Nursing Care - Science topic

Certamente!! La continuità assistenziale infermieristica consente di ottenere risultati migliori per il pz. non solo perchè l'infermiere che ha in carico la persona a 360° ed ha la possibilità di creare una relazione di fiducia più significativa, ma perchè si impara a conoscere la storia clinica dell'ammalato per poter individuare precocemente eventuali cambiamenti. La continuità assistenziale infermieristica permette di sviluppare meglio il concetto di Pianificazione basata su un percorso personalizzato garantendo anche un approccio migliore nella gestione anche delle malattie croniche.

Experiences of nurses providing palliative care at home are rich and complex, including:

These experiences reflect the challenges and achievements of nurses providing palliative care in the home setting, emphasizing the importance of a compassionate and dedicated approach to assisting patients and families during their most challenging times.

Sabina Dalsborn some studies that might be useful:

Luszczynska, A., Scholz, U., & Schwarzer, R. (2005). The general self-efficacy scale: multicultural validation studies. The Journal of psychology, 139(5), 439–457. https://doi.org/10.3200/JRLP.139.5.439-457

Hennein, R., Nanziri, L. M., Musinguzi, J., Ggita, J. M., Turimumahoro, P., Ochom, E., Gupta, A. J., Halder, A., Katamba, A., White, M. A., Pietrzak, R. H., Armstrong-Hough, M., & Davis, J. L. (2022). Cultural Adaptation and Validation of the General Self-Efficacy Scale in Ugandan Community Health Workers. Global implementation research and applications, 2(4), 371–383. https://doi.org/10.1007/s43477-022-00064-1

Fisher, E., Law, E., Dudeney, J., Eccleston, C., & Palermo, T. M. (2019). Psychological therapies (remotely delivered) for the management of chronic and recurrent pain in children and adolescents. The Cochrane database of systematic reviews, 4(4), CD011118. https://doi.org/10.1002/14651858.CD011118.pub3

Prochaska, J. J., Delucchi, K., & Hall, S. M. (2004). A meta-analysis of smoking cessation interventions with individuals in substance abuse treatment or recovery. Journal of consulting and clinical psychology, 72(6), 1144–1156. https://doi.org/10.1037/0022-006X.72.6.1144

Hallo Mareike,

die Literatur von Tom Kitwood solltest du dir ansehen, Messung des Wohlbefindens bei Demenzkranken,

einen Einblick gibt:

„ Wie geht es Ihnen?“ Konzepte und Materialien zur Einschätzung des Wohlbefindens von Menschen mit Demenz, Landes Initiative Demenz, NRW

Gruß

Espero ajudar! DOI: http://dx.doi.org/10.33448/rsd-v11i15.37637

Hello,

Brazilian professor Paulo Correia is a great research in this field: https://www.researchgate.net/profile/Paulo-Correia-10

You can see all the papers that he has written.

Best regards,

Attached are the list of publications and presentations on MTM. Here is 2 minute YouTube that explains it: https://youtu.be/OXPdZX-1O3I

Although low concentrations of inhaled nitric oxide may be therapeutic, both nitric oxide and its oxidation product nitrogen dioxide are potentially toxic. The threshold limits for time-weighted average concentrations of nitric oxide and nitrogen dioxide issued by the American Conference of Governmental Industrial Hygienists are 25 and 3 ppm, respectively. The attention of these gases in the breathing space of hospital personnel during the administration of nitric oxide to adult patients has not been reported.

I would contact the organization with these questions. You will also want to make the questionnaire as short as possible, and stress the shortness to participants. You may have to offer a chance at remuneration or a prize. There may also be support groups for hospice workers you could contact.

Open this... https://towardsdatascience.com/linear-regression-detailed-view-ea73175f6e86

Good Luck

@ uzma.... Thanks for your on the subject matter.

Hey Jenny, U please go through this article, you will get idea about direct patient care, indirect patient care time.

http://medind.nic.in/nad/t10/i2/nadt10i2p81.pdf

Dear Peter Donald Griffiths I know you have collaborated on this issue with several Italian researchers, but as far as I know the "Safer Nursing Care Tool" is not used in Italy. The SNCT is mentioned in some Italian nursing studies, but they do not describe its use in my country. Currently, in Italy the "Index of Caring Complexity" is being studied, which refers to the theoretical model developed by Marisa Cantarelli.

