December 2018
Regional & Remote Feature + Aboriginal scholarship program to support mental health in remote communities + Alexandra introduces Victoria's first Advanced Care Planning clinic + Vision loss a devastating problem in rural and remote communities + Happy feet - foot care for nurses and midwives
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December 2018 We hope you enjoy perusing the range of opportunities included in this issue. If you are interested in pursuing any of these opportuities, please contact the advertiser directly via the contact details provided. If you have any queries about our publication or would like to receive our publication, please email us at contact@healthtimes.com.au DISTRIBUTION 46,300
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HealthTimes - December 2018 | Page 11
Aboriginal scholarship program to support mental health in remote communities.
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urtin University and Managing Director of Indigenous Psychological Services Dr Tracy Westerman have launched a unique scholarship program to support Indigenous students to study psychology. The Dr Tracy Westerman Aboriginal Psychology Program will support Aboriginal students to study psychology at Curtin University in undergraduate or postgraduate courses. Dr Westerman, who became the first Aboriginal person to complete a combined Masters/PhD in Clinical Psychology in 2003, will personally donate $10,000 per annum over five years, totalling $50,000. “The Dr Tracy Westerman Aboriginal Psychology Scholarship Program will aim to foster the development of the next generation of clinicians committed to researching and delivering evidence-based, best practice into our high-risk communities,” Dr Westerman said. “As a proud Njamal woman from the Pilbara region of Western Australia, my vision is to support students with remote and rural connections through their university studies with the aim of becoming Aboriginal psychologists skilled in Indigenous-specific mental health and suicide prevention and intervention programs.” The scholarship program will encourage graduates to give back to the remote communities most in need of mental health
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care services. “The benefit of working in remote communities is that there are significantly greater challenges as a clinician to work at the ‘coal face’ of those in greatest need and often with an absence of resources to assist. “It challenges you as a psychologist in the best possible way, and the learning curve is significant. “Most of my professional work has been in remote areas, and it is in these areas that I learnt the most about what being a psychologist meant. To be able to see the impacts across whole communities is so very humbling,” said Dr Westerman. Dr Westerman said she wants to inspire the next generation to see these regions as an opportunity to change lives. “This generation can then inspire future generations – the more examples we have of local people capable of working at the most complex end of suicide and mental ill health the more it encourages others.” Curtin University Vice-Chancellor Professor Deborah Terry thanked Dr Westerman for her generous support for Indigenous education and encouraged other organisations to support the worthy cause. “This scholarship program offers a unique opportunity to invest in Aboriginal education and the future wellbeing of some of our most
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vulnerable regional and remote communities,” Professor Terry said. The scholarship is vital because remote communities have the highest rates of suicide and mental health needs, explained Dr Westerman. “Remoteness is related to this and the more remote, the more complex and diverse the culture becomes. “It is so important that we have the greatest number of psychologists in these areas of greatest need. “Most importantly, the scholarship is also a program in which I will personally mentor successful recipients in evidence-based best practice to ensure that these communities will ideally have the resources that are needed. “It is an unconscious bias that exists with regard to mobilising resources into these areas, and the scholarship was, to be honest, borne out of this frustration that the highest risk
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communities seem to be forgotten by funding bodies. “The scholarship program aims to address the obvious skills shortage in these areas, but we need to do this urgently. “We are currently seeking donations for the scholarship with the aim of achieving a minimum of $250,000 in funds annually. “This will ensure that the scholarship exists in perpetuity. While I have personally donated $10,000 annually for the first five years, Curtin University’s endowment trust enables the scholarship to survive off interest, and the target is, therefore, $250,000,” said Dr Westerman. Anyone can donate at https://alumniandgive. curtin.edu.au/giving-to-curtin/where-to-give/ westermanscholarship/
HealthTimes - December 2018 | Page 13
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HealthTimes - December 2018 | Page 15
Vision loss a devastating problem in rural and remote communities
