Republic of the Philippines

Laguna State Polytechnic University

Province of Laguna
ISO 9001:2015 Certified
Level I Institutionally Accredited
College of Nursing and Allied Health

LSPU SELF-PACED LEARNING MODULE (SLM)

WELCOME to Theoretical Foundation in Nursing!

This course is designed to introduce the evolution of nursing under two major
criteria: the history and its significance to the nursing practice around the globe. This is
created to introduce the nursing theorist and their works and its impact on the nursing
practice, education and research. The course focuses on selected nursing theorist,
concepts and nursing metaparadigm (Person, Health, Environment and Nursing).
It will also emphasize the application of appropriate nursing concepts and actions
holistically and comprehensively. One of the goals of this course is for you to appreciate
the value of evidence-based nursing practice in the application of nursing and related
model theories.
Let’s enjoy and explore the beginning of your nursing journey.

Course Name THEORETICAL FOUNDATION IN NURSING

This course deals with the meta-concepts of a person, health,
environment and nursing as viewed by the different theorists.
Likewise, it includes non-nursing theories such as systems,
Course Description
developmental and change theories. It presents how these
concepts and theories serve as guide to nursing practice. It further
deals with health as a multi-factorial phenomenon and the
necessary core competencies that the nurse needs to develop.
Course Credits 3 Units Lecture
Hours per Sem 54 Hours
Sem/AY First Semester/2020-2021

LSPU SELF-PACED LEARNING MODULE: THEORETICAL FOUNDATION IN NURSING (NCM 100)

Prepared by: ARVIN M. BAES, MAN, RN
 LEARNING OUTCOMES
Students should be able to meet the following intended learning
outcomes:
A. Integrate relevant concepts and metaparadigm of theories
on Person, Health, Environment and Nursing in nursing
practice.
B. Apply appropriate nursing concepts and actions holistically
and comprehensively.
C. Appreciate the value of evidence-based nursing practice in
the application of nursing and related model theories.
D. Ensure a working relationship utilizing relevant concepts/
theories of effective communication and interpersonal
Intended Learning relationship in nursing practice.
Outcomes E. Discuss relevant concepts of collaboration with
interpersonal, cultural, and relevant theories.
F. Describe specific management and leadership concepts
and principles in selected theories.
G. Assume responsibility for lifelong learning, own personal
development and maintenance of compliance.
H. Appreciate the value of evidence-based nursing practice in
the application of nursing and related models/ theories.
I. Exemplify love for country in service of the Filipinos.
J. Discuss the systems of informatics related to the application
of nursing theories.
K. Demonstrate caring as the core of nursing, love of God, love
of country and love of people.
L. Manifest professionalism, integrity and excellence.
At the end of the lesson, students should be able:
A. To integrate relevant concepts and metaparadigm of
theories on Person, Health, Environment and Nursing in
nursing practice.
B. To apply appropriate nursing concepts and actions
holistically and comprehensively.
Objectives C. To appreciate the value of evidence-based nursing practice
in the application of nursing and related model theories.
D. To discuss relevant concepts of collaboration with
interpersonal, cultural, and relevant theories.
E. To demonstrate caring as the core of nursing, love of God,
love of country and love of people.

LSPU SELF-PACED LEARNING MODULE: THEORETICAL FOUNDATION IN NURSING (NCM 100)

Prepared by: ARVIN M. BAES, MAN, RN
 MODULE
So never lose an opportunity of urging a practical beginning, however small, for it is

I wonderful how often in such matters the mustard-seed germinates and roots itself.
- Florence Nightingale

INTRODUCTION TO NURSING THEORY: HISTORY & SIGNIFICANCE

COURSE CONTENT:
A. Searching for specialized nursing knowledge led nurse scholars to theories that
guide research, education, administration, and professional practice
B. Nursing followed a path from concepts to conceptual frameworks to models to
theories, and finally to middle range theory, in this theory utilization era.
C. Nursing history demonstrates the significance of theory for nursing as a division of
education (the discipline) and a specialized field of practice (the profession).
D. Knowledge of the theory development process is basic to a personal
understanding of the theoretical works of the discipline.
E. Theory analysis begins the process of identifying a decision-making framework for
nursing research or nursing practice.

