15 January 2021
This interview with Adelaide Forensic Nurse Practitioner Tracey Markham is a slightly abridged version of an article originally published by The Nurse Break. The Nurse Break is an Australian nursing blog that interviews nurses and
students from across Australia. Check out their website here: www.thenursebreak.org.
Meet Tracey Markham! She is currently a Nurse Practitioner, Interpersonal Violence Forensic Nurse, at Yarrow Place. This is an extremely unique and rare role in Australia. This is a MUST read, especially if you’re interested in forensic nursing, sexual health nursing and correctional/mental health nursing.
Tell us about yourself and what inspired you to move into forensic nursing?
My nursing career to date spans over 25 years, across a diverse range of roles and practise settings including acute hospital, Detention Centres, Drug Court, Mental Health, Prison Health.
Having always had a love of crime, law and mystery I completed a certificate of Forensic Nursing at Flinders University in 2003 and by the end was the sole graduate – as at this point forensic nursing was in its infancy and unfortunately still is in South Australia.
Having developed a real passion in this field, I persisted and looked for a niche where I could practice ‘anything Forensic’. I saw a new job opportunity of being a crisis worker at Yarrow Place, supporting women and men who had been sexually assaulted. As a nurse with passion and a feminist point of view I thought I could do more and worked tirelessly to create the role of sexual assault nurse examiner within Yarrow Place. I have been in this role since 2014 and in this time has seen over three hundred women and men providing them with a forensic service and medical care.
I also provide clinical leadership, education and support to metro and county nurses who conduct forensic medical examinations in Whyalla, Mt Gambier and the Riverland.
I have completed post-graduate qualifications in Mental Health, Management, Sexual Health, and also the USA based Sexual Assault Nurse Examiner Training Program through Duquesne University, Pittsburgh. Eager to learn and push the role of forensic nursing I have completed studying a Masters in Nurse Practitioner through Flinders University and is the first Interpersonal Violence Forensic Examiner Nation-wide.
What is a forensic nurse and how do you become one?
A forensic nurse is a Registered or Advanced Practice Nurse who has received specific education and training. Forensic nurses provide specialised care for patients who experience acute and long-term health consequences associated with victimisation or violence, and/or have unmet evidentiary needs relative to having been victimised or accused of victimisation.
Forensic nurses provide consultation and testimony for legal proceedings that are either civil or criminal in nature and relate to nursing practice, care given, and opinions rendered regarding findings such as injury interpretation. Forensic nursing care is not separate and distinct from other forms of medical care, but rather integrated into the overall care needs of individual patients. It is where the health of a person and the legal systems intersects.
In Australia, Forensic nurses work in a variety of fields, including sexual assault, domestic violence, child abuse and neglect, elder mistreatment, corrections, and forensic mental health. In the United States, where forensic nurses have been practising for over 40 years, forensic nurses most frequently work in hospitals, community anti-violence programs, coroner’s and medical examiners offices, corrections institutions and in the aftermath of mass disasters and death investigation.
There are forensic Nursing courses at some University’s in Australia; there is a master of forensic nursing at Notre Dame, Swinburne University has a Forensic mental health course and NSW Education Centre Against Violence (ECAV) has a graduate certificate Medical and Forensic management of adult sexual assault. Internationally there are many courses.
Even if you do not have a specific role as a forensic nurse having the background knowledge assists you in thinking differently and providing care differently. As health professionals when someone attends hospital inadvertently we destroy evidence on victims or offenders. Forensic nurses are well placed within an emergency department as with a little bit of knowledge you can give great care at the same time as preserving evidence.
Training as a forensic nurse assists with helping to identify what is evidence and use forensic language to describe wounds and then record the evidence and collect the clinical notes that will withstand judicial scrutiny.
Where do you work and which members of the multidisciplinary team do you work closely with?
I work for the Women’s and Children’s Health Network which is a public hospital in South Australia, I work in one of the hospital’s communities divisions; Youth, Women’s Safety Wellbeing Division (YWSWD). YWSWD has a focus on health care for people affected by violence, it is victim-focused, client-focused and consists of a few services.
My Youth Health – see vulnerable young people 12 to 25 years they provide medical services, therapeutic case management, counselling, groups, aboriginal health, young parenting programs and provide medical and nursing services in Adelaide Youth Training Centre, Women’s health (soon to have a name change) provide specialist services to women affected by DV, including counselling and health.
