Personal Nursing Philosophy paper

Scholarly academic references

Week 1

The Theory Era

The theory era began with a strong emphasis on knowledge development. Although in the previous two decades proponents of nursing theory and nursing theorists had begun to publish their works, it is noteworthy that they denied being theorists when they were introduced as such at the 1978 Nurse Educator Conference in New York with the Nursing Theory theme. There was understanding among those attending the conference that the presenters were theorists, and by the second day, the audience responded to their denials with laughter. This seems strange today, but this was the first time most of the theorists even met each other. Their works had grown out of content organization in nursing education courses, nursing practice administration in large agencies, and structures for the thought and action of practice. It was clear that their works were nursing theoretical structures even before they recognized them as such. The theory era, coupled with the research and graduate education eras, led to understanding of the scientific process beyond production of a scientific product Theory forms the foundation of knowledge. Nursing theories form the foundation of nursing practice, research, and education. Throughout your professional life, you will be applying theory and the knowledge derived from theory in your practice environment regardless of the setting. An understanding of the nature of nursing knowledge from a historical perspective will help you relate better to where nursing theory development is today.

Theory

Theory is defined as "an organized, coherent, and systematic articulation of a set of statements related to significant questions in a discipline that are communicated in a meaningful whole; a symbolic depiction of aspects of reality that are discovered or invented for describing, explaining, predicting, or prescribing responses, events, situations, conditions, or relationships" (Meleis, 1997, pp. 8,12)1. Thus, a theory is a coherent set of propositions and statements that describe (factor-isolating), explain (factor-relating), and predict (situation-relating) phenomena as well as prescribe (situation-producing) actions toward goals. (Dickoff et al., 1968)2.

Theory development requires perceiving phenomena that are peculiar to nursing and proposing meaningful explanation for these perceptions. The nursing profession identifies four levels of theory—metatheory, grand theory, middle range theory, and practice theory. The theories are classified based on their levels of abstraction or complexity.

A complete structure includes a conceptual model, derived theories, and correlated empirical research methods. Each conceptual model and theory is comprised of concepts and propositions. The complete structure forms a hierarchy that is based on levels of abstraction.

Most abstract: the conceptual model that provides the context or frame of reference for theory-generating and theory-testing research

Intermediate level: the theory that is generated or tested

Most concrete: the empirical research methods used to collect and analyze the data

1Meleis, A. I. (1997). Theoretical nursing: development and progress (3rd ed.). Philadelphia: Lippincott.

2Dickoff, J., James, P., & Wiedenbach, E. (1968). Theory in a practice discipline Part 1: Practice oriented theory. Nursing Research, 17(5), 415–435.

Importance of Identification of theory

Early knowledge consisted of loosely connected clusters of concepts. Later knowledge developed interrelated statements connecting the concepts. Advanced theory provided a knowledge base for intervention strategies that clusters of concepts could not.

Identification of theory is important to understand the characteristics of theory structures. A complete theory of nursing identifies the three elements of context, content, and process; some theorists articulate each element better than others.

Context is the environment in which nursing acts occur; the context of a theory describes the nature of the world of nursing and may describe the nature of the patient’s world.

Content includes the subject matter of a theory; this comprises the stable components that are acted on or that do the acting

Process implies the action part of the theory, the intervention elements.

In addition to these elements, all theories should be examined for certain common factors:

Theories should be based on concepts and propositions

Theories should be specific to the nursing context

Theories can be applied to many situations

Theories should be relevant to potential users

Theories should be easy to define it in operational terms

Theories should correspond with empirical findings

Theories should demonstrate internal consistency.

Florence Nightingale made the first attempts at theory-based nursing during the late 19th and early 20th centuries. She organized a group of women to deliver care under her supervision and that of war surgeons. She established the need for hygiene, with environmental change as the means to enhance healing. For her, the nursing domain was the patient and the environment in which care was offered. Her goals were to expose the unhealthy conditions of soldiers, to gain support for the need for nurses, and to achieve formal education for nurses. She was the first to use data collection and analysis to prove efficacy of nursing actions.

The Nursing-Theory Connection

The new millennium has witnessed a rapid change in the global healthcare arena. This profession is continually evolving to face the monumental changes that have emerged. In the past, nursing theories were taught strictly from an academic point of view. Those in practice saw little connection or integration of theory and practice. However, the contemporary move toward evidence-based practice has seen nursing professionals applying theory to describe, predict, and prescribe nursing practice.

