List of Titles

Enhancing alcohol and other drug (AOD) screening by emergency nurses

- Kelly, David, Chan, Raymond, Plummer, Virginia

Authors: Kelly, David , Chan, Raymond , Plummer, Virginia
Date: 2015
Type: Text , Journal article
Relation: Australian Nursing and Midwifery Journal Vol. 22, no. 10 (2015), p. 49
Full Text: false
Reviewed:
Description: Within Australia it is culturally acceptable to consume alcohol and it is an integral part of the Australian way of life (Australian Government 2013). The National Drug Household Survey stated that about fourfifths of Australians aged 14 or older reported they had consumed alcohol in the past year and 6.5% drank on a daily basis (2013).

The road to nursing

- Arnott, Nick, Paliadelis, Penny, Cuickshank, Mary

Authors: Arnott, Nick , Paliadelis, Penny , Cuickshank, Mary
Date: 2019
Type: Text , Book
Full Text: false
Reviewed:
Description: Commencing a nursing qualification can be an exciting yet daunting prospect. The Road to Nursing empowers nursing students to become effective practitioners by providing an in-depth foundational knowledge of the key concepts and skills that will underpin their entire nursing journey. Written by an expert team of academics and practising nurses, this text emphasises the importance of meaning-making, supporting students to critically engage with key knowledge that informs their ongoing learning, development and professional identity. Each chapter supports learning through pedagogical features including case studies, nursing perspectives, reflections, key terms, review questions and research topics, The additional activities accessed through the VitalSource eBook reaffirm comprehension and encourage critical thinking. The Road to Nursing is written in an accessible narrative style, providing a friendly guiding voice that will support students from the classroom into practice.

Perceptions of knowledge of disaster management among military and civilian nurses in Saudi Arabia

- Al Thobaity, Abdulellah, Plummer, Virginia, Innes, Kelli, Copnell, Beverley

Authors: Al Thobaity, Abdulellah , Plummer, Virginia , Innes, Kelli , Copnell, Beverley
Date: 2015
Type: Text , Journal article
Relation: Australasian Emergency Nursing Journal Vol. 18, no. 3 (2015), p. 156-164
Full Text: false
Reviewed:
Description: Summary Background It is generally accepted that nurses have insufficient knowledge about disaster preparedness due to a lack of acceptance of core competencies and the absence of disaster preparedness in nursing curricula.1 This study explored nurses’ knowledge and sources of knowledge, and skills as they relate to disaster management in Saudi Arabia, where more than 4660 people have died, 32,000 people have been affected, and US$4.65 billion in damage has been caused by disaster since 1980.2 Methods A quantitative, non-experimental, descriptive research design. Results Nurses in Saudi Arabia have moderate knowledge concerning disaster preparedness. However, nurses in military hospitals possess more knowledge than those who work in government hospitals. The majority of nurses gained their knowledge and skills from disaster drills. Conclusions Nurses need more education in all areas of disaster management, most importantly in their roles during response to disasters. Nurses perceive themselves as not well-prepared but they are willing to improve their skills in disaster preparedness if educational opportunities are provided.

Quick View

Are patients with concussion getting optimal discharge advice at a regional emergency department?

- Brown, Ashlee, Twomey, Dara, Wong Shee, Anna

Authors: Brown, Ashlee , Twomey, Dara , Wong Shee, Anna
Date: 2018
Type: Text , Journal article
Relation: Australian Journal of Rural Health Vol. 26, no. 2 (2018), p. 134-135
Full Text:
Reviewed:
Description: Mild traumatic brain injury (mTBI), known as concussion, is receiving increasing global attention. Growing concerns about the potential long-term effects of mTBI have highlighted the need for good management and follow- up care.1 Given that regional emergency departments (EDs) experience higher rates of mTBI presentations compared with metropolitan EDs and are often the first point of contact, the provision of evidence-based care in these settings is crucial for positive patient outcomes.2 Followup after mTBI has shown promising results in reducing the number and severity of symptoms.

