Nursing_Fundamentals_Catalogue

Setting the standard as the leading fundamentals texts for Australian and New Zealand nursing students

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Fundamentals of Nursing suite

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POTTER & PERRY’S FUNDAMENTALS OF NURSING, 5E – ANZ EDITION By Jackie Crisp, Clint Douglas, Geraldine Rebeiro and Donna Waters Publication date: 26th September, 2016

FUNDAMENTALS OF NURSING

CLINICAL SKILLS WORKBOOK, 3E By Geraldine Rebeiro, Damian Wilson, Natashia Scully and Leanne Jack Publication date: 26th September, 2016

A complete fundamentals of nursing suite that continues to set the standard as the leading fundamentals texts for Australian and New Zealand nursing students. Potter & Perry’s Fundamentals of Nursing, 5e – ANZ Edition and F undamentals of Nursing Clinical Skills Workbook, 3e focus on the very important basics – the fundamentals of care that are the building blocks on which professional nursing practice is built. These new editions will prepare students for the dynamic and evolving nature of nursing practice and will challenge them to become competent, engaged and agile nurses of today, leading the way to be effective nurses of the future. Now aligned to the Registered Nurse Standards for Practice, 2016 (AUS) and Competencies for Registered Nurses, 2007 (NZ), both Potter & Perry’s Fundamentals of Nursing, 5e – ANZ Edition and Fundamentals of Nursing Clinical Skills Workbook, 3e are the only fundamentals suite in the market that are aligned to the Registered Nurse Standards for Practice, 2016.

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Potter & Perry’s Fundamentals of Nursing, 5e – ANZ Edition A bestselling title for over 15 years, the updated 5th edition of Potter & Perry’s Fundamentals of Nursing, 5e – ANZ Edition is an essential resource for all nursing students. The importance of safe and effective person-centred care continues to feature throughout, with a new emphasis on professional responsibility and accountability. Clinical examples and Critical reflection points highlight how the quality of nursing care, knowledge and skills can impact people’s lives and mean the difference between recovery and ongoing illness and complications.

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Words from Donna Waters, on behalf of the Editorial Team

View full list of Contributors + Reviewers

“Nursing of the future will be situated in many contexts and we believe it is crucial for you to understand the dynamic and evolving nature of your practice.”

“In this edition, we welcome a number of academics and clinicians

to the experienced writing team, and

acknowledge their expert contemporary knowledge and contribution to perspectives on health and health care.”

“The editorial team sincerely want you to

discover why seemingly routine activities, such as feeding, bathing, toileting, walking or turning patients, are so critically important to your nursing and nursing care.”

“Everyone who has contributed to this text has done so because they want you to be the best nurse you can possibly be.”

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TABLE OF CONTENTS

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PART 1 Evolving nursing: nursing and the healthcare environment Chapter 1 Creating a proactive and dynamic nursing profession NEW! Chapter 2 Building nursing practice: the Fundamentals of Care Framework NEW! Chapter 3 Engaging patients and keeping them safe NEW! PART 2 Framing nursing: critical processes in nursing practice Chapter 4 Developing clinical reasoning for nursing practice Chapter 5 Gathering relevant information and making decisions Chapter 6 Setting priorities, taking action and evaluating outcomes Chapter 7 Developing and using nursing knowledge PART 3 Positioning nursing: professional responsibility and accountability for safe and effective care Chapter 8 Coordinating care and teamwork Chapter 9 Examining the ethical practice of nursing Chapter 10 Practising nursing within Australian regulatory frameworks Chapter 11 Acting in accordance with New Zealand regulatory frameworks Chapter 12 Placing communication at the centre of person-centred care Chapter 13 Documenting, retrieving and using information to inform practice NEW! PART 4 Adapting nursing: people, context and culture Chapter 14 Understanding and applying cultural safety: philosophy and practice of a social determinants approach Chapter 15 Engaging in family-centred care Chapter 16 Considering the developmental context from conception to adolescence Chapter 17 Considering the developmental context of youth and adults Chapter 18 Working with older people Chapter 19 Considering the person with disability

PART 5 Relating nursing: human basis of nursing practice Chapter 20 Self-identity: life as a journey of self-discovery Chapter 21 Understanding sexuality and sexual health Chapter 22 Working with dying, death and grief PART 6 Practising nursing: scientific basis of nursing practice Chapter 23 The vital signs: using a primary survey approach for patient assessment Chapter 24 Undertaking a focused assessment: physical assessment of body systems Chapter 25 Infection control Chapter 26 Skin integrity and wound care Chapter 27 Medication therapy PART 7 Focusing nursing: basic human needs Chapter 28 Promoting mobility Chapter 29 Hygiene Chapter 30 Fostering sleep Chapter 31 Nutrition Chapter 32 Bowel elimination Chapter 33 Urinary elimination Chapter 34 Fluid, electrolyte and acid-base balance Chapter 35 Oxygenation Chapter 36 Managing pain Chapter 37 Managing stress and adaptation PART 8 Situating nursing: contexts of care Chapter 38 Focusing on community-based care: the older person Chapter 39 Working in acute care environments Chapter 40 Meeting the mental health needs of individuals and their carers Chapter 41 Caring for the cancer survivor

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KEY FEATURES

• Fundamentals of Care Framework for nursing practice enables students to recognise and understand their perceptions of nursing and use concepts, hypotheses, frameworks, theories and everyday clinical experiences to think creatively about nursing and provide holistic person-centred care • Generic approach to clinical reasoning enables students to work with any of the Clinical Reasoning models they may encounter across their undergraduate or postgraduate studies • Increased focus on the concept of ‘self-care’ to encourage student nurses to put strategies in place to ensure their own emotional, cognitive and physical health • An enhanced focus on family involvement in patient care as part of the person-centred care approach to creating caring and therapeutic relationships with patients

• Directly aligned to Fundamentals of Nursing Clinical Skills Workbook, 3e

• 75 Clinical Skills link applied nursing skills to effective clinical practice

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Building nursing practice: the Fundamentals of Care Framework

Engaging patients and keeping them safe

Rebecca Feo, Tiffany Conroy, Jan Alderman and Alison Kitson

Tiffany Conroy, Rebecca Feo, Jan Alderman and Alison Kitson

Learning outcomes Mastery of the contentwill enable you to:

KEYTERMS Biomedicalmodel, p. 26 Biopsychosocial model,p. 27 Concepts,p.16 Conceptual framework,p.16 Contextof care, p. 20 FundamentalsofCare Framework,p. 17

