Awareness Of Nurses Research Articles

수술실간호사의 환자안전문화인식과 안전관리활동의 관계에서 임파워먼트의 조절효과

Purpose: The purpose of this study was to identify the moderating effect of empowerment of perioperative nurses in the relationship between their patient safety culture awareness and safety management activities of surgery nurses. Methods: The participants were 262 perioperative nurses in JeollaNam-do, JeollaBuk-do, and GyungsangNam-do. Patient safety culture awareness, safety management activities, and empowerment were measured using self-report questionnaires from October 20 to November 10, 2014. The collected data were analyzed using SPSS Win 24.0 for Windows. Results: The results of the study were as follows. the average score of patient safety culture awareness of surgery nurses was 3.57±0.48, that on safety management was 4.22±0.54, and that on empowerment was 3.67±0.63. In correlational analyses, there were significant positive correlations between patient safety culture awareness and not only safety management activity but also empowerment. Moreover, patient safety culture awareness and empowerment showed meaningful positive correlations. Empowerment of nurses influences the relationship between their patient safety culture awareness and safety management activity. Conclusion: In sum, it found that empowerment of surgery nurses affects the relationship between patient safety culture awareness and safety management activity. To provide safe nursing, it is necessary to continue developing programs to increase safety management activities and educate empowerment and conduct follow-up studies of strategic policies so that patient safety culture awareness can be established and human resources within the organization can be supported.

Improving Depression, Hope, and Quality of Life in Dialysis Patients Using Health Promotion Education Groups

Taiwan has the highest incidence and prevalence of dialysis in the world. The literature suggests that severity of depression at the beginning of dialysis treatment is an independent predictor of survival. Depression significantly worsens the condition of chronic renal disease patients, with the adverse consequences of depression including increased mortality and hospitalization rates as well as poor compliance and quality of life. Given the importance of this problem, providing safe and effective information and good nursing care to dialysis patients is urgently needed. The purpose of this study was to explore the effects of implementing health promotion education groups on self-perceived depression, hope, and quality of life in dialysis patients. Dialysis patients who met the study criteria and had provided consent to participate in the health promotion education group were randomly assigned to either the treatment group (20 persons) or the control group (20 persons). In the control group, routine dialysis treatment and nursing care were maintained. In addition to receiving routine dialysis treatment and nursing care, the experimental group participated in health promotion education group activities for 90 minutes, twice a week for a total of 8 sessions. The quantitative data from both groups and the qualitative data analysis of the experimental group were used to assess the effects of the intervention. The results showed that the intervention had significantly improved self-perceived depression, hope, and quality of life in the experimental group. The participants indicated that the health promotion education group had helped them learn to adapt to their physical conditions, change their mindset, learn to regard happiness as the purpose of life, and maintain hope and increase mutual support in the face of difficulties. This study demonstrated that the cross-disciplinary integrated care provided through health promotion education groups is able to significantly improve depression, hope, and quality of life in dialysis patients. Thus, health promotion education groups arranged by the case management nurses for dialysis patients have the potential to promote mental health and quality of life in these patients. Therefore, continuing education is recommended to strengthen the awareness and knowledge of dialysis case management nurses with regard to applying integrated cross-disciplinary care in health promotion education groups and to promoting the implementation of these groups in the holistic care of dialysis patients.

Project to Decrease the Incidence of Neonatal Hypothermia in the Newborn Center

An investigation found that 66.7% of the neonatal hypothermia (body temperature < 36.5°C) cases diagnosed within one hour of transfer from the delivery room in our hospital were affected by a significantly increased risk of physiological abnormalities, which subsequently increased their risk for mortality. Therefore, monitoring and maintaining the normal body temperature of newborn infants are vital in infant care. This project aimed to improve the current situation of neonatal hypothermia. This project was implemented from Oct. 1, 2016 to Oct. 31, 2017 and used several approaches to improve neonatal hypothermia. A neonatal hypothermia caring protocol was developed and the infant admission materials were standardized; the infant hypothermia alert card and posters were displayed in easy-to-notice locations; an in-service training course on neonatal hypothermia was provided; and an infant hypothermia care checklist was tabulated for examination and recognition. After the implementation of this project, the average time required to raise the body temperature of infants to normal (36.5°C) was 1.5 hours, which was 2 hours faster than the pre-project time of 3.5 hours. Moreover, the time needed to raise the body temperature to normal was one hour for newborn infants with birthweights ≥ 2,500 grams, which was one hour faster than the pre-project time of two hours, and 1.5 hours for newborn infants with birthweights < 2,500 grams, which was three hours faster than the pre-project time of 4.5 hours. The goals of this project were effectively achieved in both groups. Neonatal hypothermia is an important issue affecting the health status of newborn infants. This project strengthened the awareness of nurses regarding neonatal hypothermia and is worthwhile to be implemented in clinical neonatal care.