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ision loss is a growing problem in rural and remote Australian communities, and blindness among Indigenous Australians is three times the rate of non-Indigenous Australians, said Dr Angus Turner, Director of Lions Outback Vision. The need for high quality and professional outreach health services in these communities is critical, said Dr Turner, who has been providing retinal screening and diabetic retinopathy management, telehealth support, optometry and ophthalmology services in Western Australia for the past eight years. In 2015, the Vision Van, a custom-built mobile eye health clinic, was mobilised to take specialists and specialist equipment to regions without access to eye health care services that are essential for quality of life, explained Dr Turner. “The Vision Van has covered hundreds of thousands of kilometres throughout Western Australia, and each week we treat hundreds of people and identify patients who require surgery for cataracts, trachoma, glaucoma and diabetic retinopathy. “As well as having on board doctors and nurses, the Vision Van is supported by visiting optometrists, who provide screening and treatment for refractive error, including the provision of low-cost spectacles. “We see patients in regional centres as well as tiny towns and communities. In many cases,
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we can see Indigenous patients in their familiar environment, rather than asking them to travel great distances from home. Another important component of the work of Lions Outback Vision is the LOV food program, launched in 2017. This education program offers a fun and interactive way for children in rural and regional Western Australia to learn about the relationship between eye health, diabetes and food. “The program provides practical cooking lessons and tips and builds the capacity of local health staff to deliver health outcomes to the community. This type of local capacitybuilding is a core principle of LOV.” Dr Turner said being able to deliver the highest quality eye health care to people who generally can’t access it, or who might have to travel hundreds of kilometres from home to receive appropriate care and treatment, is the most rewarding part of his work with Lions Outback Vision. “Last year we undertook more than 7000 ophthalmology patient consultations, and the Vision Van travelled almost 24,000 kilometres. It is so satisfying to be able to make a tangible difference to the quality of life of all of these Australians. “The transformational work we do gives us immense satisfaction. When you perform cataract surgery on an Indigenous patient, and she is able to see her grandchildren for the first
time in her life, it brings tears to your eyes. “When you treat a patient for his rapidly deteriorating sight that inhibits his ability to carry out valuable work teaching Aboriginal rangers, it is both humbling and rewarding. “We are treating individuals, but there are ripple effects right throughout the community and economy. “We also derive great satisfaction from working with local nurses, Aboriginal health workers, Aboriginal liaison officers, GPs and optometrists, to share our knowledge and help to enhance their skills,” said Dr Turner. The Vision Van and LOV program will continue to expand their geographic reach and services as there is an ongoing need in rural and remote Western Australia. “One of our dreams is to establish a North West Hub, to better service the vast Pilbara and Kimberley regions. More than 100,000 people live in these regions, yet there are currently no ophthalmic specialists located there. “We believe that closing the vision gap in Australia’s North West will come from a model that has a hub in a town such as Broome, and then weekly optometry and ophthalmology services delivered throughout the regions to places such as Karratha, Port Hedland, Fitzroy Crossing and Halls Creek. “Through this model, we would develop a stronger connection to the community and gain a better understanding of regional eye health issues.” One of the biggest challenges of the Vision Van and LOV program is bringing others along on the journey to support these vital services,
explained Dr Turner. “Stakeholders such as governments, public health sector leaders and funders such as philanthropists and companies are important to LOV’s sustainability, so we need to ensure they support us in our critical agenda to close the gap in vision problems.” Dr Turner said he encourages any health professional to grab the opportunity to work in regional and remote healthcare with both hands. “I would love to see more young ophthalmologists gain the experience of working in regional Australia, helping to address the inequality of eye health care for those living outside of the metropolitan area. “It is such a privilege to be able to work in areas of great need, and there is enormous value to be derived from caring for disadvantaged or marginalised people and communities. “Working regionally or remotely often enables health professionals to experience a full range of conditions and circumstances, as well as the diversity of patients that they might not be exposed to in a metropolitan environment. “It gives people the opportunity to truly make a difference, in a tangible way. “There is a special collegiality and spirit of collaboration among people working in the bush that is unique and adds a lot of depth to the work that we do,” said Dr Turner.
