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Books > Medicine > Nursing & ancillary services > Nursing
This accessible textbook introduces a wide spectrum of ideas, approaches, and examples that make up the emerging field of implementation science, including implementation theory, processes and methods, data collection and analysis, brokering interest on the ground, and sustainable implementation. Containing over 60 concise essays, each addressing the thorny problem of how we can make care more evidence-informed, this book looks at how implementation science should be defined, how it can be conducted, and how it is assessed. It offers vital insight into how research findings that are derived from healthcare contexts can help make sense of service delivery and patient encounters. Each entry concentrates on an important concept and examines the idea's evidence base, root causes and effects, ideas and applications, and methodologies and methods. Revealing a very human side to caregiving, but also tackling its more complex and technological aspects, the contributors draw on real-life healthcare examples to look both at why things go right in introducing a new intervention and at what can go wrong. Implementation Science: The Key Concepts provides a toolbox of rich, contemporary thought from leading international thinkers, clearly and succinctly delivered. This comprehensive and enlightening range of ideas and examples brought together in one place is essential reading for all students, researchers, and practitioners with an interest in translating knowledge into practice in healthcare.
This book examines the interactional practices of nurse practitioners (NPs) and the delivery of health care in the US. The author takes a discourse analytic approach, examining the linguistic resources that NPs employ in their interactions with patients. These linguistic features are connected to the concept of professional competency with specific focus on the enactment of the patient-centered approach. Analytic focus is placed on how NPs address organizational responsibilities during medical visits with patients, the form and function of patient education, the use of indirect speech, and the role that small talk plays in health care encounters. The book explores the understudied professional field of nurse practitioners and examines their linguistic practices with an eye on crossing disciplinary boundaries, integrating research from linguistics, discourse analysis and health communication. It will appeal to those interested in medical discourse analysis and health communication, as well as applied linguistics scholars.
Relational Care focuses on how people working in and around healthcare can improve the delivery of whole person care. This text integrates Systems Theory and a range of communication tools to support readers in working collaboratively and developing individualized road maps for difficult conversations. Focusing on the relationships between patient, family, and clinician, known as the Relational System, the authors explore how effective communication in healthcare can improve the well-being of all. Beginning with theoretical chapters, the Personal System is described as body, mind, and spirit. Using both Systems encourages readers to see the whole person as they practice. The book incorporates how relational practice improves care in topics such as grief, end-of-life care, stress, and burnout, giving bad news and resolving conflict. Each chapter includes case studies, reflective questions, and prompts for critical thinking to help the reader embed their learning. This practice-changing textbook will be useful to a range of health practitioners, including nurses, Physician Assistants, physicians, and more. It can be used as a supplemental reading for medical interviewing and communications courses.
Originally published in 1984 and concentrating on the West Midlands area of the UK, this book describes the innovations that were made and all that was involved in bringing about changes in care provision for elderly people. The areas covered include hospital-based geriatric and psychogeriatric services, changes in the public housing sector, the development of a domiciliary physiotherapy service and community nursing teams for the terminally ill. These new attitudes and practical treatment changes succeeded in radically altering the climate of care and were the result of small innovatory groups of care-providers.
As nurses, we hear about mindfulness all the time, but what does that actually mean in practice? In this book readers are invited into conversation to explore how mindfulness influences palliative care nurses' approaches to caring for themselves and others through experiences of living-dying. Under the guise of stress reduction and self-care, the assumption often made is that mindfulness can smooth out difficult experiences. Instead, the objective of this inquiry is not to bypass the practice of caring in those spaces that are really hard, but to understand how nurses are working directly within them. Calling out from the shadows-and our bodies-the intensity of palliative care nursing practice arises. In this text, a dialogue unfolds of nurses caring in deeply meaningful practice environments while searching for ground that is perpetually shifting, uncertain, and fraught with suffering and strong emotion. Integrating literature across nursing, sociology, and contemplative scholarship, evocative stories from palliative care nurses lead in this conversation-their words in italics-showing how they are guided into action through connection with-in their bodies. At other times, stories show how nurses are taking pause and drawing on various somatic practices to unravel entanglements that touch on their own humanity. These stories also offer insight into how systemic forces, across educational and organizational institutions, are either enhancing or constraining the way nurses engage mindfulness as a relationally embodied ethic of care. This insightful volume is not a how-to guide, rather it is a timely resource exploring approaches for palliative care nurses to care for themselves and others with mindfulness and compassion. Those seeking nuanced perspectives, particularly in relation to embodying mindfulness through suffering and strong emotion, will be drawn to this text. Qualitative researchers studying emotionally sensitive topics may also find inspiration in the narrative, arts-based, and embodied methods that shape this inquiry.
