NR 500 Week 7 Discussion: Healthful Environments
Chamberlain University NR 500 Week 7 Discussion: Healthful Environments– Step-By-Step Guide
This guide will demonstrate how to complete the Chamberlain University NR 500 Week 7 Discussion: Healthful Environments assignment based on general principles of academic writing. Here, we will show you the A, B, Cs of completing an academic paper, irrespective of the instructions. After guiding you through what to do, the guide will leave one or two sample essays at the end to highlight the various sections discussed below.
How to Research and Prepare for NR 500 Week 7 Discussion: Healthful Environments
Whether one passes or fails an academic assignment such as the Chamberlain University NR 500 Week 7 Discussion: Healthful Environments depends on the preparation done beforehand. The first thing to do once you receive an assignment is to quickly skim through the requirements. Once that is done, start going through the instructions one by one to clearly understand what the instructor wants. The most important thing here is to understand the required format—whether it is APA, MLA, Chicago, etc.
After understanding the requirements of the paper, the next phase is to gather relevant materials. The first place to start the research process is the weekly resources. Go through the resources provided in the instructions to determine which ones fit the assignment. After reviewing the provided resources, use the university library to search for additional resources. After gathering sufficient and necessary resources, you are now ready to start drafting your paper.
How to Write the Introduction for NR 500 Week 7 Discussion: Healthful Environments
The introduction for the Chamberlain University NR 500 Week 7 Discussion: Healthful Environments is where you tell the instructor what your paper will encompass. In three to four statements, highlight the important points that will form the basis of your paper. Here, you can include statistics to show the importance of the topic you will be discussing. At the end of the introduction, write a clear purpose statement outlining what exactly will be contained in the paper. This statement will start with “The purpose of this paper…” and then proceed to outline the various sections of the instructions.
How to Write the Body for NR 500 Week 7 Discussion: Healthful Environments
After the introduction, move into the main part of the NR 500 Week 7 Discussion: Healthful Environments assignment, which is the body. Given that the paper you will be writing is not experimental, the way you organize the headings and subheadings of your paper is critically important. In some cases, you might have to use more subheadings to properly organize the assignment. The organization will depend on the rubric provided. Carefully examine the rubric, as it will contain all the detailed requirements of the assignment. Sometimes, the rubric will have information that the normal instructions lack.
Another important factor to consider at this point is how to do citations. In-text citations are fundamental as they support the arguments and points you make in the paper. At this point, the resources gathered at the beginning will come in handy. Integrating the ideas of the authors with your own will ensure that you produce a comprehensive paper. Also, follow the given citation format. In most cases, APA 7 is the preferred format for nursing assignments.
How to Write the Conclusion for NR 500 Week 7 Discussion: Healthful Environments
After completing the main sections, write the conclusion of your paper. The conclusion is a summary of the main points you made in your paper. However, you need to rewrite the points and not simply copy and paste them. By restating the points from each subheading, you will provide a nuanced overview of the assignment to the reader.
How to Format the References List for NR 500 Week 7 Discussion: Healthful Environments
The very last part of your paper involves listing the sources used in your paper. These sources should be listed in alphabetical order and double-spaced. Additionally, use a hanging indent for each source that appears in this list. Lastly, only the sources cited within the body of the paper should appear here.
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Sample Answer for NR 500 Week 7 Discussion: Healthful Environments
Reflect on an experience in which you were directly involved or witnessed incivility in the workplace. Provide a brief synopsis of the situation. How did this make you feel? How did you respond? What were the consequences of this situation? Provide an example of how this negatively affected the work environment and outcomes. How could the situation have been prevented? Discuss strategies that would support a healthy work environment.
- Incivility in the workplace can happen in a variety of ways. Sometimes, it can be happening around us without us noticing the effects of it right away. One situation that I can recall involving incivility in the workplace happened with one of our new graduate nurses in the emergency room. This new graduate nurse was one of our own nurse techs who transitioned to a nurse upon obtaining her license. She was overall a great person, but she was very attentive to details and asked many questions, as new nurses should do. This sometimes caused some of the other nurses to be annoyed with her. Some nurses became passive aggressive with her. McNamara (2012) states, “Passive aggressive behaviors are typically more subtle behaviors, but they can be just as disruptive to the work environment. These include failure to support a coworker, setting someone up for failure, treating someone with silence or refusal to communicate, being impatient with another’s inquiry, communicating incomplete information that results in sabotage, and expressing a negative attitude that affects a coworker’s confidence.”
