Nursing Post - Issue 14: Community Nursing

Page 1

theNursingPost www.nursingpost.com.au

The Career and Education magazine for Nurses and Health Professionals

This issue’s feature

“Pathways to Commu nity Nursing” Look inside to see the WINNER of the Prepaid Mastercard Competition!

25 July 2011 - Issue 14

Visit us online for the latest jobs and articles


RealNurses RealChoice Nursecare Personnel is Tasmania’s own nursing agency, owned and managed by Tasmanian nurses. We offer offer RNs, ENs (M.E.): • All shifts, statewide • Above award (casual) rates and bonuses • CPD opportunities • Respect & appreciation - Lots of it!!

Call us today...

1800 240 988 to explore the possibilities. W: www.nursecaretas.com.au


If you can see yourself working across

Australia, or across the WORLD then give us a call today!

We have placements available in Australia and overseas including the Middle East, UK and the USA. We offer Casual, Permanent, Aged Care, ICU, Theatre, Rural and Remote Contracts.

Call Fay Samios: 1300 123 450 health@australianrecruiting.com www.australianrecruiting.com


From the Editor... Welcome to Issue 14 Hello readers! In this issue we take a closer look at the multifaceted field of Community nursing. We explore the various specialisations and the pathways that lead to a rewarding career in this diverse field. The demand for professionals in community nursing is on the rise so learn more about it on page 17. Congratulations goes out to Tania Adda from Sarina Hopsital & PHCC in Queensland for winning our Front Cover competition for this issue. According to Tania, the photos was “taken on International Nurses Day at the World Famous Sarina Hospital“ where the Doctors also got involved in the celebrations (and in the winning photo). Thanks Tanya for submitting such a happy and colourful photo of the staff celebrating IND. We would like to announce the WINNER of the Prepaid Mastercard ($300 AUD) Competition. The winner is.........Jane Lowe from South Australia. Congratulations Jane!!! We hope you have fun spending your prize and thank you for participating in our competition.

Inside this issue

Turn to page 17 now to learn about the variety that Community Nursing can give to your career. An opportunity not to be missed!

Look out next issue as we bring you new prizes and new competitions and we also take a look at Theatre/Critical Care nursing and what the profession entails.

Advertisers Index

Nursecare Personnel . ....................................... Australian Recruiting Group .............................. Pulse................................................................. Healthcare Australia . ........................................ Silverchain ....................................................... UTOPIA: Urapuntja Health Service...................... MHS Nurses Agency ......................................... Hays Healthcare................................................. Smart Salary .................................................... CCM International.............................................. CQ Nurse........................................................... UHG................................................................... Medacs............................................................. Mediserve Nurses Agency.................................. WA Country Health Service (WACHS).................. NAHRLS.............................................................

2

Inside Cover 1 3 4 5 6 7 8 9 11 11 12 13 14, Back Cover 15 16

Ngaanyatjarra Health Service............................. 19 Miwatj Health.................................................... 20 Ceduna Koonibba AHS....................................... 23 Promesse ........................................................ 25, 36+37 RACHS . ............................................................ 26 ENA Work UK..................................................... 27 ABN: 28 105 044 282 | PO BOX 6213, East Perth, WA, 6892 Ph: +(618) 9325 3917 | Fax: +(618) 9325 4037 E: admin@nursingpost.com.au | W: www.nursingpost.com.au Next Publication Details: Issue 15: 08 August 2011 Material Deadline: 01 August 2011 Editor: Kelvin Chong | For media-kits, deadlines or advertising queries, please contact Manish Shah | Printed by Westcare Pty Ltd


3


With so many agencies to choose from, it is hard to know which will best meet your needs.

To ensure you get shifts where and when you want, there are a few crucial questions you should ask when selecting an agency......

Da re t o co m pa

re N ot e s

A re y o u o n t h e Pu b li c H ea lt h Te n d e r A g re e m e nt ?

HCA

O th e r

D o y o u h a ve E x cl u s iv e P ro v i d e r A g re e m e nt s? D o y o u h a ve Q u ic k pa y o p t io I ca n g et pa i d i n 2 4 h rs? n s w hi ch m ea n s D o y o u pa y L o n g S e rv ic e L ea ve? D o y o u h a ve a Vo l u nt a ry I n co m e D i st S ch e m e? ri b ut io n D o y o u h a ve O n li n e E d u ca t io n a l R e s o u w hi ch e qu a l rc e s C P D po i nt s? D o y o u h a ve an a ll o w s y o u t o O n li n e B oo ki n g s S y st e m ma n a ge you w hi ch r o w n b oo ki n g s? D o y o u p ro v i d e Fre e U n if o rm s? D o y o u p ro v i d e Fre e C ri m i n a l H i st o ry C h e ck s? A re y o u a pa rt o f A u st ra li a ’ s L a rg e st N A g e n cy g ro u u rs i n g p?

At Healthcare Australia we can confidently answer “YES” to all the above questions. As Australia’s Largest Nursing Agency Group, we can assure YOU we have MORE Choice, MORE Shifts & MORE Opportunities for you throughout Queensland and New South Wales.

1300 NURSES (1300 687 737) 4


Flexible shifts to suit your needs! EVERY MINUTE. EVERY HOUR. EVERY DAY. WE CARE.

Calling all Registered Nurses!

Don’t want to work night duty anymore then come and work for Silver Chain! We have vacancies for full time and part time positions throughout the South East Metropolitan area in both the Home Hospital & Clinical Service areas

Competitive salary packaging scheme! Car, phone and all equipment provided! Extensive orientation program and many training opportunities! Variety of shifts!

Home Hospital

• Provides acute hospital substitution type care to patients, in their own home including IV antibiotics, anticoagulation management, catheterisation etc. • Contact Karen White Clinical Nurse Consultant Manager 0406315547 for further information

Clinical Service

• Provides clinical assessments, acute and chronic wound management, diabetes, stoma care etc in a cohesive team environment • Contact Julie Martin Clinical Nurse Consultant Manager 0410222139 for further information

Silver Chain offers comprehensive training and specialist support to all successful applicants, as well as providing a dynamic team work environment and generous salary packaging (earn up to $16,050 tax free per annum). To apply for a position with Silver Chain email your resume and cover letter to recruitment@silverchain.org.au or mail to the following address: Recruitment Office 6 Sundercombe Street, OSBORNE PARK WA 6017 Fax: (08) 9242 0268

5


UTOPIA

Urapuntja Health Service Aboriginal Corporation

Exciting new opportunities for true believers in Primary Health Care.

