Add nursing assessment packs, ward board, and nurse performance KPIs.

Seeds NEWS2/Braden/Morse/pain packs with visit vitals and a unit dashboard for MAR, assessments, notes, and handover activity. Co-authored-by: Cursor <cursoragent@cursor.com>
2026-07-20 10:32:52 +00:00
parent cb6e59e5ed
commit 9eb6c21828
18 changed files with 1511 additions and 16 deletions
@@ -0,0 +1,39 @@
+<?php
+
+namespace App\Http\Controllers\Care;
+
+use App\Http\Controllers\Controller;
+use App\Http\Controllers\Care\Concerns\ScopesToAccount;
+use App\Models\CareUnit;
+use App\Services\Care\CarePermissions;
+use App\Services\Care\NursePerformanceService;
+use Carbon\Carbon;
+use Illuminate\Http\Request;
+use Illuminate\View\View;
+
+class NursePerformanceController extends Controller
+{
+    use ScopesToAccount;
+
+    public function show(Request $request, CareUnit $careUnit, NursePerformanceService $performance): View
+    {
+        $this->authorizeAbility($request, 'nursing.performance.view');
+        $this->authorizeOwner($request, $careUnit);
+        abort_unless((int) $careUnit->organization_id === (int) $this->organization($request)->id, 404);
+
+        $from = $request->filled('from')
+            ? Carbon::parse($request->input('from'))->startOfDay()
+            : now()->subDays(7)->startOfDay();
+        $to = $request->filled('to')
+            ? Carbon::parse($request->input('to'))->endOfDay()
+            : now()->endOfDay();
+
+        $report = $performance->unitReport($careUnit, $this->ownerRef($request), $from, $to);
+
+        return view('care.nursing.performance', [
+            'unit' => $careUnit->load('department.branch'),
+            'report' => $report,
+            'canManage' => app(CarePermissions::class)->can($this->member($request), 'admin.departments.manage'),
+        ]);
+    }
+}
@@ -0,0 +1,114 @@
+<?php
+
+namespace App\Http\Controllers\Care;
+
+use App\Http\Controllers\Controller;
+use App\Http\Controllers\Care\Concerns\ScopesToAccount;
+use App\Models\CareUnit;
+use App\Models\Visit;
+use App\Services\Care\AssessmentService;
+use App\Services\Care\CareFeatures;
+use App\Services\Care\CarePermissions;
+use App\Services\Care\NursingAssessmentService;
+use Illuminate\Http\RedirectResponse;
+use Illuminate\Http\Request;
+use Illuminate\View\View;
+
+class NursingAssessmentController extends Controller
+{
+    use ScopesToAccount;
+
+    public function unitBoard(Request $request, CareUnit $careUnit, NursingAssessmentService $nursing): View
+    {
+        $this->authorizeAbility($request, 'nursing.assessments.view');
+        $this->authorizeOwner($request, $careUnit);
+        abort_unless((int) $careUnit->organization_id === (int) $this->organization($request)->id, 404);
+
+        app(CareFeatures::class)->ensureAssessmentCatalog();
+
+        $permissions = app(CarePermissions::class);
+        $member = $this->member($request);
+
+        return view('care.nursing.assessments-board', [
+            'unit' => $careUnit->load('department.branch'),
+            'templates' => $nursing->nursingTemplates(),
+            'rows' => $nursing->unitBoard($careUnit, $this->ownerRef($request)),
+            'canCapture' => $permissions->can($member, 'nursing.assessments.manage')
+                || $permissions->can($member, 'assessments.capture')
+                || $permissions->can($member, 'assessments.manage'),
+            'canVitals' => $permissions->can($member, 'vitals.manage'),
+            'engineEnabled' => app(CareFeatures::class)->enabled(
+                $this->organization($request),
+                CareFeatures::ASSESSMENTS_ENGINE,
+            ),
+        ]);
+    }
+
+    public function start(
+        Request $request,
+        CareUnit $careUnit,
+        Visit $visit,
+        AssessmentService $assessments,
+        CareFeatures $features,
+    ): RedirectResponse {
+        $this->authorizeAbility($request, 'nursing.assessments.manage');
+        $this->authorizeOwner($request, $careUnit);
+        $this->authorizeOwner($request, $visit);
+        abort_unless((int) $visit->care_unit_id === (int) $careUnit->id, 404);
+        abort_unless($features->enabled($this->organization($request), CareFeatures::ASSESSMENTS_ENGINE), 404);
+
+        $features->ensureAssessmentCatalog();
+
+        $validated = $request->validate([
+            'template_code' => ['required', 'string', 'max:100'],
+        ]);
+
+        $assessment = $assessments->start(
+            $visit->patient,
+            $validated['template_code'],
+            $this->ownerRef($request),
+            $this->member($request),
+            [
+                'visit' => $visit,
+                'actor' => $this->actorRef($request),
+            ],
+        );
+
+        return redirect()
+            ->route('care.assessments.show', $assessment)
+            ->with('success', 'Nursing assessment started.');
+    }
+
+    public function storeVitals(
+        Request $request,
+        CareUnit $careUnit,
+        Visit $visit,
+        NursingAssessmentService $nursing,
+    ): RedirectResponse {
+        $this->authorizeAbility($request, 'vitals.manage');
+        $this->authorizeOwner($request, $careUnit);
+        $this->authorizeOwner($request, $visit);
+        abort_unless((int) $visit->care_unit_id === (int) $careUnit->id, 404);
+
+        $validated = $request->validate([
+            'bp_systolic' => ['nullable', 'integer', 'min:40', 'max:300'],
+            'bp_diastolic' => ['nullable', 'integer', 'min:20', 'max:200'],
+            'pulse' => ['nullable', 'integer', 'min:20', 'max:300'],
+            'temperature' => ['nullable', 'numeric', 'min:30', 'max:45'],
+            'spo2' => ['nullable', 'integer', 'min:50', 'max:100'],
+            'respiratory_rate' => ['nullable', 'integer', 'min:4', 'max:60'],
+            'notes' => ['nullable', 'string', 'max:1000'],
+        ]);
+
+        $nursing->recordVisitVitals(
+            $visit,
+            $this->ownerRef($request),
+            $this->actorRef($request),
+            $validated,
+        );
+
+        return redirect()
+            ->route('care.care-units.assessments', $careUnit)
+            ->with('success', 'Ward vitals recorded.');
+    }
+}
@@ -0,0 +1,54 @@
+<?php
+
+namespace App\Models;
+
+use App\Models\Concerns\BelongsToOwner;
+use Illuminate\Database\Eloquent\Model;
+use Illuminate\Database\Eloquent\Relations\BelongsTo;
+
+class VisitVital extends Model
+{
+    use BelongsToOwner;
+
+    protected $table = 'care_visit_vitals';
+
+    protected $fillable = [
+        'owner_ref',
+        'organization_id',
+        'visit_id',
+        'patient_id',
+        'care_unit_id',
+        'bp_systolic',
+        'bp_diastolic',
+        'pulse',
+        'temperature',
+        'spo2',
+        'respiratory_rate',
+        'recorded_by',
+        'recorded_at',
+        'notes',
+    ];
+
+    protected function casts(): array
+    {
+        return [
+            'temperature' => 'decimal:1',
+            'recorded_at' => 'datetime',
+        ];
+    }
+
+    public function visit(): BelongsTo
+    {
+        return $this->belongsTo(Visit::class, 'visit_id');
+    }
+
+    public function patient(): BelongsTo
+    {
+        return $this->belongsTo(Patient::class, 'patient_id');
+    }
+
+    public function careUnit(): BelongsTo
+    {
+        return $this->belongsTo(CareUnit::class, 'care_unit_id');
+    }
+}
@@ -3,6 +3,7 @@
 namespace App\Services\Care;

 use App\Models\AssessmentTemplate;
+use App\Models\ClinicalPathway;
 use App\Models\Organization;
 use Database\Seeders\AssessmentTemplateSeeder;
 use Database\Seeders\ClinicalPathwaySeeder;
@@ -72,16 +73,24 @@ class CareFeatures
            return;
        }

-        if (AssessmentTemplate::query()->whereNull('organization_id')->exists()) {
-            return;
+        $nursingCodes = ['news2', 'braden', 'morse', 'pain_nrs'];
+        $haveNursing = AssessmentTemplate::query()
+            ->whereNull('organization_id')
+            ->whereIn('code', $nursingCodes)
