NurseClick F EBRUA RY / M A RCH 2 0 16
A blemish in Australia’s cosmetic surgery industry
Be inspired by The Power of Now at the 2016 National Nursing Forum
ACN voices – meet our representatives
Expanding the NP scope of practice to meet health care needs
In this edition
Adjunct Professor Kylie Ward FACN, CEO of ACN
The latest health care news
A blemish in Australia’s cosmetic surgery industry
Be inspired by The Power of Now at the 2016 National Nursing Forum
ACN voices – meet our representatives
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Welcome Adjunct Professor Kylie Ward FACN, CEO of ACN
Welcome to the March edition of NurseClick. A significant way in which the Australian College of Nursing (ACN) is influencing better health outcomes is through our representative activities, which draws on the expert knowledge and experiences of our Members and Fellows. In this issue, we profile two of our representatives, Dr Anne Williams MACN and Christine Mackey MACN, to highlight the important work they are doing on behalf of ACN and thank them for their valuable contribution in helping to give nurses a voice in health care decision making. This type of collaboration and leadership is vital in ensuring policies and standards of practice keep up with the ever-changing health care space. The field of cosmetic medicine seems to be falling behind significantly in this respect. ACN Policy team members Anita Pak and Liza Edwards MACN take a look at this burgeoning industry and discuss the need to define a model of practice to support nurses working in this area. ACN believes it is critical that the nursing profession in Australia takes the lead in this space and welcomes nurses working in cosmetic medicine to form a Community of Interest. If you would like to express interest or share your views, please email email@example.com
Our Members and Fellows also play a big role in helping to inform our position statements and policy recommendations. As part of multinational initiative, Choosing Wisely Australia, ACN will be putting forward recommendations of some tests, treatments and procedures that clinicians and consumers should question. ACN Member Engagement Manager, Colleen Kinnane MACN, shares the collaboration and consultation process with other nursing bodies and our membership in the lead up to the Wave II launch on 16 March. I am excited to announce that the call for abstracts is open for ACN’s key annual event, the National Nursing Forum. This year, we’re encouraging presenters to embrace the theme, The Power of Now, and really think about the way in which they deliver their content. To promote this innovation, ACN is accepting alternative presentation formats, such as interviews, role plays, videos and storytelling; the opportunities are endless and we are eager to receive some contemporary submissions. See our events feature for more information.
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In the news Nat ional Significant health gap remains between Australians with disability and those without disability Australians with disability are still significantly more likely to report having poor health than those without disability, according to a new report released by the Australian Institute of Health and Welfare. The report, Health status and risk factors of Australians with disability 2007–08 and 2011–12, shows that in 2011–12, half (51%) of Australians aged 15–64 with severe or profound disability (that is, sometimes or always needing personal help with activities of self-care, mobility or communication) rated their health as 'poor or fair', compared with 6% for those without disability. Read more
Medical marijuana is now legal in Australia The Australian parliament has passed new national laws paving the way for the use of medicinal cannabis by people with painful and chronic illness. Amendments to the Narcotic Drugs Act permit both legally-grown cannabis for the manufacture of medicinal cannabis products in Australia. Recreational cannabis cultivation and use remains illegal with state-based criminal laws still in place. Read more
Pancreatic cancer is really four separate cancers: study A landmark seven-year study has identified that pancreatic cancer is not one, but four types of cancer. The research findings, published in the peer reviewed journal Nature, is the most detailed pancreatic cancer study to date. It opens the door to new treatments for one of the most devastating and difficult to treat cancers. Read more
Never a better time to treat hepatitis C, but thousands still unaware Experts are calling for the billion dollar investment by the Federal Government to subsidise new generation hepatitis C medicines to be supported by a concerted effort to improve public awareness of ground-breaking medicines and help people living with the virus reconnect with hepatitis C care. March marked the start of the largest single investment in the Pharmaceutical Benefits Scheme with subsidies granted to three new medicines. However, experts are also concerned that many of the 230,500 Australians living with hepatitis C are still “completely unaware of the new treatments or the enormous benefits they offer.” Read more
Gardasil creator is testing a DNA vaccine to wipe out cervical cancer-causing HPV virus One in four adults have had the cervical cancercausing human papillomavirus at one point in their lives, but a new breakthrough led by the creator of the Gardasil vaccine could stop the virus before it causes cancer. Professor Ian Frazer won the Australian of the Year award for the creation of the Gardasil vaccine, which gives immunity from about 75% of human papillomavirus (HPV) strains and now he's working on another vaccine to treat those who are already infected. Read more
Stem cells used to regrow damaged knee cartilage in world-first trials Melbourne researchers have pioneered a new stem cell treatment that could replace surgery for problematic joints. Doctors claim to have halted damage caused by degenerative conditions and even reversed it. The therapy involves a liposuction procedure to take and separate stem cells from a patient's fat, then storing, duplicating and testing those cells. The cells are then injected into the damaged joint - usually knees, but also possible with hips, shoulders or ankles. Read more
World WHO supports Fiji's health needs caused by Tropical Cyclone Winston
Type 1 diabetes 'could boost cancer risk'
In response to Fiji's call for international assistance in the aftermath of Tropical Cyclone Winston, the World Health Organization (WHO) is providing emergency medical supplies and additional personnel to support Fiji as it organizes relief efforts for the survivors. Fiji has declared a State of Emergency.
Insulin-dependent, or type 1, diabetes may increase the risk of some cancers and reduce the chances of developing others, new research has shown. The disease, marked by an inability to produce the hormone insulin, is associated with an increased risk of cancers of the stomach, liver, pancreas and womb, scientists found. But it was also linked to reduced rates of some other cancers including two of the most common affecting women and men – breast and prostate.