Virginia Henderson's theory is also positive (although my favorite is logotherapy) :

http://nursing-theory.org/theories-and-models/henderson-need-theory.php

It should de carried our through inter-professional cooperation.

My colleagues and I in Australia are developing a Death Literacy Index based on the public health palliative care approach.

Nurses entering the profession must be held to a high standard from the start of their training. By saying that we must expecting excellence from them, I do not mean that ward sisters should be like drill sergeants, but rather lead in a positive manner. Change their locus of motivation from complying to avoid being in trouble, to complying in order to give the patient effective, efficient and compassionate care. Treat our novice nurses with respect, especially the ones that start of being better qualified. Listen to them, they have the latest information and guide them to being not only being a learned professional, but also a caring professional. Do not accept students into this profession who are in this only to earn a salary one day. There are thousands of other directions they can pursue. This profession is not for the faint - hearted. The basics of ethics are being taught in all nursing programmes on a theoretical level, but true ethical decision-making requires emotional maturity and resilience which cannot be taught, but comes from experiential knowledge. Experience takes time. Be patient with our novices, lead with example, as mentioned previously, hold them to a high standard, and they will get there

It required awareness in public, strict vigilance by monitoring agencies etc. Because in India the public is not aware of paramedical staff qualification they look towards only doctors qualification.

Regards

Dr. Kamath Madhusudhana

In a sequential explanatory design, the qualitative data is used to explain the results from the quantitative analysis. If the original study used two separate samples to address different research questions, it is unlikely that this design will fit.

As an entrepreneur in nursing profession we need to cost nursing services to justify income generated by nurses for better pay and improvement of working environment. For doctors consultant fee laboratory investigation fee etc. but nursing services which are core in healthsector is equated to bed servo which include laundry services etc.how can nurses quantify n cost their services?

Thank you so much Abdulqadir, I will look at it

Please let me know if the following references/sites are useful to you:

1.  Can we measure the quality of nursing? | The Health Foundation

http://www.health.org.uk/newsletter/can-we-measure-quality-nursingNov 28, 2012 ... Factors such as presence of pressure sores and healthcare-associated infections are more closely linked to the quality of nursing care, and ...

2.  Nursing Care Quality Measurement - Wiley Online Library

http://onlinelibrary.wiley.com/doi/10.1111/1552-6909.12276/pdfNursing Care Quality Measurement. An official position statement of the. Association of Women's. Health, Obstetric and. Neonatal Nurses. Approved by the.

3.  Karen instruments for measuring quality of nursing care: construct ...

https://academic.oup.com/intqhc/article/23/3/292/1791788/The-Karen-instruments-for-measuring-quality-ofJan 17, 2011 ... Valid and reliable instruments for measuring the quality of care are needed for evaluation and improvement of nursing care. Previously ...

4.  Performance Measurement of Nursing Care - Nov 25, 2016

http://journals.sagepub.com/doi/abs/10.1177/1077558707299260PDF download for Performance Measurement of Nursing Care, Article Information .... Evaluating quality of care using modular nursing on a multispecialty unit.

5.  The National Database of Nursing Quality Indicators - American ...

http://www.nursingworld.org/mainmenucategories/anamarketplace/anaperiodicals/ojin/tableofcontents/volume122007/no3sept07/nursingqualityindicators.aspxEvaluating the quality of nursing practice began when Florence Nightingale identified nursing's role in health care quality and began to measure patient ...

Dennis

Dennis Mazur

Care left undone during nursing shifts: Associations with workload and perceived quality of care

Intensive care needs intensive nursing..

What a wonderful line of questioning. There's much published on the topic, such as perceptions of nursing care quality from different perspectives- patients, nurses' and institutions.  More recently, I've seen social identity and patients perception's of nursing care quality discussed. What peaks your curiosity in this area?

Greetings, 

The La Monica–Oberst Patient Satisfaction scale (LOPSS) is a valid tool and developed to measure patients' satisfaction with nursing care services. 

Hi Sarah, I'm really glad I've come across your post. I'm currently exploring patient sleep within inpatient mental health environments. Although, we do not check vital signs throughout the night (unless clinically indicated) we do check on patients every hour or even every 15 minutes if the risk is high. The observation policy is there to maintain safety but severely impacts sleep and therefore patient recovery. I will use this paper to support my findings. Thank you for sharing. 

