Approach to Global Health Promotion - Report Example

Health Promotion Assessment B - Portfolio Matriculation number Word Count: 3414 Table of Contents Task Atkins and Murphy article 2 Task 2: Evidence-based approach to global health promotion 4 Task 3: Determinants and trends mini-essay 6 Task 4 School-based health promotion 8 Task 5: Nurses’ role in smoking cessation 10 Task 6: HPHS self-assessment 12 Health Promoting Health Services Self Assessment Tool 12 Task 7: Priorities in Workplace health and health promotion 19 Task 8: Health promotion projects and strategies 20 Task 9: Reflection on the module content 22 References 23 Task 1: Atkins and Murphy article Reflection or reflective practice is a consciously occurring voluntary process in which an individual thinks about an experience and interprets it in order to learn from the experience (Atkins and Murphy 1994). According to Bond et al. (1985), reflection is a part of the learning process in which individuals explore their past experiences to gain a newer and better understanding of these. The outcome of reflection is ‘learning through experience’. Several critical thought processes occur during reflection. Firstly, an individual becomes conscious of uncomfortable thoughts and feelings. The individual then starts to critically analyse the situation in which he examines his feelings as well as his knowledge on how the experience and the individual have affected one another. According to Boud et al. (1985), the critical thought processes that arise at this stage are: association (involves the correlation of feelings generated by the experience and those occurring during reflection with previous knowledge), integration (in which the individual tends to find relationships between the bits of information. At this stage, if a meaningful association is derived, a new pattern of ideas is formed by the individual), validation (in which the individual tests whether his new appreciations are consistent with existing beliefs and knowledge to validate the authenticity of his feelings and ideas) and appropriation (in which the individual owns the knowledge he gained through the above three processes). This knowledge becomes a part of his identity and value system. The individual thus gains a new perspective on a particular experience, thereby learning something out of the experience. Reflection in action occurs while the experience is still continuing, while reflection on action occurs after the experience is over. Reflection in action involves the application of previous learning in a present scenario while reflection on action involves the application of the present learning in a future scenario. Reflection in action influences the present decision making process while reflection on action contributes to learning that can be applied in the future. In the Gibbs model of reflection, the process of reflection ends with an action plan in which the individual plans what he would do if the same experience arose again (Gibbs 1988). In the Atkins and Murphy model on the other hand, reflection ends with the identification of learning that has occurred (Atkins and Murphy 1994). I would prefer the Atkins and Murphy model because it is highly unlikely for any new experience to be the same as the previous one. Rather than thinking how to do things differently in future, I will rather think how my learning can be applied in any kind of future scenario. Task 2: Evidence-based approach to global health promotion In her talk, Esther Duflo (2010) attempted to answer the question whether financial aid actually helps in reducing poverty. She equated financial aid with leeches, how they were used in Medieval times to treat diseases. If the outcome was good or bad, we did not know for sure if it was the leeches that were beneficial, similar to the question whether financial aid has helped in reducing poverty. She therefore proposed that using evidence based approach to reducing poverty, we can achieve targeted goals. The three evidence based approaches she discussed as examples are as follows: In Udaipur district in Rajasthan, she and her team found that the rate of immunization among children was fairly low despite the presence of vaccination substations. Mothers tended to postpone the immunization of their children or avoid it altogether. Her team made the immunization process ‘easy’ by conducting a monthly camp, and offered a kilo of lentils as an ‘incentive’. This led to higher immunization rates. In Kenya, her team offered discount vouchers to bed nets to curb malaria. Some people were given 100% discount, some received 20%, and so on. It was seen that people who got nets for free were more likely to buy the nets again. This approach proved that people did not stop valuing such items even if they got them for free. A third approach was that of educational interventions. It was seen that by letting people know the benefits of education, it was possible to increase their likelihood of going to school. In places where people are infested with intestinal worms, deworming school children increased their likelihood to attend school. This resulted in 30 extra years of education. My reflection: What surprised me most in this talk is the fact that while we take it for granted that by giving financial aid, we are doing our bit for the good of society, it does not really make much of a difference in reducing poverty. The