November 2019
Education special feature + Maintaining Professional Standards: The Nursing Portfolio + Why dual degrees open more - and more unique - nursing doors + Paediatric hypnosis underused but highly effective, says therapist + Reducing C-Sections in Midwifery Practice
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HealthTimes - November 2019 | Page 03
November 2019 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 - November 2019 | Page 05
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Continuing Education Opportunities Putting Cognitive Behavioural Skills into Practice This training program consists of 7 online webinars, plus skills practice between sessions. It aims to develop cognitive behavioural therapy skills so you can help patients to manage their chronic pain. (see website for dates)
Dealing with Emotionally-Challenging Patient Encounters This workshop will help you learn how to respond to patients’ emotions, and importantly, how to manage your own emotional responses to patient behaviour. (Mar 2020)
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CME and PD credits available For dates & further information visit: sydney.edu.au/medicine/pmri/education
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HealthTimes - November 2019 | Page 07
Find your specialty, we have over 20 to choose from. Study postgraduate nursing online, part time and applied in your workplace.
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HealthTimes - November 2019 | Page 09
Maintaining Professional Standards: The Nursing Portfolio
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tudent nurses, nurses and midwives are required to keep track of their continuing professional development goals, accomplishments, knowledge and skills in a professional portfolio, which shouldn’t be confused with a resume. What is a professional portfolio? A nursing portfolio is a collection of all achievements, continuing professional development (CPD) activities, competencies, experiences, and professional goals. A nursing portfolio is used to satisfy the legal requirements of registration and to show prospective employers a drive and commitment to the profession, explained Nurse Consultant Claire Dunkley. Why is a portfolio important? Annie Butler, Federal Secretary ANMF, said the Nursing and Midwifery Board of Australia (NMBA) require nurses and midwives to complete continuing professional development (CPD) that is set out by minimum requirements. Meeting minimum standards is crucial, as when nurses and midwives apply to renew their registration or endorsement, they are
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required to declare that they have complied with this standard. “Their compliance may be audited. It may also be checked if the NMBA receives a notification about them. “Nurses and midwives are required to maintain records of their CPD activity for five years in case they are audited. “If they are required to provide the NMBA with evidence of their CPD activities, their professional portfolio will help them to demonstrate they have met the CPD requirements,” said Ms Butler. What should be included in a portfolio? There are ten essential components to a professional nursing portfolio:
2. 3. 4. 5. 6. 7. 8. 9. 10.
1. Date Source of CPD Identified learning needs Action plan Type of activity Description of the topic Reflection on learning Application to practice Evidence Hours
What do you put into a nursing portfolio? Nurses and midwives should put every
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professional experience into their portfolio, from annual professional development reviews to formal education, said Ms Dunkley. • All in-services and workshops attended within an organisation and externally (include knowledge gained and it applies to practice. • Conferences (you can give inservices to staff to demonstrate your willingness to upskill your colleagues to achieve best patient outcomes). • Work experiences – from a difficult patient case, to ‘acting up’ in different positions, and any leadership opportunities. • Further formal and informal studies undertaken. • Competencies (all workplaces require competencies for practice). • Employment records. • Annual professional development reviews.
