The purpose of this assignment is to allow the learner to demonstrate writing skills, organizational skills, and ability to correctly present ideas and credit others in APA formatting when writing a professional paper.
This assignment enables the student to meet the following course outcomes.
CO #3. Demonstrate effective verbal, written, and technological communication using legal and ethical standards for transferring knowledge using success resources provided to Chamberlain students. (PO #3)
CO #4. Integrate critical thinking and judgment in professional decision-making in collaboration with faculty and peers. (PO #4)
CO #5. Apply concepts of professionalism when planning for personal, intellectual, and professional development. (PO #5)
CO #9. Demonstrate accountability for personal and professional development by assessing information and technology competence, implementing plans for upgrading technology skills, and using effective strategies for online student success using resources provided to Chamberlain students. (PO #5)
Submit the assignment to the Week 6 Dropbox by Sunday, 11:59 p.m. MT.
This assignment is worth a total of 200 points.
PREPARING THE PROFESSIONAL PAPER
1. Carefully read this document (Professional Paper Guidelines), including the Rubric.
2. Download the APA Paper Template from Doc Sharing (APA Resources category). Rename that document as Your Last Name Professional Paper.docx. Save it to your own computer or drive in a location where you will be able to retrieve it later. Type your assignment directly on the saved document. Remember that only Microsoft Word 2010 or a later version is acceptable. The document must be saved as a .docx. Save frequently to prevent loss of your work.
3. Mechanics of the Professional Paper include:
a. Times New Roman size 12 typeface (font) double spaced with 1-inch margins
b. No abstract
c. Correct APA format
d. Correct spelling, apostrophe use, grammar, paragraphing, and sentence structure
e. Contents must include Title Page, body of the paper (500?600 words including Introduction, two Main Points from your Professional Paper Worksheet outline, and Conclusion), and References page.
f. Two Main Points and Conclusion should be Level 1 headings. No Level 2 headings are needed for this short paper.
g. References should only include your Hood textbook and the assigned article for the competency approved by your instructor.
h. Contents of the paper must include any revisions suggested by your instructor in Professional Paper Worksheet feedback.
4. When your assignment is complete, save and close your Professional Paper. You are strongly encouraged to submit your paper to the Turnitin Draft Dropbox (see information in Course Resources under Course Home tab) to check your own similarity index. When you are happy with your paper and your similarity index is below 24%, submit your completed paper as an attachment to the Week 6 Professional Paper Dropbox by the due date. See the Week 6 Assignments page for step-by-step instructions on how to use the Dropbox. Per Chamberlain policy, any final paper submitted with a similarity index greater than 24% will be investigated for potential plagiarism.
DIRECTIONS AND GRADING CRITERIA
Category Points % Description: See Rubric for details.
Introduction 25 12.5% Clearly introduce and define the topic, as well as describe its importance to professional nursing.
First Main Point 50 25% Clearly address the First Main Point including 2 or more sub-points from Professional Paper Worksheet.
Second Main Point 50 25% Clearly address the Second Main Point including 2 or more sub-points from Professional Paper Worksheet.
Conclusion 25 12.5% Clearly summarize the paper and make a concluding statement.
Title Page 2 1% Title page adheres to the format of the APA Paper Template assigned.
Margins, font, spacing, headings 4 2% Margins, font, spacing, and headings adhere to APA format.
Citations 9 4.5% Provide APA format citations for each idea (and/or words) not originally your own.
References 10 5% References page adheres to APA format for Hood textbook and assigned scholarly professional nursing journal article.
Organization, clarity, structure, paragraphing 15 7.5% Writing is organized and clear using appropriate structure and paragraphing. Paper contains 500-600 words excluding title page and references page.
Spelling and apostrophe use, grammar, punctuation, and professional wording 10 5% Writing adheres to American English rules of spelling, apostrophe use, punctuation, and grammar. Wording is professional.
Total 200 points 100% A quality assignment will meet or exceed all of the above requirements.
Assignment Criteria A: (92?100%)
Outstanding or Highest Level of Performance B: (84?91%)
Very Good or High Level of Performance C: (76?83%)
Competent or Satisfactory Level of Performance F: (0?75%)
Poor or Failing or Unsatisfactory Level of Performance
25 points Clearly introduces and defines the topic, as well as describes its importance to professional nursing.