Multi-Agency Protection Service – supports the local health care response through sharing information to reduce risk and harm of DV – referrals direct from SAPOL.
Yarrow Place Rape and Sexual Assault Service – provides provision of medical, forensic and counselling services to people who have been raped and or sexually assaulted. Our divisions work closely together and often refer to one another depending on what the best outcome for the client is. Each service works in a multi-disciplinary team consisting of Doctors/ nurses/ social workers/ Aboriginal Health workers and admin staff.
What is your scope as a nurse practitioner in this field?
My scope is interpersonal violence, this includes providing health care and forensic care to people affected by sexual assault, domestic violence, elder abuse, at times assisting with post mortem examinations, giving expert evidence to the court as a witness, giving an opinion on other cases, providing outreach domestic violence and sexual assault clinics.
As a nurse practitioner, I can practise independently and diagnose, provide treatment and prescribe medications to people that fall under this scope. Many of the medications I would prescribe would be in a prophylactic way or at a follow-up appointment. Many of the medications are to prevent pregnancy, prevent HIV and other STIs.
Another aspect of my role is training. I do a lot of training of other staff and support staff new doctors and nurses in this area. I provide ongoing support and leadership to Rural areas and we have created a hub and spoke model so victims of sexual assault can get a service closer to home in=f they are a rural client.
How did your career in correctional and mental health nursing prepare you for your current role?
My career in corrections was one of the reasons I wanted to work in sexual assault and with vulnerable victims. Many of the men and women I came across had many adverse childhood experiences (ACEs) which have a tremendous impact on future development and future violence victimisation and perpetration.
Some of the main ACEs that occur in childhood that undermine a child’s stability or safety are witnessing violence – either in the community or in the home, drug use in the home, mental health issues, being abused or neglected, having someone close to either murdered or attempt suicide.
What I am saying is many of the people incarcerated were victims of violence before being a perpetrator of violence. Once in prison (which in most cases is punitive rather than rehabilitative) it is definitely a case of a fight, flight or freeze, these people live there and have to deal with ongoing victimisation daily. There are many allegations of rape in the prison that go unreported for a variety of reasons none of them good. I in my naivety wanted to change this or at least give a good response to those who required health care.
Working in prison health was an excellent experience and I grew as a nurse and did a variety of roles. We often had no medical doctor so you had to respond to all emergencies, run daily clinics, do mental health assessments and be quite independent. Mental health is a tool everyone should learn and do a rotation through, as it underpins people’s behaviour so having a greater understanding of this is only a benefit in how you care for someone.
What are the steps involved in a forensic examination?
There are 7 main steps to a forensic examination (FME).
- Obtain informed consent – there are 3 parts to the consent, consent
to medical care, consent to the forensic exam we have the power to do
this under the criminal law forensic procedure act 1935 and consent to
give the information and evidence collected to the police as part of
their investigation.
- Conduct a patient history (both medical and forensic) – history is
collected in patients’ words and this guides medical care, forensic
collection and where to look for evidence. Direct questions are also
asked to seek further information.
- Head-to-toe physical assessment – this is thorough looking for injury, in the hair, mouth, ears, all body surfaces.
- Detailed anogenital assessment – this is an external and internal examination with a speculum and proctoscope (if necessary)
- Collect evidence – we collected evidence by rolling swabs over
surfaces of the body that may have been touched, kissed, licked, bitten
or touched with bodily fluids, urine and blood are also collected and
anything else unusual found on the body that could be related to the
assault. Clothing that is damaged has debris or any fluids is also
collected. Photography of any injuries is collected.
- Offer treatment and medications – treatment for any minor injuries,
referrals for larger injuries. Prophylactic medications are offered for
emergency contraception, chlamydia, Hep B and HIV.
- Provide discharge instructions – instructions on how to take
medications and possible side effects. Letters to a GP or other health
professionals if the patient requires. Appointment times for follow up
with our service or another service if necessary. Referral numbers for
client’s safety and or counselling, these could include homelessness
services, mental health services, 1800 respect and lifeline. The FME can take anywhere between 2 to 4 hours, it can sometimes take
longer depending on the number of injuries or other complications such
as mental health.
What are the main types of patients you see and what is the forensic nurses role?
