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Nursing documentation: Frameworks and barriers

WENDY BLAIR AND BARBARA SMITH

NZNO, HWNZ Post Graduate Coordinators Group, MidCentral Health Nurse Governance Council,
Palmerston North, New Zealand
The quality of nursing documentation is an important issue for nurses both nationally and internationally. Nursing docu-
mentation should, but often does not show the rational and critical thinking behind clinical decisions and interventions,
while providing written evidence of the progress of the patient. A number of frameworks are currently available to assist
with nursing documentation including narrative charting, problem orientated approaches, clinical pathways, and focus
notes. However many nurses still experience barriers to maintaining accurate and legally prudent documentation.
A review of nursing documentation of patient care and progress towards achieving outcome goals in our organisation
identified a lack of clear and easy to follow information about the patient’s progress. In order to address with this issue a
project group was established to look at different frameworks for nursing documentation. The aim of the project was to
identify and implement a documentation framework that would encourage critical thinking and provide evidence of the
rationale for nursing actions utilising a problem based approach in order to provide accurate evidence of patient progress.
This paper provides a synopsis of available literature related to the frameworks mentioned above, highlights barriers to
safe, timely and accurate documentation for nurses, and concludes with an explanation of the framework chosen as a result
of this review.

Keywords: nursing documentation; nursing reports; literature review; progress notes

T he quality of nursing documentation is an

important issue for nurses both nationally and
internationally. It is clear from many cases on the
New Zealand Health and Disability Commissioner
Website (Health and Disability Commissioner,
2009) that issues related to poor nursing docu-
mentation need to be urgently addressed. Different
nursing documentation methods such as SOAPIE
are used to provide frameworks that guide nursing
documentation. However these methods do not
necessarily meet the documentation needs of busy
clinical areas in the current health environment
because they focus on single problem entries and
patients are often complex with multiple problems.
Nursing documentation in our organisation
has lacked a clear rationale for clinical decisions
and evidence of critical thinking. In order to deal
with this issue a project group was established to
look at different methods of nursing documenta-
tion. The aim of this project was to identify a
method that would encourage critical thinking
by using a problem based approach. This article
provides a summary of the literature reviewed at
the commencement of this project and a sum-
mary of the framework chosen as a result of this
review.
The review of literature sought to identify cur-
rent methods of nursing documentation in order
to identify any that could be used to improve
the quality of nursing progress notes. A litera-
ture search was performed using CINAHL and
MEDLINE. Key words used included the follow-
ing; documentation, progress notes, and nursing
reports. The review focused on documentation
methods, problem orientated documentation,
barriers to documentation, risk management, and
legal implications. Literature published between
1998 and 2011 was reviewed. Some seminal pieces
of literature have been included from 1974 to 1997
as these provide relevant background informa-
tion. Much of the more recent literature available
is in the form of systematic reviews with a focus
on electronic documentation (Kelly, Brandon,
& Dicherty, 2011), audit instruments (Wang,
Hailey, & Yu, 2011), and accuracy of documenta-
tion (Paans, Nieweg, Van der Schans, & Sermeus,
2011) which have not been discussed in this paper.
Much of the available literature accessed was
related to nursing documentation within acute
care settings and originated from Europe (Darmer
et al., 2006; Ehrenberg & Birgersson, 2003;
Ehrenberg, Ehnfors, & Thorell-Ekstrand, 1996;

160 CN Volume 41, Issue 2, June 2012


Hellesø & Ruland, 2001; Idvall & Ehrenberg,
2002) with a focus on electronic documentation
(Gjevjon & Hellesø, 2010; Häyrinen & Saranto,
2009; Kelly et al., 2011; Laitinen, Kaunonen, &
Astedt-Kurki, 2010). Several articles were direct
translations from their original language mak-
ing some of the information hard to decipher
and resulting in the original meaning being lost
(Ioanna, Stiliani, & Vasiliki, 2007; Karlsen, 2007).
Relevant Australian literature was sparse and
covered issues related to documentation in aged
care settings (Daskein, Moyle, & Creedy, 2009;
Pelletier, Duffield, & Donoghue, 2005) and a hos-
pital wide nursing documentation project (Tranter,
2009). A specific search for New Zealand litera-
ture uncovered one publication which outlined
the SOAP method of documentation (Gagan,
2009), and discussed the benefits and advantages
of using this framework. Also present were articles
aimed at providing nurses and other health care
professionals with extra guidance about different
methods of documentation and the important
components of legally prudent progress notes
(Burgum, 1996; Dimond, 2005b; Griffith, 2004;
Grooper & Dicapo, 1995). A variety of guidelines
to assist with development of institutional policies
for nursing documentation were also located via
the internet (College of Nurses Ontario [CNO],
2005; College of Registered Nurses of British
Columbia [CRNBC], n.d.; Nurses Board of South
Australia [NBSA], 2006).