Preparing for success

- Wikander, Lolita, Lyons, Judith

Authors: Wikander, Lolita , Lyons, Judith
Date: 2019
Type: Text , Book chapter
Relation: The road to nursing Chapter 4 p. 48-60
Full Text: false
Reviewed:
Description: In this chapter, you will learn how to plan your study around your existing commitments. You will be encouraged to build on your stengths and improve in areas that may hold you back. You will learn how to find time to study and be kind to your future self. This chapter gives you an idea of the different kinds of academic support you may be able to access and provides some hints for using the online study environment to your advantage. Critical reflection in self-directed learning will assist you to develop strategies for lifelong learning. Learning in the university context is self-directed, and the skills developed and employed in your nursing education will ensure you have mastered the graduate attributes needed to continue learning while you practise a s a nurse. Self-directed learning means being active and constructive in your learning process. This entails being clear on what your learning goals are and making a choice about how you will achieve your learning goals. It also involves deciding what strategies you will adopt in your own learning, together with what the teachers require you to do for successful completion of your courses. The section on relection and self-directed learning provides you with strategies for deep learning, which is learning for understanding as opposed to surface learning like cramming to pass tests. If you employ deep learning strategies, this learning will form the basis of your knowledge and skills, and you will be able to build on and apply it in new contexts. You are a partner in the learning endeavours. You will discover that you learn not only from your lecturers, but also from your peers and networks. You will be provided with hints for making both formal and informal peer support and group work function effectively for you. Finally, you will be given suggestions for using social media to help feel connected while simmultaneously avoiding common pitfalls in your journey to become the best nurse you can.

Feasibility and acceptability of a volunteer-mediated diversional therapy program for older patients with cognitive impairment

- Shee, Anna Wong, Phillips, Bev, Hill, Keith, Dodd, Karen

Authors: Shee, Anna Wong , Phillips, Bev , Hill, Keith , Dodd, Karen
Date: 2014
Type: Text , Journal article
Relation: Geriatric Nursing Vol. 35, no. 4 (2014), p. 300-305
Full Text: false
Reviewed:
Description: Understanding the perceptions of stakeholders is critical for determining acceptability and feasibility of volunteer-mediated programs. This study evaluated the feasibility and acceptability for staff, volunteers, patients and their carers, of a volunteer diversional therapy program for patients with cognitive impairment undergoing inpatient rehabilitation. Post-program structured interviews were conducted with the volunteers (n = 10), patients (n = 30) and their carers (n = 3); and nursing staff (n = 6) participated in a focus group. Thematic analysis identified five themes (values, attitudes, knowledge, purpose, support) in two dimensions (personal, team culture). Overall, patients, carers, staff and volunteers were satisfied with the volunteer program and perceived benefits for quality of care. Recommendations for improvements to the program related to staff engagement with the program and the volunteers' education and training. The volunteer diversional therapy pilot program for patients with cognitive impairment on a sub-acute ward was acceptable and feasible for patients, carers, staff and volunteers. (C) 2014 Mosby, Inc. All rights reserved.

The safe administration of medication : Nursing behaviours beyond the five-rights

- Martyn, Julie-Anne, Paliadelis, Penny, Perry, Chad

Authors: Martyn, Julie-Anne , Paliadelis, Penny , Perry, Chad
Date: 2019
Type: Text , Journal article
Relation: Nurse Education in Practice Vol. 37, no. (2019), p. 109-114
Full Text: false
Reviewed:
Description: This paper discusses the findings from the observation phase of a more extensive, appreciative inquiry qualitative study exploring registered nurses' experiences of administering medications. The observations aimed to explore the participants' application of the five-rights of medication administration in practice. Twenty registered nurses working in inpatient medical/surgical units at a regional Australian hospital were observed administering medications from the commencement to the completion of their shift. A data collection tool based on the five-rights of medication administration was used. The findings indicated that medication administration was not as routine as the rights framework suggests. Indeed, what was observed rarely reflected all the criteria of the rights framework. Notably, in practice, some of the rights were unable to be observed because the critical thinking that underpins the rights are implicit. However, the participants were observed to implement strategies beyond those described by the rights framework that ensured safe and timely medication administration. In brief, medication administration in contemporary healthcare settings is more complicated than the linear process suggested by the rights framework. So more attention is warranted, to the safe practice strategies of nurses who, to deal with complex clinical contexts. Their person-centred strategies respond to patient circumstances and maintain safety.

