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I
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Min
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Hea
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[
1
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Ad
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Pro
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b
s
tacle
s
in
im
p
lem
en
tin
g
n
u
r
s
in
g
ca
r
e,
attr
ib
u
tin
g
t
h
em
t
o
a
lack
o
f
s
u
f
f
icien
t
k
n
o
wled
g
e
ab
o
u
t
th
e
co
d
e
o
f
eth
ics
an
d
th
e
ab
s
en
ce
o
f
r
o
le
m
o
d
els
wh
o
teac
h
th
e
co
d
e
o
f
eth
ics
in
n
u
r
s
in
g
p
r
ac
tice
[
1
2
]
.
T
h
e
r
esear
ch
o
u
tco
m
es
in
d
icate
th
at
n
u
r
s
es
p
o
s
s
es
s
in
g
a
p
o
s
itiv
e
a
n
d
ca
r
in
g
attitu
d
e
in
h
er
en
tly
ap
p
ly
eth
ical
p
r
in
cip
les
wh
en
d
eliv
er
in
g
n
u
r
s
in
g
ca
r
e
to
p
atien
ts
[
1
3
]
.
Stu
d
en
ts
co
m
m
o
n
ly
m
ak
e
er
r
o
r
s
,
with
th
e
m
o
s
t
f
r
e
q
u
en
t
o
n
es
b
ein
g
r
elate
d
t
o
co
m
m
u
n
icatio
n
,
m
ed
icatio
n
,
an
d
p
r
o
ce
d
u
r
al
asp
ec
ts
[
1
4
]
.
T
h
e
r
es
ea
r
ch
f
in
d
in
g
s
in
d
icate
th
a
t
s
tu
d
en
ts
co
m
m
it
m
ed
ical
er
r
o
r
s
p
r
im
ar
ily
b
ec
a
u
s
e
o
f
in
s
u
f
f
icien
t
k
n
o
wled
g
e
ab
o
u
t
p
r
o
ce
d
u
r
es
an
d
in
ad
e
q
u
ate
s
u
p
er
v
is
io
n
d
u
r
in
g
clin
i
ca
l
p
r
ac
tice
[
1
5
]
.
An
o
th
er
r
ep
o
r
t
h
ig
h
lig
h
ts
a
s
u
b
s
tan
tial
p
r
ev
alen
ce
o
f
m
ed
ical
er
r
o
r
s
am
o
n
g
n
u
r
s
in
g
s
tu
d
en
ts
,
with
ap
p
r
o
x
im
ately
h
alf
o
f
th
em
m
ak
in
g
s
u
ch
er
r
o
r
s
d
u
r
i
n
g
th
eir
ed
u
c
atio
n
al
p
r
o
g
r
am
[
1
6
]
.
T
h
e
em
o
tio
n
al
co
n
s
eq
u
en
ce
s
f
o
r
s
tu
d
en
ts
wh
o
m
ak
e
m
is
tak
es in
clu
d
e
ex
p
er
ien
cin
g
d
is
o
r
d
er
s
s
u
ch
as f
ea
r
an
d
a
n
x
iety
[
1
7
]
.
Ad
d
itio
n
al
r
esear
ch
r
ev
ea
ls
ch
allen
g
es
in
im
p
lem
en
tin
g
n
u
r
s
in
g
ca
r
e,
p
ar
ticu
lar
ly
r
elate
d
t
o
cu
ltu
r
al
d
if
f
er
en
ce
s
,
with
lan
g
u
ag
e
v
ar
ian
ce
s
b
ein
g
a
p
r
o
m
i
n
en
t
is
s
u
e.
I
n
ad
e
q
u
ate
av
ailab
ilit
y
o
f
l
an
g
u
ag
e
tr
an
s
lato
r
s
an
d
in
s
u
f
f
icien
t
ed
u
ca
ti
o
n
an
d
tr
ain
in
g
co
n
tr
ib
u
te
to
th
ese
o
b
s
tacle
s
[
1
8
]
.
Ap
p
r
o
x
im
ately
o
n
e
-
th
ir
d
o
f
n
u
r
s
es
s
elf
-
id
en
tify
as
cu
ltu
r
ally
i
n
co
m
p
eten
t,
wh
ile
n
ea
r
ly
h
al
f
co
n
s
id
er
th
e
m
s
elv
es
cu
ltu
r
ally
co
m
p
eten
t
in
p
r
o
v
id
i
n
g
n
u
r
s
in
g
ca
r
e.
T
h
e
lev
el
o
f
cu
ltu
r
al
d
iv
er
s
ity
tr
ain
in
g
ex
p
e
r
ien
ce
an
d
s
elf
-
p
er
ce
iv
ed
c
u
ltu
r
al
co
m
p
eten
ce
s
ig
n
if
ican
tly
in
f
l
u
en
ce
s
n
u
r
s
es'
o
v
er
all
cu
ltu
r
a
l
co
m
p
eten
ce
[
1
9
]
.
Su
m
m
ar
il
y
,
th
e
is
s
u
es
am
o
n
g
s
tu
d
en
ts
en
co
m
p
ass
d
e
f
icien
cies
in
attitu
d
es/s
o
f
t
s
k
ills
,
in
ter
p
er
s
o
n
al
r
elatio
n
s
h
ip
s
,
p
r
o
f
ess
io
n
al
v
alu
es,
lim
ited
k
n
o
wled
g
e
ab
o
u
t
eth
ics,
o
cc
u
r
r
en
ce
s
o
f
m
ed
ical
er
r
o
r
s
,
cu
ltu
r
al
b
ar
r
ier
s
in
ex
ec
u
tin
g
n
u
r
s
in
g
ca
r
e
,
an
d
an
u
n
d
e
r
d
ev
elo
p
ed
ca
p
ac
ity
f
o
r
ca
r
in
g
b
eh
av
io
r
,
s
p
ec
if
i
ca
lly
in
ex
p
r
ess
iv
e
o
r
em
o
tio
n
al
ca
r
in
g
.
T
h
e
ch
allen
g
es
e
x
p
er
ien
ce
d
b
y
s
tu
d
en
ts
ca
n
im
p
ed
e
th
e
attain
m
en
t
o
f
c
o
m
p
eten
cies
d
u
r
in
g
th
e
lear
n
in
g
p
r
o
ce
s
s
.
Hen
ce
,
ad
e
q
u
ate
p
r
e
p
ar
atio
n
is
cr
u
cial
t
o
en
s
u
r
e
s
tu
d
en
ts
ar
e
well
-
eq
u
ip
p
ed
f
o
r
clin
ical
lear
n
in
g
.
C
ar
in
g
b
e
h
av
io
r
p
la
y
s
a
s
ig
n
if
ican
t
r
o
le
in
i
n
f
lu
e
n
cin
g
th
e
ac
h
iev
em
e
n
t
o
f
s
tu
d
en
t
co
m
p
eten
cies
[
2
0
]
.
Ad
d
itio
n
ally
,
v
a
r
io
u
s
f
ac
to
r
s
im
p
ac
t
th
e
r
ea
lizatio
n
o
f
n
u
r
s
in
g
co
m
p
eten
cies,
i
n
clu
d
in
g
p
r
ac
tical
ex
p
er
ien
ce
,
th
e
lea
r
n
in
g
e
n
v
ir
o
n
m
en
t,
in
d
iv
id
u
al
c
h
ar
ac
ter
i
s
tics
,
th
e
lear
n
in
g
p
r
o
ce
s
s
,
an
d
ca
r
in
g
b
e
h
av
io
r
.
Af
f
ec
tiv
e
r
ea
d
in
ess
in
s
tu
d
en
t
s
is
v
ital
to
o
p
tim
izin
g
th
eir
k
n
o
wled
g
e
a
n
d
s
k
ills
.
E
d
u
ca
tio
n
al
in
s
titu
tio
n
s
m
u
s
t
d
esig
n
lear
n
in
g
en
v
ir
o
n
m
e
n
ts
th
at
s
u
p
p
o
r
t
th
e
en
h
an
ce
m
en
t
o
f
s
tu
d
en
t
co
m
p
eten
ce
[
2
1
]
.
T
o
en
h
a
n
c
e
re
ad
in
ess
f
o
r
p
r
ac
tice
in
n
u
r
s
in
g
ed
u
ca
tio
n
,
th
e
r
e
is
a
n
ee
d
to
f
o
cu
s
o
n
im
p
r
o
v
in
g
attitu
d
es
an
d
s
o
f
t
s
k
ills
.
I
m
p
lem
en
tin
g
c
h
ar
ac
ter
lear
n
i
n
g
,
wh
ich
e
n
h
an
ce
s
af
f
ec
tiv
e
s
k
ills
,
p
r
o
v
es
ef
f
ec
tiv
e
wh
en
co
m
p
lem
en
ted
b
y
p
r
io
r
c
o
g
n
itiv
e
a
n
d
p
s
y
ch
o
m
o
to
r
lear
n
i
n
g
ex
p
er
ien
ce
s
[
2
2
]
.
I
n
c
o
r
p
o
r
atin
g
c
h
ar
ac
ter
lea
r
n
in
g
is
cr
u
cial
in
s
tu
d
en
t e
d
u
ca
tio
n
as it sig
n
if
ican
tly
in
f
lu
en
ce
s
th
eir
af
f
ec
tiv
e
b
eh
av
io
r
.
Ma
s
ter
in
g
ess
en
tial
ch
ar
ac
te
r
is
tics
is
cr
u
cial
f
o
r
n
u
r
s
es
as
co
m
p
eten
c
y
n
ec
ess
itat
es
s
tr
o
n
g
in
ter
p
er
s
o
n
al
in
te
r
ac
tio
n
s
k
ills
with
p
atien
ts
[
2
3
]
.
I
t
is
im
p
er
ativ
e
to
co
n
ti
n
u
e
th
e
n
u
r
s
in
g
c
h
ar
ac
ter
ed
u
ca
tio
n
p
r
o
g
r
a
m
d
u
r
in
g
clin
ical
lear
n
i
n
g
[
2
4
]
.
T
h
is
f
o
r
m
o
f
ed
u
ca
tio
n
s
h
ap
es
th
e
p
er
s
o
n
ality
r
eq
u
ir
ed
f
o
r
p
r
o
v
id
in
g
ca
r
e
to
p
atien
ts
[
2
5
]
an
d
co
n
tr
ib
u
tes
to
f
o
s
ter
in
g
tr
u
s
t
a
n
d
c
o
n
f
id
en
ce
in
th
e
n
u
r
s
in
g
p
r
o
f
es
s
io
n
with
in
s
o
ciety
[
2
6
]
.
