Promoting good health A02 Rebecca Tomlin

In A02 I will be showing a comprehensive description of job roles of two key workers who are involved in promoting good health, there will be justifications of skills and qualities for each key worker. I will also give two preventive measures including these being applied. I will show an in depth understanding of the implications of current health promotion initiatives.

Promoting good health A02 Rebecca Tomlin

Firstly I will be looking at the job roles and skills of a care assistant within a residential home. Their job roles are to be part of the nursing team, whose aims are to ensure that resident’s nursing, personal and psychological needs are met on a daily basis, to help promote as much personal and physical independence and choice as possible, in the activities of daily living undertaken by the residents within the Nursing Home.To help maintain a stimulating and attractive environment for the residents, to assist residents in washing, dressing and undressing, to participate in the basic nursing care of the residents, under the supervision of trained staff, e.g. bed-bathing, pressure area care, mouth care, eye care, to assist the residents with their toileting needs, including continence promotion, to change beds, tidy resident’s rooms and do light cleaning. To help in the serving of meals and drinks, feeding those residents who are unable to feed themselves and ensuring that each resident receives the meal or diet that he/she has requested and is suitable for his/her needs, maintain confidentiality regarding resident’s particulars. Assist in activities within the Home, Undertake any other duties as required in order to keep the Nursing Home running smoothly, as delegated by the trained nursing staff or Home Manager. Care assistant improve the lives of vulnerable people. Within this job you will work with people on a weekly or daily basis assisting them in practical activities such as going to the shops or helping people to bed. You could be working in a care home or visiting people in their own homes

In A02 I will be showing a comprehensive description of job roles of two key workers who are involved in promoting good health, there will be justifications of skills and qualities for each key worker. I will also give two preventive measures including these being applied. I will show an in depth understanding of the implications of current health promotion initiatives.

Promoting good health A02 Rebecca Tomlin

depending on the job and assisting care workers in their activities. According to the care assistant I am studying she said “It is a very rewarding career and can be done on a contract, permanent or temporary basis and there are specific day and night care assistant jobs available. Being a care assistant involves, caring for you clients, who can include: children, the elderly, people with disabilities and families; by assisting with medications to helping with household chores. I love doing this job it is so fulfilling.”

Promoting good health A02 Rebecca Tomlin

You may be liaising with people from other departments such as; social services, housing officers and GP’s, so you will need to have good communication skills. You will need to be sensitive to people of different backgrounds and be able to listen and communicate well with your clients. This will include the amount of eye contact given, facial expressions, angle of head, and tone of voice, body language, gestures, posture, muscle tension, touch, and proximity and so on. All these skills will make up to how the service user is going to feel all these skills can be used negatively and positively but the service provider has to make sure they use it in a positive way.A second language may be required in some cases; the reason for this is because every health and social care setting has multi cultural people, for example Punjab, Slovakian, Polish and so on. The reason for this is that they may not speak English so to have a second language it is important and very helpful. A care assistant must be able to speak good English and communicate well.Care assistants need to be enthusiastic, good team players, caring, patient, and also enjoy caring and helping people. Patience, compassion, tact and a sense of humour are vital qualities, especially if you work with people who do not like to admit that they need help. For example if a service user is feeling upset because they have just come back from the doctors and they have had some kind of treatment it’s the care assistants job to be patient and calm with them. They must give them the support and compassion. You must understand that every resident has the right to keep as much independence as they can. You will need to

Promoting good health A02 Rebecca Tomlin

treat each resident as an individual, with different physical and emotional needs. You should be able to talk and listen to people from all backgrounds. You will need to be discreet, and able to ease people's embarrassment when you help them with personal tasks for example washing or using the toilet. You must be able to give help and support with residents' concerns or emotional problems. You must be prepared to learn and develop new knowledge and skills.

Promoting good health A02 Rebecca Tomlin

Unlike individuals who wish to become healthcare professionals, potential healthcare assistants do not need to hold any specific qualifications or have a scientific background. However, individuals will need to pass a medical check and, because of the amount of close contact with vulnerable patients of all ages, a Criminal Records Bureau check will also have to be carried out. Furthermore, a driving license is useful, since healthcare assistants often need to visit patients in their own homes throughout the day.

Once healthcare assistants have started work, they can study for NVQ qualifications in Health or Health and Social Care. These qualifications will allow employees to learn more about patient care and, once they have been completed, individuals will often be allowed to perform tasks which require a greater level of responsibility.