The people I see have been victims of a crime. I see men and women over the age of 15 who have been raped and or sexually assaulted and or in a family and domestic violence situation. I provide the provision of forensic care and or medical care.
The forensic examination has several objectives: ultimately it is done as part of an investigation to assist police and the courts in prosecution. However, it is much more and each examination can take up to 2 -4 hours and sometimes longer depending on the circumstances. Other parts of the examination include:
- Crisis intervention, support and advocacy
- Information gathering from the victim for forensic medical history;
- An examination including head to toe medical assessment;
- Coordination of treatment of injuries;
- Documentation of biological and physical findings; written documentation and photographic;
- Collection of evidence from the victim’s body; including swabs, blood, urine, other debris;
- Information, treatment and/or referrals for sexually transmitted infections, pregnancy and other non-acute medical issues;
- Follow-up care as needed to facilitate additional healing, treatment or collection.
Another part of my role is I provide medical care in an outreach capacity; these clinics are like pop up clinics usually held in Non-Government Organisation (NGO) domestic violence sites but are not limited to other sites such as hospitals, other institutions, Yarrow Place, Women’s Health sites.
The outreach clinics were developed in recognition of poor health outcomes for people who experience interpersonal violence. Consistent and comprehensive engagement with a GP can be difficult due to the controlling nature of the violence and the possible frequent relocations to improve safety.
As such, it’s a must draw on general knowledge and clinical skills to conduct a proficient health assessment acknowledging the health impacts of interpersonal violence. I provide best practice by remaining up-to-date with current women’s health issues (contraception, sexual and gynaecological health) and general men’s issues around STIs, domestic violence and sexual assault and ultimately ensure safety and mandatory obligations are met, using the family safety framework risk assessment (FSF) CARL notifications and mental health assessments when necessary.
There is no specific population group, SA and DV occurs across all socioeconomic and demographic groups however predominantly affects women and children, I am not at all saying it doesn’t happen to men, it does and probably much more than the reported numbers.
There are groups that are more vulnerable to violence these groups are; people with disabilities, elderly, Aboriginal and Torres Strait Islanders, people from culturally linguistic backgrounds, children, people in prison and the transgender community.
What are the most common types of injuries, assaults or abuse you see? And can you tell us about the photography of evidence?
Types of assaults vary as do injuries, majority of injuries I see are bruises, petechiae bruises, abrasions, lacerations on the body and within the anogenital area. Injuries are not seen on everyone and only about 50% of people we see have a genital injury.
Sometimes there are significant injuries that require surgical intervention, thankfully these injuries are less rather than more. It is important to remember medical care always trumps forensic care.
Many of the people I see have either been sexually assaulted/raped or are in or were in an intimate partner relationship that was affected by violence. Common injuries that would be seen are bruises from blunt force trauma, abrasions from blunt force trauma and friction, lacerations from blunt force trauma usually resulting in a full-thickness injury caused by tearing or splitting of the skin, incisions from sharp objects such as glass or stab wounds.
Any physical injuries we see we take photos of. The Photography rule is 3 photos per injury or cluster of injuries. The first photo is to show the anatomical location of the injury, the second photo you use a measuring tool and colour chart and the third photo you would take a close up.
Other types of common violence that people might not think about as it often doesn’t leave a scar you can see but probably causes more long term health problems is controlling behaviour, psychological abuse, financial abuse, emotional abuse, visa abuse and technological facilitated abuse.
One of the injuries I would like to talk about a little more is Strangulation; it is probably more common than people are aware of. Strangulation can be potentially lethal; they say it’s the last warning shot of escalating violence.
Strangulation can lead to ongoing health problems, such as stroke and even death. When you think about the anatomy it is understandable as strangulation is defined as the obstruction of blood vessels and/or airflow in the neck, resulting in asphyxia.
The result of Asphyxia is Hypoxia and Anoxia. Hypoxia means oxygen is not reaching the tissue and Anoxia is the absence of oxygen supply to tissue. A small child could kill someone by strangulation as long as they had all the variables in place to make it lethal: anatomical location, quality of applied force, duration of applied force and surface area of applied force.
Estimates in research state that it takes approximately 4 pounds of pressure to block the jugular vein and only 5-6 pounds of pressure to Pull the trigger of a gun. It takes 11 pounds of pressure to block the carotid artery and up to 20 pounds of pressure to open a can of soft drink. 33 pounds of pressure to block the trachea/airflow and approximately 80-100 pounds of pressure of an average male handshake. Like I said these are estimates and depend on several other variables such as age, current health and medications they may be on but it shows you how easy it is.