Currently recruiting:

• Health Promotion Officer • Clinical Nurse Manager • Experienced Registered Nurses; full time ready now! Urapuntja Health Service needs Experienced Registered Nurses with current clinical experience. Acute care medicine and primary health care experience preferred, with proven communication and computing skills, you will support a team with full commitment to primary health care. You will be working together in a multi-disciplinary team in a cross-cultural setting. We encourage Indigenous nurses to apply for these positions.

Next Issue Feature

Theatre & Critical Care Nursing 8th Aug

Issue 15

We look at the various pathways a community nurse can diversify into and examine the issues facing health professionals in this field

We are also looking for a Public Health Promotion Officer; for a position with a focus on a choice of programs ‘hygiene and nutrition’, mothers and babies program, or a focus on ‘youth and healthy lifestyles’ This is not necessarily an RN position; health promotion experience or similar must be proven. As our team is now growing strong, we would like to add a Clinical Manager, are you looking for a challenge, have good ideas on public health and ready to lead a team into the future? Don’t hold back - if you think you fit the bill give me a call! For application and information please call Sarah Doherty (08) 89569875 or send an email to : ceo@urapuntjahealth.org Urapuntja Health Service is an Aboriginal community controlled health organization situated in the Alyawarr region of Central Australia, 280km NE of Alice Springs. We have a population of 1200 people living across 16 small communities. Attractive wages, salary packaging arrangements, and subsidized accommodation in a beautiful setting, is on offer to reliable resilient individuals who have some time to devote to us.

DO YOU REALLY WANT TO MAKE A DIFFERENCE IN REMOTE ABORIGINAL HEALTH? This is your chance to take a crucial role in an organization whose mission is to maximize indigenous health and has remarkable statistics to prove it. Opportunities to put your ideals into practice exist in this exciting time in health evolution. 6

Upcoming Features DATE 22nd Aug 5th Sept 19th Sept

SPECIAL FEATURES Mental Health Education CPD Quiz and Working Abroad

If you are interested in participating in any of the above publications either by advertising or editorial contributions, don’t hesitate to contact us on: (08) 9325 3917 or email: admin@nursingpost.com.au.


MHS NEEDS

M RE MENTAL HEALTH NURSES

Mental Health Staffing Specialists, MHS Nurses Agency is the only stand alone Mental Health specific Nursing Agency We have a growing list of clients looking for quality staff, so why not give us a call and let us know what you want to do. If we don’t already have what you want we will try and get it for you.

WS NELASH F

All of our nurses and clients receive the following benefits ! Flexipay : Work today get paid tomorrow, no fees, no restrictions ! All office staff are Mental Health trained ! Parking Allowances ! Above award pay rates to all nurses ! Free mandatory education modules ! Free mental health specific education ! Casual, contract and permanent work ! Local, regional and interstate ! Great customer service ! Very attractive charge rates to all clients What we need ! Enthusiastic, excited nurses who want to do a great job ! Great clients that appreciate our service and our nurses

So if you’re a Mental Health Nurse looking for an extra shift, a short term contract, or even a change of scenery, why not work with the agency that knows Mental Health.

Call MHS now on 1300 527 034! enquiries@mhsnurses.com.au - www.mhsnurses.com.au Mental Health Staffing Specialists...All we do is Mental Health! Owned and operated by Mental Health Nurses. 7


talented nurses the uk is Calling

If you are a Registered Nurse whose next stop is the UK then we can offer you a vast variety of work options across the public and private sectors. You can choose agency work or let us secure you a permanent based role depending on your career goals and travel plans. We cover locations across the UK and have work for Nurses in the following areas: general medical/ surgical, emergency, theatre, intensive care, critical care, coronary care and paediatrics. We offer a free personalised service where we guide you through all the paperwork required to ensure you can start working when you choose. We also offer the following benefits when you work as an agency worker through us including: • • • • • • • • •

£500 relocation bonus (speak to your consultant for eligibility) Free CRB (UK police check) Free Australian police check Competitive rates of pay including penalty rates Generous refer a friend bonus Free uniform (Agency Nurses only) Biggest choice of nursing vacancies Organise your ONP booking The support of an Australian and UK based consultant to support you

To be eligible to work in the UK you require solid post graduate experience which includes your Graduate Nursing Program and NMC registration as well as an eligible visa. uk information sessions are coming soon to the following locations: Brisbane - Thursday 25th August Sydney - Thursday 8th September Melbourne - Thursday 29th September Enquire now to book your place. For further information or to receive a free information pack and start preparing for your trip contact your local consultant. Qld / nt / nsW / Wa rose holden t: 07 3243 3023 e: rose.holden@hays.com.au ViC / sa / tas / nZ kerrie smith t: 03 8562 4288 or 0800 001 718 (Free Call nZ) e: kerrie.smith@hays.com.au

hays.com.au 8


Save on everyday expenses like shopping, groceries and bills.

Bills look smaller tax free.

Save up to $4,300 per year* Pay your bills tax-free Get a living expenses card and shop tax-free

Call us on 1300 219 835 or visit our website. www.TaxFreeBills.com.au

*Salary packaging of living expenses is only available to employees of the Department of Health in WA, SA, and VIC. Savings indicated are based on employees packaging the full $9,095 tax-free cap amount at the highest income tax bracket for the 2011-12 financial year. An administration fee applies. Actual savings will vary depending on your income tax bracket. NEW_Living_nursepost- June2011.indd 1

15/07/2011 3:20:57 PM

Visit us Online! Go to nursingpost.com.au for the latest healthcare jobs, feature articles and stories! Subscribe to our newsletter and get every latest issue delivered straight to your email! Visit us online to sign up!

9


Not Ready For Winter Yet? Head to The Middle East for all year round sunshine or the UK & indulge in a European summer!

Saudi Arabia: Our most popular location! Work in a state-of-the-art hospital while enjoying a salary paid tax free & all year round sunshine. Vacancies exist for Staff & Charge Nurses, Managers & Directors.