Effects of umbilical cord milking on premature neonates’ and mothers’ outcomes

Background: Umbilical Cord Milking (UCM) is a safe and likely technique for both the mothers and their neonates which improve the neonatal outcomes. The aim of the study was to assess the effects of umbilical cord milking on premature neonates' and mothers' outcomes.Methods: Design: Quasi-experimental research design was utilized. Setting: Emergency and Labor Unit of Women's Health University Hospital and Neonatal Intensive Care Unit (NICU) in Assiut University Children Hospital were the setting which the study was implemented. Subjects: It included 80 mothers and their premature neonates. The subjects were divided randomly into two groups (40 premature neonates who were received the UCM as a study group and 40 premature neonates as a control group who received the Immediate Cord Clamping [ICC]). Tool: One structured interview questionnaire was designed especially for this study. It included two parts: Personal and clinical data of the studied mothers and premature neonates.Results: The Hemoglobin (Hb) level significantly increased in the study group when compared to the control group within 6 hours of birth (12.11 vs. 10.61) and at 36-48 hours after UCM (12.27 vs. 11.32). Also, UCM had significantly improved the need for blood transfusion, death rate, and length of hospital stay among premature neonates in the study group.Conclusions and recommendations: UCM improved preterm neonates' outcomes as increasing Hb level, less need for blood transfusion, and decline incidence of death, lowers length of hospital stay. Recommendations: Increasing awareness of neonatology, pediatric, and obstetric nurses about benefits and technique of UCM through health education program.

Safe injection awareness and practices among nursing staff in an Egyptian and a Saudi hospital

BackgroundUnsafe injection practices are an occupational hazard among the nursing staff. Awareness of nurses’ staff members about safe injection practices may vary between different hospitals according to the policies adopted for staff training and systematic auditing.AimTo assess awareness and practice of safe injection among nursing staff in a Maternal and Child Hospital, Qassim Region, Saudi Arabia, and Beni-Suef University Hospital, Egypt.MethodsA cross-sectional study using a structured questionnaire. Observations included 500 injections (250 from each hospital) from October to December 2017.ResultsThe mean awareness total scores in both hospitals were 9.98 ± 1.76 and 11.12 ± 0.96 respectively with a significant difference among observed nurses (P = 0.001). The mean safe injection practice total score was 27.13 ± 3.11 and 27.39 ± 2.17. Past year safe injection training was received for 95% and 70% for observed Egyptian and Saudi group of nurses. The majority of nurses (98.8%) were aware of the importance of safe injection practices to minimize blood-borne diseases, and 95.2% of them were aware of the placement of sharps disposal box beside the place of injection procedure. Exposure to the past year needlestick injuries (NSIs) was higher among the observed Egyptian nurses (P = 0.001). Using appropriately stored and refilled disinfectants was done by 48.5% and 51.5% of the observed nurses. Needle separation from its syringe inside sharps disposal box and sharps disposal boxes near patient care areas were observed in 95.2% and 95.6% of both hospitals respectively.Conclusions and recommendationNurses of both hospitals have good awareness and practice of injection safety. This might be attributed to the adoption of appropriate training courses. There is a need for continuous training sessions and auditing for nursing staff to ensure safe injection practices.