Previous experience in any caring role will be invaluable for individuals hoping to become healthcare assistants. Previous medical experience is useful but not essential. Volunteer work of any kind will look good on a CV as well.

Secondly, I am looking at the job roles of a nurse.

The job roles of a nurse consist of assessing, observing and reporting on the condition of patients; preparing patients for operations and procedures. Recording pulse, temperature and respiration and keeping accurate records of these observations. To set up drips and blood transfusions, Maintaining and checking intravenous infusions, Administering

Promoting good health A02 Rebecca Tomlin

drugs and injections, To assist with tests and evaluations, Respond quickly to emergencies, Explaining treatment and procedures to parents or guardians, Supporting, advising and educating patients and close relatives. engaging in and promoting teamwork, including working alongside specialist doctors and nurses, health visitors, social workers, radiographers and physiotherapists.

Observing strict hygiene and safety rules and ensuring that visitors also observe any rules on the ward or unit.

Writing reports and updating records before completing a shift.

Adult nurses provide care too, and support the recovery of, patients suffering from acute (short-term) and long-term illnesses and diseases or those requiring surgery. They focus on the needs of the patient rather than the illness or condition.

They also promote good health and well being through education.

Nurses plan and carry out care within a multidisciplinary team but are the main point of contact for patients. Adult nurses work mainly in hospitals and the community, attached to a health centre or general practice and in residential homes, specialist units, schools and hospices. Many nurses work with patients in their own homes.

As a nurse you need to have these skills:

Excellent people skills - You will be providing care for people of all ages and backgrounds. You should be able to put people at their ease, gain their confidence and deal sympathetically with their problems and fears.

Promoting good health A02 Rebecca Tomlin

Good communication and observation, these are crucial to good nursing. You need to be a good at listening as well as talking and you have to be constantly alert to changes in patients' conditions and the implications in terms of care. As a nurse is more frequently in contact with the patients, he/she should have excellent communication skills. These include speaking as well as listening skills. The nurse should be able to openly talk with the patients and their family members in order to understand their needs and expectations. He/she should be able to explain the treatment given to the patient.

Ability to answer questions and offer advice, Nurses are the most frequent point of contact for patients, so you must be able to answer their questions, share your knowledge and skills with patients, their families and friends and make sure their needs are recognised by the rest of the care team.

Happy to work as part of a team as a nurse you will be part of a multi-disciplinary team that includes doctors, physiotherapists, anaesthetists, pharmacists, dieticians’ and many more.

Dealing with emotionally charged situations, nursing can sometimes involve managing distress. You'll play a key part in helping patients and families come through their crises.

A good nurse should be highly qualified and trained. She/he should have a sound knowledge of the nursing profession, obtained from a reputed institute. He/she should always be ready to learn more.

Watchfulness is an important quality of a good nurse. He/she should be alert every moment about the condition of a patient. He/she should be able to notice a minor change in the patient’s health status.

A good nurse should have an emotional stability. Nursing is a very stressful job. Everyday the nurses witness severe traumatic situations, surgeries and deaths. The nurse should be mentally strong and should not get disturbed by such incidences.

Promoting good health A02 Rebecca Tomlin

Good presence of mind is crucial in the nursing profession. In any critical condition or medical emergency, if the doctor is not there, then the nurse should not get confused. He/she should be confident enough to take the correct decisions. Kindness and empathy are the qualities that every nurse should possess. The nurse should be calm and kind to the patients, even if they are aggressive. The nurse should understand the pains and suffering of patients. He/she should provide comfort and sympathy to the patients, instead of getting angry with them.

A good nurse should be flexible about his/her working hours and responsibilities. Nursing is a time demanding profession. It’s not like that to work for specific hours. Medical emergencies can occur at any time. Nurses often have to extend their duty hours, work in overnight shifts, or work on weekends too. They should not complain about that.

A good nurse should have a strong physical endurance. He/she should be able to perform a number of taxing manoeuvres, stand up for a long period of time or lift heavy objects/people on a daily basis. A nurse should have a respect for people and rules. He/she should be devoted to the professions He/she should be aware of different cultures and traditions and confidentiality requirements of the patients. He/she should respect the wishes of the patients.

