Abstract Community health nursing is a discipline bearing a pivotal role in the wellbeing of people in a given society. Community health risk assessment is one of the roles in nursing mainly for ensuring disease prevention and good outcome of services offered by practitioners. Implementation of a community health risk...
Foundation of the Study Hospitals and medical institutions face several organizational challenges, and one of them is the inability to retain employees, especially nurses (May, Bazzoli, & Gerland, 2006, p. 316). The following study will be aimed at explaining the origins of this problem. The findings of this research can...
Reflection occupies a significant place in nursing and is actively encouraged to withdraw conclusions, discover new insights, and consider further actions. Reflecting should be purposeful, focused, and should raise significant questions (Nicol and Dosser, 2016). Reflection entails a certain level of mindfulness and can be referred to as the ability...
As a registered nurse who was willing to embark upon the path of knowledge improvement, I was passionate about continuing my educational journey and obtaining a BSN degree. Thus, in 2018, having formed a sober estimate of my resources, such as free time after work, I started the RN-BSN program...
Introduction Nurses have an extremely challenging job that demands not only medical but also cultural knowledge. Nurses work with people from various backgrounds and can experience misunderstandings with patients whose background is different from their own. Therefore, it is vital for nurses and other medical professionals to be aware of...
Introduction The process of teaching future professionals is always associated with challenges and risks. However, in the sphere of healthcare education, these challenges are more numerous. Those who decide to become academic nurse educators (ANEs) have to be fully committed not only to the teaching dimension of their work but...
The article in question, published in 2017, dwells upon the relationship between oncology nurses’ burnout and their personality traits. The purpose of the study was to measure the level of oncology nurses’ burnout, evaluate the stage of their burnout suffering, and analyze the correlation between personality traits and burnout (De...
Performance Scorecard Identification of the Patient Population Anoka-Metro Regional Treatment Center (AMRTC) provides inpatient psychiatric care to adult men and women that require hospital-level treatment and supervision. These individuals exhibit a variety of diagnoses that cannot be treated within a standard community hospital. According to Vollm et al. (2018), the...
A clear understanding of the roles that a nurse plays in the hospital environment allows making the performance as effective as possible. The communicative aspect of a nurse’s role is particularly important since it helps to obtain crucial information about a patient’s well-being faster (Norouzinia, Aghabarari, Shiri, Karimi, & Samami,...
Summary of the Interview The interview was conducted in the hospital… and Ms. Gordon agreed to be a participant. The interview questions were prepared in advance, and the answers were recorded; moreover, some issues were also clarified by phone to collect all the necessary information. Ms. Gordon is a geriatric...
Abstract The medical discipline seeks to skillfully get the dynamic relationship as a premise for activity and reflection to gain positive health directions and information that encourages future engagement and thought. Working with different categories of patients, a modern nurse creates an atmosphere of respectful attitude to the patient’s past...
Introduction The introduction of medical informatics dates back to the mid-1970s, though some studies were conducted already in the 1950s. In recent years, several types of research have shown that a large number of fatal events in healthcare structures could have been prevented through the broader use of electronic health...
Nurses have many responsibilities within a hospital as they assist doctors in procedures and monitor patient’s condition during the entirety of their stay in the hospital. One of their primary responsibilities is delivering medication, and failure to administer it is among the most severe mistakes a nurse can make. This...
Introduction Carol Huston predicted the most crucial nurse leader competencies, which would be required for 2020. These are a global perspective of healthcare development, technology skills, decision-making ability, managerial abilities, staying current with political processes, team building skill, the capability of keeping the balance between authenticity and performance expectations, and...
Introduction The management of long-term care facilities can be challenging due to the specific services provided by these units. It is essential to consider the peculiarities of long-term care to ensure the provision of high-quality services and proper performance of the unit. Such areas as staffing and quality often require...
Case Facts The case concerning a patient who was prescribed an unusually large dosage of insulin, 80 instead of 8.0, is a medication mistake issue that requires immediate attention both from staff and leadership. The problem is alarming because the administration of a large insulin dosage can result in nausea,...
One of the principles of informed consent is the requirement to tell patients the absolute truth about their illnesses, as well. Moreover, the law requires that the patient should be provided with information about interventions and possible complications. The nurse’s role in this matter is hard to overestimate since they...
