Executive Summary There is a growing demand for ER nurses in Canada and their shortage, especially due to the pandemic is a subject of interest to the entire healthcare fraternity. ER nurses offer direct and individualized care to patients on the basis of applying scientific nursing principles. Canadian nurses’ unions...
The nursing practice may go smoothly, but sometimes evidence-based practice is required to implement critical changes. For example, there is always a lack of time when there is a need to implement EBP, such as working out plans for essential nursing training. Lack of time is a substantial barrier that...
The story of specific individuals who have endured different life-threatening diseases such as cancer is a long and heartbreaking one. Since then, very few people have survived such ailments and being able to live and tell their story has always been an outstanding achievement since the beginning of life. In...
Common Stress Reactions Stress can be defined as a stimulus, external or internal, that causes a state of physical, emotional, or psychological strain. The effects of stress can range from reduced productivity to physical violence or even death based on the type, period, and severity. It also causes loss of...
Nursing is a profession that has proven to be vital in the medical field, especially in recent years. However, specific challenges arise in the aspects of the work environment and retention of nurses. The crisis occurring in the healthcare system is critical, and therefore needs strategies implemented in order to...
The nursing profession is both exciting and challenging, which is why it is crucial for students to be fully aware of the difficulties that they will inevitably face when starting to practice nursing. An article by Dabkowski (2022) outlines that one must be confident and resilient when performing nursing tasks....
Introduction Cultural competency is a crucial skill in nursing since it ensures that effective, affordable, and efficient healthcare services are delivered to patients. In addition, these abilities are essential in promoting patient advocacy, as it enhances the competence to interact effectively with people from diverse cultures (Jongen et al., 2018)....
Introduction Emergency nurses have a difficult task because a calamity needing international aid occurs on average once every seven days. Many people worldwide have perished in recent years because of natural disasters. Disasters such as Hurricane Michael and Hurricane Irma in Florida have compelled healthcare professionals to reassess their procedures...
Technology is growing its importance in the development of health care provision. Like many other professions, nursing is also going to be impacted by the emergence of technology and, in particular, robots. Delivery robots are an innovative approach to patient care that might positively influence healthcare. I have chosen this...
Nursing profession is among the leading human health sciences with significant theory- practice gaps. While the learners are well equipped with both knowledge and skills during different levels of training, which is in clinical and practical, there still remains a huge mismatch in their actual practice in the health institutions....
Heart disease is a condition that involves any issues happening to the heart. The treatment of this illness depends on the type of heart disease. For example, anticoagulants are applied “to prevent harmful clots from forming in the blood vessels” (American Heart Association, n.d., para. 8). Hence, health providers recommend...
The situation related to nurse negligence is described in detail in Lean’s (2019) article. A Broward hospital patient, Michael Slusher, experienced a fall due to his nurse answering her phone and trying to help him and the same time. The case was elevated to the Fourth District Court of Appeal...
Introduction People may want or need to select a profession during any period of their lives. Young people usually find it especially difficult to make the right decision and choose wisely. Nursing is the best choice for those seeking a profession that would allow growth and development, feeling of making...
Overview It goes without saying that cultural competence is immeasurably significant in nursing. Culturally competent nurses avoid stereotypes and are able to provide high-quality health care delivery to diverse patients, understanding and taking into consideration their cultural, religious, and individual values and beliefs. At the same time, diversity also includes...
Introduction The article, “Predictors of burnout in nurses working in inpatient rooms at a public hospital in Indonesia,” was written by Yumi Yestiana, Tri Kurniati, and Abdul Aziz Alimul Hidayat. After reviewing several studies, they identified burnout as a psychological problem arising from physical and emotional fatigue (Yestiana et al.,...
Comprehensive Plan of Care Utilizing Maslow’s Hierarch of Needs A comprehensive care plan should focus on the holistic wellness of a patient. Thus, when following Maslow’s hierarchy of needs, it needs to consider the client’s physiological needs, safety, love, accomplishment, and self-actualization, respectively (Weimann & Weimann, 2017). For instance, one...
Introduction The purpose of this report is to evaluate the article “Impact of Nurse-Patient Relationship on Quality of Care and Patient Autonomy in Decision-Making” written by Jesús Molina-Mula and Julia Gallo-Estrad. In this paper, the author analyzes the nurse-patient relationship in order to examine its impact on clinical practice. The...
