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CURRENT TRENDS IN NURSING

I. INTRODUCTION: Before nursing began to emerge as a profession. Sick people are normally look after by their families. Those who dont have relatives and some other resources they need the help of others. During 17 th, 18th centuries in Europe nursing and medicine were at low effective no real advances were made. Slowly the movement has come in nursing from nursing in the home to nursing in the work house, nursing in the voluntary hospital the beginning of organization in nursing, organization of the college of nursing to the general nursing council. The modern nursing has been evolved in the last 5 years and still advancing. The nursing must be aware of trends to make correct decisions white planning the future. II. DEFINITION OF TRENDS: Trends means a change on movement in a particular direction. (Dictionary) A trend in nursing profession is a change that is taking place in present days in any field of nursing it may be in education, service or practice which affects the profession as a whole. III. DEFINITION OF NURSING: 1) According to modern nursing is an art and science and a profession by which we render, serve to human begins to help him to regain on to keep a normal state beings to help him to regain on to keep a normal state of body and mind when it cant accomplish this it help him for the relief from physical pain, mental, anxiety or spiritual discomfort. 2) Nursing practice is a direct service, goal directed and adopted to be needles of the individual, the family and community during health and illness. Nursing is a dynamic therapeutic and education process in

meeting the health needs of the individual family and society. (American nurses Association 1965). IV. TYPES OF TRENDS: Trends in nursing do not occur isolated but each one has a basis of related changes in other fields. They are Social trends or social changes. Professional trends. International trends in nursing field. Changes in nursing profession itself.

SOCIAL TRENDS: Nursing profession services to meet the need of the society particularly the needs R/T to health and well being. The changes in society will influence to bring about changes in nursing professions. The government began serious efforts to meet the health needs of the nation after independence. The BHORE report 1946. The health survey and development committee group by SIR JOSEPH BHORE has brought forth these changes. An intensive effort by the government to meet the needs of the people specially those in the health needs of the people especially those in the rural population. Gradual improved education of the people with a growing awareness of health needs. Advanced technology / machinery. The change role of women. The continuing growth of population.

PROFESSIONAL TRENDS IN NURSING: There is a trend in nursing profession towards meeting the criteria of profession. Profession develop is taken from apprentice ship in hospital to schools of nursing to managerial direction level. The current trend area. CARE GIVER: Nurse as a care given, does not only cure the disease. She will deliver the holistic health including measures to restore emotional spiritual and social well being. CLINICAL DECISION MAKER: As a clinical decision maker nurse uses her thinking skills throughout the nursing process to provide effective care for the patient. PROTECTOR AND CLIENT ADVOCATE: As a protector she will help the client to maintain safe environment for the client and takes steps to prevent injury and protect the client from possible averse effects of diagnostic and treatment measures. As a client advocate the nurse protects the clients human and legal rights and provide assistance in asserting those rights when need arises. CASE MANAGER: As a care manager, the nurse co-coordinator, the activities of each members of health team. The main role of this person is to review the care being provided to the client and assist which delays, such as a testing or making arrangement for discharge. An insurance case manager is also available to assist in hospital case manager which complex clients. REHABILITATOR: Rehabilitation is the process by which the individual return to maximum levels of functioning after illness, ancient or disabling, that changes their lives

and the nurse helps them adopt as fully as possible this include teaching client, help cope the life style changes. COMMUNICATOR: A role of communication is general to all other nursing roles nursing involves communication which the clients, families, colleagues other health care professionals without clear communication it is impossible to give care effectively, make decisions, meet the communities. COMFORTER: The role of comforter, caring for the client as a person is a traditional and historical and historical are in nursing and has control to be important as nurse have assumed new roles physical and emotional support of ten help give the client strength to recover, while giving care the nurse care provide comfort by demonstrating care for an individual which unique feelings are need. TEACHER / EDUCATION: As a teacher nurse explains to clients concepts and facts about health demonstrate procedures such as self care activities, that the client fully understand, reinforces the learning and evaluate the clients progress in learning teaching may be formal or information like in casual conservation. The nurse uses the teaching methods that match the clients capabilities and needs and incorporate other resources such as family in her teaching plans. needs of individuals, families and

CAREER ROLES:
Nursing profession offers expanded role and different kinds of career opportunities.

