Documentation and Reporting Notes with MCQs

Documentation, Reporting and Health Records: Notes, PDF, MCQs & Important Questions

Published On: October 21, 2026

Documentation and Reporting: There is a famous saying in nursing: “If it is not documented, it is not done.” A nurse may give excellent care, but if it is not written correctly, no one else knows about it, and it cannot protect the nurse in a legal case. In this chapter you will learn what records and reports are, why we keep them, how to write them correctly, the different methods and formats of charting, the legal guidelines, handover (SBAR), incident reports, and the basics of electronic records and nursing informatics.

Learning objectives: understand the purposes and principles of records and reports; know the types of client records and common record-keeping formats; explain the guidelines of documentation (recording and reporting); describe legal guidelines; and explain the methods and systems of documentation.

Meaning and Definitions of Documentation

Documentation is a way of communicating information about the patient (assessment, diagnosis, planning, implementation and evaluation of care and treatment) in written form.

Documentation is any written or electronically generated information related to the patient and his care and treatment. It is used for communication of observations, decisions, actions and outcomes. (Perry and Potter, 2010)
Nursing documentation refers to written or electronically generated client information obtained through the nursing process. (Association of Registered Nurses of Newfoundland and Labrador, 2010)

Purposes of Documentation

Purpose	Description
To facilitate communication	Nurses tell other nurses and care providers about the patient’s status, interventions done and results. Accurate documentation lowers the chance of miscommunication and errors.
To promote good nursing care	Encourages nurses to assess patient progress, find which interventions are effective, and record changes to the plan of care.
To promote nursing research	Documentation can improve the quality of nursing practice and patient care through research.
To meet professional and legal standards	It shows that the nurse used nursing knowledge, skills and judgement as per professional standards. Nursing documentation may be used as proof in lawsuits and disciplinary hearings.

Guidelines of Effective Documentation

Guideline	Meaning
Factual	Objective information about what the nurse sees, hears, feels, smells and thinks. Subjective data are documented in the client’s exact words.
Accurate	Use exact measurements.
Complete	Includes the patient’s response, communication with the family and entries on all assessment forms.
Timely	Document the date and time in each entry. Never record in advance.
Concise	Brief and complete.
Legible	Write clearly with a blue or black pen. If a mistake occurs, draw a line through it and write the correction above or next to it with your initials.

*How to correct an error in a record (single line, correct entry, initials)*

Confidentiality

It is the nurse’s responsibility to keep the patient’s records and information confidential. She should not discuss assessment, examination, diagnosis or treatment with any other person or health personnel who is not involved. Only members of the health team directly involved in the patient’s care should have access to records. The patient may ask for a copy of his medical records, as he has a right to be informed. Nurses are legally and ethically bound to protect patient information from any unauthorized person or source. A valid reason and permission are needed when records are used for data collection, education or research. All records are stored by the medical record department of the hospital.

Records and Reports

Record	Report
A permanent written communication that documents information relevant to a client’s health care management. It is a clinical, scientific, administrative and legal document about nursing care given to an individual, family or community.	An oral or written exchange of information shared between caregivers or workers. It is the summary of the services of a person or personnel and of the agency.

Purposes of records and reports

Purpose	Explanation
Communication	Between health team members about treatment, care, procedures done, needs and progress.
Planning patient care	Daily progress guides the team in planning care and treatment.
Quality improvement and audit	Reviewing records checks the standard and quality of care.
Research	Source of data for retrospective and prospective studies and for finding new nursing interventions.
Education	Used for case studies; helps students relate theory to practice.
Reimbursement	Source for receiving payment from government or insurance companies.
Legal documentation	A legal document that protects both patient and health care professional.
Quality of care	Helps identify the patient’s needs and goals and appraise the quality of care.
Decision analysis	Helps administration analyse decisions about client needs, finances, and overused and underused services.
Vital statistics	Useful to evaluate services given to the community.
Health service planning	Helps find the health problems people are suffering from.

Types of Client Records

Client records are documents containing all the information about the health history of the client from the time of admission till discharge.

