HUFFLEPUFF

House Members: Suzanne Norwood, Robbie Wilson, Monica Manis, Michelle Stevens, Lindsay Ellis, Julie Greear, Julie Craddick, Billy Sanders, Andrea Allison, and Adam Horn

- **Model IV: Study Guide: Here are a couple answers to the questions in the study guide that were left blank.**

**Evidence based practice (EBP): focusing on the use of research to improve practice. In nursing, making decisions about the care one delivers to patients based on research or evidence.**

**Critical Thinking:**

**The Nursing Process (assess, plan, implement, evaluate- know the correct order)** ==Nursing standards of care Nurse Licensure Compact States (list 5 of these 24 states) from website []: Maine, New Hampshire, Rhode Island, Delaware, Maryland, Virginia, Tennessee, North Carolina, South Carolina, Kentucky, Mississippi, Wisconsin, Iowa, Missouri, Arkansas, Texas, North Dakota, South Dakota, Nebraska, Colorado, New Mexico, Arizona, Utah, Idaho ==

**Hope this helps some! Monica**

Module III - Study Guide Info

Define QSEN = Quality and Safety Education for Nurses

The 6 Components as listed on the study guide (in this order) = Safety, Quality Improvement, Informatics, Evidence-Based Practice, Teamwork & Collaboration, & Patient-Centered Care

The 3 components to continuously improve the quality and safety of the healthcare systems in which nurse's work = Knowledge, Skills, & Attitudes

The Civility, Incivility information is self-explanatory from the article link Dr. McCook gave us.

Explain why an RN would want to become certified through ANCC and provide an example. = Certification protects the public by enabling anyone to identify competent people more readily. Simultaneously, it aids the profession by encouraging and recognizing professional achievement. Certification also recognizes specialization, enhances professionalism and, in some cases, serves as a criterion for financial reimbursement. It may also foster an enlarged role within the employment setting. Because certification of nursing practice signifies attainment of specific criteria and knowledge, skills, and abilities in a specific specialty field, certified nurses comprise a minority of the professional nursing population. You can add your own example if this is not sufficient.

Identify 3 areas in which Tennessee received a failing grade of "F" from the document "Vanderbilt Women's Report Card for 2009." = You can find this information straight from the article itself; very straightforward (it's even in graph format).

Thanks and that's my contribution! Robbie

Thank you Robbie!! I have the same answers. The only thing is there was no link for me to view Vanderbilt Women's Report Card so I searched for and found it online. Mic :)


 * ROBBIE YOU ARE THE BEST! I GUESS YOU CAN COME BACK TO OUR CIRCLE FRIENDS NOW! **

// Thanks Robbie! I did find the graph on the Vanderbilt page....sad that so many of the failing grades for TN is with the minorities, esp African Americans, and with STI's. Monica // //Thank you, Robbie! I have all of the same answers too. Very helpful indeed :) Suzanne :)// //﻿ //

Module II: Nurse Theorists / Scholars / Leaders and Evidence Based Practice (EBP)

Step I: Identify the 15 nurses listed below in the brief summaries, Step II: Determine the 10 remaining nurses from the list that don't have summaries and each of you write up a brief summary of ONE nurse similar to the 15 I completed Step II: Post your 10 edited summaries with their answers on this page right below these instructions Step IV: Review the posting of the other 3 groups, I will use the summaries from your 4 groups on this weeks quiz


 * POST your ten new summaries here with names

**1. This nurse theorized nursing as both a science and an art. Her model provided the way of viewing the unitary human being as integral with the universe and one with the environment. There are four basic concepts to her model: energy fields, openness, pattern, and four-dimensionality (also referred to as pandimensionality). Humans and environment do not have energy fields, they are energy fields. The human being and the environment cannot be understood in isolation of each other. Openness is characteristic of both humans and the environment, transcends through time and space and is integral with one another. Pattern refers to characteristics of an energy field perceived as a single wave, refers only to an energy field (of man and environment) and changes continuously. Four-dimensionality refers to energy fields (man and environment) not being bound by time or space.**  **Martha Rogers** (Michelle Stevens)

**2. "The nurse is responsible for helping the patient avoid and alleviate the distress of unmet needs." She developed the Human to Human Relationship Model. She presented this model in her book, Interpersonal Aspects of Nursing. The theory explained: Nursing is accomplished through human to human relationships from initial encounter through stages of emerging identities, developing empathy and later, sympathy. She encourage "genuine" nurse to patient, human to human relationships. She also encouraged helping the family to find meaning in their suffering.** ** Joyce Travelbee ** (Mike Sanders)