reduction of poverty requires more intelligent and concerted efforts that go beyond just giving blind financial aid. We need to target the actual need of the poor, the actual problems of the poor, the reasons that hold them back from free education, immunization, food, etc. and use the financial aid to alleviate and counteract these problems. Only then, we can be satisfied that we have actually given aid. Task 3: Determinants and trends mini-essay Key Health Issues Facing Singapore, Currently and In the Future The healthcare system of Singapore is highly appreciated for its cost-effectiveness and high standards, with citizens having extremely good physical access to healthcare (Kang and Leong 2012). Singapore is a high income, developed country in the World Health Organisation (WHO) Western Pacific region. Residents in Singapore generally have good health with high life expectancy and low mortality rates. This has resulted in an ageing population with increasing chronic health issues. Chronic diseases such as asthma, diabetes, heart disease, stroke, hypertension and chronic respiratory problems are currently a major cause of illness and deaths in Singapore. Therefore, while Singapore currently faces a chronic-disease burden, its future health issues will have a high proportion of age-associated diseases because of its ageing population. Chronic diseases are medical illnesses that continue for a long period of time. The major chronic diseases affecting the Singapore population are stroke, lipid disorders, diabetes mellitus, chronic obstructive pulmonary disease (COPD) and asthma (Health Promotion Board 2013). According to reports by the Health Promotion Board, about 5% adults and about 20% children have asthma. Asthma when untreated can be fatal. The Health Promotion Board has also reported, according to a National Health Survey of 2010 that 1.7 million Singaporeans are at high risk of developing obesity related diseases such as heart diseases and diabetes. In fact, at the time of the survey, 1 million Singaporeans were already pre-diabetic or suffered from at least one or more chronic diseases. Another major health issue faced by Singapore is that of mental illness. According to estimates by the Ministry of Health, 1 in every 6 Singaporeans suffers from a mental health association problem (NVPC 2010). Moreover, the suicide rates have also been increasing in Singapore. Other health concerns currently faced by Singapore include myopia, colorectal cancer, and thalassemia (Health Xchange 2012). Around 30% of the Primary One kids in Singapore have vision defects (Health Xchange 2012). Each year, colorectal cancer is diagnosed in around 1500 Singaporeans. Thalassaemia is the most common genetic condition in Singapore with around 5% or 1 in 20 persons being a carrier of the disorder. Heart disease, cancer and pneumonia are among the top five conditions of hospitalization in Singapore (Ministry of Health 2013). Hypertension is the top disease burden, with 23.5% prevalence among adults between 18 to 69 years of age, followed by diabetes, high cholesterol and obesity. The ageing population in Singapore is the fastest growing in the world. Future health issues that Singapore may face thus include age related disorders such as dementia. Singapore had realized this in the 1980s itself and a Committee on the Problems of the Aged was formed by the Ministry of Health to study its implications and to recommend solutions to challenges that will be posed by the ageing population (Goh 2006). The current health issues faced by Singapore are chronic health disorders while the future health issues it will face are age-associated disorders such as dementia. This is because Singapore has the fastest growing ageing population, which is perhaps a resultant of its robust healthcare systems. The healthcare system of Singapore however needs to focus more on the quality of life rather than life expectancy. Task 4 School-based health promotion Précis Studies have shown that around 70-80% children in the 5 to 18 years age bracket do not meet the national recommendation for daily consumption of fruits and vegetables (Nathan et al. 2011). Consumption of fruits and vegetables protects against obesity and respiratory disorders. Schools play a critical role in health behavior development in children. Therefore, Nathan et al. explored the implementation of vegetable and fruit breaks for children in schools. Schools can help children develop healthy dietary and lifestyle habits. For this research, the authors approached the principals of schools to study their attitudes and the barriers to vegetable and fruit break implementation. A telephonic interview was conducted with a random sample of three hundred and eighty four principals. It was seen that a majority of the principals agreed to the importance of the school’s role in providing an environment that encourages healthy eating habits in children. The barriers that prevented the implementation of vegetable and fruit breaks were that there was little support from parents, there was not enough time available for such breaks in the present curriculum, limited availability or high cost of fruits and vegetables, lack of support from school teachers and executives, disruption of classroom routine, resulting mess in classroom, and lack of teacher confidence in the intervention. It was also found that less than half of the