+            ->where('is_current', true)
+            ->count();
+
+        $empty = ! AssessmentTemplate::query()->whereNull('organization_id')->exists();
+
+        if ($empty || $haveNursing < count($nursingCodes)) {
+            Artisan::call('db:seed', [
+                '--class' => AssessmentTemplateSeeder::class,
+                '--force' => true,
+            ]);
        }

-        Artisan::call('db:seed', [
-            '--class' => AssessmentTemplateSeeder::class,
-            '--force' => true,
-        ]);
-
-        if (Schema::hasTable('care_clinical_pathways')) {
+        if (Schema::hasTable('care_clinical_pathways')
+            && ! ClinicalPathway::query()->whereNull('organization_id')->exists()) {
            Artisan::call('db:seed', [
                '--class' => ClinicalPathwaySeeder::class,
                '--force' => true,
@@ -590,6 +590,9 @@ class CarePermissions
            $abilities[] = 'nursing.notes.manage';
            $abilities[] = 'nursing.handover.view';
            $abilities[] = 'nursing.handover.manage';
+            $abilities[] = 'nursing.assessments.view';
+            $abilities[] = 'nursing.assessments.manage';
+            $abilities[] = 'nursing.performance.view';
        }

        if (in_array('analytics.department.view', $abilities, true)) {
@@ -597,6 +600,8 @@ class CarePermissions
            $abilities[] = 'mar.view';
            $abilities[] = 'nursing.notes.view';
            $abilities[] = 'nursing.handover.view';
+            $abilities[] = 'nursing.assessments.view';
+            $abilities[] = 'nursing.performance.view';
        }

        return array_values(array_unique($abilities));
@@ -0,0 +1,195 @@
+<?php
+
+namespace App\Services\Care;
+
+use App\Models\Assessment;
+use App\Models\CareUnit;
+use App\Models\MarAdministration;
+use App\Models\NursingNote;
+use App\Models\StaffAssignment;
+use App\Models\User;
+use App\Models\Visit;
+use App\Models\VisitVital;
+use App\Models\WardHandover;
+use Carbon\Carbon;
+use Carbon\CarbonInterface;
+use Illuminate\Support\Collection;
+
+class NursePerformanceService
+{
+    /**
+     * Aggregate nursing KPIs for a care unit over a date range.
+     *
+     * @return array<string, mixed>
+     */
+    public function unitReport(
+        CareUnit $unit,
+        string $ownerRef,
+        ?CarbonInterface $from = null,
+        ?CarbonInterface $to = null,
+    ): array {
+        $from = Carbon::parse($from ?? now()->subDays(7))->startOfDay();
+        $to = Carbon::parse($to ?? now())->endOfDay();
+
+        $visitIds = Visit::owned($ownerRef)
+            ->where('care_unit_id', $unit->id)
+            ->pluck('id');
+
+        $mar = MarAdministration::owned($ownerRef)
+            ->where('care_unit_id', $unit->id)
+            ->whereBetween('recorded_at', [$from, $to])
+            ->get();
+
+        $marGiven = $mar->where('status', MarAdministration::STATUS_GIVEN)->count();
+        $marHeld = $mar->where('status', MarAdministration::STATUS_HELD)->count();
+        $marRefused = $mar->where('status', MarAdministration::STATUS_REFUSED)->count();
+        $marMissed = $mar->where('status', MarAdministration::STATUS_MISSED)->count();
+        $marTotal = $mar->count();
+        $marOnTime = $mar->filter(function (MarAdministration $a) {
+            if ($a->status !== MarAdministration::STATUS_GIVEN || ! $a->scheduled_for) {
+                return false;
+            }
+
+            return $a->recorded_at->between(
+                $a->scheduled_for->copy()->subMinutes(30),
+                $a->scheduled_for->copy()->addMinutes(60),
+            );
+        })->count();
+
+        $notes = NursingNote::owned($ownerRef)
+            ->where('care_unit_id', $unit->id)
+            ->whereBetween('recorded_at', [$from, $to])
+            ->get();
+
+        $vitals = VisitVital::owned($ownerRef)
+            ->where('care_unit_id', $unit->id)
+            ->whereBetween('recorded_at', [$from, $to])
+            ->count();
+
+        $nursingCodes = NursingAssessmentService::NURSING_PACK_CODES;
+        $assessments = Assessment::owned($ownerRef)
+            ->whereIn('visit_id', $visitIds->isEmpty() ? [0] : $visitIds->all())
+            ->whereBetween('created_at', [$from, $to])
+            ->whereHas('template', fn ($q) => $q->whereIn('code', $nursingCodes))
+            ->with('template')
+            ->get();
+
+        $assessmentsCompleted = $assessments->where('status', Assessment::STATUS_COMPLETED)->count();
+        $assessmentsDraft = $assessments->where('status', Assessment::STATUS_DRAFT)->count();
+
+        $handovers = WardHandover::owned($ownerRef)
+            ->where('care_unit_id', $unit->id)
+            ->whereBetween('created_at', [$from, $to])
+            ->get();
+
+        $assignedStaff = StaffAssignment::owned($ownerRef)
+            ->where('care_unit_id', $unit->id)
+            ->where('status', 'active')
+            ->effectiveOn($to)
+            ->with('member')
+            ->get();
+
+        $byActor = $this->byActor(
+            $mar,
+            $notes,
+            $assessments->where('status', Assessment::STATUS_COMPLETED),
+            $handovers->where('status', WardHandover::STATUS_COMPLETED),
+        );
+
+        return [
+            'from' => $from,
+            'to' => $to,
+            'placed_patients' => Visit::owned($ownerRef)
+                ->where('care_unit_id', $unit->id)
+                ->whereIn('status', [Visit::STATUS_OPEN, Visit::STATUS_IN_PROGRESS])
+                ->count(),
+            'mar' => [
+                'total' => $marTotal,
+                'given' => $marGiven,
+                'held' => $marHeld,
+                'refused' => $marRefused,
+                'missed' => $marMissed,
+                'on_time_given' => $marOnTime,
+                'on_time_rate' => $marGiven > 0 ? round(($marOnTime / $marGiven) * 100, 1) : null,
+                'compliance_rate' => $marTotal > 0
+                    ? round((($marGiven) / $marTotal) * 100, 1)
+                    : null,
+            ],
+            'notes' => [
+                'total' => $notes->count(),
+                'by_type' => $notes->groupBy('note_type')->map->count()->all(),
+            ],
+            'vitals' => [
+                'total' => $vitals,
+            ],
+            'assessments' => [
+                'started' => $assessments->count(),
+                'completed' => $assessmentsCompleted,
+                'draft' => $assessmentsDraft,
+                'completion_rate' => $assessments->count() > 0
+                    ? round(($assessmentsCompleted / $assessments->count()) * 100, 1)
+                    : null,
+                'by_template' => $assessments
+                    ->groupBy(fn (Assessment $a) => $a->template?->code ?? 'unknown')
+                    ->map(fn (Collection $group, $code) => [
+                        'code' => $code,
+                        'name' => $group->first()->template?->name ?? $code,
+                        'completed' => $group->where('status', Assessment::STATUS_COMPLETED)->count(),
+                        'total' => $group->count(),
+                    ])
+                    ->values()
+                    ->all(),
+            ],
+            'handovers' => [
+                'total' => $handovers->count(),
+                'completed' => $handovers->where('status', WardHandover::STATUS_COMPLETED)->count(),
+            ],
+            'assigned_staff' => $assignedStaff->count(),
+            'by_actor' => $byActor,
+        ];
+    }
+
+    /**
+     * @param  Collection<int, MarAdministration>  $mar
+     * @param  Collection<int, NursingNote>  $notes
+     * @param  Collection<int, Assessment>  $assessments
+     * @param  Collection<int, WardHandover>  $handovers
+     * @return list<array<string, mixed>>
+     */
+    protected function byActor(
+        Collection $mar,
+        Collection $notes,
+        Collection $assessments,