Although the progress in the global healthcare industry, including nursing as its integral part, has been outstanding in recent decades, issues continue to exist. One of the biggest among those is inadequate staffing, which is observable even in developed countries and can have fatal outcomes. Notwithstanding the seriousness of the...
Introduction The learning process is arduous for anyone, mainly because of the heavy workload. Nevertheless, it is worth highlighting medicine as a field and, in particular, nursing as one of the most difficult professions to study. This can be explained by the fact that the level and amount of responsibility...
Although the phenomenon of evidence-based practice (EBP) is not new to the field of medical practice, both researchers and practitioners are faced with the issue of EBP implementation in the workplace. Scholarly evidence addresses a variety of potential obstacles to the implementation of research into daily operations, namely, organizational and...
The notion of cultural competence in nursing refers to providing care to patients considering their cultural features and peculiarities. It is necessary to be aware of the values, beliefs, and worldviews of culturally diverse staff members and patients because it is a way to improve the quality of care and...
In a study presented by Cleary‐Holdforth et al. (2021), the researchers conducted a nationwide survey in order to define the overall clinical professionals’ beliefs in terms of evidence-based practice (EBP) and the value and likelihood of its implementation. The strength of the article is its explicit demonstration of the guidelines...
The policy viewed is the demand for education for nurse practitioners. With the rapid development of technologies and the advancement of research areas, nurse practitioners should undergo additional training for obtaining a qualification. However, the political arena’s stakeholders face the negative implications of the shortage of appropriate regulations that promote...
When introducing any meaningful change to a healthcare facility, attention should always be paid to the individuals and facilities that can be affected by such a change. These people are also known as stakeholders, as they are the ones explicitly or implicitly influenced by the organization’s actions (Hendricks, 2019). Thus,...
The central part of the Joint Commission’s (2021) National Patient Safety Goals (NPSG) list is the goal titled “use medicines safely” (p. 1). The administration of prescribed medicines constitutes a huge part of nurses’ work, and this is the area where mistakes most often occur. The rationale behind goals on...
Article Summary “A randomized controlled study to evaluate the effectiveness of 2 treatment methods in reducing incidence of short peripheral catheter-related phlebitis” Physicians and nurses use short peripheral catheters (SPC) to administer fluids, drugs, and blood products to patients. Approximately 70 % of patients in acute care hospitals require SCP....
Centrella-Nigro, A. M., Alexander, C. (2017). Using the teach-back method in patient education to improve patient satisfaction. Journal of Continuing Education in Nursing, 48(1), 47–52. Web. The authors address the teach-back method used in the nursing profession as a way of confirming whether patients understand what one has explained to...
Role nurses play in the law-making process to influence the final bill passage The legislative process through which a bill follows before becoming law has eight stages. Regardless of whether the bill is federal or national, the stages constitute bill introduction, committee action, hearing, mark-up, committee report, floor action, conference...
When timely noticed and resolved, public health issues can dramatically improve well-being nationwide, and nursing practitioners are capable of achieving these improvements. For instance, observation of patients’ activities in my practicum site, the East Orange Hospital Clinic, revealed the tendency to skip the follow-up appointment with the doctor. Such behavior...
Introduction Few occupations are as crucial to the maintenance of the health and well-being of the population as nursing. Illnesses, ailments, traumas, and other physical conditions force people to become dependent on others. Nurses are responsible for the well-being of patients when their health deteriorates, and outside help is necessary....
Nursing expertise plays a critical role in the quality of medical services provided to patients. After obtaining a Registered Nurse (RN) degree, many nurses question the relevance of receiving a Bachelor of Science in Nursing (BSN), as they believe in the power of practical experience. However, some researchers claim that...
Introduction The task of rendering high-quality medical services within hospitals can be addressed when employees effectively cooperate. In order to do so, they rely heavily on the principles and frameworks of interprofessional collaboration elaborated for coordinating their efforts. Therefore, the examination of these approaches alongside the role of baccalaureate-prepared nurses...
Older paper filing techniques are being phased out in favor of electronic health records (EHR). Nursing specialists can use electronic health records to document patient care and obtain information that can help prioritize care. Furthermore, information entered into computer systems can be accessible by the care team, including doctors and,...
