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Beyond the needle.

The nurse's role in pre-travel counseling

Editor's note: The following information was submitted to NANB in response to an "Ask a Practice Advisor" article on pre-travel immunization which appeared in the spring 2006 edition of Info Nursing. Nan Cleator, national practice consultant, client services team, VON Canada, offers additional information to nurses in determining whether they have the required competencies to administer a vaccine. Ms. Cleator pointed out the following in her letter sent to the Association: "In closing, as a pre-travel consultant, I was delighted that you thoroughly addressed the professional steps for providing immunization. I hope ... [the following] will help in thinking beyond vaccine (or the needle)."

In general, the practice advisor's response to the question was comprehensive and helpful. However, because the subject is "travel immunization," some additional words of caution might be useful for nurses who are trying to determine if they have the "knowledge, skill, and judgment required to assess the appropriateness of the vaccine."

The Public Health Agency of Canada (PHAC) supports a Committee to Advise on Travel Medicine and Travel (CATMAT) (http://www. catmat-ccmtmv/index.html). CATMAT provides competency guidelines and information for health professionals who provide services to travellers. According to CATMAT, it is estimated that out of 1,000,000 Canadians who travel to tropical destinations annually, less than 10% seek pre-travel medical advice. A significant increase in the number of Canadian travellers who have acquired malaria abroad reflects this situation. In 1997, more than 1,000 cases of malaria were reported in Canada, compared to 430 cases in 1994. There is no vaccine that protects against malaria. Recommendations for prophylactic medications are region specific and guidelines for avoiding mosquito bites are important.

Malaria is not the only hazard. Pre-travel nurses assist clients to avoid severe illness through region specific counseling (For example, how to avoid contaminated food and water, sexually transmitted diseases, and so forth.). They also provide information about the prevention and management of non-infectious risks such as:

* the effect of travel on current medical conditions (for example, diabetes mellitus, cardiopulmonary disease);

* travel-associated illnesses (for example, motion sickness, jet lag, barotrauma);

* environmental illness (for example, sun, heat, cold, pollution, altitude);

* threats to personal security;

* modes of transportation and their dangers (for example, motorcycles, private vehicles, public transport);

* trauma (for example, injuries, accidents); and

* psycho-social issues of long-term travel (for example, culture shock, adaptation).

Pre-travel medicine is an emerging specialty. In the "Guidelines for the Practice of Travel Medicine" (CATMAT), there is a caution about general health professionals providing pre-travel advice.

Concerns about the quality of advice provided to Canadian travellers have been presented. Anecdotal reports and several studies suggest that many Canadians are receiving pre-travel advice from health-care practitioners who are ill equipped to provide up-to-date advice; in fact, incorrect advice provided to some Canadian travellers has led to severe consequences, including death.

Nurses who advise Canadian travellers need the most current and practical information on the prevention and treatment of travel-related diseases and illnesses. The PHAC through CATMAT designates and monitors pretravel clinics. Only clinics designated by CATMAT have the authority to administer Yellow Fever Vaccine and provide International Certificates of Yellow Fever Vaccination.
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Title Annotation:The nurse's role in pre-travel counseling
Publication:Info Nursing
Geographic Code:1CANA
Date:Mar 22, 2007
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