(23?25 points) Introduces and defines the topic, as well as describes its importance to professional nursing.
(21?22 points) Introduces and defines the topic, as well as describes its importance to professional nursing. Depth and detail are fair. (19?20 points) May not introduce or define the topic, or may not describe its importance to professional nursing in a sufficient manner.
First Main Point
50 points Clearly addresses the First Main Point including 2 or more sub-points from Professional Paper Worksheet. Specifics are excellent.
(46?50 points) Addresses the First Main Point including 2 or more sub-points from Professional Paper Worksheet. Specifics are good.
(42?45 points) Vaguely addresses the First Main Point including 2 or more sub-points from Professional Paper Worksheet. Specifics are fair.
(37?41 points) May or may not address the First Main Point. May or may not include 2 or more sub-points from Professional Paper Worksheet. Specifics are minimal.
Second Main Point
50 points Clearly addresses the Second Main Point including 2 or more sub-points from Professional Paper Worksheet. Specifics are excellent.
(46?50 points) Addresses the Second Main Point including 2 or more sub-points from Professional Paper Worksheet. Specifics are good.
(42?45 points) Vaguely addresses the Second Main Point including 2 or more sub-points from Professional Paper Worksheet. Specifics are fair.
(37?41 points) May or may not address the Second Main Point. May or may not include 2 or more sub-points from Professional Paper Worksheet. Specifics are minimal.
25 points Clearly summarizes the paper and makes a concluding statement.
(23?25 points) Summarizes the paper and makes a concluding statement.
(21?22 points) Summary and concluding statement are fair.
(19?20 points) May or may not include both summary and concluding statement.
2 points Title page adheres well to the format of the APA Paper Template assigned (0-2 errors).
(2 points) Title page somewhat adheres to the format of the APA Paper Template assigned (3 errors).
(1 point) Title page does not adhere well to the format of the APA Paper Template assigned (4 or more errors). (0 points)
Margins, font, spacing, headings
4 points Margins, font, spacing, and headings adhere well to APA format.
(4 points) Margins, font, spacing, and headings adhere fairly well to APA format.
(3 points) Adherence of margins, font, spacing, and headings to APA format is only fair.
(2 points) Margins, font, spacing, and headings do not adhere well to APA format.
9 points Provide very good APA format citations for each idea (and/or words) not originally your own (0?1 error).
(9 points) Provide good APA format citations for each idea (and/or words) not originally your own (2?3 errors).
(8 points) Provide fair APA format citations for each idea (and/or words) not originally your own (4 errors).
(7 points) Provide minimal APA format citations for each idea (and/or words) not originally your own (5 or more errors).
10 points References page adheres well to APA format for Hood textbook and assigned scholarly professional nursing journal article (0-1 error).
(9?10 points) References page mostly adheres to APA format for Hood textbook and assigned scholarly professional nursing journal article (2-3 errors).
(8 points) References page APA format for Hood textbook and assigned scholarly professional nursing journal article has fair format (4 errors).
(7 points) References page may not adhere to APA format for Hood textbook and assigned scholarly professional nursing journal article (5 or more errors).
Organization, clarity, structure, paragraphing
15 points Writing is very well organized and clear using very good structure and paragraphing.
Paper contains 500-600 words excluding title page and references page.
(14?15 points) Writing is organized and mostly clear using appropriate structure and paragraphing.
Paper contains 500-600 words excluding title page and references page.
(12?13 points) Writing organization is fair and sometimes uses appropriate structure and paragraphing.
Paper contains slightly fewer than 500 words or slightly more than 600 words excluding title page and references page.
(11 points) Writing is not well organized and not clear using minimal appropriate structure and paragraphing.
Paper contains significantly fewer than 500 words or significantly more than 600 words excluding title page and references page.
Spelling and apostrophe use, grammar, punctuation, and professional wording
10 points Writing adheres very well to American English rules of spelling, apostrophe use, punctuation, and grammar. Wording is very professional.
(9?10 points) Writing mostly adheres to American English rules of spelling, apostrophe use, punctuation, and grammar. Wording is usually professional.
(8 points) Writing sometimes adheres to American English rules of spelling, apostrophe use, punctuation, and grammar. Wording is sometimes professional.
(7 points) Writing does not always adhere to American English rules of spelling, apostrophe use, punctuation, and grammar. Wording is not always professional.