Introduction Nursing management covers multiple issues which can be researched for further insights into the theory and practice of a specific healthcare area. The analysis and implementation of such research are essential for further enhancing patient care. As such, the current paper discusses the issue of socialization and transitioning. Socialization...
Introduction Various theories currently exist in the nursing practice that are applied in many research studies regarding advanced nursing practice and related fields. According to Duman et al. (2020), a complimentary nursing education unit includes clinical and theoretical education. That is why many different theories are used to develop programs...
Scenario This scenario presents a 49-year old patient with rheumatoid arthritis who visits the hospital with a primary complaint of fever. The patient is under medication with a prescription of prednisone 5 mg, and methotrexate 10 mg every Friday morning, and atorvastatin 40 mg. The patient who works at a...
The observations made over the years of working as a nurse demonstrate that, in most cases, the principles of compassion and empathy encourage nurses to always prioritize the patient’s needs. Although such a position is, by all means, justified by the specifics of the profession and morality, nurses tend to...
Health care is the most important social structure in the life of both an individual and any state. Professional nursing organizations focus on the support and professional development of nurses. The objectives of this type of specialized non-profit organization are implementation and protection of the rights of medical and pharmaceutical...
Introduction A fall is defined as an event that results in a person unintentionally lying on the ground, the floor, or some other lower level. People who survive falls and suffer disabilities, especially the elderly, are at considerable risk of needing institutional admission and further long-term care (LeLaurin & Shorr,...
This paper is a plan proposal for the capstone project in the setting of stress management in pre-licensure nursing students. The work explores various challenges associated with increased stress levels that pre-licensure nursing students may face and defines methods and strategies used to manage that stress. The impairing effects explain...
The US medical system is at a high level, but in practice, when implementing changes, failures can occur. The hospital’s problems are a lack of nurses and a lack of cultural competence. It translates into the need to processing and receiving negative feedback from patients. To address the issue, the...
Introduction Social justice is a concept that is crucial for every person’s well-being. Scholars have examined social justice in diverse fields, including sociology and ethnic studies (Valderama‐Wallace & Apesoa‐Varano, 2019). Many people face discrimination based on racial, ethnic, educational, and several other differences and the promotion of social justice is...
Introduction The Westmount Health Facility in Queensbury, NY, has previously been cited for violating various federal nursing regulations. Violations refer to any inconsistencies in the practice of nurses or any other nursing home employees with regard to the standards of practice as espoused in the CMS Manual System. Disciplinary actions...
Introduction In organizations, people are usually united in groups or teams, which serve as its main structural elements. This reduction of personnel is primarily due to the fact that only groups can perform those tasks with which no one is working separately. The use of group activities is attractive not...
The preciseness and legibility of nursing practice are of high importance. Legislations provide rather comprehensive guidelines for almost every case. However, the ethical reasonings sometimes lead to controversial decisions which require extensive revisions, for example in the assigned case of writing a prescription to a family member who is not...
Introduction The nursing profession is based on the principle of serving clients and providing them with the assistance and support they require. Such a principle also entails the need to ensure an excellent level of inter-and intra-professional communication among the personnel in order to deliver the highest-quality services to clients....
Planning a specific learning session or course, it is vital to consider how the desired outcomes will be achieved and how they can contribute to acquiring desired skills and experiences. Under these conditions, setting correct goals and establishing a schedule to accomplish them is vital for successful professional development and...
Introduction According to Entry-level competencies for the practice of registered nurses, a nurse has many competencies, including leadership, coordination, clinician, education, and many others. Since stereotypes can be carried over the years, the purpose of this work is to collect and present information regarding nursing in the modern world. Stereotypes...
Leadership is a vital part of any project’s implementation; thus, the appropriate style must be identified and used throughout the process. Indeed, managing teams and addressing the inevitable changes requires a person in charge to be influential, flexible, and open to communication (Cziraki et al., 2018). When a project is...
Standards and laws ensure order and the provision of high-quality care in the healthcare system. Laws and regulatory acts help nurses to remain accountable and make sure they deliver care properly in the best interest of the patient. Licensure and certification are part of these regulations that create the necessary...