There are many scales to measure patients satisfaction such as the NSNS.

the attached article has more details

Hi Nader

The answer depends on the goal of the patient education. E.g. if you want to increase knowledge, you can use any pedagogical/ androgogical theory. Using additional written materials (not only verbal explaining) enhances the effect. Judging baseline knowledge (simply by asking patients) and health literacy of the patients are important aspects of tailored information. If the content is information about a specific disease, I find the common sense theory (Leventhal) very useful.

If you want to increase skills (e.g. skill to self-inject), I find social-cognitive theory (including the promotion of self-efficacy) very useful. + giving patients enough time to practice and get feedback under supervision of nurses.

If you want to change life style/ teach health promotion, the task is diffcult. State of the art-theories are the Transtheoretical Model of Change (Prochaska/ DiClemente) and Motivational Interviewing (Rollnick/ Miller). Changing every day behavior is not a matter days, but of an effort over several intervention points + ongoing support/ feedback.

Regards, Robert

Dear Patience,

I do believe that compassion is crucial for high quality nursing care and nurses must be competent in this matter. I also agree with Jonas about the effect of cultural differences on perception of compassion among nurses and nurse students. I'm interested in doing this study too.

I have enclosed a recently published paper on development and validation of an instrument to measure nurses' compassion competence. Thanks. Alaa

Hi Rania, you might consider applying your benchmark criteria when reviewing the notes yourself for the omission(s) in care you are going to measure.  Or you could consider using an expert panel of nurses to  review the case notes and indicate if the omission in care was 'avoidable' or not.  This is just a thought as I am sure there are many other ways to tackle this question. 

I have not read or written any papers about Hyperemesis and Psych Component because i havent had enough cases to write something compelling.

I did write one about:  Mothers and long dysfunctional labors. Midwifery Today Int Midwife.2006:80:32-3 that is posted on research gate:

Thank you Dr. Nader for this important question.

I think this is essential and critical issue for nurses to be competent in their communication with their clients. From observations to the nurses perfomance and interaction with the patients, it seems there is a significant probelm here. A sisgnifcant protion of nurses dont communicate appropriately with patients, dont provide adequate information for them, dont dedicate time for listening and advocating.

There should be a major revision for nurses role and to develop guidlines to rectify this issue.

Regards

Nurses caring for patient on ECMO need to have in-depth knowledge of cardiovascular & respiratory system physiology. Further they need to have understanding of complications related to ECMO. I think, Lot of literature is available on ECMO and Nursing Management, based on that you can prepare your need assessment tool and get the tool validated by experts in cardiovascular and critical care nursing.

Hello Alessia

I had a look to find if I could find anything of relevance, but there is not a lot written regarding research into informed consent for nursing care in these patients. I have not accessed the full text of this paper, but you might feel that it is relevant:

Okonkwo, O., Griffith, H. R., Belue, K., Lanza, S., Zamrini, E. Y., Harrell, L. E., ... & Marson, D. C. (2007). Medical decision-making capacity in patients with mild cognitive impairment. Neurology, 69(15), 1528-1535.

Likewise this paper:

Appelbaum, P. S. (2010). Consent in impaired populations. Current neurology and neuroscience reports, 10(5), 367-373.

This paper looks at the need for future research into the subject:

Lai, J. M., & Karlawish, J. (2007). Assessing the capacity to make everyday decisions: a guide for clinicians and an agenda for future research. The American journal of geriatric psychiatry, 15(2), 101-111.

These might be relevant:

Lingler, J. H., Hirschman, K. B., Garand, L., Dew, M. A., Becker, J. T., Schulz, R., & DeKosky, S. T. (2008). Frequency and correlates of advance planning among cognitively impaired older adults. The American Journal of Geriatric Psychiatry, 16(8), 643-649.

Jefferson, A. L., Lambe, S., Moser, D. J., Byerly, L. K., Ozonoff, A., & Karlawish, J. H. (2008). Decisional capacity for research participation in individuals with mild cognitive impairment. Journal of the American Geriatrics Society, 56(7), 1236-1243.

Very best wishes,

Mary

Hi Barbara, you might find it interesting: http://www.ncpc.org.uk/sites/default/files/Public_Health_Approaches_To_End_of_Life_Care_Toolkit_WEB.pdf

BW,

Heloise

Hi Andres  This is avery important question . I suggest you to address the organisation of nurses called " Admiral Nurses " which operates in the UK. they have vast experience in coping with dementia patients .