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Alexandra offers local residents access to Victoria’s first Advanced Care Planning clinic
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he regional town of Alexandra is home to Victoria’s first Advanced Care Planning Clinic, thanks to the determination and passion of local nurse, Jeanie Hurrey, who spent five years campaigning to the make the clinic a reality. A nurse for more than 20 years, Ms Hurrey has been working for the Alexandra Health District on the Acute Ward and in Urgent Care since 2004. However, it was during her very first nursing rotation on the oncology and haematology ward that she fell in love with palliative care. “My interest and passion has long been palliative care, and advocating patients’ wishes,” says Ms Hurrey. “Throughout my nursing career I’ve witnessed too often the emotional stress families experience when trying to second guess what their loved ones’ wishes are when it comes to making decisions about their medical treatment. “I have also experienced that stress first hand several times with my own family.” Ms Hurrey first became aware of Advance Care Planning after hearing a feature on radio news some years ago. “It piqued my interest and inspired me to gain the skills and knowledge to implement ACP at Alexandra District Health, starting with the Respecting Patient Choices workshop at the Austin Hospital. “After implementing ACP at ADH and a process by which ACDs are recognised and stored, I endeavoured to promote ACP in GP clinics. “It was important to try and aim for people to do ACP while they were well rather than in hospital whilst they were unwell.” However, Ms Hurrey says she quickly
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recognised that GPs are time poor with their appointments, and ACP wasn’t itemised on Medicare. “As much as I tried to see patients during my shift, time allowed to see them was dependent on how busy the ward and Urgent Care was. “And so my idea of the clinic hatched.” Ms Hurrey first suggested the idea of an ACP Clinic about 5 years ago, however with ongoing changes in senior management, getting it off the ground proved a challenge. “I persisted with increasing community awareness of ACP as well as promoting it to patients and colleagues alike at ADH. “The present senior management of ADH recognises the importance of ACP and the value a clinic would be to our community, so in April this year during the first National Advance Care Planning Week, ADH launched the ACP Clinic.” The clinic is run fortnightly from the Primary Care Services of ADH. Members of the community have the opportunity to book an appointment with Ms Hurrey so she can guide them through appointing medical treatment decision makers and/or making an advance care directive. Appointments for individuals run for an hour, while couples have an hour and a half. They then take their documents to their GP to sign, and once signed, the documents are directly scanned into their file before providing certified copies to those who are/would be involved in their healthcare. “The clinic has been received extremely well,” Ms Hurrey says. “Since the launch of the clinic, I have been booked out each fortnight. Ms Hurrey believes that having access to an
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ACP clinic is important, particularly in regional communities where access to professional advice is limited. “People are very protective of their bodies but they’re even more protective and passionate about preserving how they live their lives. “This is evident in our district as I am often asked to provide information talks about ACP to community groups.” Ms Hurrey says the impact of the clinic is clear, not only through numerous positive outcomes, but by taking into account, some of the unfortunate consequences to patients who have not made their wishes known. “Recently we lost an elderly patient who had been unwell for some time and had been reluctant to complete an advance care directive. “They had recently been discharged from hospital when their condition deteriorated rapidly and they were returned to hospital. “The hospital staff knew that they would not want to be transferred to Melbourne and would
opt for comfort care in Alexandra but we had to transfer them. “There was no advance care directive and we couldn’t reach their substitute decision maker. “They died the following day in Melbourne.” Fortunately, the patient’s family was with them in the end, however Ms Hurrey says this case was a good example of just how important advanced care directives are. “I have been very fortunate with the support provided to me by my managers and my colleagues, but also from other healthcare providers such as the GP clinics, our local ambulance crew and the local residential aged care facilities. “We’re all working together to ensure our community is well informed about their options, and have the opportunity to document their values and preferences.”