After completing their BSN program, some nurses practice and enhance their expertise in the workplace while others choose to simultaneously pursue the next step of professional expertise and become a Doctor of Nursing Practice (DNP) or get a Ph.D. in Nursing. The fundamental difference between the two doctorate programs is...
The concept of burnout refers to emotional exhaustion, depersonalization, and lack of energy and motivation to work efficiently. The most common reason for burnout among nurses is a high workload that is caused by the shortage of medical personnel. The issue of burnout has become immensely topical during the COVID-19...
Introduction To ensure that a healthcare facility meets the level of service quality that it claims, the extent of nurse staffing must be appropriate. In turn, the shortage of health care workers, particularly, the rise in the number of patients per nurse, it likely to entail a range of adverse...
The ethical basis of a nurse’s professional activity is humanity and mercy. Accepting and sharing universal and general medical moral values, the professional corps of nurses declares the uniqueness of their profession and the resulting unique nature of honest relationships with colleagues and patients (Sherman and Cohn, 2020). The most...
Evidence-based decisions are crucial in nursing practice, and the professional must be capable of providing considerable arguments for their actions. The academic setting teaches the theoretical aspects of gathering and analyzing the information, selecting sources, and conducting research, while the practicum hours completion enables an intern to use their knowledge...
The rationale for Choosing Nursing Path The interviewee responded that her ultimate reason for choosing nursing as a profession was the opportunity to help patients and their families directly. She emphasized that although physicians play a significant role in treating the disease and saving a patient’s life, the patient needs...
Introduction The article focuses on exploring ways in which physical activity can improve psychological well-being. However, the author noted that this subject had not been extensively researched in a population such as nursing students. Accordingly, a research study was conducted to establish the relationship between physical activity and psychological health....
Upon entering nursing school, some students think that these several years of studying will be the most learning-intensive in their lives. I used to be one of them; I considered that the knowledge I would gain at university would be comprehensive, and I would not need to return to studying...
Critical thinking can and is encouraged to be used during all phases of the nursing process. Critical is helpful for nurses in the process of problem-solving and decision-making process regarding the treatment of patients (Papathanasiou et al., 2014). In the assessment stage, it is necessary to make reliable observations and...
Executive Summary The shortage of primary healthcare providers makes the policymakers and system administrators concerned about decreasing interest and readiness of registered nurses to become Family Nurse Practitioners (FNP). One of the most significant problems facing novice FNPs is their preparedness for advanced practice and the number of responsibilities and...
The social role, goals, and objectives of nursing education are to train medical specialists with the best education to provide highly qualified medical care and preserve and ensure the population’s health. The development of professional education among nursing staff in the United States is designed to strengthen the scientific base...
Nursing requires constant communication with people, including medical staff and patients. Therefore, nurses should be ready for some disrupting situations that may affect their work. However, there should be regulations and work ethics that ensure effective interaction of nurses with each other. Team respect is a crucial aspect of the...
Patients not returning to their follow-up appointments is a critical clinical practice issue that decreases the quality of services and must be included in the East Orange Hospital Clinic systematic agenda. Indeed, many of my practicum site’s beneficiaries represent the impoverished population and, therefore, experience difficulties following their physicians’ recommendations...
Policies are powerful strategies to achieve sustainable improvement in healthcare, enhance organizations’ performance and the services’ quality. When an initiative is established on the policymaking level, it receives broad support and allows the providers’ to adjust their operations and work strategies. The IOM Future of Nursing Practice Report Brief contains...
By providing medical care to diverse populations of patients many challenges and difficulties can occur, especially when treating non-native English speakers. Such difficulties may include the misunderstanding of symptoms due to the patients’ inability to explain his health issues and the need to explain the final diagnosis in the simplest...
Introduction Resource allocation and resource rationing, although similar concepts, raise some unique ethical issues, especially in nursing. In the ever-changing modern world, it is essential to consider the allocation and rationing of nursing and medical resources in the most efficient way. Furthermore, the existing limitations to the quality and quantity...
I welcome you to this evidence-based (EB) care plan and remote collaboration utilization video presentation based on a Villa Health scenario. The scenario is about Caitlynn Bergan, who has cystic fibrosis and lives in hard to reach area. Goodridge and Marciniuk (2016) found that caring for patients in remote areas...
