Phlebotomy Essentials
6th Edition
ISBN:9781451194524
Author:Ruth McCall, Cathee M. Tankersley MT(ASCP)
Publisher:Ruth McCall, Cathee M. Tankersley MT(ASCP)
Chapter1: Phlebotomy: Past And Present And The Healthcare Setting
Section: Chapter Questions
Problem 1SRQ
Related questions
Question
How may have the community colleges impacted on your healthy and unhealthy habits?
And restaurants
![Abstract
Objective: According to the US Affordable Care Act, restaurant chains are required
to provide energy (calorie) and other nutrition information on their menu. The
current study examined the impact of menu labelling containing calorie
information and recommended daily calorie intake, along with subjective nutrition
knowledge, on intention to select lower-calorie foods prior to the implementation
of the Affordable Care Act.
Design: Full factorial experimental design with participants exposed to four
variants of a sample menu in a 2 (presence v. absence of calorie information)
x2 (presence v. absence of recommended daily calorie intake).
Setting: Large, public university in the Southwest USA.
Subjects: Primarily undergraduate college students.
Results: Majority of participants were 19-23 years of age (mean 21-8 (sD 3-6) years).
Menu information about calorie content and respondents' subjective nutrition
knowledge had a significantly positive impact on students' intention to select
lower-calorie foods (B=0-24, P<0-001 and ß=0-33, P<0-001, respectively);
however, recommended daily calorie intake information on the menu board did
not influence students' intention to select lower-calorie foods (B=0-10, P=0-105).
Gender played a significant role on purchase intent for lower-calorie menu items,
with females more affected by the calorie information than males (p=0-37,
P<0.001).
Conclusions: Findings support the role menu labelling can play in encouraging a
healthier lifestyle for college students. College students who are Generation Y
desire healthier menu options and accept nutritional labels on restaurant menus as
a way to easily and expediently obtain nutrition information.
The consumption of away-from-home meals in the USA
has increased dramatically over the years and accounted
for 43-1% of consumers' food budget in 2012, compared
with only 25.9% in 1970). Increasing interest by con-
sumers in changing their diet and in restaurants being
more transparent about menu items) has resulted in a
desire for restaurants to include nutrition information for
patrons. To aid this consumer need, in 2010, the Afford-
able Care Act was signed into law in the USA, amending
wamchang
section 403(q) of the Federal Food and Drug Act.
began
nug act
As amended, section 403(q) requires restaurant chains and
similar retail food establishments operating as part of a
chain under the same name with twenty or more locations
to provide energy (calories, i.e. kilocalories) and other
nutrition information for standard menu items, including
foods on display, self-service foods, and on menus and
menu boards. The law takes effect on 5 May 2017 (5). Its
primary purpose is to make nutrition information on
w
*Corresponding author: Email mroseman@olemiss.edu
798
With Generation Y, the number of college students
has risen dramatically in the USA; in 2016, nearly
20-5 million students are expected to attend US colleges.
and universities, constituting an increase of about
5 million since 2000(13). The nutrition health of US college
students is important; nearly 32% of college students self-
report a high BMI (>25-0 kg/m2), classifying them as
overweight or obese. College students tend to be
physically inactive, have little time or ability to cook
nutritious meals, are exposed to large portion sizes at
eating facilities (¹5) and like fast foods due to their low cost
and convenience (16)
Nutrition information on restaurant menus
Customers perceive restaurants to be socially responsible
when they provide healthful food and nutrition informa-
tion, with highly health-conscious customers reacting
more strongly to healthy foods than their counterparts(17),
Data of menu items from the largest restaurant chains for
2012-2013 found that mean calories among menu items.
did not change, while the amount of calories in newly
(18.10)
Keywords
Menu labelling
Calorie information
Recommended daily calorie intake
Nutrition knowledge
restaurant foods available to consumers in a direct,
accessible and consistent manner, to enable consumers to
make informed and healthful dietary choices. Prior to
the Affordable Care Act, some cities and states enacted
their own laws requiring chain restaurants to post nutrition
information on their menu boards and menus6,7),
prompting interest in research on restaurant menu label-
ling. Initiated in 2010, some major national restaurant
chains such as Panera Bread Company and McDonald's
to voluntarily post calories on their menu boards at
company-owned stores (8,9)
Generation Y, also known as Millennials, is loosely
defined as young adults who were born between 1980
and 2000(10) with the first Millennials reaching adulthood
around the year 2000). While the buying power of
Generation Y consumers is projected to eclipse that of Baby
Boomers(12), there is limited research focusing on their
healthy eating and purchase behaviours in restaurants.