HealthTimes - December 2018 | Page 19
Happy feet - foot care for nurses and midwives
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here aren’t many professions more taxing on the feet than that of a nurse or midwife. Long shifts, concrete floors and the demands of the job can take a significant toll, but you can remedy the abuse with a little self-care according to podiatrists. Podiatrist Daniel Fitzpatrick said nurses and midwives are the most prevalent patient he sees at his podiatry clinic. “I think we all underestimate how taxing the role of these caregivers is on the lower limb and their bodies in general. I know after fifteen years of seeing the same types of conditions in nurses and midwives we now realise that their feet cop a battering,” said Mr Fitzpatrick. It is vital for nurses and midwives to be proactive with their foot health if they want to continue in their profession, explained Mr Fitzpatrick. “Unfortunately, we all tend to put off treatment, but nurses and midwives have such a physical job that they don’t have the leeway that the rest of us do.” Nurses and midwives spend the majority of their time at work on their feet, so painful conditions become chronic quickly, said Mr Fitzpatrick, and once these issues get to that stage, they become costlier to fix and may require surgery or pain-relieving injections. A study published in the International Journal of Nursing Practice, investigating foot health and impact on work wellbeing in Finnish
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nurses, found that nurses had a variety of foot problems, with dry skin, foot pain, and corns and calluses being the most prevalent. The study concluded that foot problems were common among nurses and were associated with individual and work-related factors. The incidence of long-term diseases, the need for specialist appointments and related impact on work performance were all associated with foot health, and as such prevention of foot problems should be prioritised. The research paper highlighted the importance of regular assessment and self‐ care by nurses, and in severe cases, professional podiatric care. Also, health care organisations need to develop work ergonomics and occupational health care programs to support foot health and work wellbeing in this profession. 7 tips on keeping feet tiptop Daniel Fitzpatrick recommends the following self-care tips for nurses and midwives. 1. Do calf stretches Stretching the calves (the back of the bottom part of your leg) is vital to foot function. The calves can tighten the muscles at the bottom of the feet and as a result increase minor tears and pain. “I’m sure patients in our clinic think all I do is talk about calves, but they are vital and
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cause so many knee and foot problems. They are particularly relevant when you stand up for a living.” How to stretch your calves • Find a wall and place the palms of your hands on it at around shoulder height. • Place one foot in front of the other so that toes are pointing in the same direction and feet are parallel to each other. The back heel should touch the ground. • For the first stretch, bend the front knee and keep your back knee straight. • Hold for 30 seconds. • For the second stretch, bend the back knee of the back leg. • Hold for 30 seconds. • Repeat on opposite leg. How often? Mr Fitzpatrick advises that calf stretches be performed four times a day, ensuring stretches are held for 30 seconds and continued for three weeks. If there is not a
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significant improvement in symptoms, book an appointment with a podiatrist. 2. Tennis ball exercise This exercise is excellent for loosening soft tissues and getting the natural lubricant back into the joints. It can help everything from plantar fasciitis to osteoarthritis. It’s great as an exercise for nurses and midwives at the end of a day. How to do this exercise • Sit on the edge of a chair with the tennis ball under your toes. • Roll the tennis ball from your toes to your heel, applying as much pressure as you can tolerate. • Roll the ball around in small circles on your forefoot (from your toes to under the ball of your foot). • Now roll the ball around in small circles on your arch (from the end of the ball of your foot to the beginning of your heel).
HealthTimes - December 2018 | Page 21
• Then roll the ball around in small circles on your heel. • Repeat the above process on the other foot. 3. If you have pain get assessed! If pain lasts longer than three weeks, it can lead to chronic inflammation. This is particularly important when the point of pain is in an area that is heavily used in a work capacity, said Mr Fitzpatrick, who strongly suggests seeing a podiatrist. “So often I take a history and nurses, and midwives have been in chronic pain for o v e r six months! As a result, the problem is much harder to fix. We can usually still fix it, but it costs more and takes longer to heal while the poor patient is in pain.” Podiatrist Sarah Sweeney adds the following essential tips on foot health for nurses and midwives. 4. Custom orthotics. “I cannot stress how important it is to have proper arch support in your shoes which only a custom orthotic can offer. “A lot of my nurse patients present with plantar fasciitis (heel pain). This is due to the way they walk and stand, the fascia or arch is not supported and can become stretched and strained and extremely sore! “This is a common complaint in the nursing profession. Book in with your local podiatrist, get an assessment and see if custom orthotics will help you.” 5. Footwear! “It is imperative that nurses and midwives wear supportive shoes. The best part about this job is that they are allowed to wear joggers to work. “I recommend New Balance black leather joggers, Brookes or Asics. Always make sure that the foot is not squeezed into a shoe, as huge
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problems can occur if the shoe is ill-fitting.” 6. Regular callus and corn debridement. “Callus and corns are common due to the amount of time nurses and midwives are on their feet, and are extremely painful if left untreated. It’s important to see a podiatrist regularly to manage these conditions.” At home treatment – use a pumice stone and foot file to remove excess callus (hard skin), moisturise the feet regularly, wear cotton socks to prevent sweating, and shoe deodoriser to avoid smelly feet and shoes. 7. Avoid nail salons! “Most of these places do not sterilise. This makes you susceptible to a fungal infection in your toenails. Fungal infections are tough to get rid of. Make an appointment with a podiatrist for a medi-pedi instead. We use sterile instruments and are trained to remove ingrown toenails, corns and callus. “I cannot stress how debilitating it is to be in agony with every step you take, how scary it is to realise that you can’t walk without pain and to wonder if you will ever be pain-free again. “If nurses don’t make the right choices for their feet, they could end up with so much pain that they have no choice but to stop working,” said Ms Sweeney. Ms Sweeney said she recently treated a nurse who had a stress fracture so severe that she had to wear a moon boot for six weeks, and because moon boots are a health and safety hazard in a hospital, she had to take six weeks of unpaid leave. “The stress fracture was not from trauma – just from the way she walked around all day with no support. “Feet can look ugly after a lifetime of neglect, so it is important to treat them well. It’s important for a nurse’s health, quality of life and livelihood. Prevention is always better than cure!” said Ms Sweeney.
