Kilpack V, Dobson-Brassard S
Dartmouth-Hitchcock Medical Center, Hanover, NH 03756.
J Neurosci Nurs. 1987 Oct;19(5):266-70. doi: 10.1097/01376517-198710000-00009.
To enhance the quality of orally communicated patient care data, use of the patient's problem list and subjective objective assessment plan (SOAP) format for organizing intershift report is described. This reporting structure requires use of the nursing process, with nursing diagnosis being the focus in reporting nursing care management.
为提高口头交流的患者护理数据质量，本文介绍了使用患者问题清单和主观-客观-评估计划（SOAP）格式来组织交接班报告。这种报告结构要求运用护理程序，其中护理诊断是报告护理管理的重点。