The Authors 2016
MG Roseman et al.
they eat 36,37). Therefore, to better understand if restaurant
menu labelling affects the calorie intake of college
(Generation Y) students, the following two hypotheses
were proposed:
H1. Generation Y students have a higher intention to
select lower-calorie foods if they are provided calorie
information on restaurant menus.
H2. Generation Y students have a higher intention to
select lower-calorie foods if they are provided with
recommended daily calorie intake information on
restaurant menus.
Subjective nutrition knowledge
Consumer research distinguishes between actual knowl-
edge and subjective knowledge (38) where two con-
ceptually different constructs are defined as: 'objective
knowledge, i.e. the accurate information about the
product stored in consumer's long-term memory; and sub-
jective knowledge, i.e. people's subjective perceptions of
what or how much they know about a product based on
J
(39)](/v2/_next/image?url=https%3A%2F%2Fcontent.bartleby.com%2Fqna-images%2Fquestion%2F411c0783-0772-4201-8163-1aac6c21c12d%2Fb1fa8ccb-05f2-494a-a772-f5907b0224d2%2Fc9z67w_processed.jpeg&w=3840&q=75)
Transcribed Image Text:Abstract
Objective: According to the US Affordable Care Act, restaurant chains are required
to provide energy (calorie) and other nutrition information on their menu. The
current study examined the impact of menu labelling containing calorie
information and recommended daily calorie intake, along with subjective nutrition
knowledge, on intention to select lower-calorie foods prior to the implementation
of the Affordable Care Act.
Design: Full factorial experimental design with participants exposed to four
variants of a sample menu in a 2 (presence v. absence of calorie information)
x2 (presence v. absence of recommended daily calorie intake).
Setting: Large, public university in the Southwest USA.
Subjects: Primarily undergraduate college students.
Results: Majority of participants were 19-23 years of age (mean 21-8 (sD 3-6) years).
Menu information about calorie content and respondents' subjective nutrition
knowledge had a significantly positive impact on students' intention to select
lower-calorie foods (B=0-24, P<0-001 and ß=0-33, P<0-001, respectively);
however, recommended daily calorie intake information on the menu board did
not influence students' intention to select lower-calorie foods (B=0-10, P=0-105).
Gender played a significant role on purchase intent for lower-calorie menu items,
with females more affected by the calorie information than males (p=0-37,
P<0.001).
Conclusions: Findings support the role menu labelling can play in encouraging a
healthier lifestyle for college students. College students who are Generation Y
desire healthier menu options and accept nutritional labels on restaurant menus as
a way to easily and expediently obtain nutrition information.
The consumption of away-from-home meals in the USA
has increased dramatically over the years and accounted
for 43-1% of consumers' food budget in 2012, compared
with only 25.9% in 1970). Increasing interest by con-
sumers in changing their diet and in restaurants being
more transparent about menu items) has resulted in a
desire for restaurants to include nutrition information for
patrons. To aid this consumer need, in 2010, the Afford-
able Care Act was signed into law in the USA, amending
wamchang
section 403(q) of the Federal Food and Drug Act.
began
nug act
As amended, section 403(q) requires restaurant chains and
similar retail food establishments operating as part of a
chain under the same name with twenty or more locations
to provide energy (calories, i.e. kilocalories) and other
nutrition information for standard menu items, including
foods on display, self-service foods, and on menus and
menu boards. The law takes effect on 5 May 2017 (5). Its
primary purpose is to make nutrition information on
w
*Corresponding author: Email mroseman@olemiss.edu
798
With Generation Y, the number of college students
has risen dramatically in the USA; in 2016, nearly
20-5 million students are expected to attend US colleges.