I was lucky enough to do some training in Florida several years ago with professionals from the Strangulation Institute in San Diego – they run courses for first responders worldwide. Many Australian states are now recognising the seriousness of strangulation and injuries that can occur and the risk of death. A number of states around Australia have changed their legislation to reflect this. South Australia changed its legislation in 2019 and in the first 6 months over 300 people were charged under the new laws, if prosecuted successfully it can hold a maximum sentence of up to 7 years.
Medically it is important to know only 50% of people may have a visible injury from strangulation and just because you can’t see it does not mean it isn’t there. Injury can occur several days after the strangulation incident and people can walk around with serious injuries and not know it but be at serious risk of stroke and or death. Further investigations such as CT angiograms, MRIs and flexible laryngoscopes play an important part in the investigation of injuries.
What is the forensic nurse’s role in court and police proceedings?
It is the client’s decision if they want the police involved. If they do the evidence collected as part of the examination becomes part of the police investigation. But of course, the police investigation is much wider than the forensic examination. The examination can collaborate how a person stated they got injuries, it can sometimes provide DNA which can collaborate that something sexual occurred. Consent around the assault will be determined by the investigation.
Rape itself is not a diagnosis, so I am unable to tell someone this occurred although I can say if the examination was normal or not. Not having any genital injuries does not refute the fact that a sexual assault took place.
Often after doing a forensic we are asked by the police and DPP to write an affidavit in preparation for court. Included in an affidavit is: Your qualifications, Include work history, current role, how many examinations you have completed, the background of assault, information provided by the victim, information obtained from direct questioning, information relating to your general examination, discussion of injuries and any photos you may have taken relating to the injuries, Ano-genital examination (if applicable) and then you would write a conclusions/opinions/comments.
You may be asked to go to court as a witness to give evidence on the examination. It is not usually something you can get out of. In my workplace, it is part of the role so a subpoena is not required and we often have to attend face to face, some states attend court via video link. I have done this on one occasion as I was in the country training at the time.
How do you personally cope with the trauma you witness?
Sometimes internally I get angry for a bit, it’s sometimes hard to acknowledge the awful things people can do to one another and why. I get mad that offenders blame victims and that victims blame themselves and mostly this is because of myths and what society allows.
But it’s like any nursing job you need to leave the things you see at work and not take them home. Self-care is important. I can always debrief with my colleagues. We also get 2 hours a month where we get time away from work to do something nice for ourselves and I don’t mean go and do the food shopping.
It is a formal documented process. I get great support from my family and I have a really understanding husband who listens to me, I also have 2 Labradors that I love to run with, I go to the gym, bike ride and watch really bad TV to relax.
How do you assist people who have experienced cumulative trauma? How can nurses support patients who have experienced DV?
So many people have cumulative trauma. This is something I am really passionate about. Imagine what could be achieved if all nurses were as informed about IPV as they are about diabetes management or cardiovascular health.
Using a trauma-informed approach is a start. You don’t need to be a counsellor to provide a good first response. Crisis intervention needs to be prompt and works to contain rather than extend and explore. And most importantly you can only do this if you know how to deal with the response.
A few other helpful things are to keep personal bias in check. People with complex trauma can bring ‘baggage’ to a medical appointment, things like distrust of authority figures, fear and anxiety, difficulty with emotional regulation, discomfort with persons who are the same gender as the perpetrator, triggers, dissociation, physical pain, ambivalence about the body, conditioning to be passive, difficulty understanding boundaries we often label this patient as non-compliant, with a personality disorder.
What are some red flags/things nurses in the community/hospitals can notice that might flag DV/assault?
All patients should be assessed, emergency departments, prenatal appointments etc are an ideal place for screening people.
Ways to empower people are:
Always start by believing
- Acknowledge
- Validate
- Avoid blame
- Return control
- Promote recovery
- Provide options, information and support
Use value statements :
- Domestic violence and sexual assault are criminal offences.
- The victim is never responsible.
- The perpetrator is a 100% responsible.
- Everyone has the right to feel safe.
- Domestic
violence and sexual assault involves the exploitation of the
vulnerability, a betrayal of trust and the misuse of power.