A nurse should be active and cheerful. Her/his presence should make the patient relaxed and comfortable. The nurse’s pleasant appearance can reduce the patient’s stress and pains. His/her voice should be soft and gentle

Promoting good health A02 Rebecca Tomlin

Before working on the NHS, you will need to complete a pre-registration course. There are many pre-registration courses available throughout the UK, and at present there is no set minimum entry qualification across the board. The entry requirements differ depending on the higher education institution chosen. It is generally thought that most entry criteria for a diploma course will require candidates to possess around 5 GCSEs (or equivalent) of Grade C and above including English literature or language and a science subject. Nursing degree courses usually require candidates to have gained at least 2 A-Level qualifications or equivalent.

However, if you're considering changing career and becoming a nurse you should have good numeracy and literacy skills. You should also be an excellent team worker and possess good communication skills. You may also find that you have to work within extremely emotionally charged atmospheres and

Promoting good health A02 Rebecca Tomlin

situations, so an ability to work and communicate calmly, sympathetically and efficiently within such situations is crucial. Observation skills are also vital, as a nurse's role can often include monitoring a patient's progress, as well as the possible resulting care routes.

Julia Bryan, a community clinical nurse specialist who has worked at Saint Francis Hospice for three years, shares her day as a nurse.

9 am – The first thing I do is write up notes about the phone calls I received overnight while on call ready for the morning meeting. I received calls from hospice staff seeking advice and alerting me to a man discharged from hospital and needing a visit.

I then prepare for the day I’m going to visit two teams of district nurses about patients and three patients– two are follow-up visits and one is a new referral. Each hospice nurse looks after 20 to 30 patients at a time in a set area, mine is Romford and Collier Row.

9.30 am – I attend the team meeting and we hand-over patients and discuss workloads for the day. Afterwards we can talk to hospice doctors about patients’ symptoms and medication.

10 am – I drop into the district nurses in Romford for information about the progress of a patient we are caring for.

Promoting good health A02 Rebecca Tomlin

We work closely with district nurse teams and GPs to ensure highest standard of symptom control is given as well as supportive care to patients and their families.

10.30 am – I visit my first patient of the day a 56-year-old woman recently diagnosed with a brain tumour. She is nervous about suffering more fits after being hospitalized following one so we discuss medicine that may prevent them and keep her out of hospital, which she wants. I ask how she feels and about her session with our physiotherapist and she requests another appointment as she has back pain so I will arrange this. I review her medication as both she and her husband asked me about it and I liaise with her hospital specialists to ensure continuity of care. I explain that I will write to the GP for the new prescription.

11.30 am - I call into the Collier Row district nurse team to learn about a patient they’ve referred.

12 pm - I visit my second patient a 60-year-old woman with cancer, who had her care changed after difficulty keeping food down - she is eating better. I help the district nurse take bloods because she’s experiencing difficulty and then comfort the patient as she is upset.

12.45 pm – Time for a quick lunch while I write up the mornings’ notes before my next appointment.

1.30 pm – I visit an elderly woman with cancer for the first time, she doesn’t like to talk about how she is feeling so I learn about her history and illness from her family. I tell them how the hospice and I can help them and inform them about available financial support. Then I let them talk and outline the medication prescribed. I then introduce myself to the patient and see if she is comfortable and how she feels. Before leaving I let the family know that she is quite poorly and that I will be contacting them with a care plan shortly. My aim is to get her symptoms under control so she is comfortable.

3 pm – Back to the hospice to deal with messages and complete my notes and letters to the GPs with details of the medication I want prescribed and district nurses about any changes.

Promoting good health A02 Rebecca Tomlin

5.30 pm – I go home as someone else is on call tonight - the team is available 24-hours all year round to give advice to colleagues, healthcare professionals, patients and their carers.

“I feel privileged to have this job where I meet patients and families and help make a difference by sorting out their problems. I’m blessed I’ve got a good team and access to many services.” Says Julia Bryan.

As you can see being a nurse is a very demanding job from working from 9.00am till 5.30pm everyday. Being a nurse involves having a strong mind and being able to cope with emotional situations, making sure you maintain a professional view on the situation is important because this can be used to support families and so on. Within her life as a nurse she has to do many tasks from day to day which include – note making, meetings, handling medication, supporting patients, prescriptions, taking bloods and much more. Being a nurse is not an easy job it takes a lot of willpower and strength.

Promoting good health A02 Rebecca Tomlin

Just as there are many models of health, there are many models of health promotion too.

There are three sections which make up health promotion –

1. Health education – communication to improve health and prevent ill health by improving peoples knowledge on health, and changing their aspects on how they view their health.