and universities, constituting an increase of about
5 million since 2000(13). The nutrition health of US college
students is important; nearly 32% of college students self-
report a high BMI (>25-0 kg/m2), classifying them as
overweight or obese. College students tend to be
physically inactive, have little time or ability to cook
nutritious meals, are exposed to large portion sizes at
eating facilities (¹5) and like fast foods due to their low cost
and convenience (16)
Nutrition information on restaurant menus
Customers perceive restaurants to be socially responsible
when they provide healthful food and nutrition informa-
tion, with highly health-conscious customers reacting
more strongly to healthy foods than their counterparts(17),
Data of menu items from the largest restaurant chains for
2012-2013 found that mean calories among menu items.
did not change, while the amount of calories in newly
(18.10)
Keywords
Menu labelling
Calorie information
Recommended daily calorie intake
Nutrition knowledge
restaurant foods available to consumers in a direct,
accessible and consistent manner, to enable consumers to
make informed and healthful dietary choices. Prior to
the Affordable Care Act, some cities and states enacted
their own laws requiring chain restaurants to post nutrition
information on their menu boards and menus6,7),
prompting interest in research on restaurant menu label-
ling. Initiated in 2010, some major national restaurant
chains such as Panera Bread Company and McDonald's
to voluntarily post calories on their menu boards at
company-owned stores (8,9)
Generation Y, also known as Millennials, is loosely
defined as young adults who were born between 1980
and 2000(10) with the first Millennials reaching adulthood
around the year 2000). While the buying power of
Generation Y consumers is projected to eclipse that of Baby
Boomers(12), there is limited research focusing on their
healthy eating and purchase behaviours in restaurants.
The Authors 2016
MG Roseman et al.
they eat 36,37). Therefore, to better understand if restaurant
menu labelling affects the calorie intake of college
(Generation Y) students, the following two hypotheses
were proposed:
H1. Generation Y students have a higher intention to
select lower-calorie foods if they are provided calorie
information on restaurant menus.
H2. Generation Y students have a higher intention to
select lower-calorie foods if they are provided with
recommended daily calorie intake information on
restaurant menus.
Subjective nutrition knowledge
Consumer research distinguishes between actual knowl-
edge and subjective knowledge (38) where two con-
ceptually different constructs are defined as: 'objective
knowledge, i.e. the accurate information about the
product stored in consumer's long-term memory; and sub-
jective knowledge, i.e. people's subjective perceptions of
what or how much they know about a product based on
J
(39)
![Nutrition information on restaurant menus
Customers perceive restaurants to be socially responsible
when they provide healthful food and nutrition informa-
tion, with highly health-conscious customers reacting
more strongly to healthy foods than their counterparts
Data of menu items from the largest restaurant chains for
2012-2013 found that mean calories among menu items
did not change, while the amount of calories in newly
introduced menu items reduced significantly (1819)
Much of the research on the effects of restaurant menu
labelling encouraging individuals to choose healthier
menu items has been mixed. Some research suggests that
consumers may not want to be exposed to a menu item's
nutrition information or may overstate their use of nutri-
tion labelling Other studies on consumer behaviour
before and after the implementation of restaurant menu
labelling in the USA find no significant change in the
caloric level of menu purchases (21-23), Some studies found
a caloric reduction between pre- and post-treatment
phases and selections with fewer calories by those
viewing nutrition information on menu items when com-
pared with those who did not-27). A meta-analysis of six
controlled studies in restaurant settings found a non-
significant reduction in calories, with some consumers
stating that nutrition labelling is a healthful influence over
(29)
their purchasing decision Restaurant customers have
positive attitudes towards lower-calorie items and these
patrons are willing to pay a premium if the information
provided indicates healthy nutrition
Generation Y's healthy eating behaviours
Generation Y's health concerns are increasing); "health-
conscious' and 'adventurous' Generation Y groups seek
green restaurants, healthy menus and quality foods
ds (32)
Generation Y describe themselves as foodies), with a
Gallup poll showing that 57% of Millennials eat at a quick
service restaurant at least once weekly, compared with
47% of those aged 40-49 years, 44% of those aged 50-64
years and 41% of those aged 65 years or older, While
Millennials eat out more often than non-Millennials (3-4
28 times per week)), they are a part of the growing
trend towards consumers becoming concerned about
their health and the healthiness and quality of the foods
Methods
Research design
Undergraduate research participants were exposed to four
variants of a sample menu in a 2 (presence r. absence of
calorie information) x2 (presence r. absence of recom-
mended daily calorie intake) full factorial experimental
design. Participants saw only one of four versions of
stimulus materials in which all possessed consistent menu
items, features and descriptions but varied regarding
calorie information as follows.