+        Collection $handovers,
+    ): array {
+        $refs = collect()
+            ->merge($mar->pluck('administered_by'))
+            ->merge($notes->pluck('recorded_by'))
+            ->merge($assessments->pluck('completed_by'))
+            ->merge($handovers->pluck('handed_over_by'))
+            ->filter()
+            ->unique()
+            ->values();
+
+        $emails = User::query()->whereIn('public_id', $refs)->pluck('email', 'public_id');
+        $names = User::query()->whereIn('public_id', $refs)->pluck('name', 'public_id');
+
+        $rows = [];
+        foreach ($refs as $ref) {
+            $rows[] = [
+                'actor_ref' => $ref,
+                'label' => $names[$ref] ?? $emails[$ref] ?? $ref,
+                'mar_given' => $mar->where('administered_by', $ref)->where('status', MarAdministration::STATUS_GIVEN)->count(),
+                'mar_total' => $mar->where('administered_by', $ref)->count(),
+                'notes' => $notes->where('recorded_by', $ref)->count(),
+                'assessments_completed' => $assessments->where('completed_by', $ref)->count(),
+                'handovers' => $handovers->where('handed_over_by', $ref)->count(),
+            ];
+        }
+
+        usort($rows, fn ($a, $b) => ($b['mar_total'] + $b['notes'] + $b['assessments_completed'])
+            <=> ($a['mar_total'] + $a['notes'] + $a['assessments_completed']));
+
+        return $rows;
+    }
+}
@@ -0,0 +1,109 @@
+<?php
+
+namespace App\Services\Care;
+
+use App\Models\Assessment;
+use App\Models\AssessmentTemplate;
+use App\Models\CareUnit;
+use App\Models\Visit;
+use App\Models\VisitVital;
+use Illuminate\Support\Collection;
+
+class NursingAssessmentService
+{
+    /** @var list<string> */
+    public const NURSING_PACK_CODES = ['news2', 'braden', 'morse', 'pain_nrs'];
+
+    /**
+     * @return Collection<int, AssessmentTemplate>
+     */
+    public function nursingTemplates(): Collection
+    {
+        return AssessmentTemplate::query()
+            ->whereNull('organization_id')
+            ->where('is_current', true)
+            ->where('is_active', true)
+            ->whereIn('code', self::NURSING_PACK_CODES)
+            ->orderBy('name')
+            ->get();
+    }
+
+    /**
+     * Board rows for placed patients: latest nursing assessments + latest vitals.
+     *
+     * @return list<array<string, mixed>>
+     */
+    public function unitBoard(CareUnit $unit, string $ownerRef): array
+    {
+        $templates = $this->nursingTemplates();
+        $visits = Visit::owned($ownerRef)
+            ->where('care_unit_id', $unit->id)
+            ->whereIn('status', [Visit::STATUS_OPEN, Visit::STATUS_IN_PROGRESS])
+            ->with(['patient', 'bed'])
+            ->orderBy('placed_at')
+            ->get();
+
+        $rows = [];
+        foreach ($visits as $visit) {
+            $latestByCode = Assessment::owned($ownerRef)
+                ->where('visit_id', $visit->id)
+                ->whereIn('status', [Assessment::STATUS_DRAFT, Assessment::STATUS_COMPLETED])
+                ->whereHas('template', fn ($q) => $q->whereIn('code', $templates->pluck('code')->all()))
+                ->with(['template', 'score'])
+                ->orderByDesc('id')
+                ->get()
+                ->unique(fn (Assessment $a) => $a->template?->code)
+                ->keyBy(fn (Assessment $a) => $a->template?->code);
+
+            $latestVitals = VisitVital::owned($ownerRef)
+                ->where('visit_id', $visit->id)
+                ->orderByDesc('recorded_at')
+                ->first();
+
+            $rows[] = [
+                'visit' => $visit,
+                'patient' => $visit->patient,
+                'bed' => $visit->bed,
+                'assessments' => $latestByCode,
+                'vitals' => $latestVitals,
+            ];
+        }
+
+        return $rows;
+    }
+
+    public function recordVisitVitals(
+        Visit $visit,
+        string $ownerRef,
+        ?string $actorRef,
+        array $data,
+    ): VisitVital {
+        $vital = VisitVital::create([
+            'owner_ref' => $ownerRef,
+            'organization_id' => $visit->organization_id,
+            'visit_id' => $visit->id,
+            'patient_id' => $visit->patient_id,
+            'care_unit_id' => $visit->care_unit_id,
+            'bp_systolic' => $data['bp_systolic'] ?? null,
+            'bp_diastolic' => $data['bp_diastolic'] ?? null,
+            'pulse' => $data['pulse'] ?? null,
+            'temperature' => $data['temperature'] ?? null,
+            'spo2' => $data['spo2'] ?? null,
+            'respiratory_rate' => $data['respiratory_rate'] ?? null,
+            'notes' => $data['notes'] ?? null,
+            'recorded_by' => $actorRef,
+            'recorded_at' => now(),
+        ]);
+
+        AuditLogger::record(
+            $ownerRef,
+            'visit_vitals.recorded',
+            $visit->organization_id,
+            $actorRef,
+            VisitVital::class,
+            $vital->id,
+        );
+
+        return $vital;
+    }
+}
@@ -80,16 +80,48 @@ class ScoringService
        }

        if (str_starts_with($strategy, 'custom:')) {
-            return $this->customScore($assessment, substr($strategy, 7));
+            $result = $this->customScore($assessment, substr($strategy, 7));
+        } else {
+            $result = match ($strategy) {
+                'sum_items' => $this->sumItems($assessment),
+                'single_value' => $this->singleValue($assessment),
+                default => throw ValidationException::withMessages([
+                    'scoring' => "Unknown scoring strategy [{$strategy}].",
+                ]),
+            };
        }

-        return match ($strategy) {
-            'sum_items' => $this->sumItems($assessment),
-            'single_value' => $this->singleValue($assessment),
-            default => throw ValidationException::withMessages([
-                'scoring' => "Unknown scoring strategy [{$strategy}].",
-            ]),
-        };
+        $result['severity_label'] = $result['severity_label']
+            ?? $this->severityFromBands($assessment->template?->meta, $result['total'] ?? null);
+
+        return $result;
+    }
+
+    /**
+     * @param  array<string, mixed>|null  $meta
+     */
+    protected function severityFromBands(?array $meta, mixed $total): ?string
+    {
+        if ($total === null || ! is_numeric($total)) {
+            return null;
+        }
+
+        $bands = $meta['severity_bands'] ?? null;
+        if (! is_array($bands) || $bands === []) {
+            return null;
+        }
+
+        $score = (float) $total;
+        foreach ($bands as $band) {
+            if (! is_array($band) || ! isset($band['max'], $band['label'])) {
+                continue;
+            }
+            if ($score <= (float) $band['max']) {
+                return (string) $band['label'];
+            }
+        }
+
+        return null;
    }

    /**
@@ -0,0 +1,136 @@
+{
+  "template": {
+    "code": "braden",
+    "name": "Braden Scale (pressure injury risk)",
+    "category": "screening",
+    "version": 1,
+    "is_current": true,
+    "is_active": true,
+    "scoring_strategy": "sum_items",
+    "description": "Braden Scale for predicting pressure sore risk. Lower scores = higher risk (6–23).",
+    "meta": {
+      "capture_roles": ["nurse", "ed_nurse", "theatre_nurse", "labour_ward_nurse", "fertility_nurse", "dialysis_nurse", "midwife", "doctor", "general_physician"],
+      "specialty": "nursing",
+      "pack_family": "nursing",
+      "estimated_minutes": 5,
+      "max_total": 23,
+      "severity_bands": [
+        { "max": 9, "label": "Very high risk" },
+        { "max": 12, "label": "High risk" },
+        { "max": 14, "label": "Moderate risk" },
+        { "max": 18, "label": "Mild risk" },
+        { "max": 23, "label": "No apparent risk" }
+      ],
+      "attribution": "Braden Scale — verify licensing for commercial redistribution of branded materials."