Saudi A rabia

ates United A rab Emir

Channel Islands, UK

United Arab Emirates (UAE): Looking to enjoy the unique Middle East lifestyle without too many restrictions? Dubai or Abu Dhabi could be the spot. Vacancies exist for Staff & Charge Nurses, Managers & Directors. Guernsey, Channel Islands/UK: Prefer a more laid back lifestyle? How about Guernsey? Ideally located between the UK & France. Lined with quaint cobblestone streets, restaurants & cafes. You’ll pay a lower tax than the main land & be provided with subsidized accommodation! Vacancies also exist in the UK – Enquire now for more info...

Live SKYPE Chats direct with one of our prestigious hospital clients in Saudi Arabia!

CCM arrange the date so all you have to do is receive the call from the comfort of your own home! But there’s more! Informal chats have the potential to lead onto a formal interview. Live Skype chats are the best way to receive the most up to date information & help you decide if Saudi Arabia is for you. Obligation free & you can invite your friends! Enquire Now!

Benefits On Offer:

*Salary Paid Tax Free | *Free Flights | *Free Accommodation *Accommodation Allowance | *Free Medical Care | *Generous Annual Leave Professional Development | *Free Uniforms | Endless Travel Opportunities (*Applicable to certain contracts only)

AUS Free Phone: 1800 818 844 NZ Free Phone: 0800 700 839 dawn@ccmrecruitment.com.au raquel@ccmrecruitment.com.au

CcmAustralasia 10

www.ccmrecruitment.com


11


Independent Contract Nurses Required!

creating freedom and choice ...the innovative way

UHG is a leading provider of customised healthcare solutions for insurers, employers and individuals across Australia. We are offering unique opportunities for Registered and Enrolled Nurses to undertake sub-contract work with our innovative mobile health service division. • • • •

National Opportunities Different work locations & environments Discover new challenges Take control of your work-life balance!

The following are minimum requirements for these roles: • Competent phlebotomy skills - Min 2yrs experience • Current CPR Certification • Own Vehicle and Drivers License • PC & Printer, Internet Access, Email, Fax/Scanner • Australian Police Check • Public Liability & Professional Indemnity Insurance • ABN Experience in small business, insurance assessments, pre-employment medicals and vaccination programs would be well regarded, but not essential.

To find out more about these exciting opportunities or apply online visit

www.healthscreening.com.au

For general enquiries, please phone Jessica on (03) 9692 7049 A division of UHG : www.uhg.com.au

12


The employment experts for Nurses around Australia Specialising in a range of permanent and temporary roles for Registered Nurses in Australia and across the world

Hot Jobs Melbourne - ICU and Emergency Nurses - 457 visas available Acute Surgical RN’s - Regional NSW ICU Nurses - Country WA Contract Nurses needed for regional NSW Theatre Nurses - Sydney - 457 visa available Nurse Manager - Angio Suite - Newcastle Emergency and ICU RN’s - Remote WA Remote Area Nurses Needed - NT & WA Theatre Nurses - New Suites - Newcastle Remote Hospital Contracts for RN’s - QLD Roles Across the UK for RN’s For more information, talk to Donna Gould or David Hunter in the Medacs Healthcare Nursing team.

Contact Us Email: nurses@medacs.com.au Telephone: 1800 059 790 For a full list of our opportunities around the world go to: www.medacs.com.au

13


CALLING ALL NURSES & MIDWIVES Join the Preferred Supplier of Nurses today! Mediserve has been selected onto the panel of preferred agencies to supply nurses to the Health Departments of South Australia, Western Australia, Queensland, the Northern Territory, the Australian Capital Territory and metropolitan Melbourne.

Come and Work in WA! Mediserve is one of the largest suppliers of nurses to West Australian country hospitals including remote clinics for Indigenous communities. We are also looking for nurses to work in metropolitan hospitals in Perth.

So why worry about your next shift? Relax when you join Mediserve Nursing Agency today!

For Australia Wide positions call 1300 305 594 or call one of our offices throughout Australia ADELAIDE: (08) 8212 2595 - adelaide@mediserve.com.au BRISBANE: (07) 3229 2528 - brisbane@mediserve.com.au DARWIN: (08) 8981 2446 - darwin@mediserve.com.au 14

PERTH: (08) 9325 1332 - perth@mediserve.com.au MELBOURNE: (03) 9629 3780 - melbourne@mediserve.com.au SYDNEY: (02) 9290 2700 - sydney@mediserve.com.au

www.mediserve.com.au


WA Country Health Service Nursing Opportunities of a Lifetime Are you looking for a chance to travel, experience adventure and work in rural and remote Western Australia? A WA Country Health Service rotational nursing/midwifery program could be for you. There are three programs catering for varying levels of nursing and midwifery, ranging from Registered Nurse 1.2 and Registered Nurse or Midwife 1.3–1.9. Our rotational programs offer the opportunity to travel, experience rural and remote Western Australia and broaden your professional skills in: aged care emergency high dependency medical mental health

operating theatre paediatrics palliative care remote health surgical.

Travel, costs and accommodation are arranged for all rotational programs. WA Country Health Service provides: an attractive salary package with superannuation, subsidised accommodation and excellent professional and leave entitlements.

To find out more about the opportunities available call 08 9222 6497 or 0429 419 360, or visit www.wacountry.health.wa.gov.au

15


C

NO

N AGE

S

E Y FE

Need to get away for CPD? Call us for Locum support Freecall 1300 NAHRLS

Supporting Nurses, Midwives and Allied Health Professionals* in rural and remote Australia Apply online at:

www.nahrls.com.au

Funded by the Australian Government *Visit our website for the full list of eligible Allied Health Professions

16


Feature - Pathways to Community Nursing

Pathways to

COMMUNITY NURSING

WHAT IS COMMUNITY NURSING? Community Nurses are responsible for creating corresponding health care assessment results with treatment options relevant on an evidence basis, with their clients. Community nurses tend to work in multidisciplinary teams to ensure that patients receive the most effective health care. Community nurses will work in a range of different fields including illness/disease prevention, early intervention for chronic illness and unnecessary hospital admission. Most community nurses work within the government sector, while some work as domiciliary nurses for private organizations. Community nurses can work within various sectors of health care, with various health professionals from across different specializations. Community nurses must assist patients’ carers and/or families with creating and maintaining a suitable program in relation to the patient’s environment and coping skills. Some skills required to treat patients as part of community health care service delivery include; health promotion, prevention, early intervention, treatments and referrals. You may work with general practitioners, acute care sectors, domiciliary and community mental health nurses, specialists, allied health

specialists, health advancement specialists and community-based care providers and organizations to provide maximum care. This is to ensure that care is provided within the following range of cases and interventions: • Patients suffering from complications as a result of their illness or condition which may include diabetes, asthma, chronic respiratory, cardiac and renal conditions and palliative care • Patients suffering from depression or other mental illnesses that might place them at the risk of suicide, drug misuse or addiction, controlling the management of serious drug withdrawal states and early intervention for convicted illicit drug users • Infections, sexual health including contraception, pap smears, breast screening services and HIV/ AIDS management 17