• Articles read and reviewed. • Evidence of leadership or teaching (precepting of students, coordinator of shifts). • Service appreciation awards. • Reflective practice. How do you put a nursing portfolio together? Nurses and midwives can use the NMBA or ANMF template to record the date, source, identified learning needs, action plan, type of activity, description of the topic, reflection on learning, application to practice, evidence and hours. ANMF Branches also provide members with a hard copy and/or electronic template to assist in documenting CPD. It’s important to keep track of all continuing professional development throughout a nursing or midwifery career. All certificates and documentation can be
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collated in a display folder or recorded digitally via online tools and Apps. The following tools will help in portfolio management: • Australian College of Nursing membership online platform • iFolio online platform • Apps : o AusMed CPD o CPDme o ClinicalSkills What type of professional development is best? Completing a range of CPD activities, including formal and informal learning activities, throughout a registration period and recording them in the portfolio is key. “CPD activities must be relevant to your area of practice and have clear aims and objectives. “Ideally the types of activities are broad and varied,” said Ms Butler. Examples of professional development activities • Postgraduate studies • Attending conferences • Workshops and seminars • In-service education • Researching new procedures or medicines • Reviewing legislative or policy changes impacting practice • Participating in journal clubs • Authoring a book chapter • Having an article published in a peer-reviewed journal • Attending short courses “The ANMF not only offers many of these learning opportunities but also supports members to undertake a wide range of CPD
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activities that contribute to their professional practice portfolio,” said Ms Butler. Tips on creating and maintaining a portfolio As you only have two weeks to provide portfolio information for the NMBA should you be audited, you need to ensure that it is up to date and easily accessible, said Ms Butler. “Keeping an electronic record is ideal as it makes it easier to update as you go. A hard copy backup is also recommended. “Don’t forget to include any self-directed learning and mandatory workplace learning activities you may have done. “For CPD to be effective, make a plan, choose a range of activities and always remember to record your reflections on your learning in your portfolio,” said Ms Butler. Ms Dunkley, advises: • Keep a record of everything you do and add it to your portfolio. • Use the online platforms as they have done that hard work for you and it looks professional. • Update your portfolio quarterly – this way you’ll be up to date and also aware if you are due to add to your CPD. • Take the portfolio to every interview to stand out from the crowd. • Take every opportunity presented, you never know what doors it will open. • Reflect on your own practice regularly. “Nursing can take you and your career in many directions. “So, think outside the square – nursing isn’t limited to hospitals and clinics,” said Ms Dunkley.
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Why dual degrees open more - and more unique - nursing doors
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n early passion for paramedicine was the catalyst to registered nurse Benjamin Jenkins’ unique path to nursing, which involved the completion of a dual degree and a dynamic career that a single degree may not have afforded him. “Initially, nursing was simply a way of following my passion of becoming a paramedic,” says Jenkins. “However, it wasn’t long before I started to see the immense benefits of becoming a registered nurse. “First and foremost, the ability to care for patients at their most vulnerable, and being able to make a true positive impact, was what appealed to me the most about nursing. “Secondly, I had discovered early on in my studies, and whilst on clinical placements, that something I really enjoyed was not only the actual skills that I performed, but the conversations I would have with my patients and their families. “I was in a position to listen to their concerns, and to provide reassurance and education during what is a stressful period. I felt as if I could really make a positive impact.” Choosing which two degrees to pursue was as simple as Googling the words, nurse, paramedic and university. “I clicked on the first link, which was
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the Bachelor of Nursing and Bachelor of Emergency Health (Paramedic) from Monash University, in Victoria. “After spending the next few hours reading all about the degree, I was sold. “Not only does the dual degree allow you to study towards becoming both a Registered Nurse and a Registered Paramedic, but it was the way in which Monash constructed their degree which was incredible. “The clinical placements I went on were second to none. I would attend my nursing placements, my onroad paramedic placements, as well as attending specialist hospital placements as a paramedic student. “These specialty areas included birth suite, operating theatre, special school, coronary care unit, emergency department just to name a few. “This allowed me, as a nursing student, to discover the areas of nursing that I enjoyed, and to learn from each of these experiences.” Entrance into the dual degree at Monash University, which took four years to complete, was competitive, requiring an ATAR during the year Jenkins applied of 94. An easy choice For Jenkins, the time and effort required for entry and completion of the dual degree
was well worth it. At the commencement of his third year of university, he received the Defence University Sponsorship Scheme (DUSS) from the Australian Army, to become a Nursing Officer. After graduation, nursing students who receive DUSS complete two ‘placement’ years allowing them to practice, hone skills as a registered nurse, to then commence fulltime employment as a Nursing Officer for a set return of service obligation. “Receiving DUSS, provided an incredible opportunity to focus on my passions for leadership and volunteering. “I spent my spare time, that I would have otherwise been spent working as a fitness instructor; participating in Monash Universities flagship leadership program: ‘The Vice Chancellor’s Ancora Imparo Leadership Program’. “I attended as a delegate and later returned as a leader at the ‘National Student Leadership Forum’ held in Parliament House; I peer taught into first and second year paramedic classes; mentored high school students; and commenced my own peer teaching program into the School of Nursing & Midwifery. “All of these provided a wealth of opportunities to develop myself, and my abilities, which has been of significant help post-graduation.” A unique career path Following graduation, Jenkins moved
states, and commenced into the Intensive Care Unit (ICU) at one of Queensland’s Metropolitan Major Trauma Centres, Princess Alexandra Hospital (PAH). “The 12-month program, which included a formal Queensland Health ‘Transition to Practice Program’, was incredibly challenging, and was exactly what I was chasing as a graduate nurse, fresh into the profession. During the early stages of his studies, Jenkins’ career aspiration was to become an Intensive Care Flight Paramedic. “The paramedics in Albany would detail their incredible experiences working in this role, and I was in awe of the excitement, variety, autonomy, continual training and development, and the true impact they could have on the lives of their patients. “Knowing that I only have two placement years to experience, and to learn as much as I can, before commencing full-time as a Nursing Officer in the Australian Army, this year I moved from ICU into the Emergency Department (ED) at PAH. “I feel incredibly privileged to have worked in two critical care areas, for my first two years as a registered nurse, in such a large, and high acuity major trauma centre. “I truly believe the skills that I’ve developed over the last two years will set me up well as I enter the Australian Army fulltime in January, 2020.” Jenkins says he believes it was the dual degree in nursing and paramedicine that has set me up to achieve the level of success he’s reached over the last few years.