+    }
+  },
+  "questions": [
+    {
+      "code": "sensory",
+      "section": "Risk factors",
+      "label": "Sensory perception",
+      "answer_type": "score_item",
+      "is_required": true,
+      "sort_order": 10,
+      "score_key": "braden",
+      "options": {
+        "max": 4,
+        "choices": [
+          { "code": "1", "label": "Completely limited", "score": 1 },
+          { "code": "2", "label": "Very limited", "score": 2 },
+          { "code": "3", "label": "Slightly limited", "score": 3 },
+          { "code": "4", "label": "No impairment", "score": 4 }
+        ]
+      }
+    },
+    {
+      "code": "moisture",
+      "section": "Risk factors",
+      "label": "Moisture",
+      "answer_type": "score_item",
+      "is_required": true,
+      "sort_order": 20,
+      "score_key": "braden",
+      "options": {
+        "max": 4,
+        "choices": [
+          { "code": "1", "label": "Constantly moist", "score": 1 },
+          { "code": "2", "label": "Very moist", "score": 2 },
+          { "code": "3", "label": "Occasionally moist", "score": 3 },
+          { "code": "4", "label": "Rarely moist", "score": 4 }
+        ]
+      }
+    },
+    {
+      "code": "activity",
+      "section": "Risk factors",
+      "label": "Activity",
+      "answer_type": "score_item",
+      "is_required": true,
+      "sort_order": 30,
+      "score_key": "braden",
+      "options": {
+        "max": 4,
+        "choices": [
+          { "code": "1", "label": "Bedfast", "score": 1 },
+          { "code": "2", "label": "Chairfast", "score": 2 },
+          { "code": "3", "label": "Walks occasionally", "score": 3 },
+          { "code": "4", "label": "Walks frequently", "score": 4 }
+        ]
+      }
+    },
+    {
+      "code": "mobility",
+      "section": "Risk factors",
+      "label": "Mobility",
+      "answer_type": "score_item",
+      "is_required": true,
+      "sort_order": 40,
+      "score_key": "braden",
+      "options": {
+        "max": 4,
+        "choices": [
+          { "code": "1", "label": "Completely immobile", "score": 1 },
+          { "code": "2", "label": "Very limited", "score": 2 },
+          { "code": "3", "label": "Slightly limited", "score": 3 },
+          { "code": "4", "label": "No limitation", "score": 4 }
+        ]
+      }
+    },
+    {
+      "code": "nutrition",
+      "section": "Risk factors",
+      "label": "Nutrition",
+      "answer_type": "score_item",
+      "is_required": true,
+      "sort_order": 50,
+      "score_key": "braden",
+      "options": {
+        "max": 4,
+        "choices": [
+          { "code": "1", "label": "Very poor", "score": 1 },
+          { "code": "2", "label": "Probably inadequate", "score": 2 },
+          { "code": "3", "label": "Adequate", "score": 3 },
+          { "code": "4", "label": "Excellent", "score": 4 }
+        ]
+      }
+    },
+    {
+      "code": "friction",
+      "section": "Risk factors",
+      "label": "Friction and shear",
+      "answer_type": "score_item",
+      "is_required": true,
+      "sort_order": 60,
+      "score_key": "braden",
+      "options": {
+        "max": 3,
+        "choices": [
+          { "code": "1", "label": "Problem", "score": 1 },
+          { "code": "2", "label": "Potential problem", "score": 2 },
+          { "code": "3", "label": "No apparent problem", "score": 3 }
+        ]
+      }
+    }
+  ]
+}
@@ -0,0 +1,125 @@
+{
+  "template": {
+    "code": "morse",
+    "name": "Morse Fall Scale",
+    "category": "screening",
+    "version": 1,
+    "is_current": true,
+    "is_active": true,
+    "scoring_strategy": "sum_items",
+    "description": "Morse Fall Scale for inpatient fall risk. Higher scores = higher risk (0–125).",
+    "meta": {
+      "capture_roles": ["nurse", "ed_nurse", "theatre_nurse", "labour_ward_nurse", "fertility_nurse", "dialysis_nurse", "midwife", "doctor", "general_physician"],
+      "specialty": "nursing",
+      "pack_family": "nursing",
+      "estimated_minutes": 3,
+      "max_total": 125,
+      "severity_bands": [
+        { "max": 24, "label": "Low risk" },
+        { "max": 44, "label": "Medium risk" },
+        { "max": 125, "label": "High risk" }
+      ],
+      "attribution": "Morse Fall Scale — verify licensing for commercial redistribution of branded materials."
+    }
+  },
+  "questions": [
+    {
+      "code": "history_falling",
+      "section": "Fall risk",
+      "label": "History of falling",
+      "answer_type": "score_item",
+      "is_required": true,
+      "sort_order": 10,
+      "score_key": "morse",
+      "options": {
+        "max": 25,
+        "choices": [
+          { "code": "0", "label": "No", "score": 0 },
+          { "code": "25", "label": "Yes", "score": 25 }
+        ]
+      }
+    },
+    {
+      "code": "secondary_diagnosis",
+      "section": "Fall risk",
+      "label": "Secondary diagnosis",
+      "answer_type": "score_item",
+      "is_required": true,
+      "sort_order": 20,
+      "score_key": "morse",
+      "options": {
+        "max": 15,
+        "choices": [
+          { "code": "0", "label": "No", "score": 0 },
+          { "code": "15", "label": "Yes", "score": 15 }
+        ]
+      }
+    },
+    {
+      "code": "ambulatory_aid",
+      "section": "Fall risk",
+      "label": "Ambulatory aid",
+      "answer_type": "score_item",
+      "is_required": true,
+      "sort_order": 30,
+      "score_key": "morse",
+      "options": {
+        "max": 30,
+        "choices": [
+          { "code": "0", "label": "None / bed rest / nurse assist", "score": 0 },
+          { "code": "15", "label": "Crutches / cane / walker", "score": 15 },
+          { "code": "30", "label": "Furniture", "score": 30 }
+        ]
+      }
+    },
+    {
+      "code": "iv_therapy",
+      "section": "Fall risk",
+      "label": "IV / heparin lock",
+      "answer_type": "score_item",
+      "is_required": true,
+      "sort_order": 40,
+      "score_key": "morse",
+      "options": {
+        "max": 20,
+        "choices": [
+          { "code": "0", "label": "No", "score": 0 },
+          { "code": "20", "label": "Yes", "score": 20 }
+        ]
+      }
+    },
+    {
+      "code": "gait",
+      "section": "Fall risk",
+      "label": "Gait / transferring",
+      "answer_type": "score_item",
+      "is_required": true,
+      "sort_order": 50,
+      "score_key": "morse",
+      "options": {
+        "max": 20,
+        "choices": [
+          { "code": "0", "label": "Normal / bedrest / immobile", "score": 0 },
+          { "code": "10", "label": "Weak", "score": 10 },
+          { "code": "20", "label": "Impaired", "score": 20 }
+        ]
+      }
+    },
+    {
+      "code": "mental_status",
+      "section": "Fall risk",
+      "label": "Mental status",
+      "answer_type": "score_item",
+      "is_required": true,
+      "sort_order": 60,
+      "score_key": "morse",
+      "options": {
+        "max": 15,
+        "choices": [
+          { "code": "0", "label": "Oriented to own ability", "score": 0 },
+          { "code": "15", "label": "Forgets limitations", "score": 15 }
+        ]
+      }
+    }
+  ]
+}
@@ -0,0 +1,152 @@
+{
+  "template": {
+    "code": "news2",
+    "name": "NEWS2 (Nursing early warning)",
+    "category": "screening",
+    "version": 1,
+    "is_current": true,
+    "is_active": true,
+    "scoring_strategy": "sum_items",
+    "description": "National Early Warning Score 2 style physiological track-and-trigger for ward nursing. Scores 0–20.",
+    "meta": {
+      "capture_roles": ["nurse", "ed_nurse", "theatre_nurse", "labour_ward_nurse", "fertility_nurse", "dialysis_nurse", "midwife", "doctor", "general_physician", "emergency_physician", "obstetrician", "gynecologist", "obgyn"],
+      "specialty": "nursing",
+      "pack_family": "nursing",
+      "estimated_minutes": 3,
+      "max_total": 20,
+      "severity_bands": [
+        { "max": 4, "label": "Low" },
+        { "max": 6, "label": "Medium" },
+        { "max": 20, "label": "High" }
+      ],
+      "attribution": "NEWS2-inspired clinical scoring for operational use. Official NEWS2 materials remain Royal College of Physicians IP — verify licensing for branded redistribution."
