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College of Nursing and Pharmacy C-NCM100: THEORETICAL FOUNDATIONS OF NURSING First Semester...

College of Nursing and Pharmacy C-NCM100: THEORETICAL FOUNDATIONS OF NURSING First Semester AY 2024-2025 Module 1: Overview of Nursing Theory Time Frame: Three (3) hours Schedule of Synchronous Sessions: 1F Tuesday 3:00 – 6:00 pm 1E Thursday 3:00 – 6:00 pm 1D Friday 3:00 – 6:00 pm Mapped Learning Outcomes and Course Content for C-NCM 100 Theoretical Foundations of Nursing, Module 1 Target Learning Outcomes Content and Activities Hour At the close of the period allotted, Online Session Offline Session students should have : 3 hours 1. Trace the history of A. History Supplemental and self-directed nursing theory using a B. Terminologies learning activities concept map and discuss C. Analysis/Criteria its impact to present in Evaluating a Alligood, Martha Raile. Nursing nursing practice; Theoretical Work Theorists and their Work. 9th 2. Define terminologies D. Significance of Edition. 2018. Elsevier Pte. Ltd. related to nursing theory; Theory in Nursing Singapore 3. Explain the criteria for the E. Theory analysis of nursing theory; Components and 4. Enumerate the significance their Contributions ▪ Create a concept map that will of nursing theories in summarize the lecture about profession, academic nursing history discipline, and research; ▪ Visual representation of the four 5. Discuss the classification of (4) basic concepts of nursing nursing theory through paradigm giving example; ▪ Analyze a nursing theory as to the 6. Analyze a theoretical work following: using the different criteria o Components for analysis o Evaluation using the criteria 7. Create a visual representation of the major concepts in nursing paradigm 1. Content / Discussion / Learning Resources / Link A. History The history of professional nursing started with Florence Nightingale. She envisions nurses as a body of educated women. She recognized the unique focus of nursing and declared nursing knowledge as distinct from medical knowledge. Historical Eras of Nursing’s Search for Specialized Knowledge 1. Curriculum Era: 1900 to 1940s MAJOR QUESTION: What curriculum content should student nurses study to be nurses? EMPHASIS: Courses included in nursing programs OUTCOMES: Standardized curricula for diploma programs EMERGING GOAL: Develop specialized knowledge and higher education  What courses nursing students should take, with the goal of arriving at a standardized curriculum.  Mid-1930s - standardized curriculum had been published and adopted by many diploma programs  Moving of nursing education from hospital-based diploma programs into colleges and universities 2. Research Era: 1950 to 1970s MAJOR QUESTION: What is the focus for nursing research? EMPHASIS: Role of nurses and what to research OUTCOMES: Problem studies and studies of nurses EMERGING GOAL: Isolated studies do not yield unified knowledge  More nurse leaders embraced higher education and arrived at a common understanding of the scientific age – research was the path to new nursing knowledge.  Mid-1970s – evaluation of the first 25years of the journal Nursing Research revealed that nursing studies lacked conceptual connections and theoretical frameworks, need for conceptual and theoretical frameworks for development of specialized nursing knowledge.  Awareness of the need for concept and theory development coincided with two other significant milestones in the evolution of nursing theory.  2 Milestones Faculty: CAMILLE LOUISE S. MANALAD, RN Page 1 DARYLL HANN S. SABILE, RN  College of Nursing and Pharmacy C-NCM100: THEORETICAL FOUNDATIONS OF NURSING First Semester AY 2024-2025 o Standardization of curricula for nursing master’s education by the National League for Nursing accreditation criteria for baccalaureate and higher-degree programs o Decision that doctoral education for nurses should be in nursing 3. Graduate Education Era: 1950 to 1970s MAJOR QUESTION: What knowledge is needed for the practice of nursing? EMPHASIS: Carving out an advanced role and basis for nursing practice OUTCOMES: Nurses have an important role in health care EMERGING GOAL: Focus graduate education on knowledge development  Master’s degree programs in nursing emerged across the country to meet the public need for nurses for specialized clinical nursing practice which included courses that introduced the student to the research process.  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.  Nursing 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. 4. Theory Era: 1980 to 1990s MAJOR QUESTION: How do these frameworks guide research and practice? EMPHASIS: There are many ways to think about nursing OUTCOMES: Nursing theoretical works shift the focus to the patient. EMERGING GOAL: Theories guide nursing research and practice  As understanding of research and knowledge development increased, it became obvious that research without conceptual and theoretical frameworks produced isolated information.  