1. CLINICIAN:

The clinical nurse provides direct care to the client using the nursing process and critical thinking skills. The focus is curative and restorative. The clinical role of a nurse is to provide education to the client and family to promote health maintenance and self care, the clinician focuses in returning the client to his or her home and usual state of health.

2. NURSE EDUCATOR:
A nurse educator works in schools of nursing, staff development department of health care agencies and clients education departments nursing educators have generally back ground of clinical skills and theory knowledge. Primary focus of nurse educator is an agencys department of client education is to teach ill disabled clients and their families how to provide care in the home. The nurse educators may be specialized and certified.

3. MILITARY NURSE:
There are many opportunities to provide nursing care in armed forces. Entry into military needs atleast B.Sc, Nursing degree. Military nursing is a life long cancer and can practice in hospital, long-term care and facilities over seas.

4. CERTIFIED NURSE MIDWIFERY:


A certified nurse midwife is a certified registered nurse by the nursing council, as she can provide independent care during normal, abnormal pregnancy care of new born and gynecology services like family planning.

5. ANAESTHETIST:
She is a nurse who have received advanced training programme in anaesthesia and can provider surgical anaesthesia under the guidance and supervision of an anaesthesiologist. 6. NURSING ADMINISTRATOR:

Nurse administration for begins which the position such as a charge nurse. Nurse administrator include budgeting, staffing, strategic planning of programme and service, employee evaluation and employee development. 7. NURSE RESEARCHER: She investigates problems improve nursing care, expanding the scope of nursing practice. She can be appointed in acedemic setting. Minimum education level is doctoral degree which at least masters degree in nursing. 8. NURSE PRACTITIONER: She provides health care to clients, usually OPD, ambulatory care or community based setting a nurse practitioner may work a specific group of clients or which clients of all ages and health care needs. A nurse can take care of adult as adult nurse practitioner, provides general health needs as a family nurse practitioner and as acute care nurse practitioner in a new role of advanced practice V. NURSING THE TRENDS 1. NURSING THE NUMBERS By 2020, according to the study, the RN workforce will be roughly the same size as it is now which will be 20% below projected demand. The study found that the main reason for the older workface is a decline in the number of young women choosing nursing as a career since 1980. During the past 20 years, entry level nursing education has shifted from diploma programs to associates or bachelors degree programs. The net effect of these changes is that nurse are spending less time on their entry-level education. Even though the number of bachelors and masters programs is increasing, a far greater increase is seen in the number of nurses is

associates degree programs than in the number of nurses in hospital programs. Associates degree programs take two years to complete; hospital programs take three. The number of two-year community colleges with RN programs increased dramatically in the 1960s and has steadily risen since, At the same time, the number of three-year hospital diploma programs has been decreasing. Not only was thw demand greater for the two-year programs, but hospitals were forced by harsh economic forces-brought about by managed care system-to close unprofitable programs. One result of these shifting trends in nursing education is that, according to Donley and Flaherty, nurses are undereducated when compared with other members of the health care team. This is a real problem, as they view it, because Undereducated members of the health care team rarely sit at policy tables or are invited to participate as members of governing boards. Consequently, there is little opportunity for the majority of practicing nurses to engage in clinical or health care policy. Of todays employed RNs, 59.1% work in hospitals, 18.2% in public and community health (including occupational and school health setting ), 9.5% in ambulatory care, and 6.9% work in nursing homes and extended care facilities. The remainder of nurses work in nursing education and other settings (such as prisons, jails, and insuance companies). The settings that saw the largest increase in number of RNs were the public and community health sectors, including state health departments, community health centers, and visiting nursing services. Of nurses working in advanced practice, the majority are nurse practitioners; the next largest group is clinical nurse specialists. These two together, including those trained for both jobs, comprise approximately 80% of all APNs. 2. NURSING THE DEMAND