KEYTERMS Engagement,p.31 Environmental safety, p.38 FundamentalsofCare Framework,p. 31 Personal safety, p.33 Physical safety, p.34

FundamentalsofCare PracticeProcess, p.17 Relationship,p. 19 Tacit knowledge, p.16 Theories,p.17 Working hypothesis, p.17

Professional

Learning outcomes Mastery of the contentwill enable you to: • use the Fundamentals ofCarePracticeProcess to deliverperson- centred nursing care • recognise and understandperceptions of nursing heldby you and others • identify and use concepts,working hypotheses, frameworks and theories to inform thedelivery of your nursing care • think creatively about nursing and providing person-centred care • access a range of theories.

boundaries,p.41 Psychosocial safety, p. 35

• addresspatient safety using the Fundamentals ofCare Framework • identify potential negative consequences of your actions and how tominimise these • engagewith patients and their families to establish a therapeutic relationship • assess all elements of a patient’spersonal safety, including physical, psychosocial and environmental safety • identify and address possible risks to your personal safety as a nurse • assesswhen your relationshipwith apatient hasmoved from therapeutic to non-therapeutic • be aware of appropriatework health safety and occupational health and safety regulations and codes of practice.

Risks,p. 33 Safety,p.31 Therapeutic

relationship,p.31

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NEW TO THE FIFTH EDITION

• 4 new chapters: –– Creating a proactive and dynamic nursing profession –– Building nursing practice: the Fundamentals of Care Framework –– Engaging patients and keeping them safe –– Documenting, retrieving and using information to inform practice

• A new clinical reasoning framework to support systematic and critical reflection on approaches to practice

• Emphasis on the importance of self-reflection and awareness for delivering quality care across diverse populations

• Aligned to the Registered Nurse Standards for Practice, 2016 (AUS) and Competencies for Registered Nurses, 2007 (NZ)

• 10 new Clinical Skills including: patient handover, preparing a post- operative bed, assessment of fluid status, management of central venous access devices and management and assessment of the deteriorating patient

13 CHAPTER

KEYTERMS Ageingpopulation, p. 5 Chronicdisease, p. 6 Health expenditure, p. 5 Healthcare reform, p. 8 Nursingworkforce, p. 4 Person-centred care, p. 5 CHAPTER 1

Learning outcomes Mastery of contentwill enable you to: • discuss the importance of documentation and reporting to patients and nurses • discuss thedifferencebetweenpaper-based records and electronic records • describe the relationship between documentation and healthcare financial reimbursement • identify the purposes of a healthcare record • describe and apply guidelines for effective documentation and reporting • discuss legal guidelines for recording client care • describedifferentmethods of record-keeping • discuss the advantages of standardised documentation forms Documenting, retrieving and using information to inform practice • identify critical elements of a client’sdischarge plan • describe the role of critical pathways inmultidisciplinary documentation • identify the important aspects of long-term caredocumentation • discuss issues related to computerisation in documentation • describe thepurpose and content of a change-of-shift report (handover) and other forms of reporting • describe handover reporting tools • explain the process of verifying telephone orders. Elizabeth Cummings and Bryan Macdonald

Creating a proactive and dynamic nursing profession

Frances Hughes, David Stewart and Amanda Davies

Learning outcomes Mastery of contentwill enable you to:

KEYTERMS Acuity charting, p. 249 Casemanagement, p. 247 Change-of-shift report,p. 252 Chartingbyexception, p. 247 Clinical information systems,p.236 Criticalpathways, p. 247 DAR,p.245 Diagnosis-related group (DRG), p. 236 Documentation, p. 238 Electronic health records,p.238 Flow sheets,p.249 Focus charting, p. 245 Incident reports, p. 256

myHealthRecord, p.238 Nursing informatics, p.237 PCEHR (personally

Practicepathway, p. 10 Professional development, p. 10 Professional regulation,p.8 Scopeofpractice, p. 9

• reflect onpersonal capabilities needed for a successful nursing career, in a future healthcare system characterisedby rapid change • discuss thebroad aims and factors that are driving health reform in Australia andNew Zealand • understand the key elements of the nursing profession’s regulatory framework inAustralia andNew Zealand • discuss factors influencing nursing scope ofpractice • appreciate the importance of nursing leadership at all levels for a proactive anddynamic profession.

controlledelectronic health record), p.238

PIE,p.245 Problem-oriented medical record (POMR),p.244 Record,p.238 Report,p. 252 Resident,p. 252 SOAPIE,p.245 Source record, p.246 Standardised care plans,p.249 Transfer report, p.255 Variances,p.247

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CHAPTER 22 Working With dying, death and grief

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thegriever.A listof localpsychologistsorcounsellorswho are skilled in bereavement support can be an invaluable resource,as cananafter-hours telephone supportnumber or liaisonpersons in thegriever’s community. CLINICALREASONINGPROCESS Grieving isanatural response toa lossand isconsidered tobe abeneficialcopingprocess. It isalsoa reactiveprocessandhas therapeuticvalue.Grieving ishealthyandenables thebereaved to reflectonandaccept the realityof the loss.Thenursemust feelconfident toassess the situationcriticallyandmakean initialneedsanalysis.Theoverallgoalofnursingassessment is togather relevant informationanddata inorder togaina totalviewof theclient’shealthandpsychosocial status.By carefullyexploring informationgained from interactionand collating thedata inapreciseandmethodicalway,appropriate judgementsanddecisionscanbemade toworkwith theclient in theirgrievingprocess.Assessmentprovidesanopportunity for thenurse toexplorewith theclient information relating to perceivedandactualpriorityproblems (mentalandphysical). MAKINGAPPROPRIATE JUDGEMENTSAND DECISIONS Verbalandnon-verbalcommunication techniquescan encourage freeflowof informationandprovidemeaningful data forevaluation (seeChapter12).These include listening, reflecting,clarifying,usingnon-verbalcues,appropriateuseof silence, sharingperceptions,confrontingcontradictionsand reviewing thediscussions. Cultureanddevelopmentalconsiderationsare two factors that influencecommunication.Culturehasaprofoundeffecton the waypeoplecommunicateandbehave. It is therefore important tokeep inmind thatculturaldifferencesmay influencehow verbalandnon-verbalmessagesare interpreted.Forexample, in manySouth-EastAsiancultures–ofwhich thereare significant immigrantpopulations inbothAustraliaandNewZealand– manywomenavoideyecontactwithmen.Conversely,many Westernwomen lookdirectlyat theperson towhom theyare talking. Ageordevelopmental level canalsoaffect theway the assessment ishandled,especially if theclient isveryyoungor veryold. In theyoung,communicationdependson thechild’s cognitivematurity,asnotedabove. In theelderly,consideration mustbegiven to theextent towhich thememoryand sensory functionmaybeaffectedby theageingprocess.Thereare times whenboth theyoungand theelderly, inparticular,arehesitant to sharepersonal information,anddevelopingcommunication skills thatmaximise thepossibilityofopencommunication isa priority for studentnurses. Duringperiodsof lossoranticipated loss,aclient’semotions andbehavioursmaybe ina stateofflux.Thismakesassessment all themorechallenging.Nurses shouldnotassume they knowhowaclientor familymemberswill react.Continual assessment isessential if supportand/or interventionsare tobe compatiblewith theircurrentneeds.Assessmentof theclient and familybeginsbyexploring themeaningof the loss to the people involved.Examplesof topics tobeexplored include the survivor’smodelof theworld,personalcharacteristics suchas personality,values, thenatureof family relationships, support systems,natureof loss,culturaland spiritualbeliefs, lossof

