最新糖心Vlog

Course Coordinator: Iain Everett
Phone: +61 8 831 4308
Email: iain.everett@adelaide.edu.au
Location: School of Nursing, The 最新糖心Vlog of Adelaide

School Office
Phone: +61 8 8313 3595
Email: nursing.studentliason@adelaide.edu.au
Location: Level 3, Eleanor Harrald Building, Royal Adelaide Hospital

1	Analyse and plan nursing practice that is specific to the emergency department environment
2	Design, implement and appraise assessments appropriate for emergency patient presentations.
3	Design implement, and evaluate holistic multidisciplinary care delivery for emergency department presentations.
4	Demonstrate a knowledge base complementary to emergency clinical nursing practice
5	Assess and integrate the concepts that make emergency nursing unique
6	Appraise the pathophysiology of diseases process resulting in an emergency department patient presentation or impact upon the physiological/ psychosocial status of the patient.
7	Integrate information from current evidence based guidelines and consensus statements in order to ensure the delivery of advanced emergency nursing care.
8	Evaluate the current clinical issues in emergency nursing and consider the implications for your clinical area.

This course will require the following texts and other resources:

Bryant, B & Knight, K, 2011 Pharmacology for Health Professionals, 3rd edition Elsevier, Sydney
Curtis, K, & Ramsden, C 2016, Emergency and traumacare for paramedics and nurses. 3rd Edition,  Mosby/Elsevier, Sydney.
Huszar, RJ 2011, Basic dysrhythmias, interpretation and management, 4th edn, Mosby, St. Louis.
Proehl JA, 2009, Emergency Nursing Procedures, 4th edn, Saunders Elsevier, Sydney.
Talley, NJ & O’Connor, S 2014, Clinical examination: a systematic guide to physical diagnosis, 7th edn, Churchill/Livingstone, Elsevier, Sydney.
Marieb, EN & Hoehn, K 2012, Human anatomy and physiology, 9th edn, Pearson International/Benjamin Cummings, US. *
*Note: If you have a current human anatomy and physiology text that should be sufficient, just read the appropriate chapter.
**All texts excluding Huszar will be prescribed texts for Emergency Nursing Care II and II in semester II. ** Huszar is a recommend text for 7118 – Critical Care Essentials

Reader
The readings for this course are available electronically via MyUni.
Please note: it is your responsibiliy to organise printing should you prefer a hard copy of the reader.


There are copies of most books on reserve in the library,

Unibooks
The 最新糖心Vlog of Adelaide
Adelaide SA 5005
Phone: +61 8 8125 5160
Email: adelaide@unibooks.com.au
Website: www.unibooks.com.au

Encompass Bookshop
Shop 20, Renaissance Arcade
128 Rundle Mall
Adelaide SA 5000
Phone: 08 8224 0886
Fax: 08 8223 3570
Email: adelaide@encompassbooks.com.au
Website: www.encompassbooks.com.au

McQuillan, KA, RL, Flynn-Makic, MB & Whalen, E 2009, Trauma nursing from resuscitation through rehabilitation, 4th edn, Saunders/Elsevier, Philadelphia.
Cameron, P, Jelinek, G, Kelly, AM, Murray, L & Brown A, J 2009, Textbook of adult emergency medicine, 3rd edn, Churchill Livingston, Edinburgh.
Stone, CK & Humphries, RL 2011, Current emergency diagnosis and treatment, 7th edn, McGraw Hill, New York.

Anatomy and Physiology texts
Guyton, A & Hall, J 2010, Textbook of medical physiology, 12th edn, Elsevier/Saunders, Philadelphia

Note: You are not required to buy recommended texts. However, they provide valuable supplementary reading on various aspects of the material covered within this course and you are encouraged to have a look at them.

MyUni
All students enrolled in a postgraduate coursework nursing program have access to the School of Nursing – Postgraduate Coursework Student Centre on MyUni. If you would like the opportunity to network with other students, you can use the Communication features in the site. This site will also feature information about the latest news and events at the School of Nursing.

Unified
http://unified.adelaide.edu.au/
UNIFIED is your one-stop shop for email, calendar, MyUni and Access Adelaide. It even allows you to search the Library.
UNIFIED is available to all active students; with a single login you can access your student systems and personal information through a central website. Login with your Student ID ("a1234567") and Password.