Unfortunately, she caught onto other people’s actions and was afraid to ask questions anymore. I honestly felt bad for the girl. I took her under my wing whenever she needed help and told her that it was okay to ask questions because that’s how you learn. I reminded her that everyone started out as a new nurse in their career. The consequences of the incivility in the workplace caused her to eventually transfer to another department in the hospital. This negatively affected the work environment because we lost a potentially great emergency room nurse who was very knowledgeable. The situation could have easily been prevented if everyone would realize and remember that they once were a new nurse who had to learn by asking questions. “To help prevent lateral violence in nursing, a culture of safety is needed to create and sustain an environment where team members are encouraged to speak up to leaders and peers.” (Stanton, 2015. P8)
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McNamara, S. A. (2012). Incivility in nursing: unsafe nurse, unsafe patients. AORN Journal, 95(4), 535-540. doi:10.1016/j.aorn.2012.01.020
Stanton, C. (2015). Action needed to stop lateral violence in the perioperative setting. AORN Journal, 101(5), P7-P9.
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Sample Answer 2 for NR 500 Week 7 Discussion: Healthful Environments
Incivility in the workplace is a prevalent concern in nursing and healthcare settings. The knowledge of incivility and lateral violence in nursing is not an uncommon issue. It has been around for decades and remains a strong presence in nursing today. This causes me great sadness for the profession I hold dear. Uncivil workplace behaviors can be characterized as rude and discourteous, with no regard for others (Phillips, Smith, MacKusick, & Whichello, 2018). This repeated act that is essentially bullying, whether verbally or silently, can lead to absenteeism, low job satisfaction and morale, burnout, poor productivity, m
ental, and physical health problems for the recipient of this poor treatment (Phillips, et al., 2018). The nursing profession must take a continual stand against incivility to assure the safety and well-being of our nurses and ultimately our patients whose care can be affected by work incivility.
As a nurse of many years, I have been witness to and also the target of workplace incivility. As a novice NICU nurse many years ago, I remember the leadership in my department setting an intimidating tone for new employees. There were cliques and gossiping that ultimately led to low morale and fear. This is truly a sad and dangerous place to be when caring for the precious lives of others. In an ICU setting, nurses need to be able to work as a team to deliver effective care. The ability to discuss care situations with colleagues and receive their input in a supportive, non-judgmental way is how nurses grow in their knowledge and expertise, ultimately fine tuning their trade. When intimidation and condescending attitudes are present, nurses will question their ability to provide good care and may eventually leave the department or the profession.
I am currently serving my fourth year as an assistant nurse manager in the pediatric operating room where I am employed. Upon immediate receipt of this promotion, I felt that the staff who were once my colleagues, but now my direct reports started to treat me differently. Suddenly, I became the enemy in some employee’s perspectives as I became responsible for scheduling, assignments, time and attendance tracking, and evaluations. My determination from the start to was model kindness and compassion towards others despite often times not receiving it in return. At the end of the day, I like to reflect upon the questions: Did I do my best? Was I fair to everyone? Was there anything I could have done better? Unfortunately, even with putting my best efforts forward in communication, organization, and compassion towards others, there are those few in the department that intend on holding grudges and forming untrue opinions about me. We live in a world where very little grace is extended towards others and that is something I intend to provide more of the older I get. Presently, I am dealing with a situation with a particular surgical technologist that refuses to speak to me unless she has too. She talks to everyone around me and is generally well liked by all. She has never taken the time to get to know me personally but became very irritated with me on a few occasions when I assigned her to surgical cases. Instead of immediately coming to me with her frustrations, she would complain to her co-workers. It would be weeks of the silent treatment before I would figure out that she was upset with me. I have tried repeatedly to rectify the situation, exemplify kindness by asking how she and her family were doing, and have unfortunately gotten nowhere. She complained to our manager that I speak to her like a child and give her unfair assignments. We sat down with our manager to discuss the situation further which led to 30 minutes of her telling me how she has never liked me and does not want me to speak to her and even threatened human resources involvement. During this interaction, I wish that I handled it differently but I did let anger and defensive mechanisms take over, taking the opportunity to call