personal lifegoals,hope,phaseofgrief, risksandnursing role perceptions. When interviewing theclientand family, it is important thatan honestandempatheticapproach is taken.Bemindfulof setting the toneanddirectionof the interview,andofestablishing amutualunderstandingof thepurposeof theexchange. In the initialphase it is important toestablish rapport,ensure acomfortableandnon-threatening settingandclarify the expectationsorgoalsof the interview. Establishing rapport Establishing trustand rapport isachallengingprocess, particularlygiven theculturaldiversityofAustralianandNew Zealandpopulations.Acleardemonstrationof respect for the clientandanacceptanceof theclient’suniquenessasaperson facilitate rapport.Greet theclientbynameand introduce yourself. It isusualpracticenot touse theclient’sfirstname unless invited todo so. InAustralasian society,offering to shake hands isoneway todemonstrate sincerityandacceptance. Non-verbalbehaviours Non-verbalbehaviours shouldmatch theverbalmessages. Appropriateand sensitiveeyecontactandnon-intimidating positioning shouldbeused.Sincereandopeneyecontact (except incertaincultures/circumstances) isoftenvitalwith avulnerableperson,asnormalcontactwithothersmaybe disruptedby theemotionsgenerated fromcircumstances surrounding thedeath.Positionyourself so thatyouare facing theclient. If theclient is seated, sitata slightangleoppositebut facing,withanappropriatedistancebetween.Avoidnon-verbal behaviours suchas frowningoryawning,orexpressionsof impatienceorboredom,which implya lackof interest.When beginning the interview, itmaybeappropriate to startwith abriefbutcasualconversation thathelps theclient relax. Client-focusedcasualconversationmayhelpalleviateany awkwardness theclientmay feel in talking toa stranger in the healthcare setting.Casualconversationcanalsobea sourceof valuable information. Ensuringcomfort Ensure that theexchangeof information takesplace inaprivate setting free from interruptionsanddistractions. It is important toclarify that theclient is feelingup to the interviewbefore starting.Verbal therapeuticcommunication techniques involve open-endedquestions thatgive theclienta senseofcontrol over theprocess– forexample, ‘Tellmeaboutyour family’, ‘Howareyou feelingnow?’or ‘Whatcanyou tellmeaboutyour relationshipwithX?’ Definingexpectations At thebeginningofany interaction it is important toclarifywhat both thenurseand theclientexpect from theexchange.Make itclear thatany informationexchangedwillbe treatedwith sensitivityand respect.This isespecially important inAustralian Indigenousculturewhere theabusesof thepastcontinue to have impactsonestablishing trust in services (seeChapter14). During theassessmentphase, it is important to focusonhow theclient is reacting,notonhowyoubelieve they shouldbe reacting.Give specialattention togrief-relatedbehaviours displayedby theclient,andpaycarefulattention to theclient’s experienceand the tasksofgrief thatmaybe left incomplete, whichmay threaten theclient’spsychologicalorphysical

Clinical reasoning process

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Developing clinical reasoning for nursing practice

ClintDouglas and JackieCrisp

Learningoutcomes Mastery of contentwill enable you to: • understand the value of using a reflective and systematic approach to clinical reasoning • discuss theways inwhich a systematic approach to clinical reasoning enhances nursing knowledge and skilldevelopment • discuss theways inwhich nursing knowledge and skill development enhances the process of clinical reasoning • explain how using a systematic approach to clinical reasoning contributes to the visibility of nursing practice • explain the relationship between critical thinking and clinical reasoningwithin nursing practice • discuss the sixbasic domains evidentwithin all processes of clinical reasoning • use criticalquestioningwithin each of the six basic domains of the clinical reasoning process.

KEYTERMS Actionplanning, p. 51 Clinical reasoning cycle,p. 50 Clinical reasoning models,p. 47 Cognitivebias, p. 47 Criticalquestions, p. 56 Critical thinking, p. 49 Goals andpriorities, p. 50

Information/data, p. 51 Judgements and decisions,p. 51 Nursing knowledge, p. 52 Nursingmodels, p. 47 Outcomes,p. 49 Reasoningprocess, p. 49

PART 4 ADAPTING NURSING: PEOPLE, CONTEXT AND CULTURE

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(Ramsden 2002, Reimer-Kirkham et al 2009). Cultural safety focuseson how people are treated in society ,not how theyareculturallydifferent .That is, the importofdiversity is turnedon itshead incultural safety,as it is social responses to diversity that create health impacts not the existence of the diversity itself (Cox& Simpson 2015). Consequently, cultural safety is about power – personal, professional and institutional power in health services, and the impact on thosewho use the service; the peoplewho define the An exampleofbeing culturally unsafe MrsG is anAboriginalwoman in her 40swho goes to the hospital in the rural townwhere she lives at about11.45 am on aMondaymorning, to see a doctor.She has pains in the stomach that have kept her awake all night and got worse after breakfast.She is accompanied by a female cousin,MrsS,who is some years younger.Although only in her 40s,MrsG is a respected elder in her community, a fact that reflects the statistically reduced life expectancy of Aboriginal people. MrsG is told by the young female nurse at the front desk to take a seat in the sparse basicwaiting room. There are nomagazines, television or tea-making facilities here, such as onemight find in city hospitals.By 1.00 pm no one has come to seeMrsG and she’s not been offered somuch as a drink ofwater. Feeling frustrated andworried aboutMrsG,MrsS finally finds the courage to confront the nurse and askswhen the doctorwill be there to seeMrsG. The nurse responds by saying, ‘Doctor is on his lunch break.’She then says toMrsS, ‘Are you a drinker too, love?’At thisMrsG gets up and says to her cousin, ‘Let’s go along’, and they leave the hospitalwithout being seen. MrsG still has abdominal pain and bothwomen are angry at being referred to as ‘drinkers’, especially as both are teetotallers and devoutChristians. Lessons to be learnt from this example are: • the clientswere culturally unsafe – theywere demeaned,diminished and disempowered • the nurse and the hospital neglected their duty of care • the nurse has unexamined prejudices towards Aboriginal people and operates on stereotypes • the use of the term ‘love’ from a youngwhitewoman was offensive to such respected leaders in the community • access of these clients to health serviceswas limited by the hospital’s lunch-time policy • itmay take years for eitherwoman or their large extended families to seek help from the hospital again. Cox L2007 Fear, trust andAborigines: the historical experience of state institutions and current encounters in the health system,Health andHistory 9(2):70–92.Reproducedwith permission. CLINICAL EXAMPLE