**3. From "Man-living-health" (1981) to “human becoming" (1992) theory she believed that the goal of nursing was to help people achieve a quality of life from their own perspective, using meaning (patient’s values), rhythmicity (relationships), and transcendence (personal journey) as themes.** <span style="font-family: 'Arial Black',Gadget,sans-serif;">** Rosemarie Rizzo Parse **

<span style="font-family: 'Arial Black',Gadget,sans-serif;">**4. Ida Jean Orlando, was born in 1926. She was one of the first nursing theorists to write about the nursing process based on her own research. She was an Associate Professor at Yale School of Nursing and Director of the Graduate Program in Mental Health Psychiatric Nursing. At Yale she was the project investigator of a National Institute of Mental Health grant entitled: Integration of Mental Health Concepts in a Basic Nursing Curriculum. It was from this research that she developed her theory which was published in her 1961 book, //The Dynamic Nurse-Patient Relationship//. **

<span style="font-family: 'Arial Black',Gadget,sans-serif;">** Orlando's theory was developed in the late 1950s from observations she recorded between a nurse and patient. Orlando's Deliberative Nursing Process Theory focuses on the interaction between the nurse and patient, perception validation, and the use of the nursing process to produce positive outcomes or patient improvement. Orlando's key focus was to define the function of nursing. Major dimensions of Orlando’s theory include: distress (unmet needs of the patient); nursing roles (pt. behavior may not represent true need/nurse validates his/her understanding of the need with the pt.); nursing actions (directly/indirectly provide for the patient’s immediate need); and outcome (a change in the behavior of the pt. indicating either a relief from distress or an unmet need). Other items to consider in Orlando’s theory are: __function of professional nursing__ (organizing principle); __presenting behavior__ (problematic situation); __immediate reaction__ (internal response); __nursing process discipline__ (investigation); and __improvement__ (resolution). **

<span style="font-family: 'Arial Black',Gadget,sans-serif;">** The use of Orlando’s theory assures that patients will be treated as individuals and they will have active and constant input into their own care. It prevents inaccurate diagnosis or ineffective plans because the nurse has to constantly explore her reactions with the patient. It provides for the assertion of nursing’s independence as a profession and her belief that this independence must be based on a sound theoretical frame work. The theory guides the nurse to evaluate her care in terms of objectively observable patient outcomes. Helps make evaluation a less time consuming and more deliberate function, the results of which would be documented in patients’ charts. And, the nursing profession can pursue Orlando's work for re-testing and further development of her work. **

<span style="font-family: 'Arial Black',Gadget,sans-serif;">** Orlando's theory remains one the of the most effective practice theories available. The use of her theory keeps the nurse's focus on the patient. The strength of the theory is that it is clear, concise, and easy to use. While providing the overall framework for nursing, the use of her theory does not exclude nurses from using other theories while caring for the patient. ** <span style="font-family: 'Arial Black',Gadget,sans-serif; font-size: 13px;"> **Ida Jean Orlando** (Robbie Wilson)

<span style="font-family: 'Arial Black',Gadget,sans-serif;"> 5. I have studied health-promoting behaviors and illness prevention behaviors which led me to develop the Health Promotion Model. I believe that the primary focus of health care should be health promotion and illness prevention. Preventing disease rather than simply trying to cope with it once we are affected by it is a much healthier and satisfying approach to life. Increasing physical activity will have a positive impact on our health. I also helped to develop the “Girls on the Move” program. Who am I? <span style="color: #0000ff; font-family: 'Arial Black',Gadget,sans-serif; font-size: 16px; line-height: 115%;">﻿Nola Pender

===<span style="font-family: 'Arial Black',Gadget,sans-serif;">6. This person considered nursing to be both a science and an art. She felt that nurses should focus on the patient and not on the actual disease itself. She felt every patient underwent both internal and external stressors and that each patient expressed these stressors in different and unique ways. She felt it was the nurse’s duty to the patient to help remove the stressor and regain equilibrium for the patient. This theorist stated that each person was a system composed of 8 subsystems, which include ingestive, eliminative, affiliative, dependency, sexual, aggressive-protective, achievement, and restorative. She felt that the goal of nursing was to reach a place where these 8 subsystems remained stable. === <span style="font-family: 'Arial Black',Gadget,sans-serif;">** Dorothy Johnson **// (Monica Manis) //