Health educators include in a wide range of professions including teachers, social workers, practice nurses, health visitors, leisure centre staff, and so on.

In some of these jobs it is part of it that you have to make people aware of risks of certain things and also to enlighten them on their health for example health visitors and practice nursing.

However in some cases, you may have a job which you have to use initiative and warn people of the risks of certain things just like a community police officer. If a community police officer was patrolling a certain area and saw a group of teenagers who were drinking and intoxicating themselves it would be beneficial for the community police officer to put forward the risks of what they were doing.

2. Health protection – population measures to safeguard health through legislation, financial and social means. This might include legislation to govern health and safety at work or food hygiene, and using taxation policy to reduce smoking levels or car use, by raising the price of cigarettes or petrol.

3. Prevention – reducing or avoiding the risks of diseases and ill health primarily through medical ‘interventions’.

Promoting good health A02 Rebecca Tomlin

It is all too easy to see health promotion as solely focusing on preventing people from becoming ill. But also it has three tiers of health prevention.

Here is Tannahil’s model of health promotion from health and social care AS level book.

Primary prevention - which is an attempt to eliminate the possibility of getting a disease, for example making people aware of risks that are linked to smoking, poor diet, no exercise and so fourth. An example of making people aware of risks of certain health issues is within schooling and education. By talking to the children, creating poster, leaflets, hand outs and so on making children aware of the risks of smoking, drinking,

Health education

Health Protection

Prevention

5

4 7

3

61

2

1 Preventative services Immunisation, cervical screening, Developmental surveillance

2 Preventative health education

Substance use education in schools

3 Preventative health protection

Fluoridation of water supplies

4 Health education for preventative health education

Lobbying for fluoridation or seatbelt legislation

5 Positive health education

Work with young people to develop positive self-esteem

6 Positive health protection

Smoking bans in public

7 Health education aimed at positive health protection

Lobbying for a ban on tobacco advertising or smoking bans in pubs

Promoting good health A02 Rebecca Tomlin

drugs etc and this could make an impact on the Childs life at a young age.

Secondary prevention - which addresses those people identified as being in the early stages of a disease, usually through early detection and symptoms. The action for this focuses on addressing the underlying causes, in order to alleviate any further symptoms. A nurse can carry out a breast screening which is Secondary prevention because this is a part of the process where they find out if they have a disease. The NHS breast screening programme provides free breast screening every three years for all women in the UK aged 50 years and over. Around one and a half million women are now screened in the UK each year. Women aged between 50 – 64 years are routinely invited for breast screening every three years, and work is being carried out to extend the programme to women up to and including the age of 70 by 2004. According to Neil Moonies health and social care book.

Women less than 50 years are not offered routine screening. Mammograms seem not to be as effective in pre-menopausal women, possibly because the density of the breast tissue makes it more difficult to detect problems and also because the incidence of breast cancer is lower. The average age of the menopause in the UK is 50 years old.

Breast screening is a method of detecting breast cancer at a very early stage. The first step involves x-raying of each breast – a mammogram – which is taken while carefully compressing the breast. The mammogram can detect small changes in breast tissue, which may indicate cancers that are too small to be felt either by the women

Promoting good health A02 Rebecca Tomlin

herself or by a doctor. There are over 90 breast screening units in the UK.

This is a very good service that the NHS offers because it can detect the sign of cancer in early stages, women can ask for advice if they think they have cancer or if they have been diagnosed with it. Nurses support women who may not be able to talk with family or friends but can talk to someone who knows the profession and who knows all about breast cancer.

Tertiary prevention - this refers to the control and reduction of an already established disease. Somebody with cancer may be given 6 months left to live and no chance of recovering but tertiary prevention and health related professionals can help give the support and advice to a cancer sufferer, helping them to deal with their disease and to make the next 6 months the most comfortable and happiest.

A care assistant can implement Tertiary prevention. This is when they know someone who has a disease and they try to help them deal with it and get on with the daily lives as normal as possible.

For example and older person who lives in a care home may have developed over a period of time pressure ulcers.

Pressure ulcers are also called decubitus ulcers or bed sores, are a big problem in hospitals, nursing homes and patient homes. Pressure ulcers are areas where the skin has broken down. They can go very deep to the bone. Pressure ulcers can cause pain and very serious infections that can lead to death.