Today there are more than 126,000 unfilled nursing positions-around 7% below the workforce requirement. The nursing shortage is expected to continue. A recent workface study by the bureau of Health professions projects a 12% deficit in nurses for 2010, a 20% deficit by 2015, and a staggering 29% shortage of RNs in 2020. Advances in medical technology and pharmaceuticals as well as healthy lifestyle choices have resulted in the graying of America, as life expectancy increases and quality of life improves. The current number of unfilled nursing positions is a frightening concept when the number of nurses needed to care for the 78 million baby boomers is considered, especially when they reach age 65 in a few years and begin placing unprecedented demands on the health care system. 3. WHY THE SHORTAGE Why, if theres job security and decent pay, is there such a profound shortage of nurses? The reasons are numerous and complex. A 20-year buildup of conditions created the prefect storm-our current protracted, calamitous nursing shortage. This transformed health care system transferred such of inpatient care to the outpatient setting and to patients homes. This shift is reflected in the dramatic decrease in the average hospital length of stay during the last two decades. Ns who work in hospitals is that todays patients are sicker than in the past, requiring more intense nursing care. Another factor that has influenced todays shortage was a 1995 report by a blue-ribbon commission funded by the pew Charitable Trusts. The report warned that hospital emerges would close the doors of almost 50% of our nations hospitals by 2000, which would mean a loss of 60% of hospital beds and a surplus of 200,000 to 300,000 nurses. The Pew prediction was wrong, and far fewer hospitals closed than anticipated, but the report left its mark on history by discouraging young people from entering the nursing field.

Dealing with intense assignments and extra shifts over worked and have becomes stressed, burned out, and left with little job satisfactions; all these factors contribute to the nursing shortage. Furthermore, as nurses get older and retire, more people are leaving than entering the profession, even with increased enrollments in schools of nursing. Women account for 95% of nurses, yet young women are not choosing to become nurses as frequently as they once did. This is leading to a further reduction in the number of nurses. But at the same time that nursing enrollment is down, the number of women entering medicine is increasing. We dont have the capacity to educate as many nurses as we used to, as evidenced by a far higher number of applicants than enrollees. Gail Collins wrote about the shortage in a 2001 New York Times article: [Nurses are] unhappy, and they spreading the word. Management has a right to be efficient and demand results, as long as everybody remembers that the nurses of the future have a right to sign up for dentistry or accounting. 4. NURSING THE EFFECTS The JCAHO report shows that the shortage contributed to nearly a quarter of the unanticipated problems in hospitals that resulted in patient death or injury, citing insufficient numbers of nurses as a reason for those cases. A major factor in ED overcrowding and diversions, cancellation of elective surgeries, discontinuation of clinical services, and limitations in the health care system;s ability to respond to mass casualties. Ninety percentage of nursing homes report that they do not have enough nurses to provide even the most basic level of care, and some home health care agencies are being forced to refuse new admissions. Reversing the nursing shortage will not be simple, but its fixable, and its up tous. It will take a community- nurse executives, hospital leadership, policymakers, schools of nursing, physicians, creditors, private industry, and nurses. The JCAHO report calls for reforms to the nursing education syatem and

for the federal government to tie Medicaid and Medicare payments to a hospitals improvement in nursing care and nurses work environment. Studies by Linda H. Aiken, P.hD., RN., FRCN.,FAAN., and others have demonstrated the value of the program in terms of fostering both positive patient outcomes and satisfactory work environment for nurses. 5. POLICYMAKERS: The nursing shortage has certainly received the attention of the U.S.media. Policymakers at the state and national levels have watched the news, read newspapers, listened to constituents, and began to pass legistation to alleviate the shortage. In mid-2002 the Nurse reinvestment Act was passd by congress and signed by president Bush. This law modified funding for existing nursing programs-including ones for advanced practice nursing, basic nursing (nurse education, practice, and retention), nursing workforce diversity, and loan repayment and scholarship and created geriatric care training and faculty loan programs. Most states have begun to address the shortage through legislation and funding to expand nursing. Some states have passed laws to improve the workplace. Private industry: Private industry aggressively addressing the shortage is Johnson & Johnsons 2002 advertising campaign, featuring the dare to care television spots that portrayed nurses positively. In February 2002 the company launched a two-year. Campaign to attract more people to the nursing profession. The campaign includes scholarships for undergraduate nursing students and nurse educators; television advertisement celebrating nurses and their contributions; national fundraising events to honor excellence in nursing (and to support student and faculty scholarships); and recruitment brochures, posters, and videos.