+    }
+  },
+  "questions": [
+    {
+      "code": "respiration",
+      "section": "Physiology",
+      "label": "Respiration rate (breaths/min)",
+      "answer_type": "score_item",
+      "is_required": true,
+      "sort_order": 10,
+      "score_key": "news2",
+      "options": {
+        "max": 3,
+        "choices": [
+          { "code": "0", "label": "12–20", "score": 0 },
+          { "code": "1", "label": "9–11", "score": 1 },
+          { "code": "2", "label": "21–24", "score": 2 },
+          { "code": "3a", "label": "≤8", "score": 3 },
+          { "code": "3b", "label": "≥25", "score": 3 }
+        ]
+      }
+    },
+    {
+      "code": "spo2",
+      "section": "Physiology",
+      "label": "SpO₂ scale 1 (%)",
+      "answer_type": "score_item",
+      "is_required": true,
+      "sort_order": 20,
+      "score_key": "news2",
+      "options": {
+        "max": 3,
+        "choices": [
+          { "code": "0", "label": "≥96", "score": 0 },
+          { "code": "1", "label": "94–95", "score": 1 },
+          { "code": "2", "label": "92–93", "score": 2 },
+          { "code": "3", "label": "≤91", "score": 3 }
+        ]
+      }
+    },
+    {
+      "code": "air_oxygen",
+      "section": "Physiology",
+      "label": "Air or oxygen",
+      "answer_type": "score_item",
+      "is_required": true,
+      "sort_order": 30,
+      "score_key": "news2",
+      "options": {
+        "max": 2,
+        "choices": [
+          { "code": "0", "label": "Air", "score": 0 },
+          { "code": "2", "label": "Oxygen", "score": 2 }
+        ]
+      }
+    },
+    {
+      "code": "systolic_bp",
+      "section": "Physiology",
+      "label": "Systolic BP (mmHg)",
+      "answer_type": "score_item",
+      "is_required": true,
+      "sort_order": 40,
+      "score_key": "news2",
+      "options": {
+        "max": 3,
+        "choices": [
+          { "code": "0", "label": "111–219", "score": 0 },
+          { "code": "1", "label": "101–110", "score": 1 },
+          { "code": "2", "label": "91–100", "score": 2 },
+          { "code": "3a", "label": "≤90", "score": 3 },
+          { "code": "3b", "label": "≥220", "score": 3 }
+        ]
+      }
+    },
+    {
+      "code": "pulse",
+      "section": "Physiology",
+      "label": "Pulse (bpm)",
+      "answer_type": "score_item",
+      "is_required": true,
+      "sort_order": 50,
+      "score_key": "news2",
+      "options": {
+        "max": 3,
+        "choices": [
+          { "code": "0", "label": "51–90", "score": 0 },
+          { "code": "1", "label": "41–50 or 91–110", "score": 1 },
+          { "code": "2", "label": "111–130", "score": 2 },
+          { "code": "3a", "label": "≤40", "score": 3 },
+          { "code": "3b", "label": "≥131", "score": 3 }
+        ]
+      }
+    },
+    {
+      "code": "consciousness",
+      "section": "Physiology",
+      "label": "Consciousness",
+      "answer_type": "score_item",
+      "is_required": true,
+      "sort_order": 60,
+      "score_key": "news2",
+      "options": {
+        "max": 3,
+        "choices": [
+          { "code": "0", "label": "Alert", "score": 0 },
+          { "code": "3", "label": "CVPU", "score": 3 }
+        ]
+      }
+    },
+    {
+      "code": "temperature",
+      "section": "Physiology",
+      "label": "Temperature (°C)",
+      "answer_type": "score_item",
+      "is_required": true,
+      "sort_order": 70,
+      "score_key": "news2",
+      "options": {
+        "max": 3,
+        "choices": [
+          { "code": "0", "label": "36.1–38.0", "score": 0 },
+          { "code": "1a", "label": "35.1–36.0 or 38.1–39.0", "score": 1 },
+          { "code": "2", "label": "≥39.1", "score": 2 },
+          { "code": "3", "label": "≤35.0", "score": 3 }
+        ]
+      }
+    }
+  ]
+}
@@ -0,0 +1,49 @@
+{
+  "template": {
+    "code": "pain_nrs",
+    "name": "Pain NRS (0–10)",
+    "category": "screening",
+    "version": 1,
+    "is_current": true,
+    "is_active": true,
+    "scoring_strategy": "single_value",
+    "description": "Numeric rating scale for pain intensity at rest / with activity.",
+    "meta": {
+      "capture_roles": ["nurse", "ed_nurse", "theatre_nurse", "labour_ward_nurse", "fertility_nurse", "dialysis_nurse", "midwife", "doctor", "general_physician", "emergency_physician"],
+      "specialty": "nursing",
+      "pack_family": "nursing",
+      "estimated_minutes": 1,
+      "max_total": 10,
+      "severity_bands": [
+        { "max": 3, "label": "Mild" },
+        { "max": 6, "label": "Moderate" },
+        { "max": 10, "label": "Severe" }
+      ]
+    }
+  },
+  "questions": [
+    {
+      "code": "pain_score",
+      "section": "Pain",
+      "label": "Pain intensity (0 = none, 10 = worst imaginable)",
+      "answer_type": "scale",
+      "is_required": true,
+      "sort_order": 10,
+      "score_key": "pain",
+      "options": {
+        "min": 0,
+        "max": 10,
+        "step": 1
+      }
+    },
+    {
+      "code": "pain_location",
+      "section": "Pain",
+      "label": "Location / notes",
+      "answer_type": "text",
+      "is_required": false,
+      "sort_order": 20,
+      "options": {}
+    }
+  ]
+}
@@ -0,0 +1,41 @@
+<?php
+
+use Illuminate\Database\Migrations\Migration;
+use Illuminate\Database\Schema\Blueprint;
+use Illuminate\Support\Facades\Schema;
+
+/**
+ * Visit-scoped vitals for ward nursing (no consultation required).