TOTAL: 200 points possible
Professional Paper Worksheet Template
Student Name: Kianna Anderson Date: 9/15/16
Item Instructions Type your answers below
Approved Paper Topic (from Week 1 Assignment):
Clearly state the Nurse of the Future Nursing Core Competency topic that was approved as your topic in Week 1 Time Management Plan Assignment.
Page numbers in Hood textbook on your topic:
Clearly state page numbers in Hood textbook that correspond to the selected topic. Hood, L. Hood, L. J. (2014) Leddy & Pepper’s conceptual bases of professional nursing (8th ed.). (85?88)
Reference for Journal Article:
Create a reference for the assigned article using correct APA format including: authors, year, article title, journal name, volume number, issue number, page numbers, italics, parentheses, punctuation, line spacing, and hanging indent.
AACN Essentials of Baccalaureate Education October 20, 2008
Retrieved from: http://www.aacn.nche.edu/education-resources/BaccEssentials08.pdf
Quotation with Citation:
Type a quotation (10?25 words) from the assigned article using correct APA citation including quotation marks, authors? names, year, page numbers, and parentheses. Do not use words or ideas the authors cited from another source. Effective communication and collaboration among health professionals is imperative to providing patient centered care. (AACN Essentials of Baccalaureate Education, 2008,pg 22)
Paraphrased Area and Citation:
Type appropriately paraphrased version of the words quoted in the section above using correct APA citation including authors? names, year, and parentheses. Do not use words or ideas that the authors cited from another source. In nursing care, communication is deemed effective when the health care professionals collaborate to provide patient centered care. (AACN Essentials of Baccalaureate Education, 2008,pg 22)
Professional Paper Outline:
Develop outline for professional paper including introduction, 2 main topics, and conclusion (all with excellent subtopics as required on Template). Excellent specifics used. Introduction: In nursing care, communication is one of the key competencies that ensure nurses can give good quality care to their patients. Patient centered care is one of the aspects that should be assessed through ensuring active participation of patients in care. Effective communication is pertinent in developing these traits since it ensures that patients can understand and develop important attributes that are essential in giving proper care to the patients accordingly.
1st Main Point: Effective communication is important to the level of care given to the patient.
Nurses need to develop proper communication tools where they connect with their patients to ensure that they give patients the best level of care. Communication therefore, should be clear and concise to ensure that one understands all aspects that have been identified and developed in giving proper care.
2nd Main Point: Patient centered care is only effective if proper communication methods and tools are used.
In patient-centered care, patients need to have the best communication methods and tools to ensure that they are understood by all parties involved. Since patient centered care involves the level of care where other people are involved it is important to ensure that proper communication tools are employed to meet the needs of individuals accordingly
In conclusion, effective communication is an important trait in giving quality care to the patients. It is therefore important to ensure that the proper tools and models are employed for patients to receive proper patient-centered care.
CREATIVITY AND CONNECTIONS
BUILDING THE FRAMEWORK FOR THE FUTURE OF
NURSING EDUCATION AND PRACTICE
Massachusetts Department of Higher Education Nursing Initiative
Nurse of the Future
Nursing Core Competencies?