her out on the poor behavior she exhibits towards me on a daily basis. In the end, not much was resolved, my leader advised us to start anew and try to leave negative feelings towards each other in the past. I go to work each day with a desire to provide exemplary care to my patients and support to my team. Unfortunately, not much has changed with my interactions with this surgical technologist as she refuses to speak to me still unless it is a work-related matter, and then she does it begrudgingly. In a recent attempt to improve this situation, I reached out to my manager and fellow leadership group to let them know that despite efforts, this employee continues to display negativity to me in and out of my presence as has been told me to by other employees. My fellow leadership team did not provide the clarification and support I was seeking, but instead responded that I was just one person and this individual is a ray of sunshine to others. One fellow leader responded that she expects staff to talk negatively about us and not agree with everything we do. This response has ultimately left me feeling more isolated and alone in this situation. I am currently at a loss as to how to proceed. I have worked many years to reach my current position. Through hard work and dedication, I have been able to advance my nursing practice and hold my professionalism to a high standard. Phillips, Stalter, Winegardner, Wiggs, & Jauch (2018), describe workplace incivility and its consequences such as nursing resignations, mental anguish, and potential patient safety concerns. Personally, I have felt mental anguish over this situation and have indeed considered other positions. As present, I have decided to stick with it and continue to strive for excellence and maintain dignity despite the discomfort I feel when I am around this individual.
Having known earlier how this employee felt about me and addressing the issue upfront could have potentially led to a different outcome. Over time, tension and frustrations tend to build up in individuals which can lead to grudges and long-lasting opinions. Knowing this, I intend to address concerns and disagreements immediately from now on. I also feel that pursuing my MSN and addressing concepts such as incivility through scholarly review is empowering me to look past personal matters and seek out the root cause of incivility, better equipping me with a deeper knowledge base towards the subject. This in turn will help me develop better leadership skills in my current and future positions as a master’s prepared nurse.
Strategies that support a healthy work environment are education on incivility in the workplace and how to counteract this detrimental behavior. This should be provided upon hire and repeatedly through computer based learning, staff meetings, and educational retreats. If a healthcare system invests in creating a just culture that maintains accountability for behaviors and actions, civil behavior will grow and support a healthy work environment (Phillips, et al., 2018). Leadership should have zero tolerance for incivility and be able to role model appropriate behaviors that promote team cohesiveness and support.
References
Phillips, G., MacKusick, C., & Whichello, R. (2018). Workplace incivility in nursing: A literature review through the lens of ethics and spirituality. Journal of Christian Nusing, 35(1), 7-12. doi: 10.1097/CNJ.0000000000000467
Phillips, J., Stalter, A., Winegardner, S., Wiggs, C., & Jauch, A. (2018). Systems thinking and incivility in nursing practice: An integrative review. Nursing Forum, 2018, 1-13. doi: 10.111/nur.12250
Sample Answer 3 for NR 500 Week 7 Discussion: Healthful Environments
Incivility is one of the problems which affect the healthcare environment negatively. While some nurses get involved directly in incivility, others experience it as it happens between other staff members. Even though it is a common phenomenon, it sometimes gets overlooked. Incivility has been shown to lead to toxic working environments and poor working conditions. Incivility may take different forms, such as bullying, disruptive conduct, unfair conduct, subtle harassment, and rudeness (Green, 2019). Therefore, the purpose of this assignment is to reflect on an experience of incivility at the workplace.
Some time ago, I experienced a first-hand act of incivility. We were always encouraged in the facility to inquire from colleagues and the senior staff members if there was anything unclear or when in doubt. Therefore, as a way of avoiding medication errors, I approached one of the senior nursing staff to help confirm the details of a medication of I was supposed to administer to a patient in terms of dosage and route. To my surprise, the nurse reacted angrily and rudely, shouting that it was a show of incompetence. The nurse even criticized me in front of others, shouting that my skills were short and that I could not handle the simplest of tasks.
The situation made me feel bad, disrespected, and demoralized. The comments of incompetence and half-baked skills cut into me and bruised my self-esteem. I thought for a while about my competence and ability concerning the skills. I don’t think I did anything wrong to warrant such a dress-down. I was only trying to be extra careful so that I don’t commit any medication errors which can lead to adverse outcomes.