Relevance to Present and Future

Theories are a reflection of the past, present, and future of nursing. Understanding the relevance of theories will enhance the relationship of concept with practice. This will help you comprehend the complex phenomena and interconnectedness between theory and practice and build a new way of thinking, understanding, working, and living.

Relevance to Research

Research on theories help in the systematic investigation of the domain of knowledge. Research acts as a source of knowledge development. Research studies conducted on nursing theories help highlight the interlinking cyclical connection between theory and practice. Learners get an idea about the interconnectedness between real world clinical issues, theory, and actual research.

Nursing theories

Nursing theories are normally derived from conceptual models in which the nursing metaparadigm phenomena are clearly identified (Fawcett, 1983)3. For this reason, the conceptual model is considered a precursor of nursing theory (Peterson, 1977; Fawcet 1983)4. A conceptual model of nursing is a set of abstract concepts and propositions that are integrated into a meaningful configuration and represents an involvement in theoretical formulations by describing nursing phenomena and their interrelationships in abstract terms (Fawcett, 1983).

The concepts of a conceptual model are so abstract and general that they often cannot be observed or tested directly and may not even be defined. The concepts and definitions of each conceptual model are often stated in a distinctive vocabulary where the meaning of each term is connected to the unique focus of the conceptual model. Therefore, the same terms may have different meanings in different conceptual models.

Each conceptual model provides a different perspective from which to view the phenomena that are within the domain of inquiry of a particular discipline. Most disciplines have more than one conceptual model; each focuses on certain phenomena that are regarded as relevant and other phenomena are ignored because they are deemed less important.

3 Fawcett, J. (1983). Hallmarks of success in nursing theory development. In P. L. Chinn (Ed.), Advances in nursing theory development. Aspen, DN: Rockville, p. 3–17.

4Peterson, C. J. (1977). Questions frequently asked about the development of a conceptual framework. Journal of Nursing Education, 16( 4 ), 22–32.

My autobiography.

I am currently in Miami, FL. I have been living here since I came from Cuba 17 years ago. I received my RN license in 2017 with an associate degree, and I obtained my BSN last august. Since I received my RN license in 2017, I have worked in home health, clinical trial clinic, med-Surg floor nurse, ER nurse, and how I'm a hospice clinical liaison. I expect to increase my knowledge of nursing theories and how I can apply these theories to nursing. I'm still undecided between going back to the ER or stay in the hospice field and go for the palliative route. Since I started my nursing career, my goal and objective have always been to obtain my Master's degree and become a nurse practitioner, and now thanks to this course, fulfilling my goal is getting closer. I'm always up for new challenges, and I think that I can grow within my organization, and I believe that this course can help me along with getting my master's in science of nursing. I am excited to be a part of this class and good luck to everyone!

Week 2

Theory Development – Barrier and Stimulants

Development of a theoretical body of knowledge, unique to the nursing domain, is directly proportional to equivalent strides taken in the area of research. Effective integration of theory and practice is essential for the survival and growth of the nursing profession. To continue the cycle of meaningful advancements, researchers need to identify barriers and overcome them. Along with this, they also need to take note of factors that stimulate the process of theory development. Let's examine how knowledge has played a crucial role in setting obstacles in the path of theory development on the one hand and, on the other, how it has facilitated the development of nursing theories.

How did knowledge act as a barrier to the process of theory development?	How did knowledge act as a stimulant in the process of theory development?
Use of the knowledge of other disciplines was long seen as superior to that developed by nurses.	Knowledge breeds knowledge; existing theory now provides impetus for further refinement and development.
Other disciplines, such as sociology, psychology, and physiology, prepared their students to do research in nursing and develop theories for nurses, rather than encouraging nursing to prepare its own students to do research and theory development.	Old paradigms are challenged by new ones as they are influenced by social factors, factors in healthcare, and practice changes.
The National League for Nursing (NLN) requirement for colleges and universities often resulted in the development of curricula with esoteric content.	The new worldview is less mechanistic, more congruent with women's views of science and nurses' views of health; it is more wholistic and ecological.
The knowledge base developed was unrelated to practice and was far removed from preparing students to be change agents in practice.	Nurses are trained to observe record, analyze, and solve problems, and this unique source of knowledge has provided research efforts that are, finally, far more based in the practice realm than ever before.
The academic focus was on conceptual models as a way to develop theories and theoretical thinking, and often lost sight of the reason to conceptualize in the first place, that is, the underpinnings of nursing practice and patient care.	Nurses spend long hours with patients and family, and are better able to identify and understand patterns of phenomena, rather than perceive health and nursing as a series of isolated incidents.
Development of conceptual models and theories was encouraged as a way to justify and define the status of nursing as a profession, and required the existence of theories.	The move toward the development of middle-range theories, rather than grand theories and conceptual models, has allowed nurses involved directly in the provision of care to ask practice-based questions, do research to answer those questions, and develop new information on a more manageable scale.