Version 1: No calorie or recommended daily calorie
intake information.
Version 2: Only calorie information.
Version 3: Only recommended daily calorie intake
information.
Version 4: Both calorie and recommended daily calorie
intake information.
Restaurant nutrition menu labelling on healthy eating behaviours
variable (intention to select lower-calorie foods); and
potential confounding variables (gender, age, frequency
of dining out, BMD).
Research participants were recruited at a campus
cafeteria of a large, public university in the Southwest USA
to voluntarily participate in the study. Prior to conducting
the research, the study protocol was approved by Texas
Tech University's Internal Review Board.
Subjective nutrition knowledge
Consumer research distinguishes between actual knowl
edge and subjective knowledge where two con-
ceptually different constructs are defined as: 'objective
knowledge, ie. the accurate information about the
product stored in consumer's long-term memory; and sub-
jective knowledge, i.e. people's subjective perceptions of
what or how much they know about a product based on
their own subjective interpretation of what one knows
Both forms of knowledge have contributed to the literature;
for example, subjective and objective measures of nutrition
knowledge are significantly associated with self-reported
use of nutrition labels on grocery products. While
objective knowledge is related to an increase in healthful
eating patterns by college students, subjective knowledge
is also a good predictor- or even a better motivator - than
objective knowledge in dietary behaviour and food choices
when selecting healthier options from food labels. Thus,
an additional hypothesis was proposed:
Each version of the sample menu contained six menu
items selected from a list of Burger King sandwiches using
calorie information from its official website. The sand-
wiches included BK Veggie Burger: 320 kcal (1339 kJ),
Tendergrill Chicken Sandwich: 360 kcal (1506 kJ), Deluxe
Cheeseburger: 420 kcal (1757 kJ); Whopper Sandwich:
760 kcal (3180 kJ); Double Whopper Sandwich: 900 kcal
(3766 kJ); and Triple Whopper Sandwich, 1140 kcal
(4770 kJ). Fifty participants were exposed to the stimulus
materials for each version of the menu. Participants were
randomly selected regarding the menu version they
viewed. To randomize the menus, five field researchers
were located in the north, south, east, west and centre of
the cafeteria with ten questionnaires of each sample menu,
H3. Generation Y students who have higher subjective
nutrition knowledge have a higher intention to select
lower-calorie foods on restaurant menus.
Hypothesized model
To better understand the current study, a conceptual fra-
mework is depicted in Fig. 1. The hypothesized model
includes three independent variables: () calorie informa-
tion, (ii) recommended daily calorie intake information
and (iii) subjective nutrition knowledge, a dependent
Calorie information
Recommended daily
calorie intake
information
Subjective nutrition
knowledge
H1
H₂
H₂
Fig. 1 Hypothesized conceptual framework
Intention to select
lower-calorie foods
Contounding variables
Gender
-Age
Frequency
.BMI
799
Measures
Independent measures
There were three independent variables in the study:
(i) calorie information (presence z. absence: CI); (ii) recom
mended daily calorie intake information (presence r
absence: RDCI); and (iii) respondents' subjective nutrition
knowledge (SNK). The operationalization of CI and RDCI is
illustrated in Fig. 2. In addition, SNK was measured with
multiple statements based on a previous research study using
an eleven-point Likert-type scale (0='not at all'; 10=
extremely, but modified to fit the current study. The
three SNK statements were: (i) In general, how much do
you think you know about the topic of nutrition?; (ii) 1 do
not really know very much about nutrition in general; and
(iii) 'Compared to most people, I am quite knowledgeable
about nutrition.