I
n
h
ig
h
e
r
ed
u
ca
ti
o
n
,
c
h
ar
ac
ter
ed
u
ca
tio
n
h
o
ld
s
a
s
tr
ateg
ic
r
o
le
in
cu
ltiv
atin
g
e
m
o
tio
n
s
an
d
h
ab
its
th
r
o
u
g
h
th
e
in
teg
r
atio
n
o
f
ca
r
i
n
g
b
eh
a
v
io
r
in
t
o
d
aily
life
a
n
d
th
e
lear
n
i
n
g
p
r
o
ce
s
s
[
2
7
]
–
[
2
9
]
.
Th
e
ef
f
ec
tiv
en
ess
o
f
ch
a
r
ac
ter
e
d
u
ca
tio
n
lies
in
th
e
d
ev
elo
p
m
en
t
o
f
a
well
-
s
tr
u
ctu
r
ed
ch
ar
ac
ter
lear
n
in
g
m
o
d
el
th
at
ef
f
ec
tiv
ely
co
n
v
ey
s
id
ea
s
an
d
in
f
o
r
m
atio
n
th
r
o
u
g
h
o
u
t th
e
lear
n
i
n
g
p
r
o
ce
s
s
.
C
h
a
r
a
c
t
e
r
l
e
a
r
n
i
n
g
f
o
r
n
u
r
s
i
n
g
s
t
u
d
e
n
ts
i
n
v
o
l
v
e
s
ac
q
u
i
r
i
n
g
k
n
o
w
l
e
d
g
e
o
f
v
a
l
u
e
s
a
n
d
c
h
a
r
ac
t
e
r
(
m
o
r
a
l
k
n
o
w
i
n
g
)
,
r
e
c
o
g
n
i
z
i
n
g
t
h
e
s
i
g
n
i
f
i
c
a
n
c
e
o
f
v
a
l
u
es
a
n
d
c
h
a
r
a
c
ter
(
m
o
r
a
l
f
e
e
l
i
n
g
)
,
a
n
d
a
l
i
g
n
i
n
g
b
e
h
a
v
i
o
r
w
i
t
h
g
o
o
d
v
a
l
u
e
s
a
n
d
c
h
a
r
a
c
t
e
r
(
m
o
r
a
l
b
eh
a
v
i
o
r
)
[
3
0
]
.
I
t
i
s
c
r
u
c
i
a
l
f
o
r
c
h
a
r
a
c
t
e
r
l
e
a
r
n
i
n
g
t
o
b
e
c
e
n
t
e
r
e
d
a
r
o
u
n
d
c
a
r
i
n
g
,
a
s
i
t
i
s
e
s
s
e
n
t
ia
l
f
o
r
d
i
r
e
c
t
p
r
a
c
t
i
c
e
an
d
p
a
t
i
e
n
t
i
n
t
e
r
a
c
t
i
o
n
,
h
o
l
d
i
n
g
s
i
g
n
i
f
i
c
a
n
t
m
e
a
n
i
n
g
f
o
r
p
a
t
i
e
n
t
s
a
n
d
t
h
e
i
r
f
a
m
i
l
i
e
s
[
3
1
]
,
[
3
2
]
.
C
a
r
i
n
g
s
e
r
v
e
s
a
s
t
h
e
f
o
u
n
d
a
t
i
o
n
f
o
r
c
o
m
p
r
e
h
e
n
s
i
v
e
n
u
r
s
i
n
g
p
r
o
f
e
s
s
i
o
n
a
l
d
e
v
e
l
o
p
m
e
n
t
,
e
n
c
o
m
p
a
s
s
i
n
g
b
o
t
h
i
n
s
t
r
u
m
e
n
t
al
as
p
e
c
ts
(
r
e
l
ate
d
s
k
i
ll
s
)
a
n
d
e
m
o
t
i
o
n
a
l
as
p
e
c
ts
o
f
c
a
r
i
n
g
(
c
o
n
n
e
c
t
e
d
t
o
e
m
o
t
io
n
s
o
r
p
r
o
f
e
s
s
i
o
n
a
l
v
a
l
u
e
s
)
.
I
n
t
e
g
r
a
t
i
n
g
c
h
a
r
a
c
t
e
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T
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r
in
g
-
b
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h
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r
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r
l
e
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o
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d
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n
t
h
e
c
a
r
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q
u
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t
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m
o
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t
i
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h
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t
e
r
f
o
r
m
a
t
i
o
n
[
3
3
]
–
[
3
5
]
.
T
h
e
r
e
f
o
r
e
,
t
h
i
s
s
t
u
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y
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g
-
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r
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d
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a
w
a
n
d
c
u
l
t
u
r
al
s
e
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s
i
ti
v
i
t
y
.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
n
t J
Pu
b
lic
Hea
lth
Sci
I
SS
N:
2252
-
8
8
0
6
Th
e
in
flu
en
ce
o
f c
a
r
in
g
-
b
a
s
ed
ch
a
r
a
cter le
a
r
n
in
g
in
terven
tio
n
s
o
n
th
e
p
r
a
ctica
l
…
(
B
h
a
kti
P
erma
n
a
)
393
2.
M
E
T
H
O
D
2
.
1
.
Study
d
esig
n
T
h
e
r
esear
ch
ad
o
p
ted
a
q
u
asi
-
ex
p
er
im
e
n
tal
d
esig
n
th
at
in
v
o
lv
ed
m
ea
s
u
r
in
g
o
u
tco
m
es
b
o
th
b
ef
o
r
e
an
d
af
ter
t
h
e
in
ter
v
e
n
tio
n
.
T
h
i
s
ap
p
r
o
ac
h
allo
wed
f
o
r
th
e
c
o
m
p
ar
is
o
n
o
f
ch
an
g
es
o
v
er
tim
e
with
in
th
e
s
tu
d
y
g
r
o
u
p
.
Ad
d
itio
n
ally
,
a
co
n
tr
o
l
g
r
o
u
p
was
i
n
clu
d
ed
to
p
r
o
v
id
e
a
b
aselin
e
f
o
r
as
s
ess
in
g
th
e
im
p
ac
t
o
f
th
e
in
ter
v
en
tio
n
b
y
c
o
n
tr
asti
n
g
it
with
a
g
r
o
u
p
th
at
d
i
d
n
o
t
r
ec
ei
v
e
th
e
tr
ea
tm
en
t.
2
.
2
.
Set
t
ing
a
nd
s
a
m
ple
T
h
is
r
esear
ch
was
co
n
d
u
cted
with
in
a
n
u
r
s
in
g
p
r
o
f
ess
io
n
al
s
tu
d
y
p
r
o
g
r
am
in
th
e
city
o
f
B
an
d
u
n
g
,
s
p
an
n
in
g
f
r
o
m
Ap
r
il
to
J
u
n
e
2
0
2
3
.
T
h
e
s
am
p
le
s
ize
f
o
r
th
e
s
tu
d
y
was
d
eter
m
in
e
d
u
s
in
g
a
2
-
p
r
o
p
o
r
tio
n
d
if
f
er
en
ce
test
ca
lcu
latio
n
,
r
es
u
ltin
g
in
3
3
r
esp
o
n
d
en
ts
f
o
r
b
o
th
th
e
in
ter
v
en
tio
n
g
r
o
u
p
a
n
d
th
e
co
n
tr
o
l
g
r
o
u
p
[
3
6
]
.
Pu
r
p
o
s
iv
e
s
am
p
lin
g
was
em
p
lo
y
ed
as
th
e
s
am
p
lin
g
te
ch
n
iq
u
e,
with
s
am
p
les
s
elec
te
d
f
r
o
m
a
s
p
ec
if
ic
s
tu
d
y
p
r
o
g
r
am
b
ased
o
n
p
r
ed
e
ter
m
in
ed
cr
iter
ia.
T
h
e
ch
o
s
en
s
tu
d
y
p
r
o
g
r
am
h
o
ld
s
ac
cr
ed
ita
tio
n
o
f
B
an
d
v
e
r
y
good
an
d
h
as
ex
p
r
ess
ed
its
willin
g
n
ess
t
o
co
n
d
u
ct
tr
ain
in
g
p
r
o
g
r
am
s
alig
n
ed
with
th
e
cr
ea
ted
m
o
d
u
les.
I
n
clu
s
io
n
cr
iter
ia
f
o
r
th
is
s
tu
d
y
en
co
m
p
ass
ed
s
tu
d
en
ts
in
t
h
e
clin
ical
s
tag
e
o
f
th
e
n
u
r
s
in
g
p
r
o
f
ess
io
n
,
en
r
o
lled
in
a
n
u
r
s
in
g
p
r
o
f
ess
io
n
s
tu
d
y
p
r
o
g
r
a
m
with
B
an
d
v
er
y
g
o
o
d
ac
cr
ed
itatio
n
,
an
d
p
o
s
s
ess
in
g
p
er
m
is
s
io
n
f
r
o
m
th
e
s
tu
d
y
p
r
o
g
r
am
to
p
ar
tak
e
i
n
th
e
tr
ain
in
g
.
E
x
clu
s
io
n
cr
iter
ia
in
clu
d
ed
s
tu
d
en
ts
wh
o
wer
e
u
n
well
an
d
u
n
a
b
le
to
co
m
p
lete
o
n
e
clin
ical
s
tag
e.
Dr
o
p
o
u
t
cr
iter
ia
wer
e
d
e
f
i
n
ed
as
s
tu
d
en
ts
wh
o
f
ailed
t
o
atten
d
t
r
ain
in
g
o
n
m
o
r
e
th
an
two
o
cc
asio
n
s
o
r
d
i
d
n
o
t a
d
h
er
e
to
p
r
o
ce
d
u
r
es in
an
o
r
d
e
r
ly
m
a
n
n
er
.
2
.
3
.
Va
ri
a
ble a
nd
m
ea
s
ures
I
n
th
is
s
tu
d
y
,
t
h
e
in
d
ep
en
d
en
t
v
ar
iab
le
is
th
e
ca
r
in
g
-
b
ased
ch
ar
ac
ter
lear
n
in
g
m
o
d
u
le,
wh
ile
th
e
d
ep
en
d
e
n
t
v
ar
ia
b
le
is
p
r
ac
tical
n
u
r
s
in
g
c
o
m
p
eten
c
y
,
s
p
e
cif
ically
f
o
cu
s
in
g
o
n
eth
ics,
law,
an
d
cu
ltu
r
al
s
en
s
itiv
ity
.
