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Books > Medicine > Nursing & ancillary services > Nursing > General
Are you wondering if a career in Mental Health Nursing is right for you? If you are considering studying Mental Health Nursing or have already begun your course this book is the perfect tool to see if you have what it takes to be a Mental Health Nurse. It will tell you what to expect in your studies and address the ups and the downs of becoming a Mental Health nurse. It contains personal anecdotes from students who have already completed their course and advice from Mental Health lecturers on how to get the most out of your studies. This book will guide you through your course from beginning to end and prepare you for your future career.
Many professionals confront ethical issues concerning their proper roles and the manner in which they should carry out those roles. This book is aimed at those studying for entry into the various professions (such as teaching or social work) where ethical questions are commonly faced. It introduces readers to both the techniques and depth of ethical argument drawn from the fields of critical thinking and informal logic and enables practitioners to use these techniques so they can be deployed as 'tools of thought' for thinking in a carefully reasoned and extended way about problems of professional ethics. The book also provides a brief introduction to some of the normative and meta-ethical theory relevant to the principled discussion of professional ethics. Post-graduate students and academics should also find the treatment of some of the complexities of extended reasoning, in particular its focus upon careful metacognitive tracking and planning of an inquiry, to be of interest.
Developing Holistic Care for Long-term Conditions focuses on how to help people with long-term health conditions cope more effectively. It brings together physical and mental health, offering a holistic approach for students and practitioners in a variety of care settings. Comprising four sections, this text introduces the policy and background to caring for people with chronic illness as well as the psychosocial impact of long-term conditions. Essential skills for practice are explored including holistic assessment, symptom control and the promotion of effective partnership between client and carer in supporting coping, recovery and end of life care. There is an emphasis on maximising individual health potential and resilience with the role of nutrition, exercise, complementary therapy and spirituality considered. The focus is on client centred care which addresses the whole person, mind and body. The extensive final section presents examples of key health issues where UK national guidelines have been published including: Long-term neurological conditions Diabetes Mental health Cancer Coronary heart disease Older people This evidence-based book takes note of the relevant National Service Frameworks and offers an informative and pragmatic guide for all those learning about caring for the chronically ill, as well as providing a useful reference work for qualified nurses and allied health professionals.
Developing Holistic Care for Long-term Conditions focuses on how to help people with long-term health conditions cope more effectively. It brings together physical and mental health, offering a holistic approach for students and practitioners in a variety of care settings. Comprising four sections, this text introduces the policy and background to caring for people with chronic illness as well as the psychosocial impact of long-term conditions. Essential skills for practice are explored including holistic assessment, symptom control and the promotion of effective partnership between client and carer in supporting coping, recovery and end of life care. There is an emphasis on maximising individual health potential and resilience with the role of nutrition, exercise, complementary therapy and spirituality considered. The focus is on client centred care which addresses the whole person, mind and body. The extensive final section presents examples of key health issues where UK national guidelines have been published including: Long-term neurological conditions Diabetes Mental health Cancer Coronary heart disease Older people This evidence-based book takes note of the relevant National Service Frameworks and offers an informative and pragmatic guide for all those learning about caring for the chronically ill, as well as providing a useful reference work for qualified nurses and allied health professionals.
This book should prove valuable in relieving stress and anxiety, especially important nowadays as the journey from diagnosis to cure or death is longer due to improvements in medical treatments. Healthcare workers and the general public worldwide would benefit as death is universal. The writing style is engaging and easy to read, yet highly informative. I would recommend this book to my patients and their families and friends. Dr. Suzanne Ward BMED FRAGP General Medical Practitioner Canberra, Australia This easy to read manual is invaluable reading following a life-threatening medical diagnosis. It is a comprehensive, clear and concise guide which can help reduce stress and improve healing potential. Written by a Registered Nurse (ret) who worked in the USA, UK, and Australia, she discusses why expressing fears soon after diagnosis can be beneficial for healing. Whatever the diagnosis, Cancer, Heart Attack, Stroke, Parkinson's Disease, etc., you, your family, friends and colleagues will have worries and fears about your future. Reducing fears and stress early on gives more positive room for healing. This manual is indispensable for Doctors and Nurses, encouraging them to learn why and how discussing fears early on is a positive healing opportunity rather than being negative. Various complementary therapies are discussed to use in combination with traditional medicine, maximizing healing opportunities. While we plan for births and marriages, we find it difficult to talk and plan for our deaths, even though none of us escapes it! This book provides tools and suggestions for preparing Wills, Advanced Directives, and listing assets and wishes at whatever age, the sooner the better. Being prepared makes life so much easier for all. Learn how to live a more content, peaceful life alongside your family, friends, neighbors and globally. Life is not a dress rehearsal. Learn how to live fully NOW.