The Texas Board of Nursing outlines the roles of both licensed vocational nurses (LVNs) and registered nurses (RNs). An LVN provides patient-centered care to patients with basic healthcare needs. This is achieved through the collection of data and the performance of focused evaluations, assisting in the planning and modification of...
Besides being professional in a specific medical field, a nurse should be aware of different psychological principles. Sufficient knowledge of psychology allows a healthcare worker to establish a closer connection with a patient and provide more effective medical care. At the same time, the basics of psychology help understand the...
The main task of a nurse is to assess the patient’s state correctly and offer optimal treatment. For this purpose, a nurse performs mandatory steps called the nursing process, and most often, they form a cycle rather than a linear sequence (Yoost & Crawford, 2019). These steps are assessment, diagnosis,...
Abstract The purpose of this theoretical framework is to indicate concepts, theories, and models which guide the realization of the capstone project on the topic of improving hemodialysis treatment adherence by removing barriers and providing patient education. The concepts important for the project include treatment adherence, treatment non-adherence, barriers, patient...
The turnover rate for high-level nurse practitioners, which is considerable, tends to be higher compared to their lower-level counterparts (Shi & Li, 2016). Newly recruited nurses usually exhibit an increased turnover rate due to a poor level of satisfaction with their jobs. Therefore, it can be stated that human resource...
The Doctor of Nursing Practice (DNP) program lists several categories of competencies that a graduate should master; these categories are described by the American Association of Colleges of Nursing as part of the essentials of doctoral education for nurses (AACN, 2006). Helpful strategies for evaluating these competencies are self-assessment and...
Data Collection Research problems can help researchers decide the most appropriate methodology for their study. Methodologies that create the structure to conduct a study and analyze its data bring new understandings of the research problem (Charmaz, 2006). This research study will use the methodology of constructivist grounded theory, which allows...
Introduction The political and economic environment seems to greatly affect the nursing practice. There are several domains of nursing that can be influenced by changes in those spheres, namely: interprofessional healthcare, nursing management, and interpersonal relationships. Identifying how these areas can be affected by changes in the political and economic...
Roper-Logan-Tierney model of nursing, widely employed in the United Kingdom, is based on the research conducted by Nancy Roper in 1970. One of the key strategies used by this model is evaluating the patient’s performance in regard to 12 specific activities of living, among which are mobilizing, breathing, eating and...
New Employee Orientation Blueprint Background Transition to a new workplace is associated with significant stress, together with decreased effectiveness and efficiency of employees (Strauss, Ovnat, Gonen, Lev-Ari, & Mizrahi, 2016). Stress may lead to a significant drop in the quality of care due to mistakes and missed treatments (Strauss et...
Life and death have always been topical matters for the humanity. While each person may consider his or her own mortality at some point in life, terminally ill patients begin to look at the matter from a different perspective. Some of such patients become desperate enough to resort to suicide....
Introduction The given research will primarily focus on the validity of online nursing education as well as analyze the main pitfalls of such an approach. The study is significant because modern education is shifting towards an online format under the current COVID-19 pandemic and social distancing measures. Therefore, it is...
Abstract Midwifery practice involves an intermediary role of promoting collaboration between all stakeholders, especially between family members and health care practitioners. Midwives inform the patient and family about the possible risks associated with the pregnancy, coordinate advanced care for complicated cases, and offer family support. They quell anxiety and stress...
The quality of nursing services provided to the future mothers depends not only on the qualification of midwives, though the latter issue also matters significantly, but also on the efficacy of information transfer from midwives to patients and vice versa. More importantly, the significance of establishing an efficient feedback system...
Shortly, midwives are expected to face new challenges in perfecting their responsibilities as partners, practitioners, and leaders in maternity care provision. Among the areas where the practice of midwifery is anticipated to be extremely challenging is in ensuring effective communication with all involved stakeholders. Since midwives provide vital care not...
Overview The described scholarly activity is concerned with designing, implementing, and evaluating a patient experience initiative in the hospital. The project is based on the results of the HCAHPS scores and domains. The initiative focuses on three primary issues that the facility has to reform. The first one is the...
Issue Identification Nursing Schools and Regulation Concerns The process of managing staff-related issues while opening and closing nursing schools, as well as handling problems associated with student debt, providing relevant information to students, and more, are admittedly complex since they require a perfect understanding of how a nursing school is...