Awareness, Attitude and Vaccination Status Regarding Hepatitis B amongStaff Nurses of a Teaching Hospital in North India

Background: Hepatitis B is a well-documented occupational hazard for health care workers, including both doctor and paramedical personals. Vaccination is the best way by which one can arm oneself against Hepatitis B virus (HBV) infection. The present study was conducted to assess awareness, attitude and vaccination status of staff nurses of a teaching hospital in north India. Materials and Method: All the staff nurses (170) who gave consent to participate in the study were enrolled in the study. A self-structured close ended questionnaire comprising of three parts was used to collect information. First part comprised of questions on demography, second part assessed subjects’ awareness regarding HBV infection and third part comprised of questions on immunization status. Chi-square test and multiple linear regression analysis were used for statistical analysis. Results: The mean age of the study subjects was 24.9 ± 6.8 years. Awareness regarding HBV infection was present among 94.7% (161) of subjects. Universal Precautions were followed by 81.8% (139) of subjects. Only 18.8% (32) subjects were following correct method of disposal of Biomedical Waste (BMW). The odds of getting immunized were 4.46 times greater in subjects who had awareness of Hepatitis B infection than those who did not. Conclusion: Awareness regarding HBV injection and its coverage was high among the subjects. Very few subjects were aware regarding correct route of transmission emphasizing the need for effective intervention programmes designed to increase knowledge about HBV infection.

Awareness about tuberculosis among nurses working in a tertiary care hospital in Solan, Himachal Pradesh

Background: Tuberculosis has remained a disease of public health importance since ages and is known to inflict large quantum of socioeconomic cost on the society. Since nurses are in direct contact with both hospitalised and ambulatory patients, they are likely to play a vital role in the effective implementation of the RNTCP. The present study attempts to evaluate the awareness of nurses about TB.Methods: This cross sectional study was conducted in a tertiary care institute, Maharishi Markandeshwar Medical College and Hospital, Kumarhatti, Solan for period of 1 year. Data was collected from 180 staff nurses and appropriate statistical tests were applied for evaluation of the same.Results: Knowledge regarding the predisposing factors causing the disease, first line drugs under DOTS treatment, full form of DOTS, patient wise boxes and about the side effects of the treatment were comparatively low among the subjects.Conclusions: Nurses are directly handling and managing patients but the knowledge and awareness of tuberculosis was not satisfactory among them. Therefore efforts must be made to organize regular workshops and periodic seminars to upgrade their knowledge.

Maxillofacial Nursing: Assessing the Knowledge and Awareness of Nurses in Handling Maxillofacial Injuries Through a Comprehensive Survey.

AimTo assess the knowledge and awareness of nurses in handling maxillofacial injuries.MethodA cross-sectional questionnaire study was conducted among the staff nurses of the multi-specialty Gokul Newtech Hospital, Jamnagar, Gujarat. Forty nursing staff were included in the study. Kruskal–Wallis ANOVA, Spearman’s correlation and Mann–Whitney U tests were applied for statistical analysis.ResultThere was no statistically significant difference between the mean knowledge score concerning the study participant’s age, work experience, and education. According to the survey, a majority of the nurses either did not know the answer or answered incorrectly.ConclusionIt can be concluded that there is a requirement of new guidelines and recommendations in the existing teaching and training modules being followed by the nursing schools across the country.Electronic supplementary materialThe online version of this article (10.1007/s12663-019-01240-x) contains supplementary material, which is available to authorized users.

Caring for the Entire Unit: Psychiatric Nurses' Use of Awareness.

Psychiatric nurses have a level of responsibility for everyone residing on the unit, which contributes to the need to nurse the population on the unit as a whole. Because the knowledge base regarding psychiatric nursing interventions in acute care settings is limited, this hermeneutic phenomenological study explored psychiatric nurses' experiences in providing nursing interventions to adult clients in acute care settings. Six expert psychiatric nurses were recruited through purposive, snowball sampling and were interviewed individually to gain a rich understanding of the psychiatric nursing interventions they provided to adult clients in acute care mental health settings. Analysis of the data revealed themes of awareness and person-centered care. This article focuses on the theme of Awareness, with subthemes of self-awareness, awareness of the client, and situational awareness. Situational awareness in psychiatric nursing has remained generally unexplored, and this research adds to the current knowledge base. Implications for practice, research, and education are discussed. [Journal of Psychosocial Nursing and Mental Health Services, 57(9), 17-23.].