awareness of themselves as cultural beings. Further, all healthprofessionalsneed toconsiderhowculture,classand socialmarginality impactonbothhealthandhealthcare. In the following sectionswewill show that social responses to clients’class,ethnicity,genderorabilities influencepeople’s lifechancesandhealth.Suchconcernsare intimatelyrelated to the social determinants of health, that is, to factors beyond the controlandbehavioursof individuals.To come to gripswith these complex issueswe introduce you now to themodel of cultural safety and discussmore fully the specific conceptualisation of culture that underlies the modeland its focuson the socialdeterminantsofhealth. Cultural safety Cultural safety ( kawa whakaruruhau ) was developed within theMāori community in the 1990s byMāorinurse scholarIrahapetiRamsden inAotearoaNewZealand(1993, 2002).Ramsdenandcolleaguesdeveloped themodelpartly in response to a first-yearMāori nursing student’s astute comment: ‘Youpeople talk about legal safety, ethical safety, safety in clinical practice and a safe knowledge base, but whataboutculturalsafety?’(Ramsden2002:1).TheseMāori nursing students alerted Ramsden to the expectations they felt to conform to the dominant institutional culture and their experience of non-Māori ‘experts’ lecturing to them about traditionalMāori culture.Their experiences suggested that there was only one correct, authentic way of beingMāori, which, as urbanMāori whose ancestors experienced thedisruptionsofcolonisation, theycouldnot embrace. Cultural safety therefore aimed for cultural change by exposing and addressing such power imbalances to decrease the impact of cultural dominance and racism in health care, education and research (McCleland 2011). Ramsden also saw that nursing curricula were devoid of structural issues and were designed by and for those who did not share her cultural position or experience of colonisation. She challenged this cultural dominance, particularly theway it shapedpolicyanddevelopednurses asmerebiomedical techniciansrather thanagentsofsocial change (Ramsden 2002).Ramsden saw cultural safety as away for nurses to consider how their socialisation and cultural position impacted on their work, emphasising the links between ill-health and dispossession, economic status and political agendas. This social determinants approach contrastswith individualist biomedical notions that illnessesmerelyoccur ‘withinbodies’. Underpinnedbycriticalsocialtheory,culturalsafetyalso recognises thatnursingcare,educationandresearcharenot value neutral activities but reflect socio-political contexts and thevalues,assumptionsandprioritiesof those involved

Learning outcomes

Clinical examples

CHAPTER 3 Engaging patiEnts and kEEping thEm safE

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CHAPTER 9 Examining thE Ethical practicE of nursing

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of ‘characterological excellence’ in determining ethical conduct (Oakley 2006, Van Hooft 2014).This is made manifest by the expression of suchmoral virtues as care, compassion, kindness, empathy, sympathy, altruism, generosity, respectfulness, trustworthiness, personal integrity, wisdom, courage and fairness.Virtue theorists claim that without the characterological excellence of virtue, ‘a person could, robot-like, obey everymoral rule and lead the perfectlymoral life’, but in doing sowould be actingmore like ‘a perfectly programmed computer’ than amorally responsible human being (Pence 1991). There isa sense inwhichbeingmoral involvesmuchmore thanmerely following rules; themissing link, claimvirtue theorists, is character.On thispoint,Pence (1991)writes: we need to know much more about the outer shell of behaviour to make such judgments, that is, we need to know what kind of person is involved, how the person thinks of other people, how he or she thinks of his or her owncharacter,how theperson feelsaboutpastactions,and alsohow theperson feelsabout theactionsnotdone. Virtue ethics is particularly relevant to nursing and to nursing ethics since virtuous conduct is intricately linked to therapeutic healing behaviours and the promotion of humanhealth andwellbeing. The nursing profession’swell-articulated ethic of care (regardedbymany influentialnurse theoristsas themoral foundation, essence, ideal and imperative of nursing) is consistent with a virtue theory of ethics (see the classic works of the following nurse theorists:Benner&Wrubel 1989,Gaut 1991,Gaut&Leininger 1991,Leininger 1988, 1990, Roach 1987,Watson 1985a, 1985b). Significantly, virtue ethics is enjoying a renaissance in the nursing ethics literature – particularly in regard to the issue of caring forvulnerableandmarginalisedgroupsofpeopleat risk of being treated as ‘different’ by healthcare providers (Armstrong2006,2007). cross-cultural ethics As highlighted by the ‘Mr G’ case discussed on p. 139, anotherperspectiveon ethics andbioethics thatwarrants considerationbynurses is cross-cultural ethics.Thebasic assumptions of cross-cultural ethics reflect the views that: n ethics isverymuch aproductof the culture, society andhistory fromwhich ithas emerged n all cultureshave amoral system,butwhat this system is andhow it is appliedwillvary across, and sometimes evenwithin,different cultures n there isno such thing as auniversal ethic; that is,one ultimate standardofmoral conductwhich applies to allpeople equally regardlessof their individual circumstances, context and culture– inotherwords,