Introduction American society like any other industrialized country has to face major public health issues. Such diseases as cancer, cardiovascular disorders, diabetes are regarded as some of the primary areas of concern. Obesity is one of the major issues to address as over two in three adult Americans are obese...
Introduction Healthcare practitioners increasingly acknowledge the need to make patient-centered care (PCC) a part of their everyday clinical practice. A growing recognition to embrace PCC as a core of new models of care delivery is also evident among governments, international healthcare organizations, and lobby groups (Kitson, Marshall, Bassett, & Zeitz,...
Introduction Training opportunities are integral for nurses in all countries. Nurse knowledge and skills have to be constantly improved to provide patients with high-quality clinical care. This research proposal aims at developing a plan for a future project about the peculiarities of e-learning platforms, their application in emergency triage in...
Introduction As methods for analyzing concepts have proliferated in nursing, a critical method ological issue has arisen. Analytic techniques for examining conceptual meaning have incorporated varied strategies for advancing the concept under the rubric of concept analysis, concept development, and theory building. The authors argue that this evo lution has...
Health care informatics is one of the aspects a qualified nurse should consider in working toward evidence-based practice and quality improvement (American Association of Colleges of Nursing, 2006). The American Medical Informatics Association (n.d.) defines nursing informatics as the “science and practice (that) integrates nursing, its information, and knowledge, with...
Week 1: 8/30-9/5 The first week of applying the newly acquired skills to practice was admittedly the most difficult one due to the amount of information that I had to process and the range of issues that had to be addressed. It was clearly the most informative stage of my...
Introduction The present paper is devoted to the investigation of the advanced nursing practice (ANP) leadership from the perspective of the ethic of care (EC). The paper includes a discussion of EC, which is structured to demonstrate its difference from the ethic of justice (EJ). This comparison allows pinpointing the...
Introduction The need for cost-effective care is increasing as total healthcare expenditures grow. Healthcare providers are challenged with evaluating scientific evidence to inform a practice change aimed at improving patient outcomes. Being a costly yet mostly preventable complication, hospital-acquired pressure ulcers (hapus) cause much suffering to patients in acute care...
Week 1 The goal during the first week of the course was to investigate the strategies to ensure quality and safety in health care. One of the primary objectives was to critique and propose the best quality measures to improve patient safety. Here, it was vital for me to employ...
Week 1: 10/25-10/31 As a DNP, being aware of the key roles that are relevant and are typically assigned to one is essential. Therefore, starting the implementation of the succession plan with setting priorities in line was critical to my further success. Indeed, by arranging the key objectives and determining...
Introduction The process of designing and implementing a quality improvement (QI) program in a nursing home requires significant effort from all involved specialists. Apart from financial needs that follow every QI initiative, members that want to enact change in an organization have to consider the theoretical framework behind their program’s...
Introduction Sustainability in health care and nursing is an integral concept that defines the quality of care, directions of possible development, and appropriate changes. The relationships between quality outcomes, safety measures, and nursing science are close enough, so they determine the work of different facilities, including people, programs, and protocols....
Introduction Today, much attention is paid to the development and improvement of nursing science due to its initial goal of promoting high-level patient-centered care. Nurses have to demonstrate their knowledge and make sure to apply different theories and frameworks in practice. Nursing theory is based on a group of interrelated...
Social Inequality at School Each student enters an educational institution for a reason. Be it career, pleasure, new skills, or new acquaintances. In either scenario, students have to understand that in a few years, their education will be finished and there would come a time to plan everything anew. Therefore,...
Introduction In any organization, recruiting and retaining the right staff are the major issues facing the organization’s policymakers (Cosack 1). With the currently registered nurse shortages, concerns about nurse turnover and retention have heightened. To solve these challenges, health care organizations aim at improving their nurse retention. In so doing,...
SimChart is an Electronic Healthcare Record (EHR) system that was developed to teach nurses to work with EHRs (Elsevier, 2013). The evaluation framework should take the specifics of SimChart into account. It is noteworthy that there appears to be a shortage of frameworks meant for EHR simulations; the present research...
The professionals in any occupation are exposed to a particular level of conflict inside the workplace. The tension and psychological oppression, or bullying from the side of managers or co-workers often become a reason for leaving the place of employment or the profession in general. When viewed from the perspective...
