'If it is not recorded, it has not been done!'? consistency between nursing records and observed nursing care in an Italian hospital.
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B. Vincenzi | R. Alvaro | M. D. De Marinis | M. Piredda | M. Pascarella | F. Spiga | D. Tartaglini | M. Matarese
[1] Ruth Williams,et al. Nursing and Midwifery Council. , 2009, Nursing management.
[2] Christine Urquhart,et al. Nursing record systems: effects on nursing practice and healthcare outcomes. , 2009, The Cochrane database of systematic reviews.
[3] Marianne Wallis,et al. A comparison of activities undertaken by enrolled and registered nurses on medical wards in Australia: an observational study. , 2008, International journal of nursing studies.
[4] Brian Hakes,et al. Assessing the Impact of an Electronic Medical Record on Nurse Documentation Time , 2008, Computers, informatics, nursing : CIN.
[5] P. Griffiths,et al. A comprehensive audit of nursing record keeping practice. , 2007, British journal of nursing.
[6] E. Idvall,et al. The quality of postoperative pain management from the perspectives of patients, nurses and patient records. , 2007, Journal of nursing management.
[7] Aled Jones. Admitting hospital patients: a qualitative study of an everyday nursing task. , 2007, Nursing inquiry.
[8] M. Lepp,et al. In search of details of patient teaching in nursing documentation--an analysis of patient records in a medical ward in Sweden. , 2006, Journal of clinical nursing.
[9] S. Simmons,et al. Direct observations of nursing home care quality: Does care change when observed? , 2006, Journal of the American Medical Directors Association.
[10] A. Palese,et al. Documentazione scritta (consegne e piani di assistenza) , 2006 .
[11] A. Palese,et al. [The written nursing reports]. , 2006, Assistenza infermieristica e ricerca : AIR.
[12] Kathryn Zeitz,et al. Nursing observations during the first 24 hours after a surgical procedure: what do we do? , 2005, Journal of clinical nursing.
[13] H. Kehlet,et al. Effects of posture on postoperative pulmonary function , 2003, Acta anaesthesiologica Scandinavica.
[14] Oili Karkkainen,et al. Evaluation of patient records as part of developing a nursing care classification. , 2003, Journal of clinical nursing.
[15] A. Ehrenberg,et al. Nursing documentation of postoperative pain management. , 2002, Journal of clinical nursing.
[16] Monica L Taylor,et al. A study of professional nurses' perceptions of patient education. , 2002, Journal of continuing education in nursing.
[17] M Ehnfors,et al. The accuracy of patient records in Swedish nursing homes: congruence of record content and nurses' and patients' descriptions. , 2001, Scandinavian journal of caring sciences.
[18] A. Ehrenberg,et al. Auditing nursing content in patient records. , 2001, Scandinavian journal of caring sciences.
[19] C. Kirrane. An audit of care planning on a neurology unit. , 2001, Nursing standard (Royal College of Nursing (Great Britain) : 1987).
[20] L. Adamsen,et al. Discrepancy between patients' perspectives, staff's documentation and reflections on basic nursing care. , 2000, Scandinavian journal of caring sciences.
[21] D. Lamond,et al. The information content of the nurse change of shift report: a comparative study. , 2000, Journal of advanced nursing.
[22] R. Moloney,et al. A systematic review of the relationships between written manual nursing care planning, record keeping and patient outcomes. , 1999, Journal of advanced nursing.
[23] A. Martin,et al. Documentation practices of nurses in long-term care. , 1999, Journal of clinical nursing.
[24] G. Ljunggren,et al. Review of nursing documentation in nursing home wards - changes after intervention for individualized care. , 1999, Journal of advanced nursing.
[25] D. Allen,et al. Record-keeping and routine nursing practice: the view from the wards. , 1998, Journal of advanced nursing.
[26] M. Briggs,et al. A qualitative analysis of the nursing documentation of post-operative pain management. , 1998, Journal of clinical nursing.
[27] D. Stein,et al. Describing pain management documentation. , 1998, Medsurg nursing : official journal of the Academy of Medical-Surgical Nurses.
[28] L. Thomas,et al. The nursing record as a research tool to identify nursing interventions. , 1997, Journal of clinical nursing.
[29] D. C. McWay. Legal aspects of health information management , 1996 .
[30] G. Nordström,et al. Nursing documentation in patient records. , 1996, Scandinavian journal of caring sciences.
[31] F. Casey. Documenting patient education: a literature review. , 1995, Journal of continuing education in nursing.
[32] K. McLeish,et al. Developing care plan documentation: an action research project. , 1995, Journal of nursing management.
[33] B. Davis,et al. Evaluation of nursing process documentation. , 1994, Journal of advanced nursing.
[34] M Ehnfors,et al. Nursing care as documented in patient records. , 1993, Scandinavian journal of caring sciences.
[35] P. Wicker. Standards for records and record keeping. , 1993, The British journal of theatre nursing : NATNews : the official journal of the National Association of Theatre Nurses.
[36] Dennis Ke,et al. Point of care technology: impact on people and paperwork. , 1993 .
[37] L. Jorfeldt,et al. The care and handling of peripheral intravenous cannulae on 60 surgery and internal medicine patients: an observation study. , 1993, Journal of advanced nursing.
[38] J. Robinson,et al. The use and limitations of Phaneuf's Nursing Audit. , 1992, Journal of advanced nursing.
[39] G. Harvey. An evaluation of approaches to assessing the quality of nursing care using (predetermined) quality assurance tools. , 1991, Journal of advanced nursing.
[40] R. Tapp. Inhibitors and Facilitators to Documentation of Nursing Practice , 1990, Western journal of nursing research.
[41] A. Donabedian,et al. The quality of care. How can it be assessed? , 1988, JAMA.
[42] Marcus L. Walker,et al. The Nursing Process: Assessing, Planning, Implementing, Evaluating , 1988 .
[43] Carmen de la Cuesta-Benjumea. The nursing process: from development to implementation , 1983 .
[44] Julia Johnson,et al. The Quality of Care , 2010 .
[45] C. Johnston,et al. Randomised clinical trial of physiotherapy after open abdominal surgery in high risk patients. , 2005, The Australian journal of physiotherapy.
[46] B. Dimond. Prescription and medication records. , 2005, British journal of nursing.
[47] H. Taylor. An exploration of the factors that affect nurses' record keeping. , 2003, British journal of nursing.
[48] P Wainwright,et al. Nursing record systems: effects on nursing practice and health care outcomes. , 2003, The Cochrane database of systematic reviews.
[49] J. Griffiths,et al. The wider implications of an audit of care plan documentation. , 1999, Journal of clinical nursing.
[50] K. Dennis,et al. Point of care technology: impact on people and paperwork. , 1993, Nursing economic$.
[51] J. Gryfinski,et al. Implementing Focus Charting: process and critique. , 1990, Clinical nurse specialist CNS.
[52] S. Openshaw. Literature review: measurement of adequate care. , 1984, International journal of nursing studies.
[53] S. Openshaw. Literature Review: measurement of adequate , 1984 .
[54] C. de la Cuesta. The nursing process: from development to implementation. , 1983, Journal of advanced nursing.
[55] Helen Yura,et al. The nursing process;: Assessing, planning, implementing, evaluating , 1973 .