Quick View

Nursing as a profession

- Lyons, Judith, Bliss, Suzanne

Authors: Lyons, Judith , Bliss, Suzanne
Date: 2019
Type: Text , Book chapter
Relation: The road to nursing Chapter 12 p. 183-203
Full Text: false
Reviewed:
Description: All regulated health practitioners need to be aware of the standards imposed on them by their regulatory body in order for them to be able to practise. The standards are imposed on nurses and midwives by the Australian Health Practitioner Regulation Agency (AHPRA), which regulates the Australian workforce through the Nursing and Midwifery Board of Australia (NMBA). The NMBA regulates registered nurses, enrolled nurses and midwives. This chapter focuses on the professional aspects of nursing. It is intended to assist you to understand your obligations to obtain and retain your nursing or midwifery registration and your legal, regulatory and moral obligations both as a nursing or midwifery professional and as an individual. It also differentiates the scope of practice for the registered nurse, enrolled nurse and midwife, as we have the responsibility to provide safe, quality care to our clients. The first section discusses the general legal and regulatory requirements for nurses. Next, we turn to the Professional Practice Framework that constitutes a key part of nurses' legal and regulatory obligations. The Professional Practice Framework forms the overarching statement of nursing's values contained in the Code of Ethics and Code of Conduct, as well as the recently implemented Standards for Practice for Registered and Enrolled Nurses (NMBA 2016a, 2016c). We explain the registration standards first, then examine the new Standards for Practice. These standards replaced the old Competency Standards on 1 July 2016, and were developed to better reflect contemporary practice in nursing. The next section contains information on professional boundaries, including the recently updated Codes of Ethics and Conduct. Finally, we make some brief remarks relation to scope of practice.

The divided self: Near death experiences of resuscitated patients: a literature review

- Cant, Robyn, Cooper, Simon J., Chung, Catherine, O'Connor, Margaret

Authors: Cant, Robyn , Cooper, Simon J. , Chung, Catherine , O'Connor, Margaret
Date: 2012
Type: Text , Journal article
Relation: International Emergency Nursing Vol. 20, no. 2 (2012), p. 88-93
Full Text: false
Reviewed:
Description: This paper explores the prevalence of ‘near death experience’ phenomena associated with a resuscitation event and examines the current state of evidence for causation. Patients’ reports of unusual recollections associated with a period of unconsciousness (perceived as approaching death) have fascinated individuals and the medical fraternity. Near death experiences (NDE) are reported in 4–9% of general community members and up to 23% of critical illness patients, although they can occur in healthy individuals who may think they are in peril. One explanation is that paranormal visions that include seeing bright lights, a tunnel and having feelings of peace may be a stage of enlightenment as death approaches. More objective explanations point to neuro-chemical changes in a stressed or dying brain as explanation for nearly all the elements of near death experience. However if this is so, NDE should occur in all patients who are critically ill and near death. In general, patients report positive psychological outcomes after a near death experience. Nurses can support patients during a time of crisis by assisting them and their families to comprehend the experiential event using effective communication and listening skill.

Issues post-stroke for Muslim people in maintaining the practice of salat (prayer) : A qualitative study

- Mohamed, Che Rabiaah, Nelson, Katherine, Wood, Pamela, Moss, Cheryle

Authors: Mohamed, Che Rabiaah , Nelson, Katherine , Wood, Pamela , Moss, Cheryle
Date: 2015
Type: Text , Journal article
Relation: Collegian Vol. 22, no. 3 (2015), p. 243-249
Full Text: false
Reviewed:
Description: Background: Muslims throughout the world perform salat (prayer) five times a day; salat involves a person reciting the Holy Qur'an while being in several positions. There are several steps that should be carried out before prayer, including wudhu (ablution) and covering one's awrah (body). Objectives: To identify educational needs for stroke patients and their caregivers in Malaysia. Another purpose is to report on the needs identified by stroke patients and their families related to salat. Methods: Descriptive qualitative study. Phase 1 involved semi-structured interviews with stroke patients (. n=. 5), family caregivers (. n=. 5) and health professionals (. n=. 12) in Kelantan Malaysia. Phase 2 involved presenting the findings from Phase 1 to the health professionals with the aim of establishing priorities and processes to develop education strategies for stroke patients and their families. Results: Preparing for and performing salat was challenging for both patient and family carers to do following a stroke. Themes identified were prayer and the meaning of the stroke events for participants, difficulties praying post-stroke, prayer as part of rehabilitation therapy. Conclusion: Providing culturally safe care should include how nurses assess and support patients and their caregivers post stroke to meet their prayer needs. Nurses have a role in discussing with stroke patients and their families how in addition to its spiritual and customary benefits, prayer and for Muslims reciting the Holy Qur'an can have cognitive and rehabilitation benefits, as well as being a source of psychological support for stroke patients. © 2014 Australian College of Nursing Ltd.