+ */
+return new class extends Migration
+{
+    public function up(): void
+    {
+        Schema::create('care_visit_vitals', function (Blueprint $table) {
+            $table->id();
+            $table->string('owner_ref')->index();
+            $table->foreignId('organization_id')->constrained('care_organizations')->cascadeOnDelete();
+            $table->foreignId('visit_id')->constrained('care_visits')->cascadeOnDelete();
+            $table->foreignId('patient_id')->constrained('care_patients')->cascadeOnDelete();
+            $table->foreignId('care_unit_id')->nullable()->constrained('care_care_units')->nullOnDelete();
+            $table->unsignedSmallInteger('bp_systolic')->nullable();
+            $table->unsignedSmallInteger('bp_diastolic')->nullable();
+            $table->unsignedSmallInteger('pulse')->nullable();
+            $table->decimal('temperature', 4, 1)->nullable();
+            $table->unsignedSmallInteger('spo2')->nullable();
+            $table->unsignedSmallInteger('respiratory_rate')->nullable();
+            $table->string('recorded_by')->nullable();
+            $table->timestamp('recorded_at');
+            $table->text('notes')->nullable();
+            $table->timestamps();
+
+            $table->index(['visit_id', 'recorded_at']);
+            $table->index(['care_unit_id', 'recorded_at']);
+        });
+    }
+
+    public function down(): void
+    {
+        Schema::dropIfExists('care_visit_vitals');
+    }
+};
@@ -27,16 +27,24 @@
                    $canMar = $permissions->can($member, 'mar.view');
                    $canNotes = $permissions->can($member, 'nursing.notes.view');
                    $canHandover = $permissions->can($member, 'nursing.handover.view');
+                    $canAssess = $permissions->can($member, 'nursing.assessments.view');
+                    $canPerf = $permissions->can($member, 'nursing.performance.view');
                @endphp
                @if ($canMar)
                    <a href="{{ route('care.care-units.mar', $unit) }}" class="btn-primary">MAR board</a>
                @endif
+                @if ($canAssess)
+                    <a href="{{ route('care.care-units.assessments', $unit) }}" class="btn-secondary">Assessments</a>
+                @endif
                @if ($canNotes)
                    <a href="{{ route('care.care-units.notes', $unit) }}" class="btn-secondary">Nursing notes</a>
                @endif
                @if ($canHandover)
                    <a href="{{ route('care.care-units.handovers', $unit) }}" class="btn-secondary">Handovers</a>
                @endif
+                @if ($canPerf)
+                    <a href="{{ route('care.care-units.performance', $unit) }}" class="btn-secondary">Performance</a>
+                @endif
                @if ($canManageUnit)
                    <a href="{{ route('care.care-units.edit', $unit) }}" class="btn-secondary">Edit unit</a>
                    <a href="{{ route('care.staff-assignments.create', ['care_unit_id' => $unit->id]) }}" class="btn-secondary">Assign staff</a>
@@ -0,0 +1,106 @@
+<x-app-layout title="Assessments · {{ $unit->name }}">
+    <div class="space-y-6">
+        <div class="flex flex-wrap items-start justify-between gap-4">
+            <div>
+                <p class="text-sm text-slate-500">
+                    <a href="{{ route('care.care-units.show', $unit) }}" class="text-indigo-600 hover:text-indigo-800">{{ $unit->name }}</a>
+                    <span class="text-slate-300">/</span>
+                    Nursing assessments
+                </p>
+                <h1 class="mt-1 text-2xl font-semibold text-slate-900">Ward assessment board</h1>
+                <p class="mt-1 text-sm text-slate-500">NEWS2, Braden, Morse, pain, and visit vitals for placed patients.</p>
+            </div>
+            <a href="{{ route('care.care-units.performance', $unit) }}" class="btn-secondary">Performance</a>
+        </div>
+
+        @unless ($engineEnabled)
+            <div class="rounded-xl border border-amber-200 bg-amber-50 px-4 py-3 text-sm text-amber-900">
+                Assessments engine is disabled for this organization. Enable it under Settings → Rollout.
+            </div>
+        @endunless
+
+        <div class="overflow-hidden rounded-2xl border border-slate-200 bg-white">
+            <table class="min-w-full text-sm">
+                <thead class="bg-slate-50 text-left text-xs uppercase text-slate-500">
+                    <tr>
+                        <th class="px-4 py-3">Patient</th>
+                        <th class="px-4 py-3">Latest vitals</th>
+                        @foreach ($templates as $template)
+                            <th class="px-4 py-3">{{ $template->code }}</th>
+                        @endforeach
+                        <th class="px-4 py-3"></th>
+                    </tr>
+                </thead>
+                <tbody class="divide-y divide-slate-50">
+                    @forelse ($rows as $row)
+                        @php
+                            $visit = $row['visit'];
+                            $vitals = $row['vitals'];
+                        @endphp
+                        <tr>
+                            <td class="px-4 py-3 font-medium">
+                                {{ $row['patient']?->fullName() }}
+                                <div class="text-xs text-slate-400">{{ $row['bed']?->label ?? 'No bed' }}</div>
+                            </td>
+                            <td class="px-4 py-3 text-xs text-slate-600">
+                                @if ($vitals)
+                                    BP {{ $vitals->bp_systolic }}/{{ $vitals->bp_diastolic }}
+                                    · P {{ $vitals->pulse }}
+                                    · SpO₂ {{ $vitals->spo2 }}
+                                    <div class="text-slate-400">{{ $vitals->recorded_at?->format('d M H:i') }}</div>
+                                @else
+                                    —
+                                @endif
+                            </td>
+                            @foreach ($templates as $template)
+                                @php $assessment = $row['assessments']->get($template->code); @endphp
+                                <td class="px-4 py-3">
+                                    @if ($assessment)
+                                        <a href="{{ route('care.assessments.show', $assessment) }}" class="text-sky-600 hover:text-sky-800">
+                                            {{ $assessment->status === 'completed'
+                                                ? ($assessment->score?->severity_label ?? ($assessment->score?->total_score !== null ? $assessment->score->total_score : 'Done'))
+                                                : 'Draft' }}
+                                        </a>
+                                    @else
+                                        <span class="text-slate-400">—</span>
+                                    @endif
+                                </td>
+                            @endforeach
+                            <td class="px-4 py-3 text-right">
+                                @if ($canCapture && $engineEnabled)
+                                    <div class="inline-flex flex-wrap justify-end gap-1">
+                                        @foreach ($templates as $template)
+                                            <form method="POST" action="{{ route('care.care-units.assessments.start', [$unit, $visit]) }}">
+                                                @csrf
+                                                <input type="hidden" name="template_code" value="{{ $template->code }}">
+                                                <button type="submit" class="rounded border border-slate-200 px-2 py-1 text-xs text-slate-700 hover:bg-slate-50">{{ strtoupper($template->code) }}</button>
+                                            </form>
+                                        @endforeach
+                                    </div>
+                                @endif
+                            </td>
+                        </tr>
+                        @if ($canVitals)
+                            <tr class="bg-slate-50/60">
+                                <td colspan="{{ 3 + $templates->count() }}" class="px-4 py-3">
+                                    <form method="POST" action="{{ route('care.care-units.vitals.store', [$unit, $visit]) }}" class="grid gap-2 sm:grid-cols-7">