schools implemented a vegetable and fruit break at the recommended level. The study has shown that more initiatives are required for increasing the adoption of such breaks in schools if the benefit of healthy dietary habits such as vegetable and fruit consumption is to be promoted among children and youth. Nathan et al. suggest that the barriers to such interventions are not insurmountable and that increasing awareness among parents and school principals about the advantages of these interventions will prove to be useful. My reflection Nathan et al. have proposed a very effective method of promoting healthy eating habits among school aged children in schools. By inculcating such habits at a young age, it is more likely that such habits will persist into adulthood. Children learn the most at school and therefore, vegetable and fruit breaks at school are a very effective intervention. It is seen that some of the most important barriers against these interventions is lack of support from parents and teachers. In nursing practice, I feel that the recommendations of the study will be very helpful. In my practice, I will try to increase awareness among adults and children I come across regarding healthy eating habits, especially the consumption of fruits and vegetables. I will also educate them regarding body weight management, lipid level monitoring etc. to make them realize how susceptible one can be to obesity and related disorders. By increasing the confidence of adults and children on the benefits of fruits and vegetables, it will be possible to promote healthy eating habits not only at school or at a particular age but throughout the life of an individual. This way, both adults and children will be benefited and such activities will be promoted in the community. Task 5: Nurses’ role in smoking cessation The research by Whyte et al. (2006) is a case study on Nurses’ opportunistic interventions with patients in relation to smoking. The study was conducted by Rosemary E. Whyte (a Post-Doctoral Research Fellow), Hazel E. Watson (Professor of Nursing) and Jean McIntosh (Professor of Community Nursing Research). It was conducted and published in 2006. The aim of the study was to investigate the health education and practice of hospital nurses, especially regarding how they provided health education on smoking. The study highlighted the critical role of nurses in promoting health through health education. A qualitative case study design was implemented in the study to explore the opportunistic provision of health education by nurses on smoking. Twelve nurses and forty patients from three general hospitals in Scotland participated in this study and data was collected through voice recordings of oral interactions, recall interviews of nurses and through a semi-structured interview with each nurse. Self-completed patient lifestyle questionnaire etc. were also employed for data collection after taking verbal and written consents from the participants. The findings of the study were noted under four key elements: the teachable moment, readiness to learn, oral communication and information on smoking. The teachable moment is the moment in which a nurse identifies that a patient needs to be questioned regarding his smoking habits and taught healthy practices. The readiness of the patients to learn these was also gauged. The oral communication and information given by nurses were also analyzed and it is seen that nurses are willing and ready to impart education on smoking. However, nurses fail to take full advantage of the opportunities they get for providing smoking related education. The study has concluded that the opportunistic interventions of nurses to patients regarding smoking can be the stepping stone for more specialized interventions. The limitations of the study in my opinion are that it has a small sample size, more interactions should have been examined and that the use of recording equipment could have made the nurses more conscious about the content of their interaction. The strength of the study is that it is based on real (recorded) nurse-patient interaction. My reflection The research delves on a very important consideration – which is the opportunistic approach of nurses to impart health education on smoking. Smoking has been implicated in a number of fatal disorders such as cancers and respiratory problems. Therefore, by promoting healthy practices and warning against the dangers of smoking, nurses can bring about a major change in the incidence of smoking. More such studies should be done so that effective interventions through health promotion can be designed and implemented in health care institutions. Knowledge and possession of skills on health promotion is extremely vital for nurses as they are in direct contact with patients and patients often place a great deal of faith in nurses. They communicate with patients more than doctors and other health staff. Therefore, if nurses possess adequate knowledge, and know when and how to impart the knowledge to patients in an effective manner, they can help promote good health in the community. However, it is essential to provide them with guidelines as to how they can make their interactions with patients more effective and informative. What nurses usually lack is knowledge regarding such aspects and by increasing knowledge about matters such as smoking, addiction, etc., it will be possible