T
h
e
in
s
tr
u
m
en
t
u
tili
ze
d
f
o
r
m
ea
s
u
r
in
g
co
m
p
ete
n
ce
is
a
m
o
d
if
ied
v
er
s
io
n
o
f
th
e
eth
ical
an
d
leg
al
p
r
in
cip
les
p
r
ac
tice
q
u
esti
o
n
n
air
e,
alo
n
g
with
an
ad
ap
ted
f
o
r
m
o
f
th
e
tr
a
n
s
cu
ltu
r
al
s
elf
-
ef
f
icac
y
s
ca
le
q
u
esti
o
n
n
air
e
[
3
7
]
.
I
t
is
im
p
o
r
tan
t
to
n
o
te
th
at
th
e
in
s
tr
u
m
en
t's
v
alid
ity
an
d
r
eliab
ilit
y
h
av
e
b
ee
n
estab
lis
h
ed
,
with
a
co
r
r
elatio
n
co
e
f
f
icien
t
(
r
)
r
an
g
i
n
g
f
r
o
m
0
.
6
7
5
t
o
0
.
8
5
3
,
s
u
r
p
ass
in
g
th
e
cr
itical
c
o
r
r
elatio
n
t
h
r
esh
o
ld
(
r
tab
le)
o
f
0
.
3
6
1
,
an
d
a
C
r
o
n
b
ac
h
'
s
alp
h
a
v
alu
e
o
f
0
.
9
5
0
,
ex
c
ee
d
in
g
th
e
ac
ce
p
tab
le
th
r
esh
o
ld
o
f
0
.
7
0
0
.
2
.
4
.
I
nte
rv
ent
io
n
T
h
e
r
esear
ch
er
co
n
d
u
cted
th
e
in
ter
v
en
tio
n
b
y
im
p
lem
e
n
tin
g
a
m
o
d
u
le
t
h
at
co
v
e
r
ed
v
ar
i
o
u
s
to
p
ics.
T
h
e
m
o
d
u
le
co
m
p
r
is
ed
f
o
u
r
p
ar
ts
:
-
Par
t 1
f
o
cu
s
ed
o
n
m
o
tiv
atio
n
a
n
d
lear
n
in
g
attitu
d
es.
-
P
a
r
t
2
a
d
d
r
e
s
s
e
d
c
h
a
r
a
ct
e
r
d
e
v
e
l
o
p
m
e
n
t
,
c
a
r
i
n
g
b
e
h
a
v
i
o
r
,
a
n
d
k
e
y
c
h
a
r
a
c
t
e
r
i
s
ti
cs
o
f
n
u
r
s
es
,
i
n
c
l
u
d
i
n
g
s
i
n
c
e
r
e
w
o
r
k
c
h
a
r
a
c
t
e
r
,
e
m
p
a
t
h
e
ti
c
c
h
ar
a
c
t
e
r
,
c
r
i
ti
c
a
l
t
h
i
n
k
i
n
g
c
h
a
r
a
c
te
r
,
r
e
s
p
o
n
s
i
b
l
e
c
h
a
r
a
c
t
e
r
,
a
n
d
to
u
g
h
c
h
a
r
a
c
t
e
r
.
-
Sectio
n
3
d
elv
e
d
in
to
n
u
r
s
in
g
co
m
p
eten
cy
ar
ea
s
.
-
Sectio
n
4
co
v
e
r
ed
asp
ec
ts
r
ela
ted
to
th
e
cu
r
r
icu
lu
m
,
lib
r
ar
i
es
,
lab
o
r
ato
r
ies,
an
d
ed
u
ca
tio
n
al
f
ac
ilit
ies.
T
h
e
in
ter
v
en
tio
n
in
v
o
l
v
ed
d
i
v
er
s
e
lear
n
in
g
m
eth
o
d
s
s
u
ch
as
lectu
r
es,
d
is
cu
s
s
io
n
s
,
b
r
ain
s
to
r
m
in
g
,
s
to
r
y
tellin
g
,
s
im
u
latio
n
s
,
s
elf
-
r
ef
lectio
n
,
co
n
te
x
tu
al
lear
n
in
g
,
p
r
o
b
lem
-
b
ased
lear
n
in
g
,
co
ll
ab
o
r
ativ
e
lear
n
in
g
,
g
am
e
-
b
ased
lear
n
in
g
,
an
d
ex
p
er
ien
tial
lear
n
in
g
.
T
h
e
i
n
ter
v
e
n
tio
n
s
p
an
n
ed
a
d
u
r
atio
n
o
f
1
2
wee
k
s
,
with
ea
c
h
s
ess
io
n
last
in
g
1
0
0
m
i
n
u
tes.
T
en
m
ee
tin
g
s
wer
e
co
n
d
u
cted
o
n
ca
m
p
u
s
,
wh
ile
an
ad
d
itio
n
al
two
wee
k
s
wer
e
d
ed
icate
d
to
s
ess
io
n
s
at
th
e
s
tu
d
en
ts
'
p
r
ac
ti
ce
s
ites
.
2
.
5
.
Da
t
a
c
o
llect
io
n
T
h
e
r
esear
ch
er
s
co
llected
d
at
a
af
ter
s
ec
u
r
in
g
eth
ical
ap
p
r
o
v
al
an
d
r
esear
ch
p
e
r
m
is
s
io
n
f
r
o
m
t
h
e
r
elev
an
t
in
s
titu
tio
n
.
E
t
h
ical
ap
p
r
o
v
al
f
o
r
t
h
is
r
esear
ch
was
g
r
an
ted
b
y
th
e
r
esear
ch
eth
ics
co
m
m
is
s
io
n
o
f
th
e
Facu
lty
o
f
Nu
r
s
in
g
,
Air
lan
g
g
a
Un
iv
er
s
ity
,
with
r
ef
er
e
n
ce
n
u
m
b
er
2
6
9
7
-
KE
PK,
d
ated
No
v
em
b
er
2
1
,
2
0
2
2
.
T
h
e
r
esear
ch
er
co
llab
o
r
ated
with
th
e
h
ea
d
o
f
t
h
e
s
tu
d
y
p
r
o
g
r
a
m
to
c
o
o
r
d
in
ate
th
e
s
a
m
p
le
s
elec
tio
n
an
d
d
eter
m
in
e
th
e
s
ch
ed
u
le
an
d
lo
ca
tio
n
in
ac
co
r
d
an
ce
with
th
e
ag
r
ee
d
-
u
p
o
n
ter
m
s
.
T
h
e
q
u
esti
o
n
n
air
e
was
p
r
ep
ar
e
d
o
n
lin
e
an
d
ad
m
in
is
ter
ed
to
r
esp
o
n
d
en
ts
b
ef
o
r
e
a
n
d
af
ter
th
e
in
ter
v
en
tio
n
f
o
r
b
o
th
th
e
in
ter
v
en
tio
n
an
d
c
o
n
tr
o
l
g
r
o
u
p
s
.
R
esp
o
n
d
en
ts
wh
o
co
m
p
leted
th
e
q
u
esti
o
n
n
air
e
c
o
n
f
ir
m
ed
th
eir
p
ar
ticip
atio
n
with
t
h
e
r
esear
ch
er
.
2
.
6
.
Da
t
a
a
na
ly
s
is
T
h
e
d
ata
an
aly
s
i
s
f
o
r
t
h
is
r
esear
ch
em
p
lo
y
e
d
d
escr
ip
ti
v
e
s
tatis
tic
s
,
in
clu
d
in
g
av
e
r
ag
es,
f
r
eq
u
e
n
cy
d
is
tr
ib
u
tio
n
s
,
an
d
p
er
ce
n
ta
g
es.
I
n
ad
d
itio
n
to
d
escr
ip
tiv
e
a
n
aly
s
is
,
in
f
er
en
tial
an
aly
s
is
was
co
n
d
u
cted
.
T
h
e
n
o
n
p
a
r
am
etr
ic
W
ilco
x
o
n
m
atch
p
air
s
test
was
u
til
ized
to
ex
am
in
e
th
e
d
if
f
er
en
ce
s
b
et
wee
n
p
r
e
-
test
an
d
p
o
s
t
-
test
s
co
r
es
with
in
b
o
th
th
e
in
ter
v
en
tio
n
a
n
d
co
n
tr
o
l
g
r
o
u
p
s
.
T
o
test
th
e
p
o
s
t
-
test
d
if
f
e
r
en
ce
s
b
etwe
en
th
e
two
g
r
o
u
p
s
(
in
ter
v
e
n
tio
n
a
n
d
co
n
tr
o
l)
,
th
e
n
o
n
p
ar
am
etr
ic
Ma
n
n
-
W
h
itn
ey
U
-
t
est
was
em
p
lo
y
ed
.
T
h
e
ac
ce
p
tan
ce
o
f
t
h
e
h
y
p
o
th
esis
was c
o
n
tin
g
en
t o
n
a
s
ig
n
if
ican
ce
v
alu
e
o
f
<0
.
0
5
.
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No
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1
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Ma
r
ch
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9
1
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399
394
3.
RE
SU
L
T
S AN
D
D
I
SCU
SS
I
O
N
T
ab
le
1
in
d
icate
s
th
at
b
o
th
th
e
in
ter
v
en
tio
n
a
n
d
c
o
n
tr
o
l
g
r
o
u
p
s
h
av
e
a
r
elativ
ely
s
im
ilar
av
er
ag
e
ag
e
,
with
a
m
ajo
r
ity
b
ein
g
f
em
al
e.
Mo
v
in
g
to
T
a
b
le
2
,
it
elu
cid
ates
th
at
th
e
in
ter
v
en
tio
n
g
r
o
u
p
,
co
n
ce
r
n
in
g
p
r
ac
tical
n
u
r
s
in
g
c
o
m
p
eten
c
y
b
ased
o
n
eth
ics,
law,
an
d
c
u
ltu
r
al
s
en
s
itiv
ity
,
ex
h
ib
ited
a
h
ig
h
ca
teg
o
r
y
o
f
7
2
.
7
%
b
e
f
o
r
e
r
ec
eiv
in
g
th
e
c
ar
in
g
-
b
ased
ch
ar
ac
ter
lear
n
in
g
in
ter
v
en
tio
n
.
