King Khalid

University Nursing College

4th Year, 8th level
Nursing Administration Department

Part. I
Content of Clinical Sheets
.
1. The kardex
2. Methods of patient care assignment.
- Case method.
- Functional method.
- Team method.

3. Records and reports.

- Shift report.
- Medical record.
- Incident Report.
- Unit Report (Statistical Report)

4.Time Schedule.
- Block Scheduling.
- Cyclic Scheduling.

5. Job analysis.

6. Job description.

7. Performance appraisal.
- Ranking method
- Paired comparison.
- Graphic rating scale.
- Check List.
- Forced choice.
- Critical incident diary.
- Management by objective.

8. Staff development program.

 King Khalid
University Nursing College
4th Year, 8th level
Nursing Administration Department

Kardex
Diagnosis: Sex: Occupation: Age: Marital status:

Bed No.: Room No.: Hospital No.:

Date of admission: Date of operation:

Vital signs on admission:

- Temp: c - pluse: b/m - Resp: c/m - Bl.P: mmhg

Daily vital signs:

- Temp: c - pluse: b/m - Resp: c/m - Bl.P: mmhg

Diet :

Elimination: - Urine: Stool:

Level of activity: - Mobile - Immobile: - Mobile with assistance

Special care

Allergy

Patients' Name:

Medication Investigation
Date Name Dose Route Frequency Type Date of Date of results
taken receive

Head nurse name:

King Khalid University Nursing College

4th Year, 8th level
Nursing Administration Department
 Assignment Sheet (Case Method)

Unit Name: No. of patient:

Head nurse Name: Number Of staff&mix:

Date & time Staff's name Patient’s Name Diagnosis

Signature of the head nurse

King Khalid University

Nursing College
4th Year, 8th level
Nursing Administration Department
 Assignment Sheet (Functional Method)

Unit Name: No. of patient:

Head nurse Name: Number Of staff&mix:

Date & time Staff name Duties & responsibilities

Signature Of The head nurse

King Khalid University

Nursing College
4th Year, 8th level
Nursing Administration Department
 Assignment Sheet (Team Method)

Date: Unit: Head Nurse Name:

Team leader's name: No. of team members&mix:

Team members Basic duties Special duties

N.B: Team leader report Signature of the head nurse

Team leader Report

Date: Unit: Head Nurse Name: Team leader's name:
No. of team members: No. of team members &Mix:
 Patient Report :

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Staff Report:

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Unit Report:

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Signature Of Team leader

Signature of Head nurse

 King Khalid University
Nursing College
4th Year, 8th level
Nursing Administration Department
Shift Report
Date: Unit: No. of beds:
Head nurse: Patient census:

Room No. Patients' name Diagnosis Summary of patients' condition

Bed No.

No. of admissions : No. of discharges: No. of critical:

No. of deaths : No. of transfers :

Signature of The head nurse

 King Khalid University
Nursing College
4th Year, 8th level
Nursing Administration Department
Unit Report (Statistical Report)
Name of unit: Name of the nurse: No of beds:

Date Patient Admissions Discharges Transfer Death Critical Total

Time Census patient

Signature of the head nurse

 King Khalid University
Nursing College
4th Year, 8th level
Nursing Administration Department

Incident report form

Unit name: Name of the head nurse:

Patient name: age: sex:

Date of admission: Diagnosis:

Attending physician:

List of medication within 6 hours if permanent:

Type of incident:-

-Error in medication -Patient movement (Fall)

-Diagnostic procedure - Treatment - Others

Date: Time : Shift:

Description of incident:

Name of first person or persons present at time of incident:

Nursing interventions:

Date: Time: Sig :

Follow up:

Sig :

Signature of the head nurse

 King Khalid University
Nursing College 4th
Year, 8th level Nursing
Administration Department

Medication Record

Unit: Date:
Number of patients:
Patients' name Medication prescribed Remarks

N/ name of medication D/dose R/route F/frequency

Signature of the head nurse

 King Khalid University
Nursing College
4th Year, 8th level
Nursing Administration Department

Job Analysis
Date: Job title: Division:

Revised date: Department: Code No.:

Educational qualification

Physical and mental requirement

Skills needed

Job relationship (accountability)

Duties and responsibilities

Signature of the head nurse

 King Khalid University
Nursing College
4th Year, 8th level
Nursing Administration Department

Job Description
Date: Job title: Division:

Revised date: Department: Code No.:

Job position requirements

(Educational qualification, professional requirements, professional

requirement)

Job relationship

Duties and responsibilities

Special demands

Signature of the head nurse

 King Khalid University
Nursing College
4th Year, 8th level
Nursing Administration Department

Staff Development Program Sheet

Nurse’s Name : Date : Group :
Duration Of Program : Program Title : Place :
General Objectives : -

Date Specific Contents Media Teaching Evaluation

Time Objectives methods methods

Signature of the head nurse

 King Khalid University
Nursing College
4th Year, 8th level
Nursing Administration Department

Anecdotal Record
Unit : Date:

Name of nurse:

Positive situation: Negative situation:

Name of nurse:

Positive situation: Negative situation:

Name of nurse:

Positive situation: Negative situation:

 King Khalid University
Nursing College
4th Year, 8th level
Nursing Administration Department

Students' Clinical Performance Follow up

Students' Name:

Assignment Date Acceptable Acceptable Not Remarks

Performance with help Acceptable

Signature Of Clinical Instructor

 King Khalid University
Nursing College
4th Year, 8th level
Nursing Administration Department

Nursing progress notes

Patient name:……………………….. Patient Number:…………

Date:........................... Shift:…………………….

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Signature(full name)
 King Khalid University
Nursing College 4th
Year, 8th level Nursing
Administration Department
Time Schedule for Unit
from to
Days&date S S M T WT F S S M T W T F S S M T W T F S S M T W T F S S
Nuses
names 1 2 3 4

D: Day shift E: Evening shift N: Night shift -: Off duty

Signature of The head nurse