Originally published in 1979, this book explains why so many people suffer behavioural changes in later life; how this affects those around them; the services that exist to assist older people and those who work with them and how such services can be profitably used. A recurring theme is the interaction of the different varieties of mental illness with one another and with physical, emotional, social and personality factors. The book provides detailed guidance for social workers caring for the elderly on such topics as how an assessment of a mentally disturbed older person can be made; procedure for removal from home under a court order and compulsory admission to hospital; ways of communicating with elderly people and gauging the needs of relatives and carers.
Originally published in 1981 and edited by a pioneer in psychogeriatric services, this book spans medicine, psychiatry, social work and organisation of services of the elderly, written by eminent authors from several different professions. Chapters include those on stroke rehabilitation, dementia, neurosis, psychotherapy for the elderly and institutional care, among others. The book discusses many issues which remain as pertinent today as when it was first published, not least the problems of providing health services for ageing populations.
Originally published in 1975, this book traces the problems which arise for families coping with a chronic childhood disease - cystic fibrosis. The discussion of these problems is important for the families of other seriously ill or disabled children, all of whom are faced with similar implications of their situation. The book looks at the stressful situations which face them: mastering the child's treatment technique, assisting them to come to terms with their disease. It deals with the practical problems which arise for the parents and siblings of a sick child and explores the profound repercussions of the loss of a child on the entire family, considering the ways in which many of these families managed to transcend their problems.
Originally published in 1974, and written by paediatricians, social workers, nurses and a parent who cared for her dying child, this book is concerned with pinpointing the problems which exist for parents and those involved in the care of sick children, both in terms of accepting the facts of a child's illness, and in loving supporting and giving them maximum enjoyment within the limits of their condition. The fears and anxieties of such children are examined - separation from parents, fear of pain, an increasing sense of difference and in some cases a very real appreciation of their situation. All these limit the child's happiness, and ways of counteracting them are suggested. Similarly the distress of parents and of medical advisers is discussed.
Just Care is Akemi Nishida's thoughtful examination of care injustice and social justice enabled through care. The current neoliberal political economy has turned care into a business opportunity for the healthcare industrial complex and a mechanism of social oppression and control. Nishida analyzes the challenges people negotiate whether they are situated as caregivers, receivers, or both. Also illuminated is how people with disabilities come together to assemble community care collectives and bed activism (resistance and visions emerging from the space of bed) to reimagine care as a key element for social change. The structure of care, Nishida writes, is deeply embedded in and embodies the cruel social order-based on disability, race, gender, migration status, and wealth-that determines who survives or deteriorates. Simultaneously, many marginalized communities treat care as the foundation of activism. Using interviews, focus groups, and participant observation with care workers and people with disabilities, Just Care looks into lives unfolding in the assemblage of Medicaid long-term care programs, community-based care collectives, and bed activism. Just Care identifies what care does, and asks: How can we activate care justice or just care where people feel cared affirmatively and care being used for the wellbeing of community and for just world making?
This book explores various practices and policies related to ageing issues in India. It addresses ageing concerns from a theoretical and empirical viewpoint with in-depth analyses of existential dimensions of ageing. It provides deep insights into ageing in India by discussing demographics related to health and social differentials, gender concerns, retirement problems, epidemiological transition taking place in the country with rising problem of dementia and mental health problems. It consists of 23 chapters written by various established as well as upcoming scholars in the field. The authors cover a broad range of topics with regard to provisions for institutional care, geriatric practice and emerging issues of elder abuse. The book will appeal to professionals and to lay people getting interested in ageing India from a social, health, gender, economic, psychological and emotional aspects.