Feature - Pathways to Community Nursing

• Patients suffering from the health risks associated with ageing such as; dementia, arthritis, risk of falls, continence management, improving social networks. • Women’s and men’s clinics. • Assisting patients in making the transition from home to hospital, and vice versa. • Supporting and representing people who have suffered from or are at risk of domestic violence, financial abuse, marginalised by social bias or disadvantaged by gaps in ageing government policies. • Health care for youths : this involves supplying information and advice for youths and children, parenting advice and providing injury prevention by improving immunisation rates throughout their lifespan • Generalist Community Health Nursing • Community health nurses work with a Community Health Team and the general public to organize and deliver appropriate services that act as promoters of health, safety, independence and well-being for people living within the community. • You will also experience caring for a number of clients from the frail aged, people with disabilities, people with chronic illnesses, and patients who

may require assistance before and after hospital visits and stays. You will visit patients within their homes to assist them with completing physical, functional, emotional, social, safety and environment dynamics. Nurses assist patients with developing and maintaining care goals by organizing agreed care activities with the patient, monitor the care plan and make changes as required. Nurses within this field also consult with other care services that may include Meals on Wheels, Domiciliary Nursing Services, Medical Aids Subsidy Scheme, Home care services and Taxi Subsidy Schemes to name a few. Community health nurses also work with hospital staff in creating prevention methods to avoid unnecessary hospitals admissions. This is managed by identifying what support needs are required of the patient, providing education and arranging for sufficient care for community members. If hospitalization of a patient does occur, then the nurse will need to provide assistance by coordinating and supporting the patient’s care before and after their stay at the hospital. Community health nurses are required to conduct health promotion activities within speciality roles that include dementia care, diabetes, continence and asthma education.

“ 18

Community nurses can work within various sectors of health care, with various health professionals from across different specializations.

• Refining access to proper nutrition, housing and employment


Remote Area Nurses & Personal Care Assistants Ngaanyatjarra Health Service is an Aboriginal Community Controlled Health Service providing primary and preventative health care to 11 communities in the Great Victoria and Gibson Deserts of WA (Central Desert region).

Remote Area Nurses

• Highly attractive remuneration including salary packaging and generous leave allowances • 6 weeks annual leave plus 4 weeks availability leave, plus 8 days travel per annum • Financial support towards your Continuing Professional Development after 12 months • Comfortable, furnished, air-conditioned accommodation free of charge • 4WD vehicle provided for travel within the Ngaanyatjarra lands for work purposes

Requirements

• General registration with the Board of Nursing and Midwifery of Australia • Recent acute experience • Primary health care experience • National Police Clearance and Working with Children documentation • Recent remote nursing experience will be highly regarded These are permanent roles, but NHS also welcome inquiries from RNs considering short-term contracts. The job application pack is available at www.nghealth.org.au. Applications (which must address the selection criteria) close on the 5th August 2011.

Personal Care Assistants

• Contract roles • Comfortable, furnished, air-conditioned accommodation free of charge • Flights to and from the Ngaanyatjarra Lands provided

Requirements

• Qualifications and experience working with Aged Care • Experience in remote Indigenous settings is highly desirable • National Police Clearance documentation

For enquiries

call Nicole on 08 8950 1756 email hr@nghealth.org.au

19


POSITIONS VACANT:

REGISTERED NURSES Miwatj Health is an Aboriginal community controlled primary health care service based in the Nhulunbuy area. We are currently seeking applications from suitably qualified and experienced individuals to help us build on recent initiatives in primary health care aimed at improving the health of local people in Aboriginal communities on the Gove Peninsula.

WE ARE SEEKING TO FILL THE FOLLOWING POSITIONS: MIDWIFE

This position will involve working in outreach services on the Maternal and Child Health Program.

CHRONIC DISEASE NURSE

This position involves working with the Chronic Disease Program.

CASUAL/PART TIME NURSE (two days per week)

This position involves working in an acute care setting at Gunyangara clinic. A minimum qualification as a Registered Nurse 4 is required for these positions. In addition there should be a commitment to working in a team situation with Aboriginal people and an ability to communicate effectively with team members and clients. Accommodation negotiable.

FOR A POSITION DESCRIPTION AND SELECTION CRITERIA PLEASE CONTACT THE HR OFFICER ON 08 8939 1901 OR EMAIL HR@MIWATJ.COM.AU. For further information please contact the Health Services Manager on 08 8939 1900. APPLICATIONS CLOSE 14 AUGUST 2011. 20


Feature - Pathways to Community Nursing

Alcohol and drug nurses work within a variety of health clinics, health centres, homes, communitybased organizations, as well as work within government sectors such as Police and Corrective Services and Education. The main components of these programs include withdrawal management from psychoactive drugs, opioid treatment services, brief and early intervention programs, alcohol and drug counselling and relapse preventions. For the management and treatment of people with alcohol and drug services, consultation liaison services are available to General Hospital Services, Mental Health, Watch-house and general practitioners to name a few. Alcohol and Drug nurses must work cohesively with Mental Health and general Community Health Services to provide a full set of services to patients who may have more than one diagnosis. Health promotion and education about alcohol and drug issues is facilitated within clinician education programs and alcohol and drug campaigns for the community, families and individuals.

PUBLIC HEALTH NURSING Public Health

Nurses are responsible for assisting in the development and conduction of immunisation programs that will allow the Health Service District

to successfully complete immunisation targets, which are established by the National Health and Medical Research Council (NHMRC). This institution is involved in providing extensive education and advice to health professionals, community centres and groups, and the general public. These nurses also play an important role in the monitoring of all reported conditions and the necessary steps required to take public action. For example, public health nurses have been required to treat the public with vaccinations for preventable diseases such as meningococcal disease.

INDIGENOUS HEALTH NURSING.