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HealthTimes - December 2018 | Page 23
Dietitian consults should be routine for women trying to conceive, says expert
O
bstetricians and GPs should be more educated on the impact of diet on fertility, according to Fertility and Prenatal Dietitian Melanie McGrice, who says consulting a dietitian or nutritionist should become routine for couples trying to conceive. “Diet impacts fertility in quite a few different ways,” says Ms McGrice. “I’m passionate about diet for fertility for two key reasons. “One is simply that it can assist with different dietary conditions that directly impact fertility. “For example, if somebody has undiagnosed Celiac disease, that can have a significant impact on fertility. “I’ve had clients who have been trying IVF for years and years only then to find out that the woman had undiagnosed Celiac disease. “Once that was treated, they were able to conceive properly.” There are multiple other conditions, such as Crohn’s disease and even endometriosis, that are also impacted by diet. Another common cause of infertility, according to Ms McGrice, is insulin resistance. “Sixty percent of people who are overweight have insulin resistance, and one in two women who are planning to conceive fit within that category, so it’s a high number of women.
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“Insulin has a domino effect on other fertility hormones which make it difficult to conceive.” In fact, Ms McGrice says about one in three women who are struggling to conceive, are doing so as a result of insulin resistance. On the flipside, women with very low percentages of body fat can also struggle to conceive due to the impact on ovulation, and diet plays a key role here also. “So there are lots of reasons where diet can help women to conceive.” Along with conception itself, there is increased research that shows the direct impact of diet on what is commonly referred to as “the first 1000 days”. “That is the main time for genetic programming which goes on to influence our life and our health for decades to come.” Ms McGrice says in her view, every woman who is planning to conceive should be having a consultation with a dietitian. “It can really help to optimise your baby’s genetics and it can also help to optimise fertility.” While women more commonly seek allied health services when trying to conceive, there is an increasing amount of research that shows men’s nutrition also impacts fertility. However Ms McGrice says more research
is required, in order to better understand the impact, as is being done in relation to women’s fertility. “There is a really interesting study by harvard which shows that by making just five dietary changes, it can help optimise women’s fertility by 65 per cent. “Diet is so incredibly powerful for fertility. I don’t think there’s enough knowledge about it and even when I’m presenting to doctors they often say they had no idea that diet has such a big impact on fertility.” While research in the area is relatively new, it coincides with an increase in reports of fertility issues, due to increased aged, obesity, dietary conditions and malnutrition. “There are so many more conditions that impact fertility as well, so for those reasons we’re seeing increases in rates of infertility. “But often people are going to fertility clinics before looking at a holistic view to the issue.” Ms McGrice says while she agrees with the guidelines that suggest fertility treatment be sought following 12 months of trying for those under 35, and 6 months for those over, she feels women should be consulting with a dietitian as soon as they start trying to conceive. “Often people go straight onto their folic acid supplements, but it’s not just about taking something out of a bottle, you actually need to look at your diet.” Ms McGrice is passionate about educating the medical community about the direct impact of dietary changes to fertility, and often presents to GPs and reproductive specialists to make them more aware.
“I’m very passionate about educating the medical profession on just how important diet is. “I’m often asked to go and speak to different conferences and so forth, where I’ll explain to them about the importance of diet for fertility and the often end up referring patients to us.” Ms McGrice also runs a YouTube channel for patients and professions called Nourish Fertility which includes mini tutorials around fertility and diet, and runs an online program, www.malaniemgraph.com/join, about optimising your diet for fertility. “It really takes people through step by step about how to optimise their diet for fertility, looking at nutrition and supplements, weight, diet and physical activity. “It demonstrates the importance of really having a good look at your diet with the perspective of fertility. “I’ve been through my own fertility journey as well so I have a lot of empathy for my clients. “I’m surprised at how unaware some medical professionals are, but you know about what you’re most passionate about, and I’m passionate about educating the industry and helping as many women as possible optimise their fertility.”