Takes the fear out of learning about genetics and genomics for the nursing professionalWith its focus on the basics of genetics and genomics in nursing practice, this Fast Facts resource is the first to fill the content gap in this important area. Its streamlined format-featuring bulleted, step-by-step information and brief paragraphs-disseminates key content that is presented simply and understandably. The book examines how genetics impacts families and the care they need, and provides nurses with the genomic knowledge to advocate for personalized patient and family care, and to improve patient outcomes. Following a discussion of the science and foundations of genetics and genomics, this resource addresses their impact on patient care and application in nursing practice. It covers the relationship of genetics and genomics to health, prevention, screening, diagnostics, prognostics, and selection and monitoring of treatment. Case studies demonstrate how genomic concepts are applied in practice, and underscore their implications for patients with cancer, cardiovascular disease, psychiatric disorders, and autoimmune deficiencies. End of chapter questions are designed to assess knowledge. Also included are online resources that examine the latest genetic/genomic advancements and their impact on nursing. Key Features: Simplifies difficult concepts for ease of understanding Explains the difference between genetic testing and genetic screening Discusses ethical, legal, and social concerns specific to genetics and genomics Describes the application of genetics and genomics in healthcare Explains how knowledge of genetics and genomics can guide healthcare decisions Helps nurse educators teach genomic content Educates nurses in using genetic advances to improve patient outcomes
Rapid Emergency and Unscheduled Care outlines the fundamental skills and knowledge necessary to work in the emergency and unscheduled care setting, including pre-hospital care. * Highlights key history/assessment knowledge, identifying red-flags, and defining and assisting with making a diagnosis * Explores over 140 presenting ailments, with core information on definition, aetiology, epidemiology, history, examination, investigations and management. Incorporating words of wisdom and advice from experienced practitioners, this A-Z reference book is essential for all those working in emergency care settings, including doctors, nurse practitioners, nurses, paramedics, and allied health professionals.
Small enough to keep with you on the job, this well organized and fully updated reference created just for nurse anesthetists helps you find important information quickly. Descriptions of surgical procedures include patient monitoring and assessments that happen before, during, and after. Drugs are listed by generic name, and information on trade names, dosages, indications, adverse effects and more is provided with each. Disease descriptions include key lab results, clinical manifestations, and anesthesia implications. Together, these supply you with what you need to provide the best care for your patients. "...The jobbing anaesthetist can open it at any page, and find something of interest" Reviewed by: C. J. R. Parker on behalf of the British Journal of Anaesthesia, Nov 2014 Convenient, quick-reference format is organized into three parts: common diseases, common procedures, and drugs. Disease monographs include definition, incidence and prevalence, pathophysiology, laboratory results, clinical manifestations, treatment, anesthetic considerations, and prognosis. Monographs of surgical procedures include a brief description, preoperative assessments (including health history, physical assessment, and patient preparation), anesthetic technique, perioperative management, and postoperative implications. Drug monographs include generic names, trade names, indications, anesthetic considerations, pharmacokinetics, dosages, and adverse effects. Expert CRNA authors provide the current clinical information you'll use in daily practice. UPDATED disease information includes the latest treatment and anesthetic considerations. NEW drug information includes interactions and effects of key new drugs with common anesthetic agents. NEW surgical procedures include up-to-date information on new minimally invasive and laparoscopic procedures. NEW appendices include drug, laboratory, and pediatric tables for easy reference.