a ‘one sizefits all’ approach to ethics (Johnstone2012, 2016). In any culturally diverse society it is imperative that a culturally informed,knowledgeableand sensitiveapproach to health care is taken (Johnstone 2012, Johnstone & Kanitsaki 2008). One reason for this is that a failure to adopt such an approach can result in otherwise serious moral harm being caused to people.Cross-cultural ethics, therefore,goesfarbeyondmerelyconsideringandcritiquing the nature and content of mainstream ethical theories; it also involves a systematic examination of the moral implicationsofculturaland linguisticdiversity inhealthcare domains; for example, the extent towhichpatientsofnon- English-speaking and diverse cultural backgrounds suffer unnecessarily on account of the cultural and language differencesbetween themand theirprofessionalcarers (see deBruijneetal2013,Divietal2007, Johnstone&Kanitsaki 2006,2009a,Suurmondetal2010). Nurses and other healthcareworkers have a stringent moralresponsibility toavoidand/orprevent theotherwise avoidable moral harms that can result from a failure to take into account the language and cultural needs of theirpatients (Johnstone&Kanitsaki 2006, 2008, 2009a). The harmful aftermath of racism in health care is a particular example of this.Racism in nursing and health care is a problem that has not been formally recognised as an important ethical professional issue (Johnstone & Kanitsaki 2009b, 2010). A cross-cultural approach to ethics would not only help identify the existence of racism in nursing and healthcare contexts, but also guide an effective response for dealingwith it and, if not successful in eradicating it, at leastminimise its harmful consequences topatienthealth. Truth-telling around cancer and other life-limiting diagnoses stands as one of the most controversial issues in cross- cultural health care. Research has shown that truth-telling is not just an issue for people fromGreek backgrounds, but also for people from other traditional cultural backgrounds (e.g. Iranian, Pakistani, Japanese, Italian, Korean,Chinese). In these cases, truth-telling about a diagnosis of serious life-limiting illnesses (especially cancer-related illnesses) is regardedasharmful, ‘undesirable’andhence tobeavoided– most notably on the grounds that it could undermine the ill lovedone’shopeand thewill to live (Johnstone2012,2016). Problems most commonly arise in situations where the healthcare provider (e.g. doctor, nurse) does not share the same cultural background as the patient and family,whose cultural world views are unfamiliar and even confronting to them andwhich they do not understand. WORKING WITH DIVERSITY

RESEARCH HIGHLIGHT

Research highlights

in decision-making about the care they receive. A meaningful relationship with the patient enables you as thenurse tomake sound clinical decisions that are based on thepatient’sbest interests. • nurses’ values andbeliefs (e.g. their thoughts, perceptions, attitudes and associatedbehaviours) • nurses’ knowledge and skills (both clinical skills and supportbehaviours) • nurses’ ability to communicate effectively in a variety ofways • how thephysical and social contexts inwhich care is takingplace affect thenurse–patient relationship Patient safety was of central concern to Florence Nightingale as reflected in her quote, ‘the very first requirement in a hospital is that it should do the sick no harm’ (Nightingale1859).Safetycontinues tobeaconcern for many modern healthcare systems, with evidence suggesting thatNightingale’sdoctrineof ‘doingnoharm’ is notbeing completely followed.The InstituteofMedicine’s (IOM) landmark publication Crossing theQualityChasm (2001), for example, argued that theUShealthcare system was failing todeliverconsistent,high-qualitymedicalcare, with such care instead frequently harming or injuring patients. The IOM called for fundamental changes to 21st-centuryhealthcare systems to ensure the safetyof all patients. In this part of the chapter, we consider how the Fundamentals of Care Framework helps you to address Research focus developing apositive relationshipwithpatients is known tobe important for thedeliveryof high-quality care.this paper sought to identify the factors that contribute to the developmentof a caring relationshipbetween thenurse andpatient. Researchabstract the study involved conducting an umbrella review. Umbrella reviewsbring together evidence from existing systematic reviews inorder to synthesise the available evidenceon aparticular topic.thisumbrella review looked at studies examiningpatients’ andnurses’ perspectivesonwhat is important in the nurse–patient relationship.theumbrella review identified six key areas that are associatedwithdeveloping andmaintaining caring,positive nurse–patient relationships.they are: • nurses’ andpatients’ expectationsof the relationship safety as one of the fundamentals of care

patient safety concerns when providing care. As can be seen from Figure 3-1, safety is conceptualised as a fundamentalof care, alongwithother fundamentals such asnutrition,hydrationandelimination.Thenurse–patient relationship is central to ensuring this fundamental need is appropriately met. While policy and organisational structures focusingon safetyundoubtedlyhave an impact on the ability of nurses to deliver safe and effective care, our focus in this chapter ison equipping you as a student and beginning nurse with the skills to operate in a safe manner.That is, to ensure patient safety becomes part of yourpersonal andprofessional responsibility as anurse. Patient safety encompasses three interrelated elements: physical, psychosocial and environmental safety.At the intersectionof thesedifferent typesof safety lies thepatient’s personalsafety (seeFigure3-2). It isonly when each of these types of safety are appropriatelymet that patients can be considered safe. Ensuring patients’ personal safety requires nurses to embed patients’ needs in their thinking, reflection and assessment processes (Kitson et al 2014). Careful assessment and planning prior toany interventionor interactionwithapatientwill ensure that injury and harm do not occur and that any safety risks are reduced. positive relationshipwith theirpatientsbut can also experienceguilt and frustrationwhen agoodquality nurse–patient relationship is not achieved. Reference WiechulaR et al 2015Umbrella reviewof the evidence: What factors influence the caring relationship between anurse andpatient? Journalofadvanced nursing,doi:10.111/jan.12862. • the impactof the relationshiponpatients/families, nurses and nursing students. Evidence-basedpractice • the nurse–patient relationship shouldbebasedon nursing’s inbuilt values such as trust, sympathy, support and responsibility, and these values should be reflected in the attitudes andbehavioursof nurses. • Compassionate care and technical skill are equally important indeveloping andmaintaining the nurse–patient relationship. • nurses need to consider the context inwhich they areproviding care andhow thismight impact the nurse–patient relationship. • the nurse–patient relationship notonly has an impactonpatients and families/carers,buton nurses aswell.nurses findgreat reward in a