Nurse of the Future: Nursing Core Competencies? | 1
Table of Contents
Defining NOF Nursing Core Competencies: Assumptions, Nursing Core Competencies,
and the Nursing Core Competency Model 3
Nursing Knowledge 7
The Nurse of the Future Nursing Core Competencies
>> Patient-Centered Care 9
>> Professionalism 13
>> Leadership 17
>> Systems-Based Practice 19
>> Informatics and Technology 22
>> Communication 27
>> Teamwork and Collaboration 31
>> Safety 34
>> Quality Improvement 36
>> Evidence-Based Practice 37
Professional Standards 42
General Bibliography 43
Nurse of the Future: Nursing Core Competencies? | 2
In March 2006, the Massachusetts Department of Higher Education (DHE) and the Massachusetts Organization of Nurse Executives (MONE) convened
a facilitated working session entitled Creativity and Connections: Building the Framework for the Future of Nursing Education and Practice. This
invitational session brought together 32 experienced professionals from the major statewide stakeholders in nursing education and practice. The group
included nurse leaders from a variety of practice settings, educators from both public and private higher education representing all degree levels, and
representatives from the Department of Higher Education, the Board of Registration in Nursing, the Massachusetts Center for Nursing (MCN), the
Massachusetts Association of Colleges of Nursing (MACN), the Massachusetts/Rhode Island League for Nursing (MARILN), and other national
accrediting agencies, including the National League for Nursing Accrediting Commission (NLNAC) and the Commission on Collegiate Nursing
An important outcome of the conference was the development of the following mission statement to guide future work: Establish a formal coalition to
create a seamless progression through all levels of nursing that is based on consensus competencies which include transitioning nurses into their practice
settings. An additional key outcome involved the establishment of the following top priorities:
n Creation of a seamless progression through all levels of nursing education
n Development of sufficient consensus on competencies to serve as a framework for educational curriculum
n Development of a statewide nurse internship/preceptor program
At the end of the conference a working group was formed composed of deans and faculty representing all segments of nursing education, and nursing
practice leaders and clinical nursing staff representing the continuum of care. From 2006 through 2009, the working group researched and reviewed
standards, initiatives, and best practices in nursing education and formed a foundation for moving the priorities forward. To expedite the process, the
group formed two working committees: the Massachusetts Nurse of the Future (NOF) Competency Committee (see membership list, back cover), which
was charged with furthering the development of a seamless continuum of nursing education by identifying a core set of nursing competencies; and the
MONE Academic Practice Integration Committee, which was charged with using the identified competencies as a framework for developing a statewide
transition into practice model.
This report summarizes the work of the NOF Competency Committee. In the report, the committee describes the process it used to identify NOF Nursing
Core Competencies, presents the NOF Core Competency Model?, and defines the ten NOF Nursing Core Competencies and the knowledge, attitudes and
skills associated with each. Key terms used in the document are highlighted in bold and are defined in the Glossary.
Nurse of the Future: Nursing Core Competencies? | 3
Defining the Nurse of the Future Nursing Core Competencies and Core Competency Model
The NOF Competency Committee used a multi-step process to define a core set of nursing competencies for the nurse of the future. As a first step, the
group identified and synthesized competencies obtained from other states, current practice standards, education accreditation standards, national
initiatives, and projected patient demographic and healthcare profiles for Massachusetts. The committee also reviewed the Institute of Medicine?s core
competencies for all healthcare professionals (Institute of Medicine [IOM], 2003) and the Quality and Safety Education for Nurses model (Quality and
Safety Education for Nurses [QSEN], 2007). Information and data obtained through this process of research, analysis, and dialogue formed the basis for
the development of a preliminary set of NOF Nursing Core Competencies.
The committee then used a formalized process to obtain feedback on the preliminary set of core competencies from the nursing education and practice
community throughout the state. The feedback process included online opportunities, two statewide summits, on-campus meetings with faculty from
public and private associate and baccalaureate nursing education programs, and meetings with nursing leadership groups and nursing practice councils
from a variety of healthcare organizations across the state. Feedback was also obtained through a gap analysis process developed in consultation with a
nurse expert involved with the development of the QSEN competencies. Through this process, nursing programs and their clinical practice partners
evaluated their curriculum and identified gaps between what is currently being taught and what they determined should be taught for students to master
the NOF Nursing Core Competencies by graduation. Eight nursing programs in collaboration with their clinical practice partners participated in this
After synthesizing the feedback, the committee conducted another review of the literature, comparing the preliminary set of core competencies against
nationally accepted models, guidelines, and standards. The preliminary set of competencies was also compared to the CCNE Essentials of Baccalaureate of
Education (American Association of Colleges of Nursing, 2008), the Bologna Accords (Zabalegui, Loreto, & Josefa et al., 2006; Davies, 2008), the
Competency Outcomes and Performance Assessment (COPA) model (Lenburg, 1999), the National League for Nursing?s educational competencies for
graduates of associate degree nursing programs (National League for Nursing [NLN], 2000), and the Accreditation Council for Graduate Medical
Education competencies (Accreditation Council for Graduate Medical Education [ACGME], n.d.). Information and data obtained by the review and
feedback process was then incorporated into an updated version of the NOF Nursing Core Competencies.
The updated version of the core competencies is presented in this report and is also available online at www.mass.edu/nursing. The NOF Competency
Committee encourages nurses from practice, academe, and professional nursing organizations to review and disseminate the competencies. To help
monitor how they are used, the committee asks users of the NOF Nursing Core Competencies to complete the Tracking and Permission Form, also
available on the website.