+                                        @csrf
+                                        <input type="number" name="bp_systolic" placeholder="Sys" class="rounded-lg border-slate-300 text-sm">
+                                        <input type="number" name="bp_diastolic" placeholder="Dia" class="rounded-lg border-slate-300 text-sm">
+                                        <input type="number" name="pulse" placeholder="Pulse" class="rounded-lg border-slate-300 text-sm">
+                                        <input type="number" step="0.1" name="temperature" placeholder="Temp" class="rounded-lg border-slate-300 text-sm">
+                                        <input type="number" name="spo2" placeholder="SpO₂" class="rounded-lg border-slate-300 text-sm">
+                                        <input type="number" name="respiratory_rate" placeholder="RR" class="rounded-lg border-slate-300 text-sm">
+                                        <button type="submit" class="btn-secondary text-xs">Record vitals · {{ $row['patient']?->first_name }}</button>
+                                    </form>
+                                </td>
+                            </tr>
+                        @endif
+                    @empty
+                        <tr><td colspan="{{ 3 + max($templates->count(), 1) }}" class="px-4 py-8 text-center text-slate-500">No patients placed on this unit.</td></tr>
+                    @endforelse
+                </tbody>
+            </table>
+        </div>
+    </div>
+</x-app-layout>
@@ -0,0 +1,97 @@
+@php $r = $report; @endphp
+
+<x-app-layout title="Performance · {{ $unit->name }}">
+    <div class="space-y-6">
+        <div class="flex flex-wrap items-start justify-between gap-4">
+            <div>
+                <p class="text-sm text-slate-500">
+                    <a href="{{ route('care.care-units.show', $unit) }}" class="text-indigo-600 hover:text-indigo-800">{{ $unit->name }}</a>
+                    <span class="text-slate-300">/</span>
+                    Nurse performance
+                </p>
+                <h1 class="mt-1 text-2xl font-semibold text-slate-900">Unit nursing KPIs</h1>
+                <p class="mt-1 text-sm text-slate-500">MAR compliance, vitals, assessments, notes, and handovers.</p>
+            </div>
+            <form method="GET" class="flex flex-wrap items-end gap-2">
+                <div>
+                    <label class="block text-xs font-medium uppercase text-slate-500">From</label>
+                    <input type="date" name="from" value="{{ $r['from']->toDateString() }}" class="mt-1 rounded-lg border-slate-300 text-sm">
+                </div>
+                <div>
+                    <label class="block text-xs font-medium uppercase text-slate-500">To</label>
+                    <input type="date" name="to" value="{{ $r['to']->toDateString() }}" class="mt-1 rounded-lg border-slate-300 text-sm">
+                </div>
+                <button type="submit" class="btn-secondary">Apply</button>
+            </form>
+        </div>
+
+        <div class="grid gap-4 sm:grid-cols-2 lg:grid-cols-4">
+            <div class="rounded-2xl border border-slate-200 bg-white p-5">
+                <p class="text-xs font-semibold uppercase tracking-wide text-slate-500">MAR given</p>
+                <p class="mt-2 text-3xl font-semibold text-slate-900">{{ $r['mar']['given'] }}</p>
+                <p class="mt-1 text-sm text-slate-500">of {{ $r['mar']['total'] }} recorded · compliance {{ $r['mar']['compliance_rate'] ?? '—' }}%</p>
+            </div>
+            <div class="rounded-2xl border border-slate-200 bg-white p-5">
+                <p class="text-xs font-semibold uppercase tracking-wide text-slate-500">On-time MAR</p>
+                <p class="mt-2 text-3xl font-semibold text-slate-900">{{ $r['mar']['on_time_rate'] ?? '—' }}%</p>
+                <p class="mt-1 text-sm text-slate-500">{{ $r['mar']['on_time_given'] }} given within window</p>
+            </div>
+            <div class="rounded-2xl border border-slate-200 bg-white p-5">
+                <p class="text-xs font-semibold uppercase tracking-wide text-slate-500">Assessments done</p>
+                <p class="mt-2 text-3xl font-semibold text-slate-900">{{ $r['assessments']['completed'] }}</p>
+                <p class="mt-1 text-sm text-slate-500">{{ $r['assessments']['completion_rate'] ?? '—' }}% of {{ $r['assessments']['started'] }} started</p>
+            </div>
+            <div class="rounded-2xl border border-slate-200 bg-white p-5">
+                <p class="text-xs font-semibold uppercase tracking-wide text-slate-500">Notes / vitals</p>
+                <p class="mt-2 text-3xl font-semibold text-slate-900">{{ $r['notes']['total'] }} / {{ $r['vitals']['total'] }}</p>
+                <p class="mt-1 text-sm text-slate-500">{{ $r['handovers']['completed'] }} handovers · {{ $r['placed_patients'] }} placed now</p>
+            </div>
+        </div>
+
+        <div class="grid gap-6 lg:grid-cols-2">
+            <div class="rounded-2xl border border-slate-200 bg-white p-6">
+                <h2 class="text-base font-semibold text-slate-900">Nursing packs</h2>
+                <ul class="mt-4 divide-y divide-slate-100 text-sm">
+                    @forelse ($r['assessments']['by_template'] as $row)
+                        <li class="flex items-center justify-between py-2">
+                            <span>{{ $row['name'] }}</span>
+                            <span class="text-slate-500">{{ $row['completed'] }}/{{ $row['total'] }}</span>
+                        </li>
+                    @empty
+                        <li class="py-2 text-slate-500">No nursing assessments in range.</li>
+                    @endforelse
+                </ul>
+            </div>
+
+            <div class="rounded-2xl border border-slate-200 bg-white p-6">
+                <h2 class="text-base font-semibold text-slate-900">By clinician</h2>
+                <div class="mt-4 overflow-x-auto">
+                    <table class="min-w-full text-sm">
+                        <thead class="text-left text-xs uppercase text-slate-500">
+                            <tr>
+                                <th class="pb-2 pr-3">Staff</th>
+                                <th class="pb-2 pr-3">MAR</th>
+                                <th class="pb-2 pr-3">Notes</th>
+                                <th class="pb-2 pr-3">Assess</th>
+                                <th class="pb-2">Handover</th>
+                            </tr>
+                        </thead>
+                        <tbody class="divide-y divide-slate-100">
+                            @forelse ($r['by_actor'] as $actor)
+                                <tr>
+                                    <td class="py-2 pr-3 font-medium">{{ $actor['label'] }}</td>
+                                    <td class="py-2 pr-3">{{ $actor['mar_given'] }}/{{ $actor['mar_total'] }}</td>
+                                    <td class="py-2 pr-3">{{ $actor['notes'] }}</td>
+                                    <td class="py-2 pr-3">{{ $actor['assessments_completed'] }}</td>
+                                    <td class="py-2">{{ $actor['handovers'] }}</td>
+                                </tr>
+                            @empty
+                                <tr><td colspan="5" class="py-3 text-slate-500">No activity attributed yet.</td></tr>
+                            @endforelse
+                        </tbody>
+                    </table>
+                </div>
+            </div>
+        </div>
+    </div>
+</x-app-layout>
@@ -18,6 +18,8 @@ use App\Http\Controllers\Care\StaffAssignmentController;
 use App\Http\Controllers\Care\VisitPlacementController;
 use App\Http\Controllers\Care\MarController;
 use App\Http\Controllers\Care\NursingDocumentationController;
+use App\Http\Controllers\Care\NursingAssessmentController;
+use App\Http\Controllers\Care\NursePerformanceController;
 use App\Http\Controllers\Care\DeviceController;
 use App\Http\Controllers\Care\DisplayPublicController;
 use App\Http\Controllers\Care\DisplayScreenController;
@@ -447,6 +449,11 @@ Route::middleware(['auth', 'platform.session'])->group(function () {
        Route::get('/care-units/{careUnit}/handovers/{wardHandover}', [NursingDocumentationController::class, 'showHandover'])->name('care.care-units.handovers.show');