Nurses working within this field are required to provide appropriate services within a cultural context, across the community’s lifespan, specifically in regards to indigenous members. Indigenous health services are mainly targeting the health issues within the Indigenous population. A few popular cases of health issues within indigenous people include cardiovascular disease, cervical and breast cancer, diabetes, alcohol addiction and drug issues. These are all treatable and even preventable diseases to some extent, but some patients may suffer from morbidity, as well as their mortality rates dropping quite significantly. Hence their

Nurses also play an important role in the monitoring of conditions and the necessary steps required to take public action.

ALCOHOL AND DRUG NURSING.

21


life spans shorten. Immunisation is also another significant service that is part of the nurse’s role. Within this field, nurses will work with Indigenous Health Workers, community leaders and elders to provide the most appropriate service within the culture of the community and individual.

SEXUAL HEALTH AND HIV / AIDS NURSING

Sexual Health nurses are required to work as independent nurse practitioners in helping to control and prevent sexually transmissible diseases that include HIV, Hepatitis B and C. Some duties that sexual health nurses carry out include assessments, performing routine serology for pathological examination, as well as providing routine treatments and medications for sufferers. Some other treatments include HIV testing in addition to counselling, contact-tracing and follow ups for reportable diseases. The patients with multiple diagnoses will tend to be case-managed individually. This may include patients with drug, alcohol and mental health problems as an example. As a service, sexual health clinics supply the public with a free and confidential service by offering sexual health tests, information, counselling, pregnancy testing, family planning tips and emergency contraception facilities. As part of the service, sexual health clinics also have specialist and community based HIV/ AIDS services that provide clinical care, support for patients and loved ones, and ongoing chronic disease management. 22

Indigenous health services are mainly targeting the health issues within the Indigenous population.

Feature - Pathways to Community Nursing

ACUTE IN-HOME & POST-ACUTE NURSING

Nurses working within this field of post-acute and acute care provide home services to help patients and their carers in developing their skills to care for themselves in regards to a specialised or complicated health issue. These health issues that may have forced a patient to attend a hospital may have been prevented or minimized through the establishment of services to the patient within their own home. Some services that a nurse within this field will be covering include issuing intravenous antibiotics and wound management. Nurses will have to work closely within the acute care sector, which will involve communicating constantly with the patient’s general practitioner, as well as with a multidisciplinary health care team, to deliver quality services.

CHILD HEALTH & SCHOOL BASED YOUTH HEALTH NURSING. Child Health

nurses help to assist and education parents on their health, development and wellbeing of families and their children from date of birth to the age of 18. This is accomplished by working cohesively with the parents of children, carers and youth general practitioners to assist in preventing and detecting health problems within early stages. Child Health nurses are also required to provide support and encouragement for all aspects of the parenting role.


Position Vacant Clinic Manager Ceduna Koonibba Aboriginal Health Service Aboriginal Corporation is calling for applications for the position of Clinic Manager.

Classification: RN3 Remuneration: $84,006 per annum Hours: 38 hours per week Term: 3 Year Contract Ceduna Koonibba Aboriginal Health Service Aboriginal Corporation Clinic provides Primary Health Care services to the Ceduna community, surrounding homelands and communities and is located in the beautiful Eyre Peninsula surrounded by many beautiful beaches and renowned for its famous King George Whiting and Oysters. The Corporation has recently undergone a governance change from SA Government to Aboriginal Community Controlled which has included an organisational restructure. Ceduna Koonibba Aboriginal Health Service Aboriginal Corporation are now seeking an experienced Clinic Manager to advance the primary objective of the organisations Strategic Plan by oversighting the day to day management of the clinic and a team of health care workers. Accommodation is available if relocation is required. For more information on this position, please contact Tanya Darke on (08) 8626 2600. For a copy of the Job and Person Specification please contact Donna Farmilo on (08) 8626 2600 or by email: donna.farmilo@health.sa.gov.au Applications are due in by close of business Monday 1st August 2011 and are to be addressed to: Kerry Colbung, CEO, Ceduna Koonibba Aboriginal Health Service Aboriginal Corporation PO Box 314, CEDUNA SA 5690

23


Feature - Pathways to Community Nursing

HOSPITAL/LIAISON NURSING A Liaison

nurse assists patients who are making the transition from acute settings to their homes. They are responsible in organizing appropriate community based services to enable clients to receive care in their own homes. Liaison nurses also provide the necessary resources for discharge planning. They are also the relevant person to contact within community based service providers, which also assist in the prevention of avoidable patient hospital admissions by providing adequate community based support services where necessary.

HOW DO I BECOME A COMMUNITY NURSE? If you are considering a career in community nursing, there are many postgraduate courses you can choose from within Australia. They range from general community health, alcohol and drug, sexual health, HIV/AIDS, public health, nurse immuniser, maternal and child health, mental health, aged care, indigenous studies, health education, health promotion and advancement, continence management, diabetes nurse education and accreditation, women’s and men’s health, rehabilitation, cultural and indigenous awareness, teaching, management and administration, as well as leadership. To find the nearest educational institute that offers one of the above courses, visit: www.hotcourses.com.au

WHAT OPPORTUNITIES ARE AVAILABLE? Hospitalization costs are

constantly increasing within the Australian Health system, and with a new national shift occurring to direct more health care into communities and community facilities, there has never been a better time to start a career in Community Health. This, plus a new incentive by the Government to improve health care services by integrating new approaches for the delivery of these services.

24

Ideally people who have chronic diseases or conditions that occurred due to ageing will be case-managed by community health nurses, potentially in the near future. Potentially, community nurses will be required to liaise with hospitals, GP’s and community based organizations to help manage the transition from home-hospital-home for patients. This is for both the pre and post acute nursing care deliveries. Community nurses working within the following specializations such as sexual health, alcohol and drugs, women’s health, child health and diabetes will always have work as there are never enough community nurses employed today. Nurses who have valuable experience in population or indigenous health will have the advantage to work in clinical delivery within primary healthcare centres. There will always be valuable opportunities for experienced nurses for teaching and research positions in the tertiary sector, as well as the local, State and Federal health government levels.