Australia has a similar aged care system and approach to assessing quality of care to Ontario, Canada.

The Australian Government has recently introduced a voluntary program for aged care providers to collect information and report on the following three quality indicators made publicly available for consumers to see:

1. Pressure injuries

2. Use of physical restraint

3. Unplanned weight loss

This national programme is in its initial phases and is modeled off the Victorian programme which was first implemented in 2006 and in addition to the three quality indicators listed above, also includes falls and fractures, and use of nine or more medicines.

There are a number of other important quality indicators that could be added to the list to inform consumers and promote injury prevention initiatives, including mortality, hospital admissions, and assaults, particularly those between residents. However this is probably some way off. 

There has also been some debate over whether the national program for reporting quality indicators should be made mandatory or remain voluntary. With any kind of quality assessment program in long-term care there are always going to be issues of under reporting, but many argue that this would likely be exacerbated under a mandatory reporting system. The aim of the voluntary system is to promote transparency in aged care decision making and to encourage aged care providers to see how they match up with their competitors and constantly strive for improvement.

I hope this information is helpful.

Thank you Deborah Jean Verran ·

  nurses can develop resilience by adapting to change to new environment. Able to manage pressure and challenges everyday. The role of the preceptors also to expose the reality of the routines and practices as well as the co-worker attitudes plus learning from own mistakes or from other's experiences.

Yes, both the attached file and the following link have tremendous resources on preceptor competencies.

Good luck

elderly multiple problem in nursing home quality of life

Palliative care, while commonly assumed to deal only with treatment in the last days or weeks of a chronic progressive disease is broader. It can also refer to the range of interventions for persons with chronic pain resulting from a range of non-terminal conditions. Expertise in pain management is in the best cases a focus within the context of a range of rehabilitative, social and psychological services. These are all cases where one won't be cured but life goes on for days, weeks, and years. 

Barriers to such care in all cases is financial. That is, funding agencies are cautious about providing monies for non-curative treatments. In Oregon, in the USA, was the case of a woman denied expensive chemo' treatments (palliative) but offered a speedy physician-assisted termination. There are also barriers in assessing and providing the type of home-based or other aides (mobility, for example a powered wheelchair) and home care where needed. 

Some medical experts in other disciplines find themselves uneasy with chronicity and see such cases as "over," alas. 

Finally, the public is often fearful of "terminal" and "chronic" conditions where relatives, in earlier years, suffered from untreated pain conditions. And, too, they see someone with limits and say "I don't want to be like that". But all our studies show that, today, most train is treatable and that a restricted life is, by the account of those leading such lives (including high spinal injury patients) while different potentially fulfilling.

So the broad movement of the palliative care physician is for care and treatment when a patient can not be cured but can live, with assistance, as full a life as conditions permit.

Actually, I have developed an instrument that measures Patient Perspectives of Nurse Vigilance - which includes a subscale on quality and safety. I am still testing with patient population for reliability and validity- but performed well with panel of experts. 

Our RRT is comprised of:

Respiratory therapist

Nursing supervisor

Charge nurse from the SICU or MICU

EKG tech

IV therapy

and if needed the Hospitalist on pager. 

We can do a RRT with or without Hospitalist MD. This just depends on time of day as we involve the pt's primary MD and we have residents on site since we are a teaching hospital.

I hope this helps. 

The CSNAT has been successfully trialed in Australia and this has been reported in three publications early this year (below). A copy of the tool can be obtained from Gail Ewing: ge200@cam.ac.uk

Aoun SM, Grande G, Howting D, Deas K, Toye C, Stajduhar K, Ewing G. The

impact of the Carer Support Needs Assessment

Tool (CSNAT) in community palliative care

using a Stepped Wedge Cluster Trial. PLos One

2015;10(4):e0123012. DOI:10.1371/

journal.pone.0123012

Aoun SM, Deas K, Toye C, Ewing G, Grande G,

Stajduhar K. Supporting family carers to

identify their own needs in end of life care:

Qualitative findings from a stepped wedge

cluster trial. Palliative Medicine 2015;29(6):

508–17. DOI:10.1177/0269216314566061

Aoun SM, Toye C, Deas K, Howting D, Ewing G, Grande G, Stajduhar K. Enabling a family carer-led assessment of support needs in homebased

palliative care: Potential translation into

practice. Palliative Medicine 2015 April 20; Epub

ahead of print. DOI:10.1177/0269216315583436

You could look at Joanne Duffy's Caring Assessment Tool. 