INTRODUCTION TO NURSING THEORY:

• A brief history of nursing development from vocational to professional describes
the search for nursing substance that led to this exciting time in nursing history as
linkages were strengthened between nursing as an academic discipline and as
professional practice

• The history of this development provides context and a perspective to understand

the continuing significance of nursing theory for the discipline and profession of
nursing.

• Analysis of nursing theoretical works and its role in knowledge development is

presented as an essential process of critical reflection.

HISTORY OF NURSING THEORY:

• The history of professional nursing began with Florence Nightingale.

• Nightingale envisioned nurses as a body of educated women at a time when

women were neither educated nor employed in public service.

• Following her wartime service of organizing and caring for the wounded in Scutari
during the Crimean War, Nightingale’s vision and establishment of a School of
Nursing at St. Thomas’ Hospital in London marked the birth of modern nursing.
LSPU SELF-PACED LEARNING MODULE: THEORETICAL FOUNDATION IN NURSING (NCM 100)
Prepared by: ARVIN M. BAES, MAN, RN
 • It was during the mid-1800s that Nightingale recognized the unique focus of
nursing and declared nursing knowledge as distinct from medical knowledge. She
described a nurse’s proper function as putting the patient in the best condition for
nature (God) to act upon him or her.

• Despite this early edict from Nightingale in the 1850s, it was 100 years later, during
the 1950s, before the nursing profession began to engage in serious discussion of
the need to develop nursing knowledge apart from medical knowledge to guide
nursing practice. This beginning led to awareness of the need to develop nursing
theory.

• 1950’s, some nursing leaders aspired for nursing to be recognized as a profession

and become an academic discipline, nursing practice continued to reflect its
vocational heritage more than a professional vision.

• The transition from vocation to profession included successive eras of history as

nurses began to develop a body of specialized knowledge on which to base
nursing practice.

• Nursing had begun with a strong emphasis on practice, and nurses worked
throughout the century toward the development of nursing as a profession.

HISTORICAL ERAS OF NURSING:

1. Curriculum Era (1900 to 1940s)
2. Research Era (1950 to 1970s)
3. Graduation Education Era (1950 to 1980s)
4. Theory Era (1980 to 1990s)
5. Theory Utilization Era (21st Century)

CURRICULUM ERA (1900 to 1940s)

• Addressed the question of what content nurses should study to learn how to be a
nurse.

• During this era, the emphasis was on what courses nursing students should take,
with the goal of arriving at a standardized curriculum

• Mid-1930s, a standardized curriculum had been published and adopted by many

diploma programs.

• The idea of moving nursing education from hospital-based diploma programs into
colleges and universities also emerged during this era.

LSPU SELF-PACED LEARNING MODULE: THEORETICAL FOUNDATION IN NURSING (NCM 100)

Prepared by: ARVIN M. BAES, MAN, RN
 • The curriculum era emphasized course selection and content for nursing programs
and gave way to the research era, which focused on the research process and the
long-range goal of acquiring substantive knowledge to guide nursing practice.

RESEARCH ERA (1950 to 1970s)

• This era began during the mid-century as more nurse leaders embraced higher
education and arrived at a common understanding of the scientific age—that
research was the path to new nursing knowledge.

• Nurses began to participate in research, and research courses were included in

the nursing curricula of early developing nursing graduate program.

• In the mid-1970s, an evaluation of the first 25 years of the journal Nursing

Research revealed that nursing studies lacked conceptual connections and
theoretical frameworks, accentuating the need for conceptual and theoretical
frameworks for development of specialized nursing knowledge (Batey, 1977).

• The first milestone is the standardization of curricula for nursing master’s education
by the National League for Nursing accreditation criteria for baccalaureate and
higher-degree programs, and the second is the decision that doctoral education
for nurses should be in nursing.

GRADUATION EDUCATION ERA (1950 to 1980s)

• Master’s degree programs in nursing emerged across the country to meet the
public need for nurses for specialized clinical nursing practice.

• Also, during this era, nursing master’s programs began to include courses in
concept development and nursing models, introducing students to early nursing
theorists and knowledge development processes.

• Development of nursing knowledge was a major force during this period.

• The baccalaureate degree began to gain wider acceptance as the first educational
level for professional nursing, and nursing attained nationwide recognition and
acceptance as an academic discipline in higher education.

• Nurse researchers worked to develop and clarify a specialized body of nursing

knowledge, with the goals of improving the quality of patient care, providing a
professional style of practice, and achieving recognition as a profession.