A. Ward records

Record	Use
Patient clinical record	Includes inpatient as well as outpatient records.
Doctor’s prescription sheet	Doctor writes all the treatment to be started.
Lab investigation forms	Colour-coded slips sent with samples; reports are charted in these forms.
Consent form	Taking the patient’s consent for any therapeutic or diagnostic procedure.
Diet sheet	Prescription of the diet and daily dietary requirement.
Intake output chart	Records intake and output.
Reports of physiotherapy	Therapies like physiotherapy, occupational therapy or play therapy.
Instruction book	Special instructions related to the patient.
Census record	Total admissions, discharges, transfers in and out, absconding patients and deaths in the ward.
Admission and discharge book	Total admissions and discharges per day.
Call book	Earlier used to write the doctor’s name, date, time and purpose of a call for patient consultation.
Complaint book	Repairs needed, such as electricity or water supply.
Movement register	Movement of health care team members.
Indent book	Orders supplies from the stores: medicines, linen and other items.
Drug maintenance book	Supply and demand of drugs in the area.
Crash cart register	All drugs and equipment in the crash cart.
Death register	Number of patients who died in the ward.

B. Nursing records

Record	Use
Nursing assessment records	Data from history taking and physical examination.
Care plan	Outline of nursing care provided and interventions carried out.
Progress notes	Show the progress made and overall improvement.
Kardex	Series of cards in a portable index file or computer forms; information is quickly accessible to all health professionals.
Flow sheets	Record nursing data quickly and concisely, giving an easy view of the client’s condition over time.
Vital signs sheet	Temperature, pulse, respiration and blood pressure, shown graphically.
Medication record	Details of all medicines given.
Intake and output record	Measurement of fluid intake (oral, tube, IV) and output (urine, vomit, drain) per day.
Discharge and transfer summary	A note written by the nurse when the patient is discharged or transferred.

C. Educational records

Records used by nursing institutes: course plans, unit plans, master rotation and clinical rotations of students and staff, minutes of committee meetings, student health records and cumulative records, annual reports, affiliation records, written policies, budget proposals, brochures, and staff development programme details.

D. Administrative records

Records kept by top management: philosophy, policies, vision and mission, staff details and job descriptions, records of treatments, admissions, equipment losses and replacements, personnel performance and other administrative records.

Electronic Health Records (EHR) and Computerized Documentation

EHR: “a collection of various medical records that get generated during any clinical encounter or events.” (Vikaspedia, 2019). It includes all information in a traditional health record, plus the patient’s health profile, behavioural and environmental information.

Benefits of EHR

Easy availability and easy storage of patient records.
Fewer lost records and better record quality.
Improves accuracy and speed of diagnosis; easy transfer.
Tracks clinical progress and improves patient compliance.
Easy to update, used by many users, low-cost backup.
Improves health care decisions, gives evidence-based care and supports research.

Benefits to clinicians	Benefits to patients
Availability of information when and where needed; decision support; organization of information; easier preparation of reports; ease of order entry; no multiple entries of the same data.	Knowledge of who has access to their data; individualized treatment anywhere the computer-based record is available; ability to check their own record.

Categories of computerized documentation

Category	Features
Clinical systems	Data entry related to the client, data sorting and analysis by computer, communication among team members, and client safety.
Multinational infosys (management information systems)	Staff scheduling, finance, statistical and administration reports.
Education	Enable health education and passing of instructions.

Pros and cons

Pros	Cons
Focus on client outcomes; bedside terminals combine information from monitoring equipment; saves nurses’ time; links many sources of client information; fast sending and receiving of requests and results; legible; reinforces standards of care; standard terminology improves communication.	Client privacy may be violated if security measures are not used; breakdowns make information temporarily unavailable; the system is expensive; long training periods may be needed for a new or updated system.

How to ensure confidentiality of computerized documents

Always use your own ID password only and never leave the system unattended while logged in.
Log out immediately when work is finished.
Do not leave recording for the last moment; make the entry as the task is completed.
Follow all policies for the hospital information management system (HIMS) or nursing information management system (NIMS).
If you lose your ID password, report it at once to the authorities.