Dependent measure
The dependent variable was respondents' intention to
select lower-calorie foods using an eleven-point Likert-
type scale. Participants responded to the statement: "Based
on the menu, please rate your purchase intention toward
each menu item' (0='very probably not; 10='definitely).
In order to empirically operationalize the construct, the
following formula was used:
Intention to select lower-calorie food
Sum of ratings of the three lowest-calorie items x 100.
Sum of ratings of all six items
The three lowest-calorie sandwiches in the numerator
included the Veggie Burger, Tendergrill Chicken Sandwich
and Deluxe Cheeseburger. Therefore, the intention to select
the lower-calorie food ranged from 0 to 100, 0 meant that
respondents selected the higher-calorie menu items and 100
meant that the lower-calorie foods were chosen.
Data analysis
Prior to model testing, data were tested for univariate and
multivariate outliers and normality using the statistical
software package IBM SPSS Statistics Version 22.0. There
were no univariate outliers detected and no violation of
normality. However, eight multivariate outliers were
identified using Mahalanobis' distance and were deleted
for model testino As a result a sample of 197 was used for](/v2/_next/image?url=https%3A%2F%2Fcontent.bartleby.com%2Fqna-images%2Fquestion%2F411c0783-0772-4201-8163-1aac6c21c12d%2Fb1fa8ccb-05f2-494a-a772-f5907b0224d2%2Fwh8p2ex_processed.jpeg&w=3840&q=75)
Transcribed Image Text:Nutrition information on restaurant menus
Customers perceive restaurants to be socially responsible
when they provide healthful food and nutrition informa-
tion, with highly health-conscious customers reacting
more strongly to healthy foods than their counterparts
Data of menu items from the largest restaurant chains for
2012-2013 found that mean calories among menu items
did not change, while the amount of calories in newly
introduced menu items reduced significantly (1819)
Much of the research on the effects of restaurant menu
labelling encouraging individuals to choose healthier
menu items has been mixed. Some research suggests that
consumers may not want to be exposed to a menu item's
nutrition information or may overstate their use of nutri-
tion labelling Other studies on consumer behaviour
before and after the implementation of restaurant menu
labelling in the USA find no significant change in the
caloric level of menu purchases (21-23), Some studies found
a caloric reduction between pre- and post-treatment
phases and selections with fewer calories by those
viewing nutrition information on menu items when com-
pared with those who did not-27). A meta-analysis of six
controlled studies in restaurant settings found a non-
significant reduction in calories, with some consumers
stating that nutrition labelling is a healthful influence over
(29)
their purchasing decision Restaurant customers have
positive attitudes towards lower-calorie items and these
patrons are willing to pay a premium if the information
provided indicates healthy nutrition
Generation Y's healthy eating behaviours
Generation Y's health concerns are increasing); "health-
conscious' and 'adventurous' Generation Y groups seek
green restaurants, healthy menus and quality foods
ds (32)
Generation Y describe themselves as foodies), with a
Gallup poll showing that 57% of Millennials eat at a quick
service restaurant at least once weekly, compared with
47% of those aged 40-49 years, 44% of those aged 50-64
years and 41% of those aged 65 years or older, While
Millennials eat out more often than non-Millennials (3-4
28 times per week)), they are a part of the growing
trend towards consumers becoming concerned about
their health and the healthiness and quality of the foods
Methods
Research design
Undergraduate research participants were exposed to four
variants of a sample menu in a 2 (presence r. absence of
calorie information) x2 (presence r. absence of recom-
mended daily calorie intake) full factorial experimental
design. Participants saw only one of four versions of
stimulus materials in which all possessed consistent menu
items, features and descriptions but varied regarding
calorie information as follows.
Version 1: No calorie or recommended daily calorie
intake information.
Version 2: Only calorie information.
Version 3: Only recommended daily calorie intake
information.
Version 4: Both calorie and recommended daily calorie
intake information.
Restaurant nutrition menu labelling on healthy eating behaviours
variable (intention to select lower-calorie foods); and
potential confounding variables (gender, age, frequency
of dining out, BMD).
Research participants were recruited at a campus
cafeteria of a large, public university in the Southwest USA
to voluntarily participate in the study. Prior to conducting
the research, the study protocol was approved by Texas
Tech University's Internal Review Board.