SPECIALIZED FIELDS AVAILABLE FOR COMMUNITY NURSING: •Community Health Nurse •Alcohol and Drug Nurse •Sexual Health Nurse •Child Health Nurse •Schoolbased Nurse •Women’s Health Nurse •Family Health Nurse •Acute In-Home •Post-Acute Nurse •Immunisation Nurse •Public Health Nurse •Council Nurse •Aged Care Nurse •Dementia Nurse •Continence Nurse •Hosp/ Community Liaison Nurse •Indigenous Health Nurse •Community Nurse Educator •Sexual Health Nurse Educator •Alcohol & Drug Nurse Educator •Diabetes Nurse Educator •Continence Nurse Adviser •Community Nurse Manager •Community Nursing Director •Community Mental Health Nurse


When you can live on 15% of your salary, Venice looks good for a weekend away! From Riyadh in Saudi Arabia to the romantic canals of Marco Polo’s Venice is about a 5-hour flight. That’s at least 14 hours less than from where you’re sitting right now - and you can make the trip for a long weekend in a 4-star hotel with breakfast daily, for what you can save in under 10 days on Middle East rates of pay. With no income tax, rent, utility or transport costs to pay, up to 85% of your salary becomes ‘disposable income’ to use as you please. So you can use your generous holidays to take advantage of the many travel bargains available across the Gulf, or you can

build a substantial investment for your future. Demand for Aussie/NZ nurses in the Middle East is as strong as ever. We have many excellent opportunities, at all levels and in most specialties - just tell us what you’re looking for. It’s very important to get reliable advice to help you find the job that best fits your skills and aspirations. Promesse has many years of experience and the local contacts to find you the perfect opening, so contact Christine Kohleis RN on info@promesse.com.au or simply call for a chat on the FREECALL numbers below.

The banks of Venice’s Grand Canal are lined with over 170 splendid buildings dating to the 13th/18th centuries

experts on the gulf SAUDI ARABIA •

UNITED ARAB

FREECALL 1800 002 388 AUS 0800 542 100 NZ www.promesse.com.au info@promesse.com.au

EMIRATES

Q A T25A R


MyRAHCExperience Pauline Rubin | Registered Nurse Like many registered nurses nearing retirement, Queenslander Pauline Rubin was in search of a balance between her work schedule and changing lifestyle. Through RAHC’s short term placements Polly is able to continue her career and contribute her skills and experience into health centres in remote Indigenous communities across the Northern Territory. “I was experienced in both nursing and in life, less restricted by family commitments and free to work short term contracts,” Polly said. Polly contacted RAHC and was then placed in a nursing position in Alice Springs. Sitting in the centre of a vast red desert with majestic mountain ranges of spiritual significance, Polly says, “I am in awe of this ancient land. I do feel I am making a difference as an experienced professional and helping to ‘close the gap’. I am now on my third placement, working in the red centre of Australia, and enjoying the best days of my career with generous pay and work conditions. Perhaps it is true we save the best for last!”

Get involved. Call 1300 MYRAHC or apply online at rahc.com.au

Funded by the Australian Government 26


AFFORD TO

TR AVEL EVERY

3 MONTHS!

EUROPEAN NURSING AGENCY:

Live-in Care – England • NO bills or fees • 3 month contracts • Take time off to travel • Return to work when you’re ready • Help to set up a UK bank account & NI# • NO nurses registration required • Weekly wage + holiday pay • Many positions available • Free accom & meals • Flexible start dates

PH: 07 5563 0002

www.workuk.com.au 27


Educational Courses, Conferences & Events

Educational Courses, Conferences & Events Article: The 5 Rights of Clinical Reasoning........................................... 30-31 Ausmed Publications................................................................................31 Oceania University of Medicwine..............................................................32 Navitas.....................................................................................................32 12th Australian Prostate Cancer Conference.............................................33

AUGUST 12th Australasian Prostate Cancer Conference Together in discovery and care Provider: Australian Prostate Cancer Research Centre Victoria Date: 3-5 August 2011 Location: Melbourne Convention and Exhib Centre, VIC. www.prostatecancerconference.org.au/

Sydney CAREX 2011 Australia’s premier health & aged care expo Provider: Total Aged Services Date: 10-11 August 2011 Location: Rosehill Racecourse, Sydney, NSW. www.totalagedservices.com.au/carex.asp 28

22nd Annual (ACRA) Conference Casting a wider net Provider: Australian Cardiovascular Health and Rehabilitation Association (ACRA) Date: 8-10 August 2011 Location: Hyatt Regency, Perth, WA www.cdesign.com.au/acra2011/information_ general.html

12th International Mental Health Conference Personality Disorders: Out of the Darkness Provider: The Australian & New Zealand Mental Health Association Date: 24-26 August 2011 Location: Radisson Resort, Gold Coast, QLD www.anzmh.asn.au/conference2011/


11th Australian Palliative Care Conference Together in discovery and care Provider: Palliative Care Queensland Date: 30 August - 2 September 2011 Location: Cairns Convention Centre, Qld www.palliativecareqld.org.au/events/

21st Annual TheMHS Conference Resilience in Change Provider: TheMHS Conference Date: 6-9 September 2011 Location: Adelaide Convention Centre, SA www.themhs.org/2011-conference

15th Annual NT Chronic Diseases Network Conference Out of the shadows, into the spotlight chronic diseases, mental health Provider: Chronic Diseases Network Date: 8-9 September 2011 Location: Darwin Convention Centre, NT www.cdnconference.com.au/

7th National Laser and Cosmetic Medicine Conference Date:17-18 September 2011 Location: Sydney Convention and Exhibition Centre. www.dcconferences.net.au/lcmc/

Congress of Aboriginal & Torres Strait Islander Nurses Conference Are we there yet? Date: 21-23 September 2011 Date: Mecure Hotel, Brisbane Qld www.indiginet.com.au/catsin/

Aged Care Nurse Managers Conference Date: 21-22 September 2011 Location: Caulfield Racecourse, Melbourne www.totalagedservices.com.au

Breastfeeding: A changing paradigm Presenters Pam Heselev and Fay Paxton. Date: 24 September 2011 Location: Citigate Hotel,169-179 Thomas Street, Haymarket, NSW www.breastfeedingconferences.com.au

AIATSIS National Indigenous Studies Conference 2011 Date: 19-23 September 2011 Location: Canberra www.aiatsis.gov.au/research/conf2011/ conf2011.html

29

Educational Courses, Conferences & Events

September


The 5 “Rights” of Clinical Reasoning Educational Courses, Conferences & Events

D

ynamic, unpredictable and reactive: could these three words be describing your last nursing shift? Pressure on hospitals and nursing staff are constantly increasing, as is the need for nurses to exercise more than adequate clinical reasoning skills.