Principles and Guidelines for Documentation and Reporting

Principle	Description
Date and time	Write date and time every time an entry is made, in 24-hour or conventional form as per institutional policy.
Correct spelling	Correct spelling of the patient’s name, diagnosis and medicines.
Timing	Frequency of documentation depends on institution policy or the patient’s condition. Never write notes before giving the care.
Appropriateness	Record only information that pertains to health, diagnosis, medication, treatment and care. Irrelevant information must not be recorded because it may invade privacy.
Legal prudence	Records are legal documents. Accurate and complete documentation protects nurses and can be used as evidence in court.
Accuracy	Include client name, UHID or CR number, gender, diagnosis, and page numbers. Use standard abbreviations and measurements. Describe wounds objectively (size, shape, edges, healing type, discharge colour, smell, viscosity).
Comprehensive yet specific	Complete but not lengthy; in chronological order; brief phrases and accepted abbreviations; do not leave blank spaces between lines.
Legibility	Clear handwriting that is easy to read.
Organizing	Chronological order by date, time and sequence, ideally following the nursing process.
Sequence and timeliness	Document on time or as early as possible; record the time of medication, treatment, procedures and assessments.
Correction	Do not cut or erase an error. Draw a single line, write the correct entry and put your initials.
Omission	Do not omit anything; do not leave blank spaces between words.
Signature	Sign after every entry with your name and designation.
Confidentiality	Only members of the team directly involved in care may see the record.
Terminology	Use standardized abbreviations, symbols and terms. Write the full form when in doubt.
Permanence	Use a dark-coloured ink pen. Follow hospital policy on pen colours (for example death is written in red ink).
Factual	Descriptive, objective data gathered by the nurse using her skill and competence. Subjective statements are recorded in the patient’s exact words.
Current	Keep documents up to date; chart immediately to avoid errors.

Do’s and Don’ts (summary)

Do	Don’t
Write date, time, and sign every entry. Use blue or black ink. Record facts and exact words. Chart as soon as care is given. Report errors promptly. Follow hospital abbreviation list.	Do not record in advance. Do not erase, scratch out or use correction fluid. Do not leave blank spaces. Do not write opinions, blame or irrelevant information. Do not share passwords. Do not photocopy an incident report.

Legal Guidelines for Documentation and Reporting

Records are legal documents that can be used as evidence. Accurate and complete records give legal protection to nurses, other team members and the patient. Mistakes that lead to legal implications:

Not following the guidelines of documentation.
Documentation not fully completed.
Failure to record prevention efforts, particularly for falls, side rails, call bell in reach, restraints (if used), smoking and other potential for injury.
Failure to record treatments and care given.
Failure to record the patient’s refusal of care, or the family’s refusal to accept care.
Incomplete incident reports (and noting incident reports in the patient’s chart).
Failure to record that the client did not follow orders (non-compliance).

Nurse’s responsibility for record keeping and reporting

Records must be accurate to give a sound basis for care planning. Errors must be corrected promptly.
In reporting a criminal act, the nurse should reveal information only to the police.
Records should be descriptive, objective and reliable, complete, concise and thorough.
Delay in recording and reporting can cause serious omissions and delay in care.
Nurses are legally and ethically obliged to keep information confidential.

Methods and Systems of Documentation

A. Narrative documentation

The traditional method of recording nursing care in a story-like format. Disadvantages: repeated information, time-consuming, and the reader has to sort through much information to find the data needed.

B. Problem Oriented Medical Record (POMR)

Places emphasis on the client’s problems; data are organized by problem or diagnosis.

*Four basic components of the Problem Oriented Medical Record*

Component	Description
Data base	All information known about the client when he first enters the health care agency.
Problem list	Derived from the data base; problems are listed in the order identified.
Plan of care	Initial list of orders or plan, made with reference to the active problem.
Progress notes	Chart entries made by all health professionals involved. The SOAP format is frequently used.

Example of a SOAP note (added):
S: “I feel pain in my right leg when I walk.”
O: Right calf warm and red, mild swelling, pain score 6/10, pulse 88/min.
A: Acute pain related to inflammation of right calf.
P: Elevate the leg, give analgesic as prescribed, reassess pain after 30 minutes, inform the doctor.

C. Problems, Interventions and Evaluation (PIE)

Groups information into three categories (Problem, Intervention, Evaluation) and consists of a client care flow sheet and progress notes. PIE notes are numbered according to the client’s problems.

D. Focus charting (DAR)

Uses DAR notes: Data (subjective and objective), Action or nursing intervention, Response of the client (evaluation of effectiveness). It helps track the client’s condition and progress.
Example (added): Focus: Fever. D: Temp 101 F, flushed face, patient says “I feel hot.” A: Tepid sponging given, paracetamol given as ordered. R: Temp 99.4 F after 1 hour, patient comfortable.