For more information, including easy to follow instructions visit https://unified.adelaide.edu.au/web/mycampus/home.

Library Resources
Help for Nursing Students
The 最新糖心Vlog of Adelaide Library has a website to help nursing students use the library and its resource (www.library.adelaide.edu.au/guide/med/nursing).

Remote student library service
The 最新糖心Vlog of Adelaide Library provides a document delivery and loans service to non-metropolitan students who do not visit a 最新糖心Vlog of Adelaide campus to attend classes (www.adelaide.edu.au/library/docdel/external.html).

Turnitin
Please note, you will be required to submit most assignments via TURNITIN, however as a student you can also use TURNITIN to support your learning with regard to academic writing and referencing.

This course will be presented as a series of weekly four hour sessions – each Wednesday of semester I from 0800 – 1400, a scheduled break will be timetabled into each week. There will be a blend of lectures, tutorials and practical activities.

The theoretical and clinical components will be supported by readings, online content and classroom teaching. This will be presented as face to face lectures and tutorials and in 2016, EN I will be combining with our critical care colleagues from Intensive Care and Cardiology for a majority of our learning/teaching time. Online articulated lectures (for most topics – some may not be applicable) will be available for you to view before you come to the lecture. On the day of the lecture/presentation we will be using our time in a much more interactive way in a tutorial format with case studies, discussions and practical sessions on the topic if appropriate.

Participation in discussion during lectures, tutorials and practical sessions is expected.
The course coordinator will also visit your clinical area. This will enable you to discuss issues or seek additional clarification for aspects of emergency assessment and nursing care as presented throughout this course and subsequent courses.

Lectures/ Tutorials
The student is expected to attend Course lectures every Wednesday morning from 8:00 am to 1300 on the 最新糖心Vlog of Adelaide or Royal Adelaide Hospital Campus, North Terrace.
Student participation and discussion will be expected in all sessions.

Readings
A reading list has been compiled for this course and will be made available through MyUni. Lecture and readings have been carefully chosen. All of these are required and have been selected to optimise your knowledge on the topic and so that they will continue to be of use after you graduate.

Clinical Practice and Skills Acquisition
This course supplements theoretical knowledge with field based learning. Students are required to complete clinical skills and work a minimum of 300 clinical hours in the emergency department during this semester

It is expected that you will need to invest about 24 hours per week of study to successfully complete this course. This includes all study activities, attendance at lectures, readings and assessment. Thus some weeks it will be more and others less. It is recommended that you plan your time commitment to the course at the beginning of the semester.

This course considers the pathophysiology of patient conditions requiring emergency care, the scientific basis of emergency presentations will be presented in detail.
The practical application of this knowledge will also be presented thereby enabling the student to assess; plan , prioritorise and implement care and assess the outcomes of the care delivery.
Specifically, topics considered are listed below.

Introduction to Emergency Nursing
Emergency Nursing as a specialty practice began its evolution in the second half of the 20th century. It continues to evolve today. This course will represent emergency nursing as it is currently practised both nationally and internationally. Specifically, reference will be made to the 最新糖心Vlogn clinical setting, and this will include public and private sector metropolitan emergency departments, and rural settings. International emergency nursing care will also be discussed.
Broad triage concepts and more specifically, the Australasian Triage Scale will be referred to. This will enable the student to appraise, analyse and understand the care requirements of those presenting with the specific pathologies covered throughout the course. This will provide a foundation for subsequent discussion throughout the program.

Signs symptoms and presenting complaints
The transition from knowledge of pathology and mechanisms of injury, to how the patient presents, and what signs and symptoms they have will form a portion of this course. It will be a natural progression to move from knowledge of the processes that cause morbidity to an understanding of the signs and symptoms that occur concurrently with that disorder. Without this intermediate stage the emergency RN will be unable to make the necessary step to a comprehensive assessment, imperative to sound nursing care delivery in the emergency area. Students will be expected to understand why patients have the signs and symptoms they do, and their significance in order to apply this knowledge to assessment, care and subsequent evaluation of the clinical state.

Assessment, care and evaluation
The student will learn the processes of assessment and care of the emergently ill person. In order to do this appropriately the learner will be instructed in the skills of evaluating treatment.
Students will also come to appreciate the wider dimensions of the emergency department. They will also learn to assess and care for those whose problems are not so urgent.