LSPU SELF-PACED LEARNING MODULE: THEORETICAL FOUNDATION IN NURSING (NCM 100)

Prepared by: ARVIN M. BAES, MAN, RN
 • In the 1970s, nursing continued to make the transition from vocation to profession
as nurse leaders debated whether nursing should be other-discipline based or
nursing based.

• An important precursor to the theory era was the general acceptance of nursing as
a profession and an academic discipline in its own right.

THEORY ERA (1980 to 1990s)

• It was a natural outgrowth of the research and graduate education eras.

• Doctoral education in nursing began to flourish with the introduction of new

programs and a strong emphasis on theory development and testing.

• The theory era accelerated as works began to be recognized as theory, having

been developed as frameworks for curricula and advanced practice guides. It was
at the Nurse Educator Conference in New York City in 1978 that theorists were
recognized as nursing theorists and their works as nursing conceptual models and
theories.

• 1980s was a period of major developments in nursing theory that has been
characterized as a transition from the pre-paradigm to the paradigm period.

• The prevailing nursing paradigms (models) provided perspectives for nursing

practice, administration, education, research, and further theory development.

• In the 1980s, Fawcett’s seminal proposal of four global nursing concepts as a

nursing metaparadigm served as an organizing structure for existing nursing
frameworks and introduced a way of organizing individual theoretical works in a
meaningful structure.

• Classifying the nursing models as paradigms within a metaparadigm of the person,

environment, health, and nursing concepts systematically united the nursing
theoretical works for the discipline.

THEORY UTILIZATION ERA (21st Century)

• The emphasis shifted to theory application in nursing practice, education,
administration, and research.

• In this era, middle-range theory and valuing of a nursing framework for thought
and action of nursing practice was realized. This shift to the application of nursing
theory was extremely important for theory-based nursing, evidence-based
practice, and future theory development.

LSPU SELF-PACED LEARNING MODULE: THEORETICAL FOUNDATION IN NURSING (NCM 100)

Prepared by: ARVIN M. BAES, MAN, RN
SIGNIFICANCE OF NURSING THEORY
1. Significance for the Discipline
2. Significance for the Profession

SIGNIFICANCE FOR THE DISCIPLINE

• Nurses entered baccalaureate and higher-degree BOX 1: THE MEANING OF A
programs in universities during the last half of the DISCIPLINE AND A
twentieth century, and the goal of developing PROFESSION
knowledge as a basis for nursing practice began to be • A discipline is specific to
realized. academia and refers to a
branch of education, a
• Nursing had passed through eras of gradual department of learning, or a
development, and nursing leaders offered their domain of knowledge.
perspectives on the development of nursing science. • A profession refers to a
specialized field of practice,
founded upon the theoretical
• They addressed significant disciplinary questions structure of the science or
about whether nursing was an applied science or a knowledge of that discipline and
basic science. accompanying practice abilities
Data from Donaldson, S. K., & Crowley, D.
M. (1978). The discipline of nursing. Nursing
• History provides evidence of the consensus that was Outlook, 26(2), 1113–1120.; Orem, D.
(2001). Nursing: Concepts of practice (6th
reached, and nursing doctoral programs began to ed.). St. Louis: Mosby.; Styles, M. M. (1982).
open to generate nursing knowledge. The 1970s was On nursing: Toward a new endowment. St.
Louis: Mosby.
a significant period of development.

LSPU SELF-PACED LEARNING MODULE: THEORETICAL FOUNDATION IN NURSING (NCM 100)

Prepared by: ARVIN M. BAES, MAN, RN
 • In 1977, after Nursing Research had been published for 25 years, studies were
reviewed comprehensively, and strengths and weaknesses were reported in the
journal that year.

• In 1978, Fawcett presented her double helix metaphor, now a classic publication,
on the interdependent relationship of theory and research.

• Also, at this time, nursing scholars such as Henderson, Nightingale, Orlando,

Peplau, and Wiedenbach were recognized for the theoretical nature of their earlier
writings. These early works were developed by educators as frameworks to
structure curriculum content in nursing programs. Similarly, Orlando’s (1961, 1972)
theory was derived from the report of an early nationally funded research project
designed to study nursing practice.