“While damage and needs assessments are ongoing, we anticipate that health needs will include access to clean water, trauma care, detecting and controlling increased communicable disease transmission, food safety, continuity of chronic disease case management and psychosocial support,” said Dr Liu Yunguo, WHO Representative to Fiji. Read more
Ministers pledge to improve access to vaccines at first-ever Ministerial Conference on Immunization in Africa With one in five African children lacking access to all needed and basic life-saving vaccines, ministers of health and other line ministers countries committed themselves to keep immunization at the forefront of efforts to reduce child mortality, morbidity and disability. At a landmark Ministerial Conference on Immunization in Africa held from 24-25 February, in Addis Ababa, Ethiopia the ministers signed a declaration to promote the use of vaccines to protect people of all ages against vaccine-preventable diseases and to close the immunization gap by 2020. Read more
Nurses are first point of care, education and community resilience to Zika virus, says ICN As the largest group of health professionals in the world, and the first point of care for many, nurses are key to educating patients on prevention and risk of the Zika virus and providing care to those who need treatment, says the International Council of Nurses. “With nurses providing the majority of primary health care in most countries, it is important they are aware of the risks of the virus, the ways to prevent its spread, and when testing and treatment are needed,” said Dr Frances Hughes, ICN’s Chief Executive Officer. Read more
Scientists strengthen link between Zika virus and temporary paralysis Scientists may have the first evidence that Zika can cause temporary paralysis, according to a new study of patients who developed the rare condition during an outbreak of the virus in Tahiti two years ago. Zika is currently spreading with alarming speed across the Americas. WHO declared the epidemic to be a global emergency several weeks ago based on suspicions it may be behind a surge in disturbing birth defects and in Guillain-Barre syndrome, a neurological illness that mostly lasts a few weeks. Read more
Aus tr alian C ollege of Nur sing Update ACN media submission: Older Australians must have real choice on care
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ACN NURSING & HEALTH EXPO 2016
The Australian College of Nursing (ACN) recently released a media statement welcoming the proposed Federal Government reforms designed to give older Australians greater choice and control over aged care services, but wants assurances people will not be worse off under the new system. “A person-centred approach to care can have many advantages,” Chief Executive Officer of the Australian College of Nursing, Adjunct Professor Kylie Ward said. “We want to ensure these advantages are optimised and risks addressed.” Read the full media release on the ACN website.
Do you have plans for International Nurses Day? Register your workplace, university or community centre as an ACN National Nurses Breakfast host and you will receive a free hosting kit full of materials to help theme and decorate your venue. The ACN National Nurses Breakfast is the perfect opportunity to come together with friends and colleagues to celebrate International Nurses Day and the invaluable contribution nurses make to the health of our society. Visit ACN’s National Nurses Breakfast page to find out more and register your event today.
If you are a nurse working in a general practice setting, the Nursing in General Practice (NiGP) Handbook is essential reading, and it’s FREE. The NiGP handbook was developed by the Australian College of Nursing to provide up to date and useful information about nurse and specialist nurse practitioner roles in contemporary general practice settings. It contains details about employing and supporting RNs and ENs, the current regulatory environment, how to maximise the benefits, including the Practice Nurse Incentive Program and the range of MBS items that support nursing services in general practice. Click here to order your FREE printed copy today. Click here to download a PDF version
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Saturday 16 April 2016 8.30am – 2.30pm Melbourne Convention & Exhibition Centre
A blemish in Australia’s cosmetic surger y industr y By Anita Pak and Liza Edwards MACN, ACN Policy Team
Australia’s cosmetic surgery industry is thriving. The Australasian College of Cosmetic Surgery (ACCS) census for 2012-2013 suggests that the number of some cosmetic procedures is growing by up to 30% each year1. Given the increasing popularity of cosmetic medicine, there have been recent calls for regulation in the industry to be improved. The term ‘cosmetic surgery and procedures’, also referred to as aesthetic surgery, refers to a surgical procedure that “revises or changes the appearance” of a body part and may include changing the “colour, texture, structure or position of normal bodily features”.2 There are also many treatments which alter the structure of body tissues without the need for surgery. The most common non-surgical procedures include the “administration of dermal filler and or muscle relaxants into the face for loss of volume, noninvasive facial rejuvenation, chemical peels and skin resurfacing”.3
1 Hudson, L 2013, Rising Costs of Cosmetic Surgery, The Australian, viewed 10 February 2016, http://www.theaustralian.com.au/news/rising-costs-of-cosmeticsurgery/story-e6frg6n6-1226717854478. 2 Medical Board of Australia 2015, Public Consultation Paper and Regulation Impact Statement- Registered Medical Practitioners Who Provide Cosmetic Medical and Surgical Procedures, MBA, VIC Australia. 3 Choice 2014, Looking for a lift, viewed 10 February 2016, https://www.choice. com.au/health-and-body/beauty-and-personal-care/skin-care-and-cosmetics/ articles/cosmetic-surgery-not-all-pretty.
Cosmetic surgery differs from plastic surgery as it is normally initiated by the consumer for aesthetic reasons while plastic surgery is typically focused on repairing a defect to restore normal function.45 Importantly, plastic surgeons may perform cosmetic procedures but they are not classed as cosmetic surgeons.6 Whilst plastic surgery and cosmetic surgery are two closely interrelated disciplines, the training and certification pathway varies significantly for each field. Determining what standards should be expected of cosmetic surgery providers has significant challenges for the general consumer. Cosmetic surgery is not recognised by the Australian Medical Council (AMC) as a medical speciality but is considered a field of practice for which there is currently no minimum qualification or level of training. As a result, practitioners may have varying levels of experience and expertise, the skill of which may be difficult for prospective patients to identify. Unlike other specialty colleges that require applicants to gain formal qualifications in order to admit them as members, membership to the ACCS is not recognised by the Australian Medical Council as signifying a minimum level of education or specialist training.
4 Choice 2011, Hoping to turn back time? , viewed 8 February 2016, https://www. choice.com.au/health-and-body/beauty-and-personal-care/anti-ageing-treatments/ articles/non-surgical-antiageing-treatments. 5 American Board of Cosmetic Surgery 2016, Cosmetic Surgery, Plastic Surgery- What’s the Difference?, viewed 8 February 2016, http://www. americanboardcosmeticsurgery.org/patient-resources/cosmetic-surgery-vs-plasticsurgery/. 6 Choice 2014, Looking for a lift, viewed 10 February 2016, https://www.choice. com.au/health-and-body/beauty-and-personal-care/skin-care-and-cosmetics/ articles/cosmetic-surgery-not-all-pretty.