Taking a history
This topic will consider the theory that determines how a nursing and medical history is compiled in the emergency setting.

Assessment
Assessment will be taught in a systematic and logical fashion. It will follow the processes outlined in the recommended texts. More particularly the student will be expected to achieve comprehensive assessment skills that utilise the primary, secondary and focussed assessments.

Trauma assessment
This session will consider the evaluation of those patients presenting as a result of trauma. Trauma will be defined, international, national and local epidemiological issues will be discussed. This session will also consider the assessment of trauma using the principles of primary and secondary survey in conjunction with EMST principles for the management of trauma. This topic will provide an overview, specific and in-depth trauma assessment and management topics will be presented in semester 2.

Care
Patient care is central to the nurse's role, and emergency nurses are no exception. To this end the person presenting to the emergency department must be considered within the context of their environment, and not just as a person with a particular need. People presenting to the triage desk are not 'chest pains', 'NOF's' or 'facial lacerations'! But individuals seeking professional attention that deserve to be treated with respect, empathy, and as part of a family and its society.
The failure of emergency nurses to treat their patients as valuable individuals may lead to dire consequences in which presenting complaints are misinterpreted as trivial.

Within this course both medical and nursing care will be addressed, in order for nurses to grasp the roles and to be able to coordinate care. It is recognised that nurses in the emergency department are part of a team that is working together in order to achieve optimal patient care. Thus this course will teach care as a part of a team response as well as the nurse's individual responsibilities. Furthermore it will be the aim of this course to bring to the student's attention the most recent advances, and best clinical practice currently available.

Evaluation
In order to achieve optimal patient care the student will be informed of methods that will enable him or her to evaluate the care that is given. This will include the evaluation of both medical and nursing care, for as previously outlined, patients are managed by a team approach, and therefore, it is imperative that nurses be responsible for evaluating all treatment that is performed. Taking a wider view of nursing competency, it is important that nurses evaluate care in order to contribute to research that directs best clinical practice.

Basic and advanced life support
Prior to commencing the Master of Nursing Science (Emergency Nursing) students will be expected to be very familiar with the skills of Basic Life Support.
The student will be introduced to key concepts of advanced life support, a focus will be on emergency airway management and the specific challenges that emergency clinicians may face, as well as the concept of emergency anaesthesia.

Advanced life support is an integral component of this course, and will be based on the policy statements of the 最新糖心Vlogn Resuscitation Council, and related literature from Europe and the US. Students will be expected to gain a sound knowledge in the most up to date life support guidelines, and be able to apply these in the clinical setting.

Respiratory Physiology and Acute Respiratory Pathopysiology
This topic will consider the principles of advanced respiratory physiology and how these relate to critical illness and emergency treatment. In particular, there will be discussion of the defence mechanisms of the respiratory tract, control of respiration, the mechanics of breathing, factors influencing diffusion across the alveolar capillary membrane and the transport of oxygen and carbon dioxide.

Therapeutics: Oxygen Therapy/ Airway Management / Principles of Supported / Assisted Ventilation
This topic will consider the nature of therapeutics used for respiratory failure in emergency department and intensive care patients. The principles of oxygen therapy will be considered, together with the related terminology, physiological effects and safety aspects.
Basic and advanced airway management will be presented from techniques such as positioning of the patient, to the use of advanced airway management techniques such as endotracheal intubation. Supported and assisted ventilation will be examined from basic support techniques such as Continuous Positive Airway Pressure (CPAP) to therapies such as controlled ventilation. The issue of nursing management of patients receiving these therapies will be considered, as well as physiological effects and possible complications.

Respiratory Failure, Monitoring and Assessment and Acid Base Balance
The monitoring, assessment and specialised nursing care of patients with actual or potential respiratory failure will be considered. The analysis of observations, monitoring parameters and the technologies used are reviewed. An introduction to the importance of Acid/Base balance in relating to body homeostasis will be reviewed in detail.

Respiratory Emergencies and Thoracic Trauma
This topic will consider the pathophysiology of respiratory emergencies. Pulmonary oedema, chronic airways limitation, infection, asthma, and pulmonary embolus will be considered. The specialised nursing care requirements of such patients will also be discussed.
Trauma to the thorax will be discussed with consideration of the mechanism of injury, pathology, presenting complaints, emergency assessment and care.