Research and theory together were required to produce nursing science.  The prevailing nursing paradigms (models) provided perspectives for nursing practice, education, administration, research and further theory development 5. Theory Utilization Era: Twenty – First Century MAJOR QUESTION: What new theories are needed to produce evidence of quality care? EMPHASIS: Nursing theory guides research, practice, education, and administration. OUTCOMES: Middle range theory may be from quantitative or qualitative approaches EMERGING GOAL: Nursing frameworks produce knowledge (evidence for quality care) B. Terminologies 1. Philosophy – beliefs and values that define a way of thinking and are generally known and understood by a group or discipline 2. Models – are representations of the interaction among and between the concepts showing patterns. They present an overview of the thinking behind the theory and may demonstrate how theory can be introduced into practice 3. Conceptual Framework – a group of related ideas, statements, or concepts 4. Domain – the perspective or territory of a profession or discipline 5. Process – a series of organized steps, changes or functions intended to bring about the desired results 6. Paradigm – refers to a pattern of shared understanding and assumptions about reality and the world; worldview or widely accepted value system 7. Metaparadigm – the most general statement of discipline and functions as a framework in which the more restricted structures of conceptual models develop. Much of the theoretical work in nursing focused on articulating relationships among four major concepts: person, environment, health, and nursing 8. Hypothesis – testable relationship statement 9. Relational Statement – define the relationships between two or more concepts. They are the chains that link concepts to one another. 10. Principle – considered to be truth that is the foundational to other truths 11. Law – considered to be absolute truth that guides intellectual thought and behavior 12. Research – application of systematic, scientific method to study phenomena and generate knowledge (tentative, subject to change as theory is tested-theoretical based knowledge) understanding (fact). Theory ▪ A theory, by traditional definition, is an organized, coherent set of concepts and their relationships to each other that offers descriptions, explanations and predictions about phenomena. Parker (2001) ▪ A theory is a set of concepts, definitions, relationships and assumptions that project a systematic view of phenomena. Potter (2004) ▪ A theory is a reasoned proposed explanation of an occurrence, or something that will occur or be produced, for which absolute proof is lacking. Blackwell (2005) Faculty: CAMILLE LOUISE S. MANALAD, RN Page 2 DARYLL HANN S. SABILE, RN  College of Nursing and Pharmacy C-NCM100: THEORETICAL FOUNDATIONS OF NURSING First Semester AY 2024-2025 ▪ A theory is a set of concepts and propositions that provide an early way to view phenomena. Delaune and Ladner (2006) ▪ A theory is an abstract statement to predict, explain, or describe the relationships among concepts, constructs or events. It is tested by observation and research using factual data. Mosby (2006) ▪ A theory is a supposition or system of ideas that is proposed to explain a given phenomenon. Kozier (2008) Types of Theory a.) Established - Represents the collective culmination of facts, principles, and laws that have been repeatedly tested through research overtime and found to be consistently valid and reliable b.) Speculative – It has to be tested through research and found to be consistently true, valid, reliable in answering questions, solving problem and describing and explaining phenomena Purposes of Theory a.) Answer questions b.) Solve problems c.) Understand, describe, and explain Characteristics of theory It can be confirmed to become a fact It can be disapproved It can be modified by research findings It can be developed to replace existing theory It is used to guide a practice It is consistent with other validated theories, laws, and principles but leave open, unanswered question that need to be investigated (Udan, 2011) Components of Theory 1. Concept ▪ Building blocks of theories ▪ An idea formulated by the mind ▪ An experience perceived and observed ▪ They are primarily the vehicles of thought that involve images. Two types of concept a.) Abstract concept – mentally constructed independent of a specific time or place b.) Concrete concept – directly experienced and relate to a particular time or place Classification of concept a) Discrete concept – identifies categories or classes of phenomena b) Continuous concept – permits classification of dimensions or gradations of a phenomenon 2. Proposition ▪ Explains the relationship of different concepts ▪ Defines the nature of a relationship 3. Definition ▪ Definitions are used to convey the general meaning of the concepts of the theory. Definitions can be theoretical or operational. Theoretical Definition – Define a particular concept based on the theorist’s perspective. Operational Definitions – States how concepts are measured. 