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Drawing on the universal values in health care, the second edition of Quality and Safety in Nursing continues to devote itself to the nursing community and explores their role in improving quality of care and patient safety. Edited by key members of the Quality and Safety Education for Nursing (QSEN) steering team, Quality and Safety in Nursing is divided into three sections. Itfirst looks at the national initiative for quality and safety and links it to its origins in the IOM report. The second section defines each of the six QSEN competencies as well as providing teaching and clinical application strategies, resources and current references. The final section now features redesigned chapters on implementing quality and safety across settings. New to this edition includes: * Instructional and practice approaches including narrative pedagogy and integrating the competencies in simulation * A new chapter exploring the application of clinical learning and the critical nature of inter-professional teamwork * A revised chapter on the mirror of education and practice to better understand teaching approaches This ground-breaking unique text addresses the challenges of preparing future nurses with the knowledge, skills, and attitudes (KSAs) necessary to continuously improve the health care system in which they practice.
Master the fundamentals of nursing while developing your critical-thinking and test-taking skills. More than 1,200 classroom-tested, NCLEX-style questions - including more than 440 alternate-item-format questions - reflect the latest advances in medical technology as well as the most recent guidelines and standards of care for nursing practice. An easy-to-follow format organizes information into 24 content areas. Each question provides answers and rationales for correct and incorrect responses and strategies for how to develop your critical-thinking skills. Alternate-format questions, including multiple choice, select all that apply, fill-in-the blank, ordered response, graphic, and chart/exhibit items. Rationales for correct and incorrect responses. 100-question final exam in book. A focus on the needs of the beginning nursing student taking a fundamentals course. Glossary of more than 250 common English words often found on nursing tests for the benefit of ESL and other students. All questions field tested by nursing students and an expert panel of nurse educators. Instructor resources: Ebook Student resources: Ebook
This text standardizes the terminology and criteria for measurable or desirable outcomes as a result of interventions performed by nurses. Clinicians, students, educators, researchers, and administrators in a variety of clinical, educational and research venues can use the classification, which serves as an important focus for both cost containment and effective care. This new edition is even more comprehensive and includes specific indicators that can be used as intermediate outcomes or to evaluate and rate the patient in relation to outcome achievement. 490 research-based nursing outcome labels promote standardization of expected patient outcomes. Definitions, lists of indicators, publication facts lines, and references provide all of the information you need to understand outcomes. A label name, definition, set of indications, 5 point Likert measurement scale, a publication facts line, and selected references are presented for each outcomes. Linkages between NOC outcomes and 2012-2014 NANDA-I Diagnoses and Functional Health Patterns promote clinical decision-making. Core outcomes are included for specialty practice across care settings. 107 NEW outcome labels allow you to better define patient outcomes that are responsive to nursing care. NEW! Health Management class added to the NOC taxonomy includes outcomes that describe the individual's role in the management of an acute or chronic condition.
Richly illustrated in stunning full colour throughout, this new volume builds on the success of the previous edition and covers everything you need to know to get through your exams safely with the minimum of stress. Prepared in a 'no nonsense', easy-to-read fashion, Mosby's Textbook of Dental Nursing, second edition, covers the A-Z of the latest curriculum and contains an array of helpful 'pull out' boxes and other learning features to help you recall key facts. Fully updated with the latest information on legislation and professional practice - including the appropriate use of Social Media - this volume includes updated and new information on anatomy, charting, drug allergy, governance and care of minority and vulnerable groups. Prepared by leading authorities in the field, Mosby's Textbook of Dental Nursing, second edition is ideal for candidates sitting NEBDN exams, as well as serving as a ready reference for fully qualified dental nurses and therapists in the hospital, community or general practice setting. Ideal for all pre-registration nursing students Friendly, no nonsense writing style makes learning easy Stunning Gray's Anatomy artwork aids understanding of human structure and function Useful learning features include 'Terms to Learn', 'Key Points', and 'Identify and Learn' boxes Over 150 photographs further bring the subject to life! Fully updated throughout to incorporate all aspects of the NEBDN pre-registration syllabus Accompanying website includes MCQs and other helpful revision aids to help you prepare for exams Presents new information on aspects of anatomy, charting, drug allergy, minority and vulnerable groups, fire safety and security Discusses the latest guidance on the use of Social Media Downloadable image bank helps you prepare essays and assignments