“The fast paced growth of the (cosmetic) industry, due to the ever increasing demand requires the industry workforce to redesign their scope of practice in a world where professional regulation and related legislation often do not keep pace” The exact numbers of nurses working in the area of cosmetic nursing in Australia is unknown with neither the Nursing and Midwifery Board of Australia or the Australian Institute of Health and Welfare maintaining such detailed data, however it is estimated to be in the hundreds.7 Nurses working in this area practice under various titles including ‘Cosmetic Nurse’, ‘Aesthetic Nurse’ or ‘Nurse Injector’, with the scope of practice varying widely.
British Association of Cosmetic Nurses (BACN) was established in 2010 and, similarly to medical colleges, stipulates minimum education requirements, competency and training requirements.9 These positive steps to clarify minimum standards provide a framework for nurses to confidently and safely develop their scope of practice within a supportive professional framework and perhaps highlight the next steps for cosmetic nursing in Australia.
The context of care for these nurses is becoming increasingly varied, some practice independently in nurse led clinics and others in multidisciplinary environments.8 The fast paced growth of the industry, due to the ever increasing demand requires the industry workforce to redesign their scope of practice in a world where professional regulation and related legislation often do not keep pace. For nurses, this can create a blurring of lines making it difficult to ensure they remain supported by their professional regulatory framework.
Currently the majority of both undergraduate nursing and advanced practice degree courses do not include cosmetic medicine as a specialty option. There have been several reviews undertaken in the Australian context that have considered these issues in relation to cosmetic surgical and medical procedures, however these have largely referred to medical practitioners working in the area.10
The recognition and regulation of nurses working within the area of cosmetic medicine differs across the world. Both the United Kingdom (UK) and the United States of America (USA) have recognised that nurses employed in the area of cosmetic medicine form a unique professional cohort. As such, the 7 O’Keefe, E & Hoitink, S. 2013, Cosmetic nursing: Pioneering a cosmetic, skin rejuvenation and aesthetic nursing model of practice, Australian Nursing Journal. vol. 21, no. 2, pp. 36-37. 8 The Right Medicine 2015, Professional Practice Standards and Scope of Practice for Aesthetic Nursing Practice in Australia, viewed 10 February 2016, http://www.accs.org.au/pdf/DRAFT-FOR-CONSULTATION-Professional-PracticeStandards-Scope-Practice-Aesthetic-Nursing-Practice-in-Australia-20150501.pdf
The most recent development for cosmetic nursing has been the release of the draft document Professional Practice Standards and Scope of Practice for Aesthetic Nursing Practice in Australia by The ACCS in 2015. The draft consultation standard is the first of its kind in Australia, and aims to set a benchmark for nursing care delivered in cosmetic medicine and surgery.11
9 Ibid. 10 New South Wales Government 2015a, Cosmetic Surgery and The Private Health Facilities Act 2007: The Regulation of Facilities Carrying Out Cosmetic Surgery: Discussion Paper, NSW Australia 11 Ibid.
The draft document acknowledges that an education and training pathway should be developed to guide industry standards, minimum education requirements and guide best practice. Moving forward, it is vital for nursing to maintain this position and continue to lead the development of professional standards in cosmetic nursing and articulating the scope of practice. It is not unexpected, given the rapidly increasing number of cosmetic providers offering services in a largely unregulated environment, that a number of potentially unsafe practices have been highlighted. Most commonly related to the use of laser and intense pulse light therapy (IPL), these practices are often a result of the substandard education and safety training of operators. It is estimated there are between 2,600-5,000 laser operators in Australia including doctors, registered or enrolled nurses, dermal and or beauty therapists and tattoo removalists with some operators having limited or no training at all. The standard of qualifications in laser operation vary enormously. Training is often provided by manufacturers and distributors, however very few formal training programs are available. Currently only Queensland, Tasmania and Western Australia regulate operators of class 3B and 4 laser. Lasers used for common cosmetic purposes such as hair removal can cause adverse side effects and can cause significant injury such as severe blistering and permanent scarring. Data from 59 NSW hospitals showed that in a five-year period to 2012 that “the face was the most common area where injuries were reported from the misuse of an IPL device”.12
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12 Australian Radiation Protection and Nuclear Safety Protection Agency 2015, Intense Pulsed Light Sources (IPLs) and Lasers for Cosmetic or Beauty Therapy Consultation Regulatory Impact Statement, ARPANSA, NSW Australia.
ACN believes it is critical that the nursing profession in Australia takes the lead in this space. Nurses must work collaboratively to define a model of practice and thus a professional organisation to support nurses working in cosmetic medicine. ACN would welcome and support those nurses working in this rapid growing industry, to create a community of interest. Please email your expressions of interest to email@example.com
Untrained operators may rarely have professional indemnity insurance which provides the consumer with little protection should injury occur. Furthermore, cosmetic procedures are not normally carried out in the traditional hospital setting, rather in private clinic facilities. In most states the type of procedure that can be carried out in a private clinic setting is only governed by the level of anaesthesia used. For example, under the Private Health and Facilities Act (NSW) and Regulation, facilities carrying out cosmetic surgery are required to be licenced if patients are sedated resulting in more than conscious sedation or if patients are administered a major regional, general or epidural anaesthetic. Likewise, there are no guidelines which outline what equipment, quantities and combination of drugs and staffing levels are required which has serious implications in the case of emergency.13 Inappropriate prescription practice and use of cosmetic injectables remains a further source of concern. Cosmetic injectables are a non-surgical treatment which can be used to restore volume and reduce wrinkles in the skin. The prescription and use of these drugs is classified under the Poisons 13 New South Wales Government 2015a, Cosmetic Surgery and The Private Health Facilities Act 2007: The Regulation of Facilities Carrying Out Cosmetic Surgery: Discussion Paper, NSW Australia.