4. Assumptions ▪ Statement that specifies the relationship or connection of factual concepts ▪ Excluded from measurement and testing ▪ “Taken for granted reality” Facts ▪ When observations consistently proven true over time Phenomenon ▪ A term given to describe an idea or responses about an event, a situation, a process, a group of events, or a group of situations Phenomena may be temporary or permanent. Nursing theories focus on the phenomena of nursing. Faculty: CAMILLE LOUISE S. MANALAD, RN Page 3 DARYLL HANN S. SABILE, RN  College of Nursing and Pharmacy C-NCM100: THEORETICAL FOUNDATIONS OF NURSING First Semester AY 2024-2025 Relationships of Concepts, Propositions, Assumptions and Definitions with Theory and Phenomena Concepts Systematically Propositions THEORY VIEW PHENOMENA Assumptions organized Definitions CTTO: Theoretical Foundations of Nursing Philippine Perspective by: Eufemia F. Octaviano, Carl E. Balita REMEMBER! phenomenon generates ideas ideas are defined by concepts relationships between concepts that will lead to propositions, propositions generate hypotheses hypotheses are tested through research Research findings constantly proven to be true over time becomes facts, principles, and laws, which are important to establish a THEORY C. Analysis/Criteria in Evaluating a Theoretical Work 1. Clarity Reviewed in terms of semantic clarity and consistency and structural clarity and consistency Considers the meaning of terms used, and definitional consistency and structure speaks to the consistent structural form of terms in the theory. Analysis begins as the major concepts and sub-concepts and their definitions are identified. Words with multiple meanings within and across disciplines should be defined carefully and specifically according to the framework (philosophy, conceptual model, or theory) within which it is developed. Clarity and consistency are facilitated with diagrams and examples. 2. Simplicity Chinn and Kramer (2011) called for simple forms of theory, such as middle range, to guide practice. A theory should be sufficiently comprehensive, presented at a level of abstraction to provide guidance, and have as few concepts as possible with simplistic relations to aid clarity. Reynolds (1971) contends, “The most useful theory provides the greatest sense of understanding” (p. 135). Walker and Avant (2011) describe theory parsimony as “brief but complete” (p. 195). 3. Generality To determine the generality of a theory, the scope of concepts and the goals within the theory are important to be examined. The more limited the concepts and goals, the less general the theory is, consequently, the broader the scope, the greater is the significance of the theory. The more abstract the work is, the more the middle range theory can be drawn from it 4.Empirical Precision / Accessibility Defined as the degree in which the defined concepts are observable in actual setting. It is in line with testability and the ultimate use of the theory Hardly elaborated that the empirical adequacy can be measured by the evidences that supports the theory Congruence of theoretical claims and empirical evidences. 5. Derivable Consequences / Importance Since research, theory, and practice are closely related, nursing theory lends itself to research testing, and research testing leads to knowledge for practice. Nursing theory guides research and practice, generates new ideas, and differentiates the focus of nursing from that of other professions (Chinn & Kramer, 2011). Ellis (1968) indicates that to be considered useful, “it is essential for theory to develop and guide practice... theories should reveal what knowledge nurses must, and should, spend time pursuing” (p. 220). D. Significance of Theory in Nursing NURSING was recognized as both… DISCIPLINE – is specific to academia and refers to a branch of education, a department of learning, or a domain of knowledge. Faculty: CAMILLE LOUISE S. MANALAD, RN Page 4 DARYLL HANN S. SABILE, RN  College of Nursing and Pharmacy C-NCM100: THEORETICAL FOUNDATIONS OF NURSING First Semester AY 2024-2025 PROFESSION – refers to a specialized field of practice, founded upon the theoretical structure of the science or knowledge of that discipline and accompanying practice abilities Criteria for development of the Professional Status of Nursing a.) Utilizes in its practice a well-defined and well-organized body of specialized knowledge that is on the intellectual level of the higher learning. b.) Constantly enlarges the body of knowledge it uses and improves its techniques of education and service through use of the scientific method. c.) Entrusts the education of its practitioners to institutions of higher education d.) Applies its body of knowledge in practical services vital to human and social welfare. e.) Functions autonomously in the formulation of