In just the past decade, the emergence of digital health has finally become palpable. Enhanced by the pandemic, social justice events, and planetary health urgency, Realizing Digital Health - Bold Challenges and Opportunities for Nursing explores that evolution with a focus on capturing the current state of digital health. Anchored in an introduction to digital health, new technologies, opportunities, and challenges are described. Consideration of the opportunities and challenges of digital health calls for specific attention to ethical considerations. This book includes a current state synopsis of healthcare in the USA, with the inclusion of specific implications for nursing leaders and executives. Engagement of the people (patients, families, communities) working in partnership to enhance health is described. Information management and the necessary definition and access to data are discussed with a particular explication of the function of information management and operational decision-making. The challenges and learnings related to informatics drawn from the experiences of leaders in large health systems shed insight into the current state of informatics-enabled digital health and healthcare. The global example of the integration of technology, nursing, and health systems expands our knowledge of the current state as well as explores possibilities. This book concludes with a commitment to and description of the current state of teamwork and the integral role/functions within informatics, nursing, and healthcare. This book provides the reader with a succinct overview of digital technologies, a reality-anchored description of the current state in the USA and globally and highlights the core foundation and integration of informatics and information management. This book stimulates thought and actions to advance digital health within a full partnership among the people, organizations, systems, and global imperatives including planetary survival. This book lifts up the next era calling for full teamwork, collaboration, and partnership as we emerge into a true global community. Nursing and Informatics for the 21st Century - Embracing a Digital World, 3rd Edition is comprised of four books which can be purchased individually: Book 1: Realizing Digital Health - Bold Challenges and Opportunities for Nursing Book 2: Nursing Education and Digital Health Strategies Book 3: Innovation, Technology, and Applied Informatics for Nurses Book 4: Nursing in an Integrated Digital World that Supports People, Systems, and the Planet
COVID-19 has brought unprecedented challenges in the care of older adults. During the first surge of the pandemic, governments all over the world struggled with high disease severity and increased mortality among older adults. This work documents the impact of the pandemic by collating information from different countries and by synthesizing inputs from several knowledge domains-Sociology, Gerontology, Geriatrics, Medicine and Public Health. The impact on older adults is examined primarily with respect to three main issues-pervasive ageism, spread of infections in care homes worldwide, and the unintended harm of public health measures on geriatric population in different care settings. The complex tensions between epidemic control and the need to respond to social and economic imperatives are investigated with respect to disadvantaged and vulnerable older adults. The book also critically examines international ageing policies with the intention of identifying gaps in pandemic response in particular, and approaches to older adult care in general. In the light of the evidence presented, lessons are drawn which might improve aged care and strengthen emergency preparedness. Finally, considering the evolving nature of the pandemic, new international responses to older adult care and pandemic management are presented as an epilogue. It is anticipated that the book would help nourish critical thinking and implement new solutions to older care during and beyond the pandemic
In Nursing in an Integrated Digital World that Supports People, Systems, and the Planet, the leading-edge innovators in digital health applications, global thought leaders, and multinational, cooperative research initiatives are woven together against the backdrop of health equity and policy-setting bodies, such as the United Nations and the World Health Organization. As the authors prepared this book, the world is struggling with the core issues of access to care, access to needed medical equipment and supplies, and access to vaccines. This access theme is reflected throughout the policy and world health chapters with an emphasis on how this COVID-19 pandemic is exposing the fissures, divides, unfairness, and unpreparedness that are in play across our globe. Sustainability and global health policy are linked to the new digital technologies in the chapters that illustrate healthcare delivery modalities that nurse innovators are developing, leading, and using to deliver care to hard-to-reach populations for better population health. A trio of chapters focus on the underlying need for standards to underlie nursing care in order to capture the data needed to enable new science and knowledge discoveries. The authors give particular attention to the cautions, potential for harm, and biases that the artificial intelligence technologies of algorithms and machine learning pose in healthcare. Additionally, they have tapped legal experts to review the legal statues, government regulations, and civil rights law in place for patients' rights, privacy, and confidentiality, and consents for the United States, the United Kingdom, and the European Union. The book closes with a chapter written by the editors that envisions the near future-the impact that the new digital technologies will have on how care is delivered, expanding care settings into community and home, virtual monitoring, and patient generated data, as well as the numerous ways that nurses' roles and technology skill sets must increase to support the global goals of equal access to healthcare. Nursing and Informatics for the 21st Century - Embracing a Digital World, 3rd Edition is comprised of four books which can be purchased individually: Book 1: Realizing Digital Health - Bold Challenges and Opportunities for Nursing Book 2: Nursing Education and Digital Health Strategies Book 3: Innovation, Technology, and Applied Informatics for Nurses Book 4: Nursing in an Integrated Digital World that Supports People, Systems, and the Planet
This new edition of a bestselling, evidence-based textbook provides a comprehensive overview of psychiatric and mental health nursing. Keeping service users and their recovery at the centre of care, the holistic approach will help nurses to gain the tools and understanding required to work in this complex area. Extensively updated for this new edition, the text looks at: Aspects of mental health nursing: covering topics such as ethics, developing therapeutic relationships and supervision. The foundations of mental health nursing: discussing diagnosis, assessment and risk. Caring for those experiencing mental health distress: looking at wide range of troubles including anxiety, bipolar disorder, eating disorders and issues around sexuality and gender. Care planning and approaches to therapeutic practice: exploring ideas, pathways and treatments such as recovery, CBT, psychodynamic therapies and psychopharmacology. Services and support for those with mental health distress: covering topics such as collaborative work, involvement of service users and their families and carers, and a range of different mental healthcare settings. Mental health nursing in the twenty-first century: highlighting emerging and future trends including the political landscape, physical health and health promotion, and technological advances. This accessible and comprehensive textbook integrates service user perspectives throughout and includes student-friendly features such as learning outcomes, key points summaries, reflection points and further reading sections. It is an essential resource for all mental health nursing students, as well as an invaluable reference for practising nurses.