Curriculum Development in Nursing Education, Third Edition provides nursing students with the theory and practical ideas necessary to develop an evidence-based, context-relevant, unified curriculum. Throughout the text the authors guide students to develop this type of curriculum with an emphasis on a concept-based curriculum. The Third Edition also emphasizes the importance of a conceptually and visually unified curriculum and offers ideas on how to achieve this throughout the text. The Third Edition focuses on the concepts of faculty development, ongoing appraisal, and scholarship which are new to nursing education literature. This text includes a chapter dedicated to each of these concepts: curriculum development, implementation, and evaluation as well as concrete examples around how to execute them. New content also addresses development, implementation, and evaluation of a curriculum offered via distance learning. New to the Third Edition: * Continued emphasis on the development of evidence-informed, context-relevant, and unified nursing curriculums * New sections on designing a concept-based curriculum and concept-based courses * Exploration of new ideas around readiness for curriculum implementation including fidelity of implementation * Expanded section on distance learning in nursing education featuring ideas around exemplary teaching Key Features: * Specific examples around the development of an evidence-based curriculum * In-depth coverage of the role of faculty development, ongoing appraisal, and scholarship as core processes of curriculum work * Instruction for how to design concept based courses * Brain-based learning
Designed with speed and simplicity in mind, this pocket-sized glossary provides an A-Z reference guide to over 1,900 key biological terms used in nursing. Key Features: 1. Prepare for practice - Clear definitions of commonly used terminology 2. Learn the language - Phonics-based guidance on pronunciation 3. Deepen your knowledge - Breaks down complex terms to aid understanding
This book is an important new resource for clinicians caring for ventilator dependent children, who often have complex health care needs, are supported by advanced technology and are at high-risk of serious complications. Despite the complicated health care needs of children who rely on chronic respiratory support, there are few guidelines and little evidence available to guide the clinicians who care for these patients. This book covers the many aspects involved in the care of these complex children, with input from experts in the fields of pediatric pulmonology, intensive care, ethics, respiratory therapy, and nursing. In depth chapters provide an introduction to the use of chronic invasive and non-invasive ventilation in children and describe and review what is known about methods of delivering ventilator support, care of the chronically ventilated patient in the community , use of chronic ventilator support in patients with disorders commonly leading to respiratory failure and outcomes for patients and their caregivers. This book is intended to be useful not only for pediatric pulmonologists, but also for intensivists, cardiologists, physical medicine/rehabilitation specialists, nurses, respiratory therapists and the primary care physicians involved in the complexities of managing care for this unique group of special needs children.
"The New Prescriber "is a comprehensive, accessible textbook that provides essential coverage of the three core components for prescribing: the client/patient, the evidence, and the pharmacology.
Divided into three sections, this text first looks at the consultation with the patient, and outlines legal, professional and ethical frameworks which guide medical and non-medical prescribing. The second section is devoted to evidence-based practice, highlighting key skills essential to all clinicians. This section encourages the student to identify why evidence-based practice should underpin prescribing decisions. The third and final section is concerned with pharmacology. The student is introduced to basic concepts of pharmacodynamics and pharmacokinetics, adverse drug reactions and variability of response. The importance of these pharmacological principles is highlighted throughout the subsequent discussion of drug groups affecting major body systems.
Key features: Pulls together all key elements of prescribing using an integrated approach'Stop and Think' boxes and practice application activities provided throughout, enabling the reader to link theory to practiceKey terms and glossary provided
This text is invaluable for all nursing, health and medical students taking courses in prescribing and pharmacology.
Mental Health: A person-centred approach adopts an all-encompassing approach to engaging with, responding to and supporting people with mental illness and substance abuse. This substantially updated second edition incorporates the latest mental health research, including a new chapter focusing on psychotropic medications, while retaining the strong narrative approach of the first edition. Readers are encouraged to connect theory, practice and the lived experiences of consumers and carers. The diverse range of consumer and carer perspectives enhances readers' understanding of the process of recovery from mental illness, the use of mental health services and the provision of mental health support, by encouraging them to make human connections as they read. Written by an expert author team, Mental Health: A person-centred approach is an essential resource for students, supporting the development of safe, high-quality, person-centred care in both the Australian and New Zealand contexts.