===<span style="font-family: 'Arial Black',Gadget,sans-serif;">7. “My thesis is that nursing art is not comprised of rational nor reactionary actions but rather of deliberative action” says this theorist. She developed her theory based on her years spent in both clinical and teaching settings. She felt that the primary responsibility of a nurse was to identify the patient’s need for help. She felt that if the need for help required intervention, it was that nurse’s duty to implement a plan of care based on the desires of the patient. === <span style="font-family: 'Arial Black',Gadget,sans-serif;">** Ernestine Wiedenbach ** // (Monica Manis) //

<span style="font-family: 'Arial Black',Gadget,sans-serif;">** 8. My patient centered approach to nursing was developed from my practice and is considered to be a human needs theory. I grouped nursing into 21 problem areas guiding patient care and promoting the use of nursing judgment. These areas address the biological, psychological, and social areas of patient care. I feel that the nurse needs knowledge on basic science and specific nursing skills, as well as knowledge skills in the communication, psychology, sociology, growth and development and interpersonal realations...I believe that nursing is focused on meeting a patient's total health needs. ** <span style="font-family: 'Arial Black',Gadget,sans-serif;">** ﻿Fay Abdellah ** <span style="font-family: 'Arial Black',Gadget,sans-serif;">**﻿** <span style="font-family: 'Arial Black',Gadget,sans-serif;">**9. I developed comfort theory in 1990s. I described comfort as existing in 3 forms: relief, ease, and transcendence. I also described 4 contexts in which patient comfort can occur: physical, psycho spiritual, environmental, and sociocultural. An example of relief comfort is when a patient’s pain is relieved by a prescribed pain medication. If a patient is content, he/she is experiencing ease comfort like when an issue causing anxiety is addressed. Transcendence is described when a patient can rise above challenges. I described HCN health care needs as those identified by the patient and family in a practice setting. Intervening variables are factors that are unlikely to change like prognosis and social support. Comfort is the immediate desirable outcome of nursing care according to Comfort Theory. Comfort Theory describes nursing as the process of assessing a patient’s comfort needs and then developing and implanting interventions and then re-evaluating patient’s comfort. Assessment can be objective or subjective.** <span style="font-family: 'Arial Black',Gadget,sans-serif;"> **Katharine Kolcaba** // ﻿(Andrea Allison) //

<span style="font-family: 'Arial Black',Gadget,sans-serif;">10. I introduced the concept that expert nurses develop skills and understanding of patient care over time through a sound educational base as well as a multitude of experiences. I wrote a famous book entitled "From Novice To Expert". My theory suggests that one could gain knowledge and skills ("knowing how") without ever learning the theory ("knowing that"). I believe that having nursing skills as experience is a prerequisite for becoming an expert, and that there are 5 levels of nursing experience: novice, advanced beginner, competent, proficient, and expert. Listed below are some of my certifications/accomplishments: <span style="font-family: 'Arial Black',Gadget,sans-serif;">** Patricia Benner ** (//Lindsay Ellis//)
 * <span style="font-family: 'Arial Black',Gadget,sans-serif;">BA in Nursing - Pasadena College/Point Loma College
 * <span style="font-family: 'Arial Black',Gadget,sans-serif;">MS in Med/Surg nursing from UCSF
 * <span style="font-family: 'Arial Black',Gadget,sans-serif;">PhD -1982 from UC Berkeley
 * <span style="font-family: 'Arial Black',Gadget,sans-serif;">1970s - Research at UCSF and UC Berkeley
 * <span style="font-family: 'Arial Black',Gadget,sans-serif;">Has taught and done research at UCSF since 1979
 * <span style="font-family: 'Arial Black',Gadget,sans-serif;">Published 9 books and numerous articles
 * <span style="font-family: 'Arial Black',Gadget,sans-serif;">Published ‘Novice to Expert Theory’ in 1982
 * <span style="font-family: 'Arial Black',Gadget,sans-serif;">Received Book of the Year from AJN in 1984,1990,1996, 2000

<span style="color: #00ff00; font-family: Arial,Helvetica,sans-serif;">__ <span style="font-family: Arial,Helvetica,sans-serif; font-size: 16px;">Following the list of 25 nurse leaders below (most of which are considered out key nursing theorists) I have listed 15 brief summaries of the women from key facts/ concepts associated with the nurse leaders name. As a group of 10 you will work to match the names to the their corresponding synopsis. In addition you are to write a brief synopsis of the remaining 10 women not already summarized …so one summary per person for the group of 10.