Subjective nutrition knowledge
Consumer research distinguishes between actual knowl
edge and subjective knowledge where two con-
ceptually different constructs are defined as: 'objective
knowledge, ie. the accurate information about the
product stored in consumer's long-term memory; and sub-
jective knowledge, i.e. people's subjective perceptions of
what or how much they know about a product based on
their own subjective interpretation of what one knows
Both forms of knowledge have contributed to the literature;
for example, subjective and objective measures of nutrition
knowledge are significantly associated with self-reported
use of nutrition labels on grocery products. While
objective knowledge is related to an increase in healthful
eating patterns by college students, subjective knowledge
is also a good predictor- or even a better motivator - than
objective knowledge in dietary behaviour and food choices
when selecting healthier options from food labels. Thus,
an additional hypothesis was proposed:
Each version of the sample menu contained six menu
items selected from a list of Burger King sandwiches using
calorie information from its official website. The sand-
wiches included BK Veggie Burger: 320 kcal (1339 kJ),
Tendergrill Chicken Sandwich: 360 kcal (1506 kJ), Deluxe
Cheeseburger: 420 kcal (1757 kJ); Whopper Sandwich:
760 kcal (3180 kJ); Double Whopper Sandwich: 900 kcal
(3766 kJ); and Triple Whopper Sandwich, 1140 kcal
(4770 kJ). Fifty participants were exposed to the stimulus
materials for each version of the menu. Participants were
randomly selected regarding the menu version they
viewed. To randomize the menus, five field researchers
were located in the north, south, east, west and centre of
the cafeteria with ten questionnaires of each sample menu,
H3. Generation Y students who have higher subjective
nutrition knowledge have a higher intention to select
lower-calorie foods on restaurant menus.
Hypothesized model
To better understand the current study, a conceptual fra-
mework is depicted in Fig. 1. The hypothesized model
includes three independent variables: () calorie informa-
tion, (ii) recommended daily calorie intake information
and (iii) subjective nutrition knowledge, a dependent
Calorie information
Recommended daily
calorie intake
information
Subjective nutrition
knowledge
H1
H₂
H₂
Fig. 1 Hypothesized conceptual framework
Intention to select
lower-calorie foods
Contounding variables
Gender
-Age
Frequency
.BMI
799
Measures
Independent measures
There were three independent variables in the study:
(i) calorie information (presence z. absence: CI); (ii) recom
mended daily calorie intake information (presence r
absence: RDCI); and (iii) respondents' subjective nutrition
knowledge (SNK). The operationalization of CI and RDCI is
illustrated in Fig. 2. In addition, SNK was measured with
multiple statements based on a previous research study using
an eleven-point Likert-type scale (0='not at all'; 10=
extremely, but modified to fit the current study. The
three SNK statements were: (i) In general, how much do
you think you know about the topic of nutrition?; (ii) 1 do
not really know very much about nutrition in general; and
(iii) 'Compared to most people, I am quite knowledgeable
about nutrition.
Dependent measure
The dependent variable was respondents' intention to
select lower-calorie foods using an eleven-point Likert-
type scale. Participants responded to the statement: "Based
on the menu, please rate your purchase intention toward
each menu item' (0='very probably not; 10='definitely).
In order to empirically operationalize the construct, the
following formula was used:
Intention to select lower-calorie food
Sum of ratings of the three lowest-calorie items x 100.
Sum of ratings of all six items
The three lowest-calorie sandwiches in the numerator
included the Veggie Burger, Tendergrill Chicken Sandwich
and Deluxe Cheeseburger. Therefore, the intention to select
the lower-calorie food ranged from 0 to 100, 0 meant that
respondents selected the higher-calorie menu items and 100
meant that the lower-calorie foods were chosen.
Data analysis
Prior to model testing, data were tested for univariate and
multivariate outliers and normality using the statistical
software package IBM SPSS Statistics Version 22.0. There
were no univariate outliers detected and no violation of
normality. However, eight multivariate outliers were
identified using Mahalanobis' distance and were deleted
for model testino As a result a sample of 197 was used for
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