        Route::post('/care-units/{careUnit}/handovers/{wardHandover}/complete', [NursingDocumentationController::class, 'completeHandover'])->name('care.care-units.handovers.complete');

+        Route::get('/care-units/{careUnit}/assessments', [NursingAssessmentController::class, 'unitBoard'])->name('care.care-units.assessments');
+        Route::post('/care-units/{careUnit}/visits/{visit}/assessments', [NursingAssessmentController::class, 'start'])->name('care.care-units.assessments.start');
+        Route::post('/care-units/{careUnit}/visits/{visit}/vitals', [NursingAssessmentController::class, 'storeVitals'])->name('care.care-units.vitals.store');
+        Route::get('/care-units/{careUnit}/performance', [NursePerformanceController::class, 'show'])->name('care.care-units.performance');
+
        Route::get('/staff-assignments', [StaffAssignmentController::class, 'index'])->name('care.staff-assignments.index');
        Route::get('/staff-assignments/create', [StaffAssignmentController::class, 'create'])->name('care.staff-assignments.create');
        Route::post('/staff-assignments', [StaffAssignmentController::class, 'store'])->name('care.staff-assignments.store');
@@ -0,0 +1,217 @@
+<?php
+
+namespace Tests\Feature;
+
+use App\Http\Middleware\EnsurePlatformSession;
+use App\Models\Assessment;
+use App\Models\AssessmentTemplate;
+use App\Models\Branch;
+use App\Models\CareUnit;
+use App\Models\Department;
+use App\Models\Member;
+use App\Models\Organization;
+use App\Models\Patient;
+use App\Models\User;
+use App\Models\Visit;
+use App\Models\VisitVital;
+use App\Services\Care\AssessmentService;
+use App\Services\Care\VisitPlacementService;
+use Database\Seeders\AssessmentTemplateSeeder;
+use Illuminate\Foundation\Testing\RefreshDatabase;
+use Tests\TestCase;
+
+class CareNursingAssessmentsAndPerformanceTest extends TestCase
+{
+    use RefreshDatabase;
+
+    protected User $owner;
+
+    protected Organization $organization;
+
+    protected CareUnit $unit;
+
+    protected Visit $visit;
+
+    protected Patient $patient;
+
+    protected function setUp(): void
+    {
+        parent::setUp();
+        $this->withoutMiddleware(EnsurePlatformSession::class);
+
+        $this->seed(AssessmentTemplateSeeder::class);
+
+        $this->owner = User::create([
+            'public_id' => 'nursing-de-owner',
+            'name' => 'Owner',
+            'email' => 'nursing-de@example.com',
+        ]);
+
+        $this->organization = Organization::create([
+            'owner_ref' => $this->owner->public_id,
+            'name' => 'Nursing DE Hospital',
+            'slug' => 'nursing-de-hospital',
+            'settings' => [
+                'onboarded' => true,
+                'facility_type' => 'hospital',
+                'plan' => 'pro',
+                'plan_expires_at' => now()->addMonth()->toIso8601String(),
+                'rollout' => ['assessments_engine' => true],
+            ],
+        ]);
+
+        Member::create([
+            'owner_ref' => $this->owner->public_id,
+            'organization_id' => $this->organization->id,
+            'user_ref' => $this->owner->public_id,
+            'role' => 'hospital_admin',
+        ]);
+
+        $branch = Branch::create([
+            'owner_ref' => $this->owner->public_id,
+            'organization_id' => $this->organization->id,
+            'name' => 'Main',
+            'is_active' => true,
+        ]);
+
+        $department = Department::create([
+            'owner_ref' => $this->owner->public_id,
+            'branch_id' => $branch->id,
+            'name' => 'Medicine',
+            'type' => 'general',
+            'is_active' => true,
+        ]);
+
+        $this->unit = CareUnit::create([
+            'owner_ref' => $this->owner->public_id,
+            'organization_id' => $this->organization->id,
+            'department_id' => $department->id,
+            'name' => 'Medical Ward',
+            'kind' => 'inpatient',
+            'is_active' => true,
+        ]);
+
+        $this->patient = Patient::create([
+            'owner_ref' => $this->owner->public_id,
+            'organization_id' => $this->organization->id,
+            'branch_id' => $branch->id,
+            'patient_number' => 'P-NDE-1',
+            'first_name' => 'Ama',
+            'last_name' => 'Mensah',
+            'gender' => 'female',
+        ]);
+
+        $this->visit = Visit::create([
+            'owner_ref' => $this->owner->public_id,
+            'organization_id' => $this->organization->id,
+            'branch_id' => $branch->id,
+            'patient_id' => $this->patient->id,
+            'status' => Visit::STATUS_IN_PROGRESS,
+            'checked_in_at' => now(),
+        ]);
+
+        app(VisitPlacementService::class)->place(
+            $this->visit,
+            $this->unit,
+            null,
+            $this->owner->public_id,
+            $this->owner->public_id,
+        );
+    }
+
+    public function test_nursing_packs_are_seeded(): void
+    {
+        foreach (['news2', 'braden', 'morse', 'pain_nrs'] as $code) {
+            $this->assertNotNull(
+                AssessmentTemplate::currentSystemByCode($code),
+                "Missing nursing pack {$code}",
+            );
+        }
+    }
+
+    public function test_start_nursing_assessment_from_unit_board(): void
+    {
+        $this->actingAs($this->owner)
+            ->post(route('care.care-units.assessments.start', [$this->unit, $this->visit]), [
+                'template_code' => 'news2',
+            ])
+            ->assertRedirect();
+
+        $assessment = Assessment::query()->where('visit_id', $this->visit->id)->first();
+        $this->assertNotNull($assessment);
+        $this->assertSame(Assessment::STATUS_DRAFT, $assessment->status);
+        $this->assertSame('news2', $assessment->template->code);
+
+        $this->actingAs($this->owner)
+            ->get(route('care.care-units.assessments', $this->unit))
+            ->assertOk()
+            ->assertSee('Ama')
+            ->assertSee('NEWS2');
+    }
+
+    public function test_record_visit_vitals_and_performance_dashboard(): void
+    {
+        $this->actingAs($this->owner)
+            ->post(route('care.care-units.vitals.store', [$this->unit, $this->visit]), [
+                'bp_systolic' => 120,
+                'bp_diastolic' => 80,
+                'pulse' => 72,
+                'spo2' => 98,
+                'respiratory_rate' => 16,
+                'temperature' => 36.8,
+            ])
+            ->assertRedirect(route('care.care-units.assessments', $this->unit));
+
+        $this->assertDatabaseHas('care_visit_vitals', [
+            'visit_id' => $this->visit->id,
+            'pulse' => 72,
+            'care_unit_id' => $this->unit->id,
+        ]);
+
+        $member = Member::query()->where('user_ref', $this->owner->public_id)->first();
+        $assessment = app(AssessmentService::class)->start(
+            $this->patient,
+            'pain_nrs',
+            $this->owner->public_id,
+            $member,
+            ['visit' => $this->visit->fresh(), 'actor' => $this->owner->public_id],
+        );
+
+        $this->actingAs($this->owner)
+            ->put(route('care.assessments.update', $assessment), [
+                'answers' => ['pain_score' => 4],
+            ])
+            ->assertRedirect();
+
+        $this->actingAs($this->owner)
+            ->post(route('care.assessments.complete', $assessment))
+            ->assertRedirect();
+
+        $assessment->refresh()->load('score');
+        $this->assertSame(Assessment::STATUS_COMPLETED, $assessment->status);
+        $this->assertNotNull($assessment->score);
+        $this->assertSame('Moderate', $assessment->score->severity_label);
+
+        $this->actingAs($this->owner)
+            ->get(route('care.care-units.performance', $this->unit))
+            ->assertOk()
+            ->assertSee('Unit nursing KPIs')
+            ->assertSee('Assessments done');
+    }
+
+    public function test_visit_vitals_model_created(): void
+    {
+        VisitVital::create([
+            'owner_ref' => $this->owner->public_id,
+            'organization_id' => $this->organization->id,
+            'visit_id' => $this->visit->id,
+            'patient_id' => $this->patient->id,
+            'care_unit_id' => $this->unit->id,
+            'pulse' => 80,
+            'recorded_at' => now(),
+            'recorded_by' => $this->owner->public_id,
+        ]);
+
+        $this->assertSame(1, VisitVital::query()->where('visit_id', $this->visit->id)->count());
+    }
+}