THANK YOU KINDLY 

Hello Janicie ,

I attached a link to an article on the topic. It is written in Spanish. 

Diseño y validación de contenido de rúbricas para evaluar las competencias prácticas en estudiantes de Enfermería

Design and content validation of rubrics for assessing practical competencies in nursing students 

Autors: Joaquín Salvador Lima-Rodríguez, Prof. Marta Lima-Serrano, Prof. José María Ponce-González, Prof. María Dolores Guerra-Martín

University of Seville, Spain

Best regards, Maria Dolores Guerra-Martin

Thank you for your comments!

Attached implications of my study:

Nurses, who represent 65% of human resources in the Bolivian health system structure, must actively participate in the design of culturally adapted prevention programmes and health education interventions. In this regard, governmental health authorities, NGOs and international organisations should be actively engaged and aware of our study’s results, particularly highlighting the importance of local agents to promote their capacitation as well as the empowerment of indigenous populations. Nursing could develop programmes and interventions based on the transcultural care theory, preserving healthy cultural practices, negotiating the adaptation of others and remodelling those which support risk behaviours. Without an in-depth knowledge of this population’s cultural framework, any attempt at an intervention runs the risk of being done in vain.

Ramona T. Mercer developed the Nursing model known as “Maternal Role Attainment”. You can also check http://www.kangaroomothercare.com/ and NINO-Neuroscience for Improved Neonatal Outcomes at http://ninobirth.org/

Good luck with your research

I have a few papers in English to get you started:

Myer, S.  & Amendolair, D.  (2014). Time is of the essence:  Retain your older nurses.  NursingManagement, 45(5), 12-6.

Clendon, J. & Walker, L. (2013). Nurses age over 50 years and their experience of shift work.  Journal ofNursing Management, 21, 903-13.

Letvak, S., Ruhm, C. & Gupta, S. (2013). Difference in health, productivity, and quality of care in younger and older nurses. Journal of Nursing Management, 21, 914-21.

Check the bibliographies as well for more potential helpful literature.

Hi Charlotte,

thanks for your comments. As you know, three dimensions or levels of health literacy were identified: functional (where is icluded the numeracy capability you pointed about), interactive and critical. 

In my opinion, it is necessary to take into account these dimensios in the design of assesment tools and interventions. In our mobile application, we ask the user, after use, to perform what they learned. For example, accesing and request a medical appointment. At the same time, the app returns information, thus having objective data of user empowerment. 

Written information, especially if autoinformed, has its drawbacks and limations.

Greetings.

In my practice I provide hypothetical case Study with study guide

Should not move unnecessarily, Careful position in transferring the patient, prevent further damage, There are aides to assist with the moving of the

spine-injured patient. Then take him for surgery.

Dear Lisa

I spent a year following the stories of frail older people in hospital waiting for a bed in a nursing home. I visited them during this time and collected stories full of humour, resilience and despair. These people were 'bed blockers' and we still have this in the UK

 

We use IPC in all our patients who undergo pneumonectomy for five days postoperatively, combined with enoxoparin for six weeks. The rationale is to prevent (mostly fatal) embolic events in the unique remaining lung. This procedure is now in place for six years and we had no such events in this timeframe. (it is of course an event that is rare, but before we used ICP, major embolic events were seen in about 1% of pneumonectomy patients; we do 40+ pneumonectomies a year, so calculating the odds it seems an improvement).

For the use: the first three days the IPC is running 24/24, when the patient is fully mobilized the IPC is only used during the night. Most patients complain, not of discomfort wearing them, but from the noise the pumps make.

This is of course a totally different population from stroke patients, but we feel it works

We make every attempt to provide thepatient oral health clearance/treatment once it is determined that a patient requires cardiac surgery. This may require a more aggressive approach, but removes bacterial infection prior to the cardiac procedure. However, I realize working in an academic environment may provide a better opportunity to establish these types of referral relationships with the cardiology community. But, whenever possible,dental clearance before cardiac surgery is desirable.