• Nursing conceptual frameworks began to be used to organize curricula in nursing

programs and were recognized as models that address the values and concepts
of nursing.

• The creative conceptualization of a nursing metaparadigm (person, environment,

health, and nursing) and a structure of knowledge clarified the related nature of the
collective works of major nursing theorists as conceptual frameworks and
paradigms of nursing (Fawcett, 1984). This approach organized nursing works into
a system of theoretical knowledge, developed by theorists at different times and in
different parts of the country.

• Each nursing conceptual model was classified on the basis of a set of analysis and
evaluation criteria.

• Knowledge of persons, health, and environment forms the basis for recognition of
nursing as a discipline, and this knowledge is taught to those who enter the
profession. Every discipline or field of knowledge includes theoretical knowledge.
Therefore, nursing as an academic discipline depends on the existence of nursing
knowledge (Butts & Rich, 2011).

SIGNIFICANCE FOR THE PROFESSION

• It is vital to the practice of professional nursing. Recognition as a profession was
a less urgent issue as the twentieth century ended because nurses had made
consistent progress toward professional status through the century.

• Higher-degree nursing is recognized as a profession today having used the criteria

for a profession to guide development.

• A knowledge base that is well defined, organized, and specific to the discipline was
formalized during the last half of the twentieth century, but this knowledge is not

LSPU SELF-PACED LEARNING MODULE: THEORETICAL FOUNDATION IN NURSING (NCM 100)

Prepared by: ARVIN M. BAES, MAN, RN
 static. Rather, it continues to grow in relation to
the profession’s goals for the human and social
welfare of the society that nurses serve.
• The application of nursing knowledge in
practice is a criterion that is currently at the
forefront, with emphasis on accountability for
nursing practice, theory-based evidence for
nursing practice, and the growing recognition
of middle-range theory for professional nursing
practice.
• As individual nurses grow in their professional
status, the use of substantive knowledge for
theory-based evidence for nursing is a quality
that is characteristic of their practice (Butts &
Rich, 2011). This commitment to theory-based
evidence for practice is beneficial to patients in
that it guides systematic, knowledgeable care.
• Professional practice requires a systematic
approach that is focused on the patient, and
the theoretical works provide just such
perspectives of the patient.
• It is important that nurses have continued
recognition and respect for their scholarly
discipline and for their contribution to the health of society.
BOX 2: CRITERIA FOR
DEVELOPMENT OF THE
PROFESSIONAL STATUS OF
NURSING
1. Utilizes in its practice a well-defined and
well-organized body of specialized
knowledge is on the intellectual level of
the higher learning.
2. Constantly enlarges the body of
knowledge it uses and improves its
techniques of education and service.
3. Entrusts the education of its practitioners
to institutions of higher education.
4. Applies its body of knowledge in practical
services vital to human and social
welfare.
5. Functions autonomously in the
formulation of professional policy and
thereby in the control of professional
activity.
6. Attracts individuals with intellectual and
personal qualities of exalting service
above personal gain who recognize their
chosen occupation as a life work.
7. Strives to compensate its practitioners by
providing freedom of action, opportunity
for continuous professional growth, and
economic security.
Data from Bixler, G. K., & Bixler, R. W. (1959). The
professional status of nursing. American Journal of
Nursing, 59(8), 1142–1146.

• Finally, and most important, the continued recognition of nursing theory as a tool
for the reasoning, critical thinking, and decision making required for quality nursing
practice is important because of the following:

“Nursing practice settings are complex, and the amount of data (information) confronting
nurses is virtually endless. Nurses must analyze a vast amount of information about
each patient and decide what to do. A theoretical approach helps practicing nurses not
to be overwhelmed by the mass of information and to progress through the nursing
process in an orderly manner. Theory enables them to organize and understand what
happens in practice, to analyze patient situations critically for clinical decision making; to
plan care and propose appropriate nursing interventions; and to predict patient
outcomes from the care and evaluate its effectiveness.” -Alligood, 2004

• Philosophies of nursing, conceptual models of nursing, nursing theories, and

middle-range theories provide the nurse with a view of the patient and a guide for
data processing, evaluation of evidence, and decisions regarding action to take in
practice (Alligood 2014, in press; Butts & Rich, 2011; Chinn & Kramer, 2011;
Fawcett & Garity, 2009).
LSPU SELF-PACED LEARNING MODULE: THEORETICAL FOUNDATION IN NURSING (NCM 100)
Prepared by: ARVIN M. BAES, MAN, RN
 MODULE
No man, not even a doctor, ever gives any other definition of what a nurse should be than

II this – ‘devoted and obedient’. This definition would do just as well for a porter. It might even
do for a horse. It would not do for a policeman. - Florence Nightingale

HISTORY AND PHILOSOPHY OF SCIENCE

1. Rationalism
2. Empiricism
3. Early Twentieth Century Views
4. Engagement Views

Historical Views of the Nature of Science

• To understand the science of nursing, certain questions must be established in
order to organize the theory in nursing.