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“It was the combination of the variety of clinical placements, the hand-on approach of repetitive training during paramedic classes, the similar course content taught from both the prehospital and hospital settings, the ability to compete in student paramedic competitions, and the structured ABC approach that paramedic students are taught, that provided the confidence in my abilities to start my career directly into a large major trauma centre’s ICU as a registered nurse.” Dual degrees aren’t for everyone “For me, the dual degree has been the perfect catalyst to my nursing career, however, I don’t believe it’s for everyone,” says Jenkins. “You really have to ask yourself what your goals are, and where you see yourself in the future.
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“With paramedicine now being recognised through AHPRA, it has now created new challenges for the dual qualified clinician. “Needing to maintain a minimum number of hours working in both professions may be difficult for some, given that both careers require you to have completed a graduate program.” Paying for two sets of registrations each year can be costly, and the need to maintain a certain number of continuing practical development (CPD) for each career can be time consuming. “It may take a few years, as AHPRA refines the expectations of national registration, before the dual trained nurse paramedic can get a solid grasp of their yearly expectations. “For now, however, it can be rough to maintain both registrations.”
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HealthTimes - November 2019 | Page 17
Paediatric hypnosis underused but highly effective, says therapist
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lthough not widely accessed, hypnotherapy can be a highly effective treatment for children, provided therapists understand that modifications required when compared with adult treatment, says psychotherapist and hypnotherapist, Dr Karen Phillip. “Child hypnosis is a very effective way of resolving different emotional and behavioural problems. “Children are very suspectable to trance-like states as they are generally more open to suggestion,” says Dr Phillip. “Children tend to respond to hypnotic suggestion better than adults because they are more in touch with their imaginations.” Dr Phillip says children can benefit from hypnotherapy after experiencing trauma and loss, for rebuilding self-confidence from bullying, phobias and fears, sleep issues, nail-biting eyelash or hair pulling or bed wetting. However, due to a lack of understanding, it’s rarely accessed by parents or suggested by therapists. “If we think about it logically, most issues are created by the thoughts we attach to them,” she says. “Hence, if the mind attaches these connections, hypnotherapy can aid the mind to disconnect these emotional attachments and adjust the thoughts and feelings to
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something more positive and beneficial. Trained hypnotherapists and those parents and children who have benefited from hypnotherapy understand the lifelong benefits that are achieved.” Hypnotherapy with children is approached differently than adults as the child’s mind is more accepting and open, says Dr Phillip. But while the approach is different, suggestions are similar, with techniques and suggestions adapted according to the age and development of the child for the most effective results. “Most children, once rapport and trust are developed with the therapist, usually respond very well and quickly. “Children enjoy the relaxed hypnosis process and usually respond quickly to suggestions.
“It is an enjoyable experience, and the results can occur surprisingly fast.” There are some limitations though, which comes down to the child’s willingness to cooperate. “If the child does not wish to change, then change is challenging to achieve. “We can only aid and support what the mind wants; we cannot make a person do anything they do not want to do.” Often, says Dr Phillip, after explaining
how hypnosis works in childlike language, children are happy to participate. “I explain they will be really relaxed as they use their imagination to resolve their problems.