The history of nursing Nursing is the ability and science of supporting individuals in learning to care for them whenever possible and of caring for them when they are unable to meet their own needs. Nursing developed into a scientific profession from an unorganized way of caring for the ill,...
Every professional requires his or her knowledge to be up-to-date to stay competent, which cannot be truer in the sphere of nursing (Dyson, Hedgecock, Tomkins, & Cooke, 2009). Rapid changes and the constant arrival of new challenges in practice and theory dictate the need for continuous data refreshment and replenishment...
Overview Safety Together Training is a workshop that has been developed by RWJBarnabas Health for clinical professionals in order to train them on how to avoid any preventable harm and provide the high-quality care without errors. This specific training is based on resolving clinical and non-clinical cases, problems, and examples...
Introduction An advanced practice nurse must provide high standards of care for any patient. The utmost professionalism and personal approach to caregiving are expected from the advanced nursing staff (Carney, 2016). Therefore, I need to participate in the Medicare Reimbursement Program to be adequately prepared for the provision of care...
Legislations on nursing practice Legislations on nursing practice.all countries have legislation to determine the practice of the health professions. Legislative and regulatory practices and mechanism vary between countries and within them, where regulation is the responsibility of a country or province. Countries such as Norway have detailed requirements for mandatory...
Almost every profession has its cultural peculiarities that are unique to each field of professional activity. Such characteristics include specific vocabulary, body language, behavioral patterns, ethics, rules, values, and many others. All of these are more or less present in each profession. In this paper, specific patterns of nursing group...
Nurses are guided by nursing theories that are recognized as organized and systematic claims concerning principal issues in the nursing profession. Nursing models aim at describing relationships between nursing problems, predicting impacts, and improving care. In other words, a theory can be viewed as a way in which reality in...
Nurses use technology in the form of electronic health records to collect, manage, analyze, and communicate patients’ information. The chief goal of using nursing informatics is improving the care offered to clients. However, the use of technology in hospitals may result in ethical concerns that should wisely be handled by...
Introduction Nursing is part of the healthcare profession that deals with the care of individuals to ensure their optimal health and enjoyment of quality life (Faulkner, 1996, p.). In various parts of the world, various health care facilities are faced with the problem of inadequate number of nurses. Consequently, it...
According to Charalambous and Goldberg (2016), professional nurses work in settings that require proper documentation for effective communication with other members within healthcare facilities. They prepare records that are utilized by doctors or other personnel providing care to patients or assistive workers whose primary role is to provide services that...
Stressful situations can slow down the flow of feel-good oxytocin hormones, which are essential for the nursing process (Smith, 2014). The stressful environment brought on by conflict in Juanita’s home means that she always mitigates or attends to conflict situations and is, therefore, less stimulated to produce breast milk. Breaking...
The key items in delivering high-quality patient care are excellent skills of health care professionals and detailed analysis of the incidents, resulting in better understanding of the current needs of the existing system. Therefore, all possible decisions should be taken into account to improve patient care. It is advisable to...
The purpose of my essay is to identify several possible opportunities in a locale I’d like to work if I’d be graduating from nursing school in 90 days. Also I will highlight the most important factors in choosing an occupation and bring up some examples of questions that may help...
Introduction As conceptualized in the theories of nursing, self-care, and persons, the organizing framework is a tool that purposely reflects the necessary training and expected outcomes of students who enroll in the RN-BSN program (Campeau, 2015). A brief synopsis of the domains where the framework has been applied reflects outcomes...
Theoretical Framework It is possible to examine the proposed question of using quality assurance scores as an early diagnosis measure for peripheral vascular disease (PVD) through two frameworks for health promotion. The first involves the Health Promotion Model (HPM) introduced in 1982 by Nola Pender (Khodaveisi, Omidi, Farokhi, & Soltanian,...
Introduction For the majority of the 20th century, nursing care was characterized by being nurse centered (Alligood, 2017). Patients were treated as passive observers and were not expected to take an active role in deciding their healthcare outcomes. Such an approach overburdens nurses while robbing patients of their agency. A...
The term “scholarship in nursing” is used to denote activities aimed at advancement of teaching and nursing practice. Boyer (1990) put emphasis on discovery, teaching, application, and integration scholarship as four most important areas of academic work. The Faculty Development Plan should include activities required for faculty advancement in each...