Named a 2013 Doody's Core Title Winner of an AJN Book of the Year Award of 2009 ""There is little doubt that every ACNP in practice or in
training will want a copy of this reference in their lab coat
pocket." " ""Long overdue-This comprehensive critical care text will fill
the void, especially for nurses advancing from BSN to Advanced
Practice. The authors have covered all the basics and produced a
text that provides a well-rounded knowledge base for critical
care."" This book defines what it means to be a nurse in critical care. With this text, Acute Care Nurse Practitioners (ACNPs) will learn what to expect in the critical care unit, and how to manage various complications with patients in acute and intensive care settings. Significant emphasis is given to the complex pathophysiology and appropriate management of common problems encountered in the critical care environment, including trauma, infections, and disease. One chapter is also dedicated to the medical, legal, and ethical aspects of critical care. "Critical Care" is thus the must-have reference for graduate students as well as for practicing ACPNs. Key topics include:
Winner of an AJN Book of the Year Award for 2009
Designated a Doody's Core Title "Caring for the older adult population is a challenge and the goal of nursing practice is to help preserve or restore an older adult's function and maximize their well-being and quality of life. This book is a wonderful resource for assisted living clinicians and nurses who wish to serve this population. It is well written, easy to read, and well organized so it can be used as a textbook for nursing students in geriatric nursing." Score: 94, 4 stars --"Doody's" "This book, written by and for nurses across the spectrum of nurse providers (advanced practice nurses, delegating nurses, and the direct care workforce), covers all aspects of management as well as the many common clinical problems and syndromes we encounter among older adults. Further, this book proposes wonderful assessment and intervention material that will help the entire health care team keep residents within their AL communities through early recognition and management of acute illnesses. Kudos to our nursing colleagues for editing this publication and may it serve as the useful guide for AL residents across the country." --John B. Murphy, MD This book provides a comprehensive overview of both management activities and clinical competencies for assisted living nurses. The authors provide practical guidelines and decision-making models to help nurses address both the large- and small-scale challenges of their daily practice. With "Assisted Living Nursing, " readers can gain the essential problem-solving and task management skills critical to their daily work. The contributors cover a wide range of topics, including: Management Clinical Practice Ultimately, this book serves as the definitive, one-stop resource, addressing virtually every topic of interest to assisted living nurses.
This new edition of Drug Calculations for Nurses teaches healthcare professionals how to perform drug calculations with confidence and competence. It provides step-by-step guidance to carry out accurate drug calculations, with units and drug strengths clearly explained. This bestselling pocket-size book begins with the basic mathematical skills required to perform calculations, including tips on estimating answers. It then covers drug strengths and concentrations, dosage calculations, IV infusion therapies, and pharmacodynamics and pharmacokinetics. Separate chapters focus on children, adults and the elderly, addressing specific challenges encountered in these populations, with new content on pregnancy, and renal and liver function. Helpful worked examples, key points, and objectives are included in every chapter, and this new edition includes more calculations for prescribing and patient-focused scenarios. The companion website, www.drugcalcsnurses.co.uk, provides a comprehensive test bank, with a pre-test and revision test to identify strengths and weaknesses, along with additional practice questions for readers to test themselves on. Designed for students and practitioners in nursing, midwifery and allied health, this textbook enables readers to improve their numeracy skills for clinical practice and develop their understanding of the broader context for these calculations.