Af
ter
th
e
in
ter
v
en
tio
n
,
th
e
r
e
was
a
n
o
tab
le
in
cr
ea
s
e
to
9
0
.
9
%.
C
o
n
v
er
s
ely
,
th
e
co
n
tr
o
l
g
r
o
u
p
s
h
o
wed
a
d
ec
r
ea
s
e
in
th
e
h
ig
h
c
ateg
o
r
y
f
r
o
m
8
7
.
9
%
to
8
4
.
8
%.
T
ab
le
3
f
u
r
th
er
ex
p
o
u
n
d
s
th
at
th
e
i
n
ter
v
en
tio
n
g
r
o
u
p
d
e
m
o
n
s
tr
ated
a
s
ig
n
if
ican
t
d
if
f
er
en
ce
in
p
r
ac
tical
n
u
r
s
in
g
c
o
m
p
eten
c
y
b
ased
o
n
eth
ics,
law,
an
d
cu
lt
u
r
al
s
en
s
itiv
ity
b
ef
o
r
e
a
n
d
af
t
er
th
e
ca
r
in
g
-
b
ased
ch
ar
ac
ter
lear
n
in
g
in
ter
v
en
tio
n
,
with
a
p
-
v
alu
e
o
f
0
.
0
0
0
(
p
<0
.
0
5
)
.
I
n
c
o
n
tr
ast,
th
e
c
o
n
tr
o
l
g
r
o
u
p
s
h
o
wed
n
o
s
ig
n
if
ican
t
d
if
f
e
r
en
ce
(
p
-
v
al
u
e=
0
.
0
6
5
;
p
>0
.
0
5
)
.
T
h
er
e
wer
e
o
v
e
r
all
d
if
f
e
r
en
ce
s
in
p
r
ac
tical
n
u
r
s
in
g
co
m
p
eten
cy
b
etwe
en
th
e
i
n
ter
v
en
tio
n
a
n
d
co
n
tr
o
l g
r
o
u
p
s
(
p
=0
.
0
2
3
;
p
<0
.
0
5
)
.
Mo
r
eo
v
er
,
wh
en
c
o
n
s
id
er
in
g
co
m
p
ete
n
cy
s
u
b
-
v
ar
iab
les
,
th
e
in
ter
v
e
n
tio
n
g
r
o
u
p
d
i
s
p
lay
ed
a
s
ig
n
if
ican
t
d
if
f
er
e
n
ce
in
et
h
ical
n
u
r
s
in
g
c
o
m
p
eten
c
y
(
p
=
0
.
0
0
1
;
p
<0
.
0
5
)
,
r
u
le
-
b
ased
n
u
r
s
in
g
co
m
p
eten
ce
(
p
=0
.
0
0
0
;
p
<
0
.
0
5
)
,
an
d
cu
ltu
r
ally
s
en
s
itiv
e
n
u
r
s
in
g
co
m
p
eten
cy
(
p
=
0
.
0
0
0
;
p
<0
.
0
5
)
b
e
f
o
r
e
an
d
af
ter
th
e
ca
r
in
g
-
b
ased
ch
ar
ac
ter
lear
n
i
n
g
in
ter
v
en
tio
n
.
C
o
n
v
er
s
ely
,
th
e
co
n
tr
o
l
g
r
o
u
p
d
i
d
n
o
t
s
h
o
w
a
s
ig
n
if
ican
t
d
if
f
er
en
ce
f
o
r
a
n
y
o
f
th
e
s
u
b
-
v
ar
iab
les.
I
n
s
u
m
m
a
r
y
,
th
er
e
wer
e
d
if
f
er
en
ce
s
in
all
co
m
p
e
ten
cy
s
u
b
-
v
a
r
iab
les
b
etwe
en
th
e
in
ter
v
e
n
tio
n
a
n
d
c
o
n
tr
o
l g
r
o
u
p
s
.
T
ab
le
1
.
Dem
o
g
r
ap
h
ic
ch
ar
ac
t
er
is
tics
o
f
p
h
ase
3
r
esear
ch
r
esp
o
n
d
e
n
ts
(
n
=6
6
)
No
C
h
a
r
a
c
t
e
r
i
s
t
i
c
s
I
n
t
e
r
v
e
n
t
i
o
n
(
n
=
3
3
)
Co
n
t
r
o
l
(
n
=
3
3
)
F
r
e
q
u
e
n
c
y
(
f
)
P
e
r
c
e
n
t
a
g
e
(
%)
F
r
e
q
u
e
n
c
y
(
f
)
P
e
r
c
e
n
t
a
g
e
(
%)
1
A
g
e
m
e
a
n
22
.
7
22
.
5
2
G
e
n
d
e
r
M
a
n
4
1
2
.
1
7
2
1
.
2
W
o
ma
n
29
8
7
.
9
26
7
8
.
8
T
ab
le
2
.
Descr
ip
tio
n
o
f
n
u
r
s
in
g
co
m
p
ete
n
cy
ca
teg
o
r
ies f
o
r
t
h
e
in
ter
v
en
tio
n
an
d
co
n
t
r
o
l
g
r
o
u
p
s
b
ef
o
r
e
an
d
af
ter
th
e
ca
r
in
g
-
b
ased
c
h
ar
ac
te
r
lear
n
in
g
in
ter
v
en
tio
n
V
a
r
i
a
b
l
e
/
s
u
b
v
a
r
i
a
b
l
e
G
r
o
u
p
Pre
-
t
e
st
P
o
st
-
t
e
st
C
a
t
e
g
o
r
y
F
r
e
q
u
e
n
c
y
(
f
)
P
e
r
c
e
n
t
a
g
e
(
%)
C
a
t
e
g
o
r
y
F
r
e
q
u
e
n
c
y
(
f
)
P
e
r
c
e
n
t
a
g
e
(
%)
P
r
a
c
t
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c
e
s
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r
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t
h
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c
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l
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s
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t
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v
e
I
n
t
e
r
v
e
n
t
i
o
n
Lo
w
0
0
Lo
w
0
0
M
o
d
e
r
a
t
e
9
2
7
.
3
M
o
d
e
r
a
t
e
3
9
.
1
H
i
g
h
24
7
2
.
7
H
i
g
h
30
9
0
.
9
C
o
n
t
r
o
l
Lo
w
0
0
Lo
w
0
0
M
o
d
e
r
a
t
e
4
1
2
.
1
M
o
d
e
r
a
t
e
5
1
5
.
2
H
i
g
h
29
8
7
.
9
H
i
g
h
28
8
4
.
8
T
ab
le
3
.
R
esu
lts
o
f
d
if
f
e
r
en
t v
ar
iab
le
test
s
b
ef
o
r
e
an
d
af
ter
t
h
e
ca
r
in
g
-
b
ased
ch
a
r
ac
ter
lear
n
in
g
in
ter
v
en
tio
n
f
o
r
th
e
i
n
ter
v
en
tio
n
an
d
co
n
tr
o
l g
r
o
u
p
s
V
a
r
i
a
b
l
e
/
s
u
b
v
a
r
i
a
b
l
e
G
r
o
u
p
M
a
n
n
-
W
h
i
t
n
e
y
t
e
st
W
i
l
c
o
x
o
n
t
e
s
t
Pre
-
t
e
st
P
o
st
-
t
e
st
M
e
a
n
SD
S
i
g
M
e
a
n
SD
S
i
g
Z
S
i
g
P
r
a
c
t
i
c
e
s
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r
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t
h
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c
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6
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5
Et
h
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c
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I
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1
3
.
6
4
1
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9
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0
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9
3
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1
4
.
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,
6
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C
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2
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1
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6
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1
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7
0
4
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0
8
8
R
u
l
e
s
-
b
a
se
d
I
n
t
e
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v
e
n
t
i
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n
2
3
,
2
4
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0
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4
.
2
4
2
,
6
8
1
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0
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3
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7
8
7
0
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C
o
n
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r
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l
2
3
.
7
9
2
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2
2
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3
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,
7
2
2
0
.
0
8
5
C
u
l
t
u
r
a
l
l
y
s
e
n
s
i
t
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v
e
I
n
t
e
r
v
e
n
t
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o
n
2
3
.
7
3
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9
8
0
0
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0
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1
2
6
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3
6
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8
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6
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6
4
-
1
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6
5
1
0
.
0
9
9
3
.
1
.
Dis
cus
s
io
n
3
.
1
.
1
.
Ca
ring
-
ba
s
ed
cha
ra
ct
e
r
lea
rning
m
o
du
le
C
h
ar
ac
ter
lear
n
in
g
is
ess
en
tially
ch
ar
ac
ter
d
e
v
elo
p
m
e
n
t,
s
er
v
in
g
as
th
e
co
r
n
er
s
to
n
e
i
n
s
h
ap
in
g
s
tu
d
en
ts
'
p
o
s
itiv
e
ch
ar
ac
ter
tr
a
its
an
d
lay
in
g
th
e
g
r
o
u
n
d
wo
r
k
f
o
r
a
r
esil
ien
t
p
er
s
o
n
ality
.
I
t
i
s
a
g
r
ad
u
al
p
r
o
ce
s
s
th
at
n
ec
ess
itate
s
tim
e
f
o
r
in
t
er
n
aliza
tio
n
,
as
it
in
v
o
lv
es
th
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tr
an
s
m
is
s
io
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o
f
v
alu
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d
th
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ltiv
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itiv
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tin
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m
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f
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tin
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o
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co
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m
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g
p
r
o
ce
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s
,
an
d
its
im
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f
ec
tiv
en
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ec
o
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ch
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r
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te
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lear
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in
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,
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tu
d
en
ts
n
o
t
o
n
l
y
ac
q
u
ir
e
k
n
o
wled
g
e
Evaluation Warning : The document was created with Spire.PDF for Python.
I
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Hea
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N:
2252
-
8
8
0
6
Th
e
in
flu
en
ce
o
f c
a
r
in
g
-
b
a
s
ed
ch
a
r
a
cter le
a
r
n
in
g
in
terven
tio
n
s
o
n
th
e
p
r
a
ctica
l
…
(
B
h
a
kti
P
erma
n
a
)
395
ab
o
u
t
th
e
m
ain
ch
a
r
ac
ter
is
tics
o
f
n
u
r
s
es
b
u
t
also
d
ev
elo
p
a
s
en
s
e
o
f
th
ese
q
u
alities
an
d
,
u
ltima
tely
,
cu
ltiv
ate
th
e
d
eter
m
in
atio
n
to
em
b
o
d
y
p
o
s
itiv
e
h
ab
its
in
t
h
eir
d
aily
p
r
ac
tice
[
3
8
]
.