PART 1 EVOLVING NURSING: NURSING AND THE HEALTHCARE ENVIRONMENT

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Nursing’s contribution to these three elements is greater than any other health profession.The nursingworkforce is the single largest clinical workforce with the most direct clinical care time.Nurses continue to provide care with resilience and versatility, while often withminimal resources and organisational support.Nursing can be, as the International Council of Nurses (ICN 2015) states, ‘a force for change’. Unfortunately, reform may have short-term goals, including immediate funding reductions. As the largest workforce and, therefore, the highest cost burden, the nursingworkforce isoften cut, leaving fewerpeople todo morework. Research shows that RN staffing levels have direct implications for patient care. It demonstrates that hospitalswith a higher ratio of degree-preparedRNs-to- patients have lower mortality rates (Aiken et al 2014). Hospitals with lower RN staffing numbers are linked to an increasednumberof adverse events including falls and medication errors (Duffield et al 2014). As a result, the aimsofhealthcare reform arenot realised. The escalating costs of health care require that measuresbe taken to contain costs to levels that countries can afford and sustain.Thesepressureshighlight theneed for how resources in health care, particularly nursing, can be used to their optimal level. When the nursing profession is optimised, evidence demonstrates that the quality of health service provision improves.When the qualityof services improve, resourcesareoftenusedmore efficiently. For example, an optimised and appropriately resourcednursingworkforce is linked to reduced adverse events (asmentioned above), improved health literacy of patients, reduced length of stay, decreased readmission rates, improved hospital avoidance and better patient outcomes (Aitken2014).As such, the threeaimsofhealth reform canbe achieved. • CRITICALREFLECTION POINT Whywould supportingRNs towork to their full scope ofpracticecreateamoreefficienthealth system?How important ishealth literacy to the futureofhealthcare provisionandhowcannursingcontribute to improving health literacy? Nursing leadership and healthcare reform The nursing profession is uniquely placed to lead healthcare reform . Nurses have close interaction with patients and their families in all health settings across the health continuum. They can help interpret and understand people’s needs and expectations for health care.Theyareactively involved indecision-makingwithin

the clinical team and inmanagement.They do thiswith a foundation of care informed by research and evidence. This understanding, experience and proximity to the patients’ needs are critical components of what nursing canbring to the table andhow it can enable reform. As such, nurses have an important contribution to make in health service planning, management and policy setting. Nurses must contribute to public policy development throughmanagement and leadership roles at all levels andwithdirect engagementwith theirprofes- sionalorganisations.Toachieve this levelof responsibility, itcannotbeassumed that itwillautomaticallybeprovided to the profession.Historically, inmany instances, nurses have been left out of the decision-making process and have been leftwith implementing an initiative or policy thathasnotbeenwell informed.The roleof theprofession therefore must be proactive to maintain this level of influence and involvement. Just as important as the planning and policy setting, nursesneed tobe leaders inhealthcaremanagement.The InternationalCouncilofNurses(2015)assertsthatnursing servicesmust be directlymanaged by nurses.The reason for this is that the professionmust be responsible for the professionalpractice ofnursing.Noprofession outside of nursing iswell positioned enough to be held to account and to lead the scope of practice and the standards for practiceof theRN. • CRITICALREFLECTION POINT Thinkabouta recenthealth issuediscussed in thenews. Didnursinghavea voice?Howdo you thinknursescan promote their stories, insights, researchandexpert opinions via socialmedia? Regulation of the nursing profession TheNursing andMidwifery Board ofAustralia (NMBA) and Nursing Council of New Zealand are responsible for professional regulation and setting standards, codes and guidelines for thenursing andmidwiferyprofessions (Box 1-2).The role of professional colleges and associa- tions in developing specific standards of practice and credentialling individual nurses is increasing. RNs are individuallyaccountable for theirownpracticeandhavea personal responsibility tomaintain their competency and meet professional standards in order to maintain their licence to practise.The role of theRN has evolved along with changes in advancing technology, newly defined patient needs and changes to the way health care is delivered. In thisway, it isnotunreasonable to expect that the roleof theRNwill continue to evolve and change. It is

Working with diversity

Critical reflection points

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| Empowering Knowledge

Sample student nursing care plans

CHAPTER 20 Self-identity: life aS a journey of Self-diScovery

465

SAMPLE STUDENT NURSING CARE PLAN

Gathering relevant informationanddata james isa24-year-oldwhohas recentlybeendiagnosed withHiv.theclinic registerednurse (rn)hasbeen talking to james during his last three visits. during that time james expresses a fear of dying and anger with God: ‘HowcanGoddothistome?this justcan’tbehappening!’ thern attempts to learnmore about james’s faith and sources of spiritual support. james begins to cry and admits that he feels very alone. ‘i just don’t knowwhat

to believe in anymore; this has happened so suddenly. it is as though God and everyone else has abandoned me. i am so afraid. life isn’t making sense.’ in further discussion,jamessayshehasbeenunable tosleep,has little desire for food and is having difficulty findingways to talk to his friends. Priorityproblem(s) Spiritual distress related to fear and uncertainty of advanced illness.

Skills

Makingappropriate judgementsanddecisions

Settingprioritiesandestablishinggoals

Expectedoutcomes

clientwill express a senseofpurpose.

clientwilldiscuss how the experienceof havingaidS may have apositive influence in life. client expresses a senseof confidence in treatments available foraidS. clientbegins to talkof the future.

client regains a senseof hope.

Preparing forand takingaction

Rationale

Instilling hope • Plana session todiscuss typicalcourseofHiv, emphasising the typicalpatternof remissionswith drug therapy.review therapiesavailable for treatment. Spiritual support • encourage client’s expressionof loneliness through establishing a caringpresence. • listen to client’s feelings and concerns. • Have clientdiscuss his ability to copewithHiv and themeaning it has spiritually.use spiritual resources.

Knowledge aboutdiseasewill help client think as a person livingwithHiv rather thandyingwithHiv.reality ofdisease coursewill help instilhope.

Presence reflectsbeing in tunewith the client and displays caring. it is an effective technique thatmakes a topicofdiscussionmore approachable.

PART 6 PRACTISING NURSING: SCIENTIFIC BASIS OF NURSING PRACTICE

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Peoplequestion andbecomeopen todiscovering their unique spiritualmeaning after a crisis that threatens health.Provide clientwith a resource from his communityof faith to share concerns.

SKILL 27-5

Administering rectal suppositories Delegationconsiderations Administeringmedicationsby the rectal route requires theproblem-solving and knowledge-application abilities ofprofessionalnurses. In some statesofAustralia and NewZealand, client care attendantsor enrolled nurses may legallybe able to administermedications via this

Evaluating impactsandoutcomes 1. askclient todiscusswhatmeaninghehasgained from experiencingHiv.

2. Have clientdiscuss how heplans to adjust to the disease in the future (including continuing work, social activities, and soon).