professional policy and thereby in the control of professional activity. f.) Attracts individuals with intellectual and personal qualities of exalting service above personal gain who recognize their chosen occupation as a life work. g.) Strives to compensate its practitioners by providing freedom of action, opportunity for continuous professional growth, and economic security. Importance of Nursing Theory Nursing theories help recognize what should set the foundation of practice by explicitly describing nursing. By providing a definition of nursing, nursing theory also helps nurses to understand their purpose and role in the healthcare setting. Theories serve as a rationale or scientific reasons for nursing interventions and give nurses the knowledge base necessary for acting and responding appropriately in nursing care situations. Nursing theories provide the foundations of nursing practice, helps generate further knowledge, and indicate in which direction nursing should develop in the future (Brown, 1964). By providing nurses a sense of identity, nursing theory can help patients, managers, and other healthcare professionals to acknowledge and understand the unique contribution that nurses make to the healthcare service (Draper, 1990). Nursing theories prepare the nurses to reflect on the assumptions and question the values in nursing, thus further defining nursing and increasing knowledge base. Nursing theories aim to define, predict, and demonstrate the phenomenon of nursing (Chinn and Jacobs, 1978). It can be regarded as an attempt by the nursing profession to maintain and preserve its professional limits and boundaries. In many cases, nursing theories guide knowledge development and directs education, research, and practice although each influences the others. (Fitzpatrick and Whall, 2005). Purposes of Nursing Theory 1. Profession Clinical practice generates research questions and knowledge for theory. In a clinical setting, its primary contribution has been the facilitation of reflecting, questioning, and thinking about what nurses do. Because nurses and nursing practice are often subordinate to powerful institutional forces and traditions, the introduction of any framework that encourages nurses to reflect on, question, and think about what they do provide an invaluable service. 2. Academic Discipline Much of the earlier nursing programs identified the major concepts in one or two nursing models organized the concepts and build an entire nursing curriculum around the created framework. The unique language in these models was typically introduced into program objectives, course objectives, course descriptions, and clinical performance criteria. The purpose was to explain the fundamental implications of the profession and to enhance the status of the profession. 3. Research Development of theory is fundamental to the research process where it is necessary to use theory as a framework to provide perspective and guidance to the research study. Theory can also be used to guide the research process by creating and testing phenomena of interest. To improve the nursing profession’s ability to meet the societal duties and responsibilities, there need to be a continuous reciprocal and cyclical connection with theory, practice, and research. This will help connect the perceived “gap” between theory and practice and promote the theory-guided practice. Faculty: CAMILLE LOUISE S. MANALAD, RN Page 5 DARYLL HANN S. SABILE, RN  College of Nursing and Pharmacy C-NCM100: THEORETICAL FOUNDATIONS OF NURSING First Semester AY 2024-2025 E. Theory Components and their Contributions CLASSIFICATION OF THEORIES IN NURSING 1. By Abstraction a.) Metatheory ▪ Refers to a theory about theory ▪ In nursing, meta-theory focuses on broad issues such as the processes of generating knowledge and theory development, and is a forum for debate within the discipline. ▪ E.g. J. Dickoff’s and P. James’s Theory of Theories b.) Grand Nursing Theories ▪ Most complex and broadest in scope; does not provide guidance for specific nursing interventions ▪ They attempt to explain broad areas within a discipline and may incorporate numerous other theories. ▪ They are non-specific and comprised of relatively abstract concepts that lack operational definitions. ▪ Provides definition for the nursing metaparadigm concepts: person, nursing, health and environment ▪ E.g. Imogene King – General Systems Theory, Ida Jean Orlando – Nursing Process Theory c.) Middle Range Nursing Theories ▪ Lies between the nursing models and more circumscribed concrete ideas (practice theories) ▪ Substantively specific and encompass a limited number of concepts and a limited aspect of the real world. ▪ Maybe: (1) description of a particular phenomenon, (2) an explanation of the relationship between phenomena, (3) prediction of the effects of one phenomenon or another. ▪ E.g. Dorothy Johnson – Behavioral Systems Theory, Rozzano C. Locsin – Advancing Technology, Caring and Nursing d.) Practiced Level Nursing Theories / Microtheories / Prescriptive Theories / Situation-Specific Theories ▪ Least complex, focuses on a specific patient population at a specific time, thus they are more specific and produce specific direction for practice ▪ More direct effect on nursing practice ▪ E.g. theories in infant bonding, oncology pain management e.) Partial Theories ▪ Those in the development stage ▪ Some concepts have been identified and some relationships between them have been identified, but the theory is not complete. 