In developing the NOF Nursing Core Competencies, the Competency Committee identified a set of assumptions to serve as a framework for its work and
as guiding principles for the design of a competency-based education and practice partnership model. The assumptions include the following:
n Education and practice partnerships are key to developing an effective model.
? Nursing education and practice settings should facilitate individuals in moving more effectively through the educational system
? An integrated practice/education competency model will positively impact patient safety and improve patient care
? Nursing practice should be differentiated according to the registered nurse?s educational preparation and level of practice and further
defined by the role of the nurse and the work setting
Nurse of the Future: Nursing Core Competencies? | 4
? Practice environments that support and enhance professional competence are essential
n It is imperative that leaders in nursing education and practice develop collaborative curriculum models to facilitate the achievement of a minimum
of a baccalaureate degree in nursing by all nurses.
? Advancing the education of all nurses is increasingly recognized as essential to the future of nursing practice
? Evidence has demonstrated that nurses with higher education levels have a positive impact on patient care
n A more effective educational system must be developed, one capable of incorporating shifting demographics and preparing the nursing
workforce to respond to current and future health care needs and population health issues.
? The NOF Nursing Core Competencies are designed to be applicable across all care settings and to encompass all patient populations across
? Evidence-based knowledge and sensitivity to variables such as age, gender, culture, health disparities, socioeconomic status, race and
spirituality are essential for caring for diverse populations in this global society
n The nurse of the future will be proficient in a core set of competencies.
? There is a differentiation in competencies among practicing nurses at various levels
? Competence is developed over a continuum and can be measured
n Nurse educators in education and in practice settings will need to use a different set of knowledge and teaching strategies to effectively integrate
the Nurse of the Future Nursing Core Competencies? into curriculum.
THE NURSE OF THE FUTURE NURSING CORE COMPETENCIES
The NOF Nursing Core Competencies emanate from the foundation of nursing knowledge. The competencies, which will inform future nursing
practice and curricula, consist of the following:
n Patient-Centered Care n Leadership n Communication
n Professionalism n Systems-Based Practice n Teamwork and Collaboration
n Informatics and Technology n Safety n Quality Improvement
n Evidence-Based Practice (EBP)
THE NURSE OF THE FUTURE CORE COMPETENCY MODEL
The Nurse of the Future Nursing Core Competency? model is a graphic representation of the NOF Nursing Core Competencies and their relationship to
nursing knowledge. In the model, nursing knowledge has been placed at the core to represent how nursing knowledge in its totality reflects the overarching
art and science of the nursing profession and discipline. The ten essential competencies, which guide nursing curricula and practice, emanate from this
central core and include patient-centered care, professionalism, leadership, systems-based practice, informatics and technology, communication,
teamwork and collaboration, safety, quality improvement, and evidence-based practice. The order of the competencies does not indicate any hierarchy, as
all the competencies are of equal importance. The competencies are connected by broken lines because distinction between individual competencies may
be blurred; the competencies overlap and are not mutually exclusive. The competencies are similarly connected to the core by a broken line to indicate the
reciprocal and continuous relationship between each of the competencies and nursing knowledge.
Nursing knowledge and each of the ten competencies are described in more detail in the following sections of this report. For each competency, a
definition is provided that identifies expectations for all professional nurses of the future. Essential knowledge, attitudes, and skills (KAS), reflecting the
cognitive, affective, and psycho-motor domains of learning, are also specified for each competency. The KAS identify expectations for initial nursing
practice following completion of a pre-licensure professional nursing educational program.
Nurse of the Future: Nursing Core Competencies? | 5
MASSACHUSETTS DEPARTMENT OF HIGHER EDUCATION
Nurse of the Future Nursing Core Competencies?
The Art and Science of Nursing
K ? Knowledge
A ? Attitudes
S ? Skills
E ENV RI
S A K K A S NURSING
KNOWLEDGE Patient-Centered Care
Nurse of the Future: Nursing Core Competencies? | 6
NOF CORE COMPETENCIES AND MODEL DEVELOPMENT REFERENCES
Accreditation Council for Graduate Medical Education. (n.d.). ACGME Outcome Project.
Retrieved from http://www.ACGME.org/outcome/comp/compFULL.asp
American Association of Colleges of Nursing. (2008). The essentials of baccalaureate
education for professional nursing practice (2nd ed.). Washington, D.C.: Author.