C
h
ar
ac
ter
lear
n
in
g
aim
s
to
estab
lis
h
a
s
y
s
tem
atic
ap
p
r
o
ac
h
f
o
r
im
p
ar
tin
g
ch
ar
ac
ter
v
alu
es
to
s
tu
d
en
ts
,
e
n
co
m
p
ass
in
g
co
m
p
o
n
e
n
ts
s
u
ch
as
k
n
o
wled
g
e,
awa
r
en
ess
,
will,
an
d
ac
tio
n
to
im
p
lem
en
t
th
ese
v
alu
es.
T
h
ese
v
alu
es
ex
ten
d
to
war
d
s
o
n
e'
s
r
elatio
n
s
h
ip
with
Go
d
Alm
ig
h
ty
,
s
elf
,
as
well
as
r
e
s
p
ec
t
an
d
co
u
r
tesy
to
war
d
s
o
th
er
s
.
E
d
u
ca
to
r
s
an
d
lectu
r
er
s
n
ee
d
to
ex
h
ib
it
p
atie
n
ce
,
h
eig
h
ten
ed
awa
r
en
ess
,
an
d
a
d
ee
p
er
u
n
d
er
s
tan
d
in
g
,
r
ec
o
g
n
i
zin
g
th
at
ch
ar
ac
ter
ed
u
ca
tio
n
is
a
g
r
ad
u
al
p
r
o
c
ess
th
at
r
eq
u
i
r
es
tim
e
f
o
r
t
h
e
in
ter
n
aliza
tio
n
o
f
p
o
s
itiv
e
v
alu
es
i
n
to
o
n
e'
s
p
er
s
o
n
ality
tr
aits
.
T
o
f
ac
ilit
ate
th
e
im
p
lem
en
tatio
n
o
f
ch
ar
ac
ter
ed
u
ca
tio
n
,
a
m
o
r
e
o
p
er
a
tio
n
al
g
u
id
e,
in
t
h
e
f
o
r
m
o
f
m
o
d
u
les,
p
r
o
v
es
es
s
en
tial.
T
h
ese
m
o
d
u
les
s
er
v
e
as
s
tr
u
ctu
r
ed
to
o
ls
to
g
u
i
d
e
an
d
s
u
p
p
o
r
t
t
h
e
in
co
r
p
o
r
atio
n
o
f
ch
a
r
ac
ter
v
al
u
es in
to
th
e
ed
u
ca
tio
n
al
p
r
o
ce
s
s
.
T
r
ain
in
g
m
o
d
u
les
s
er
v
e
as
c
o
m
p
r
eh
e
n
s
iv
e
g
u
id
es
f
o
r
c
o
n
d
u
ctin
g
tr
ain
in
g
o
r
lear
n
i
n
g
ac
tiv
ities
.
W
ith
in
th
ese
m
o
d
u
les,
th
er
e
is
an
i
n
clu
s
io
n
o
f
class
-
b
ased
ch
ar
ac
ter
ed
u
ca
tio
n
,
s
ch
o
o
l
cu
ltu
r
e
-
b
ased
c
h
ar
ac
ter
ed
u
ca
tio
n
,
an
d
co
m
m
u
n
ity
-
b
ased
ch
ar
ac
ter
ed
u
ca
tio
n
.
T
h
is
m
u
lti
-
f
ac
eted
ap
p
r
o
ac
h
e
n
s
u
r
es
th
at
ch
ar
ac
ter
ed
u
ca
tio
n
is
in
teg
r
ated
in
to
v
ar
io
u
s
asp
ec
ts
o
f
th
e
lea
r
n
in
g
en
v
ir
o
n
m
en
t,
e
n
co
m
p
ass
in
g
th
e
class
r
o
o
m
,
th
e
b
r
o
ad
e
r
s
ch
o
o
l
cu
ltu
r
e
,
an
d
c
o
n
n
ec
tio
n
s
with
t
h
e
co
m
m
u
n
ity
.
T
h
e
m
o
d
u
les
p
r
o
v
id
e
a
s
tr
u
ct
u
r
ed
f
r
am
ewo
r
k
to
im
p
lem
en
t
ch
ar
ac
ter
ed
u
ca
tio
n
ef
f
ec
tiv
ely
ac
r
o
s
s
d
if
f
er
e
n
t
s
ettin
g
s
an
d
lev
els
with
in
th
e
ed
u
ca
tio
n
al
s
y
s
tem
[
3
9
]
.
T
r
ain
in
g
o
r
lear
n
in
g
m
o
d
u
les
p
lay
a
cr
u
cial
r
o
le
in
en
h
an
cin
g
lectu
r
er
co
m
p
ete
n
ce
,
p
ar
ticu
lar
ly
in
ter
m
s
o
f
p
r
o
f
ess
io
n
al
co
m
p
eten
ce
.
W
h
en
it
co
m
es
to
f
o
s
ter
in
g
s
tu
d
en
t
ch
a
r
ac
ter
d
e
v
elo
p
m
e
n
t,
lectu
r
er
s
ar
e
task
ed
with
cr
ea
tin
g
m
o
d
u
les
th
at
s
er
v
e
as
v
alu
ab
le
to
o
ls
to
f
ac
ilit
ate
lear
n
in
g
,
g
u
id
e
th
e
im
p
lem
en
tatio
n
o
f
ed
u
ca
tio
n
al
a
ctiv
ities
,
an
d
a
s
s
is
t
s
tu
d
en
ts
in
c
o
m
p
r
e
h
en
d
in
g
t
h
e
m
ater
ial
ef
f
ec
tiv
el
y
.
T
h
ese
m
o
d
u
les
co
n
tr
ib
u
te
to
th
e
o
v
er
all
ef
f
e
ctiv
en
ess
o
f
th
e
ed
u
ca
tio
n
al
p
r
o
ce
s
s
b
y
p
r
o
v
i
d
in
g
a
s
tr
u
ct
u
r
ed
an
d
o
r
g
an
ized
ap
p
r
o
ac
h
to
teac
h
in
g
,
u
ltima
tely
s
u
p
p
o
r
tin
g
b
o
th
th
e
lectu
r
er
'
s
co
m
p
eten
ce
an
d
th
e
s
tu
d
en
ts
'
u
n
d
er
s
tan
d
in
g
an
d
in
ter
n
aliza
tio
n
o
f
th
e
s
u
b
j
ec
t
m
atter
[
4
0
]
.
C
h
ar
ac
ter
e
d
u
ca
tio
n
m
o
d
u
les
p
lay
a
p
iv
o
tal
r
o
le
in
e
n
h
an
ci
n
g
th
e
ef
f
ec
tiv
en
ess
o
f
lear
n
in
g
o
u
tco
m
es
ac
r
o
s
s
af
f
ec
tiv
e,
co
g
n
itiv
e,
an
d
p
s
y
c
h
o
m
o
to
r
asp
ec
ts
.
T
h
ese
m
o
d
u
les
co
n
tr
ib
u
te
to
im
p
r
o
v
e
m
en
ts
in
th
e
af
f
ec
tiv
e
d
o
m
ain
,
r
ef
le
ctin
g
p
o
s
itiv
e
ch
ar
ac
ter
attitu
d
es
o
b
s
er
v
ab
le
in
s
tu
d
en
ts
'
ac
tio
n
s
an
d
attitu
d
es
d
u
r
in
g
th
e
lear
n
i
n
g
p
r
o
ce
s
s
.
Ad
d
itio
n
ally
,
th
e
co
g
n
itiv
e
asp
ec
t
is
p
o
s
itiv
ely
in
f
lu
en
ce
d
,
ev
id
e
n
ce
d
b
y
s
tu
d
en
ts
'
r
esp
o
n
s
es
to
lectu
r
er
s
'
q
u
esti
o
n
s
an
d
th
eir
in
q
u
is
itiv
e
attitu
d
e
to
war
d
s
th
e
d
is
cu
s
s
ed
m
ater
ial.
T
h
e
p
s
y
ch
o
m
o
to
r
as
p
ec
t,
wh
ic
h
ev
alu
at
es
s
tu
d
en
ts
'
p
r
ac
tical
p
r
ac
tices
an
d
s
k
ills
,
is
also
p
o
s
itiv
ely
im
p
ac
ted
b
y
th
e
im
p
lem
en
tatio
n
o
f
ch
a
r
ac
ter
ed
u
ca
tio
n
m
o
d
u
les.
I
n
ess
en
ce
,
th
ese
m
o
d
u
les
co
n
tr
ib
u
te
to
a
m
o
r
e
h
o
lis
tic
an
d
co
m
p
r
eh
e
n
s
iv
e
d
ev
elo
p
m
en
t
o
f
s
tu
d
e
n
ts
ac
r
o
s
s
v
ar
i
o
u
s
d
im
en
s
io
n
s
o
f
lear
n
in
g
[
4
1
]
.
Ad
d
itio
n
al
r
esear
c
h
d
e
m
o
n
s
tr
ates
th
at
th
e
ca
r
in
g
m
o
d
el
(
T
C
M)
m
o
d
u
le
h
as
th
e
ca
p
ac
ity
to
e
n
h
an
ce
ca
r
in
g
b
eh
a
v
io
r
am
o
n
g
n
u
r
s
e
s
,
in
cr
ea
s
e
s
er
v
i
ce
s
atis
f
ac
tio
n
,
an
d
p
o
s
itiv
ely
im
p
ac
t
b
o
t
h
th
e
af
f
ec
tiv
e
an
d
tech
n
ical
asp
ec
ts
o
f
n
u
r
s
in
g
ca
r
e
in
ter
v
en
tio
n
s
[
3
8
]
.
Mo
r
eo
v
er
,
th
e
r
e
is
f
u
r
th
e
r
co
n
f
ir
m
atio
n
f
r
o
m
o
th
e
r
s
tu
d
ies
th
at
lear
n
in
g
th
r
o
u
g
h
a
m
o
d
u
le
is
an
ef
f
ec
tiv
e
m
ea
n
s
to
im
p
r
o
v
e
ca
r
in
g
b
eh
a
v
io
r
.