<span style="font-family: Arial,Helvetica,sans-serif; font-size: 16px;">Module II quiz this week will be a matching quiz. I have provided the synopsis of 15 nurses from the list your group will develop the remaining 10 and all will posted and used for the quiz. The quiz opens Thursday at noon closes Saturday June 4th at 11:59 pm.

<span style="font-family: Arial,Helvetica,sans-serif;">21 Nursing Theorists followed by 4 leading public health/community care focused nurses <span style="font-family: Arial,Helvetica,sans-serif; font-size: 16px;">22. Clara Barton: nurse, humanitarian <span style="font-family: Arial,Helvetica,sans-serif; font-size: 16px;">23. Mary Carson Breckenridge: nurse midwife, role in maternal infant and frontier health <span style="font-family: Arial,Helvetica,sans-serif; font-size: 16px;">24. Jessie Sleet Scales: leader in Public Health Nursing <span style="font-family: Arial,Helvetica,sans-serif; font-size: 16px;">25. Lillian Wald: nurse, social worker
 * 1) <span style="font-family: Arial,Helvetica,sans-serif; font-size: 16px;">Florence Nightingale - Environment theory
 * 2) <span style="font-family: Arial,Helvetica,sans-serif; font-size: 16px;">Hildegard Peplau - Interpersonal theory
 * 3) <span style="font-family: Arial,Helvetica,sans-serif; font-size: 16px;">Virginia Henderson - Need Theory
 * 4) <span style="font-family: Arial,Helvetica,sans-serif; font-size: 16px;">Fay Abdella - Twenty One Nursing Problems
 * 5) <span style="font-family: Arial,Helvetica,sans-serif; font-size: 16px;">Ida Jean Orlando - Nursing Process theory
 * 6) <span style="font-family: Arial,Helvetica,sans-serif; font-size: 16px;">Dorothy Johnson - System model
 * 7) <span style="font-family: Arial,Helvetica,sans-serif; font-size: 16px;">Martha Rogers -Unitary Human beings
 * 8) <span style="font-family: Arial,Helvetica,sans-serif; font-size: 16px;">Dorothea Orem - Self-care theory
 * 9) <span style="font-family: Arial,Helvetica,sans-serif; font-size: 16px;">Imogene King - Goal Attainment theory
 * 10) <span style="font-family: Arial,Helvetica,sans-serif; font-size: 16px;">Betty Neuman - System model
 * 11) <span style="font-family: Arial,Helvetica,sans-serif; font-size: 16px;">Sister Calista Roy - Adaptation theory
 * 12) <span style="font-family: Arial,Helvetica,sans-serif; font-size: 16px;">Jean Watson - Philosophy and Caring Model
 * 13) <span style="font-family: Arial,Helvetica,sans-serif; font-size: 16px;">Madeleine Leininger -Transcultural nursing
 * 14) <span style="font-family: Arial,Helvetica,sans-serif; font-size: 16px;">Patricia Benner - From Novice to Expert
 * 15) <span style="font-family: Arial,Helvetica,sans-serif; font-size: 16px;">Lydia E. Hall - The Core, Care and Cure
 * 16) <span style="font-family: Arial,Helvetica,sans-serif; font-size: 16px;">Nola Pender’s Health Promotion Model
 * 17) <span style="font-family: Arial,Helvetica,sans-serif; font-size: 16px;">[|Joyce Travelbee] - Human-To-Human Relationship Model
 * 18) <span style="font-family: Arial,Helvetica,sans-serif; font-size: 16px;">[|Margaret Newman] - Health As Expanding Consciousness
 * 19) <span style="font-family: Arial,Helvetica,sans-serif; font-size: 16px;">[|Katharine Kolcaba] - Comfort Theory
 * 20) <span style="font-family: Arial,Helvetica,sans-serif; font-size: 16px;">[|Rosemarie Rizzo Parse] - Human Becoming Theory
 * 21) <span style="font-family: Arial,Helvetica,sans-serif; font-size: 16px;">[|Ernestine Wiedenbach] - The Helping Art of Clinical Nursing

<span style="font-family: Arial,Helvetica,sans-serif; font-size: 16px;">The following are 15 brief statements/summaries of nurses that have distinguished themselves in the profession and shaped the development of nursing science theory.