• Epistemology is concerned with the theory of knowledge in philosophical inquiry.

The particular philosophical perspective selected to answer these questions will
influence how scientists perform scientific activities, how they interpret outcomes,
and even what they regard as science and knowledge.

• The development of nursing science has evolved since the 1960s as a pursuit to
be understood as a scientific discipline. Being a scientific discipline means
identifying nursing’s unique contribution to the care of patients, families, and
communities. It means that nurses can conduct clinical and basic nursing research
to establish the scientific base for the care of individuals across the life span.

RATIONALISM
• Rationalist epistemology (scope of knowledge) emphasizes the importance of a
priori reasoning as the appropriate method for advancing knowledge.

• A priori reasoning utilizes deductive logic by reasoning from the cause to an effect
or from a generalization to a particular instance.

o Example: Lack of Social Support (Cause), will result in hospital readmission

(effect). The traditional approach proceeds by explaining hospitalization
with a systematic explanation (theory) of a given phenomenon.

• This conceptual system is analyzed by addressing the logical structure of the

theory and the logical reasoning involved in its development. Theoretical
LSPU SELF-PACED LEARNING MODULE: THEORETICAL FOUNDATION IN NURSING (NCM 100)
Prepared by: ARVIN M. BAES, MAN, RN
 assertions derived by deductive reasoning are then subjected to experimental
testing to corroborate the theory. Reynolds (1971) labeled this approach the
theory-then-research strategy.

EMPIRICISM
• The empiricist view is based on the central idea that scientific knowledge can be
derived only from sensory experience (i.e., seeing, feeling, hearing facts).

• Bacon believed that scientific truth was discovered through generalizing observed
facts in the natural world. This approach, called the inductive method, is based
on the idea that the collection of facts precedes attempts to formulate
generalizations, or as Reynolds (1971) called it, the research-then-theory
strategy.

• Skinner asserted that advances in the science of psychology could be expected if

scientists would focus on the collection of empirical data. He cautioned against
drawing premature inferences and proposed a moratorium on theory building until
further facts were collected.

o Skinner’s (1950) approach to theory construction was clearly inductive. His

view of science and the popularity of behaviorism have been credited with
influencing psychology’s shift in emphasis from the building of theories to
the gathering of facts between the 1950s and 1970s

• The difficulty with the inductive mode of inquiry is that the world presents an infinite
number of possible observations, and, therefore, the scientist must bring ideas to
his or her experiences to decide what to observe and what to exclude (Steiner,
1977).

EARLY TWENTIETH CENTURY VIEWS OF SCIENCE AND THEORY

• During the first half of this century, philosophers focused on the analysis of theory
structure, whereas scientists focused on empirical research (Brown, 1977).

• There was minimal interest in the history of science, the nature of scientific
discovery, or the similarities between the philosophical view of science and the
scientific methods (Brown, 1977).

• Positivism, a term first used by Comte, emerged as the dominant view of modern
science (Gale, 1979).
LSPU SELF-PACED LEARNING MODULE: THEORETICAL FOUNDATION IN NURSING (NCM 100)
Prepared by: ARVIN M. BAES, MAN, RN
 • Modern logical positivists believed that empirical research and logical analysis
(deductive and inductive) were two approaches that would produce scientific
knowledge (Brown, 1977).

• The logical empiricists offered a more lenient view of logical positivism and argued
that theoretical propositions (proposition affirms or denies something) must be
tested through observation and experimentation (Brown, 1977).

• The increasing use of computers, which permit the analysis of large data sets, may
have contributed to the acceptance of the positivist approach to modern science
(Snelbecker, 1974).