to ensure that nurses make full use of their interactions with patients to impart this knowledge. Task 6: HPHS self-assessment Health Promoting Health Services Self Assessment Tool Management Policy Score Your institution has performed well in this area. You should constantly review and evaluate the implementation of health promotion policies in your institution. You should also provide the necessary infrastructure for health promotion activities. Patient Assessment Score Your institution has done well in this area. Remember to review the assessment process and guidelines regularly so that they remain relevant and updated. Patient Information and Intervention Score Your institution has done well on this aspect. Customised interventions for patients should be incorporated into the patients pathways in a way that can be easily understood. Patients should be empowered with the ability to self-care. This empowerment should include knowledge and skills which target the patients physical, mental and social domains. Healthcare institutions are credible sources of health information for patients and the community. Available information should be current, accessible and easily understood by the general population. Promoting a Healthy Workplace The greatest asset of an organisation is its staff. Promoting a healthy workforce improves productivity, reduces absenteeism and controls healthcare costs. Your institution should provide health services for staff which includes access to health screening and health care. They should also provide access to services that enable staff to be good role models for healthy living. Your institution has done well in this aspect. Promoting a healthy workforce improves productivity, reduces absenteeism and controls healthcare costs. Continuity and Cooperation Score Your institution has done well in this aspect. Communication between health care providers is important for continuity of care for patients. Upon discharge, patients should also be given appropriate advice on self-care. You are encouraged to partner with community services to reach out to the community. Through these collaborative efforts, we can maximise the use of existing materials and human resources to further strengthen public participation in health promotion activities. For further consultation or to enquire about your assessment please contact your respective HPHS representative. Janet Loo – Email: janet_loo@hpb.gov.sg or Tel: 6435 3572 Akila Andiappan – Email: Akila_andiappan@hpb.gov.sg or Tel: 6435 3247 Ren Min Choo – Email: ren_min_choo@hpb.gov.sg or Tel: 6435 3429 Health Promoting Health Services Self Assessment Tool MANAGEMENT POLICY: Adopting the Health Promotion Policy 1. Is health promotion included in your organisations stated aims and mission framework? Yes HPHS Leadership 2. Is there an internal Health Promoting Health Services (HPHS) committee who is dedicated to overseeing the implementation of the framework in the institution? Yes 3. Has the institutions Health Promotion policy been formally adopted or revised by the executive management within the past 2 years? Yes 4. Are the Health Promotion policies aligned with the national priority areas? Yes 5. Budget for Health Promotion activities Yes 6. Guidelines are available for action for the following groups:(Select all applicable) Patients,Staff 7. Are there health promotion activities? Yes Awareness 8. Health Promotion activities as evidenced by:(Select all applicable) Time-table 9a. Is policy information readily available to all staff? Yes 9b. How is policy communicated to staff?(Select all applicable) Newsletter 9c. Staff are aware of content of policy Partly Evaluation of Health Promotion activities 10a. Budget for evaluation of Health Promotion activities Yes 10b. Data collection for Health Promotion activities Yes 10c. Evaluation of Health Promotion activities Yes PATIENT ASSESSMENT: Guidelines for Health Promotion needs assessment 11. Guidelines are present for assessment of Health Promotion needs : Yes 12a. Guideline topics(Select all applicable) Smoking Status,Alcohol consumption,Nutritional status,Physical activity,Psycho-social-economic status 13. How regularly are guidelines reviewed? Yearly Implementation of Health Promotion Needs Assessment 14a. Assessment is documented in the patients record  Outpatient notes: Yes Inpatient notes (on admission): Yes Inpatient notes (Upon discharge): Yes 14b. Patients are informed about their Health Promotion needs recommendation. Yes PATIENT INFORMATION AND INTERVENTION: Patient Information 15. Patient is given customised information based on his/her Health Promotion needs assessment.(May include counselling, referrals, etc) Yes 16. Communicating with patients Do staff provide health information in the language the patient is most comfortable with (eg. Chinese, Malay, English and Tamil)?: Partly Do staff deliver and explain concepts using language patients can easily understand?: Yes 17. Written materials Are written health materials available in several languages (i.e. Chinese, Malay, English and Tamil)?: Partly Are health materials written in plain language to ensure it can be understood by a wide audience?: Yes 18. Is patient satisfaction of Health Promotion activities evaluated? Yes 19. Is evaluation done to assess patients satisfaction of Health Promotion activities in your institution? Yes 20. What are the means of evaluating patients satisfaction of Health Promotion activities in your institution?