I oversee the end-of-life and postmortem practice of a trauma hospital in a high-risk, inner city community of Los Angeles. We devote particular attention to the needs of our over-sized patients and the unique challenges they bring to their famlies when they die. As most of my families have little if any resources to provide a traditional funeral, much less the added funerary expenses involved with larger persons, we developed a protocol for maintaining their dignity, preservation, and privacy that mirrors the care of patients with a lesser habitus (we call our expired patients 'patients' after they die,because they are stil in our care). We have a cooling protocol if they are unabe to be placed in traditional morgue drawer the first 24-30 hours after death; we have contracted with a local mortuary with a room refrigeration system to hold them after that window, especially if the family needs a bit more time. We do not charge the families for this service.

Families appreciate having referrals to mortuaries who offer emotional support and reduced rates, knowing cremation is often their only option. It took time and patience to put it all in place -i.e. shaping the use of language and behavior, artfully crafting step-by-step instructions, and partnering with the funeral homes. The driving force behind the practice is love and acceptance - of the living and the dying, of the small and the not-so-small. If you have any questions, jet me an e-mail.

In my opinion the nursing education is not simply to raise awareness of rules and procedures, but to help learning how to get in touch with the cognitive and emotional processes present in places of care and that are started by caring of the patient.

We teachers should think of a training of health professionals that recognized the ethical and epistemological roots of nursing, putting at the center of caring enhancement of human relationship between nurse and patient.

The evolution of scientific knowledge takes place within different contexts of practice in relation to life stories, so nursing student has the need to deepen the emotional dimension of the experience of fragility and pain.

Anicia, we have some basic data from a study we did at one of our customer sites with some alarm data from a PedsICU. I am happy to share it with you. paul.mcgurgan@excel-medical.com

I agree with Chika Ugochukwu recommending the use of Nursing process to provide individualized holistic care. In addition, nursing care should be holistic regardless of the method of nursing care. The body, mind and spirit are intertwined and inseparable.

Dear Myfanwy,

in my opinion it could be useful to "train" nurses in order to care about "bad-news communicating"; everyday we see doctors that maybe are not so empathyc or have not enough time to explain, answer etc. with family members of a patient.

Although this kind of work has always been linked with the figure of the doctor, I really think that a nurse can do this job and can do it better, because the point is that a nurse has the competence to speak clearly and professionally but has also a "strict relation" with the patient, so a nurse can be more empathyc with families.

In my University, both medicine and nursering courses have lessons about this, although I think it's more something you "have inside" and you understand when you practice in hospital.

Best regards

Hi Marianne, I know your study. Recently I conducted a literature review about this issue for an italian nursing journal, (Now in press) and I found many citations about your study, which I think is very interesting. Nice to meet you. Best regards. Nicola

Thank you Sabita Mondal. The definition was for my dissertation. I ended up using resources and creating an operational definition that did not include those specific terms but said relatively the same thing. Happily, I can say that I successfully defended my dissertation on May 18.

If I could pose a follow-on question here, from the body of literature in this area, what your position on direction of relationship between disability (for example, measured through ADLs) and falls? Would be quite essential to prevention efforts, but remains unclear from my reading of the literature. As a concrete example, we have a data set from six countries with fall-related injury and disability variables - and at this point have removed disability from the dependent variables in the model. Any insights would be appreciated.

I with one of my colleagues have led a number of 8 week workshops for family caregivers. The content is focused on developing psychological skills to build resilience and cope with stress. We use techniques of cognitive behavioral therapy, stress reduction, and developing strengths (e.g. social support, faith, rituals of meaning). Unfortunately this is not published. I am collecting data.

We follow a common system -- on Patient Dependency for ADL

1. Critically ill Patients (Fully Dependent): Patient:Nurse Ratio -- 1:1 or 2

2. Moderately ill Patients (Partially Dependent): Patient:Nurse Ratio -- 1: 3

3. Convalescent Patient (Independent): Patient:Nurse Ratio -- 1: 5

In a teaching hospital -- (Staff Nurses' Duly Schedule is made on this basis)

1. Undergraduate / Baccalaureate Nursing students (except 1st year):

3 students = 1 Staff Nurse

2. Post Graduate Nursing students : 2 students = 1 Staff Nurse

Thank you Dimitrios, For all this useful Information.