NURSING DOCUMENTATION FRAMEWORKS
Quality of documentation is an important issue
for the current nursing workforce in New Zealand.
Documentation is defined by the CRNBC (n.d.,
p. 5) as ‘any written or electronically generated
information about a client that describes the care
or service provided to that client’. Nursing docu-
mentation is ‘an integral part of safe and effective
nursing practice’ (CNO, 2005, p. 3), and should
communicate observations, decisions, actions
and outcomes related to patient issues and care.
Documentation should accurately reflect the
health status of the patient and the care deliv-
ered while reflecting the patient’s perspective of
their health and health care (CNO, 2005). The
importance of accurate timely documentation for
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Nursing documentation CN
continuity of care and reduction of risk has also
been raised as an issue in other health related disci-
plines, with social work and physical therapy expe-
riencing similar challenges to nursing (Delaune &
Bemis-Dougherty, 2007; Reamer, 2005).
Anecdotal evidence suggests that the stan-
dard of nursing documentation is suffering as a
result of the time pressure that nurses in many
clinical environments are experiencing. Current
issues include the lack of timely entries, lack of
comprehensive and accurate information, and a
lack of accurate assessment information and fol-
low through care planning. Accurate documenta-
tion facilitates communication, promotes nursing
care, helps to meet professional and legal require-
ments, aids quality improvement and health care
research, and helps demonstrate accountability
(CNO, 2005; CRNBC, n.d.; Griffith, 2004;
NBSA, 2006). Conversely poor documentation
potentially negatively affects patient care, profes-
sional accountability and organisational risk.
There are a variety of frameworks for managing
nursing documentation in the literature accessed
for this review. These include narrative charting,
problem orientated approaches, clinical path-
ways, and focus charting. Other tools such as the
North American Nursing Diagnosis Association
(NANDA) nursing diagnoses have also been used
to enhance the quality of nursing documentation
(Müller-Staub, Needham, Odenbriet, Lavin, &
van Achterberg, 2007).
Narrative charting involves documenting
interventions and their impact in chronological
order covering a set time frame (CNO, 2005;
CRNBC, n.d.). When nurses write progress notes
using this method they tend to write a lot mak-
ing it difficult to retrieve relevant information
from the notes in a timely way. Narrative notes
also tend to be time consuming and repetitive
and may not reflect the nursing process (Hager &
Munden, 2008; Mosby, 2006). This framework is
not ideal for our current health care environment
even though it is still commonly used by many
nurses to document the care they provide.
One of the potential solutions to the lack of
critical thinking and clinical reasoning within
current nursing documentation could be the use
of a problem-orientated approach. This is not a
Volume 41, Issue 2, June 2012 CN 161
CN Wendy Blair and Barbara Smith
new approach to documentation as much of the
available literature about problem-orientated
nursing notes is not contemporary ranging from
1972 to 2003. In the past problem-orientated
notes have been used to record all elements of
patient care (Ehrenberg et al., 1996; Thoma &
Pittman, 1972). This system of charting involves
using a problem sheet to document identified
nursing problems, a care plan that established
specific actions for each identified problem, nar-
rative notes related to interventions carried out in
relation to the problem, and a flow sheet (obser-
vation chart) allowing sequenced recording of
tasks related to the patient i.e., vital signs (Thoma
& Pittman, 1972).
The VIPS model (developed in Sweden) is a
problem oriented approach developed in 1991 to
support the systematic documentation of nurs-
ing care while promoting individualised care
(Ehrenberg et al., 1996). This model is based on
the concepts of well-being, integrity, prevention,
and safety. It consists of two levels: the first cor-
responds with the nursing process model (nurs-
ing history, status, diagnosis, goal, intervention,
outcome, and discharge) and the second with
subdivisions for nursing history, status and inter-
ventions. The VIPS model provides a structured
way of documenting nursing care that makes
nurses think more about how they interact
with patients, allowing more of a nursing focus
(Bjorvell, Wredling, & Thorell-Ekstrand, 2003).