E. Charting by exception (CBE)

A system in which only abnormal or significant findings (exceptions to the norm) are recorded. Key elements: flow sheets, standards of nursing care, and keeping all flow sheets at the patient’s bedside.

F. Case management

Multidisciplinary care plans that include client problems, key interventions and expected outcomes within an established time frame.

Reporting

Purposes of report writing: to show the kind and quality of service given to the patient; to show the patient’s progress and the outcome of treatment and care; to help study health conditions; and to help plan further care.

Types of reports

Oral reports: given when the information is for immediate use and not for permanence, for example the nurse assigned to the patient reporting to the nurse who will relieve her.
Written reports: used when information will be used by several personnel and is of more or less permanent value, for example day and night reports, census, interdepartmental reports, and reports on situations, events and conditions.

A. Handover report between shifts (change-of-shift report)

Objective: to maintain continuity of care so that patients get services quickly, precisely and accurately. It has two aspects: (1) patient handover preparation and implementation, and (2) documents, facilities and equipment (patient medical record and handover sheet).

Nurse giving the report (previous shift):

Completes documentation of all patients (number of patients, those getting treatment, new, discharged, transferred or died).
Documents all special events during the shift.
Reviews and updates the care plan as per the patient’s response, needs and medical orders.
Draws conclusions from what happened and what was found.
Allocates patients to the next nurse.

Nurse receiving the report: looks at the patient allocation and briefly reads the medical records of the patients she will treat.

Implementation of handover:

Hand over at the patient’s bedside using the SBAR method.
Inform the patient about the handover and whether family may join; introduce the next shift nurse.
The previous nurse explains the patient’s condition, things done and the next plan.
Data reported should include: patient’s name, age, date of entry, treating doctor, medical and nursing diagnosis, laboratory and radiological results, complaints, diet, fluid balance, vital signs and action plans.
Check all tubing connections and catheters attached to the patient.
Do not hand over confidential data to the patient.

SBAR method

Letter	Information to give
Situation	Patient’s name, age, length of stay, doctor in charge; nursing problem and diagnosis; other identification details and patient location.
Background	Current condition: chief complaint, re-assessment (vital signs and more), abnormal diagnostic test results, patient medication record.
Assessment	Assessment of the current condition including clinical signs and other specific conditions.
Recommendation	Interventions that can be done to manage the patient’s current condition.

B. Transfer report

Communication of information about clients from the nurse on the sending unit to the nurse on the receiving unit. Include: client’s name, age, primary doctor and medical diagnosis; summary of medical progress up to transfer; current physical and psychosocial status; current nursing diagnoses or problems and care plan; any critical assessments or interventions to be done shortly; and need for special equipment.

C. Incident report

The nurse who witnessed the incident files the report.
Describe concisely what happened in objective terms.
Do not try to explain the cause of the incident.
Describe the client’s condition at the time of the incident objectively.
Report actions taken by the nurse and doctor at the time.
No nurse is blamed in an incident report.
Submit it as soon as possible and never make a photocopy. Do not note the incident report in the patient’s chart.

D. Census report

A combined daily report that shows the total number of patients and the number of admissions, discharges, transfers, births and deaths.

E. Birth and death report

Nurses are responsible for sending the birth and death report to government authorities for registration within the specified time.

F. Anecdotal report

An anecdote is a brief account of some incident. Incident reports and reports on accidents, mistakes and complaints are legal in nature. A written record about some observation of a person or his or her work is called an anecdotal note.

Guidelines for report writing

Be clear in your own mind before writing. Reports lacking facts may be biased or worthless.
Conciseness, accuracy and completeness are essential.
It is better to write several reports than one report with more than one main subject.
Use simple, commonly used words for non-technical reports; scientific terms for reports to professional personnel; specific rather than general words; a single meaningful term instead of phrases.
Use good sentences and paragraphs, observe margins, spell properly, use correct pronouns and punctuation, and be neat.
Avoid abbreviations except in clinical charting.
Write in a conversational manner, put the date on every report, and if it is typed by someone else, check it before signing.

*FACO, the mnemonic for writing reports*

FACO: Fact based, Accurate, Complete and correct, Organized.