(Select all applicable) Feedback forms General information for patients, staff and visitors 21. Health information is available and accessible to all 3 target groups -- patients, staff and visitors. Yes (Information available to all target group) 22. Types of Health Information resources(Select all applicable) Online,Printed materials 23. Health Information Topics(Select all applicable) Healthy Lifestyle (Physical activity, smoking cessation),Chronic Diseases (Diabetes Mellitus, Hypertension, Dyslipidemia),Weight Management,Mental Health 24. Health information is written in plain language that is understood by the target audience. Yes PROMOTING A HEALTHY WORKPLACE: Staff competency 25a. Hospital induction program provides Health Promotion training for staff Yes 25b. Continuing professional development (e.g. CME, CPE, etc) includes Health Promotion topics Yes 25c. Is Health Promotion (contribution/participation) included in the performance appraisal system? Partly 25d. Job descriptions for all staff include relevant Health Promotion activities Yes 26. Are you an award recipient of the Singapore HEALTH Award 2010? No 27. Is assessment of Health Promotion needs for staff performed? Yes 28. Do your institution offer health screening for your employees on a regular basis? Yes 29. Do you provide or facilitate access to target programmes for staff at risk of life-style related disease? Yes 30. Target programme topics(Select all applicable) Smoking,Substance abuse,Obesity,Chronic disease 31. Are there healthy programmes (including talks/forums/ad-hoc activities) offered for all staff? Yes 32. Healthy programmes topics(Select all applicable) Smoking control,Healthy eating,Mental wellbeing,Physical activity,Health screening,Weight management 33. Do all staff participate in at least one Health Promotion activity a year? Partly CONTINUITY AND COORPERATION: Patients continuity of care 34a. Are there follow up plans clearly stated in the patients notes? Yes 34b. Are patients given clear follow up instructions upon discharge or after consultation? Yes 34c. Is relevant medical information shared with the external follow up partner (allied health professional, step down care or primary health care provider) to ensure continuity of patients care? Yes Collaboration with external partners 35. Number of Health Promotion activities/programmes targeted at the community that are jointly organised by the institution and external partner(s)? 1-2 36. Which type(s) of external partners do you collaborate with? Primary Care My reflection The questionnaire (Health Promotion Board 2010) made me realize the strengths of my hospital and the areas in which it needs improvement. My hospital has performed well in all the five areas assessed. What surprised me most is the vastness of health promotion, how it is implemented, whom it affects, and the health areas it covers. I have understood the importance of updating the health information sources of hospitals and making it available for use by patients. The questionnaire results point out that my hospital should partner with community services in order to reach out to the community. I will analyze this document in depth and formulate suggestions regarding health promotion to forward to my hospital management. Task 7: Priorities in Workplace health and health promotion As per the Ministry of Health Singapore (2010) document, the key stakeholders involved in health promotion at workplace are employers, employees and the government. This is because workplace health benefits employees, employers as well as the nation, directly and indirectly. Workplace health is critical as it has a direct bearing on the well-being of employees. A good workplace environment ensures physical, emotional, mental, and socio-economic satisfaction. The promotion of workplace health involves increasing awareness of employees regarding the importance and benefits of healthy lifestyles, behaviors and diets to ensure prolonged good health. Acknowledgement and practice of healthy habits prevents the incidence of chronic diseases, life-threatening diseases, stress and morbidity. A healthy workforce also implies less medical leaves and low medical costs, benefiting both employees and the employers. By enhancing workplace health, it will be possible to increase the efficiency, productivity and fitness of employees, which will have a collective benefit on the nation. A robust workforce ensures a robust functioning of an organization. Happy, healthy and satisfied employees also have happy and healthy families, as they can further promote healthy habits at home. Organizations and employers need to take responsibility for workplace health through effective interventions and health promotion measures. Some of the recommended measures for increasing and improving health promotion at workplace include the assessment of the effectiveness, quality and success of health promotion programs targeted at the workplace. The creation of better interventions and strategized approaches towards health promotion are mentioned. There is a need for collaboration and cooperation between key agencies and entities such as the MOM and HPB for the betterment of workplace safety, health and well-being. Employers and organizational heads need to work proactively in ensuring that the organization is not contributing