Schedule as Schedule Four (S4) drugs. This includes cosmetic injectables such as botulinum toxin (Boxtox, Dysport), hyaluronic acid (Juvaderm, Resylane), Poly-Lactic Acid (Sculptra) and other non-permanent fillers and lignocaine. All Australian States and Territories have independent Drugs and Poisons legislation. For example, in New South Wales (NSW) the Poisons and Therapeutic Goods Act (1966 no 31) authorises a registered nurse to administer a S4 drug when a medical practitioner is not present only if the patient has been previously assessed by a doctor and a prescription and patient specific authorisation to administer the drug has been provided.14 Similarly, in Victoria (VIC) the Drug Poisons and Controlled Substances Act (1981) has no legislative restriction preventing a nurse from administering an S4 drug such a botox so long as the patient has been reviewed by a doctor and a prescription issued 1516 Therefore nurses who perform injections of S4 medications without a patient having been assessed 14 Australian College of Aesthetic Medicine 2015, ACAM Submission to AHPRA May 2015, Consultation- Cosmetic medical and surgical procedures provided by medical practitioners, ACAM, NSW Australia. 15 Stark, J 2009, Nurses hold Botox ‘parties’, The Sydney Morning Herald, viewed 29 February 2016 at http://www.smh.com.au/national/nurses-hold-botox-parties20090822-eue9.html 16 Drugs, Poisons and Controlled Substances ACT 1981 (VIC), viewed 29 February 2016, http://www.austlii.edu.au/au/legis/vic/consol_act/dpacsa1981422/
by a medical officer and a prescription issued, may be in breach of the relevant Poisons Act in effect in each state. Unregistered individuals such as beauty therapists are not allowed to administer S4 medications. It is imperative the nursing and medical profession continue to collaboratively work towards stricter regulation of cosmetic injectables. This would allow for a clear professional code of conduct to be established. Most recently, NSW Minister for Health, Jillian Skinner, has supported an initiative by the NSW Government to release a discussion paper proposing tighter regulation of cosmetic services. It is evident that there is work to be undertaken that informs both government and relevant professional bodies of the need to establish clear guidelines regarding minimum standards in cosmetic medicine.17 Cosmetic nursing is an exciting emerging field of practice for nurses. It is important those minimum standards in cosmetic medicine to ensure congruence with existing professional, legislative and regulatory requirements.
Trainers and Assessors do you meet the new Adult learners’ LLN requirements? In the ever-changing and diverse work environment, plus with the growing numbers of Assistants in Nursing in the workforce, being able to address issues in language, literacy and numeracy skills is becoming more and more challenging. The National Foundation Skills Strategy for Adults (2012) requires that all trainers working in the Australian VET system have the skills and knowledge to support the development of adult learner language, literacy and numeracy requirements. If you hold a Certificate IV in Training & Assessment completed prior to 2014, you may need to update your qualification to include the unit of competency TAELLN411 Address adult language, literacy and numeracy skills, offered by The Australian College of Nursing (ACN). This single unit of competency can be completed as a stand-alone unit via distance or face to face learning. Completing it will allow you to recognise core language, literacy and numeracy demands when conducting training and assessment. The cost is $275.00* and the unit is offered 7 times per year. For more information go to www.acn.edu.au/rto or call our Customer Service team on 1800 265 534
17 New South Wales Government 2015b, Cosmetic Surgery Industry Under Spotlight, media release, 9 Dec 2015, viewed 10 February 2016, http://www.health. nsw.gov.au/news/Documents/20151209_00.pdf
* Subject to change
Be inspired by The Power of N ow at the 2 016 National Nur sing Forum
The National Nursing Forum, which in 2016 will be held in Melbourne on 26â€“28 October, is ACNâ€™s signature annual event bringing together nurses from around the country. Our theme this year, The Power of Now, will explore where we are as a profession and how we operate as teams and as individuals. We will look at the current and most vital issues nurses are facing and the creative way nurses are leading necessary reform. As nurses we lead busy lives and The Power of Now brings us back to the moment of being mindful and self-aware and offers an opportunity to take a closer look at our own wellbeing. This creates a flow-on effect that has a positive impact on what we have to offer in our everyday lives. Our ability to have the confidence to know and trust in ourselves helps us to constantly evolve as leaders so that we can be our best selves every day. Moreover, we are better poised
to provide care for our patients, clients, residents and communities. ACN invites oral and poster abstract submissions for the Forum program from across the nursing profession in health and aged care, education, management, academia, clinical or research areas that address the most current and topical issues affecting nursing today. Abstracts can be strengthened by identifying a clear link to the Forum theme, The Power of Now. Submissions close on 8 May 2016. We look forward to welcoming you to our key annual event in Melbourne this October.
Submissions close on 8 May 2016 View the abstract guidelines
Go to acn.edu.au/nnf2016 register Early bird registrations close 31 August 2016
AC N voices – meet our represent atives Everyday somewhere around the nation, an ACN representative is making sure our collective voices are heard. ACN representatives ensure that the views of the nursing profession are at the forefront of health care decision making.
“Patient experience is sometimes underrated and I feel excited and inspired to contribute my expertise to this important Australian initiative.”
We harness the expert knowledge, experience and insights of our members and through ACN representation activities we facilitate the vital conversations about health and aged care and the leading role that nurses play in designing health care models and giving care. One of our amazing member benefits is that you too can offer your expertise and become an ACN representative. Keep your eye out for our representation calls for expression of interest promoted through our weekly eNewsletter – we look forward to your future engagement with ACN Representation. Meet two of our valued member representatives who are making a difference through their active participation in ACN representation activities.
If you are interested in future representation opportunities with ACN, please email firstname.lastname@example.org
for the Centre for Nursing Research at Sir Charles Gairdner Hospital. In my PhD (2003) I developed a substantive theory regarding the experience of hospitalised patients and have subsequently developed two research instruments: the “PEECH” (Patient Evaluation of Emotional Care experience in Hospital) and the “PEECE” (Patient Evaluation of Emotional Comfort Experienced). Dr Anne Williams MACN
Dr Anne Williams MACN What committee are you representing ACN on? I am currently representing ACN as the nursing representative on the Australian Commission on Safety and Quality in Health Care, Hospital Patient Experience Expert Advisory Group (EAG). What led to your interest in this area? I am an experienced nurse researcher and have been researching in the area of patient experience for over 20 years, specifically regarding the relational and psychosocial aspects of patient care. I am the Professor of Health Research at Murdoch University in Perth, and maintain my links to acute care clinical nursing working as a Research Consultant
How important is this ACN representation opportunity to you and how has this opportunity benefitted your career? It is a great privilege for me to represent ACN on this group. Patient experience is sometimes underrated and I feel excited and inspired to contribute my expertise to this important Australian initiative.
What is the most recent work out of the Expert Advisory Group and what major items have been discussed? The advisory group has been established to develop two questionnaires to measure Australian patient experience in hospital and day procedure. At the first meeting the project design and methodology were discussed, and the findings from work-to-date presented. Can you highlight the benefits arising for the profession as a result of the work of the EAG? Representation of the nursing profession on this advisory group is vitally important. The nature of nursing work provides us with substantial knowledge and insight about the experience of patients. The national focus on this area of health care is likely to have upshots for nursing and positive implications for patients.