Clinical Simulation Teaching Program to Promote the Effectiveness of Nurses in Coping With Workplace Violence

Workplace violence is a phenomenon that is prevalent around the world. Nursing personnel are one of the most frequent victims of workplace attacks. Beyond the harm done to physical health, mental health, and workplace morale, workplace violence also leads to the loss of personnel and causes severe injury to institutions and nursing professionals. The aim of this study is to improve the awareness, attitudes, and self-confidence of nurses with regard to workplace violence using clinical simulation teaching and training courses. A total of 400 clinical nurses at a tertiary hospital in Taipei City were enrolled and randomly assigned into either the experimental group, which received the education intervention, or the control group, which received no intervention. A total of 392 enrolled participants completed the study, including 200 in the experimental group and 192 in the control group. Before and after the intervention, a structured questionnaire was used to collect data, which were analyzed using a GEE model with SPSS V.23. After the clinical simulation teaching course, awareness of workplace violence as well as related attitudes and self-confidence were higher in the experimental group than the control group. Moreover, the posttest scores and pretest-posttest differences in scores were significantly higher in the experimental group than in the control group (p < .001). Advanced analysis of the data showed that cognition scores, being older in age, and having a registered nurse grade of N3 were all associated with earning a higher score. In addition, in terms of attitude, registered nurse grade was found to correlate positively with score. Further, male participants earned higher self-confidence scores than their female colleagues and participants who worked in either the emergency or psychiatric departments earned higher scores. The "Workplace Violence Clinical Simulation Teaching and Training Course" was shown to improve the awareness, attitudes, and self-confidence of clinical nurses with regard to workplace violence and may thus help reduce the risk and harm of violence in this category. In the future, contextual teaching courses on workplace violence prevention should be developed for different nursing levels, divisions, and units based on their specific characteristics and needs.

A Convergence Study on Awareness of Pediatric Nurses and Nursing Prospects among Nursing Students after Pediatric Clinical Practicum

본 연구는 간호대학생들의 아동간호학 실습 후 아동간호사와 간호직전망에 대한 인식을 조사하여 교육프로그램의 기초자료를 얻고자, 간호학과 3학년 143명을 대상으로 시행된 서술적 융합조사연구이다. 수집된 자료를 SPSS 21.0으로 기술통계, 평균비교, 상관관계 및 위계적 회귀분석을 시행하였다. 아동간호사에 대한 전문적인식이 5점 만점에 4.09±0.61 점으로 전통적인식이나 사회적인식보다 높았고, 간호직전망은 5점 만점에 3.31±0.65점이었다. 성별, 연령, 간호학만족도, 실습병원유형에 따라 아동간호사 인식에 부분적으로 유의한 차이가 있었고, 간호학만족도가 보통인 대상자의 간호직전망 인식이 높았다(p<.002). 아동간호사에 대한 인식의 하위영역과 간호직전망 인식 간 양의 상관관계가 있었고(r=.287~.510, p<.01), 위계적 다중회귀분석 결과, 아동간호사에 대한 전통적인식, 사회적인식이 간호직전망에 영향을 미치는 요인이었고, 변수들의 설명력은 29.2%이었다(p<.001). 결론적으로 아동간호사에 대한 전통적 및 사회적 인식을 높임으로써 간호직전망 에 대한 인식을 높일 필요가 있다.

Prevalence and risk factors leading to orthopedic wound infection at Assiut Hospital University

Background: Orthopedic wound infection is an infection of the skin and other soft tissue can lead to infection of bones (osteomyelitis) and joints (septic arthritis). Aim of the study is to assess prevalence and risk factors leading to orthopedic wound infection at Assiut Hospital University. Research design a descriptive research design was used to meet the aim of the study. Tools: the following tools were utilized for data collection Tool (I): Patient's interview questionnaire sheet Tool (II): Assessment of risk factors leading to wound infection. Results: Prevalence of orthopedic wound infection at Assiut University Hospital over the past three months from May to July from of the year 2018 was 57 patients out of 200 patients admitted to orthopedic and trauma department, the majority of the studied patients were have anemia (54.5%), (64%) of the studied patients received blood transfusion, (19 %) were having diabetes mellitus, the majority of them (97.5%) received a prophylactic antibiotic, (21%) were having menstruation during surgery for females, (88.5%) were have closed fracture .Conclusion: Prevalence of orthopedic wound infection at Assiut University Hospital over three months was (28.5%), there was a positive correlation between dressing technique and wound infection of the studied sample. Recommendations: Increase the awareness of nurses through attending scientific meeting and conferences and to keep them pace with the rapidly growing wealth of knowledge and practice.

The Relationship Between Physician/Nurse Gender and Patients' Correct Identification of Health Care Professional Roles in the Emergency Department.