Communication within the Health Care Team

Different verbal and written communication takes place within the team.
Written communication uses records such as the instruction book, call book and treatment book.
Verbal orders are later recorded in written form.
A consultation request is sent to a specialist who reviews the patient’s condition.
Referral is written communication where patient details are sent to a department for further treatment. Example: a diabetic patient with kidney failure is referred to the nephrology department.

Nursing Informatics

Nursing informatics is a specialty that integrates nursing science, computer science and information science to manage and communicate data, information, knowledge and wisdom in nursing practice.

“Application of computer technology to all fields of nursing: nursing services, nurse education and nursing research.” (Scholes and Barber, 1980)
“A combination of computer science, information science and nursing science designed to assist in the management and processing of nursing data, information and knowledge to support the practice of nursing and the delivery of nursing care.” (Graves and Corcoran, 1989)

Purposes of nursing informatics: to support the use of the nursing process; computer-based scheduling to allocate staff; computers for patient education; computer-assisted learning in nursing education; nursing use of a hospital information system; and research on information nurses use in patient care decisions.

Chapter Focus Points

Documentation is a communication tool. Systems include narrative, POMR, PIE, charting by exception and case management.
A record is a permanent written communication; reports are oral or written exchanges of information.
It is the nurse’s responsibility to keep records and information confidential.
Nursing informatics integrates nursing, computer and information science.

Documentation and Reporting MCQs (Nursing Foundation Notes)

Q1. Documentation in nursing means:

Writing or electronically recording information about the patient and care
Only giving verbal reports
Only billing
Only photography

Answer: A. It communicates assessment, diagnosis, planning, implementation and evaluation in writing.

Q2. Which is NOT a guideline of effective documentation?

Factual
Accurate
Concise
Delayed

Answer: D. The six are factual, accurate, complete, timely, concise, legible.

Q3. Subjective data in a record should be written in:

Nurse’s own words
Client’s exact words
Abbreviations
Pencil

Answer: B. Objective data are what the nurse sees, hears, feels and smells.

Q4. Entries should be made with:

Pencil
Blue or black pen
Red pen always
Any colour

Answer: B. Death is written in red ink as per hospital policy.

Q5. If you make a mistake in a record, you should:

Use correction fluid
Tear the page
Draw a single line, write the correct entry and initial it
Overwrite it

Answer: C. Never erase or scratch out.

Q6. Recording in advance is:

Acceptable
Not allowed
Compulsory
Preferred

Answer: B. Document date and time each time and never in advance.

Q7. A record is best defined as:

An oral exchange
A permanent written communication of information relevant to a client’s care
A bill
A letter

Answer: B. A report is an oral or written exchange of information.

Q8. Reports can be:

Only oral
Only written
Oral or written
Only electronic

Answer: C. Oral reports are for immediate use; written for permanence.

Q9. Which purpose of records helps get payment from insurance?

Research
Reimbursement
Education
Audit

Answer: B. Records are a source for payment.

Q10. Which ward record shows total admissions, discharges, transfers and deaths?

Census record
Call book
Indent book
Complaint book

Answer: A. Also absconding patients.

Q11. The book used to order supplies like medicines and linen is the:

Indent book
Call book
Instruction book
Death register

Answer: A. From the stores.

Q12. Kardex is:

A series of cards kept in a portable file giving quick information
A lab report
An X-ray
A bill

Answer: A. It can be computer generated too.

Q13. Records of course plans, unit plans and student health records are:

Ward records
Nursing records
Educational records
Administrative records

Answer: C. Used by nursing institutes.

Q14. Philosophy, policies, vision and mission records are:

Educational records
Administrative records
Nursing records
Ward records

Answer: B. Maintained by top management.

Q15. EHR stands for:

Electronic Health Record
Emergency Health Report
External Hospital Record
Electronic Hospital Report

Answer: A. A collection of medical records generated during clinical encounters.

Q16. Which is a benefit of EHR?

Easy availability and storage
Higher chance of lost files
Slower diagnosis
No backup

Answer: A. Also easy update, multiple users and low-cost backup.

Q17. Which is a con of computerized documentation?

Legible information
Breakdowns make information temporarily unavailable
Standard terminology
Quick transfer of results

Answer: B. Also expensive and needs training.

Q18. To protect computerized records, a nurse should:

Share her password
Use own ID password and log out after work
Leave the system logged in
Make entries at the end of the day

Answer: B. Report a lost password immediately.