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“To have the opportunity to be involved in such an important education strategy at a national level is both satisfying and rewarding”
Do you want to further your career and become an assessor, facilitator, educator or trainer?
Due to my skills in haematology nursing and curriculum development the Committee invited me to join a working party to identify the key learning areas for the national educational framework/curriculum for medical practitioners, nurses, health professionals, stakeholders and consumers in relation to patient blood management and safe transfusion practice. What led to your interest in this area? Christine Mackey MACN
Christine Mackey MACN What committee are you representing ACN on? I represent ACN on The National Blood Authority National Education and Training (NEAT) Committee and have been working with the committee since July 2014. The role of the committee is to develop a national education and training strategy to promote best practice and collaboration within the blood sector and to reduce duplication of education materials. The goal of the committee is to develop an educational framework that identifies the essential, skills and knowledge required by health professionals at particular stages in their career, in relation to safe practice in transfusion medicine and patient blood management. The framework aims to identify the key learning priorities (KLPs) for the next three years based on a defined set of criteria and develop an action plan to develop resources and tools to support the implementation of the strategy.
With a nursing career in haematology nursing of over 30 years and experience in higher education teaching postgraduate nursing for 15 years, this was a perfect opportunity to use my skills on a project combining both my passions. I was working as the postgraduate program coordinator at the ACN at the time the expression of interest was advertised and had experience with curriculum development which was one of the skills the NEAT Committee were seeking in addition to haematology. What is the most recent work out of the committee and what have been the major items discussed? The NEAT project aims to develop national standards, competencies and information needs to support best practice relevant to transfusion and patient blood management. At present the overall structure of the framework is drafted and scoping is underway with the medical practitioners soon to be followed by nurses and other health professionals.
Can you highlight the benefits arising for the profession as a result of this committee? Establishing national standards of education and safe practice for blood product transfusion and patient blood management will benefit all levels of nurses and assist those with an extended scope of practice. In this current climate of change and our increasing quest for evidence based practice, it is hoped that this will lead to improved patient outcomes. How important is this ACN representation opportunity to you and how has this opportunity benefitted your career? To have the opportunity to be involved in such an important education strategy at a national level is both satisfying and rewarding. I feel I have made a real contribution not only to the nursing profession but the wider community. The experience has inspired me to undertake a PhD at Edith Cowan University in Perth, WA, where I am currently working part-time as a senior project officer in the School of Nursing and Midwifery.
Build your skills and knowledge and gain a recognised qualification in health care workplace training with a Certificate IV from the Australian College of Nursing. ACN offers the TAE40110 Certificate IV in Training and Assessment, a nationally recognised qualification that has been customised especially for Health Care workers including nurses. This course enables those working in health to gain knowledge and skills in planning, designing, implementing and reviewing training and assessment within the VET and workplace context. The Australian College of Nursing (ACN) also offers a single unit of competence TAELLN411 Address language, literacy and numeracy skills and an Assessor Skill Set of three core units (TAESS00001). These are offered via distance or face to face learning throughout the year, currently there are 5 intakes annually. We also offer RPL and upgrades of previous qualifications. Prices: TAE40110 Certificate IV Training and Assessment face to face (Parramatta Campus**) – $2150.00* TAE40110 Certificate IV Training and Assessment distance – $1950.00* A single unit of competency – $275.00* TAESS00001 Assessor Skill Set – $820.00*
For more information go to www.acn.edu.au/rto or call our Customer Service team on 1800 265 534 * Subject to change ** Minimum numbers required – face to face can be delivered in your workplace prices on application
Informing wise choices across the health care sys tem The Australian College of Nursing (ACN) is preparing to put forward its recommendations as part of Choosing Wisely Australia’s Wave II launch in March. ACN Member Engagement Manager Colleen Kinnane MACN gives us a wrap-up of ACN’s participation so far.
Australia has joined the multinational Choosing Wisely campaign to focus on health consumer and health care professional choices when it comes to provision of services, treatments, diagnostic tests and clinical interventions. The ultimate aim of this campaign is to improve the quality of care for consumers across the health system by reducing unnecessary or ineffective tests and interventions that research has proven lead to minimal or no improvement and may occasionally cause harm. The campaign began in the USA in 2014, moved to Canada, then Europe and is now in Australia. The Australian campaign began with six medical colleges in April 2015 and is about to launch Wave II in March 2016 with a more diverse group of health professionals. This group is focused on the important conversation with health consumers about making wise choices through informed critical decisionmaking. These ‘wise choices’ have the potential to improve the quality of care outcomes by eliminating unnecessary and sometimes harmful tests, treatments and procedures. In September 2015 ACN as nursing lead, established a collaborative working party incorporating a diverse range of nursing expertise. Professional nursing
bodies involved in initial collaboration included the Congress of Aboriginal and Torres Strait Islander Nurses and Midwives (CATSINaM), CRANAplus, Australian Primary Health Care Nurses Association (APNA) and the Australian College of Mental Health Nurses (ACMHN). ACN’s membership was also consulted via its publications and website, and at its annual event, the National Nursing Forum. This consultation provided a broad view from nurses, in particular our members, regarding planning and delivery of nursing care across Australia. An interactive session at the Forum invited delegates to actively participate in identifying those nursing practices, interventions or tests that evidence shows provide no benefit or may even lead to harm. As a result, ACN identified ‘Top Five’ recommendations, which aim to encourage a dialog between health professionals and consumers leading to carefully considered choices regarding health outcomes. At this point, specialist nursing groups were approached for comment on our recommendations. This group included the Australasian College for Infection Prevention and Control (ACIPC), the Australian Diabetes Educators Association (ADEA),
Choosing Wisely Australia’s Program Implementation Manager, Dr. Robyn Lindner, addresses the ACN interactive session at the 2015 National Nursing Forum.
the Continence Nurses Society Australia (CNSA), the Australian and New Zealand Urological Nurses Society (ANZUNS), the Medical Imaging Nurses Association (MINA), and the Australian and New Zealand Orthopaedic Nurses Association (ANZONA). Final consultation with ACN Members and Fellows prior to submission has ensured a collaborative result. Since the Forum in October, the ACN Policy Team has been very busy reviewing available supportive evidence for these nursing interventions. Our recommendations and the supportive evidence can now be submitted to Choosing Wisely Australia for inclusion in the Wave II launch and publication via their website. After the national launch in Sydney, which will be attended by ACN’s President Adjunct Professor Kathy Baker AM FACN (DLF) and ACN’s CEO Adjunct Professor Kylie Ward FACN on 16 March 2016, ACN will share its final five nursing recommendations and more than 50 tests, treatments and procedures that are of proven low value or carry an unnecessary risk identified by the other participant health professional groups.