Even though the situation made me feel bad, I contained my anger and walked away from the scene. I did not want to create any commotion as patients were close by. I spoke with another staff member who helped countercheck the medication details. The nurse also indicated that the reaction by the senior nurse was inappropriate and uncalled for and that I did well not to respond violently. I made efforts to meet the nurse leader to hold further discussions regarding the matter and how best to handle such situations in the future.
The situation had various consequences. One of the consequences was a strained relationship between myself and the senior nurse. Since I didn’t like how the nurse addressed me, the situation made our working relationship to get sour. Again, the nurse leader was also willing to come in and mediate to ensure the working relationship was restored. The situation also had negative impacts on the work environment and the outcomes. For example, other junior nurses were more withdrawn and never willing to inquire and consult the senior nurses. There is also a potential impact on the outcomes since there are higher chances of making mistakes, such as medication-related errors, when there is no consultation.
The situation could have been prevented by constantly reminding the staff to be gentle and avoid rudeness as much as possible. Talking gently to others helps avert conflicts that could have been caused by rudeness. Various strategies can be used to support a healthy work environment. One of the strategies is encouraging open communication. Open communication helps individuals pass across the intended information and message, preventing conflicts and promoting a healthy environment (Kim et al.,2018). The other strategy is offering support for each other in the work environment. Support ensures that everyone feels comfortable in the work environment, creating a healthy environment.
Conclusion
Workplace incivility has various negative impacts on the staff and the work environment. Therefore, appropriate ways should be used to avoid it. This assignment has described a case of workplace incivility and its impacts.
References
Green, C. A. (2019). Workplace incivility: nurse leaders as change agents. Nursing Management, 50(1), 51–53. Doi: 10.1097/01.NUMA.0000550455.99449.6b
Kim, K. J., Yoo, M. S., & Seo, E. J. (2018). Exploring the influence of nursing work environment and patient safety culture on missed nursing care in Korea. Asian Nursing Research, 12(2), 121-126.
Sample Answer 4 for NR 500 Week 7 Discussion: Healthful Environments
I recall an experience as a recent graduate nurse in which I was bathing and caring for an eighteen-year-old female patient who had experienced prolonged severe carbon monoxide poisoning. Because of the exposure, she lost her parents and sibling, and she was the sole survivor. She suffered a severe anoxic brain injury that left her mentally devastated. It happened to be my first nursing position straight out of school in the PICU where I had previously worked as a patient care tech. During patient care, the charge nurse came on the overhead speaker in the patient’s room and pretended to talk to the patient. The charge nurse made crude remarks about how the patient was enjoying the bath and needed a boyfriend, would I like to be that man for her? I was in the middle of bathing the patient with another staff nurse when we heard the voice come over the speaker. At the moment that it happened I was not sure how to take the comments. However, I knew enough to know that her actions and comments were inappropriate and far from the standard of care.
As a male nurse, I was still learning how to best care for female patients. Each time I cared for a female patient I was extra intentional in showing respect, dignity, and upholding their privacy whenever possible. This situation caught me off guard and made me feel uncomfortable. My first reaction was to smile, but then the seriousness of the patient’s unfavorable prognosis caught my attention and helped redirect my focus back to the severity of her condition and vulnerability. I was not bothered so much about what the implications of the comment implied towards me as a male nurse but was troubled by the notion that we as health care providers were misbehaving toward the patient and in many ways taking advantage of her mental state and preying on her inability to defend herself. I merely justified the event in my mind and labeled it as the staff just being silly. The charge nurse and other staff members got a real laugh out of the whole thing as the story was retold latter that day.
Regarding the consequences of the situation, most would argue and say nothing happened because none of the patient’s family or relatives and other neighboring families ever found out. As for implications for the patient, one might think it did not matter since she is incapable of understanding what took place. Had a family member heard about the incident or a member of leadership, the situation could have cost the charge nurse her job or at minimum caused for a movement to re-educate the staff on ethical practice standards of best care.
According to Andersson and Pearson, as cited in (Hunt, & Marini, 2012), the term “incivility” encompasses low-intensity behavior that lacks a clear intent to harm, but violates social norms and can cause harm. According to Lambert, Lambert & Ito, as cited in (Hunt, & Marini, 2012), nurses who have less than satisfactory relationships with their coworkers are more likely to leave their jobs. While I did not have any intentions on leaving my job after the incident, I could have turned this negative situation into a decisive, constructive learning moment in which all staff members could have reflected upon its possible negative implications. I might have gained some resistance from my co-workers, but ultimately an environment conducive to excellence is one worth fighting and advocating for. Unfortunately, I allowed my voice to go unheard, and I failed to support civility. I should have imaged my daughter or loved one laying there in that patient’s bed and treated her with compassion and empathy.
