本專案是以系統理論，綜合輸入、處理過程、輸出及回饋之原理，設計「胸腔內科病患護理評估記錄表」。並以「胸腔內科護理記錄評值表」，評值使用胸腔內科病患護理評估記錄表前後之護理記錄，經paired t考驗結果，顯示使用胸腔內科病患護理評估記錄表之後，護理人員書寫護理記錄之完整性有顯著的進步（t值=－16.34，p＜0.001）。使用胸腔內科病患護理評估記錄表後，能節省時間人力，因之將此評估記錄表推廣應用到其它胸腔內科病房，藉由完整的胸腔內科病患護理評估記錄表之應用，有助於護理人員擬定適合於病人需要之護理計畫，進而提供病患完善而且整體性之護理。

　　　　　The project used system theory, multiple inputs, treating process and feedback principle to design the Chest Medical Assessment Nursing Documentation (CMAND). The chest nursing recording evaluation sheet was used to evaluate the percent for recording the nursing care documentation. We found that nursing care documentation is much improved in comparison with the results before using the CMAND (P<0.001). Nurses' satisfaction was increased with using CMAND. The application of CMAND was completely accepted by nurses due to saving time and reducing manpower. The CMAND was also applied in other chest medical wards which offers some benefits for patient needs care plan and holistic intervention of patient care.