Davies, R. (2008). The Bologna process: The quiet revolution in nursing higher education.
Nurse Education Today. 28, 935-942.
Institute of Medicine. (2003). Health professions education: A bridge to quality. Washington, DC:
National Academies Press.
Lenburg, C. (1999). The framework, concepts, and methods of the Competency Outcomes and
Performance (COPA) Model. Online Journal of Issues in Nursing. Retrieved from
National League for Nursing Council of Associate Degree Nursing Competencies Task Force.
(2000). Educational competencies for graduates of associate degree nursing programs.
New York: Author.
Quality and Safety Education for Nursing. (2007). Quality and safety competencies. Retrieved
Zabalegui, A., Loreto, M., Josefa, M. et al. (2006). Changes in nursing education in the
European Union. Journal of Nursing Scholarship. 38(2), 114-118.
Nurse of the Future: Nursing Core Competencies? | 7
Nursing is a scholarly profession and practice-based discipline and is built on a foundation of knowledge that reflects nursing?s dual components of science
and art. Nursing knowledge in conjunction with a liberal education prepares learners to enter practice with identified core competencies.
A solid base in liberal education provides the distinguishing cornerstone for the study and practice of professional nursing (American Association of
Colleges of Nursing [AACN], 2008, p. 11). A strong foundation in liberal arts includes a general education curriculum that provides broad exposure to
multiple disciplines and ways of knowing. As defined by the Association of American Colleges and Universities (AAC&U), a liberal education is one that
intentionally fosters, across multiple fields of study, wide ranging knowledge of science, cultures, and society; high level intellectual and practical skills; an
active commitment to personal and social responsibility; and the demonstrated ability to apply learning to complex problems and challenges (AAC&U,
2007, p. 4). A liberal education includes both the sciences and the arts (AACN, 2008, p.10).
As a scientific discipline, nursing draws on a discrete body of knowledge that incorporates an understanding of the relationships among nurses, patients,
and environments within the context of health, nursing concepts and theories, and concepts and theories derived from the basic sciences, humanities, and
other disciplines. The science of nursing is applied in practice through a critical thinking framework known as the nursing process that is composed of
assessment, diagnosis, planning, implementation, and evaluation. The steps of the nursing process serve as a foundation for clinical decision-making and
evidence-based practice. Nurses use critical thinking to integrate objective data with knowledge gained from an assessment of the subjective experiences
of patients and groups, and to apply the best available evidence and research data to the processes of diagnosis and treatment. Nurses use clinical
reasoning to respond to the needs of the populations they serve and to develop strategies to support optimal outcomes that are most appropriate to the
patient or situation while being mindful of resource utilization. Nurses continually evaluate the quality and effectiveness of nursing practice and seek to
optimize outcomes (American Nurses Association [ANA], 2004).
The art of nursing is based on a framework of caring and respect for human dignity. The art and science of nursing are inextricably linked, as a
compassionate approach to patient care carries a mandate to provide that care competently. Competent care is provided and accomplished through
delegated, independent and interdependent practice (Koloroutis, 2004, pp. 123-25), and through collaborative practice (Tomey, 2009, p. 397) involving
other colleagues and/or the individuals seeking support or assistance with their healthcare needs (ANA, 2004, p. 12).
The distinctive focus of the discipline of nursing is on nursing actions and processes, which are directed toward human beings and take into account the
environment in which individuals reside and in which nursing practice occurs (Fawcett & Garity, 2009). This distinctive focus is reflected in the
metaparadigm of nursing, which identifies human beings (patients), the environment, health, and nursing as the subjective matter of interest to nurses
(ANA, 2004). In the context of nursing knowledge, these constructs are defined as follows:
Human beings/patients ? the recipient of nursing care or services. This term was selected for consistency and recognition and support of the historically
established tradition of the nurse-patient relationship and recipients of nursing care. Patients may be individuals, families, groups, communities, or
populations. Further, patients may function in independent, interdependent, or dependent roles, and may seek or receive nursing interventions related to
disease prevention, health promotion, or health maintenance, as well as illness and end-of-life care. Depending on the context or setting, patients may at
times more appropriately be termed clients, consumers, or customers of nursing services (AACN, 1998, p. 2).
Environment ? the atmosphere, milieu, or conditions in which an individual lives, wor