negatively to the health of the workforce and that healthy habits are promoted among the employees. Task 8: Health promotion projects and strategies Project 1 CSS Project 2 TOUCH Project 3 Strategy to stop TB Project 4 Strategy on Diet, Physical Activity and Health The scope of this project Is it local, regional, national, or international? This is a national project. This is a national project. This is an international project. This is an international project. The target of this project Is it for individuals, groups, communities or populations This project is targeted at women aged 25 and above who never had sex. This project is aimed at low income families with single parent. This project is aimed at people suffering from TB. This project is not specifically directed at anyone. The main focus of the project Is it physical, mental, intellectual, emotional, social, or societal in focus? Intellectual Physical Emotional Intellectual Mental Physical Societal Emotional Intellectual Physical Societal Intellectual Physical The need for the project Established by individuals, community, voluntary organisation, statutory organisation or government? Government Voluntary organization WHO WHO Method(s) used in the project to enable health improvement? 1:1 input, leaflet, advice or education, group work, community action, TV/radio messages or laws/policies? 1:1 input Advice or education Group work 1:1 input Advice or education Group work Community action Leaflet Advice or education Laws/policies 1:1 input Leaflet Advice or education Group work Community action TV/radio messages Laws/policies Task 9: Reflection on the module content Before the module, I was a little concerned about distance education. I was not really sure if it would help me achieve my learning objectives, and whether I will be able to devote time voluntarily in finishing the assigned tasks. However, I found it easy, stress free and physically less tasking to complete the module online. Some of the reading materials took a long time to read and assess because of the length of their content, the language used and the complexity of the topic. Some of the reading materials such as Atkins and Murphy (1994) gave me a new perspective on the thought processes associated with experiences. I also came to know about the Touch Community Services (Touch 2014), which I found to be very inspirational. Some reading materials took me a while to understand fully, especially when the research associated was vast and new to me. Completing the assignments and the module was interesting. I was expecting to get a lot of learning on important aspects of health promotion, which I did get throughout the module. I planned my timing strictly so as to finish the module in a systematic manner. I leant the importance of health promotion for every individual, especially on how I can apply it to my practice. I will apply my learning throughout my degree education as well as during my practice and interaction with patients. I have learnt the responsibility associated with being a part of the healthcare force of a nation. References Atkins S, & Murphy K, (1994) ‘Reflective practice.’ Nursing Standard 8 (39), pp. 49-56. Boud D, et al. (1985) Reflection: Turning Experience into Learning, London, Kogan Page. Gibbs G, (1988) Learning by Doing: A guide to teaching and learning methods, Further Education Unit, Oxford Brookes University, Oxford. Goh O (2006) ‘Successful Ageing — A Review of Singapores Policy Approaches.’ Ethos 1, available at https://www.cscollege.gov.sg/Knowledge/Ethos/Issue%201%20Oct%202006/Pages/Successful-Ageing-A-Review-of-Singapores-Policy-Approaches.aspx. Health Promotion Board (2010) Online self-assessment of HPHS Standards, available at http://surveys.hpb.gov.sg/s3/hphs. Health Promotion Board (2013) available at http://www.hpb.gov.sg/. Health Xchange (2012), 5 health conditions of special concern in Singapore, available at https://sg.news.yahoo.com/blogs/fit-to-post-health/5-health-conditions-special-concern-singapore-114644436.html. Kang SH, & Leong, CH (2012), Singapore Perspectives 2012: Singapore Inclusive: Bridging Divides, World Scientific, Singapore. Ministry of Health (2014), Top 10 Conditions of Hospitalisation, available at https://www.moh.gov.sg/content/moh_web/home/statistics/Health_Facts_Singapore/Top_10_Conditions_of_Hospitalisation.html. Ministry of Health Singapore (2010) Report by the National Tripartite Committee on Workplace health, available at http://www.moh.gov.sg/content/moh_web/home/pressRoom/pressRoomItemRelease/2008/a_tripartite_committee_to_bring_down_Ill-Health_at_the_workplace.html. Nathan N, et al. (2011) ‘Vegetable and fruit breaks in Australian primary schools: prevalence, attitudes, barriers and implementation strategies.’ Health Education Research 26(4), pp. 722-731. NVPC (2010) Issues faced by the Singapore community, available at https://www.sggives.org/CheckAccess.aspx?url=/imagerepository/01_top_menu/news/2.%20issues%20faced%20by%20the%20singapore%20community.pdf. Ted Talks (2010) Esther Duflo: Social Experiments to fight poverty, available at http://www.ted.com/talks/lang/eng/esther_duflo_social_experiments_to_fight_poverty.html. Touch (2014), available at http://www.touch.org.sg/. Whyte RE, Watson HE, McIntosh J, (2006) ‘Nurses’ opportunistic interventions with patients in relation to smoking.’ Journal of Advanced Nursing 55 (5), pp. 568–577. Read More