Written in a friendly, no-nonsense, style, Children in Intensive Care is a quick reference guide to the management of the acutely ill child in the hospital, or pre-hospital, setting. Fully updated throughout and rich with useful 'Alert' boxes and tables - to make learning and reference easy - this handy publication covers a broad range of essential topics such as drug dosages and compatibilities and normal reference ranges as well as harder to find information such as chest X-ray interpretation and troubleshooting technical equipment. Compiled from daily 'on the job' collation of useful facts and figures, this manual also offers practical advice about important non-acute issues such as infection control, common childhood diseases and child protection as well as new findings on the management of sepsis, the collapsed child and care of the child following spinal surgery. With over 10,000 copies sold, this book is an absolute must for any clinician involved with the management of critically ill children, whether it be on the wards, in theatres, high-dependency or intensive care units, as well as during retrieval and in A&E. Information presented in quick reference format, with accompanying reference tables, to facilitate on-the-spot usage Advanced Life Support Group algorithms provide safe and easy-to-follow protocols to the management of emergency situations Contains input from a broad range of paediatric specialists - intensivists, anaesthetists, haematologists, oncologists, air ambulance physicians and retrieval nurses, pharmacists, specialist dieticians, and respiratory physiotherapists - to ensure full coverage and accuracy of information Contains helpful 'Quick Guide' and 'Warning' boxes to provide key information at a glance, while helpful mnemonics assist with learning Contains chapters on normal child development, safe-guarding children and young people, and patient transport Perfect for use on the wards, theatres, high-dependency units and intensive care units as well as during retrieval and A&E Ideal for newcomers and experienced staff alike, whether they be junior doctors or nursing staff Additional authorship brings the expertise of Marilyn McDougall, a Senior Paediatric Intensive Care Consultant Contains brand new chapters - oncology emergencies and pain & sedation - as well as the latest information on topics including sepsis and the collapsed neonate, and care of children after spinal surgery Comprehensively expanded cardiac chapter presents new surgical approaches as well as practical tips on pacing, care of chest drains and basic echocardiograph terminology Drug chapter now includes reversal agents, new drug profiles and an updated compatibilities chart Expanded artwork program explains clinical concepts and practical procedures
Client Education: Theory and Practice, Second Edition is intended for undergraduate courses focused on patient education and communication. This text focuses on health education and the role of health care providers, especially nurses, in working with clients such as individuals, families and groups, in health care institutions and community health settings. It addresses the need for health education; the learning process; principles of learning and assessing readiness. This text includes a client-based teaching plan that is designed to incorporate the theory presented in each chapter. The Second Edition features the Miller/Stoeckel Client Education Model, increased chapter exercises. Additional bonus content such as discussion questions and weblinks can be found on the Navigate Companion Website which is free with each new textbook purchase. Key Features: * Evidence-Based practice articles within each chapter * Miller/Stoeckel Client Education Model updated * Bonus content: discussion question, Web links, and more chapter exercises
Understanding Medical-Surgical Nursing, 6th Edition, Online Resources, and Davis Edge work together to create an interactive learning experience that teaches students to think critically and make the best patient care decisions. The text, written specifically for LPNs/LVNs, provides the comprehensive medical-surgical nursing knowledge they need to understand in this key course. Online Resources equip instructors with the lesson plans, teaching resources, and activities to create an active classroom environment where students can apply what they're learning. Davis Edge online quizzing tracks student progress; assesses their knowledge; prepares students for classroom exams and the NCLEX; and provides real time analytics to identify their weak concepts and topic areas. BONUS! Quizzes in the Instructor Reserve section of Davis Edge can be assigned to ensure your students have watched the corresponding videos from Davis's Nursing Skills Videos for LPN/LVN, 3rd Edition, sold separately. A student-oriented focus helps LPN/LVN students to master safe and effective nursing care by developing the critical-thinking and problem-solving skills they need to excel in clinical practice. Clear, concise, readable, well organized, and easy to follow, it's the text that prepares new nurses to make the connections. Instructor resources: Ebook, Davis Edge access for quizzing resources and monitoring of student progress. Includes testbanks, active classroom instructor guide, Powerpoint slides, image bank, ethical consideration discussion points, guide to better NCLEX questions Student resources: Ebook, Davis Edge access for quizzing resources, patient teaching guidelines, NCLEX prep, procedure guides, ethical considerations, chapter key points, review questions and answers with rationales, references and bibliography, animations, audio case studies, interactive clinical scenarios
The Fourth Edition of Leadership in Healthcare responds to the ever-growing importance of leadership to a healthcare professional's role today and includes updated content to reflect the new guidelines set out in the 2018 Nursing and Midwifery Council Standards. The need for leadership in an everyday context is highlighted throughout the book with reference to both theory and practice. There are case studies, practical examples, reflective questions and even anecdotes from the authors' own experience, showing students the potential and application of leadership. There are also activities that enable students to engage with every facet of leadership, as it connects to topics such as team-work, communication, problem-solving, emotional intelligence, critical self-reflection and quality of care. New to the Fourth Edition: A new chapter on Ethical, Legal and Professional Aspects in Leadership Content updates in-line with the 2018 NMC Standards, the new NMC code, and Revalidation. The book is supported by online resources for both students and lecturers, including videos, journal articles, web links, and multiple-choice questions. To download an e-inspection copy click here or request a physical copy by contacting your local sales representative.