You can get pressure ulcers by; Age - The normal aging process changes the skin and the blood circulation. The old person's skin can be dry and very fragile. It can get

Promoting good health A02 Rebecca Tomlin

irritated; it can break open into a sore and can even tear very easily. Older people may also have poor circulation. Their blood, with oxygen, may be cut off or very limited. When oxygen is not fed to the skin, it is hard to keep the skin healthy and without injury.

Lack of mobility - Pressure ulcers occur when people are not up and walking. They form when a person stays in the bed, chair or wheelchair for a long time. Blood is cut off to areas where bones are close to the skin when a person stays in a chair or in bed for a long time. The weight of the body pushes against a bony area to cut off the blood and oxygen to that area.

Poor diet - Patients and residents with a poor diet are at risk for pressure ulcers. The skin and other tissue, as well as the rest of the body, does not get the food and nutrition it needs to be healthy and without injury if the diet is not good.

Moisture - Residents and patients who are wet are at risk for pressure ulcers. Patients that are incontinent of urine or stool, those that sweat a lot and those that have draining wounds are at risk for pressure ulcers. Moisture makes the skin soft. This softness leads to skin breaks.

Mental or any other psychical problems - When a patient or resident is confused, very sleepy, or in a coma, they may not turn like other alert patients normally do even when they are sleeping. People that do not have a normal sense of pain and the physical ability to turn will remain in one position for a very long time unless someone else turns them. If a patient stays in one position for a long time, they will get a pressure ulcer

Bed sheets and chairs with wrinkled sheets or hard objects - Uneven pressure is created when sheets are wrinkled. This leads to pressure ulcers. Objects such as spoons, tissue boxes, eye glasses, food crumbs, hair pins

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and other hard objects that are left in the bed or sitting chair also cause pressure and pressure ulcers.

Pressure ulcers can lead to pain and even death. Pressure ulcers are difficult and very costly to cure once they have formed. It is, therefore, important that care assistants and other team members prevent pressure ulcers before they start.

A care assistant should assess patients for their risk of developing pressure sores. They also plan care and provide care that prevents and treats pressure sores and monitor and coordinate the care of a patient with a pressure ulcer in some hospitals and nursing homes.

Both a nurse and a care assistant have big parts of the lives of patients and residents so they can support, inhibit and communicate with them. They can help regain their patients and resident’s confidence and well being.

Health promotion research

In summer 2007, the smoking ban was brought into action by the government. “This legislation is a huge step forward for public health” quoted by health secretary Patricia Hewitt. This smoking ban includes no smoking in all work places, including restaurants and pubs selling food. Although non food pubs and private members clubs will be exempt. The government has also announced that it is planning to consult on how to protect bar workers in pubs where smoking is allowed. This legislation is a huge step forward for the public health and will help reduce

Promoting good health A02 Rebecca Tomlin

deaths from cancer, heart disease and other smoking related diseases. Did you know? Scotland, Wales and Northern Ireland have similar bans.

Anyone who lights up a cigarette illegally could be fined £50 - £30 if it is paid within 15 days.

The figure rises to £200 if an individual is prosecuted and convicted by a court.

Businesses failing to comply with the ban could be hit with fines up to £2,500.

The government hope the smoking ban will encourage people to quit smoking and realise how much harm it is doing to themselves and people around them.

Parliament sets the maximum penalties for road traffic offences. The seriousness of the offence is reflected in the maximum penalty. It is for the courts to decide what sentence to impose according to circumstances.The penalty table below indicates some of the main offences, and the associated penalties. There is a wide range of other more specific offences which, for the sake of simplicity, are not shown here. The penalty points and disqualification system is described below.

Offence Imprisonment Fine Disqualification Penalty points

*causing death by dangerous driving

14 years Unlimited Obligatory – 2 years minimum

3-11 (if exceptionally not disqualified)

*Dangerous driving

2 years Unlimited Obligatory 3-11 (if exceptionally not disqualified)

*Causing death by careless driving under the influence of drink or drugs

14 years Unlimited Obligatory-2 years minimum

3-11 (if exceptionally not disqualified)

Careless and inconsiderate driving

- £5,000 Discretionary 3-9

Driving while unfit through

6 months £5,000 Obligatory 3-11 (if exceptionally not

Promoting good health A02 Rebecca Tomlin

drink or drugs or with excess alcohol: or failing to provide a specimen for analysis

disqualified)