2. By Goal Orientation a.) Descriptive Theories ▪ First level of theory development ▪ Describe the phenomena and identify its properties and components in which it occurs. ▪ Not action oriented or attempt to produce or change a situation b.) Prescriptive Theories ▪ Address the nursing interventions for a phenomenon, guide practice change, predict consequences, propositions that call for change. ▪ In nursing, they are used to anticipate the outcomes of nursing interventions. Nursing Metaparadigm Patterns or models used to show a clear relationship among the existing theoretical works in nursing. Four Major Concepts 1. PERSON  Recipient of nursing care like individuals, families, and communities CONCEPTS OF MAN Two Approaches to Study Man Atomistic Approach It deals with structures and functions of the human body The basic unit of the human body is cell It views man as an organism composed of different system and each system is composed of organs and each organ is made up of tissue and cells Faculty: CAMILLE LOUISE S. MANALAD, RN Page 6 DARYLL HANN S. SABILE, RN  College of Nursing and Pharmacy C-NCM100: THEORETICAL FOUNDATIONS OF NURSING First Semester AY 2024-2025 Holistic approach It provides a fundamental framework on which one can base his perception or observation of the total behavior of man in relation to society. Traces the patterns of man’s relationship with other beings in the suprasystem of the society Views man as a whole organism with interrelated and interdependent parts functioning to produce behavior unacceptable and acceptable to him or to society. 1. Man as a Biological Being a.) Subordinate System Cells, organs and organ system found within individuals. These are important in carrying out daily activities which are vital to survival b.) Superordinate System It provides man with the necessary framework of relationship which links him to the family, community and society 2. Man as a System Two Types of System a.) Open system – changes matter, energy, or information in the environment b.) Closed system – self-sufficient, isolated from other system 3. Man as a Psychosocial Being Man is unique, irreplaceable individual A one-time being in this world Man is capable of rational and logical thinking Most of the time he can become irrational and illogical when provoked Man is capable of relating with others Man has the capacity to cope with stressful stimuli 4. Man as a Spiritual Being Needs the essential freedom of the human spirit To achieve this freedom, he continuously struggles and is made double difficult when he is ill. 2. ENVIRONMENT  It is the internal and external surrounds that affect the client.  It includes all positive or negative conditions that affect the patient, the physical environment, such as families, friends, and significant others, and the setting for where they go for their healthcare. 3. HEALTH  It is the degree of wellness or well-being that the client experiences.  It may have different meanings for each patient, the clinical setting, and the health care provider. Dimensions of health 1. Physical Dimension Genetic make-up, age, developmental level, race, and sex Strongly influence health status and health practices 2. Emotional Dimension Refers to feelings, affect, and the person’s ability to express these It also includes belief in one’s worth How the mind and body interact to affect body functions and body conditions, that influences health Long term stress affects the body systems and affects health habits; conversely, calm acceptance and relaxation can actually change responses to illness. 3. Intellectual Dimension Encompasses cognitive abilities, educational background and past experiences. This influences a client’s responses to teaching about health and reaction to health care during illness 4. Spiritual Dimensions Refers to the recognition and the ability to practice moral and religious principles and beliefs; recognition and maintenance of a harmonious relationship with the supreme being 5. Socio-cultural Dimension Concerns the sense of having support available from family and friends, practices, values, and beliefs that determine health 6. Sexual Dimension Refers to the acceptance and the ability to achieve satisfactory expression of one’s sexuality 7. Environmental Dimension Housing sanitation, climate and pollution of air, food and water are aspects of environmental dimensions Faculty: CAMILLE LOUISE S. MANALAD, RN Page 7 DARYLL HANN S. SABILE, RN  College of Nursing and Pharmacy