Designed to reinforce your understanding through hands-on work with high-quality published studies, the Study Guide for Understanding Nursing Research, 7th Edition, provides both time-tested and innovative exercises for each chapter in the Grove & Gray textbook. This new edition includes an expanded focus on evidence-based practice, with each chapter featuring Terms and Definitions, Linking Ideas, Web-Based Activities, and Conducting Critical Appraisals to Build an Evidence-Based Practice. The Study Guide is built around three high-quality published research studies located in the appendices and referenced throughout the book. These full-text articles, selected for particular relevance to you, will help you better understand the research and evidence-based practice processes and help you learn to appraise and apply research findings to clinical settings. Time-tested and innovative exercises include brief Introductions, Key Terms exercises, Key Ideas exercises, Making Connections exercises, Exercises in Critical Appraisal, and Going Beyond exercises to promote in-depth learning for a variety of learning styles. Answer key allows you to check your understanding and learn from your mistakes (formative assessment). Quick-reference printed tabs have been added to differentiate the answer key and each of the book's three published studies appendices (four tabs total) for improved navigation and usability. Learning activities for each textbook chapter reinforce key concepts and guide you in application to evidence-based clinical practice. NEW! Increased emphasis on evidence-based practice corresponding to the EBP emphasis in the text to help you see the value of understanding the research process and apply it to evidence-based nursing practice. NEW! Hands-on practice with three current, high-quality published studies to help you better understand the research and evidence-based practice processes and help you learn to appraise and apply research findings to clinical settings. NEW! Enhanced key terms activities compensate for the deletion of the key terms lists from the textbook that are now addressed in Study Guide activities. NEW! New Appraisal Guidelines help you to critically appraise research articles. NEW! Updated full-text articles ensure that the examples provided reflect the most current, high-quality studies that are meaningful.
Nursing Ethics And Professional Responsibility In Advanced Practice, Second Edition Is A Comprehensive Textbook Focused On Advanced Practice Nursing Ethics. The Text Proactively Addresses Challenges That Span Specialty Areas Well As Issues Unique To These Areas Of Practice. This Is The Only Resource Available That Addresses The Range Of Ethical Problems That Advanced Practice Nurses Face. Advanced Practice Nurses (Apns) Share The Same Professional Responsibilities That Other Practicing Nurses Do, However, Given Their Expanded Scope Of Practice They Assume A Role With Greater Responsibility. Advanced Practice Nurses Are Often The Primary Care Givers For Their Patients But Even When They Are Not, They Assume Total Responsibility For Some Critical Aspect Of The Patient's Care. For Example, Nurse Anesthetists Are Accountable For The Safe Induction And Recovery Of Their Patients (This Includes Understanding The Unique Nature Of Individuals), And Diabetic Clinical Nurse Specialists Are Responsible For The Education And Management Of Their Especially Vulnerable Population And For Educating Others. This Text Is Suitable For A Graduate Level Audience As Well As Those Pursuing A DNP Level Degree. Key Features Include: Relevant Case Studies Woven Throughout The Text That Refer To Content Updated Content On Electronic Media And Privacy In-Depth Coverage Of International Implications And Laws Strong Emphasis On Developing The DNP And Other Leadership Roles In Nursing Revised Women's Health Chapter Additional Content On Genetics And Genetic Testing Updated End Of Life And Palliative Care Chapter Adult Health Content Includes Information On Gerontology
Confidently prepare for the challenges of modern maternal-newborn and child health care nursing. A respected authority revised for today's changing health care environment, Maternal & Child Health Nursing, 8th Edition presents maternal-newborn and child health care not as two separate disciplines, but as a continuum of knowledge. Using a nursing process framework, this proven text applies a clear, easy-to-understand approach and wide range of built-in learning aids to help you master essential concepts and skills for success in this ever-changing and increasingly important field.