Failing to stop after an accident or failing to report an accident

6 months 

£5,000 Discretionary 5-10

Driving when disqualified

6 months (12 months in Scotland)

£5,000 Discretionary 6

Driving after refusal or revocation of licence on medical grounds

6 months £5,000 Discretionary 3-6

Driving without insurance 

  £5,000  Discretionary  6-8

Using a vehicle in a dangerous condition

- LGV £5,000PCV £5,000Other £2,500

Obligatory if offence committed within 3 years of a previous conviction for the same offence - 6 months

3 in each case

Failure to have proper control of vehicle or full view of the road and traffic ahead, or using a hand-held mobile phone while driving

-  £1,000 (£2,500 for PCV or goods vehicle)

Discretionary 3

Driving otherwise than in accordance with a licence

- £1,000 Discretionary 3-6

Speeding - £1,000 (£2,500 for motorway offences)

Discretionary 3-6 or 3 (fixed penalty)

Traffic light offences

- £1,000 Discretionary 3

No MOT certificate 

- £1,000   -

Seat belt offences - £500   -

Dangerous cycling

- £2,500   -

Careless cycling - £1,000   -

Promoting good health A02 Rebecca Tomlin

Cycling on pavement

- £500   -

Failing to identify driver of a vehicle

- £1,000  Discretionary 6

These were made by the government to try and stop people for example drinking and driving. People do not realise the risks of drinking and driving, they can cause damage to themselves, in some cases others and people around them. When driving a car you are always risking your life because you may not know what is going to happen any minute, I believe that these laws are very good and informative and list everything from drinking driving to jumping a traffic light.

Health promotion: CORE COMPETENCIES IN ACTION – THE SCHOOL SETTINGRaising public awareness Direct campaigning within schools, e.g.,

national days such as No smoking day or world aids day.The organisations of events such as sex education conferences or the supporting the school celebrations of achievements within the healthy school programme, linking with and involving the media in these types of events.

Advice and consultancy The support by specialist offered to schools participating in the healthy school programme, facilitating training and policy

Service development The ‘health promoting school award’ provides a framework for schools to incorporate health issues into their development plans in terms of training, policy development, finance and so on. The extended schools programme also provides opportunities for developing school-based health services, e.g. school nurse drop in sessions. The health promotion specialists would provide a leading role for coordinating the development of these types of service – based initiatives.

Policy development Supporting schools in the development of a wide range of specific policies including sex

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education, smoking, substance use and nutrition.

Research Undertaking research, e.g. health surveys to establish what young people’s health behaviours are in the locality or consulting young people about specific issues.

Training and education Providing in service training on health education, co facilitating classes to offer models of good practice for health and health related subjects

Resources Specialists both advise on purchases of new materials for the resource centre, and recommend resources and appropriate methods of use

Challenging prejudice and discrimination Specialists encourage the development of policies and work practices that challenge the root causes of ill health, e.g. policies around equal opportunities strategies are included in all policy documents and subsequent strategy initiatives.

Specialist health promotion services

These are now usually located with the public health team. They are small, specialised companies which support the development of new services and policies which can promote health locally. The role of these services has grown and developed over time, the flexibility to do this being largely due to the fact that it is not a profession governed by a professional body, this enabling local teams to grow and develop into new areas of practice in response to local need. However there is a national set of competencies for health promotion practice, which identifies the degree of overlap with public health practice which identifies the degree of over lap with public health practice recognising that health promotion specialists are a part of the wider public health specialism. Their role is best illustrated by the example of the activities a service might offer in the school setting as shown above.

Promoting good health A02 Rebecca Tomlin

Improving health and preventing disease is also the responsibility of those working to provide health care – especially those with community based roles.

http://www.direct.gov.uk/en/TravelAndTransport/Highwaycode/DG_069870http://www.patient.co.uk/showdoc/16#genhttp://www.acareerchange.co.uk/changing-career-becoming-nurse.htmlhttp://books.google.co.uk/books?id=47tkaxpfLGEC&pg=PT95&lpg=PT95&dq=soler+-+egan+1986&source=bl&ots=R42bsbvEOZ&sig=KmzOV1UMPZ-LJMB5BE_QvNLOpP0&hl=en&ei=6KHWS6P-MJP-0gSG7smHCA&sa=X&oi=book_result&ct=result&resnum=10&ved=0CCcQ6AEwCQ#v=onepage&q=soler%20-%20egan%201986&f=false