Background: A 2006 study of emergency medicine (EM) patients found male physicians were more often recognized as doctors that were female physicians. We sought to identify gender awareness of EM physicians and nurses by patients to see whether there has been a reduction in gender bias during the past 12 years. Materials and Methods: Before emergency department (ED) discharge or hospital admission, a convenience sample of 150 patients in an urban academic ED was anonymously surveyed to determine their awareness of the role of the health personnel involved in their care. Results: Our patients recognized male attending physicians as physicians 75.7% of the time and female attending physicians as physicians 58.1% of the time (p < 0.01). No differences were observed for resident physicians. Patients recognized male nurses as nurses 77.1% of the time, and female nurses as nurses 91.1% of the time (p < 0.01). Conclusions: These data indicate that patients continue to exhibit gender bias in the recognition of lead physicians and nurses.

Hubungan Lama Kerja Perawat Dengan Kepatuhan Pengisian Surgical Safety Checklist di Instalasi Bedah Sentral

The use of the Surgical Safety Checklist reduces mortality and surgical complication. Nurse obedience in documenting the surgical safety checklist is still low. It is showed that there is a lack of nurses awareness about the importance of surgical safety checklist in an operation. This research aims to know about the relationship between the years of service of the nurse and compliance with filling surgical safety checklist at Central Operating Theatre. Design of this study uses cross-sectional approach. Sampling technique uses total sampling technique, samples taken for study as many as 23 respondents who met the inclusion and exclusion criteria. The data are described in table form and a Fisher test was conducted with spss 21. The highest work period are they who have light of work ≥ 3 years as many as 15 respondent (65,2%) and respondents who have length of work &lt; 3 years as many as 8 respondent (34,8%), for nurses obedience 18 respondents (78,3%) who did not complete the surgical safety checklist while 5 respondents (21,7%) complete the surgical safety checklist correctly. Fisher statistic test obtained p-value data is 0,586 &gt; 0,05. There is no relationship between the years of service of the nurse and compliance with filling surgical safety checklist at Central Operating Theatre

Suicide Prevention Experiences, Knowledge, and Training among School-based Counselors and Nurses in King County, Washington - 2016.

Few studies have assessed the suicide-specific perceptions and awareness of school-based nurses and counselors. This project assessed the self-reported training, beliefs, and professional experiences of school counselors and nurses towards suicide prevention, and identified areas for enhancing efforts to respond to student suicidality. A self-report needs assessment survey was conducted with school-based nurses and counselors in King County, Washington. Group comparisons and descriptive statistics were calculated to characterize providers' perceptions and experiences. Most training experiences reported by counselors and nurses corresponded with greater perceptions of comfort in applying suicide prevention knowledge and skills. Fewer respondents endorsed means safety and safety planning as regularly implemented interventions for at-risk students compared to other interventions. Means safety and safety planning appeared to be areas for enhancing existing suicide prevention efforts.

Knowledge and Attitudes of the Nursing Students at Mosul University toward Tuberculosis

Background: Tuberculosis (TB) is one of the primary public health problems in developing countries. Aim of study: The study aims to evaluate the knowledge and attitude of nursing students at Mosul University toward tuberculosis. Methodology: A cross-sectional descriptive study design. A purposive sample of study consist of (120) nurses students fourth stage. The study was set in the Nursing College/ University of Mosul. Data were collected for the period (17th February 2018) to (25th April 2018). Dependent on the interview technique by using a questionnaire, The questionnaire was designed to achieve the aims of the study, it consisted of three parts, the first content the demographic information, the second part include general knowledge of students about categories that infected with tuberculosis, signs of disease, methods of transmission of disease, and the third part include the student attitude of tuberculosis disease. Data was analyzed by descriptive statistics, which include percentages and proportions of variables, data was prepared, organized and entered into a computer file; Statistical Package for the Social Science (SPSS, Version 11) is used for data analysis. Results: The results showed that (71.7%) female, male (28.3) was at age (22-23) year. The study showed that there is a significant difference between students' knowledge and attitude with age, and the non-significant difference between students' knowledge and there some socio-cultural factors (marital status, sex). Conclusion: The majority of the sample of females and were within the age group (22 – 23 years). The study revealed that the student knowledge was acceptable for all variables of the general information of tuberculosis disease, also the student attitude about disease revealed good. Recommendation: The study recommended the need to strengthen the knowledge and awareness of nurses and other professions working with tuberculosis patients through holding workshops and educational seminars during the study and after graduation on how to deal with the patient who is suffering from this disease or suspected of being infected.