Each new print copy includes Navigate 2 Advantage Access that unlocks a comprehensive and interactive eBook, student practice activities and assessments, a full suite of instructor resources, and learning analytics reporting tools. Gerontological Nursing: Competencies for Care, Third Edition is a comprehensive and student-accessible text that offers a holistic and inter-disciplinary approach to caring for the elderly. The framework for the text is built around the Core Competencies set forth by the American Association of Colleges of Nursing (AACN) and the John A. Hartford Foundation Institute for Geriatric Nursing. This new edition gives students the skills and theory needed to provide outstanding care for the growing elderly population. Key features include chapter outlines, learning objectives, discussion questions, personal reflection boxes, and case studies.
The Nurse's Guide to Mental Health Medicines is an invaluable, pocket sized guide to a complex subject. Each chapter provides a short and easy-to-read overview of the different drug types used in mental health nursing, focusses only on the need to know information and the associated risks and side effects. The chapters also provide a short medicines list that gives you fast facts relating to the most common drugs used in practice. Key features: Simple layout with clear tables putting the facts at your fingertips Written by nurses for nurses providing the perfect amount of detail for the busy student or practitioner Clear and simple language combined with real world case studies to cut through the jargon and terminology
When you become a ward or unit manager, sister or charge nurse, your responsibilities change and you need a very different set of skills compared to your previous roles. You are now required to manage a team of staff with a set budget and are responsible for maintaining an environment in which people can work well. This book will help you to: Identify your responsibilities and best approaches as a manager to provide patients with a high standard of care through your staff; Read through examples, suggestions and tips following a highly practical approach; Manage your staff, time and budget; Create a positive work environment; Features: Completely updated and revised content written by well-known authors with extensive experience in the field; New sections on responsible use of social media, working with different generations in the workplace; how to make an impact, taking care of yourself etc. Leading teams in the context of enduring financial and staffing constraints Part of the A Nurse's Survival Guide series. Key features: Completely updated and revised content written by well-known authors with extensive experience in the field; New sections on responsible use of social media, working with different generations in the workplace; how to make an impact, taking care of yourself etc. Leading teams in the context of enduring financial and staffing constraints
The Rapids are a series of reference and revision pocket books that cover key facts in a simple and memorable way. Each book contains the common conditions that students and newly qualified nurses encounter on the wards, in the community, and on placements. Only the basic core relevant facts are provided to ensure that these books are perfect and concise rapid refreshers. Rapid Infection Control Nursing is an essential read for all frontline nursing staff working in hospitals or community settings. Designed for quick reference, it explores the essential principles of infection control before moving on to an A-Z of the most commonly found infections. Each entry covers how the infection is spread, duration of the infectious period, key infection-control precautions, staff considerations, visitor information, and patient transfer advice. Covering all the key topics in infection prevention and control, this concise and easy-to-read title is the perfect quick-reference book for the wards. This title is also available as a mobile App from MedHand Mobile Libraries. Buy it now from iTunes, Google Play or the MedHand Store.
Compassion and caring are at the very heart of nursing - possibly that's why you were attracted to the nursing profession in the first place. But what does compassionate caring really mean in nursing practice? Compassion, Caring and Communication: Skills for Nursing Practice is a practical book that guides you through the complex dimensions of caring. It considers the ways in which you connect with patients, families and co-workers, and the long-lasting impact of emotions and feelings. Using real-life narratives, case studies and reflection activities, the authors demonstrate how you can develop and maintain the empathy and communication skills you need to create effective, compassionate and caring partnerships. New to the second edition: Comprehensively updated throughout to reflect and highlight current professional pressures and public concerns around nursing practice. Includes a broader range of relevant case studies, discussions and scenarios to engage students and qualified nurses at all levels. Contains new content about the impacts of recent government reports and policies on nursing care, developing an awareness of contemporary issues and debates. The BOND caring framework has been revised and updated alongside new 'caring indicators', to support the development of compassionate caring skills. All references have been updated using the latest sources and evidence-based studies.