Q19. POMR has how many basic components?

Two
Three
Four
Five

Answer: C. Data base, problem list, plan of care, progress notes.

Q20. SOAP stands for:

Subjective, Objective, Assessment, Plan
Sign, Observe, Act, Plan
Situation, Objective, Action, Plan
Subjective, Order, Action, Plan

Answer: A. A progress note format used in POMR.

Q21. PIE stands for:

Problems, Interventions and Evaluation
Plan, Implement, Evaluate
Patient, Illness, Examination
Problem, Information, Entry

Answer: A. Notes are numbered according to the client’s problems.

Q22. DAR notes are used in:

Focus charting
Narrative charting
Charting by exception
Case management

Answer: A. Data, Action, Response.

Q23. In charting by exception, only the following are recorded:

All findings
Abnormal or significant findings
Only normal findings
Nothing

Answer: B. Uses flow sheets and standards of nursing care kept at the bedside.

Q24. The traditional story-like method of recording is:

Narrative documentation
POMR
PIE
CBE

Answer: A. Disadvantages: repetition and time-consuming.

Q25. SBAR stands for:

Situation, Background, Assessment, Recommendation
Sign, Bed, Action, Report
Symptom, Biology, Action, Result
Situation, Behaviour, Action, Review

Answer: A. Used for bedside handover.

Q26. In an incident report the nurse should:

Blame the staff
Describe the facts objectively and not explain the cause
Make a photocopy
Write it in the patient chart

Answer: B. No nurse is blamed; submit it as soon as possible.

Q27. Who files the incident report?

Nurse who witnessed the incident
Any visitor
The patient
Pharmacy

Answer: A. Describe what happened concisely.

Q28. The mnemonic FACO for report writing stands for:

Fact based, Accurate, Complete and correct, Organized
Fast, Able, Clear, Open
Final, Actual, Concise, Orderly
Fact, Action, Care, Outcome

Answer: A. Used for writing reports.

Q29. Information about a criminal act should be revealed only to:

The media
The police
Relatives
Other patients

Answer: B. Nurses are legally and ethically bound to keep other information confidential.

Q30. Nursing informatics integrates nursing science with:

Computer science and information science
Chemistry and physics
Law and economics
Art and music

Answer: A. To manage data, information, knowledge and wisdom.

Nursing Foundation Important Questions as per INC Syllabus Pattern

Long answer questions (10 to 15 marks)

Define documentation. Describe the purposes and guidelines of effective documentation.
Explain the types of client records with examples.
Describe the methods and systems of documentation (narrative, POMR, PIE, DAR, CBE).
Explain the legal guidelines for documentation and reporting.
Describe the types of reports. Explain handover report with SBAR and incident report.
Explain electronic health records and computerized documentation with their merits and demerits.

Short answer questions (5 marks)

Purposes of records and reports
Ward records
Nursing records
Principles of documentation
Confidentiality of records
SOAP format
Focus charting (DAR)
Charting by exception
Incident report
Transfer report
SBAR method
Nursing informatics

Very short answer questions (2 marks)

Define documentation.
Differentiate record and report.
Expand SOAP, PIE, DAR and SBAR.
What is a Kardex?
What is an anecdotal note?
Write the full form of EHR.
How do you correct an error in a record?
What is FACO?
Define nursing informatics.
List four benefits of EHR.

Also read:
CHAPTER 1: Introduction to Health and Illness, Nursing Foundation Unit 1 Notes PDF
CHAPTER 2: Health Care Delivery System, Nursing Foundation Unit 2 BSc Nursing Notes
Chapter 3: Nursing as a Profession and History of Nursing in India: BSc Nursing 1st Semester Notes (Nursing Foundation)
CHAPTER 4: Hospital Admission and Discharge: Complete BSc Nursing Notes | 1st Semester Notes (Nursing Foundation)
CHAPTER 5: Communication and Nurse Patient Relationship: Complete Notes | BSc Nursing 1st Semester Notes (Nursing Foundation)
Chapter 6: Patient Education in Nursing: Notes for BSc Nursing 1st Semester, Nursing Foundation Notes with MCQs & Important Questions
Chapter 7: The Nursing Process: Complete Notes for BSc Nursing, 1st Semester, Nursing Foundation

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