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Nurses everywhere feel the strain of the shortage every day, and they are happy to get what help they can; they show their appreciation. Nurses can further contribute by joining the ANA and state and national professional nursing organizations, as well as labor and nursing specialty organizations. Organized labor plays a critical role in informing the public and policymakers about the needs of the profession. 6. NURSING THE OPPORTUNITIES: Staff nursing. The need for hospital staff nurses has continued to rise, and the good news in nursing is that nurses has continues to rise, and the good news in nursing is that nurses can continue to work at the bedside while finding fulfillment. With the move toward magnet nursing, the bar has been raised for staff-nurse contributions in hospitals. Staff nurses have opportunities that did not exist previously. We have a clinical ladder program that rewards nurses for participating in shared governance and for promoting health on a volunteer basis in the community. 7. TEACHING: There is also a shortage of nurse faculty members. New money from the government to increase the supply of nurses will have little effect if there arent enough teachers. Furthermore, the faculty shortage is a major factor that limits the enrollment in schools of nursing. The average age of a nursing teacher is 50.2 and with the retirement of this graying professorate, the shortage is expected to escalate. (This phenomenon is unique to nursing because nurses are encourage to gain clinical experience before earning higher degrees and teaching.) A nurse with five years solid experience can teach. The opportunity to guide future nurses, combined with the chance to do important research, positions teaching as a very rewaring aspect of nursing. Nurses who want to teach may do well to consider pursing this goal earlier in their careers.

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8. GENETICS NURSING: The remarkable work of the U.S Human Genome project is a catalyst for growth in the number of opportunities available to nurses. Coordinated by the department of energy and the national Institute of Health, the project, which began in 1990, has mapped the human genome-the collection of about 35,000 genes and the sequences of the 3 billion base pairs that make up human DNA. The implications for health care are profound. Most health conditions are believed to result from a combination of genetic and environmental influences; the new knowledge will improve the diagnosis and treatment of many illnesses. Physicians, nurses, and other health care workers, regardless of specialty, will need to integrate new information on genetics into routine practice, especially when explanning responsiveness to treatment and options for care. The geneticist gives a prognosis and the probability that the identified syndrome will occur in other children by the same parents. Staff nurses assist in reducing complex information into practical, understandable terms for families. 9. ADVANCED PRACTICE NURSING: This collective term refers to four speccialities; nurse practioner, clinical nurse specialist, certified nurse midwife, and certified registered nurse anesthetist. Certified registered nurse anesthetists work alongside anesthesiologists to deliver anesthesia care. Certified nurse midwives deliver infants in a highly sought after method of childbirth. 10. INFUSION NURSING: For patients and nurses, medicine is no longer dependent on pheripherally inserted short-term catheters for venous access. Implanted, tunneled, and peripherally inserted central catheters (PICCs) are used for long-term venous access, ideal for patients receiving chemotherapy with irritant or vesicant drugs, long-term antibiotic therapy, and total parenteral nutrition. The insertion

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procedure, which is a sterile technique with placement requires a medical order.

confirmed by X-ray,

Nurse clinicians take an eight hour class. After three successful supervised insertions, our institution deems participants competent to insert them. National certification as an infusion nurse is available through the infusion, Nurses society. END-OF-LIFE NURSING: The aging population has increased the demand for gerontology nurses. At the same time, a national movement toward dignifying the death experience has been taking place, giving renewed life to hospice and palliative care. PUBLIC HEALTH NURSING: The largest increase in RN employment from 1996 to 2000 was in public and community health settings (state health departments, for example). Because of the events of September 11,2001, its possible that more RNs will be employed in this setting. Last year, nurses were asked to voluntarily immunize themselves against smallpox-a vaccination not without potentially lethal side effect. ALWAYS IN DEMAND: Nurses have many choices and because of the changes brought about by the magnet program, they can work in settings where they are valued and can positively affect patient care and their own work environment. Travel nursing is in full bloom to fill seasonal needs at hospitals and elsewhere, and this kind of work is a wonderful opportunity for young nurses looking for the right community. As nurse consultants, meanwhile, nurses can work in offices, home care, health care licensing and regulating agencies, schools, legal practices, jails, and insurance and pharmaceutical companies.