“Using suggestions such as being more relaxed, having more energy, feeling confident, happy, liking themselves, enjoying the taste of new nutritious food, can all work positively.” Dr Phillip goes as far as saying paediatric hypnotherapy is one of the most effective therapies available to children, transforming their lives through hypnotic visualisation and other imaginative methods. “Hypnotherapy for children can be such a rewarding choice as children make good use of their imaginations. “The therapy can include using stories, adventures, using a hero or character from a favourite show who guides them on what to do, as many young children easily accept these.” Dr Phillip says therapists who have experience working with a variety of individuals, enables them to work effectively with children. “Much depends on the attitude of the parents and most parents bringing their children to a hypnotherapist have researched and understand the benefits, helping the child to already feel comfortable.” For Dr Phillip personally, she has successfully treated many children with
issues from nail-biting to eyelash pulling issues, bed wetting, sleep issues, fussy eating and phobias. “I recall one seven-year-old boy who was interested in eating more food but was stuck on chicken nuggets, potatoes and apples. “He refused to eat bananas, other fruits, meats and vegetables. “He came, I believed due to parental pressure, so I wasn’t sure how he would respond as I relaxed him down and told him a story. “I asked him to use his imagination and had him consume within his subconscious mind, broccoli, bananas, carrots, meat and eventually a wide range of foods, including beetroot and lettuce. “He opened his eyes excited, but I detected a little hesitation. “His mother called me the next morning elated. After having this little boy to Psychologists for months, one session of hypnotherapy enabled him to adjust his mindset and expand his food choices easily and quickly.” But while research has successfully demonstrated the benefits of hypnotherapy for adults and children, Dr Phillip says it remains the last resort. “Many people go down the standard medical or psychology track first, however, when we are dealing with behavioural and emotional issues, hypnotherapy is often the best and fastest method for beneficial results that can last forever.”
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American College of Sports Medicine releases evidence-based guidelines for physios treating cancer patients or survivors
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he American College of Sports Medicine (ACSM) has released a new set of guidelines which highlight the importance of exercise in combatting the effects of cancer treatment and improving survival rates. The new guidelines follow the convention by the college of a roundtable of experts from 17 organisations, including the American Cancer Society and the National Cancer Institute, to review the latest scientific evidence and offer recommendations about the benefits of exercise for prevention, treatment, recovery and improved survival. The Australian Physiotherapy Association (APA) has thrown its support behind the guidelines, acknowledging the important role physiotherapists play in ensuring that people with or recovering from cancer have access to the most appropriate exercise treatment plans. APA chair of cancer, lymphoedema and palliative care group, Elise Gane, said she wasn’t surprised by the findings, but was pleased that evidence was mounting at a global scale. “We’ve always known that exercise is important, but the growing evidence base for the benefits of participation in moderate intensity aerobic exercise and resistance training for better outcomes is spurring us to find new ways to motivate and support our patients with programs that best fit their needs,” said Ms Gane. “Physiotherapists working with patients with a cancer diagnosis are highly experienced in designing and managing tailored exercise programs. ACSM Immediate Past President Katie Schmitz, who co-chaired the roundtable, said with more
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than 43 million cancer survivors worldwide, there was a growing need to address the unique health issues facing people living with and beyond cancer, and better understand how exercise may help prevent and control the disease. “This esteemed, multidisciplinary group of leaders on the forefront of exercise oncology aimed to translate the latest scientific evidence into practical recommendations for clinicians and the public and to create global impact through a unified voice.” The guidelines recommend that health professionals such as physiotherapists design and deliver bespoke exercise programs for people with or recovering from cancer to support their recovery and ability to deal with the debilitating side effects of cancer treatment. The evidence based guidance suggests that prescribed exercise that best meets the needs, preferences and abilities of the individual will improve physical function, fatigue, anxiety, depression and quality of life of cancer sufferers. The new ACSM guidance includes the following findings: • Exercise lowers the risk of seven types of cancer: colon, breast, endometrial, kidney, bladder, oesophagus and stomach • For cancer survivors, exercise improves survival after diagnosis for breast, colon and prostate cancer • Exercise during and after cancer treatment improves quality of life • Recommendation includes moderate intensity aerobic training at least three times per week for a minimum 30 minutes; plus resistance training at least twice a week.