- Victims/survivors have the potential to overcome or manage the effects of domestic violence and sexual assault.
What are some traits that make a great forensic nurse?
The first things that come to mind for me are being trauma-informed, victim-focused and having a passion for the area of work. When I interview someone I really want to see passion and commitment – you have to want to do this job otherwise you probably won’t last doing it.
Other skills that are required are great communication skills, good clinical assessment skills, patience, flexibility, empathy but always having the ability to remain objective and neutral. Having experience in sexual health, mental health, drug and alcohol are also a bonus. You need to be good at taking care of yourself, resilient and recognise vicarious trauma as the work is emotionally draining and demanding, it is not glamorous as some TV shows make it out to be!
What is one myth or common misconceptions that you want to debunk about your area?
Oh, there are many, I can’t stop at one….What were you wearing? It’s a common one and very annoying. Were you drinking? Are you sure? Did you fight back, why didn’t you say no! Were you flirting, what were you doing to provoke it?
Myths have a silencing effect and discourage actually naming and identifying the crime of rape and sexual assault. It also minimises the offence.
Put these myths in the context of other crimes and they immediately seem ridiculous. E.G. your wallet was stolen – what were you wearing/were you flirting with him? Rape and sexual assault are one of the only crimes where the victim has to prove that it happened.
What are the most rewarding and difficult aspects of your area of work?
The most rewarding aspect for me is providing a service to victims of this crime that can be debilitating, sometimes life-altering and is such a violation of someone’s rights. Allowing the victim space to talk and be believed is empowering. Sometimes you can see the shift in people throughout the consultation, they might come in very reserved/ flat and feeling guilty and they leave knowing it wasn’t their fault, that they were vulnerable, not responsible and that they have a little control back.
The difficult aspects are definitely some of the stories you hear. How society reports/ reacts/ victim blames and how some people feel they have the right to do whatever they want to others. Knowing that some people’s lives have been or are filled with such horror is heart-wrenching.
If I can give a little of myself, a little care and make a smidge of difference then it’s a good day
What are your suggestions on responsibilities for ED staff in relation to evidence management/collection so on before forensics arrive?
This is a great question and there has been a bit of research on this particular question. Unfortunately, doctors and nurses who are first responders in an emergency department haven’t always fared well. With the conclusion being, patients expectations haven’t been met particularly in regards to psychological support after a sexual assault.
It is common that victims of sexual assault often seek assistance in an emergency department so there are a number of things nurses in ED can do to assist with the patient, assist with the forensic examination to help prevent contamination and preservation of evidence which assists in the process of the person if they wish to pursue legal proceedings.
First of all start by believing, always responding to the patient letting them know you believe what they say no matter what your personal thoughts are. Keep personal biases and myths to yourself, they are not helpful. Explain your role, limitations of your role and be fairly transparent. Provide the person space to talk if they need to make sure they are comfortable and in a private space (EDs are not very private spaces at times).
Don’t start questions with ‘why’ it sounds very judgmental. Sometimes after a trauma people can be quite hyper-vigilant about loud noises, bright lights, the gender of a person. I always ask my client ‘Are you ok that I am female and about to examine you’. Validate the person’s feelings, let them know that they are brave, that they didn’t do anything wrong, that rape is a crime.
Provide them with options and choices but don’t make decisions for them – this gives them some power back. This is a really important first response. A good first response helps promote recovery. You don’t have to be a counsellor, the first response is more about containing the situation rather than exploring.
One of my favourite quotes by Maya Angelou is ‘I’ve learned that people will forget what you said, people will forget what you did, but people will never forget how you made them feel’. It’s true, especially when they are feeling vulnerable and stuck in their own trauma. Sometimes patients have multiple past traumas and complex issues which can affect the way they present as they already have a distrust of professional people.
In regards to forensics a good rule is, every trauma patient that comes in should be treated as a forensic patient until proven otherwise. always wear gloves to prevent DNA contamination. If a client is needing to get undressed, put their clothing in separate paper bags, these could be sealed with the date and time. If the client needs to go to the toilet, get them to do a first pass wee, seal, sign and date and leave with the client – this will help maintain the chain of custody.
If someone has a wound the medical care of that wound trumps forensic care but good documentation, a photo (even if the client took it themselves) prior to cleaning/suturing would be helpful. If you had to cut clothes off due to that wound not cutting where the rips/tears are from the injury is also helpful for the forensic scientists and police when examining things as it can help understand mechanisms of injury
Many rural areas especially lack this service. Did your employer advertise for your position or is there room to create your own role?