<span style="font-family: Arial,Helvetica,sans-serif;">Fill in the blanks here as a group make sure you agree and match the name above to the matching summary below

<span style="font-family: Arial,Helvetica,sans-serif; font-size: 16px;">1. <span style="font-family: Arial,Helvetica,sans-serif; font-size: 16px;">Which nurse defined the role of nursing (i.e. placing their primary focus on the patient), specified the 14 functions of basic nursing care, and laid the foundation for evidence based nursing practice? They defined the role of nursing "as doing things for patients that they would do for themselves". <span style="font-family: Arial,Helvetica,sans-serif;">** Virginia Henderson **

<span style="font-family: Arial,Helvetica,sans-serif;">** 2 **. <span style="font-family: Arial,Helvetica,sans-serif; font-size: 16px;">My Conceptual model is focused on the patients' actions to meet their own therapeutic demands. The goal of nursing is to move a patient toward responsible self-care or meet existing health care needs of those who have health care deficits. To move the patient from dependency to independence, totally or with adaptive equipment with the environment, forms an integrated, functional whole. Who am I? <span style="font-family: Arial,Helvetica,sans-serif;">** Dorothea Orem **

<span style="font-family: Arial,Helvetica,sans-serif;">** 3 **. <span style="font-family: Arial,Helvetica,sans-serif; font-size: 16px;">Transcultural nursing focuses on a comparative study and analysis of different cultures and subcultures in the world regarding their caring behavior, nursing care, health-illness values, and patterns of behavior. Nursing is a learned humanistic and scientific profession that focuses on personalized care behaviors, functions, and processes that have physical, psycho cultural and social significance or meaning. The goal of nursing is to facilitate individuals to regain or maintain health in a way that is culturally congruent, or to help people face handicaps or death. Conceptual framework is focused on cultural care and health. <span style="font-family: Arial,Helvetica,sans-serif;">** Madeleine Leininger **

<span style="font-family: Arial,Helvetica,sans-serif;">** 4 **. <span style="font-family: Arial,Helvetica,sans-serif; font-size: 16px;">Who theorized that in all settings of nursing a client's goals are met through the interaction between client and nurse in her theory of goal attainment? Who is the nursing theorist that developed a model which seeks to integrate the personal, interpersonal, and social systems that influence the patient's health? <span style="font-family: Arial,Helvetica,sans-serif;">** Imogene King **

<span style="font-family: Arial,Helvetica,sans-serif;">** 5 **. <span style="font-family: Arial,Helvetica,sans-serif; font-size: 16px;">I introduced the first midwifery service in the United States and founded the Frontier Nursing Service which lowered the infant and maternal mortality rate of rural Appalachia. Eighty-five years ago my service began with "Nurses on Horseback" and has evolved to include a hospital, home health agency, rural healthcare clinics and a school of nurse midwifery and family nursing. Who am I? <span style="font-family: Arial,Helvetica,sans-serif;">** Mary Breckenridge **

<span style="font-family: Arial,Helvetica,sans-serif;">** 6 **. <span style="font-family: Arial,Helvetica,sans-serif; font-size: 16px;">Who was the first African American public health nurse, hired in 1902 by the charity organization, to visit African American families infected by TB and is credited with paving the way for African American nurses in the practice of community health. <span style="font-family: Arial,Helvetica,sans-serif;">** Jessie Scales **

<span style="font-family: Arial,Helvetica,sans-serif;">** 7 **. <span style="font-family: Arial,Helvetica,sans-serif; font-size: 16px;">She wrote the classic book "Nursing - Human Science & Human Care" which explores the balance between science and nursing that is the basis of the nursing profession. She draws from the works of Eastern and Western philosophers and emphasizes that the role that nursing plays in our society is based on human care. The practice of nursing is different from curing. It is a transpersonal relationship that includes, but is not limit to ten caritas factors. <span style="font-family: Arial,Helvetica,sans-serif;">** Jean Watson **