Wave II includes 14 health professional colleges, societies and associations: • The Royal Australian and New Zealand College of Ophthalmologists • Australian College of Nursing • College of Intensive Care Medicine of Australia and New Zealand • Australian and New Zealand Intensive Care Society • Australian Physiotherapy Association • The Society of Hospital Pharmacists of Australia • Royal Australasian College of Surgeons • Australasian Society for Infectious Diseases • Endocrine Society of Australia • Haematology Society of Australia and New Zealand • Australian and New Zealand Society of Palliative Medicine • Australasian Chapter of Palliative Medicine • Australasian College of Dermatologists
Reflec tion on s tomal ther apy nur sing – a s tudent ’s per spec tive Deborah Townsend RN, an ACN Graduate Certificate in Stomal Therapy Nursing student shares her reflective essay on her experiences while on a nursing placement.
‘Critical thinking and analysis’ is a requirement of the Nursing and Midwifery Board National Competency Standards for the registered nurse (July 2010, NMBA). It recognises the need of the registered nurse to be able to reflect on their feelings, beliefs and practice. This analysis helps the professional understand the nature of their work and adopt a critical approach to their professional activity (cited in Gimenez, Gould and Masters 2004, p.69, 2011). I readily identify with this standard as I personally reflect, as a registered nurse, undertaking postgraduate studies in Stomal Therapy Nursing. Reflection will be detailed by following the framework of Rolfe, Freshwater and Jasper (2002) using Barton’s (1970) developmental model, in which I discuss and review an experience undertaken during my clinical placement in a tertiary institution whilst working with a Stomal Therapy Nurse (STN) specialist.
What? For me I have viewed the role of an STN as a person who assists people with their bags; the person called when staff don’t want to deal with a stoma and do the unpleasant work. It was both satisfying and rewarding for me to recognise how valuable and significant the stomal therapist nurse is to the medical profession, patients and community.
Langford-Edmonds (2011) highlights the multifaceted role the stomal therapy nurse has evolved to, being that of a clinical leader, researcher, counsellor, teacher, advocate, inventor, administrator, appliance expert, consultant and agent of change. This role was evident to me when the STN and I attended a patient, an elderly gentleman, who was recovering postsurgery following the formation of an ileostomy. For the purpose of this essay I will refer to him as Mr R. The STN and I were aware of the need to review Mr R to follow up and assess his condition from his recent formation of an ileostomy. It had been noted that he had been having high faecal output, in the days prior to seeing him, of up to 2800mls within 24 hours. Mr R was being nursed in the ward environment in a fourbedded room sharing with three other men. When the STN and I approached Mr R at 0900 he was sitting on a hard plastic chair at the bedside. His bed was wet and unkempt and his clothing was soiled. Mr R spoke very softly and in limited English. He informed us that he had been sitting in the chair all night as the bag leaked and it had not been changed. On examination of Mr R’s appliance, which was attached to an overnight bag, showed that it was leaking at the connection site. When assessing the volume of output from the ileostomy it was noted that there had not been any documentation on the fluid balance chart for the past 16 hours. Whilst the STN investigated his fluid balance, reading the medical records and accessing pathology results, I facilitated in getting Mr R as comfortable as possible, by making his bed, assisting him in to it, providing him with privacy and hydration. He then indicated to me if I
could close the curtain a little further between his neighbour and him as the light had come through all night, and he had gotten little sleep. Once Mr R was warm and comfortable the STN and I addressed the care of his ileostomy, assessing the stoma and peristomal wound, changing the bag and establishing a more effective drainage system for overnight. The STN was able to engage in conversation with Mr R in the language he was fluent in. The STN followed up his care by speaking with the medical team in regards to Mr R’s high faecal output and documenting her assessment and care in the medical notes. My role, during this clinical placement was to work alongside the STN engaging in the care and management of patients with ostomies. I was to achieve experience, involvement, and complete competencies pertaining to stoma care in the ostomy patient. I feel that with our participation and involvement in Mr R’s care we accomplished this, however, I have mixed feelings stemming from this encounter. I recall having feelings of compassion, frustration, disappointment and annoyance, upon seeing the condition and state Mr R was in. I felt that Mr R was not treated with dignity and respect and I was frustrated and saddened that he was not cared for in a manner that met my expectations of adequate and complete nursing care. I question myself as to why people do not seem to have the same values I have. Further frustration and disappointment developed when reviewing the fluid balance chart and noting
ACN student Deborah Townsend
the lack of care taken in its documentation. I find it hard to understand why some staff are unable to document effectively when the situation necessitates, i.e. a sick patient whose fluid balance is compromised and requires accurate record keeping. Is it due to their lack of knowledge, possibly a breakdown in communication or something else? My feelings of frustration abated when the STN engaged with Mr R in his foreign language and he could discuss issues and express himself. It was a positive feeling to see the STN promoting and encouraging Mr R’s ongoing management and care with nursing and medical staff. The experience highlighted for me the substantial benefits to the patient if one can communicate in their language and I was further educated on product and appliance choice for managing a high output stoma. It was both a joy and a relief to see Mr R have his needs met and know that a specialist nurse, the STN was watching out for him.
“It was both satisfying and rewarding for me to recognise how valuable and significant the stomal therapist nurse is to the medical profession, patients and community.”