This type of charting can be used to facilitate
skilled nursing care and should be considered as
a valuable method of recording nursing informa-
tion (Thoma & Pittman, 1972).
A study exploring the use of the VIPS model
with electronic documentation found that the
documentation was more systematic and that the
use of abbreviations was limited (Rykkje, 2009)
making it more legally prudent. However evi-
dence suggests that nurses using this model found
it more time consuming, limiting the time they
could spend with their patients (Bjorvell et al.,
2003). This could add to problems related to
time and workload in our current health care
environment thereby limiting the usefulness of
this method of documenting. Despite this many
of the concepts contained in problem orientated
162 CN Volume 41, Issue 2, June 2012
models for documentation could be used to
enhance other structured models to increase the
flow through of information from assessment to
care plan (Darmer et al., 2006).
The SOAP/SOAPIER method is another
problem oriented approach which includes sub-
jective and objective assessment data, plan of care,
interventions, evaluation and reflection (CNO,
2005; CRNBC, n.d.). SOAP notes provide a for-
mat that is clear, brief, and supports good prob-
lem solving and is a method used by many health
related fields including chiropractors (Hamilton,
1992), dental hygienists (Jacks, Blue, & Murphy,
2008), pharmacists (Kassam et al., 2001), per-
sonal trainers (Ball & Murphy, 2008) and doctors,
as a means of recording patient care information.
Professions using the SOAP/SOAPIER for-
mat find it works well for single problem entries
(Hamilton, 1992; Jacks et al., 2008; Kassam
et al., 2001). However nursing progress notes
frequently need to refer to multiple problems,
potentially making this format more difficult to
use as it often fails to specify foci for the note
resulting in large entries that are jumbled and dis-
organised. Records that use the SOAP format can
also shift the focus from the patient to the disease
thereby perpetuating a disease-focused biomedi-
cal model of practice, making it a less desirable
documentation approach for nursing (Donnelly,
2005). In order to counteract this and create a
more patient-centred approach Donnelly (2005)
suggests that SOAP could be modified to HOAP
(history, observations, assessment and plan) in
order to ensure all aspects, including a compre-
hensive history are covered.
Despite these issues SOAP/SOAPIER seems
to be the preferred method of documentation
for nursing notes within the literature accessed.
The SOAP notes format was introduced into our
organisation in 2004 to try and improve nursing
documentation. However it has not proved to be
as effective as we had wished due to the tendency
for nurses to use SOAP to write a full retrospec-
tive shift report rather than a single problem entry.
This has resulted in reports that are often missing
important information related to specific patient
problems and containing irrelevant information
making them wordy and time consuming to read.
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Nursing documentation requires a format
that allows easy access to relevant information.
Clinical care pathways, such as an integrated care
pathway (ICP), can be developed to provide a
standardised form of documentation. They can
be used along side clinical risk and clinical gov-
ernance frameworks to manage care for patients
with similar diagnoses or problems, in order to
optimise treatment and patient satisfaction using
a multidisplinary approach (Hensen, Ma, Luger,
Roeder, & Steinhoff, 2005; McGeehan, 2007).
ICPs can be used to improve consistency of patient
care while placing importance on the provision
of individually appropriate interventions. They
can also act as a single record of care and provide
‘explicit standards’ in order to reduce unnecessary
variations in interventions (Middleton, Barnette,
& Reeves, 2001).
Some of the advantages of ICPs include
decreasing or eliminating paperwork, demon-
strating the standard of care, and decreasing the
time required to complete documentation allow-
ing more time for direct patient care (Armon,
MacFaul, Werneke, & Stephenson, 2004).
Disadvantages include a lack of individualised
planning and difficulties with recording unex-
pected issues or problems (Lee, 2005). Care path-
ways have been introduced and used successfully
within our organisation, but have not provided a
solution for our continuing issues related to the
lack of documented clinical decision making and
evidence of critical thinking in nursing progress
notes.
The focus note method of documentation was
developed in the 1990s to combat difficulties
related to the SOAP format in a small hospital in
America (Lampe, 1997). Focus charting identifies
specific problems during assessment; care is then
documented under the headings of data (subjec-
tive and objective), actions, and responses (DAR).
With this type of documentation a focus or prob-
lem is identified and the notes follow a clearly
defined format enabling information to be easily
located within the progress note (Lampe, 1997).
A variation of this type of documentation method
may assist with issues related to the documenta-
tion of clinical decision making and disorganised
progress notes by providing a framework that
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Nursing documentation CN
encourages identification of patient problems and
the ability to link those problems to functional
health patterns (Ioanna et al., 2007).