According to Pearson and Porath, as cited in (Hunt, & Marini, 2012), incivility impacts on inter-professional team function through disruption of relationships and poor cooperation, and grievances. This situation negatively affected the work environment because each nursing provider failed to work towards a basis of civility in which we would love thy neighbor and was unable to demonstrate respect for this precious soul. All parties involved missed the opportunity to stop these rude comments, thoughtless acts, or negative gestures which were a form of aggression just in a less intense form: verbal rather than physical, passive rather than active, indirect rather than direct, and subtle rather than overt. The cycle of negativity continued because we chose to stay nonjudgmental. A charge nurse and every nurse ought to withhold a position of leadership and leadership qualities lacked during that incident. Nursing is a field in which caring is the backbone of all we strive to do, and we failed to uphold that promise. ANA’s Code of Ethics for Nurses states that nurses are required to “create an ethical environment and culture of civility and kindness, treating colleagues, co-workers, employees, students, and others with dignity and respect.” Similarly, nurses must be afforded the same level of respect and dignity as others (ANA, 2015), all these standards were omitted during this occurrence. Strategies that would support a healthy work environment start with continuous self-reflection and self-awareness on our own actions thoughts and perceptions. Confronting negative behavior or perceptions immediately in a nonjudging way with constructive criticism is crucial. ANA defines a healthy nurse as one who actively focuses on creating and maintaining a balance and synergy of physical, intellectual, emotional, social, spiritual, personal and professional wellbeing (ANA 2016). These are the qualities nurse leaders should exemplify so that such crude situations mentioned earlier have no place for acceptance or tolerance and ultimately are prevented altogether.
America Nurses Association. (2016). Healthy nurse, healthy nation. Retrieved from
http://nursingworld.org/MainMenuCategories/WorkplaceSafety/Healthy-Nurse
American Nurses Association. (2015). Incivility, bullying, and workplace violence [Position
Statement]. Retrieved from file:///C:/Users/User/Downloads/PosStat-Endorsed-ANA-Incivility-Bullying-Violence.pdf
Hunt, C., & Marini, Z. A. (2012). Incivility in the practice environment: A perspective from
clinical nursing teachers. Nurse Education in Practice 12(6) pp. 366-370
doi://doi-org.chamberlainuniversity.idm.oclc.org/10.1016/j.nepr.2012.05.001
Sample Answer 5 for NR 500 Week 7 Discussion: Healthful Environments
I was the object of incivility in the workplace last month. I wrote about this in a previous discussion. However, it is my only direct experience with incivility. Therefore, I will use this experience for this discussion. The director of health services (DHS) berated me in the presence of four other nurses with a tone that should be reserved for responding to a rapist or another type of assailant. She spoke to me as though I had value not greater than that of a pile of feces. Initially I was stunned as I had not anticipated such a response from the DHS. I chose not to confront her immediately. I felt demeaned, disrespected, and dehumanized. I was angry but refrained from speaking to her about her behavior until I had allowed God to have my feelings and thoughts. After much prayer, about 30 minutes after the incident, I returned to her office and asked her if I could speak to her privately at some juncture. She responded in the affirmative. The day was ending and it appeared she was not going to have an audience with me. Therefore, I informed the administrator, who is my immediate supervisor, of what happened. He apologized for her behavior. He added that two fellow employees had informed him about her manner of speaking to me. Much later, the DHS and I talked. I began by asking what I had done or said that warranted her negative treatment of me. She never took ownership of demonstrating negative behavior. She forcefully stated it was merely my perception and she did not feel as though she had spoken in a derogatory manner. Her response was inflammatory. However, I chose not to respond negatively. At the conclusion of our discussion, I stated that since she felt it was merely my perception that she had been harsh and demeaning, I would enhance my perception by further characterizing her behavior as that of a bully. She gasped and responded that she was not a bully. I thanked her for her time and dismissed myself from her presence. Subsequently, four nurses informed me that they had been treated in a similar manner by the DHS. One nurse went on to say she had described the DHS’s behavior to a former administrator as that of a bully. The nurses who witnessed her negative behavior towards me were livid and have openly stated they have no respect for the DHS.