Professional Barriers and Stimulants

In addition to knowledge, other factors have hindered or promoted the development of theories. These barriers and facilitators can be professional and social.

Before 1970, women entered nursing because of its service orientation rather than its professional potential. Women were not career oriented; nursing was seen as an in-and-out occupation, one that could be carried out on a part-time basis. It was seen as preparation for an eventual role as wife and mother; the self-identity of nursing students lay in their roles as women, rather than in a professional identity.

Let's examine the impact of some professional factors on theory development. Sex role stereotyping, for instance, has been a major influence.

How did gender and social status act as a barrier to the process of theory development?

· Role stagnation discouraged the creativity necessary for theoretical thinking, and issues existed over the nature/nurture conflict and giver/scientist role.

· Recognition in nursing was based on the practitioner or educator roles and not based on the roles of researcher or developer of theory, as is the case in other disciplines.

· The self-perception of members of the profession for the discipline was that of low autonomy, poor advancement, and less availability of intellectual stimulation.

· Education has the role of training individuals in thinking, analysis, and conceptualization; nurses were provided training, not education.

· Former nursing training methods served to decrease curiosity and the questioning attitude. These methods thus succeeded in fostering the handmaiden image to doctors, in addition to emphasizing the role of executing orders and implementing hospital policies.

· The focus was on doing tasks, not on thinking. Hospitals played a paternalistic role in which rules and regulations were made by non-nurses, and this created an environment in which questioning was discouraged and rebelliousness punished.

Social Barriers

Social factors too have influenced nursing theory development considerably. The social barriers and stimulants to theory development are:

How did gender and social status act as a barrier to the process of theory development?	How did gender and social status act as a stimulant in the process of theory development?
As women, nurses had distinctly dual roles resulting in role overload that resulted in a state not conducive to questioning, investigation, analysis, and theory development.	Women, as an oppressed minority, have had to deal creatively with situations in which others controlled the resources; as a result, women developed flexibility, innovation, and creativity in finding alternative resources to accomplish their goals. Nurses, as women, are using what they have, valuing their uniqueness.
Female characteristics have long been conceived of as antithetical to creativity and scientific productivity.	Women's cognitive styles are learned in a lifetime of socializing, negotiating, and fostering team efforts. These have been highly valued in the increasingly team-driven, business world of healthcare.
Women were seen as less analytical and cognitive and were expected to apply, rather than create, knowledge.	Women are a minority in other fields, but are a majority in nursing, and are appreciating the full citizenship this gives them in their own field.
Women suffer from ambivalence when they break away from the mold and often experience achievement-related conflict.	The resulting different attitudes toward nursing and its professional status led to a different attitude toward its theoretical underpinnings.
Internal, intradisciplinary debates, territory/turf issues, and lack of professional cohesion have confused other disciplines and the public about the true nature of nursing as a scientifically-based profession, with its own theoretical foundations and research-tested methodologies.	Women are now recognized for their observational and abstract thinking abilities. Observation is central to nursing practice, and the ability to think abstractly is critical for theorizing. Also important for theorizing is the ability to record what is happening in a nursing care situation. Nurses are adept at describing and explaining, one of the basic elements of the nursing process.

Context, Content, and Process

The impetus for theory development increased dramatically when the NLN required a conceptual framework for nursing curricula. Each nursing education program was required to develop a theoretical framework for the delivery of nursing education. This could be the adoption of a single theory or an amalgamation of several, and were not required to be nursing theories. This became the impetus for theory development primarily in the realm of nursing education. Thus, emerging theories were used to guide teaching, but not practice or research.