The Nurse Educator's Guide To Assessing Learning Outcomes, Third Edition Is A Widely-Used Resource For Both Faculty And Nursing Education Students That Covers The Assessment Of Critical Thinking, The Development Of Learning Objectives, And The Creation Of Tests, Including Detailed Tips For Writing Many Kinds Of Individual Test Items. The Book Also Covers The Analysis Of Test Reliability. Examples Of Effective And Ineffective Test Items Are Included Throughout To Help Faculty And Nurse Educators Deepen Their Understanding Of How To Create Effective Tests And Assess Student Learning. This New Edition Addresses The Increased Pressure That NCLEX And Other Certification Exams Are Placing On Nursing Students And Faculty, And Reflects The Most Recent Updates To The NCLEX Detailed Test Plan. Each Chapter Has Been Updated With Timely Information And Examples.
Promote health and wellness for all ages and population groups! Health Promotion Throughout the Life Span, 9th Edition provides a comprehensive guide to leading health promotion concepts, from assessment to interventions to application. Its lifespan approach addresses patients' unique needs with case studies and care plans, with an assessment framework based on Gordon's Functional Health Patterns. New to this edition is expanded coverage of genomics and QSEN competencies. Written by nursing experts Carole Edelman and Elizabeth Kudzma, this bestselling text covers all the latest research and trends in health promotion and disease prevention. Separate chapters on population groups - the individual, family, and community - highlight the unique aspects of assessment and health promotion for each group. Coverage of growth and development helps you apply health promotion concepts to each age and each stage of development through the lifespan. Case studies present realistic situations with questions asking you to apply key concepts, and care plans include nursing diagnoses, defining characteristics, related factors, expected outcomes, and interventions. Quality and Safety Scenario boxes focus on QSEN-related competencies with examples of health promotion. Innovative Practice boxes outline unique and creative health promotion programs and projects currently being implemented. Healthy People 2020 boxes present goals and objectives relating to national health issues and priorities. Research for Evidence-Based Practice boxes summarize current health-promotion studies showing the links between research, theory, and practice. Diversity Awareness boxes address cultural perspectives relating to planning care. Hot Topics boxes introduce significant issues, trends, and controversies in health promotion. Think About It clinical scenarios open each chapter, and include questions to encourage critical thinking. NEW! An increased focus on genomics reflects scientific evidence supporting the use of genetic tests and family health history to guide public health interventions. NEW! Expanded discussion of QSEN competencies is included, as related to health promotion. NEW! Guidelines and recommendations are included from the latest Guide to Clinical Preventive Services from the U.S. Preventive Services Task Force. NEW! The latest information about the Affordable Care Act is included. NEW! Updated photos reflect the latest in health promotion and disease prevention.
The reassuring bromides of "chicken soup for the soul" provide little solace for nurses and the people they serve in real-life hospitals, nursing homes, schools of nursing, and other settings. In the minefield of modern health care, there are myriad obstacles to quality patient care including work overload, inadequate funds for nursing education and research, and poor communication between and within the professions, to name only a few. The seventy RNs whose stories are collected here by the award-winning journalist Suzanne Gordon know that effective advocacy isn't easy. It takes nurses willing to stand up for themselves, their coworkers, their patients, and the public.
When Chicken Soup Isn't Enough brings together compelling personal narratives from a wide range of nurses from across the globe. The assembled profiles in professional courage provide new insight into the daily challenges that RNs face in North America and abroad and how they overcome them with skill, ingenuity, persistence, and individual and collective advocacy at work and in the community. In this collection, we meet RNs working at the bedside, providing home care, managing hospital departments, teaching and doing research, lobbying for quality patient care, and campaigning for health care reform.
Their stories are funny, sad, deeply moving, inspiring, and always revealing of the different ways that nurses make their voices heard in the service of their profession. The risks and rewards, joys and sorrows, of nursing have rarely been captured in such vivid first-person accounts. Gordon and the authors of the essays contained in this book have much to say about the strengths and shortcomings of health care today and the role that nurses play as irreplaceable agents of change."
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