The 2002 hearings on lifespan report, prepared by Dr.Patricia A. Grady, discusses nursing research and how it helps address different health issues. “This study is an array of life span issues, starting from birth to old age” (National Institute of Heath, 2001). The report points out clearly that the best...
Introduction When many contemporary nursing issues are measured applying principles and standards the reality of ethics forms the core of the debate. The great question of which elements constitute ethics becomes a major bone of contention in defining the boundaries it is expected to cover in terms of everyday interaction...
Types of Qualitative Research There are three types of qualitative research that are most suitable for DBA research, namely, case study method, grounded theory, and phenomenology. Their use has become very widespread for different reasons. For instance, grounded theory is an approach that enables a researcher to formulate a hypothesis...
Mission Statement The mission of an online completion program for RNs seeking their BSN provided by Chamberlain College of Nursing is to transform healthcare in Florida by preparing highly qualified BSN nurses through evidence-based research, interprofessional collaboration practice, excellence in studies, and learning the practice of making partnerships with diverse...
Introduction: CLABSI Causes and Consequences Bloodstream infections are becoming one of the most pressing problems in the modern health care environment. Central line-associated bloodstream infection (CLABSI) invades the bloodstream in several ways: as a result of neglecting aseptic measures when placing the central line; because of a violation of maintenance...
Public Health Problem Identification Problem Description Today, the healthcare system of the United States has to deal with numerous concerns and find solutions to diverse problems that concern millions of people. Family planning and reproductive health are two fields in which the U.S. government has developed certain policies and laws...
Connecting theory and practice is an essential task in nursing since this endeavor causes a nurse to address the needs of patients more effectively while managing cases that involve handling the health issues of diverse patients. The theory to be evaluated is known as the Middle-Range Theory of Chronic Sorrow...
In May 2017, Donald Trump’s administration tried to promote the American Health Care Act (AHCA), which had been approved by the U.S. House of Representatives, to replace the Affordable Care Act (ACA), but it was not passed by the U.S. Senate. The AHCA was intended to restructure and limit resources...
Introduction The potential project will address the issue of stress reduction among nurses. Stress is acknowledged as an inevitable component of nursing practice. However, it is a negative factor that can disrupt nurses’ work, affect their health, and ultimately damage the quality of provided health care overall. That is why...
Identity of the Concept The uncertainty concept in nursing, and in fact in medicine as a whole, is one that is ever present. Because medicine deals with human beings in an ever changing environment even the most mundane cases can suddenly become something entirely different. Every human being is unique,...
Abstract Health care industry is now actively working towards enhancing the roles of health workers and is trying to create leaders out of these skilled personnel. The need for leaders among health visitors is a requirement of the future, and will ensure the progression of the profession of nursing to...
Abstract Research utilization portrays imposing research in developing an evidence-based nursing practice both on organizational and individual levels. The paper highlights the meanings of both terms, how to utilize research in nursing evidence-based practice, and barriers and facilitators to the use of research in nursing practice. Finally, the paper will...
Introduction Nursing is a profound profession based on strong personal principles of personal and professional skills. There is little doubt that nursing practice has been forced to make severe accommodations within this larger societal context as knowledge has continued to increase and attitudes and values have shifted. Nursing is one...
Abstract This paper intends to find out the factor which affects the satisfaction and retaining levels of nurses at their work places. For this purpose an introduction is provided which briefly introduces the topic to the readers, secondly the body of paper starts with the definitions of the key terms...
Introduction A student nurse plays a major role in maintaining the sound health of an individual and the family along with the other health care teams. In instances when there is a disturbance in the normal optimum level of functioning of these people, he or she has to take into...
In our contemporary times where everything better is characterized as modern and innovative, dealing with the word “traditional” seems to have a negative connotation because it can mean being not open to change or being trapped in the old-fashioned ways. In reading Newton’s article entitled “In Defence of the Traditional...
Introduction Various studies have defined the quality of care in severe psychiatric nursing. Few of them discussed below can support the view where a positive link between the psychiatric quality nursing and the corresponding impact on the mentally challenged people are figured out. One such study was undertaken in which...
Introduction Nursing theories are the creative products of nurses. They thoughtfully describe relationships and interactions within their nursing practice. Several theories have been propounded but there is no single theory which is more correct than the others. Theories have been classified into philosophies, grand theories and middle range. They aim...