The DHS has created a hostile work environment. I iterated this to the administrator. Although I have not allowed the DHS’s behavior to negatively impact my performance, many nurses and CNAs state they hate coming to work because of her behavior. Some of the CNAs are afraid of the DHS and are concerned that at the DHS’s whim they could unjustifiably be fired. At least one nurse has resigned from the facility due to the DHS.
I believe the only way that this could have been prevented is that the DHS would have acquired a higher degree of emotional intelligence prior to accepting the position as DHS. Frequently, while listening to her respond to situations, one can hear a lack of knowledge, competence, and confidence. With the possession of these traits, she most likely would not behave in the way she behaves.
Smith Phillips, Isaac MacKusick, and Whichello, (2018) suggest that the promotion of ethical behavior and spirituality would reduce workplace incivility. Smith Phillips et al. (2014) further state that professionalism in the workplace is predicated upon ethics and with a demonstration of professionalism there is the promotion of civility.
Reference
Smith Phillips, G., Isaac MacKusick, C., & Whichello, R. (2018). Workplace incivility in nursing: A literature review through the lens of ethics and spirituality. Journal of Christian Nursing, 35(1), E7. doi:10.1097/CNJ.0000000000000467
Sample Answer 6 for NR 500 Week 7 Discussion: Healthful Environments
In the media, many programs depict people fighting or arguing with each other and using profanity as normal behavior in America. Unfortunately, this type of behavior is displayed in many workplace settings and may result in devastating circumstances of great bodily harm or death. Hospitals are not immune to these poor behavioural choices by employees, recently in June 2017 a physician who had been fired from a New York hospital due to sexual harassment became upset with his co-workers and returned to the workplace and killed a coworker and wounded five others before fatally shooting himself (Fasick & Rodgers, New York Post 7/1/2017). Because the above circumstances are viewed as normal, it makes it a little difficult to identify negative behaviors related to incivility in the workplace. Sometime I do not provide direct patient care, my position allows me to watch and listen to nurses as they perform various tasks to provide patient care. Once I witnessed a physician speaking in a loud tone to a nurse at the nurse’s station regarding his patient who was a physician and a friend. He was asking about several medications and procedures that were not done and about the physician the admitting physician. The nurse remained calm during the entire interrogation and only nodding in the affirmative when she agreed with the physician. After five minutes of the verbal interrogation, another physician came to her aid and tried to calm the physician down by explaining the normal procedures when admitting a patient. It seemed to work and the nurse was able to regain her composure and continue her job of providing nursing care. Although there were many nurses at the nursing station, no one came to her aid or consoled her after the incident, and it was just another day on the job. I felt sad for her because no one should be treated this way and I responded by letting her know that she acted very professional during the entire process but should let the nurse manager know or write a report of this physician’s behavior.
The nurse stated that she would let the nurse manager know, but felt that nothing would be done to the physician to correct this behavior in the future. The nurse felt somewhat ashamed because it was done at the nurse’s station, in clear view of many nurses and other healthcare providers, but responded as if this was the normal behavior for this particular physician. It also appeared by the talk from the other nurses at the nursing station that this was the normal behavior for this physician and they must accept it.
I am not sure if this situation could have been prevented but the nurse could have felt better about herself if some of the other nurses would have asked the physician to lower the tone of his voice. This type of communication would have shown her that they supported her and the physician was not practicing professionalism in the workplace. In addition, the nurse manager must be more supportive of her staff to report such behaviors to the hospitals administrators so this type of situations does not become routine. Nurses must also feel confident with inter-professional communication so they could speak up and let physicians know that they will report them when they demonstrate this type of behavior. More work in needed to support nurses in the healthcare setting to feel comfortable working within their specialty and working with others.
References
http://nypost.com/2017/07/01/hospital-gunman-promised-to-come-back-and-shoot-former-co-worker
Lachman, V. D. (2015). Ethical issues in the disruptive behaviors of incivility, bullying, and horizontal/lateral violence. Urologic Nursing, 35(1), 39–42
Morris, K. (2012). Lateral violence in the workplace: Fact or fiction? Ohio Nurses Review, 87(1), 6–7