Quick View

Do simulation studies measure up? A simulation study quality review

- Cant, Robyn, Levett-Jones, Tracy, James, Ainsley

Authors: Cant, Robyn , Levett-Jones, Tracy , James, Ainsley
Date: 2018
Type: Text , Journal article , Review
Relation: Clinical Simulation in Nursing Vol. 21, no. (2018), p. 23-39
Full Text:
Reviewed:
Description: Simulation-based education has become a ubiquitous teaching approach in nursing. However, ensuring the quality of simulation research is critical. We reviewed the methodological quality of 26 quantitative studies published in Clinical Simulation in Nursing, 2017. The Medical Education Research Study Quality Instrument and Simulation Research Evaluation Rubric showed that nearly all studies were of moderate to high quality (rated ≥50%). Correlation coefficients showed that interrater agreement was high overall (≥0.94). In conclusion, this was a valid approach for examining simulation study quality. Although most included studies were of high quality, some elements of study reporting can be improved upon.

The influence of anxiety on student nurse performance in a simulated clinical setting : A mixed methods design

- Al-Ghareeb, Amal, McKenna, Lisa, Cooper, Simon J.

Authors: Al-Ghareeb, Amal , McKenna, Lisa , Cooper, Simon J.
Date: 2019
Type: Text , Journal article
Relation: International Journal of Nursing Studies Vol. 98, no. (2019), p. 57-66
Full Text: false
Reviewed:
Description: Background: Anxiety has a powerful impact on learning due to activation of anxiety hormones, which target related receptors in the working memory. Experiential learning requires some degree of challenge and anxiety. Patient simulation, as a form of experiential learning, has been an integrated component of health professional education internationally over the last two decades, especially in undergraduate nursing education. Little information is available to determine if and how anxiety impacts nursing students’ clinical performance during simulation. Objectives: To investigate physiological and psychological anxiety during emergency scenarios in high-fidelity simulation and understand the effect of anxiety on clinical performance. Design: First2Act was the model for the simulation intervention. Second and third year undergraduate nursing students attended a two-hour simulation session and completed a demographic questionnaire plus pre-simulation self-reported psychological anxiety scale. A heart rate variability monitor was attached to each student's chest to measure heart rate variability (as a sign of anxiety) before engaging in two video-recorded simulated emergency scenarios (cardiac and respiratory) with a professional actor playing the patient. Performance was rated by a clinician followed by video-assisted debriefing. Finally, heart monitors were removed and students repeated self-reports of psychological anxiety. Results: Students’ psychological anxiety was high pre-simulation and remained high post-simulation. With regard to physiological anxiety, students were anxious at the start of the simulation but became more relaxed toward the end as they gained familiarly with the simulation environment (p < .007). Clinical performance increased significantly in the second scenario (p < .001). Factors found to positively affect clinical performance were length of enrolment in the nursing degree (p = .001), current employment in a nursing or allied healthcare field (p = .030), and previous emergency experience (p = .047). The relationship between physiological anxiety and clinical performance was statistically not significant, although there was an indication that low level anxiety led to optimal performance. Conclusion: High-fidelity patient simulation has the capacity to arouse novice nurses psychologically and physiologically while managing emergency situations. Indicative outcomes suggest that optimal performance was apparent when anxiety levels were low, indicating that they had received insufficient training to deal with situations that induced moderate to high anxiety levels.