Reflective practice has moved from the margins to the mainstream of professional education. However, in this process, its radical potential has been subsumed by individualistic, rather than situated, understandings of practice. Presenting critical perspectives that challenge the current paradigm, this book aims to move beyond reflective practice. It proposes new conceptualisations and offers fresh approaches relevant across professions. Contributors include both academics and practitioners concerned with the training and development of professionals. Definitions of reflection (which are often implicit) often focus on the individual's internal thought processes and responsibility for their actions. The individual - what they did/thought/felt ? is emphasised with little recognition of context, power dynamics or ideological challenge. This book presents the work of practitioners, educators, academics and researchers who see this as problematic and are moving towards a more critical approach to reflective practice. With an overview from the editors and fourteen chapters considering new conceptualisations, professional perspectives and new practices, Beyond Reflective Practice examines what new forms of professional reflective practice are emerging. It examines in particular the relationships between reflective practitioners and those upon whom they practise. It looks at the ways in which the world of professional work has changed and the ways in which professional practice needs to change to meet the needs of this new world. It will be relevant for those concerned with initial and ongoing professional learning, both in work and in educational contexts.
Saunders Review Cards for the NCLEX-PN (R) Examination have been created to meet the great demand from students and faculty for a convenient, portable way for students to study for the NCLEX-PN examination. The set of boxed review cards consists of approximately 400 cards containing over 800 questions, written in the NCLEX examination format including alternate item formats. The questions, organized by client needs and integrated process just like the latest NCLEX-PN test plan, are on one side of the cards. On the reverse side are the answers, rationales, and codes for cognitive level, content area, and test plan area. A separate section of cards contains a comprehensive exam, including questions from all content areas. UNIQUE! Test-taking strategies for each practice question provide direction and hints to the correct answer. Practice questions include detailed rationales for both the correct and incorrect options. NEW! 1,200 updated practice questions reflect the most recent NCLEX-PN test plan. NEW! Questions organized by clinical area allow you to focus on areas of weakness and use the cards as study aids for your course exams. NEW! Alternate item format question types including multiple response, prioritizing (ordered response), fill-in-the-blank, figure/illustration (hot spot), and chart/exhibit prepare you for the interactive question types on the actual computerized exam. NEW! Increased pharmacology, prioritization, delegation and triage/disaster management coverage reflects the increased emphasis on these topics on the NCLEX-PN. NEW and UNIQUE! Highlighted keywords or phrases in each answer identify a recommended review topic related to the question. NEW and UNIQUE! Highlighted keywords or phrases in each test-taking strategy identify a recommended strategy to approach the question. NEW! Two-color design highlights key content.
Edge Entanglements traverses the borderlands of the community "mental health" sector by "plugging in" to concepts offered by Gilles Deleuze and Felix Guattari along with work from Mad Studies, postcolonial, and feminist scholars. Barlott and Setchell demonstrate what postqualitative inquiry can do, surfacing the transformative potential of freely-given relationships between psychiatrised people and allies in the community. Thinking with theory, the authors map the composition and generative processes of freely-given, ally relationships. Edge Entanglements surfaces how such relationships can unsettle constraints of the mental health sector and produce creative possibilities for psychiatrised people. Affectionately creating harmonies between theory and empirical "data," the authors sketch ally relationships in ways that move. Allyship is enacted through micropolitical processes of becoming-complicit: ongoing movement towards taking on the struggle of another as your own. Barlott and Setchell's work offers both conceptual and practical insights into postqualitative experimentation, relationship-oriented mental health practice, and citizen activism that unsettles disciplinary boundaries. Ongoing, disruptive movements on the margins of the mental health sector - such as freely-given relationships - offer opportunities to be otherwise. Edge Entanglements is for people whose lives and practices are precariously interconnected with the mental health sector and are interested in doing things differently. This book is likely to be useful for novice and established (applied) new material and/or posthumanist scholars interested in postqualitative, theory-driven research; health practitioners seeking alternative or radical approaches to their work; and people interested in citizen advocacy, activism, and community organising in/out of the mental health sector.
Reinforce your understanding of LPN/LVN nursing skills - and prepare for the NCLEX-PN (R) exam! Corresponding to the chapters in Foundations of Nursing, 9th Edition, this study guide provides a variety of exercises to help you review, practice, and apply nursing concepts and principles. Review questions make it easier to achieve the chapter objectives from the textbook, and critical thinking activities help you develop clinical judgment skills. Now with Next Generation NCLEX (R) (NGN)-style case studies and questions, this guide provides you with an effective study tool for the NGN exam. Variety of exercises reinforces student understanding of nursing fundamentals with multiple-choice, matching, and select-all-that-apply questions, as well as crossword puzzles. Critical thinking activities ask students to apply their knowledge to clinical scenarios. Textbook page references are included for questions and activities, simplifying lookup and review. Answer key is provided on the Evolve website for Foundations of Nursing. NEW! Next Generation NCLEX (R) (NGN)-style questions provide practice for the new question formats on the NCLEX-PN (R) exam. NEW! Updated exercises correspond to the new and revised content in Foundations of Nursing, 9th Edition. NEW! Case studies allow students to practice and apply clinical judgment skills.
