Knowledge
Deficit
(_)Actual (_)
Potential
(_) New diagnosis:_____________________________ (_) Language differences:________________________ (_) Hospitalization (_) Diagnostic test:_____________________________ ____________________________________ |
Major: (Must be present) |
(_) Verbalizes a deficiency in knowledge or skill. (_) Requests information. (_) Expresses and inaccurate perception of health status. (_) Does not correctly perform a desired or prescribed health behavior. |
Minor: (May be present) |
(_) Lack of integration of treatment plans into daily activities. (_) Exhibits or expresses psychological alteration, |
Date & Sign. |
Plan and Outcome [Check those that apply] |
Target Date: |
Nursing Interventions [Check those that apply] |
Date Achieved: |
The patient will: (_) (_) Describe (_) Identify needed (_) Other: |
(_) Assess patient’s readiness to learn by assessing emotional respose to illness:
(_) Allow person to (_) Examine patient’s (_) Assess patient’s (_) Assess preferred
(_) Assess literacy (_) Provide health (_) Plan and share (_) Evaluate patient – (_) ________________________ |
__________________________
Patient/Significant other signature
__________________________
RN signature