Literature suggests that no mater what docu-
mentation framework is used nurses require
continuing education related to documentation
in order to improve and maintain standards.
Educational programmes should be readily avail-
able and focus on diagnostic reasoning and criti-
cal thinking (Darmer et al., 2006; Lee, 2005).
Providing suitable timely education creates a chal-
lenge in our current system as it is often difficult
to get nurses away from the patient care environ-
ment for education even thought they learn better
when this occurs (Van der Wal, Dalzeal, & Kitzul,
2009).
It is clear that despite nursing documentation
being critical to safe and effective care it is some-
what unpopular, and is often seen as not being
as important as hands on nursing care (Hoban,
2003). With increasing budget constraints, infor-
mation technology, and expanded nursing roles
into more specialised areas of practice, nurses
require a method of documenting that is quick
and efficient (Pelletier et al., 2005). With the
advent of small portable computers, electronic
record keeping is rapidly becoming a viable
option within many health care settings. As a
result guidelines are now available to assist nurses
with the use of technology in documenting nurs-
ing care (CNO, 2005; CRNBC, n.d.) and suit-
ably efficient clinical systems and tools should
allow nurses to provide ‘exceptional documenta-
tion’ (Laughlin & Van Nuil, 2003).
Using well designed computer technology
to document care at the point of contact can
improve the speed and quality of documenta-
tion, resulting in more time for direct patient
care (Banner & Olney, 2009; Bosman et al.,
2003; Spencer & Lunsford, 2010). Challenges
to the use of electronic documentation include
the distances between health care regions; organ-
isational challenges related to the need for a user
friendly system; and professional challenges such
as standardising the language used and manag-
ing the change from paper to electronic records
in a constructive and supportive way (Hellesø &
Ruland, 2001; Van der Wal et al., 2009). In order
Volume 41, Issue 2, June 2012 CN 163
CN Wendy Blair and Barbara Smith
to make it practical for such packages to be used
for progress notes, computer terminals would
need to be readily available to the nurse which
remains a challenge in many New Zealand health
care environments.
Hand written notes have historically been ritu-
alistic, lacking in essential information (Wilson,
1998) and messy making them hard to read.
Electronic documentation may help to allevi-
ate problems related to legibility and the use of
abbreviation in the future (Dimond, 2005a).
Barriers to electronic documentation include lack
of computer experience, slow or poorly func-
tioning equipment, a lack of support from other
staff, and time taken to log on and off the system
(Whittaker, Aufdenkamp, & Tinley, 2009).
BARRIERS TO DOCUMENTATION
Nursing documentation has been discussed in
the literature for many years with a wide range
of studies looking at methods and barriers.
Nurses encounter major barriers to documen-
tation including time constraints, mismatches
between staffing resources and work load, lack
of clear guidelines for completing documenta-
tion, ambivalence towards documentation, and
the bureaucratic systems and institutional policies
often associated with keeping accurate documen-
tation (Dion, 2001; Meurier, 1998; Owen, 2005;
Tingle, 2001).
These problems with nursing documenta-
tion are well publicised (Kärkkäinen & Eriksson,
2005; Owen, 2005). Anecdotal evidence suggests
that nurses can view documentation as a time con-
suming nuisance. It is often left until last, result-
ing in hurried entries that lack depth and detail,
risking the loss of important data and potentially
leading to poorer patient outcomes. Nursing
documentation is often deficient, not only gen-
erally, but for specific types of records such as
wound and ulcer care (Ehrenberg & Birgersson,
2003), care of those presenting with chest pain
(Meurier, 1998), and pain management (Idvall &
Ehrenberg, 2002).
Documentation often takes nurses away from
the bedside because of the environment and rou-
tines of the clinical area. Research suggests that
nurses in acute care settings can spend up to
164 CN Volume 41, Issue 2, June 2012
25–50% of their time on documentation which
can result in less time spent with patients or work-
ing overtime to complete progress notes (Gugerty
et al., 2007; Trossman, 2002). It is clear that
nurses need to allocate time and use appropri-
ate tools for documentation in order to enhance
professional practice and patient outcomes (Reed,
1991; Wood, 2002).
Documentation has both practical and legal
implications for nursing world wide. Being able
to document in a clear succinct, legible and
legally prudent way can significantly reduce the
risk of misunderstanding and negative patient out
comes related to poor communication. Nurses
need to understand that their documentation can
be scrutinised when there has been a complaint
or incident resulting in harm (sentinel event).