Nursing scientists searched for one theory for the entire discipline. Resulting theories were too abstract and complex, or too simplistic. Practitioners believed that the theory movement required them to choose a single theory and adhere to it throughout their practice efforts. None of the theoretical models addressed all aspects of nursing. Therefore, practitioners avoided, ignored, or refused to acknowledge the use of theory in practice. Eventually, two themes evolved at this stage:

· Acceptance of the complexity of nursing and the inevitability of multiple theories to address nursing phenomena

· Acceptance of the need to test elements of theory through research before discarding them.

Now the focus moved to formulating questions about the unique nature of nursing knowledge.

Social Barriers and Stimulants

Context, Content, and Process

The impetus for theory development increased dramatically when the NLN required a conceptual framework for nursing curricula. Each nursing education program was required to develop a theoretical framework for the delivery of nursing education. This could be the adoption of a single theory or an amalgamation of several, and were not required to be nursing theories. This became the impetus for theory development primarily in the realm of nursing education. Thus, emerging theories were used to guide teaching, but not practice or research.

Nursing scientists searched for one theory for the entire discipline. Resulting theories were too abstract and complex, or too simplistic. Practitioners believed that the theory movement required them to choose a single theory and adhere to it throughout their practice efforts. None of the theoretical models addressed all aspects of nursing. Therefore, practitioners avoided, ignored, or refused to acknowledge the use of theory in practice. Eventually, two themes evolved at this stage:

· Acceptance of the complexity of nursing and the inevitability of multiple theories to address nursing phenomena

· Acceptance of the need to test elements of theory through research before discarding them.

Now the focus moved to formulating questions about the unique nature of nursing knowledge.

Early Influences

Theories explain the world. Every profession and discipline has a foundation that explains how and why it works. Every branch of science works the same way. Early theories were extremely basic and simple. Newton sat under that tree and was hit by the apple, leading him to speculate about the existence of gravity.

Once a theoretical speculation is made, it is tested through research. Newton conducted many studies or experiments that would seem, well, silly to us today. They had to do with going to various heights and dropping things. Then he dropped things of different weights to see what difference that would make. These experiments served to prove his theory and allowed him to refine it.

Today, we readily acknowledge the existence of gravity and even do complicated experiments in space where it does not exist. Thus, theory is all around us and is not unique to nursing. We are evolving new nursing theory all the time as we speculate about a new response to a nursing phenomenon and try it out. You may even have done this sometime yourself! Thus theory development is a rigorous process that relies completely on research process. It evolves continuously from areas like nursing practice, nursing education, nursing theory, and existing theory.

Nursing Practice

Theory development began with Florence Nightingale who used data collection and analysis techniques to present information about nursing and its focus. In the early days of nursing practice, a domain for nursing was identified that included the patient, the environment, and nursing care. Each subsequent stage of practice enhancement helped nurses come closer to identifying the domain for nursing and defining its theoretical base.

Nursing Education

The development of different curricula for different levels of nursing education in the mid-1950s resulted in the need to articulate the different levels of nursing practice and the educational preparation required for each. Conversely, questions emerging about the differences in nursing care provided by diploma, AD, BSN, and MSN graduates forced an articulation of nursing theory to add distinctions to practice that resulted from different educational levels. This early focus on levels of nursing practice encouraged nursing students and educators to focus on nursing concerns and problems, rather than on medical concerns and problems.

Theory development during this early period attempted to answer the questions:

· What is nursing?

· What do nurses do?

· How is nursing different from other health science disciplines?

· What is nursing knowledge?

Research

The focus on advanced education for nurses led educators to develop increased interest in the research process through research courses offered at the graduate level and through their own required research. Faculty was required to develop ideas and communicate them in the scientific arena through presentations and publications. Their research triggered further theory development on the part of their graduate students. Initial interest was on systematic inquiry through research into teaching/learning modalities, the educational milieu, and appropriate content for nursing curricula. Data derived from this research prompted related theory development which, in turn, generated further research.

Existing Theory

Arguments within the profession in the early days of theory development focused on questions of whether nursing was a separate discipline or part of medicine and whether it was a biological, social, or physical science. The search for a conceptual foundation specific and unique to nursing led to the study of the realities of nursing practice and the truths that guided its actions. These are the phenomena of nursing. Emerging theories addressed the nature of human beings in interaction with the healthcare system, as well as the processes of problem solving and decision making for bases for intervention.