Cardiac Physiology
This topic will consider the principles of advanced cardiac physiology and how these relate to critical illness and emergency treatment. In particular the physiological control of blood pressure and factors influencing blood flow to the myocardium and other body tissues will be considered.

Basic Electrocardiography
In this session the electrochemical basis of cardiac function will be presented. The basic principles of electrocardiography such as the specific properties of cardiac tissue, the normal conducting pathways of the heart and the events of the cardiac cycle will be discussed. Students will learn the identifying features of sinus rhythm and how to calculate the rate of an ECG rhythm. In addition, the fundamental laws of electrocardiography and how these laws relate to the 12 lead ECG and cardiac monitoring will be presented with particular emphasis on the application of Einthoven's Triangle, the Triaxial and Hexaxial Reference Systems. The principles of electrical safety will be outlined, as an understanding of these is essential to safely care for patients on cardiac monitors.

Arrhythmias
Students will learn how to interpret the ECG rhythm. The possible causes of arrhythmias, and the treatment and nursing care of patients with particular arrhythmias will also be discussed. The arrhythmias will be presented according to their place of origin for example, ventricular arrhythmias.

The Pathophysiology of Acute Coronary Syndromes, from Ischaemia to Infarction , ECG Diagnosis and subsequent emergency management.
These sessions will consider the pathophysiology of myocardial ischaemia and infarction. The clinical features manifested by a patients suffering from these disorders will be presented and the diagnosis and differential diagnosis will be discussed. Students will learn how to recognise ECG changes associated with ischaemia and infarction.

Recognition of Bundle Branch Block on the ECG
In this session the definition and causes of bundle branch block will be considered. Students will learn how to recognise bundle branch block on the 12 lead ECG. In addition, bi and tri-fasicular block will be considered. The clinical implications of these abnormalities will also be discussed.

Myocardial Infarction: Aetiology, Presentation and Treatment
The previous session on myocardial infarction concentrated on the ECG changes associated with this pathology. This session will add information about the causes of MI, clinical features of presentation and the most treatment modalities currently available in this state.

Determination of the mean QRS axis on ECG
In this session students will learn how to calculate the mean QRS axis on a 12 lead ECG. The causes of axis deviation and the clinical significance will also be discussed.

Treatment of Arrhythmias
In this session the different treatment alternatives for arrhythmias will be considered, including pharmacological, electrical and other possible treatments options. The effect major electrolyte imbalances, hypothermia and CNS injury has on the electrocardiograph will also be outlined.

Differentiation of Broad Complex Tachycardia
In this session students will learn some principles which assist in the differentiation of broad complex supraventricular tachycardia (SVT) from ventricular tachycardia (VT).

Environmental Emergencies: Hypothermia and Hyperthermia
This topic will consider the causes, clinical features, treatment and specialised nursing care of a patient with hyper or hypothermia. There will be a particular emphasis on the 最新糖心Vlogn perspective.

Miscellaneous Cardiac Emergencies
This topic will summarise other common cardiac emergencies that are likely to present to the emergency department.

At risk populations
This topic will introduce the concept of particular patient populations that are at a greater risk of developing cardiac disease, or suffering poor outcomes secondary to cardiac disease to students. The concepts of culture/ race; lifestyle and socio-economic circumstances affecting patients and their health status will be considered.

Current issues, trends and research in emergency nursing
Every endeavour will be made to present material that reflects recent knowledge. In addition reference will be made to current research in topics that are being addressed. The overall aim will be to provide knowledge on what is contemporary clinical practice in the international world of emergency nursing care.

The student will also be introduced into research methods that apply to the clinical settings. While this aspect of the program will be addressed in more detail in other courses, it is hoped that students will be stimulated to question their practice and analyse current methods of emergency care.

This course considers the pathophysiology, assessment, monitoring and therapeutics associated with emergency nursing. Particular focus is given to the respiratory and cardiovascular management of this patient population. This course also addresses some of the clinical skills necessary for practice as a registered nurse in the emergency department.

It is our endevaour to have Small Group Discovery (SGDE) experiences for many of our tutorial based exercises during our face to face time with students. Groups will be allocated to work together on clinical scenarios and problems that will be explored for solutions/actions that reflect evidence based care, professional team work and best practice.