Investigations of complaints and sentinel events
are undertaken in New Zealand through courts of
law or by the Health and Disability Commissioner
(New Zealand Government, 1994). Findings
from these investigations are then passed on to
the relevant professional body such as the Nursing
Council of New Zealand and evidence of poor
documentation can then be used as evidence for
professional misconduct (McGeehan, 2007).
Clinical records including nursing progress
notes contain ‘the most central information
and communication’ about patient care used by
healthcare professionals (Hellesø & Ruland, 2001
p. 799), and are one of the main sources of evi-
dence used to investigate complaints (Pennels,
2001). In some situations clinical records such
as progress notes may be the only record of the
healthcare professionals’ version of what took
place in relation to a patients care (New Zealand
Nurses Organisation, 1998).
The time taken for documentation could be
better managed by documenting ‘what should be
done’, ‘what has been done’ and ‘the outcomes of
that care’, rather than developing lengthy care plans
and nursing diagnoses (Burgum, 1996, p. 40) and
by documenting throughout the shift rather than
waiting until the end (Hoban, 2003). While it is
clear that frameworks can be used to aid the docu-
mentation process; however frameworks such as ‘the
nursing process’ could also hinder documentation
by making it more confusing and time consuming
© eContent Management Pty Ltd

(Ehrenberg & Birgersson, 2003). Nursing docu-
mentation needs to be streamlined so that it is less
time consuming. However current literature does
not elaborate on how this could be achieved.
Patients and relatives are now able to access notes
and read what has been written. As a result nurses
and other health care professionals also need to be
more prudent in how they document (Dimond,
2005a) and ensure that appropriate language is
used and appropriate entries documented. The
use of abbreviations and acronyms in documenta-
tion is problematic and a clear patient safety issue
as misinterpretation within medical and nursing
notes can lead to medical/nursing errors (Dimond,
2005a; Kuhn, 2007). Clear accurate documenta-
tion combined with effective communication is
an effective method of risk prevention within the
clinical setting (Tingle, 2001; Wilson, 1998).
TOWARD THE FUTURE: FOCUS CHARTING
As a result of this literature review we chose
to investigate the use of focus charting as the
method of documenting nursing notes for our
organisation. This method was chosen because
it encourages the clear identification of a focus
for the nursing note and provides a clear frame-
work that fits well with the nursing process which
nurses already use. It also provides information
within the nursing notes that is easy to locate as
the reader can go to the appropriate focus and see
the patients’ progress.
An outline of the focus charting method was
provided to all nursing staff and after receiv-
ing feedback we modified the method so that
it related more to the nursing process, which is
foundational to nursing within our organisa-
tion. The project group changed the original
‘data, action, response’ (DAR) to ‘assessment,
implementation, and evaluation’ (AIE). The
focus charting method reflects and simplifies the
steps in SOAPIE making it easier for nurses to
document multiple problems accurately. Figure 1
below shows the relationship between the nursing
process, SOAPIE and the AIE of focus charting.
An extra column was then added to the medi-
cal and nursing note form on the left hand side
beside the date column. This ‘focus’ column gave
nurse a place to document a statement or word
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Nursing documentation CN
FOCUS
S
A
A O
D
A
Care P
Plan I P
I
I
E E
E
FIGURE 1: RELATIONSHIP BETWEEN FOCUS CHARTING THE
NURSING PROCESS AND SOAPIE
that identified the focus of the entry e.g., mobil-
ity. This space can also be used to write the letters
A, I and E as a prompt for nurses to record rel-
evant assessment data, nursing interventions, and
evaluation information for each focus thus mak-
ing it easy to identify the relevant information.
A pilot of this form and the focus charting
method was carried out within our assessment,
treatment and rehabilitation (AT&R) wards. The
similarity between the focus method and SOAPIE
meant that nurses did not have to learn some-
thing totally new but rather apply their knowl-
edge of the nursing process in a simplified way.
Within 2 weeks of beginning staff education 70%
of nurses were successfully using this method of
documentation for their patient progress notes.
Two weeks later there was 100% uptake and feed-
back from nurses, medical staff and allied health
workers was extremely positive. There had also
been a notable improvement in the standard of
documentation evidenced by audits remaining
consistently over 95%.
A demonstration of the effectiveness of focus
charting was also gained during the pilot project
when one of the wards involved had an out break
of Norovirus. During previous outbreaks of this
kind it had taken two staff several days to review
25 sets of patient notes in order to track the out-
break. However on this occasion it took one person
approximately 3 hours to achieve the same result.