Milestones in Theory Development

Popular culture uses the media to represent the cultural elements that prevail in any given society at a particular point in time. People want to be part of a group and to understand their identity in the group; mass culture allows people to define themselves in relation to everyone else. We watch television, go to movies, listen to music, read newspapers and magazines, use the Internet, eat snacks, and dress in certain ways. We see advertisements for products and services daily, and these form part of our popular culture. It has been said that we can learn much about a culture from its advertising. Simply consider current television ads, especially those aimed at teenagers. It is easy to understand what teens want from these ads. They also give us an insight into their values. This is no less true for nursing. The ads in nursing journals of decades ago say a great deal about where we were and how far we have come. In the 1940s and 1950s, ads appeared for many products aimed at nurses themselves or for nurses to recommend those drugs or products to patients. Nurses' uniform ads were popular and often depicted an attractively-clad nurse—being looked over with interest by handsome doctors. We must all have been focused on the importance of male attention, given the importance of tight white uniform dresses! Nursing ads touted hand cream, menstrual pain relievers, various brands of coffee—even cigarettes! Nurses were all Caucasian women, and diversity did not exist.

Changes began to occur in the late 1960s and 1970s as equipment ads began to appear. Nurses could buy pink and green and blue stethoscopes that matched the pens and penlights and scissors. Form superseded function and the message was that we cared more for color coordination than for quality of equipment. Today's ads demonstrate a major shift in advertising attitudes toward nurses. Current ads are sophisticated and informative and assume that nurses now have significant decision-making ability in the workplace, as reflected in the ads for medication, hospital equipment, information resources, and so forth. Nursing images are multicultural and include men.

These changes are profound and have been reflected in the development of our theory and our knowledge base. The earliest theorists wrote when nurses were being sold custom-made uniforms and capes, white garter belts and stockings, cigarettes, and the notion that nursing was a job, not a career, one that would serve them until marriage, preferably to a doctor. The theorists today write and study at a time when all things are possible for nurses who can practice in advanced roles with prescriptive authority and who can sit in the office of the hospital CEO.

Nursing Theory Critique

Why Analyze Theories?

Theories are analyzed and reviewed to describe the theoretical basis for advanced nursing in professional nursing environments. In addition, a critique also helps to apply the knowledge gained during the critique to identify factors that aid in improving the healthcare delivery system. One of the reasons of the evaluation exercise is to ascertain how user friendly the theory is and how its weaknesses can be overcome to improve its applicability in the real environment. Further, selecting and analyzing theories develop your analytical skills and help you choose appropriate theories for future research.

Critique Evaluation Criteria

In the past few decades, healthcare professionals have been trying to further develop, test, and use proposed nursing theories. The ultimate aim of evaluation is to utilize theory in various domains like practice, research, and education.

Evaluation lays emphasis on the depth and breadth of content.

Depth: The content should encompass the four metaparadigm concepts in a relatively unambiguous manner. The theory should include a description of the person or other focus of the nursing actions, identification of the person's environment, discussion of the author's meaning of health, a definition of nursing, a statement of nursing goals or outcomes, and an outline of the nursing process. The relational propositions of the model should link all four metaparadigm concepts.

Breadth: This requires that the theory is sufficiently broad in scope to provide guidance in clinical situations and serve as the basis for research, education, and administration. Although the expectation is that the theory or model is a useful frame of reference for many nursing activities, no one theory or model is appropriate for all clinical situations.

The four elements of theory critique are: background, theory description, evaluation, and application. Background refers to origin of the theory and theorist. Theory description focuses on the major concepts of the theory. Evaluation of theory is basically an analysis of clarity, congruence, assumptions, and metaparadigms. Application refers to the level and usefulness of the theory and its weaknesses. Although most theorists start with the same view of the general purpose of nursing, in the final form, most present distinctively different views of the basic metaparadigm concepts. Different models are concerned with different problems in nurse-patient situations or different problems in person-environment interactions.

Nursing Theory and Practice

The Theory-Practice Gap

We know that the development of nursing theory is critical to the establishment of a theoretical body of knowledge that is peculiar to nursing as a science. However, theory development should not take place in isolation. It should be integrated with nursing practice if the profession is to have sustained growth and development. There has always been serious concern on the theory-practice gap.