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VI. A CHALLENGE FOR NURSES AND NURSING EXPANDING TECHNOLOGY Every person involved in health care delivery is well aware of the economic political, professional, scientific and technological forces that exert pressures on the system. Mechanisms will be built into monitoring devices to warm health care team members about deteriosting changes, alert them, and automatically affect changes in health status. Software has been devised so that patients can performs much of their own psychotherapy without clinical assistance Teaching machines will be available for patients to learn about their disease process and how to manage it All clinical records will be automatic Many persons will manage their personal health through home computers and access to this knowledge back. Genetics may becomes the most studied field for the most few decades Current research is the genome mapping project which has the potential for introducing a very radical approach to both caring and preventing illness. COMPUTER ASSISTANCE: Computer can be used to evaluate patient care. It will be possible to develop methods to assess the quality of performance of each practitioner and the cumulative performance of the staff. Increasing employment of computers for the maintenace of patient records will eventually enable health care professionals in disparate locations to access this informations and prevent problems such as conflicting prescriptions. Such individual recording could either be carried bu each person on a computer disk, or be accessible by means of a magnetized card such as the Health Security Card that many countries are promoting.

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As Japan is using computers, even Indian hospital are equipment in each ward with computers for diagnosis and the other details of the patient including hospital details. ROBOTS: Robots are also being used in clinical settings from 1994. The use of robots in intensive care units is not only time and money saving but also cuts down on human exposure to blood borne infections. Robots are also been used to conduct blood analysis. NEW THREATS TO HEALTH: Depletion of the ozone layer may precipitate a new forms of pathology. Problems secondary to waste disposal will inevitably arise. An increasing density of the worlds population may procedure a built in incubation medium for fostering new diseases The aim travel that facilitates movement of humans and animal, will create a human bone disease and their will be reasonable possibility of more retro viruses emerging that are not dependent on sexual transmission. The ironic co-existence of loneliness and population density may cause new varieties of psychological / biological stresses. As the worlds population nearly doubles, so does it social density, which can form a sociological presses that are capable of causing disruption in human functioning Patients with sociological, anthropological and psychological problems will be managed in their own settings nurses who performs well in this role build confidence in patients and this enhances the image of the profession NURSES ENTER PRIVATE PRACTICE: Nurses owned health care organization also can deliver satisfactory and effective health care service to the public. A care of patients in hospitals of the future will be different only the acutely ill, who require all the advantages of the automated hospital, will be hospitalized. This means nurses will be able to

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manage only one patient or very few patients under such intense conditions. The necessary closeness and constancy of interaction will change professional and public perception of the capability of nurses. EDUCATIONAL PREPARATION: BUILDING TOWARDS UNITY The education process is crucial become it establishes the base around which a profession can rally its strengths and plan for advancement, to understand why it is currently a problem, it may be helpful to consider several significant factors. In earlier times nurses were trained in small neighbourhood shcolls, where nursing students were kept isolation from students of the various other health professions. This contributed to a lack of understanding between others members of the other profession In the future, the Doctor of Nursing Degree as pioneered at case Western University may become the minimum background for entry into the profession. The clinical doctorate, as advanced preparation, in the analog of clinical exam board. Adopting this format will enable nurses to keep pace with the expanding theory and content of science SELF GOVERNANCE: Self governance is another means of consolidating professional pride, self imagery and clinical visibility nurses faculty members generally function under self governance staff organization as an organizational device to consolidate the strength of nursing management with that of the clinical vigor of the nursing staff. Participation in this endeavor can result in new vistas of self direction and augment the professional growth of each nurse. RECRUITMENT: Relatively few studies examine variables related to what attacts and keeps men in nursing. In all probability the characteristics listed as desirable nursing qualities are not possessed by all the women in the profession no more than are