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HealthTimes - November 2019 | Page 21
Reducing C-Sections in midwifery practice
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caesarean section is one of the most common surgical procedures in the world, and while an important life-saving intervention during labour, it is also associated with increased maternal and perinatal morbidity. Despite this, rates of caesarean sections continue to increase in most countries worldwide. Reducing rates of caesarean sections has long been an ambition of the World Health Organisation (WHO) with a goal of no more than 10 to 15 per cent of births. Currently, in Australia, the rate stands at 32 per cent, significantly higher than recommended by WHO for births that are high-risk without surgical intervention. Midwife-led care through pregnancy and childbirth could be key to reducing an increasing number of avoidable caesarean births, according to a new Deakin University study. Results of the study indicated that, compared with women allocated to usual are, women assigned to midwife-led models of care across pregnancy, labour and birth, and postnatally, were less likely to experience caesarean section, planned caesarean section, and episiotomy. What is a midwife-led model of care? A midwife-led model of care is defined
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as care where the midwife is the lead professional in the planning, organisation and delivery of care given to a woman. Midwife Kathy Fray said Australian midwives have less autonomy than many of their international counterparts. “In New Zealand, maternity care is midwife-led, which means midwives are regarded as experts in normal care. This means we know when it’s not normal and refer to our obstetric colleagues, but only when there are medical complications. “Midwifery-led care makes the difference, but the Australian health care system isn’t set up that way. “All pregnant women should see a midwife, who only refers to an obstetrician when complexities occur. It’s not dissimilar to seeing the GP for day-today and then referring a patient to a specialist,” said Ms Fray. Birth and Postpartum Doula Amanda Bernstein agrees: “I believe that if we had more midwifery based care … throughout pregnancy, birth and into the postpartum, this would improve birth outcomes. “Not just to reduce rates of caesareans or other interventions, from vaginal exams to continuous monitoring, coached pushing, inductions, but to improve birth outcomes overall. “We need more access to the continuity
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of care model with a known midwife, especially for low-risk women who often choose private obstetric care. “We need greater belief in women and their ability to birth their babies and ways to reduce fear and anxiety around birthing in general.” Debra Wakefield, Midwife and Childbirth and Early Parenting Educator, said the increase in caesarean sections in Australia is complex and multi-factorial, but necessary for the minority of women who experience complications. “Caesarean births are necessary to save the lives of mothers and babies. “There will always be a small number of mothers and babies who would die if it wasn’t for the option for a caesarean birth.” Some women chose a caesarean birth, which is also acceptable, explained Ms Wakefield, but this should be an educated choice.
“Some women opt for this mode of birth by choice. “Birth should be a woman’s choice. It is her body, and it is her baby, it is her choice. “However, she should be fully informed as to the implications of every choice she makes.” Why are caesarean sections increasing? Ms Wakefield believes many contributing factors lead to increased rates of caesarean sections, including: • Increasing BMI of Australian mothers • Altered parameters for diagnosing gestational diabetes, which demands increased surveillance of the pregnancy and often bringing on birth by 39 weeks. • Advancing age of women birthing in Australia
HealthTimes - November 2019 | Page 23
• The ideal age to give birth is between 18 and 35 years • Sedentary lifestyle, leading to: o lack of stamina for labour and birth o babies who are positioned in a less than optimal alignment to fit out. • Women telling scary stories about birth, leading to a fear of childbirth. • Social media and TV shows like “One born every minute” dramatising birth. • Increased use of “induction of labour” in recent years is possibly the biggest reason for the increase in caesarean rate. • Social reasons and maternal request. • Big baby. This is diagnosed on ultrasound, which can be up to 20% inaccurate for estimating “weight” at full term. • A medical condition of the mother (such as pre-eclampsia). Reasons that are given for caesareans: • Bigger babies. “True, we are growing bigger babies. But the fact is, we have bigger mothers too. The growth charts have not altered in as long as I can remember. There is a saying in midwifery - mothers grow babies to fit their bodies. I have seen a lot of caesareans for a suspected big baby, and they turn out to be normal-sized. • Failure to progress. “Or, as we say, failure to be patient. If mum and bub are fine, why the rush to hurry the labour? Some are slow achievers, and some are speedy. It