So what? The experience highlighted for me the valuable role the STN has when effective clinical decisions are required to ensure appropriate care and management of the ostomy patient. Crisp and Taylor (2009) recognise that the criteria for decision making should include: What needs to be achieved? What needs to be preserved? What needs to be avoided? The ability to decide on the most appropriate decisions is based on the knowledge and experience of the nurse providing the care. The Australian Association of Stomal Therapy Nurses (AASTN, 2014) details the position of an STN as a specialist role in which the general registered nurse has had further education achieving an advanced level of theoretical knowledge and clinical skills. As per standard one of the AASTN standards (2013), the STN practices at an advanced level ensuring quality outcomes for the patient. This was recognised by the knowledge, ability and experience the STN had in caring for the stoma patient and their role as part of the multidisciplinary team, participating in planning and decision making within Mr R’s care. McDonald (2014) identifies that the management of a patient with a high output stoma can be complex and complicated, requiring all members of the Allied Health team to work together to facilitate an optimal outcome for the patient. Peck et al. (2012) cited in McDonald (2014, p. 646) suggests that the output is considered high when it exceeds 1500ml per day.
Ramifications to the patient from high output losses include: the risk of fluid and electrolyte imbalances and nutritional deficiencies, and the possibility of damage to the skin from the corrosive effluent (Colwell, Goldberg and Carmel 2004). Effective documentation and monitoring of electrolytes, especially sodium and potassium, with appropriate management ensures the maintenance of a stable fluid balance (Farrell 2005 p.1051). When addressing the issue pertaining to Mr R’s fluid balance, I identified that the STN followed standard three of the AASTN (2013) competency standards. A component of standard three details that “The STN provides comprehensive, accurate and systematic, evidence based nursing care with professional autonomy in any practice setting.” This involved a complex review assessing and obtaining, through both observation and data collection, of Mr R‘s condition followed by planning and implementing the appropriate care. The STN further demonstrated AASTN (2013) standard four competency that involves “assessing the individual with their actual and perceived needs, providing a record keeping system, maintaining confidentiality with documentation in the patient notes.” The STN was able to address the problem that Mr R had of his leaking appliance system and manage it appropriately. AASTN (2013) standard three recognises that the STN will “use evidence, based on best practice, personal observation and experience to plan,
conduct and evaluate practice in ways which incorporate complexity.” In regards to Mr R’s care this standard was evident when the STN attended care of the ileostomy, sourced alternative products to manage the leaking appliance and informed the nursing staff as to how to utilise it effectively. Facilitating ongoing education of ward staff, the patient and his care giver on these appliances pertained to AASTN (2013) standard four that requires the STN to “assist individuals, significant others and communities to achieve optimal levels of wellness though health education and promotion.” The STN was communicating effectively and professionally to all the relevant people involved. Zamanzadeh et al. (2014) suggests that the establishment of a positive relationship between nurse and patient has both positive and beneficial influences for the patient. Instituting effective communication is required, for this to develop successfully. Breakdowns in communication can result in a reduced quality of care for the patient thus leading to poor outcomes for the patient and patient dissatisfaction in the health care system (Zamanzadeh et al. 2014). AASTN (2013) standard two identifies that the stomal therapy nurse use effective communication to foster collaborative relationships between the patient, health care team and health care services. I recognised the STN addressing the structure and process criteria of this standard when she attended to Mr R. Sufficient privacy was maintained, he was made comfortable in his environment, shown respect and dignity and appropriate communication skills and strategies were used. Crisp and Taylor (2009) affirm that people communicate through use of words, tone of voice, movements, facial expressions, and use of space. The STN was proficient in the foreign language that
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Mr R spoke, therefore Mr R was able to effectively communicate his questions and concerns and was able to understand his management and plan of care. This was evident to me by observing his non-verbal cues of facial expressions and movements. The STN was further able to relay this information to the multidisciplinary team thus addressing the AASTN (2013) competency standard two requiring the STN to: communicate with other health workers pertaining to attainment of optimal health for the patient, acting as advocate for the client within the health care team, intervening appropriately and counselling clients and respecting the right of clients determining the health care requirements. Crisp and Taylor (2009) suggest that physical and emotional health depends on adequate rest and sleep with the nature of an individual’s illness impacting their ability to get sufficient rest. Classens et al. (2015) recognises that the individual with a colostomy or ileostomy, an ostomate, who experiences leakage and ballooning from the appliance during the night, experiences an alteration in their sleep patterns. Further to this, the environment in the hospital ward setting can disrupt the individuals sleep routine. The individual needs to express their needs and the nurse act upon these to provide effective care. Farrington et al. (2014) identifies that barriers can impede this including; the nurses own knowledge, time constraints and how effectively the patient engages with the nurse, especially if a difference in language impairs effective communication. Price (2004) recognises that a person’s culture can produce different responses to pain and the sick role while some may openly express their problems others remain silent. In Mr R’s case the STN isolated competences in the AASTN (2013) standard three which identifies that the cultural and belief systems can influence a patient’s psychological, social and
spiritual functioning all of, which requires assessment of stressors and coping mechanisms of the patient and significant other. Implementation of strategies to support a rested sleep for Mr R were obtained by addressing further competencies in standard three: collaboration with health care professionals and significant others to provide coordinated planned health care and thorough documentation in the medical records pertaining to the client consultation.
Now what? The establishment of an effective management plan for the ostomate requires appropriate nursing care directed to the individual and their needs. The stomal therapy nurse plays a valued and important role in the delivery of optimal efficient and pertinent care to the ostomate by following the standard competencies. Encompassing these standards into the scope of practice of the STN ensures the promotion of best practice and provision of specialist care to the patient. On reflection, in my future practice as a stomal therapy nurse, I acknowledge that my role will be as a highly skilled professional whom partakes in multiple areas as a counsellor, educator, clinician, researcher and advocate for the ostomy patient. I will endeavour to continue to develop and maintain the AASTN professional standards whilst recognising the diversity of the individual and direct care according to their needs, within my scope of practice. References Australian Association of Stomal Therapy Nurses (AASTN) 2013, Standards of Stomal Therapy Nursing Practice, 4th Edn, viewed 26 November 2015 < http://www. stomaltherapy.com/standards_guidelines.php> Classens, I, Probert, R, Tielmans, C, Steen, A, Nilson, C, Dissing Anderson, B and Storling, Z, 2015, ‘The Ostomy Life Study: the everyday challenges faced by people living with a stoma in a snapshot’, Gastrointestinal Nursing, vol. 13, n.5, p.18-25. Colwell, J, Goldberg, M, Carmel, J. 2004, Fecal and Urinary Diversions: Management Principles. Mosby, St Louis. Crisp, J and Taylor, C. 2009, Potter and Perry’s fundamentals of nursing, 3rd edn, Mosby, USA.