The auditor was able to easily identify all the rel-
evant nursing entries by using the focus column to
access relevant data related to each patient’s nurs-
ing care through the A, I and E comments along
Volume 41, Issue 2, June 2012 CN 165
CN Wendy Blair and Barbara Smith
side the focus entry. This enabled the organisation
to manage patient care more effectively and react
promptly to infection control issues.
CONCLUSION
Good nursing documentation clearly and con-
cisely communicates the observations, actions
and outcomes of care, in a timely and accurate
manner. However nurses constantly struggle to
document in a way that is timely, accurate and
legally prudent. Poor nursing documentation can
place patients, staff and organisations at consid-
erable risk of physical and legal harm. Nurses
experience many barriers to completing docu-
mentation in an acceptable way. These include
time, workload constraints, attitudes towards
documentation, and institutional policies associ-
ated with documentation.
Frameworks for documentation such as focus
charting help to improve the standard of docu-
mentation and the standard of care patients
receive. After the completion of the pilot study
in our organisation focus charting was rolled out
to acute medical/surgical areas, clinics, and criti-
cal care areas that were not already using a prob-
lem focused approach. Resources and education
plans were developed to facilitate the use of this
method and we continue to provide support and
education for staff to improve documentation.
For our organisation the focus charting method
of documentation has provided solutions as well
as ongoing challenges related to longer term
compliance.
The next stage of our project is to review the
effectiveness of this method of documentation
through the development and implementation
of a specific audit tool. Along side this we have
a plan to continue regular education related to
focus documentation in order to fully imbed
this change into nursing practice. We recom-
mend that other organisations struggling with
documentation issues look at the focus note
method as it is easily adapted to different clini-
cal situations and supports nurses to provide
legally prudent information related to patient
care.
ACKNOWLEDGEMENTS
MidCentral Health Nursing Governance Council.
166 CN Volume 41, Issue 2, June 2012
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Received 29 March 2011 Accepted 27 October 2011

N O W AVA I L A B L E
MIXED METHODS RESEARCH IN THE HEALTH SCIENCES
A special issue of Int J Multiple Research Approaches – Volume 5 Issue 1 – ii+142 pages – ISBN 978-1-921348-93-8 – February 2011
Editors: Elizabeth Halcomb (School of Nursing and Midwifery, University of Western Sydney, Sydney, NSW) and
Sharon Andrew (Department of Acute Care, Faculty of Health and Social Care, Anglia Ruskin University, Chelmsford, UK)
Editorial: Dinner is served: A full course of multiple research approaches Designing mixed methods studies in health-related research with
for your health sciences methodological appetite – Michael D Fetters people with disabilities – Thilo Kroll
Writing publishable mixed research articles: Guidelines for emerg- INHospital study: Do older people, carers and nurses share the same
ing scholars in the health sciences and beyond – Nancy L Leech, priorities of care in the acute aged care setting? – Louise D Hickman,
Anthony J Onwuegbuzie and Julie P Combs Patricia M Davidson, Esther Chang and Lynn Chenoweth
Where there is no gold standard: Mixed method research in a cluster Integrating qualitative and quantitative research approaches via the
randomised trial of a tool for safe prioritising of patients by medical phenomenological method – William Paul Fisher and A Jackson Stenner
receptionists – Sally J Hall, Christine B Phillips, Phillip Gray, Amanda Barnard Factors to drive clinical practice improvement in a Malaysian intensive
and Kym Batt care unit: Assessment of organisational readiness using a mixed method
Can focus groups be used for longitudinal evaluation? Findings from approach – Kim Lam Soh, Patricia M Davidson, Gavin Leslie, Michelle
the Medellin early prevention of aggression program – Michael Ungar, DiGiacomo, John X Rolley, Kim Geok Soh and Aisai Bin Abd Rahman
Luis F Duque and Dora Hernandez Child protection workers: What they do – Rebecca O'Reilly, Lauretta Luck,
Beyond the ceiling effect: Using a mixed methods approach to measure Lesley Wilkes and Debra Jackson
patient satisfaction – Sharon Andrew, Yenna Salamonson, Bronwyn Epilogue: From 'should we be?' to 'how are we': Moving forward with
Everett, Elizabeth J Halcomb and Patricia M Davidson mixed methods health research – Sharon Andrew and Elizabeth J Halcomb
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