"Yoga for Nurses provides the means for nurses to support and
enhance our ability to care for ourselves. It gives nurses
information and strategies to deal with the physical and mental
imperatives found in our daily work life." "The first yoga instruction book directed specifically toward nurses....Dr. Kollak...has written a book that assists nurses in taking time to care for themselves. The content in this book could be easily incorporated into a nursing inservice program as a means to prevent on-the-job, stress-related injuries." --Cindy Ann Howell, RN, MS, CNOR, CMLSO Don't let mental stress, chronic pain, and fatigue disrupt your
professional and personal life any longer. Dr. Ingrid Kollak's Yoga for Nurses offers a tested therapy, proven to alleviate physical and mental pain, stress, and fatigue. As a yoga expert and a registered nurse herself, Dr. Kollak can show you how yoga is able to prevent and cure common ailments such as chronic neck and back pain, headaches, sore eyes, and lack of sleep. With this book, you'll learn how yoga works physically to reduce pain by stretching and strengthening muscles made tense from your normal, repetitive work routine. Kollak also shows you how yoga works on a mental level to provide an exceptional anti-stress program. This book, written "by" a nurse "for" nurses, presents a series
of yoga exercises and practices that will allow you to regain your
strength, reduce your physical pain, revitalize your mind, and
transform your entire work experience. Key Features:
Health promotion is an increasingly high profile aspect of a nurse's role -- both in line with health policy and as nursing has shifted from a disease model to a health model. This textbook explores how and why health promotion works in nursing, developing a new framework for understanding the nurse's role and promoting evidence-based practice. Drawing on empirical research and discussing existing theories of health promotion and of nursing, Stewart Piper identifies three principal approaches: * The Nurse as Behaviour Change Agent * The Nurse as Strategic Practitioner * The Nurse as Empowerment Facilitator The book describes the aims, processes, impact and outcomes of health promotion interventions in nursing for each of these models and identifies criteria for evaluating the associated nursing interventions -- enabling clinical judgements about effective practice. Evidence-based examples demonstrate the relationship between health promotion theory and pragmatic applications for nursing throughout. Each chapter includes an introduction, learning outcomes and exercises, making this an essential book for all nursing students studying health promotion.
Reinforce your understanding of drug administration with this practical workbook! Corresponding to the chapters in Mosby's Textbook for Medication Assistants, 2nd Edition, this workbook helps you review concepts and practice the procedures performed by medication assistants. A wide variety of exercises and activities allow you to apply your knowledge to healthcare settings. Not only will you get more out of the textbook, but you will also prepare for certification exams by building on your strengths and improving any areas of weakness. Engaging exercises enhance and reinforce your comprehension with matching, multiple-choice, fill-in-the-blank, and true/false questions. Independent learning activities challenge you to apply your knowledge to practice. Procedure checklists make it easier to learn and practice medication administration skills, and provide helpful self-evaluation. NEW! Updated exercises correspond with the updated drug information and content in Mosby's Textbook for Medication Assistants, 2nd Edition. NEW! Dosage calculation exercises allow you to practice and improve math skills.