Therapeutic relationshipandpatient considerations • Confirmspatient identity • Gainspatient consent • Initiates communicationby introductions and clarificationofpatient’s immediate needs and problems • Identifies how the skillwill affect thepatient • Discussesprocedurewith thepatient to clarify understanding • Provides reassurance • Assessespatient knowledge and expectations and ensurespatient understanding • Where necessary,provides further clarification • Explains actions andpotentialdiscomfort at all stagesofprocedure

route.For thisprocedure, client assessmentby the registered nurse is required asdelegationmay notbe

unknown, theneed tomakechanges in lifestyle,andchange in functioning,maybepresentandneed tobe recognisedand reducedwherepossible.There isoftenmore thanone stressor in theacutecare setting, thereby increasing theoverall stress level for theclientand their family. Clients receivingcare foracuteproblemsareoftenalso faced with theneed toadapt toanalteredbody imageasa result

Acutecare In theacutecare setting, thenurse is likely toencounterclients whoareexperiencing threats to their self-conceptand/or spiritualitybecauseof thenatureofdiagnosticproceduresand treatment.Threats toaperson’s senseof self,and themeaning attached to theexperience,can result inanxietyand/or fear. Numerous stressors, including thediagnosis, fearof the

appropriate. Equipment • Rectal suppository • Lubricating jelly (water soluble) • Disposablegloves

Therapeutic relationship and patient considerations

• Tissue • Drape • Medication administration record (MAR)

STEPS

RATIONALE

Ensures safe and correct administrationofmedication.

1. Reviewprescriber’sorder, including client’s name,medication name, form, route and timeof administration.

2. Review healthcare record for relevant contraindications such as rectal surgeryorbleeding.

Conditions contraindicate useof suppository.

3. Perform hand hygiene.

Reduces transferofmicroorganisms.

4. Putondisposablegloves.

Prevents contactwith infected faecalmaterial.

5. Identify client; check nameonMARwith client’s identificationbracelet and ask client’s name.

Ensures that correct client receivesmedication.

CHAPTER 27 Medication therapy

801

6. Explainprocedure to the client andgain their consent.Be specific if clientwishes to self-administer medication.

Promotes understanding and cooperation.Will enable client to self-administermedication ifphysically able.

4 CHAPTER

Developing clinical reasoning for nursing practice STEPS ■■ Criticaldecisionpoint:Generally, rectal suppository iscontraindicated in thepresenceofactive rectal bleeding.Unless suppository is forconstipation,medicationplaced ina rectumfilledwith faecesmaybe poorlyabsorbedorprematurelyexpelledwithdefecation. RATIONALE

7. Arrange supplies atbedside.

Ensures smoothprocedure.

8. Close room curtainordoor.

Maintainsprivacy andminimises embarrassment.

9. Help assume left lateral (Sims’)position.Keep client drapedwithonly anal area exposed.

Exposes anus and helps client relax external anal sphincter.Maintainsprivacy and facilitates relaxation.

ClintDouglas and JackieCrisp 11. putondisposablegloves (ifpreviousglov swere discarded).

Minimises contactwith faecalmaterial and reduces transmissionofmicroorganisms.

Learningoutcomes Mastery of contentwill enable you to: • understand the value of using a reflective and systematic approach to clinical reasoning • discuss theways inwhich a systematic approach to clinical reasoning enhances nursing knowledge and skill development • discuss theways inwhich nursing knowledge and skill development enhances theprocess of clinical reasoning • explain how using a systematic approach to clinical reasoning contributes to the visibility of nursing practice • explain the relationship between critical thinking and clinical reasoningwithin nursingpractice • discuss the six basicdomains evidentwithin all processes of clinical reasoning • use criticalquestioningwithin each of the six basic domains of the clinical reasoningprocess.

KEYTERMS Actionplanning, p. 51 Clinical reasoning cycle,p. 50 Clinical reasoning models,p. 47 Cognitivebias, p. 47 Criticalquestions, p. 56 Critical thinking, p. 49 Goals andpriorities, p. 50

Determinespresenceof active rectalbleeding.Palpation determineswhether rectum is filledwith faeces,which may interferewith suppositoryplacement. Reduces transmissionof infection.

10. Examine conditionof anus externally andpalpate rectalwalls as needed (seeChapter 24). Ifgloves become soiled,disposeof themby turning them insideout andplacing them in appropriate receptacle.

12. remove suppository fromwrapper and lubricate rounded end (see illustration). Lubricate index finger ofdomina thand.

Lubrication reduces friction as suppository enters rectal canal.

Information/data, p. 51 Judgements and decisions,p.51 Nursing knowledge, p. 52 Nursingmodels, p. 47 Outcomes,p. 49 Reasoningprocess, p. 49

Critical decision points

Step 12 Lubricating rounded endof suppository.

13. ask client to take slowdeepbreaths throughmouth and relax anal sphincter.

Forcing suppository through constricted sphincter causespain.

Steps and rationale

Suppositorymustbeplaced against rectalmucosa for eventual absorption and therapeutic action.

14. retractbuttockswithnon-dominant hand. insert suppositorygently through anus,past internal sphincter and against rectalwall, 10 cm in adults, 5 cm in children and infants.May need to applygentlepressure toholdbuttocks together momentarily.

Incorrectplacement

Correctplacement

Faeces

Faeces

Suppository

Suppository

Anal-rectal ridge

Anal sphincter Rectum

Rectum

Anal sphincter

Images

Step 14 inserting rectal suppository.

15. Withdraw finger andwipe anal areawith tissue.

provides comfort.

PART 1 EVOLVING NURSING: NURSING AND THE HEALTHCARE ENVIRONMENT

PART 4 ADAPTING NURSING: PEOPLE, CONTEXT AND CULTURE

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420

Key concepts

greater competency, so eventually the novice becomes the advanced beginner, who in turn moves through being competent to proficient and finally to expert. At the expert level, theRN is able toprovide care topatients with complex health needs and requires only indirect governance and support. Throughout the journey across the practice pathway, the RN is protected by significant safety and quality frameworks, which are themselves underpinned by evolving legislation, registration standards, professional practice standards and policies that align with best practice and evidence. The futureofnursing: leading change Through the effective use of the professional and regulatory frameworks, informed through postgraduate education and relevant experience, RNs can lead service transformation.Possibleexamplesofnewwaysofworking andnewmodelsof caremay include: n nurseproceduralistsundertakingnewdiagnostic functions, such as endoscopy n nurse-led clinicsdelivering integrated care to palliative carepatients n nurse triagemodels to streamline referralpathways intooutpatient and specialist services n public–privatepartnerships fornursepractitioners, including admissionprivileges, that enhance consumer choice n RNsworking in sustainable and economicallyviable self-employmentmodels focusedon community chronicdiseasemanagement n brokerage and community casemanagement for disability clients through theNationalDisability InsuranceScheme (NDIS) n nursesdelivering care andongoingmanagement to rural and remotepatients throughoutreach services delivered throughuseof technology andTelehealth n expanded access todiagnostics andmedicines to improve thepatient journey anddeliver services closer to apatient’shome. • CRITICALREFLECTION POINT In thinkingabout the futuredirectionsofnursingpractice, whatare thecapabilities youwillneed for success innew workenvironments thatareconstantlyevolving? Conclusion We live in a dynamic and exciting time in the history of nursing and health care.We have an insatiable appetite