Farrell, M. 2005, Smeltzer & Bare’s Textbook of Medical-Surgical Nursing, Australia and New Zealand edn, Lippincott Williams & Wilkings Pty Ltd, Philadelphia. Farrington, N and Townsend, K, 2014,’ Enhancing nurse-patient communication: a critical reflection,’ British Journal of Nursing, vol, 23, n.14, p.771-775. Gimenez, J, 2011, Writing for Nursing and Midwifery students (Palgrave study skills), 2nd revised edn, Palgrave Macmillan, United Kingdom. Langford-Edmonds, S, 2011, ‘Is clinical leadership important to advanced stomal therapy nursing practice? Journal of Stomal Therapy Australia, vol.31, n.1, p.6-9. McDonald, A, 2014, ‘Orchestrating the management of patients with high-output stomas’, British Journal of Nursing, vol.23, n.12, p. 645-649. Nursing and Midwifery Board of Australia (NMBA) 2010, National competency standards for the registered nurse, viewed 26 November 2015 <http:// www. nursingmidwiferyboard.gov.au/codes-Guidelines-statements/> Price, B, 2004, ‘Demonstrating respect for patient dignity’, Nursing Standard, vol.19, n.12, p.45-51. Rolfe, G, Freshwater, D and Jasper, M, 2002, Critical reflection for nurses and the helping professions: a user’s guide, Nursing Standard, viewed 26 November 2015.
Zamanzadeh, V, Rassouli, M, Abbaszadeh, A, Nikanfar, A, Alavi-Majd, H and Ghahramanian, A, 2014, ‘Factors Influencing Communication Between the Patients with Cancer and their Nurses in Oncology Wards’, Indian Journal of Palliative Care, vol, 20,n.1, p. 12-20.
Editor’s note: The Graduate Certificate in Stomal Therapy Nursing provides the opportunity to develop the attributes of a specialist nurse, adopting an active role in stomal therapy, wound management and continence management. The course aims to provide students with the broad theoretical framework for the stomal therapy nurse role and the ability to competently provide comprehensive nursing care for clients who have had, or are about to have, stoma formation, wounds or fistulae.
This highly interactive two day short course for early and mid-career nurses enables participants to build their confidence as leaders and further develop their leadership skills. DATES: 30–31 March 2016 Parramatta NSW 4–5 April 2016 Adelaide SA 18–19 April 2016 Perth WA 3–4 May 2016 Launceston TAS 10–11 May 2016 Canberra ACT
Next intake: July 2016
17–18 May 2016 Darwin NT
For more information, visit the Stomal Therapy Nursing education page on the Australian College of Nursing website, contact 02 9745 7500 or email email@example.com
24–25 May 2016 Brisbane QLD 1–2 June 2016 Melbourne VIC
For more information visit www.acn.edu.au
Professional Development @ACN
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Managing acute mental health-related presentations: equipping all nurses
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The Australian College of Nursing is now offering CPD short courses across the country on a variety of topics to suit nursesâ€™ professional education needs.
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NMB A update NMBA invite you to get up to date and read the newly published revised registration standards and standards for practice
standards that are currently in place. All nurses and midwives will need to meet the obligations of the revised registration standards by the registration renewal period in May 2017.
The Nursing and Midwifery Board of Australia (NMBA) have recently published revised registration standards and standards for practice which will guide Australia’s 370,303 enrolled nurses, registered nurses and midwives in their practice within the Health Practitioner Regulation National Law, as in force in each state and territory (the National Law).
The Registered nurse standards for practice will come into effect on 1 June 2016 and will replace the current National competency standards for the registered nurse.
On the 1 February 2016, the NMBA released the revised registration standards for: • continuing professional development (CPD)
The midwifery specific registration standard and guideline will come into effect on 1 January 2017. More information is available on the NMBA website. The NMBA can assure all nurses and midwives that the new regsitration standards and standards for practice do not apply to renewals of registration in 2016.
• recency of practice • professional indemnity insurance (PII) arrangements, and
• the Registered nurse standards for practice.
Registration standard: Continuing professional development
The NMBA has also published midwifery specific registration standard and guidelines, including the revised:
• Clarity has been provided about the requirement for nurses and midwives who are registered but not working, to complete CPD.
• Registration standard: Endorsement for scheduled medicines for midwives, and
• The requirement for midwives with an endorsement for scheduled medicines to complete an additional 20 hours of CPD has been revised to 10 hours of additional CPD, related to prescribing and ordering of diagnostics.
• Safety and quality guidelines for privately practising midwives. These have been published now to give enrolled nurses, registered nurses, midwives, employers and the public time to understand the updated requirements set by the NMBA become they come into effect. The revised registration standards will come into effect on 1 June 2016 and will replace the registration
Registration standard: Recency of practice • Inclusion of information for nurses and midwives who work in non-clinical practice. • Clarity has been provided about recency of practice requirements for nurses and midwives with an endorsement.
Registration standard: Professional indemnity insurance arrangements • Inclusion of automatic reinstatement. • The definition of ‘run-off cover’ has been amended for clarity. Registration standard: Endorsement as a nurse practitioner • Nurse practitioners are required to demonstrate recency of practice at the advanced practice nursing level to retain the endorsement. • The definition of ‘Program that is substantially equivalent’ has been amended for clarity. Registered nurse standards for practice • The Registered nurse standards for practice now reflect current nursing practice in all contexts. A summary of all the newly published documents and including the registration standards, the standards for practice and supporting guidelines, factsheets and policies can be found on the NMBA website. See also Registration Standards and Professional Codes & Guidelines sections on the NMBA website. The revised registration standards were approved by the Australian Health Workforce Ministerial Council on 27 August 2015 and were part of a scheduled review of registration standards. A public consultation was held as part of the review. The NMBA has published consultation reports providing a summary of the consultation processes and the rationale for any changes. The submissions to the public consultation and consultation reports will be published on the NMBA past consultations page.
NurseClick is the Australian College of Nursing's monthly e-mag focusing on topical articles related to nursing practice, policy development...
Published on Mar 6, 2016
NurseClick is the Australian College of Nursing's monthly e-mag focusing on topical articles related to nursing practice, policy development...