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doesn’t matter how fast labour progress, so long as mother and baby are well. It is more likely the hospital staff getting nervous and wanting the baby out, so their shift can finish. • Increased surveillance. “There is a trend to monitor the mother and baby more closely with heartbeat and contraction monitors. And while this is necessary in many cases, such as induction of labour, or highrisk pregnancies, it often prevents a mother from being able to move freely and birth as she feels comfortable. The other issue is, any deviation from normal in the baby’s heartbeat is pounced on. When often we don’t understand that babies go through sleepy and active phases, they also go through some pressure when coming through the birth canal and it is normal at this time for the baby to momentarily drop its heart rate. But these deviations from ‘normal’ are not tolerated for long before further intervention is often suggested,” said Ms Wakefield. What Midwives can do There are many strategies that Australian midwives can implement to help women avoid unnecessary caesarean sections, said Ms Wakefield, including: • Education on a healthy diet, exercise and lifestyle factors for woman and their partners who are planning on conceiving. • Normalise birth. Ask the woman
to talk about her thoughts, feelings and expectations around birth. Help to de-bunk myths she has come to believe through stories and media exposure. • Birth education. Encourage women to attend quality independent birth education, that is relevant to where they are birthing, such as Hypnobirthing Australia™, SheBirths, Calm Birth. • Teach women “optimal maternal positioning” techniques, to help them understand where their baby is positioned and how to help move the baby into a position more conducive to fitting out. • Have a known midwife. Continuity of care should be available for all women. When a woman knows her midwife, it helps her to feel safe and supported. • Teach coping strategies in the early stages of labour at home. If a woman comes in too early, she is more likely to have more intervention, and the more intervention, the
more likely the chance of a caesarean. • Teach how to remove fear and how to tap into endorphins and oxytocin. • The birth room. Keep the room quiet and dark to enhance oxytocin. • Minimise unnecessary people coming into the room. The birthing space should be as sacred as the conception space. Honouring that for a woman will help her feel safe. • Gain rapport early, so that if and when intervention is necessary, the trust has been established. “Always remember this birth is this woman’s birth. It is a day she will remember forever. Every word will be etched in her psyche for the rest of her life. “It is a privileged position to be a midwife. So, as a midwife, make sure the woman feels special,” said Ms Wakefield.
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HealthTimes - November 2019 | Page 27
Nursing takes Holmesglen students to Canada
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part from being asked if she had a pet kangaroo, Holmesglen nursing student Madison Banfield found her recent exchange to a Canadian college exciting and educational. Madison, 27, of Patterson Lakes, and Melissa Bell, 21, of Somerville, spent three weeks at Grande Prairie Regional College (GPRC), a post-secondary education institute in north-western Alberta. Both are in their second year of a Holmesglen Bachelor of Nursing degree. They stayed with host families, attended classes, observed hospital shifts and toured health facilities. These included the Shock Trauma Air Rescue Society (STARS) helicopter service, a prison, a safe injecting mobile site and a homeless shelter with a make-shift ‘tent city’. The student nurses spent a day in the Neonatal Intensive Care Unit (NICU) and a day in labour and delivery. Melissa also experienced a 12-hour shift in emergency and Madison a 12-hour shift on a surgical ward. Both found the locals friendly and the culture and weather like Melbourne’s. But their kangaroo knowledge was lacking. “Every second person asked if we have pet kangaroos,” Madison she says with a laugh. Other highlights included trips to picturesque Banff National Park, Muskoseepi Park and Tumbler Ridge, and horse riding around and canoeing on the stunning Lake Louise. They also ate bannock, a fried dough bread, poutine (fries with cheese curds and gravy) and maple flavoured food including bacon, candy, and
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coffee. The trip is part of a partnership with GPRC that began in 2016 and has faculty and student exchanges. In 2017, GPRC staff came to Australia, in 2018 Holmesglen staff visited Canada and in 2019 Holmesglen students visited Canada. GPRC students are expected to visit Holmesglen in 2020. Madison hopes to work in neonatal nursing, as she finds helping unwell babies rewarding. “Being given the opportunity to have a day in the NICU in Canada really cemented this for me,” she says. “I love that nursing is a career that gives you the opportunity to work in so many different areas and places. I love travelling and would love to travel with my nursing degree. “The trip was very rewarding. It was a great example of how nursing can take you anywhere in the world.” Melissa has always wanted to be a nurse and hopes to work in emergency medicine. She was surprised by how much responsibility the Canadian students took and enjoyed learning about emergency medicine, mindfulness, wound management and arterial blood gas tests. The people and places were amazing. “The beautiful views of the mountains and many waterfalls we visited were magnificent,” Melissa says. “I have never seen such a beautiful view in my life. “My thoughts of travelling as a nurse and working abroad have grown and I look forward to travelling further in the future.”
HealthTimes - November 2019 | Page 29
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