for safe, accessible, affordable and quality healthcare services.The demand for professional care provided by nurses has never been greater. RNs acrossAustralia and NewZealand are steppingup andmeeting the challenges their environments are providing. They are delivering person-centred care indiversemodels and settings across the continuum from primary to tertiary care.We have the safety and regulatorymechanisms that surround us to ensurewepractise toour scope and canbe responsive. The challenge is tomaintain our ability to be responsive to our communities and be confident and resilient in an ever-changing environment.Ensuringwework toour full scope, underpinned by ongoing postgraduate education, is not only the answer to newmodels of care, but also to the professional and personal satisfaction ofus asnurses. Nursing leadership at all levels of the healthcare system is essential to secure better health andwellbeing for our nations. Key concepts • Nursingpractice is evolving in response to social, economic andpolitical factors and changingpopulation health needs.Thesedrivers help to shape the context in which theRNpractises anddelivers care. • Healthcare costs aregrowing at an unsustainable rate.An efficient and effective healthcare system that reduceswastage is critical to ensuringpopulationhealth andwellbeing. • Health reform is continuous andwill createmore opportunities for nurses towork innewmodelsof healthcaredelivery thatprovidequality health services to individuals, families and communities. • Nurses are the largestgroupof healthprofessionals in the health system.Aproactive anddynamic nursing profession ispivotal to future healthcareprovision. • It is important that nurses are educationallyprepared for an evolving contextofpractice across a rangeof healthcare environments, including those thathave neverbeen availablebefore as a resultof innovation and technology. • Registered nursesmustbe supported towork to their full regulated scopeofpractice inorder tomaximise the efficiency and effectivenessof the nursingworkforce. • Nursesworking to their fullpotentialwill result in personal,professional and career satisfaction, aswell as ensuring thedeliveryof safe,qualitypatientoutcomes. • It is important to recognise and reinforce the important contributionof the nursingprofession at all levelsof the healthcare system, includingdirect clinical care, coordinating complexpatient care,driving safety and quality,policy and systemsmanagement, research, education and executive leadership.

Conclusion In summary, older adults are likely to access all facets of healthandwelfare services:acute, subacute, rehabilitation and community-based care, as well as residential aged care and palliative care. Nurses are often in a unique position topartnerwitholderpeople and their families to provide sensitive care that is basedon current knowledge about older adults, and that is respectful of their cultural and personal needs and requirements. Gerontology nursing is a specialty area in which knowledge of the physical, psychological and psychosocial aspects of ageing are brought together in an exciting, demanding and challenging area of nursing practice. It is important to remember that the majority of older adults lead healthy and productive lives and working with this age group requires actively embracing concepts of healthy and positive ageing, aswell as direct care and high-level communication skills.Ageing and gerontologynursing is an areaofpractice that is immensely rewarding. Key concepts • Thenumberofolderpeople, especiallyover age 85 years, is increasing in theAustralian andNew Zealandpopulations. • Positive ageing refers tomaintaining a focuson the opportunities and rewardsof ageing • Because nurses’ attitudes towardsolder adults influence thequalityof care, those attitudes need tobe basedon accurate information aboutolder adults, rather thanonmyths and stereotypes. • Older adults adapt tophysical changes in allorgan systems as they age. • Changes in social roles, family responsibilities, financial circumstances andhealth status influence the choiceof living arrangementsof anolder adult. • Olderpeopleaccesshealthandwelfare services that arecommunity-based, subacuteand rehabilitation services,aswellas inacutecareand residential settings. • Thephysical changes that accompany ageing are considered tobenormal,notpathological, although theymaypredispose theolderperson todisabilityor disease. • Cognitive impairment is notnormal in anolderperson and requires assessment and intervention. • Issues related topsychosocial changes in ageingmay include retirement, change in housing, sexuality,grief, change in relationshipswith children andpossible social isolation.

• Nursing interventions forpsychosocial concerns include therapeutic communication, touch, realityorientation, validation therapy, reminiscence and interventions to improvebody image. • Healthy ageing recommendations forolder adults includegoodnutrition, regular exercise, smoking cessation andmeasures to reduce the riskof falls and adversedrug events. • Rehabilitative nursing interventions,whether accomplished in theolderperson’shomeor in an institutional setting, stabilise chronic conditions, minimise functionaldecline andpromotehealth, increasequalityof life and independence in activities ofdaily living. Online resources Agewell; healthpromotion forolderpeople inNewZealand, www.agewell.org.nz Alzheimer’sAustralia; researchpublications related todementia and itspotential impacton society,www.fightdementia.org.au AustralianBureauofStatistics; a numberof short summaries covering thedemographicdetailsofAustralianpopulation, www.abs.gov.au AustralianCommissiononSafety andQuality inHealthCare; resources related tomedication safety, falls, infectionsdelirium andmore,www.safetyandquality.gov.au Australian InstituteofMusculoskeletalScience;detailsof research covering all aspectsof themuscloskeletal system,www.aimss. org.au AustralianPsychologicalSociety;TipSheetonAgeingPositively, www.psychology.org.au/publications/tip_sheets/ageing/ AustralianWoundManagementAssociation;guidelines including for venous ulcers,pressure injury and advice aboutwound care products,www.awma.com.au/publications/publications.php beyondblue :practical assistance to assess andmanage depression,www.beyondblue.org.au DepartmentofHealth; tools to assistwith the careofolderpeople, e.g.decision-making tools for theuseof restraints,oral and dental health forolderpeople anddepression inolderpeople, www.health.gov.au JoannaBriggs Institute; evidence-basedguidelines and best-practice informationon, for example, skin care, hydration andmanagementof constipation, http://joannabriggs.org/ MinistryofHealth; age-related residential-care services agreement forNewZealand,www.health.govt.nz/our-work/life-stages/ health-older-people/long-term-residential-care/age-related- residential-care-services-agreement NewZealandAgedCareAssociation;not-for-profit, national membershiporganisationwhich represents allpartsof the aged-care residential sector.http://nzaca.org.nz StatisticsNewZealand; a numberof short summaries covering thedemographicdetailsofNewZealandpopulation,www.stats. govt.nz UnitedNations:publications covering the health andwelfare needs ofolderpeopleglobally,www.un.org WorldHealthOrganization;publications covering abuseofolder people,www.who.int

Online resources

CHAPTER 17 Considering the developmental Context of youth and adults

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Empowering Knowledge |