Surgical hand wash includes all the procedures and practices that limit the transfer of microorganisms that could cause infections in an individual. It is most common method of hand hygiene since it aims at killing and retarding the pathogenic microorganisms and reduces chances of wound contamination in case surgical gloves...
In the case of a diabetic patient with an amputation below the knee, the multidisciplinary team acted in concordance to the needs of the client. A multidisciplinary team characteristically consists of nurses, surgeons, psychologists and physiotherapists. In the case of a patient who has just had amputation below the knee...
Article for critique Beckie, Theresa M., Beckstead, Jason W. and Webb, Mary S.; “Modeling Women’s Quality of Life after Cardiac Events”, Western Journal of Nursing Research, 2001, 23(2), 179-194, Sage Publications DOI: 10.1177/019394590102300206. Purpose of study Beckie’s group of researchers intended to investigate the quality of life in women who...
Questions concerning end-of-life care are challenging to discuss with patients and their families for many reasons. Many people may feel uncomfortable talking about death, and some individuals find these conversations unnecessary or frightful. However, end-of-life care discussions are vital for ensuring that people will voice their opinions about their health....
Introduction One of the most useful ways in which we can help other people is to listen and communicate with them in ways that enable them to share their troubles and feel better. During the following lines we will describe a number of listening, communication and helping skills. These skills...
The article entitled “Academic Microsystems: Adapting Clinical Microsystems as an Evaluation Framework for Community-Based Nursing Education” by Kathleen M. Thies, and Lea Ayers discusses and analyzes some major aspects of a partnership between a clinical agency, academic nursing program, and the community. The analysis reflects the above partnership from different...
The research follows a specific belief that examination of a phenomenon may be best understood by conducting an in-depth investigation of a certain process. The positivist paradigm of research prevails in the field of scientific research and it takes on the idea that research data is collected based on independent...
The system of caring is undergoing several changes in modern society. Hospital care is changing and depends on the financial well-being of individuals and technological advancement. Professional nursing is an art and applied science. Nursing which is traditionally known as being a caring profession is also undergoing changes and has...
This article provides readers with a comprehensive analysis of nurses’ role in permanently changing medical environment influenced by the dynamic transformation in technologies, methods of medical treatment, and the role that nurses play. New challenges require deep reformation of nurses programs and courses both at universities and other educational institutions...
Nursing has been influenced by such basic philosophical directions as positivism and naturalism. It should be stressed that these two dominant aspects built paradigms used in nursing practice. Scientists tend to use these basic aspects as the background for their medical researches and studies. The paradigm of naturalism takes the...
Introduction The article was written by Papastavrou, Kalokerinou, Papacostas, Tsangari, and Sourtzi, and was published in 2007. It was about their study of various dimensions related to burden and stress experienced by families providing care to dementia patients. Description of the study The study aimed to investigate the burden and...
Introduction Scientific and social changes of the 21st century have brought a radical change in the Health care delivery system. Nursing is an important component of the health care delivery system and the role of a nurse in inpatient welfare has no boundaries for praise. The Nursing profession has evolved...
Over the past few decades, health care administration has achieved significant progress in ensuring a smooth and risk-free life for the patients. There are various nursing approaches identified to date in this regard that focus on evaluating the quality of life (QOL) following a major health problem. The present description...
The article by Susan Jacobs, Peri Rosenfeld, and Judith Haber entitled “Information Literacy as the Foundation for Evidence-Based Practice in Graduate Nursing Education: A Curriculum-Integrated Approach” emphasizes an essential question: are the modern master’s nursing students able to sufficiently understand and use electronic information resources to make accurate clinical decisions....
The development of multiple conditions has a significant effect on a patient’s health. In the discussed case, M.K., a 45-year-old female has a history of Type II diabetes mellitus (T2D) and hypertension. Her current diagnosis is chronic bronchitis, as the patient experiences chronic cough with sputum, excessive peripheral edema, nocturia,...
Patient Initials: JB Age: 68 Gender: F Subjective Data Chief Complaint (CC): “Yellow secretions from eyes.” History of Present Illness (HPI): A 68-year-old Caucasian female presents to the office with complaints of yellow discharge from her eyes. The symptoms occurred quickly about 3 days ago, and they continue to progress...