C-NCM100: THEORETICAL FOUNDATIONS OF NURSING First Semester AY 2024-2025 4. NURSING  The interventions of the nurse rendering care in support of, or in cooperation with the client https://www.google.com/url?sa=i&url=https%3A%2F%2Fwww.jaypeedigital.com%2FeReader %2Fchapter%2F9789385891106%2Fch58&psig=AOvVaw2UafGi26c3U_HQO6PTnMwv&ust=1 592802137080000&source=images&cd=vfe&ved=0CAIQjRxqFwoTCKims8iQkuoCFQAAAAAdA AAAABAJ 2. Assessment of Learning This section will enable you to do self-check of your progress in the discussion. During the self-evaluation, you are expected to practice the virtue of honesty. A score equivalent to 75% will enable you to proceed to the assignment section. A separate sheet will be utilized to answer the questions in this section. You may repeat answering the questions until the required score equivalent is acquired. TRUE or FALSE: Write TRUE if the statement is correct and FALSE if the statement is incorrect Answer Item Statement 1 Theories are used to guide practice. 2 Theories cannot be modified once it is already stated. 3 Theories can be disapproved. 4 Nursing theory aims to view the essence of nursing care 5 Nursing theory is important to direct the nursing care given to client. Matching Type: Match column A with Column B Answer Item Column A Column B 6 Philosophy A Considered to be truth that is the foundational to other truths 7 Model B It is a series of organized steps, changes or functions intended to bring about the desired result. 8 Propositions C Observations proven true over time 9 Domain D Representations of the interaction among and between the concepts showing patterns. 10 Process E Testable relationship statement 11 Paradigm F Beliefs and values that define a way of thinking and are generally known and understood by a group or discipline 12 Hypothesis G Explains the relationship of different concepts 13 Theory H It is the perspective or territory of a profession or discipline. 14 Fact I It refers to a pattern of shared understanding and assumptions about reality and the world; worldview or widely accepted value system. 15 Principle J a set of concepts, definitions, relationships and assumptions that project a systematic view of phenomena Identification: Write the correct answer that is being described Answer Item Questions 16 The external and internal aspects of life that influence the person Faculty: CAMILLE LOUISE S. MANALAD, RN Page 8 DARYLL HANN S. SABILE, RN  College of Nursing and Pharmacy C-NCM100: THEORETICAL FOUNDATIONS OF NURSING First Semester AY 2024-2025 17 it provides man with the necessary framework of relationship which links him to the family, community and society 18 The holistic level of wellness that the person experiences 19 Genetic makeup, age, developmental level, race, and sex 20 It views man as an organism composed of different system and each system is composed of organs and each organ is made up of tissue and cells 21 Refers to feelings, affect, and the person’s ability to express these 22 Encompasses cognitive abilities, educational background and past experiences. 23 Recipient of nursing care. Provide short answers for the following questions 1. What is the goal of nursing? (2 points) 2. Identify the four concepts in a nursing paradigm and describe each. (8 points) 3. Differentiate discipline from profession. (2 points) 3. Evaluation of Learning For the evaluation of learning for Module 1, a scheduled quiz will be assigned in the Google Classroom and will be taken before the start of the next Module during the Synchronous Class. Prepare the following as part of the home activity to enhance learning for the topics in this module. All home activities should be written placed in a long bond paper and placed in a clear book. The output for this home activity will be part of the portfolio that is to be submitted at the end of the semester. ▪ Create a concept map that will summarize the lecture about nursing theory ▪ Visual representation of the four basic concepts of nursing paradigm ▪ Select a nursing theory then analyze a nursing theory as follows: Components, Evaluation using the criteria References Alligood, Martha Raile. Nursing Theorists and their Work. 9th Edition. ( 2018). Elsevier Pte. Ltd. Singapore. Smith, Marlaine C. Nursing Theories and Nursing Practice. 1st Edition. (2015). F.A. Davis. Smith, Mary Jane, Liehr, Patricia. Middle Range Theory for Nursing. 1st Edition. (2018). Springer. Other References: https://www.researchgate.net/publication/15226485_Practice_theories_in_nursing_and_a_science_of_nursin g_practice https://nurseslabs.com/nursing-theories/ https://www.slideshare.net/anandmscn/introduction-to-nursing-theories Congratulations for completing Module 1! ☺ “A journey of a thousand miles begins with a single step.” – Lao Tzu Prepared by: Cherry B. Lazatin, RN, RPh, MAN Clinical Practice Chair Approved by: Anele C. Mallari, RN, MAN, LPT Dean, College of Nursing and Pharmacy Faculty: CAMILLE LOUISE S. MANALAD, RN Page 9 DARYLL HANN S. SABILE, RN