ICU nurses feel unprepared to care for patients with mental illness : A survey of nurses' attitudes, knowledge, and skills

- Weare, Reuben, Green, Cameron, Olasoji, Michael, Plummer, Virginia

Authors: Weare, Reuben , Green, Cameron , Olasoji, Michael , Plummer, Virginia
Date: 2019
Type: Text , Journal article
Relation: Intensive and Critical Care Nursing Vol. 53, no. (2019), p. 37-42
Full Text: false
Reviewed:
Description: Objectives: To examine the knowledge, skills, and attitudes of a cohort of Australian nurses towards caring for patients with mental illness in the intensive care unit. Research design: A questionnaire was developed and distributed via internal email to all nurses working in the study intensive care unit. Responses were anonymous. Setting: A metropolitan intensive care unit located in Melbourne, Australia. Main outcome measures: Intenisve care nurses completed a 76-question self-administered questionnaire. Results: Forty intensive care nurses completed the survey, a response rate of 35.7% (n = 40/112). Respondents were predominantly female (82.5%) and held a post-graduate qualification (62.5%). ICU nurses felt that they needed further training and education to care for patients with mental illness in the intensive care unit. While respondents were empathetic to this patient group, negative stereotypes and stigma were reported by some participants. The pressures of the environment were perceived barriers to delivering optimal person-centred care for patients with mental illness. Conclusion: This sample of nurses felt they require education and support in order to care for patients with mental illness in the intenisve care unit. Further education may also help to reduce negative perceptions of this patient group.

Evaluating a blended online learning model among undergraduate nursing students : A quantitative study

- Ota, Marianne, Peck, Blake, Porter, Joanne

Authors: Ota, Marianne , Peck, Blake , Porter, Joanne
Date: 2018
Type: Text , Journal article
Relation: CIN - Computers Informatics Nursing Vol. 36, no. 10 (2018), p. 507-512
Full Text: false
Reviewed:
Description: In Australia, the emerging use of technology in higher education has brought about significant change in the delivery of undergraduate nursing programs. Universities are now tasked with delivering a blend of online and face-to-face education, while students face new and sometimes challenging online learning environments with little technical support. This article explores the attitudes held by Bachelor of Nursing students toward the blended educational mode at a rural university in Victoria, Australia. A total of 109 participants constituted a convenience sample from a Bachelor of Nursing program across all 3-year levels. Responses provided by participants who completed an online self-report questionnaire were analyzed via descriptive and inferential statistics. The results indicated that participants struggled with inaccurate expectations of workload and the technical difficulties presented by online modules. Although this area requires further research, to an extent autonomy and flexibility were identified as two prominent traits exhibited by students who flourished in the blended modes. All in all, the results of this study strongly reflect the challenges faced by undergraduate nursing students navigating newly introduced online systems in a blended mode of study.

Deteriorating patients : Global reach and impact of an e-simulation program

- Cooper, Simon J., Hopmans, Ruben, Cant, Robyn, Bogossian, Fiona, Giannis, Anita, King, Rosemary

Authors: Cooper, Simon J. , Hopmans, Ruben , Cant, Robyn , Bogossian, Fiona , Giannis, Anita , King, Rosemary
Date: 2017
Type: Text , Journal article
Relation: Clinical Simulation in Nursing Vol. 13, no. 11 (2017), p. 562-572
Full Text: false
Reviewed:
Description: Background E-simulation may enable a feasible education solution to the management of deteriorating patients. Method The study involves a pre–post quasi-experimental evaluation of global data on educational outcomes from an e-simulation program. Results Qualified nurses (n = 1,229) and final year nursing students (n = 1,742) were among 5,511 participants from 20 countries who completed the program. Both groups’ knowledge and performance improved significantly (p = <.001) with no difference between groups. Regression analysis revealed predictors of performance were education level, knowledge, experience, and being female. Participants positively evaluated the program and mode of delivery. Conclusion E-simulation may enhance students’ preparation for practice and improve qualified nurses’ management of deteriorating patients. © 2017 International Nursing Association for Clinical Simulation and Learning

Breastfeeding support in the early postpartum : Content of home visits in the SILC trial

- Ridgway, Lael, Cramer, Rhian, McLachlan, Helen, Forster, Della, Cullinane, Meabh, Shafiei, Touran, Amir, Lisa