Nursing Education and Digital Health Strategies explores the current state of health and healthcare education, as well as that of nursing informatics education. These topics include technologies-enabled education for all nurses and interprofessional collaborations from a worldwide perspective. The "New" learning for applied critical thinking will include technology, content, skills versus tools, and the use of "smart" systems for care delivery, the role of critical thinking, and uniqueness of nursing care delivery. Further, how these changes are understood as a paradigm shift that needs to be incorporated along with nursing and healthcare education is emphasized. The effects of technology on human behavior are also explored, addressing human-factors interaction, interdependence of human-computer interaction, and other effects of technology on wellbeing. As part of nursing education, learning from clients/patients to better shape and advance nursing education and scholarship are discussed. Academic-clinical practice partnerships for a digital future, how teams are working together (clinician/teacher) for better healthcare delivery and applied knowledge-including joint appointments (exchange of academia and applied expertise), academic-applied human resources, and interprofessional learning/development-are discussed. This book closes by discussing and using case studies to showcase nursing competencies for the next decade, implications for preparing the healthcare workforce for a digital world, faculty readiness, and the interaction with gaming and simulations. Nursing informatics education, including continuing education beyond academia, i.e., informal education, worldwide, as well as global challenges to support digital world capabilities are described. Hands-on Experiential Delivery and learning-based case studies are also included. Nursing and Informatics for the 21st Century - Embracing a Digital World, 3rd Edition is comprised of four books which can be purchased individually: Book 1: Realizing Digital Health - Bold Challenges and Opportunities for Nursing Book 2: Nursing Education and Digital Health Strategies Book 3: Innovation, Technology, and Applied Informatics for Nurses Book 4: Nursing in an Integrated Digital World that Supports People, Systems, and the Planet
Innovation, Technology, and Applied Informatics for Nurses explores informatics trends emerging over the next decade including personalized healthcare, telehealth, artificial intelligence, voice recognition, and predictive analytics. Emphasis is placed on their importance, benefits, and key challenges for nurses. Digital health and patient-generated data in the context of remote monitoring are highlighted with a focus on digital health tools, issues, challenges, and implications for the future. A featured case study includes the use of patient-generated data during the COVID-19 pandemic including critical lessons learned. A discussion of the technological building blocks of sensors and the Internet of Things highlights examples of how healthcare delivery system models of care are being transformed. Applied data science as an emerging healthcare discipline explores natural language processing, data science frameworks, implications for data bias, and ethical considerations. The conceptual building blocks of artificial intelligence and machine learning are outlined resulting in a call for all nurses to develop an improved understanding of implications for our practice and our patients. Telehealth is described as including modalities, services, virtual care, human factors, and financial, legal, and regulatory considerations. Key drivers and stakeholders advancing simulation-based care delivery are discussed including recommendations for how healthcare organizations can perform event simulation as they prepare to meet the risk management needs of the future. This book concludes by highlighting documentation best practices implemented during the COVID-19 pandemic. Nursing and Informatics for the 21st Century - Embracing a Digital World, 3rd Edition is comprised of four books which can be purchased individually: Book 1: Realizing Digital Health - Bold Challenges and Opportunities for Nursing Book 2: Nursing Education and Digital Health Strategies Book 3: Innovation, Technology, and Applied Informatics for Nurses Book 4: Nursing in an Integrated Digital World that Supports People, Systems, and the Planet
Delivers a comprehensive toolbox for understanding race and racism at structural, institutional, and individual levelsThis nursing handbook introduces and defines key terms about race and racism for nurses, nursing students, and nurse educators. It addresses how race and racism act as structural and core social determinants of health and propel health inequities. It moves beyond a focus on multicultural approaches for understanding inequity toward a recognition of the broader impact that both systemic and structural racism have had on inequality in health and life opportunities. Through a social justice lens, the book underscores how nurses, as frontline health professionals, need to understand racism as a factor behind these inequities and its significance to their working environment and nursing practice. In concise chapters with brief paragraphs and bulleted information, this practical handbook offers strategies for how to productively engage in a dialogue about race and racism. It considers