Poor clinical reasoning results in lack of identification of patients “at risk” of serious adverse events such as cardiac arrest, unplanned admission to intensive care and unexpected death. A recent Australian report has identified graduate nurses as often lacking in adequate clinical reasoning skills, a report that has been echoed by research in America. These skills are equally as important for seasoned nurses as they are for the new graduate, with Nurse Education Today recently publishing an article on the five “rights” of clinical reasoning as a timely reminder for all nurses.

What is clinical reasoning?

Clinical reasoning is synonymous with clinical judgement, problem solving, decision-making, and critical thinking. It is the process whereby nurses “make clinical judgements by selecting from alternatives, weighing evidence, using intuition and by pattern recognition”. It is expected that more experienced nurses will apply faster and more accurate clinical reasoning skills. Clinical reasoning is a cyclical process that can be directly linked to five “rights”: the ability to collect the right cues and take the right action for the right patient at the right time and for the right reason.

1) The right cues. Clinical reasoning is based on the ability to recognise cues in the form of identifiable physiological or psychosocial changes experienced by the patient. The nurse will refer to 30

available patient information such as handover reports, patient history, and results of investigations, but must also apply knowledge of patho-physiology, physiology, pharmacology, epidemiology, therapeutics, culture, context of care, and ethics etc. The nurse’s ability to appropriately acquire the right cues is influenced by a variety of factors including the expertise and knowledge of the decision maker, anxiety, confidence and time pressure. Judgements based on incomplete or inaccurately acquired information will inevitably lead to incorrect actions.

2) The right patient. Identifying and prioritising patients based on their needs is paramount in clinical reasoning. The right patient, in this instance, refers to a patient at risk of critical illness or a serious adverse event. Systems such as “early warning signs” and “modified early warning skills” aid nurses in identifying patients who may become critically ill. As the nurse is often “the first link in the causal chain between identification of complications and eventual rescue”, it is crucial that they are confident in identifying appropriate warning signs.

3) The right time.

Nurses will undertake clinical reasoning on multiple patients and at various times throughout their shift. Research has shown that some nurses will make up to 50 significant clinical judgements in one 8-hour shift, with intensive care nurses making up to one clinical decision every 30 seconds. It is important that nurses recognise early warning signs in order to undertake adequate interventions in a timely manner.

4) The right action. The right action is defined as “the behaviour following on from a judgement or decision”. It involves practical skills, intellectual


as a person with their own unique needs, values and individual responses to the situation.”

activities and communication skills as the nurse prioritises the action plan, identifies which procedures to follow and notifies other appropriate staff. Issues occur when documented abnormalities are not appropriately followed up, issues that research shows occur far too often. Sometimes the right action may simply be discussing the case with a more senior staff member.

5) The right reason. The right reason means that not only have the correct reasoning processes been followed, but that the reasoning is ethical, legal and professional. Clinical decision-making is not an isolated process and is dependent on many personal factors including role orientation, education and the culture and context of care. “The decisions that are made are influenced by the motivation of the nurse and their willingness to put all the data together in complete picture, as well as how completely the nurse has come to know the patient, not just as a source of data to be reasoned through, but

Continued Professional Development provided by

Comment on this clinical article at: www.ausmedonline.com/nursing-blog.html Source: Levett-Jones, T., Hoffman, K., Dempsey, J., Jeong, S., Noble, D., Norton, C., Roche, J. & Hickey, N. (2010). The “five rights” of clinical reasoning: An educational model to enhance nursing students’ ability to identifiy and manage clinically “at risk” patients. Nurse Education Today, 30, 515-520

Nursing and

Professional Practice Seminar Learn About: Registration | Discipline | Regulation

Learn more at:

www.ausmed.com.au 2011 Dates Adelaide: Melbourne: Sydney: Perth: Brisbane:

1 - 2 September 22 - 23 September 13 - 14 October 3 - 4 November 12 - 13 December 31

Educational Courses, Conferences & Events

Nurses are responsible for making a myriad of clinical judgements every day. For experienced nurses these may come quickly and easily, while for the new graduate these skills will be honed with practice. Applying the five rights of clinical reasoning will however, aid in undertaking appropriate interventions for patients at risk of serious adverse events.


RN to MBBS Earn your MBBS at Oceania University of Medicine ~ Samoa –

Many of your duties are the same as a doctor, so why not gain the rewards Gain more knowledge, more autonomy and more recognition No need to uproot family and move from friends and support systems Continue working during first two years New classes begin every March, May and August.

OCEANIA UNIVERSITY OF MEDICINE N O W I N T E R N AT I O N A L LY A C C R E D I T E D For information visit www.RNtoMBBS.org or call 1300 665 343

Enhance your career with professional development at HSA Study our industry-leading Diploma of Community Services (Mental Health). › Small class sizes taught by practising health care professionals › Convenient Melbourne CBD location › Government funding available in Victoria* Talk to us today about how Health Skills Australia can support and enhance your career and professional development.

Enrolling now | Limited places available

Contact us

1300 306 886

healthskills.com.au

*Training delivered with funding from VIC or Commonwealth Governments. Eligibility criteria applies.

32

0637

OUM-NP RNtoMBBS01/11col

Educational Courses, Conferences & Events

Your next logical step Become a physician


12th

Formerly the National Prostate Cancer Symposium

Australasian Prostate Cancer Conference Together in discover y and care

PRESENTED BY

3 - 5 AUGUST 2011

MELBOURNE CONVENTION AND EXHIBITION CENTRE MELBOURNE, AUSTRALIA TRANSLATIONAL AND SCIENTIFIC MEETING | PSYCHO-ONCOLOGY MEETING | NURSES MEETING | GENERAL PRACTITIONERS WORKSHOP | CONTINENCE MEETING

TOGETHER IN DISCOVERY AND CARE

COME TOGETHER

www.prostatecancerconference.org.au/

33

Educational Courses, Conferences & Events

Australian Prostate Cancer Research Centre VICTORIA


your photo could be on our

n ext Cov e r ! theNursingPost

Post theNursing

www.nursingpost.com.au

ati

d Educ reer an

The Ca

zine on maga

for

Look ins

LO O K

this

rsingpo

r and Ed

and He Nurses

ide for look ins ture Take a fea issue’s

www.nu

The Caree

als

ssion alth Profe

onalsfor caPrti ofession EHedaltuhcare

theNursing Po

The Career and Education magazine for Nurses and Health Professionals

m.au

ngpost.co

www.nursi

ide for this

for your chan

ce to win

sue 7 2011 - Is 18 April

magazin

SUB

Working & Studying in

V ICTORIA

Take a look at our feature to see what this great state has to offer

ur ch

LO

ance

00!!