<span style="font-family: Arial,Helvetica,sans-serif;">** 8 **. <span style="font-family: Arial,Helvetica,sans-serif; font-size: 16px;">Who was the nurse responsible for establishing the first ideas and definitions of Nursing? A service to mankind intended to relieve and pain and suffering. Nursing's role is to promote or provide the proper environment for patients. The goal of nursing is to promote the reparative process by manipulating the environment. <span style="font-family: Arial,Helvetica,sans-serif;">** Florence Nightingale **

<span style="font-family: Arial,Helvetica,sans-serif;">** 9 **. <span style="font-family: Arial,Helvetica,sans-serif; font-size: 16px;">I worked as a nurse on the Lower East Side of New York City. The year was 1912. I spent my time working with immigrant families. After a bad experience, I devoted my life to teaching women about birth control. I published a pamphlet on reproductive anatomy and sexual development, becoming the first advocate for sex education. I was an American birth control activist, advocate of eugenics, and founder of the American Birth Control League. <span style="font-family: Arial,Helvetica,sans-serif;">** Margaret Sanger **

<span style="font-family: Arial,Helvetica,sans-serif;">** 10 **. <span style="font-family: Arial,Helvetica,sans-serif; font-size: 16px;">This nurse theorized that health as an expanding consciousness was stimulated by concern for those for whom health as the absence of disease or disability is not possible. This consciousness is a process of becoming more of oneself, of finding greater meaning in life, and of reaching new dimensions of connectedness with other people and the world. <span style="font-family: Arial,Helvetica,sans-serif;">** Margaret Newman **

<span style="font-family: Arial,Helvetica,sans-serif;">** 11 **. <span style="font-family: Arial,Helvetica,sans-serif; font-size: 16px;">I was a nurse, social worker, public health official, teacher, author, editor, publisher, activist for peace, women's, children's and civil rights. I was the founder of American community nursing and regarded as the founder of visiting nursing in the United States and Canada. (hint: I also started Henry Street Settlement with help from another leader) Who is credited with creating the title "public health nurse"? <span style="font-family: Arial,Helvetica,sans-serif;">** Lillian Wald **

<span style="font-family: Arial,Helvetica,sans-serif;">** 12 **. <span style="font-family: Arial,Helvetica,sans-serif; font-size: 16px;">I drew my inspiration from the resiliency of children. My model includes the adaptive system with cognator and regulator subsystems acting to maintain adaptation in 4 adaptive modes, which are as follows: 1. physiologic-physical, 2. self-concept-group identity, 3. role function and 4. interdependence. To summarize my model it is a problem solving approach for gathering data, identifying the capacities and needs of humans, selecting and implementing approaches for nursing care and evaluation of the care provided. Who am I? <span style="font-family: Arial,Helvetica,sans-serif;">** Sister Calista Roy **

<span style="font-family: Arial,Helvetica,sans-serif;">** 13 **. <span style="font-family: Arial,Helvetica,sans-serif; font-size: 16px;">This person developed a conceptual framework that views the person as a layered, multidimensional entity in constant flux and flow with the environment. The layering in the model represents various methods of coping and defense to protect the person, with a focus on stress and feedback. views nursing as a "unique profession in that it is concerned with all of the variables affecting the individual's response to stress. Major concern for the nurse is keeping the client system stable through accuracy in assessment of effects and possible effects of environmental stressors <span style="color: #0000ff; font-family: Arial,Helvetica,sans-serif;">**Betty Neuman**

<span style="font-family: Arial,Helvetica,sans-serif;">** 14 **. <span style="font-family: Arial,Helvetica,sans-serif; font-size: 16px;">This person developed the seven nursing roles, and composed the developmental stages of the nurse-client relationship. She believed that nurses could facilitate a "shared-experience" through observation, description, formulation, interpretation, validation and intervention. <span style="color: #0000ff; font-family: Arial,Helvetica,sans-serif;">**Hildegard Peplau**

<span style="font-family: Arial,Helvetica,sans-serif;">** 15 **. <span style="font-family: Arial,Helvetica,sans-serif; font-size: 16px;">Who was the woman who founded an American branch of the Red Cross in 1881 and expanded the organizational mission to include response to any great national disaster--not just humanitarian aid in war? Had it not been for the early work and philosophy of this early pioneer in healthcare, the Federal Emergency Management Agency (FEMA) may not have been established. One of her first macro level nursing services was to Cuban citizens and American military personnel during the Spanish-American war. In addition, she also started American disaster relief efforts. <span style="font-family: Arial,Helvetica,sans-serif;">** Clara Barton **