T
h
e
m
o
d
u
le
s
er
v
es
as
a
v
alu
ab
le
g
u
id
e,
d
ir
ec
tin
g
s
tu
d
en
ts
in
th
eir
s
tu
d
ies
an
d
ev
alu
atio
n
s
,
th
er
eb
y
c
o
n
tr
ib
u
tin
g
to
th
e
en
h
an
ce
m
e
n
t
o
f
th
eir
s
k
ills
an
d
attitu
d
es
in
th
e
f
ield
o
f
n
u
r
s
in
g
[
4
2
]
.
An
ad
d
itio
n
al
p
er
s
p
ec
tiv
e
h
ig
h
lig
h
ts
th
at
th
e
h
u
m
an
ca
r
in
g
m
o
d
u
le
h
as
b
o
th
p
er
s
o
n
al
an
d
p
r
o
f
ess
io
n
al
im
p
ac
ts
o
n
s
tu
d
en
ts
wh
o
en
g
ag
e
with
it.
I
n
th
e
k
n
o
wled
g
e
s
tag
e,
s
tu
d
e
n
ts
co
n
ce
n
tr
ate
o
n
u
n
d
er
s
tan
d
in
g
"
wh
at
to
d
o
"
an
d
"
h
o
w
to
d
o
"
ca
r
in
g
in
p
r
ac
tical
s
itu
atio
n
s
.
Fo
llo
win
g
th
e
co
m
p
letio
n
o
f
th
e
m
o
d
u
le,
s
tu
d
en
ts
r
ep
o
r
ted
ad
o
p
tin
g
a
m
o
r
e
h
o
lis
tic
ap
p
r
o
ac
h
to
s
er
v
ice
d
eliv
er
y
.
T
h
e
y
ac
tiv
el
y
s
o
u
g
h
t
to
u
n
d
e
r
s
tan
d
p
atien
t
s
o
n
a
d
ee
p
er
lev
el
to
b
etter
m
ee
t
th
eir
n
ee
d
s
an
d
d
em
o
n
s
tr
ated
im
p
r
o
v
em
e
n
ts
in
th
eir
o
v
er
all
ca
r
in
g
p
r
ac
tic
es.
T
h
is
s
u
g
g
ests
th
at
th
e
h
u
m
an
ca
r
in
g
m
o
d
u
le
co
n
tr
ib
u
tes
to
a
tr
an
s
f
o
r
m
ativ
e
lear
n
in
g
ex
p
e
r
ien
ce
,
in
f
lu
en
ci
n
g
s
tu
d
en
ts
'
ap
p
r
o
ac
h
es
to
p
atien
t
ca
r
e
in
a
m
o
r
e
co
m
p
r
eh
e
n
s
iv
e
an
d
em
p
ath
etic
m
an
n
e
r
[
4
3
]
.
Sev
er
al
s
tu
d
ie
s
h
ig
h
lig
h
t
t
h
e
ef
f
ec
tiv
en
ess
o
f
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in
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m
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les
in
th
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p
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p
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th
at
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co
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tr
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to
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ch
ar
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ed
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ca
tio
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m
o
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e
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tiv
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f
o
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b
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t
h
lectu
r
er
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an
d
s
tu
d
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ts
.
T
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tili
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tio
n
o
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m
o
d
u
les
f
ac
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ates
th
e
ac
h
iev
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e
n
t
o
f
af
f
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tiv
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co
g
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itiv
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an
d
p
s
y
ch
o
m
o
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o
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asp
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ts
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s
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co
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p
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r
o
u
n
d
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c
h
ar
ac
ter
lear
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in
g
ex
p
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ien
ce
.
T
h
is
u
n
d
er
s
co
r
es
t
h
e
im
p
o
r
tan
ce
o
f
s
tr
u
ctu
r
ed
an
d
o
r
g
an
ized
lear
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in
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m
ate
r
ials
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s
u
ch
as
m
o
d
u
l
es,
in
en
h
a
n
cin
g
th
e
o
v
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all
ef
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tiv
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n
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o
f
ch
ar
ac
ter
ed
u
ca
tio
n
with
in
th
e
ed
u
ca
tio
n
al
s
ettin
g
.
3
.
1
.
2
.
P
ra
ct
ic
a
l c
o
m
pet
ency
ba
s
ed
o
n e
t
hics
E
n
g
ag
in
g
in
ch
a
r
ac
ter
ed
u
ca
tio
n
h
as
th
e
p
o
ten
tial
to
en
h
an
ce
p
r
o
f
icien
c
y
in
eth
ical
p
r
in
cip
les.
Acc
o
r
d
in
g
to
An
d
e
r
s
s
o
n
[
4
4
]
,
eth
ical
co
m
p
eten
ce
en
co
m
p
a
s
s
e
s
th
e
ca
p
ac
ity
to
r
ec
o
g
n
ize
eth
ical
d
ilem
m
as,
p
o
s
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ess
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n
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e
r
eg
ar
d
in
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th
e
eth
ical
an
d
m
o
r
al
d
im
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n
s
io
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s
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f
s
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v
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en
g
ag
e
in
r
ef
lectiv
e
p
r
ac
tices
co
n
ce
r
n
in
g
o
n
e'
s
k
n
o
wled
g
e
a
n
d
ac
tio
n
s
,
an
d
d
em
o
n
s
tr
ate
th
e
ab
ilit
y
to
m
ak
e
i
n
f
o
r
m
ed
a
n
d
p
r
u
d
en
t
c
h
o
ices
w
h
ile
ef
f
ec
tiv
ely
m
an
ag
i
n
g
e
th
ically
ch
allen
g
in
g
wo
r
k
s
ce
n
ar
io
s
.
T
h
is
et
h
ical
co
m
p
et
en
cy
is
cr
u
cial
f
o
r
r
esp
ec
tin
g
p
atien
t
r
ig
h
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an
d
elev
atin
g
th
e
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v
er
all
q
u
alit
y
o
f
s
er
v
ices.
E
th
ical
co
m
p
eten
ce
s
tan
d
s
as
a
f
o
u
n
d
atio
n
al
ca
p
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y
f
o
r
n
u
r
s
es
in
d
eliv
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in
g
h
ea
lt
h
s
er
v
ices,
en
ab
lin
g
t
h
em
to
id
en
tify
eth
ical
co
n
s
id
er
atio
n
s
in
d
ec
is
io
n
-
m
a
k
in
g
an
d
ar
r
i
v
e
at
o
p
tim
al
s
o
lu
tio
n
s
f
o
r
p
atien
ts
[
4
5
]
.
Evaluation Warning : The document was created with Spire.PDF for Python.
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Yo
s
h
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k
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Kan
ek
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[
4
6
]
em
p
h
asized
th
at
en
h
an
cin
g
p
r
o
f
icien
c
y
in
eth
ical
co
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ten
cies
is
ess
en
tial,
as
it
d
ir
ec
tly
co
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tr
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tes
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th
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ical
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tan
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th
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tati
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y
with
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r
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.
E
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co
m
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eten
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s
er
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af
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ar
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p
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ity
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o
ld
o
b
jectiv
ity
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n
d
d
em
o
n
s
tr
ate
th
e
n
u
r
s
e'
s
co
m
m
itm
en
t.
T
h
is
co
m
p
eten
cy
f
ac
ilit
ates
s
en
s
itiv
ity
in
estab
lis
h
in
g
tr
u
s
tin
g
r
elatio
n
s
h
ip
s
,
en
co
u
r
ag
es
o
b
jectiv
e
an
d
f
lex
ib
le
ac
tio
n
s
,
p
r
o
m
o
tes
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r
ef
l
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tiv
e
d
ec
is
io
n
-
m
ak
in
g
p
r
o
ce
s
s
,
an
d
en
s
u
r
e
s
th
e
p
r
eser
v
atio
n
o
f
co
n
f
id
en
tiality
an
d
h
o
n
esty
[
4
5
]
.
L
ea
r
n
in
g
eth
ics
in
n
u
r
s
in
g
is
im
p
er
ativ
e
as
it
eq
u
ip
s
s
tu
d
en
ts
f
o
r
clin
ical
p
r
ac
tice.
T
h
e
ed
u
ca
tio
n
u
n
d
e
r
tak
en
b
y
n
u
r
s
es
an
d
n
u
r
s
in
g
s
tu
d
en
ts
in
d
eliv
e
r
in
g
n
u
r
s
in
g
s
er
v
ices
ex
ten
d
s
b
ey
o
n
d
m
e
r
e
k
n
o
wled
g
e
an
d
s
k
ills
o
r
ad
h
er
en
ce
t
o
g
u
id
elin
es.
I
t
also
in
v
o
lv
es
th
e
in
co
r
p
o
r
atio
n
o
f
p
er
s
o
n
al
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alu
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b
elief
s
,
an
d
eth
ical
o
r
i
en
tatio
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in
to
th
eir
p
r
ac
tice.
T
h
is
co
m
p
r
eh
en
s
iv
e
ap
p
r
o
ac
h
en
s
u
r
es
th
at
eth
ical
co
n
s
id
er
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s
ar
e
an
in
teg
r
a
l
p
ar
t
o
f
th
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n
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r
s
in
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p
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in
f
lu
e
n
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d
ec
is
io
n
-
m
ak
in
g
an
d
ac
tio
n
s
in
p
atien
t
c
ar
e
[
4
7
]
.
T
h
is
u
n
d
er
s
co
r
es
th
e
s
ig
n
if
ican
ce
o
f
ac
q
u
ir
in
g
eth
ical
co
m
p
eten
ce
t
h
r
o
u
g
h
th
e
lear
n
in
g
o
f
v
alu
es
an
d
ch
a
r
ac
ter
.
E
n
h
a
n
cin
g
eth
ical
co
m
p
eten
ce
r
eq
u
ir
es
d
elib
er
ate
p
lan
n
in
g
an
d
im
p
lem
en
tatio
n
,
in
v
o
lv
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g
th
e
cr
ea
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o
f
co
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u
civ
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n
g
co
n
d
itio
n
s
,
th
e
d
esig
n
o
f
ef
f
ec
tiv
e
lear
n
in
g
s
tr
ateg
ies,
an
d
in
ter
ac
tiv
e
en
g
a
g
em
en
t
with
o
th
er
s
.