So when I started in this area of work there was no role for a nurse in South Australia, I thought there should have been. I took the role as a crisis response worker as it was a way I could get my foot in the door. I then got some daytime hours as a duty worker. I kept speaking to (maybe bugging) the manager of the service and doctors I worked with and stated that I would like to do the medical side of the role, I was told no for quite a long time as it was a medical consultant role.
It was even suggested to me if I wished to work in the area I should become a social worker. This was not a satisfactory answer to me as I knew I could do this job. I had studied forensic nursing 10 years prior, had done the RTO course ‘provision of forensic and medical care to those who have been raped and sexually assaulted’ through Yarrow Place and had also completed a sexual assault examiners course through a university in America.
I started to attend medical meetings in my own time to show my interest and let them know I was serious. I then started writing standing medication orders, a job and person specification and a justification for the role of the nurse, I was also helping with training. Thankfully it was a time when not many doctors were applying for the role and I got a yes from the medical team. My position was then put up through the hospital and a new position was created. I commenced doing forensics from then on and my position has only evolved over time.
What pathway would you like to see the future of your profession take over the next 10 years?
Definitely more nurses doing this work and forensic nursing being seen as a speciality area. It would be a dream come true to see more education in the Bachelors of Nursing degree. It would also be great to see this be a credentialed role, much like a mental health nurse or a midwife.
More emergency departments responding to rape and sexual assault, victims not having to travel so far or receiving a bad experience along the way.
Another thing I would like to see is a change on admission forms and assessment forms – asking about past trauma/ DV and sexual assault and a pathway for nurses/ medical officers to be able to assess, recognise and respond appropriately. Domestic and or sexual violence and childhood trauma are not diagnoses but it can certainly be the catalyst of creating many medical problems.
What are some great resources that have helped you along the way and who are the 3 people who have been most influential to you and why?
Great resources are: International Association of Forensic Nurses (IAFN), American Forensic Nurses (AFN), End Violence against women International, Forensic and Medical Sexual Assault Clinicians Australia (FAMSACA) are organisations that I do a lot of education through. I also have some colleagues in the US whom I keep in touch with, learn from and am constantly inspired by.
Virginia Lynch is recognised as the founder of forensic nursing, and I got to meet her (she probably doesn’t remember) I was so excited I sat next to her at dinner after a conference we had been at. She recognised the need for nurses to be enlightened about the preservation and relevance of forensic evidence back in the early ’80s. She had a vision ‘beyond tradition’ of nursing practice and that was inspiring to me. Her resume is my dream….one day!
Can I say all the people I work with at Yarrow Place, the Doctors who have taught me so much, pushed me to be better, encouraged me in my practice and accepted me (eventually) into their team…(I’m not sure I gave them much choice, I was like a bad smell hanging around).
The social workers who are so trauma-informed and great advocates of vulnerable victims. They listen to people’s stories, normalise their feelings, making them feel brave and encourage them to get through the aftermath of the assault by allowing them to make informed decisions. The admin team who make my job easier on a daily basis and are the front line workers of our office. They are the first kind voice or face that the client sees when they walk in and make them feel less nervous.
Also the Director of YWSWD is. It is a bunch of men and women who provide a timely approach with a feminist analysis of rape and sexual assault with a victims rights approach. Clients inspire me and are influential to who I am, they make me want to be better to do my job better. I am inspired by people who have so many traumas in their lives and come out the end smiling.
How can we work better with other health professionals in the multi-disciplinary environment?
Rape and sexual assault should always be a multi-disciplinary response as teams convey many benefits to not only the health professional but also the patient to bring about a better health outcome.
At Yarrow Place, the admin worker, social worker and medical clinician are the first points of contact and the social worker and medical clinician do the response together. The social worker takes care of the psychosocial/ emotional needs while the medical clinician takes care of the medical needs together and we provide a holistic response.
Following a response, it is up to the client who in the team is involved. It is ideal if the client has regular care from someone if they are aware of and involved in ongoing care. This could be their GP, psychiatrist, psychologist, mental health worker, Aboriginal health worker, an allied health worker.
If you would like to read the original article on The Nurse Break, just click here.