The 8th edition of this popular text has been completely revised and updated to include the latest strategies for improving your nursing leadership and management skills. It offers in-depth coverage and practical management strategies for a wide range of workplace issues such as delegation, diversity, evidence-based practice, stress management, quality improvement, legal issues, and recruitment and retention. A detailed analysis of today's nursing environment prepares you to successfully manage in the midst of a nursing shortage and an emerging multigenerational workforce. UNIQUE! A logical organization of 15 chapters separated into leadership and management sections corresponds to the number of weeks in a typical semester. Complete coverage of management issues gives you a solid understanding of financial management, technology, nursing informatics, legal and ethical issues, error reduction, quality improvement, recruitment and retention, and personnel evaluation and development. In-depth discussions of key leadership concepts help you develop effective communication, stress management, and decision-making skills. Information on hot topics such as disaster management and bioterrorism keep you at the forefront of today's complex health care environment. A global approach to nursing management reflects an increasing emphasis on diversity and the evolving clinical environment. Thought-provoking quotations throughout each chapter help relate complex theories and issues to everyday practice. Major Concepts & Definitions boxes outline and summarize the most significant ideas presented in each chapter and help clarify new terminology. Research Perspective boxes in each chapter summarize key nursing management studies, with a consistent format that outlines the purpose, methods, results, and conclusions of each study. Evolve (R) companion website offers practice worksheets, critical thinking activities, and case studies that challenge you to apply new concepts to realistic practice scenarios. Updated two-color design highlights key information for easy reference. Information on succession planning helps you expand the process beyond simply replacing positions to identifying and nurturing a pool of potential candidates for future leadership success. Tables, boxes, and illustrations synthesize and streamline complex issues and theories for quick reference. Expanded online resources give you easy access to self-assessment questions, case studies, and critical thinking activities for further study outside of the classroom.
" O]ffers excellent examples of nurses in action - effectively marrying research evidence and theories of policy influence to achieve policy change. . . .Only when we get the right policy research messages to the right policy makers will there be a real research-policy connection. Hats off to "Nursing Policy Research" authors, contributors and publisher (Springer Publishing Company) for helping move us forward." --Judith A. Oulton Nurse leaders, researchers, and evaluators face a vital problem in the profession: how to successfully translate evidence-based research into health policy. In this book, seasoned researchers share their knowledge,
skills, and expertise on the most important aspects of the research
enterprise and its connection to policy implementation. Dickson and Flynn provide the necessary tools to turn evidence-based research into health policy. With these tools, researchers will not only improve their capacity to influence policy decisions, but will take part in the advancement of the profession at large.
Australia is increasingly recognised as a multicultural and diverse society. Nationally, all accrediting bodies for allied health, nursing, midwifery and medical professions require tertiary educated students to be culturally safe with regards to cultural and social diversity. This text, drawing on experts from a range of disciplines, including public health, nursing and sociology, shows how the theory and practice of cultural safety can inform effective health care practices with all kinds of diverse populations. Part 1 explores key themes and concepts, including social determinants of health and cultural models of health and health care. There is a particular focus on how different models of health, including the biomedical and Indigenous perspectives, intersect in Australia today. Part 2 looks at culturally safe health care practice focusing on principles and practice as well as policy and advocacy. The authors consider the practices that can be most effective, including meaningful communication skills and cultural responsiveness. Part 3 examines the practice issues in working with diverse populations, including Indigenous Australians, Culturally and Linguistically Diverse Australians, Australians with disabilities, Australians of diverse sexual orientation and gender identity, and ageing Australians. Part 4 combines all learnings from Parts 1-3 into practical learning activities, assessments and feedback for learners engaging with this textbook. Culture, Diversity and Health in Australia is a sensitive, richly nuanced and comprehensive guide to effective health practice in Australia today and is a key reference text for either undergraduate or postgraduate students studying health care. It will also be of interest to professional health care practitioners and policy administrators.
Nursing Research: Designs and Methods has been written by nurses for nurses and is research-minded, conceptually and theoretically up-to-date and student-centred. It is a comprehensive introduction to nursing research that will allow readers to build up their understanding of the research process and develop confidence in its practical application. Text supported by examples from 'real life' research International perspective on nursing research Comprehensive coverage including established and innovative designs and methods
Designated a Doody's Core Title While the scope of long-term care settings has expanded from nursing homes and home care agencies to assisted living facilities and community-based health services, the training for nurses, managers and administrators, medical directors, and other professionals who work in these facilities is often fragmented. This book was developed to fill a widely-recognized gap in the management and leadership skills of RNs needed to improve the quality of long-term care. The book is based around learning modules in leadership and management competencies that were site-tested in three types of long-term care settings and revised based on the resulting feedback. Several of the nurse experts involved in the project contribute to this book. The leadership modules cover team building, communication, power and negotiation, change theory and process, management direction and design, and management that moves from conflict to collaboration. Two additional modules cover cultural competence and principles of teaching and learning related to adult education in the long-term care environment. Together, these skills will enhance the nurse's ability to build and interact with the geriatric care team, resolve conflict, negotiate for solutions, develop collaboration, and teach and mentor nurses and nursing assistants.