Assessment Task	Assessment Type	Weighting	Learning Outcome(s) being addressed
Assignment I: Essay Part 1 – Plan and search strategy	Formative	Pass/Fail 0%	4-7
Assignment I: Part 2 – Essay	Summative	35%	1, 4, 5, 7, 8
Assignment 2 Part 1: Synopsis of Presentation	Formative	Pass/Fail 0%	4-7
Assignment 2 Part 2: Presentation	Summative	30%	1-8
Examination	Formative	35%	1-4, 6-7
Clinical Skills Record		Pass/Fail 0%	1-5, 7,8

Note: To pass Emergency Nursing I, you are required to complete and pass all summative components of course. A series of mandatory clinical skills must be achieved as indicated in the clinical skills diary.

Assessment 1 – Essay
This assignment is divided into two parts. Part 1 is designed to help you complete Part 2.

Part 1 – Essay Plan and Search Strategy
Part 1 of the essay is a formative assessment. It is early in the semester and you will receive feedback on part I in order to assist you with completion of the final essay
It is a plan of your essay and a description of the literature search undertaken; this will assist you to develop skills in the use of current databases and identifying literature appropriate to the topic.


Part 2 – Complete Essay
In Part 2 of Assessment 1 you will use the essay plan developed in assessment 1, build on the references submitted and incorporate the feedback provided in Part I. These will be used to write your essay in full. It is expected that reference to seminal and contemporary literature will be made throughout.


Assessment 2 – Presentation
Synopsis of Presentation
You are required to submit a one page synopsis of your chosen presentation. This is in order to confirm your topic, and ensure that the topic is appropriate for this assignment. Introduce your topic and provide a brief paragraph which situates the topic, providing background and identifying the significance to emergency nursing. State the aims and objectives of your presentation.
Identify headings that demonstrate a logical sequence and structure for your proposed presentation.

Presentation
As clinicians, you have been exposed to current knowledge and evidence; this ensures that your practice is current and safe. It is a professional responsibility of all nurses to disseminate knowledge and is one method of ensuring that practice is current (and safe) throughout our emergency departments. As post graduate students, you have significantly enhanced your knowledge of emergency nursing. It is important to consider sharing the knowledge. This assessment provides you with the opportunity to practise writing and presenting to a group, and becoming familiar with PowerPoint, which is often used to teach or present throughout health.

Each student is required to present a 15 minutes presentation (12 min for the presentation and 3 minutes for questions) on one of the topics (or an aspect of a topic) covered in this semester. It is suggested you choose a topic that is of interest to you, you may have discovered through undertaking further reading that there are contemporary issues and/or emerging techniques or treatments for the person requiring emergency care.

Presentations will be to the students enrolled in Emergency Nursing I and the course coordinator.

Assessment 3 – Examination
The examination will consist of a combination of multiple choice questions and short answer questions. Students will be expected to be able to analyse patient situations. The examination will be two hours in duration and will examine the theory taught in Emergency Nursing Care I


Assessment 4 – Clinical Skills Record
The assessment of skills will occur throughout the semester. Students will be assessed by the critical care registered nurses and clinical titleholders, with whom they work. Please refer to the information provided in the Clinical skills record. A series of mandatory clinical skills must be completed in order to pass.

Assessments, unless otherwise stated in your Study guide, are to be submitted electronically via Assignments in MyUni via 'TURN IT IN' on the due date identified in this Study guide. Instructions for assignment submission are available for all students under Tutorials at www.adelaide.edu.au/myuni/.

An assessment submitted via MyUni must be submitted as a .doc, .docx or .rtf file. If submitting a PowerPoint presentation for marking, the .ppt or .pptx must be submitted as .pdf file. It is also important to submit your file under your name, such as surname.firstname. MyUni stamps all the other details against your filename once you submit your assessment.

The Plagiarism Statement must be signed and dated for your assessment to be marked. More information on avoiding Plagiarism is available at www.adelaide.edu.au/clpd/plagiarism/.

Plagiarism
Students are reminded that plagiarism and other forms of academic dishonesty constitute a serious offence and can result in disciplinary procedures. Students are advised to read the policy Academic Honesty and Assessment Obligations for Coursework Students Policy & Coursework Students: Academic Dishonesty Procedures policy, available at www.adelaide.edu.au/policies/230/. The following definitions should be noted.