the history of racism in the United States and then breaks down how it operates at structural, institutional, and individual levels. Case studies illustrate such concepts as microaggressions, implicit bias, power, privilege, and intersectionality in order to foster understanding and provide opportunities for both self-reflection and collective conversation. Key Features: Delivers clear and easy-to-read content in concise, bulleted format Empowers nurses to initiate conversations about race and racism in the workplace and classroom with confidence and ease Provides an historical context for understanding how racism contributes to inequities in health and economic opportunities Illustrates concepts with case studies and reflection questions Features "Fast Facts" boxes that highlight essential information at a glance Promotes the concepts of antiracism, diversity, equity, inclusion, and belonging
Child Abuse and Neglect examines the latest research on this important topic, discussing what it entails, how to recognize it, and how to report it. The book begins with an overview of child maltreatment including its history, a summary of the research, and the risk factors, before exploring issues of mandated reporting. It then considers different forms of maltreatment - physical abuse, neglect, psychological maltreatment, sexual abuse, fetal abuse, and Munchausen by Proxy Syndrome. The authors discuss incidence estimates and consequences, as well as resiliency, for each type of maltreatment, and then review legal issues including forensic interviewing. The book concludes by providing an overview of what happens to a child after a report is filed along with suggestions for preventing child maltreatment. This edition has been thoroughly updated throughout to cover the latest theory and research. Referencing the DSM-V, the book also features updated coverage of state and federal laws to reflect new legislation, and additional case studies covering real-world events such as the sexual abuse scandals within USA Gymnastics, the Boy Scouts of America, and the Southern Baptist Convention. Written with students in mind, the book features a wealth of engaging learning tools throughout, including: Theory Highlight boxes, Focus on Research boxes, Case Examples, Legal Examples, Focus on Law boxes, Discussion Questions, and Key Terms. It will be essential reading for all students taking courses on child abuse, child maltreatment, family violence, or sexual and intimate violence taught in psychology, human development, education, criminal justice, social work, sociology, women's studies, and nursing. This book will also be an invaluable resource to workers who are mandated reporters of child maltreatment and/or anyone interested in the problem. This book is based on the legal system and the Child Protection System in the United States of America. It is accompanied by a set of online instructor resources.
A state-of-the-art review of the molecular underpinnings of bone-seeking cancers, current treatment approaches for them, and future therapeutic strategies. The authors illuminate the role of various autocrine, paracrine, and immunological factors involved in the progression and establishment of bone metastases, highlighting the physiological processes that lead to bone degradation, pain, angiogenesis, and dysregulation of bone turnover. They also discuss the various strategies that appear to have promise and are currently deployed in treatment or are at the experimental stage.
This book addresses selected violations of professional nursing conduct and practices that take place in shadows or on the margins of clinical practice-incidents that represent "dark" or "gray" areas of nursing. Chapters identify threats to patient and nurse well-being that are antithetical to nurses' principles; sensitize nurses and other stakeholders to gray and dark sides of nursing through case examples; and pose evidence-based solutions for eliminating, mitigating, and addressing examples representing the gray or dark side of nursing. The book encourages organizations to promote a culture of ethical responsibility for nursing practices.
ORGANIC REACTIONS In this updated third edition of the successful and definitive nursing textbook, Nursing Practice is designed to support the student throughout the entire nursing degree. Structured around the Nursing and Midwifery Council Code of Conduct and the latest Standards for Education, it explores a range of clinical and professional issues that the student will need to know in one complete and accessible volume. Written by a number of expert practitioners and academics who are passionate about the art and science of nursing, the book includes: How the field of health and social care has changed since the second edition of this popular text was published A systems approach to make learning and application easier Thorough coverage of maternity care, surgical care, cancer care, nutrition, skin integrity, medicine administration, pain management and more The elements, principles, art and science of nursing care Nursing Practice provides invaluable information to enable student nurses, as well as registered practitioners and members of the extended nursing family such as trainee nursing associates, to develop a deeper understanding of patients' needs and to ensure that they are practicing safely and effectively. |
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