Do nurses still care? In today's inflexible, fast-paced and more accountable workplace where biomedical and clinical models dominate health care practice, is there room for emotional labour? Based on original empirical research, this book delves into personal accounts of nurses' emotion expressions and experiences as they emerge from everyday nursing practice, and illustrates how their emotional labour is adapting in response to a constantly changing work environment. The book begins by re-examining Arlie Hochschild's sociological notion of emotional labour, and combines it with Margaret Archer's understanding of emotion and the inner dialogue. In an exploration of the nature of emotional labour, its historical and political context, and providing original, but easily recognisable, typology, Catherine Theodosius emphasises that it is emotion - complex, messy and opaque - that drives emotional labour within health care. She suggests that rather than being marginalised, emotional labour in nursing is frequently found in places that are hidden or unrecognised. By understanding emotion itself, which is fundamentally interactive and communicative, she argues that emotional labour is intrinsically linked to personal and social identity. The suggestion is made that the nursing profession has a responsibility to include emotional labour within personal and professional development strategies to ensure the care needs of the vulnerable are met. This innovative volume will be of interest to nursing, health care and sociology students, researchers and professionals.
2008 AJN Book of the Year Winner Like its popular predecessor, the new edition of "Bathing Without a Battle" presents an individualized, problem-solving approach to bathing and personal care of individuals with dementia. On the basis of extensive original research and clinical experience, the editors have developed strategies and techniques that work in both institution and home settings. Their approach is also appropriate for caregiving activities other than bathing, such as morning and evening care, and for frail elders not suffering from dementia. For this second edition, the authors have included historical
material on bathing and substantially updated the section on
special concerns, including: An enhanced final section addresses ways to support caregivers by increasing their understanding of the care recipient's needs and their knowledge of interventions to improve care and comfort. It also emphasizes self-care and system-level changes to promote person-directed care. Several chapters include specific insights and wisdom from direct caregivers.
Principles and Methods of Transformative Action Research delves into both general principles and specific methods for basic steps in the action research process-asking questions, gathering and analyzing data, communicating findings, and pursuing action. The role of collaboration is emphasized, with strategies of value to experts and engaged citizens in doing participatory research and community-based knowledge-building. Detailed attention is given to specific strategies of interviewing, participant observation, and judging and weighing evidence. The book draws on creative and critically minded elements of scientific traditions, such as transparency in telling the "story" of one's inquiry, identifying data that are "exceptions to the rule," and the value of non-formulaic, improvisational designs. Quite distinctively, the book addresses how to write in one's own voice, how to integrate action-and-inquiry into one's everyday life, issues of ethics and social responsibility, and how to consider both immediate, practical needs and "bigger picture," systemic challenges. This book can serve as an undergraduate or graduate social sciences text on research methods. It is also a guidebook for action-oriented research by academics, professionals, and lay people, alike in community agencies, schools, and grassroots organizations, and for socially relevant academic research concerned with social justice, multiculturalism, and inclusiveness.
Cognitive Behaviour Therapy: A Practical Guide to Helping People Take Control explores the premise that negative beliefs play an important role in the development and continuation of mental health problems. The book offers a new integrative model of causality for instigating change, based on giving clients control and choice over these beliefs, and therefore over their mood and behaviour. This practical guide also focuses on the stigmas often attached to people with 'mental illness'. Danny C. K. Lam suggests that by providing both the client and the general public with a more accurate understanding of the nature and causes of mental health problems it is possible to de-stigmatise the 'mental illness' label. This will help the client improve self-esteem and the ability to manage personal and interpersonal difficulties and take control of their problems and responsibility for recovery. Divided into six parts, this book covers: stigma, prejudice and discrimination from societal perspectives the nature and cause of emotional upsets a therapeutic framework for change self-prejudice, personal and interpersonal issues good and bad methods of communication practical approaches to assessing problems methods of taking control. This cognitive behavioural approach to mental health problems is an innovative contribution to the field. Illustrated throughout with clinical examples and practical advice, the book is essential reading for all of those involved in mental health, from nurses to counsellors, and from medical practitioners and social workers to ministers of religion.
This practical guide provides essential knowledge and tools for nursing and healthcare students and practitioners to develop their leadership skills, from the very beginning of their practice and throughout their careers.
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