T
h
e
ap
p
licatio
n
o
f
m
o
d
u
le
in
te
r
v
en
tio
n
s
is
en
ac
ted
b
y
estab
lis
h
in
g
f
av
o
r
a
b
le
lear
n
in
g
co
n
d
itio
n
s
,
wh
ich
in
clu
d
e
th
e
id
en
tific
atio
n
an
d
ex
p
lo
r
atio
n
o
f
eth
ical
is
s
u
es
with
in
r
ea
l
-
wo
r
ld
p
r
ac
tice
s
itu
atio
n
s
[
4
7
]
.
R
ef
lectio
n
o
n
n
u
r
s
in
g
et
h
ical
v
alu
es
is
co
n
d
u
cted
b
o
t
h
in
th
e
class
r
o
o
m
an
d
d
u
r
in
g
clin
ical
p
r
ac
tice,
allo
win
g
s
tu
d
en
ts
to
cu
ltiv
ate
eth
ical
awa
r
en
ess
in
s
er
v
ice
an
d
en
h
an
ce
th
eir
s
k
ills
in
eth
ical
d
ilem
m
a
d
ec
is
io
n
-
m
ak
in
g
.
E
th
ical
co
m
p
eten
ce
is
attain
ed
th
r
o
u
g
h
a
co
m
b
in
atio
n
o
f
k
n
o
wled
g
e
an
d
p
r
a
ctica
l
ap
p
li
ca
tio
n
,
as
it
is
in
ter
twin
ed
wit
h
th
e
d
ev
elo
p
m
en
t
o
f
ch
a
r
ac
ter
s
tr
en
g
th
,
eth
ical
awa
r
en
ess
,
m
o
r
al
ju
d
g
m
en
t sk
ills
,
an
d
th
e
d
eter
m
in
atio
n
to
a
ct
eth
ically
[
4
5
]
.
3
.
1
.
3
.
P
ra
ct
ic
a
l c
o
m
pet
ency
ba
s
ed
o
n leg
a
l a
s
pect
s
Pro
f
icien
cy
in
leg
al
asp
ec
ts
is
im
p
er
ativ
e
f
o
r
n
u
r
s
es
an
d
n
u
r
s
in
g
s
tu
d
en
ts
,
g
i
v
en
th
e
s
u
b
s
tan
tial
in
f
lu
en
ce
o
f
n
u
r
s
in
g
s
er
v
ices
o
n
le
g
al
co
n
s
id
er
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n
s
.
L
e
g
al
p
r
o
tectio
n
f
o
r
h
ea
lth
wo
r
k
e
r
s
is
in
tr
icate
ly
tied
to
th
e
ad
eq
u
ac
y
o
f
au
th
o
r
ity
an
d
th
e
f
u
lf
illme
n
t
o
f
c
o
m
p
eten
ce
.
T
h
e
f
o
u
n
d
atio
n
s
f
o
r
leg
al
p
r
o
tectio
n
en
co
m
p
ass
th
e
h
ea
lth
law,
n
u
r
s
in
g
law,
g
o
v
er
n
m
en
t
r
eg
u
latio
n
s
o
n
h
ea
lth
wo
r
k
er
s
,
m
in
is
ter
o
f
h
ea
lth
r
eg
u
latio
n
s
o
n
licen
s
in
g
,
im
p
lem
en
tatio
n
o
f
n
u
r
s
in
g
p
r
ac
tice
,
an
d
s
tan
d
ar
d
o
p
er
atin
g
p
r
o
ce
d
u
r
es
(
SOP)
f
o
r
s
er
v
ices
[
4
8
]
.
Nu
r
s
es
ar
e
r
eq
u
ir
e
d
to
n
a
v
ig
a
te
v
ar
io
u
s
asp
ec
ts
with
in
th
e
leg
al
f
r
am
ewo
r
k
,
in
clu
d
in
g
p
ass
in
g
co
m
p
eten
cy
test
s
,
h
o
ld
in
g
a
r
eg
is
tr
atio
n
ce
r
tific
ate
,
an
d
o
b
tain
in
g
a
p
r
ac
tice
p
er
m
it
f
o
r
n
u
r
s
e
[
4
9
]
.
A
d
d
itio
n
ally
,
co
n
s
id
er
atio
n
s
s
u
ch
as
th
e
ty
p
e
o
f
s
er
v
ice,
p
r
ac
tice
au
th
o
r
ity
,
r
ig
h
ts
an
d
o
b
lig
atio
n
s
,
s
an
cti
o
n
s
,
an
d
ad
h
e
r
en
ce
to
ex
is
tin
g
r
eg
u
latio
n
s
ar
e
cr
u
cial
[
5
0
]
.
I
t
is
im
p
er
ativ
e
f
o
r
n
u
r
s
es
to
b
e
c
o
g
n
iza
n
t
o
f
le
g
al
r
esp
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n
s
ib
ilit
ies,
esp
ec
ially
co
n
ce
r
n
in
g
n
e
g
lig
en
ce
o
r
m
al
p
r
ac
tice,
to
p
r
e
v
en
t
p
o
te
n
tial
leg
al
r
ep
er
c
u
s
s
io
n
s
[
5
1
]
.
Hea
lth
wo
r
k
er
s
wh
o
f
u
lf
ill
th
eir
d
u
ties
with
in
th
e
b
o
u
n
d
s
o
f
th
eir
au
th
o
r
ity
an
d
d
em
o
n
s
tr
ate
co
m
p
eten
ce
ar
e
ty
p
ic
ally
r
eg
a
r
d
ed
as
i
n
n
o
ce
n
t,
lead
in
g
to
th
e
d
is
m
is
s
al
o
f
ch
ar
g
es
ag
ain
s
t
th
em
.
T
h
is
u
n
d
er
s
co
r
es
th
e
im
p
o
r
tan
ce
o
f
ad
h
er
in
g
to
p
r
o
f
ess
io
n
al
s
tan
d
ar
d
s
an
d
leg
al
r
eg
u
latio
n
s
in
th
e
h
ea
lth
ca
r
e
f
ield
to
e
n
s
u
r
e
t
h
e
p
r
o
p
er
an
d
lawf
u
l
ex
ec
u
tio
n
o
f
d
u
ties
[
4
8
]
.
N
u
r
s
in
g
s
tu
d
e
n
ts
m
u
s
t
g
r
asp
th
e
leg
al
d
i
m
en
s
io
n
s
o
f
clin
ical
p
r
ac
tice
as
th
ey
d
eliv
er
s
er
v
ices
in
h
o
s
p
itals
o
r
h
ea
lth
ce
n
te
r
s
.
Atten
tio
n
to
lear
n
in
g
le
g
al
asp
ec
ts
i
s
cr
u
cial,
an
d
ch
ar
ac
te
r
lear
n
in
g
im
p
ar
ts
v
alu
es r
elate
d
to
n
u
r
s
es'
r
esp
o
n
s
ib
ilit
ies in
n
u
r
s
in
g
s
er
v
ices.
C
h
ar
ac
ter
lear
n
in
g
en
h
a
n
ce
s
s
tu
d
en
ts
'
s
en
s
e
o
f
r
esp
o
n
s
ib
ilit
y
to
war
d
s
er
v
i
n
g
p
atien
ts
,
th
e
n
u
r
s
in
g
p
r
o
f
ess
io
n
,
an
d
th
em
s
elv
es.
Oy
etu
n
d
e
an
d
Of
i
[
5
1
]
,
ass
er
ts
th
at
m
aster
in
g
p
r
o
f
ess
io
n
al
ac
co
u
n
tab
ilit
y
in
n
u
r
s
in
g
is
ess
en
tial
f
o
r
m
ain
tain
in
g
h
ig
h
s
er
v
ice
s
tan
d
ar
d
s
an
d
p
r
ev
e
n
tin
g
h
ar
m
to
p
ati
en
ts
.
Un
d
er
s
tan
d
in
g
th
e
leg
al
asp
ec
t,
p
ar
ticu
lar
ly
in
ca
s
es
o
f
m
alp
r
ac
tice
an
d
n
eg
lig
en
ce
,
is
cr
u
cial,
as
th
ese
in
v
o
lv
e
wr
o
n
g
f
u
l
ac
ts
ca
u
s
in
g
u
n
i
n
ten
tio
n
al
o
r
in
te
n
tio
n
al
h
ar
m
.
Nu
r
s
es
well
-
v
er
s
ed
in
th
e
leg
al
asp
ec
ts
o
f
n
u
r
s
in
g
p
lay
a
k
e
y
r
o
le
in
u
p
h
o
ld
in
g
th
e
r
ig
h
ts
o
f
n
u
r
s
es,
p
atien
ts
/clien
ts
,
an
d
ad
h
er
e
n
ce
to
p
r
ac
tice
s
tan
d
a
r
d
s
.
3
.
1
.
4
.
P
ra
ct
ic
a
l c
o
m
pet
ency
ba
s
ed
o
n c
ultura
l se
ns
it
iv
it
y
Acc
o
r
d
in
g
t
o
Ma
r
k
e
y
an
d
Ok
an
tey
[
5
2
]
,
c
u
ltu
r
al
co
m
p
ete
n
cies
th
at
s
tu
d
en
ts
n
ee
d
to
a
cq
u
ir
e
f
o
r
im
p
lem
en
tin
g
n
u
r
s
in
g
ca
r
e
f
o
r
p
atien
ts
f
r
o
m
d
iv
e
r
s
e
cu
lt
u
r
es
in
clu
d
e
ca
r
in
g
,
c
o
m
p
as
s
io
n
,
co
m
m
itm
e
n
t,
ef
f
ec
tiv
e
in
ter
c
u
ltu
r
al
c
o
m
m
u
n
icatio
n
,
a
n
d
c
u
ltu
r
al
co
u
r
a
g
e
.
C
o
m
p
r
e
h
en
d
in
g
th
ese
v
alu
e
s
will
in
f
lu
en
ce
th
e
q
u
ality
o
f
s
er
v
ices
p
r
o
v
id
ed
b
y
q
u
alif
ied
n
u
r
s
es
an
d
s
tu
d
en
t
s
to
p
atien
ts
f
r
o
m
t
h
e
s
am
e
o
r
d
iv
er
s
e
cu
ltu
r
es,
as
well
as
th
e
im
p
ac
t
o
f
v
ar
io
u
s
cu
ltu
r
es
o
n
p
u
b
lic
h
ea
lth
.
I
t
is
cr
u
cial
to
i
n
co
r
p
o
r
ate
t
h
ese
v
a
lu
es
an
d
c
h
ar
ac
ter
s
in
to
n
u
r
s
in
g
lear
n
in
g
an
d
ed
u
ca
tio
n
.