EMERGENT VIEWS OF SCIENCE AND THEORY IN THE LATE TWENTIETH

CENTURY

• Foucault (1973) published his analysis of the epistemology (knowledge) of human

sciences from the seventeenth to the nineteenth century, stated that empirical
knowledge was arranged in different patterns at a given time and in a given culture
and that humans where emerging as objects of study.

• In “The Phenomenology of the Social World”, Schutz (1967) argued that

scientists seeking to understand the social world could not cognitively know an
external world that is independent of their own life experiences.

• Phenomenology, set forth by Edmund Husserl (1859 to 1938) proposed that the
objectivism of science could not provide an adequate apprehension of the world
(Husserl 1931, 1970).

o A phenomenological approach reduces observations or text to the

meanings of phenomena independent of their particular context.

o This approach focuses on the lived meaning of experiences.

• In 1977, Brown argued an intellectual revolution in philosophy that emphasized the

history of science was replacing formal logic as the major analytical tool.

• in the philosophy of science. One of the major perspectives in the new philosophy
emphasized science as a process of continuing research rather than a product
focused on findings. In this emergent epistemology, emphasis shifted to
understanding scientific discovery and process as theories change over time.

LSPU SELF-PACED LEARNING MODULE: THEORETICAL FOUNDATION IN NURSING (NCM 100)

Prepared by: ARVIN M. BAES, MAN, RN
 • According to Kuhn, science progresses from a pre-science, then to a normal
science, then to a crisis, then to a revolution, and then to a new normal science.
Once normal science develops, the process begins again when a crisis erupts and
leads to revolution, and a new normal science emerges once again (Kuhn, 1970;
Nyatanga, 2005). This is what Kuhn refers to as paradigm shift in the scientific
development within a discipline.

• Theory-based nursing practice has demonstrated the capacity to restructure

professional care, improving outcomes and satisfaction (Alligood, 2011).

INTERDEPENDENCE OF THEORY AND RESEARCH

• theory and research can be viewed as distinct operations, they are regarded more
appropriately as interdependent components of the scientific process (Dubin,
1978).

• In constructing a theory, the theorist must be knowledgeable about available

empirical findings and be able to take these into account because theory is, in part,
concerned with organizing and formalizing available knowledge of a given
phenomenon.

• The theory is subject to revision if hypotheses fail to correspond with empirical

findings, or the theory may be abandoned in favor of an alternative explanation
that accounts for the new information (Brown, 1977; Dubin, 1978; Kuhn, 1962).

• Scientific consensus is necessary in three key areas for any given theory as
follows:

(1) agreement on the boundaries of the theory; that is, the phenomenon it
addresses and the phenomena it excludes (criterion of coherence),

(2) agreement on the logic used in constructing the theory to further

understanding from a similar perspective (criterion of coherence), and

(3) agreement that the theory fits the data collected and analyzed through
research (criterion of correspondence) (Brown, 1977; Dubin, 1978;
Steiner, 1977, 1978).

• Scientific inquiry in normal science involves testing a given theory, developing new
applications of a theory, or extending a given theory.

• Caring is the wholeness of the patient’s situation, which implies that nursing care
requires interpretation, understanding, and hermeneutic experience.

LSPU SELF-PACED LEARNING MODULE: THEORETICAL FOUNDATION IN NURSING (NCM 100)

Prepared by: ARVIN M. BAES, MAN, RN
 • The philosophy of caring involves knowledge, skills, patient trust, and the ability to
manage all elements simultaneously in the context of care (Austgard, 2008).

• WHOLISM- another philosophy in understanding the patient (Hennessey, 2011).

o Wholistic nursing views the biophysical, psychological, and sociological

subsystems as related but separate, thus the whole is equal to the sum of
the parts.

o Holistic nursing recognizes that multiple subsystems are in continuous

interaction and that mind-body.

• NATURALISM has a metaphysical component that implicates that the natural

world exists; there is no non-natural or supranatural realm.

o The natural world is open, because it depends upon what method the
enquiry requires.

o Naturalism insists that knowledge and beliefs are gained by one’s senses
guided by reason, and by the various methods of science (Hussey, 2011).

o While these philosophies are proposed in the literature, nursing science is

in the early stages of scientific development

LSPU SELF-PACED LEARNING MODULE: THEORETICAL FOUNDATION IN NURSING (NCM 100)

Prepared by: ARVIN M. BAES, MAN, RN