HealthTimes - December 2018 | Page 25
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HealthTimes.com.au HealthTimes - December 2018 | Page 27
Fertilty Nursing: A roller coaster of emotions
I
nfertility affects one in four Australian couples. Described as an inability to fall pregnant following 12 months of trying, or six months for couples older than 35, infertility can result in a minefield of emotions. Fortunately, these days, there’s a wide range of infertility treatments available, from artificial insemination through to IVF. It’s big business, and involves numerous medical professionals and key players, all of whom contribute to helping couples achieve their lifelong dream of holding their baby in their arms. One of the most significant and multifaceted roles involved in the process is that of the Fertility Nurse. A Fertility Nurse’s role can range from providing support and counselling to couples considering IVF or other fertility treatments, to assisting patients in administering injections throughout the process. So complex is the role, that it took more than 15 years of active nursing before Fertility Nurse Kate Wilford even became aware that nurses could work directly in the area of reproduction and fertility. Ms Wilford first developed an interest in nursing at just 14, after completing a week’s work experienced a nursing home and quickly discovering that caring for people in what made her happy. “I think when I reflect over the last 25 years of nursing, it was about being able to treat people the way I would want myself and family to be treated,” says Ms Wilford. “Many people are at their most vulnerable and just being able to make them feel safe and reassured was what appealed to me.” It was in 2010 when Ms Wilford was working in a Day Surgery unit on a case that involved a
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woman’s health, that the shift Gynaecological Doctor commented that she would be the perfect fit for fertility nursing. “And that’s when I thought ‘Can a nurse can work in Fertility?’ and commenced seeking employment in the field of Fertility nursing. “I watched out on Seek for any job opportunities and was very fortunate to find a position as a nurse Coordinator at a Fertility Clinic near to where I lived.” While Ms Wilford says having experience with women’s health is helpful in the transition to fertility nursing, full training is provided. “I went to the START course (Start-up training in assisted reproductive technology) which was excellent.” Ms Wilford says there’s really no such thing as a typical day for a Fertility Nurse as the role is so varied. “Anything from educating patients about IVF and what to expect during their cycle, medication teaching, basic counselling, assisting with egg collection and embryo transfers, and communicating with patients about happy and sad outcomes, as well as being involved in our extensive donor program. “Being a senior nurse and donor nurse coordinator, I assist our Nurse Manager with the daily running of the nursing team, see patients, assist doctors, run the donor program and am currently involved in a research project to help improve men’s sperm health.” While Ms Wilford says she finds the role overall a rewarding experience, her personal highlight is when couples come back to visit her, bringing with them the little babies that they had so longed for. “Even just calling them to say they are pregnant can often bring tears to my eyes as you share their happiness over the phone.”
Ms Wilford says the main difference between fertility nursing and general nursing is the focus on communication and support. “I would say that Fertility nursing is more about communication, education and supporting the Fertility specialist with procedures. “Whereas general nursing involves patient loads, administering medications and injections, more hands on nursing care. “Great communication skills are a must and most definitely empathy. “I think you do need to be compassionate and love the job you do, as patients rely on you and form bonds with you, during a very stressful time in their lives.” While rewarding, Ms Wilford says the role can be emotional at times, as fertility nurses form close relationships with couples, who can remain ongoing patients for years at a time. “Especially if they have been coming through for many years and then fall pregnant
and say, miscarry. “I have cried with couples, hugged couples, cheered with couples and just been there to listen. “So I suppose it’s a roller-coaster of emotions.” Having been a Fertility Nurse for 8 years and previously a ward nurse and emergency nurse, Ms Wilford says she has found her niche. “Being involved in the donor program as an IVF nurse and being able to provide hope to couples, who have failed to conceive with their own gametes is just incredible. “To know there are so many kind and generous people in this world, who offer their eggs, sperm and surplus embryos to help another couple conceive and experience the joy of parenthood is just remarkable. “I look forward to work each morning, so I can 100% say I love Fertility Nursing.”
HealthTimes - December 2018 | Page 29
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