I
n
th
is
r
esear
ch
,
c
h
a
r
ac
ter
lear
n
in
g
h
as
s
p
ec
if
ical
ly
in
s
tr
u
cted
th
ese
v
alu
es a
n
d
b
e
h
av
io
r
s
alig
n
ed
with
cu
ltu
r
al
co
m
p
ete
n
ce
[
5
3
]
.
Pro
v
id
in
g
n
u
r
s
in
g
ca
r
e
t
h
at
is
cu
ltu
r
ally
s
en
s
itiv
e
an
d
attu
n
ed
is
a
co
m
p
le
x
en
d
ea
v
o
r
,
e
m
p
h
asizin
g
th
e
n
ee
d
t
o
ad
eq
u
ately
p
r
ep
ar
e
n
u
r
s
in
g
g
r
ad
u
ates
th
r
o
u
g
h
a
co
m
p
r
eh
e
n
s
iv
e
n
u
r
s
in
g
cu
r
r
ic
u
lu
m
[
5
4
]
.
C
u
ltu
r
al
co
m
p
eten
cy
is
an
ess
en
tial
asp
ec
t
th
at
m
u
s
t
b
e
in
teg
r
ated
in
t
o
th
e
n
u
r
s
in
g
cu
r
r
icu
lu
m
[
5
3
]
.
C
o
m
p
eten
cies
th
at
o
f
f
er
o
p
p
o
r
tu
n
ities
to
ap
p
ly
t
h
eo
r
etica
l
p
r
in
cip
les
u
n
d
er
ly
i
n
g
ca
r
e
in
p
r
ac
tical
s
ettin
g
s
with
in
a
s
u
p
p
o
r
tiv
e
en
v
ir
o
n
m
en
t
ar
e
cr
u
cial
f
o
r
t
h
e
d
ev
elo
p
m
en
t
o
f
cu
ltu
r
al
co
m
p
eten
ce
.
T
h
e
n
u
r
s
in
g
c
u
r
r
ic
u
lu
m
is
ex
ec
u
te
d
as
Evaluation Warning : The document was created with Spire.PDF for Python.
I
n
t J
Pu
b
lic
Hea
lth
Sci
I
SS
N:
2252
-
8
8
0
6
Th
e
in
flu
en
ce
o
f c
a
r
in
g
-
b
a
s
ed
ch
a
r
a
cter le
a
r
n
in
g
in
terven
tio
n
s
o
n
th
e
p
r
a
ctica
l
…
(
B
h
a
kti
P
erma
n
a
)
397
ch
ar
ac
ter
lear
n
in
g
,
co
m
m
en
ci
n
g
with
a
s
elf
-
r
e
f
lectio
n
o
n
o
n
e'
s
ca
p
ab
ilit
ies
r
eg
ar
d
in
g
cu
ltu
r
al
co
m
p
eten
ce
.
T
h
is
alig
n
s
with
p
r
e
v
io
u
s
s
tu
d
y
th
at
e
m
p
h
asizin
g
th
e
im
p
o
r
tan
ce
o
f
n
u
r
s
es
h
av
in
g
p
er
s
o
n
al
awa
r
en
ess
.
T
h
is
awa
r
en
ess
in
clu
d
es
s
elf
-
p
er
ce
p
tio
n
o
f
th
eir
cu
ltu
r
al
co
m
p
eten
ce
lev
el
b
ased
o
n
ex
p
er
ien
ce
in
p
atien
t
ca
r
e,
id
en
tific
atio
n
o
f
lea
r
n
in
g
n
ee
d
s
r
elate
d
to
p
r
ac
tical
ex
p
e
r
ien
ce
an
d
ex
p
o
s
u
r
e
to
p
atien
ts
f
r
o
m
d
i
v
er
s
e
cu
ltu
r
es,
an
d
r
ec
o
g
n
itio
n
o
f
k
n
o
wled
g
e
g
ap
s
in
c
u
ltu
r
al
co
m
p
ete
n
cy
is
s
u
es
[
5
3
]
.
T
h
e
teac
h
in
g
an
d
lear
n
in
g
a
p
p
r
o
ac
h
p
r
o
m
o
te
s
tu
d
en
t
ex
p
lo
r
atio
n
o
f
h
o
w
et
h
n
icity
,
g
en
d
er
,
cla
s
s
,
s
ex
u
ality
,
an
d
ag
e
i
n
f
lu
en
ce
th
e
u
tili
za
tio
n
o
f
h
ea
lth
s
er
v
ices
in
s
o
ciety
.
I
n
n
u
r
s
in
g
ed
u
ca
tio
n
,
it
is
cr
u
cia
l
to
e
n
s
u
r
e
th
e
d
e
v
elo
p
m
e
n
t
a
n
d
p
er
p
etu
atio
n
o
f
cu
ltu
r
ally
co
m
p
ass
io
n
ate
ca
r
e
th
r
o
u
g
h
o
u
t
b
o
t
h
ed
u
ca
ti
o
n
al
an
d
clin
ical
p
r
ac
tice
ex
p
er
ie
n
ce
s
[
5
2
]
.
C
h
ar
ac
ter
lear
n
in
g
f
o
r
cu
ltu
r
al
co
m
p
ete
n
cy
is
ap
p
lied
in
in
te
r
ac
tio
n
s
with
p
atien
ts
an
d
th
e
co
m
m
u
n
ity
.
I
t
in
v
o
lv
es
en
h
an
cin
g
s
tu
d
en
ts
'
cu
ltu
r
al
k
n
o
wled
g
e
b
y
s
tu
d
y
in
g
th
e
p
atien
t'
s
cu
ltu
r
e,
u
n
d
e
r
s
tan
d
in
g
lan
g
u
ag
e
d
if
f
e
r
en
ce
s
,
f
am
iliar
izin
g
th
em
s
elv
es with
cu
ltu
r
al
b
eh
a
v
i
o
r
s
,
an
d
lear
n
in
g
th
e
p
atien
t'
s
lan
g
u
ag
e
ter
m
i
n
o
lo
g
y
[
5
4
]
.
4.
CO
NCLU
SI
O
N
T
h
e
im
p
lem
en
tatio
n
o
f
a
c
ar
i
n
g
-
b
ased
ch
a
r
ac
ter
lear
n
in
g
m
o
d
u
le
h
as
th
e
p
o
te
n
tial
to
en
h
an
ce
th
e
co
m
p
eten
cy
o
f
p
r
o
f
ess
io
n
al
n
u
r
s
in
g
s
tu
d
en
ts
,
p
ar
ticu
lar
ly
in
p
r
ac
tical
asp
ec
ts
r
elat
ed
to
eth
ics,
law,
an
d
cu
ltu
r
al
s
en
s
itiv
ity
.
T
h
i
s
m
o
d
u
le
f
o
cu
s
es
o
n
cu
ltiv
atin
g
q
u
alities
s
u
ch
as
s
i
n
ce
r
e
wo
r
k
,
em
p
ath
y
,
to
u
g
h
n
ess
,
cr
itical
th
in
k
in
g
,
an
d
r
esp
o
n
s
ib
ilit
y
to
b
o
ls
ter
s
tu
d
en
ts
'
co
m
p
eten
cy
ac
h
ie
v
em
en
ts
.
A
r
o
b
u
s
t
ch
ar
ac
ter
is
s
ee
n
as
a
f
ac
ilit
ato
r
f
o
r
s
tu
d
en
ts
to
attain
th
eir
co
m
p
eten
cies
ef
f
ec
tiv
ely
in
v
ar
io
u
s
lear
n
in
g
en
v
ir
o
n
m
en
ts
-
class
r
o
o
m
,
lab
o
r
ato
r
y
,
an
d
clin
ic.
As
p
a
r
t
o
f
n
u
r
s
in
g
ed
u
c
atio
n
,
i
n
ter
v
en
ti
o
n
s
lik
e
ch
a
r
ac
ter
lear
n
in
g
m
o
d
u
les ca
n
b
e
in
co
r
p
o
r
ated
in
t
o
th
e
cu
r
r
icu
lu
m
,
tr
ain
in
g
p
r
o
g
r
a
m
s
,
o
r
e
x
tr
ac
u
r
r
i
cu
lar
ac
tiv
ities
.
RE
F
E
R
E
NC
E
S
[
1
]
M
i
n
i
s
t
r
y
o
f
H
e
a
l
t
h
o
f
t
h
e
R
e
p
u
b
l
i
c
o
f
I
n
d
o
n
e
si
a
,
N
u
rs
e
p
ro
f
e
ss
i
o
n
a
l
s
t
a
n
d
a
r
d
s
,
(
i
n
I
n
d
o
n
e
s
i
a
n
)
,
1
st
e
d
.
J
a
k
a
r
t
a
:
K
e
me
n
t
e
r
i
a
n
K
e
s
e
h
a
t
a
n
R
I
,
2
0
2
0
.
[
2
]
L.
-
L.
H
s
u
a
n
d
S
.
-
I
.
H
si
e
h
,
“
D
e
v
e
l
o
p
me
n
t
a
n
d
p
s
y
c
h
o
me
t
r
i
c
e
v
a
l
u
a
t
i
o
n
o
f
t
h
e
c
o
mp
e
t
e
n
c
y
i
n
v
e
n
t
o
r
y
f
o
r
n
u
r
si
n
g
st
u
d
e
n
t
s
:
a
l
e
a
r
n
i
n
g
o
u
t
c
o
me
p
e
r
sp
e
c
t
i
v
e
,
”
N
u
rs
e
Ed
u
c
a
t
i
o
n
T
o
d
a
y
,
v
o
l
.
3
3
,
n
o
.
5
,
p
p
.
4
9
2
–
4
9
7
,
M
a
y
2
0
1
3
,
d
o
i
:
1
0
.
1
0
1
6
/
j
.
n
e
d
t
.
2
0
1
2
.
0
5
.
0
2
8
.
[
3
]
C
.
N
i
e
l
se
n
,
I
.
S
o
mm
e
r
,
K
.
L
a
r
se
n
,
a
n
d
I
.
T.
B
j
ø
r
k
,
“
M
o
d
e
l
o
f
p
r
a
c
t
i
c
a
l
s
k
i
l
l
p
e
r
f
o
r
ma
n
c
e
a
s
a
n
i
n
st
r
u
me
n
t
f
o
r
su
p
e
r
v
i
si
o
n
a
n
d
f
o
r
mat
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