This gap is based on the observation that what happens in clinical situations rarely, if ever, matches what the textbooks say ought to happen. The problem of the theory-practice gap is one of the most important and fundamental issues in nursing today, as the gap calls into question the very foundation upon which nursing is based.

Nursing theory maintains that nursing is a science and that nursing knowledge is advanced through the application of the scientific method. Scientific research is seen as the predominant method of generating new knowledge.

If nursing theory cannot and does not predict what actually happens in clinical practice, with any degree of certainty, then the entire body of nursing knowledge is seen by some as redundant, and nursing is reduced to nothing more than trial and error.

Theorists claim the theory-practice gap is between what research and theory say ought to be happening, and what actually happens in the imperfect clinical world. They see practice-based nurses as failing to use research findings in practice. Their goal and rationale is that practice should move closer to the ideals of nursing theory, as nurses read research and implement results in practice.

Direct care practitioners say that the gap is between what actually works in real life and unrealistic textbooks' ideals. They feel that the gap will be bridged by nursing theory more closely reflecting the realities of clinical life. The gap is seen by some as a consequence of the way in which theory has failed to keep pace with changes in the practice of nursing. Practitioners feel that although concepts of nursing practice have undergone significant changes over the past 30 years, nursing theory has not grown in the same way.

Prevailing models of education and research result from and sustain nursing theory, often unintentionally strengthening its separation from actual nursing practice. The result is a level of mistrust by practitioners that academic knowledge can offer anything of relevance to practice situations, and a frustration on the part of academic-based researchers that practitioners will relate theory to the provision of care.

Theory, research, and education are viewed as mutually supportive, but practice is not seen as being included in the equation.

Week 3

Nursing Theory Sources

Ideas, questions, and phenomena within the domain of nursing are the sources of ideas for theory development.

Past

Initially, nursing was almost completely dependent on other disciplines for sources of theoretical content in order to provide the underpinnings of nursing practice. This allowed other disciplines, particularly medicine, to dictate the problems of nursing instead of allowing nursing to generate its own questions.

In the early days of nursing education, theoretical content was derived from the domain of medicine, as the medical paradigm was far more powerful and better developed. Thus, medicine controlled nursing theory and, as a result, the domain of its knowledge. At the same time, nursing practice was also taking the first tentative steps toward becoming a source of theory. The patient, as the recipient of care, and actual nursing acts formed the focus of early theory development, and this change in focus reflects the initial efforts to differentiate nursing and medicine.

Consequently, nurses' experience became a major source of theory because nursing care knowledge was based on personal experiences, transmitted through apprenticeship, teaching, and texts.

Present

In the recent times, nursing theory has originated from:

· Role Proliferation: Conceptualization of nursing as a set of functions became the focus of investigation, with theory evolving on how to prepare nurses for various roles.

· Basic Sciences: PhD education of nurses in sociology, psychology, anthropology, and physiology introduced ideas from other disciplines and stimulated new ways of looking at nursing phenomena.

· Nursing Process: Examination of processes in nurse-patient relationships and patient care triggered ideas and questions related to problem solving, priority setting, and decision making.

· Nursing Diagnosis: Labels were given to and a universal nomenclature was developed for problems that fall within the domain of nursing. These are actually conceptual statements about the health status of patients and, therefore, the first step in theory development.

· Concept Identification: Theory development encouraged identification of concepts central to nursing. Identification of relationships between concepts (propositions) defined a new nursing perspective.

Nursing Philosophies:

The identification of nursing theory sources that are compatible with nursing work and accommodate the nursing perspective paved the way for the emergence of nursing philosophies. Nursing philosophy consists of assumptions and beliefs that guide the framework of nursing practice. This philosophy encompasses societal and individual human experiences (Salsberry, 1994)1, and addresses two central areas of commonality: the nature of human beings and the focus of nursing. Inherent fundamental assumptions provide the foundation of nursing philosophy. These philosophies help nurses to identify the focus of nursing as something quite different from that of the biomedical sciences.

Nursing philosophies also initiate reflective practice and encourage nursing professionals—from the novice to the expert—to explore their own values regarding health, nursing, and interaction with clients.

Though there are numerous philosophies and conceptualizations which have been developed over the past few decades, in this course we'll be focusing on only a select few which have guided nursing endeavors.

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