Authors: Ridgway, Lael , Cramer, Rhian , McLachlan, Helen , Forster, Della , Cullinane, Meabh , Shafiei, Touran , Amir, Lisa
Date: 2016
Type: Text , Journal article
Relation: Birth Vol. 43, no. 4 (2016), p. 303-312
Full Text: false
Reviewed:
Description: Background: The Supporting breastfeeding In Local Communities (SILC) cluster randomized controlled trial evaluated whether a home visit focussed on infant feeding early in the postpartum period increased the percentage of infants breastfeeding at 4 months in low socioeconomic areas of Victoria, Australia. The visits were offered to women identified as at risk of early breastfeeding cessation after discharge home with a new baby. This paper describes the content of the home visits. Methods: SILC visited 1,043 women from September 2012 to March 2013, and completed a data sheet for each visit documenting topics discussed, as well as what support and resources were offered. Frequencies and percentages are presented. Results: Home visits most commonly included the provision of reassurance to women (91%). Topics discussed included general breastfeeding information (83%), supply and demand (83%), positioning (79%), and feeding frequency (78%). Newborn feeding/behavior (57%), expression of breastmilk (54%), nipple pain (41%), low breastmilk supply (41%), and the use of nipple shields (18%) were also prominent topics. The issues and support needs of women were similar across locations (rural, regional or metropolitan) and regardless of maternal parity or age. There was some variation in the resources suggested in different localities. Conclusions: New mothers require help and reassurance independent of whether this is their first or subsequent child, reinforcing the need for support, breastfeeding information, and education about normal neonatal behavior. Key aspects of support are reassurance, normalization of infant behavior, and education. © 2016 Wiley Periodicals, Inc.

Foundations of nursing practice

- Cramer, Rhian, Coombs, Nicole, Lyons, Judith, Kim, Jeong-Ah

Authors: Cramer, Rhian , Coombs, Nicole , Lyons, Judith , Kim, Jeong-Ah
Date: 2019
Type: Text , Book chapter
Relation: The road to nursing Chapter 11 p. 168-182
Full Text: false
Reviewed:
Description: Becoming a safe and contemporary nurse is more than just being able to demonstrate clinical skills or understand disease processes. It is about critical thinking - understanding why we do what we do and how to do it in the most efficient and effective way. Achieving the best outcomes for the patients is always paramount. This chapter explores the foundational principles of contemporary nursing practice: evidence-based practice, person-centred care, and communication. It also introduces the growing role of technology in healthcare and looks at how numerous factors come together to influence health outcomes for the individual patient.

The journey begins

- Arnott, Nick, Paliadelis, Penny, Cuickshank, Mary

Authors: Arnott, Nick , Paliadelis, Penny , Cuickshank, Mary
Date: 2019
Type: Text , Book chapter
Relation: The road to nursing Chapter 1 p. 3-15
Full Text: false
Reviewed:
Description: This opening chapter aims to set the scene for your undergraduate nursing journey. We welcome you to the wonderful, dynamic and diverse profession of nursing and encourage some initial thinking about what nursing is, why you have chosen this career and the sort of nurse you hope to be. We also outline the purpose, structure and features of this book, and introduce you to the key concepts and ideas underpinning your learning journey, many of which will be emphasised and explored further in subsequent chapters.

Infection prevention and control : Who is the judge, you or the guidelines?

- Bouchoucha, Stephane, Moore, Kathleen

Authors: Bouchoucha, Stephane , Moore, Kathleen
Date: 2017
Type: Text , Journal article
Relation: Journal of Infection Prevention Vol. , no. (2017), p.
Full Text: false
Reviewed:
Description: Objectives: The aim of this study was to explore the attitudes and behaviours of registered nurses and their colleagues around the adoption of standard precautions in order to determine strategies to promote adherence. Design: A qualitative exploratory descriptive design used interviews and focus group to collect data. Setting: Registered nurses and registered midwifes from a tertiary metropolitan hospital took part in the study. Participants: A voluntary sample of 29 adults was recruited from the Australian nursing (n = 25) and midwifery (n = 4) workforce. There were six men (mean age = 36.83 years; SD = 8.93) and 23 women (mean age = 41.36 years; SD = 10.25). Participants were recruited through advertisement on notice boards and emails from unit managers. Results: Thematic analysis revealed five themes but the focus here is on staff judgements which are against the guidelines. Participants indicated that where in their judgement the patient posed no risk and they judged themselves skilled in the procedure, they were justified in deviating from the guidelines. Some staff judgements appeared to be self-protecting, while others were irrational and inconsistent. Conclusions: Despite use of standard precautions being mandated, staff often deviated from them based on their own assessment of the situation or the patient. Any deviance from the guidelines is of concern but especially so when staff take it upon themselves to apply their own criteria or judgements. These results also suggest there may be some organisational inadequacies with regards to training and supervision of staff.

Showing items 61 - 80 of 143