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all the needed qualifications to be competent physician limited to men. The recruitment net has to be expanded, men will be included a those professions that recruit by gender will have an advantage and men will be included to do much to change the image of nursing. The increasing mass of scientific information is leading all of the clinical professions to enrich their respective preparations and to adopt a doctoral degree as the entry level of practice. Many parents want their children to attend colleges and universities because higher education for the professions is perceived by many to be the wave of the future. Because nursing education has not traditionally been an integral part of this movements, students may select those fields that are clearly in step with the future. Nursing doctorates and clinical doctorate in nursing (Ph.D and D.N.Sc.,) comes closer to achieve this end, than any other development in the graduate preparation of nurses. Professional degrees are usually regarded by the public as esteemed degrees are given a higher social rating than academic degree. However persons with professional degrees can be most useful when people need care, thus generating respect. Thus people who have the knowledge to assist the populace are given more recognition than those who are more remote, such a basic scientists although have scientists are as vital as applied scientists. Another advantage of the clinical doctorate in the manner of the M.D / Ph.D programs. The combination of content of a scientific doctorate with the professional one result in use of a wide range of content to develop interesting research problems and to participate with an enlarged contribution to multidisciplinary research. The image of nurse as contribution to the scientific domain would be strongly enhanced by such an event. VII. CHANGE IN ROLE IMAGE: Professional practice, licensure restrictions and significant changes in the level of recognition for nurses notably change in image and income will come if the vast majority of nurses are rigorously educated.

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Nursing has the stigma of inertia. Many nurses have not undergone the role professionalizing process of the university based professions. Role socialization for these nurses occurs for the most part in isolation from other student because they are restricted by their education and clinical commitments. Nurses know more about how and less about why than any other profession. The nursing profession has a monopoly on its practice granted by means of licensure or registration. It is the nurses obligation to supply high standard of service to the public. Only professions that maintain high public trust can except to wrild strong social influence in the affairs of health one of the earliest ways immediately enroll in graduate study. Within 5 years an entirely new crop of nurses. Careerists could be in place. The image of nurse as a super public resource would be potentiated and recognized as a professional knowledge system able to keep current with the burgeoring of scientific knowledge and human needs. VIII. SUMMARY: The current mood of unrest makes the care system valuable to change, courage and desire to do what has to be done must be demonstrated. Nurses have a splendid opportunity to move forward. Massive studies me not necessary but an aspiration to potentiate the competence of nurses. Although the change will entail some disruptions in present lifestyles of many nurses, the benefits will include improved patient care, increased social value of the profession, increased financial resume ration for the individual nurse and the self actualization of each nursing professional. As in other professions, basic preparation for nursing inbeing redefined as a result of the increased knowledge base required for practice would wild advancement is necessary to develop a strong and respected profession. Nurse can no longer be preoccupied exclusively with their own country of origin. Computer linkage throughout the would is making concerted action among nurses of various nations more feasible. So now is the time to begin each one

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who waits becomes guilty of wasing the greatest opportunity that nursing has ever had. The enmulative effect of moving in the direction of dynanic change is a stimulus to all. IX. CONCLUSION: So as such development take place from the ancient period for the nurse preparation and in the nursing practice, As trends in health care provision bring about development in nursing care new goals emerge nursing is changing continually and all nurses must take the professional responsibility of constantly motioning the service and identifying the discussing new areas of need and development the opportunities abroad which offer experience and challenges in the field of nursing. If you dont know where you have been, how do you know where you are going

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X. BIBLIOGRAPHY: 1) Ahh.J.Zwner, Professional adjustment and ethics for nursing in India, 6 th edition , Pp : 7-22. 2) Christena Barbara, Fundamental of nursing, 2nd edition, Pp:8-9. 3) Rowald Roy Robbins, The profession of nursing practice, 6 th edition, Pp:20-23. 4) Mrs Kamal,S.Joglekar hospital, Ward Management, professional adjustments and trends in nursing, Pp:157-168. 5) Lippincott, The lippincott manual of nursing practice, 6 th edition, Pp:3-4. XI. JOURNALS: 1) AJN career guide, Jan 2004, Pp: 25-32. 2) AJN career guide, Feb 2002, Vol 102, Pp : 102-103. 3) Nursing times, July 10 1996, Vol 28, Pp:48-49.

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