oxygenation, as evidenced by pallor,
cyanosis, lethargy and drowsiness.

Within 48-72 hours

Lungs clear to auscultation
Respirations 12-22/min; pulse

Instruct in breathing and coughing

techniques. Remind to perform, and
assist q3h.

Inadequate oxygenation causes

increased pulse rate. Respiratory rate
may be decreased by narcotic
analgesics. Shallow breathing further
compromises oxygenation
Enable the client to cough up
secretions. May need encouragement
and support because f fatigue and

100beats/min
Inhales normal volume of air
on incentive spirometer

pain
Administer prescribed Expectorant;
schedule for maximum
effectiveness. Maintain Fowlers or
semi-fowlers position.
Administer Prescribed analgesics.
Notify physician if pain not relieved.

Administer oxygen by nasal cannula

s prescribed. Provide portable
oxygen if client goes off unit (e.g.
for x0ray examination)
Administer prescribed antibiotic to
maintain constant blood level.
Observe for rash and GI or other
side effects

Helps loosen secretions so they can

be coughed up and expelled.
Gravity allows for fuller lung
expansion by decreasing pressure on
abdomen on diaphragm.
Controls pleuritic pain by blocking
pain pathways and altering
perception of pain, enabling client to
increase thoracic expansion.
Unrelieved pain may signal
impending complication.
Supplemental oxygen makes more
oxygen available to the cells, even
though less air is being moved by
the client, therefore reducing the
work of breathing
Resolves infection by bacteriostatic
or bactericidal effect
Allergies to antibiotics are common

IMPLEMENTING
Implementing is the action phase in which the nurse performs the nursing
interventions.
Implementing consists of doing and documenting the activities that are the
specific nursing actions needed to carry out the interventions
The degree of participation depends on the client health status

IMPLEMENTING SKILL
To implement the nursing care plan successfully, nurses need skills
1. Cognitive Skills (intellectual skills) include problem solving, decision
making, critical thinking and
creativity, they are crucial to safe, intelligent nursing
care.

2. Interpersonal Skills all of the activities, verbal and nonverbal, people

use when interacting with one
another.
o The nurse uses Therapeutic Communication to
understand the client and in turn be understood

3. Technical Skills purposeful hands-on skills such as manipulating

equipment, giving injections, bandaging, moving, lifting
and repositioning client
o Technical skills require knowledge and frequently
manual dexterity

PROCESS OF IMPLEMENTING
The process of implementing normally includes the following:
Reassessing the patient
o To make sure the intervention is still needed
Determining the nurses need for assistance
o The nurse may require assistance for one or more of the
following reasons:
o The nurse is unable to implement the nursing
activity safely or efficiently (e.g. ambulating and
unsteady or obese client)
o Assistance would reduce stress on the client (e.g.
turning a patient who experiences acute pain when
moved)
o The nurse lacks the knowledge or skills to
implement a nursing activity (e.g. a nurse who is
not familiar with a particular model of traction
equipment needs assistance the first time it is
applied)
Implementing the nursing interventions
o It is important to explain to the client what interventions
will be done what sensations to expect, what the client is
expected to do, and what the expected outcome is
Supervising the delegated care
o If care has been delegated to other health care personnel,
the nurse responsible for the clients overall care must
ensure that the activities have been implemented
according to the care plan.

Documenting nursing activities

o The nurse completes the implementing phase by

recording the interventions and client responses in the
nursing progress notes
o The nurse may record routine or recurring activities (e.g
mouth care) in the client record at the end of the shift

EVALUATING
The fifth and last phase of the nursing process.
Evaluating is a planned, ongoing, purposeful activity in which clients
and health care professionals determine
(a)
(b)

The clients progress toward achievement of goals/outcomes

and
The effectiveness of the nursing care plan

Conclusion drawn from the evaluation whether nursing interventions

should be continued, terminated or changed
Evaluation is continuous.
Evaluation continues until the client achieves the health goal or is
discharged from nursing care.
PROCESS OF EVALUATING CLIENT RESPONSES
Collecting data
Comparing data with outcomes
When determining whether a goal has been achieved, the nurse
can draw one of three possible conclusions:
1. The goal was met, the client response is the same as the desired
outcome
2. The goal was partially met, either a short term goal was achieved
but the long-term goal was not, or the desired outcome was only
partially attained
3. The goal was not met
Relating nursing activities to outcome
Drawing conclusions about problem status

When goals have been met, the nurse can draw one from the
following conclusions:
The actual problem stated in the nursing diagnosis has been resolved, or the
potential problem is being prevented and the risk factors no longer exists
The potential problem stated in the nursing diagnosis is being prevented, but
the risk factors are still present
The actual problem still exists even though some goals are being met
When goals have been partially met or when goals have not
been met, two conclusions may be drawn:
The care plan may need to be revised, since the problem is only partially
resolved.
OR
The care plan does not need revision, because the client merely needs more
time to achieve the previously established goal(s)
Continuing, Modifying, and Terminating the Nursing Care Plan
o Before making modifications, the nurse must determine
if the plan as a whole was not completely effective

EVALUATING THE QUALITY OF NURSING CARE

In each of the processes described below, nurses and all health care
providers work together as an interdisciplinary team focused on improving
client care.
Quality Assurance
o An ongoing systematic process designed to evaluate and
promote excellence in the health care provided to clients.
o Refers to evaluation of the level of care provided in a
health care agency.
- Requires 3 components:

o Structure Evaluation focuses on the setting in which

care is given. It answers this question:
what effect does the setting have on the
quality of care?
o Process Evaluation focuses on how the care was given.
It answers the questions such as these: Is the care
relevant to the clients needs?, Is the care appropriate,
complete, and timely?
o Outcome Evaluation focuses on demonstrable changes
in the clients health status as a result of nursing care.

Quality Improvement
Nursing Audit the examination and review of records
o Retrospective Audit the evaluation of a client record after
discharge from an agency
o Concurrent Audit the evaluation of clients health care while the
client is still receiving care from the agency.

NURSING CARE PLANS