to win

for eOK INSID ntry detail E s

au

rses and

Health Pro

fessiona

issue’

S

TODCAR I B E Y $3 for yo

st

st.com.

e for Nu

feature “ Work san d St udy in W

IN SI DE

$300!!

ucation

Visit us

A”

Subscri be to win today for yo a Prep aid Ma ur chance sterca rd

13 June

online fo

r the lat

2011 - Is sue 11

est jobs

and artic les

2 May 2011 - Issue 8

Just send Send us photos of: us some happy •individual or group shots snaps of you and •your colleagues or yourself working your colleagues •special or social events •someone you think deserves to from your ward! HERE is your chance to show off your photography skills (or modelling skills) by entering the Nursing Post photo competition. If selected you will be notified by email in which issue your photo will appear in. We would love a variety of work settings and ultimately there is no limitation on what your photo can be. You can submit as many times as you like!

Submit your photos to:

be credited

Please note : •When taking photos, the higher the quality (mega pixels, image size) the better. •Please ensure that you have consent for photos in which you have photographed people where consent is required •By submitting photos to the competition you agree to allow the Nursing Post to use them in future publications

EMAIL: artwork@nursingpost.com.au POST: The Nursing Post, PO BOX 6213, East Perth, WA, 6892 34

ls


WHAT’S

YO U R

STORY?

d a F U N N Y an Do you have ry st g G nursin o IN T E R E S T IN share? If e to you would lik (or ething to say you have som great on’t miss this write), then d get your story opportunity to and share your P U B L IS H E D ith others. experience w

WHAT WE WANT TO READ! Tell us a TOUCHING, INSPIRING or any LIFE-CHANGING experiences in your nursing career. Share your travel experiences from nursing in exciting locations in Australia and overseas. Send in funny tales from the ward that happened to you, a nurse colleague or a patient you looked after. PUBLISHEDl

stories wil

win aE

PRIZ wor th

$100

P L E A S E N OT E -All submissions selected for publication will be subject to editing. -Include any images or photo’s that may be relevant to your story -Story Length: 500 - 1500 words -Include your name, address, phone number, and email address. -Submit stories via email or Microsoft Word -Check online at : www.nursingpost.com.au for complete submission conditions

Submit your stories to: EMAIL: editor@nursingpost.com.au POST: The Nursing Post, PO BOX 6213, East Perth, WA, 6892 FAX: (08) 9325 4037 35


Nurses from Australia and NZ usually adapt very quickly to working conditions in the Arabian Gulf, and it’s as well that they do.

You too can

Healthcare problems are rife here, thanks in no small way to the adoption of western diets. There is no shortage of work for a professional nurse and while you are used to that, you will not be so accustomed to being much better off financially. The modern nations of the region need the help of Western nurses to build their healthcare systems. These generous employers cover most of your living expenses free of charge. With no tax or transportation costs you can save up to 85% of your salary. And at the right hospitals you’ll find great opportunities for career advancement and continuing your education. Expert advice is essential for you to make the most of the opportunities on offer - see the examples in the next column. Because Promesse specialises exclusively in placements to the Arabian Gulf, we know what we’re talking about - and we’re free and friendly too, so for the experience of a lifetime call Christine Kohleis RN.

FREECALL AUS 1800 002 388 NZ 0800 542 100 Email: info@promesse.com.au www.promesse.com.au

experts on the gulf 36

CURRENT OPPORTUNITIES

➤ UNITED ARAB EMIRATES DONs: Surgical & OR services, Critical Care, ER Discharge Planners Nurse Coordinators/Team Leaders: Cardiac Cath Lab, ER and Paeds

➤ SAUDI ARABIA SNR NURSE MANAGERS/ADONS: Cardiac Services & ER NURSING SUPERVISOR – Surgical Services NURSE EDUCATORS – Medical/ Surgical, Paediatrics, NICU/PCIU, Oncology NUMs: Cardiac OR, Cardiac Clinic, CCU, Critical Care, CSSD, ER, ICU, ICU-Neonates, Cardiac Clinic, HDU, Cardiac Surgery HDU, Medical, OutPatients, Oncology, OR -, Paeds, Surgical ASS’T NUMs: Cardiac Cath Lab, Cardiac-HDU, Cardiac, ER, OR, Paeds Cardiac ICU, ICU, OR, Oncology, Outpatients MIDWIVES NURSE COORDINATORS / TEAM LEADERS: Critical Care – all areas, Cardiac wards, OR, Medical & Surgical, HDU, PACU, Paediatrics, Oncology etc. RNs: All areas – Burns ICU, Cardiac, ER, HDU, ICU , Med, NICU, OR, PACU, Paeds, PICU, Surgical, Oncology, etc


splash out in the Arabian Gulf!

experts on the gulf


Nursing in Australia its never been easier

Mediserve has numerous vacancies for nurses at City hospitals in Adelaide, Brisbane, Darwin, Melbourne, Perth, Sydney and in Rural hospitals Australia wide! Mediserve is also seeking Registered Nurses, Midwives and Specialty Nurses from New Zealand for work in Australia. We provide:

Mediserve has been selected to the panel of agencies supplying nurses for the state Governments of South Australia, Western Australia, Queensland and the Northern Territory. This means nurses working with Mediserve have first preference for job vacancies in these states.

• Best Rates of pay (Wages paid weekly) • Superannuation payments of 9% on wages • Full insurance cover for Nurses & Midwives • Over 10 years of experience in placing local and NZ nurses • City shifts and Country/Rural contracts • Long or Short term contracts • Arranged Accommodation • Jobs for all specialities and skills

NZ NURSES! FREE FLIGHTS TO AND FROM AUSTRALIA *INC TAXES

RURAL CONTRACTS

Free flights after 10 week contract in Rural locations throughout Australia

CITY SHIFTS

Free flights after 12 weeks working for any major metropolitan hospitals in Australia Australian Nurses: 1300 305 594 NZ Nurses Freecall: 0800 9325 1332 (Please ring between 3pm-10pm NZ local time) email: nurses@mediserve.com.au


Turn static files into dynamic content formats.

Create a flipbook
Issuu converts static files into: digital portfolios, online yearbooks, online catalogs, digital photo albums and more. Sign up and create your flipbook.