Referencing: providing a full bibliographic reference to the source of the citation (in a style as determined by the School).
Quotation: placing an excerpt from an original source into a paper using either quotation marks or indentation, with the source cited, using an approved referencing system in order to give credit to the original author.
Paraphrasing: repeating a section of text using different words which retain the original meaning.
Please note: changing just a few words does not constitute paraphrasing.

Structure and Writing Style 25%

Structure (15%) • introduces/outlines/situates the topic of the essay • clearly describes the way in which the essay will proceed • the essay is structured in a logical sequence so that the content flows (headings may be used to develop the structure of the paper) • the essays ends with a cogent, defendable conclusion that summarises the discussion within the body of the paper. Writing style (10%) • the essay is written with clear sentence structure, clarity of argument and precision of expression and the spelling and grammar are correct.

Content 60%

Content (30%) • the essay question has been answered or the topic/issue has been discussed • the essay content has clear links to contemporary nursing practice • the student’s paper demonstrates a depth of understanding of the topic and significant issues. Critical analysis (30%) • the essay demonstrates a high degree of critical thought and insight by:      • providing a justification/rationale for the argument/discussion      • demonstrating they have reflected on the complex issues surrounding the topic/question      • discussing the topic from differing perspectives, thereby providing a balanced argument/discussion.

Referencing 15%

• the referencing style used throughout the paper is congruent with the School’s Student Handbook and Style Guide • the reference list is accurate (i.e. no missing page numbers, volumes, correct title etc), complete (i.e. no references in the body of the paper are missing from the reference list) and consistent with the School’s Student Handbook and Style Guide • the references cited are contemporary (i.e. less than 10 years old unless seminal papers) • primary references are used predominantly (i.e. the original reference has been cited rather than a secondary source) • there is evidence in the paper that the student has searched widely for information related to the topic/issue • the student has acknowledged all sources of information • direct quotations are only used to make crucial points or to support the discussion/argument.

Synopsis Paper for Student Presentation

Structure and Writing Style 20%

Structure (15%) • introduces the topic of the presentation • clearly describes the way in which the presentation will proceed • the synopsis is structured in a logical sequence so that the content flows (headings may be used to develop the structure) • the synopsis ends with a brief cogent, defendable conclusion that summarises the discussion within the body. Writing style (5%) • the synopsis is written with clear sentence structure and the spelling and grammar are correct.

Content 70%

• the synopsis paper summarises the topic/issue adequately • the synopsis content has clear links to contemporary nursing theory and clinical practice and is relevant to the course content

Referencing 10%

• the referencing style used throughout the synopsis paper is congruent with the School’s Student handbook and style guide • the reference list is accurate (i.e. no missing page numbers, volumes, correct title etc), complete (i.e. no references in the body of the paper are missing from the reference list) and consistent with the School’s Student handbook and style guide • the references cited are contemporary (i.e. less than 10 years old unless seminal papers) • primary references are used predominantly (i.e. the original reference has been cited rather than a secondary source) • there is evidence in the synopsis paper that the student has searched widely for information related to the topic/issue • the student has acknowledged all sources of information • direct quotations are only used to make crucial points or to support the discussion/argument.

Student Seminar Presentation

Structure 20%

• Introduces the topic and states aims of the presentation. • Clearly describes the way in which the presentation will proceed. • The presentation is structured in a logical sequence so that the content flows. • The presentation ends with a brief cogent, defendable conclusion that summarises the discussion within the presentation. • The time for the presentation is managed well, allowing adequate time for questions / debate at the conclusion of the presentation.

Content 60%

Content (30%) • The presentation has covered the topic sufficiently. • The presentation content has clear links to contemporary nursing theory and clinical practice. • The student’s presentation demonstrates a depth of understanding of the topic and associated significant issues. Critical analysis (30%) • The presentation demonstrates a high degree of critical thought and insight by:      • providing justification/rationale for the discussion;      • demonstrating they have reflected on the complex issues surrounding the topic;      • discussing the topic from differing perspectives, thereby providing a balanced discussion.

Discussion and Presentation Style 20%

• Material is presented in an interesting manner. • The student uses learning resources appropriately. • The group's interest is maintained by the student. • The student:      • is audible;      • responds to questions in an appropriate fashion;      • leads an interactive discussion that challenges the group to issues related to their nursing practice.