Awareness of Surgical Nurses Regarding Pain Assessment and Management (Suggested Nursing Guidelines)

Background: Pain considers a typical sign for every patient before & after surgery, nurses have an essential part in pain assessment and its management; therefore, they ought to have a solid foundation toward it. Aims: were to identify nurses’ awareness regarding pain assessment and management and design nursing guidelines regarding pain assessment and management. Research design: descriptive research design was utilized to conduct this study. Setting: The study was conducted in the surgical departments of Assiut University Hospital & Elazhar University Hospital. Sample: Eighty nurses were working in the surgical departments of the above mentioned hospitals. Tools: Interview pain awareness questionnaire. Results: (93.8%) of surgical nurses had poor awareness regarding pain assessment and management. Conclusion: Most of the surgical nurses had poor awareness regarding pain assessment and its management for surgical patients. Recommendation: Nurses need for in-service training programs and refreshing courses to improve their knowledge which will reflect on their practice while working with those patients

Utilization of Life-Saving Skills Among Nurses and Midwives at Murtala Muhammad Specialist Hospital, Kano

Maternal morbidity and mortality associated with pregnancy and childbirth have a significant impact on women, their families, and communities in low-income countries. This study aimed at exploring the level of awareness on Life-Saving Skills (LSS), LSS practices employed, barriers to implementation, and strategies to promote effectiveness of LSS practice. The study utilized a cross-sectional research design and a pre-tested structured interviewer-administered questionnaire to survey 154 nurses and midwives in a hospital in Nigeria with 150 maternity beds, about their “awareness” of LSS, LSS practices, and what they consider barriers to implementation and strategies to promote effectiveness of LSS practice. Results demonstrated that while 87.0% of the respondents were aware of LSS, the majority reported numerous challenges in implementing LSS. These challenges included: a shortage of skilled birth attendants (93.5%); negative attitudes of healthcare providers (79.2%); inadequate equipment and supplies (81.8%); and inadequate training for midwives (77.9%). Respondents also recommended some strategies to promote effectiveness of LSS, including provision of life-saving skills equipment (84.4%); training and retraining of personnel in LSS (88.3%); and increasing accessibility of LSS services for childbearing women (97.4%). The study concluded that although there is a high level of awareness of LSS, the midwives and nurses faced many challenges that hindered the utilization of LSS. It is recommended that multilateral collaboration be used in the study setting to overcome the limitations to utilize LSS.

Awareness of Surgical Nurses Regarding Pain Assessment and Management (Suggested Nursing Guidelines).

Awareness of Surgical Nurses Regarding Pain Assessment and Management (Suggested Nursing Guidelines).

Narratives in student nurses' knowledge development: A hermeneutical research study

BackgroundKnowledge development, and how student nurses learn to be nurses, is essential in nurse education and has implications for quality of care. There is a lack of research concerning how student nurses' knowledge development is expressed through narratives and how they deal with challenges in patient situations in professional learning. ObjectivesTo clarify the usefulness of narratives in student nurses' knowledge development and the narratives implications for learning in clinical training. Design and methodsThe study has a qualitative design with field methodology. Data consisted of observations, interviews, and fieldnotes. The data was analysed, and narratives were developed using Gadamer's hermeneutical circle. Participants and settingsSeven first- and second-year student nurses from a bachelor programme were closely followed in different patient situations during their eight weeks of clinical studies in nursing homes. ResultsIn a sample narrative, a student nurse explained how she reflected on her actions and decisions made when she shielded a patient who was in a difficult situation. ConclusionNarratives are useful for the development of student nurses' knowledge in clinical training. Student nurses' decisions and actions in the patient situation are made evident through narratives. Nursing educators and student nurses awareness of the relevance of this knowledge for understanding student nurses learning processes is of importance in professional education. Nursing educators should be more open minded to narratives as a starting point for reflection. Increased use of narratives in professional education will contribute to development of knowledge so that student nurses can manage to face patient situations as long as the situation themselves demands. Areas for further studies are other professional educations, for examples, doctor, physiotherapist, and occupational therapist.