Abstract The paper focuses on analysing, discussing, and reviewing literature on the impact of communication breakdowns on the satisfaction of patients. 10 articles are chosen, analyzed in accordance with their eligibility, and used to present the impact and significance of communication in nursing, as well as the possible ways to...
The Social Change Recognizing a lack of awareness about effective methods of addressing the global pandemic in a skilled nursing facility is vital. More consistent levels of consciousness will positively contribute to the emergence of change on multiple societal levels. COVID-19 directly impacts all health care consumers due to the...
Background Information A 48-year-old man with a history of alcohol abuse had just undergone surgery, and I provided him with postoperative care, including pain management. However, the patient refused medications because of his religious beliefs. He stated that he was a sinner, and he believed that God wanted him to...
Introduction Leadership is a vital component of any organization as it helps in providing the management function which directs the available fiscal, physical, and human resources towards achieving strategic goals with the utmost efficiency. Leaders are individuals who have the ability to inspire, motivate, guide, and direct people in an...
Nurses experience various cases during their practice that may be detrimental to their emotional well-being. In my practice, it was difficult to handle with a great amount of work and do extra hours. Stress driven by working hours made me and my peers experience burn out. By such constant stressful...
Summary Modern health systems are known to be highly interwoven systems and are often characterized as messy. The quality and safety of health care provided to patients can be improved by implementing evidence-based practice techniques by the nurse leaders to improve the population health within the community they serve. Nurses...
Obtaining an MSN degree, or a Master of Science in Nursing, is a relevant prospect, and given career goals and skills honing, this step is an essential component of professional development. According to Massimi et al. (2017), while taking into account the specifics of preparation of MSN students, this level...
Patient loyalty may be defined as a patient’s willingness to use the services of a particular medical facility repeatedly. As medical services develop and transform, patient satisfaction and loyalty become essential aspects that require consideration. In many cases, healthcare facilities shift to more business-related approaches, and the financial element becomes...
Summary In the healthcare system, there is increasing competition for fund use amongst services offered. Therefore, nursing leaders must formulate proper budgeting criteria to enable effective and efficient operations. Developing a systematic budget will allow the administrator to have deep insight into the income and necessary expenditures hence can strategize...
The video by Robert Wood Johnson Foundation (2009) shows a good example of implementations to improve the performance of nursing staff. In the video, we can see different strategies used to organize the healthcare process. The status board with three color indicators is used to highlight the workload status of...
Nursing Notes and other documentation procedures in healthcare are essential in care provision. Documentation facilitates maintaining the record of all services received by the patient and is critical for handing over duties within healthcare facilities (Kollerup et al., 2018). In the care delivery process, patients undergo several procedures, all of...
Introduction Professional associations in nursing are important for their members’ professional and personal growth. In particular, they provide resources, certification, education, and networking opportunities, as well as career assistance in various specialty areas. As a result, nurses can enhance their practice and competence, providing safe and high-quality care for patients....
An evidence-based approach toward addressing health-related issues in the clinical and nursing settings has become an inseparable part of contemporary healthcare. However, the role and weight of evidence-based decision-making for healthcare workers could use further explanation due to the misunderstandings and misconceptions surrounding the issue of EB in some healthcare...
Nursing is a profession that involves diagnosis, counseling, implementation of medical regimes, and evaluation of a patient’s medical progress. The roles of a nurse are not limited to nurses only but extend to colleagues. Notably, the nursing process helps address staff members’ shortcomings by identifying their strengths and weaknesses (Dahlin...
My philosophy of nursing is based on the idea that nurses should support patients in their strive to achieve good physical and mental health. This means that I want to use my knowledge and expertise in combination with the patient’s input on how they want to manage their health and...
The theoretical basis in the nursing profession allows a large amount of information to be gathered and structured. The principles of nursing care are based on the formation of algorithms that contribute to a speedy recovery. Theoretical courses in psychology, basics of nursing, disease-specific and age-specific course information are reinforced...
Abstract The work aims to emphasize a problem related to nursing burnout. The issue is important to address since it affects patient care quality and patient safety. Nurses’ professional burnout could be partially solved by the three actions suggested in the paper: creating a positive spiritual climate at the workplace,...
Summary Healthcare facilities should eliminate clinical variations to ensure their patients receive the highest quality and safest health services. Reducing clinical variations also helps to reduce the cost of care on a national and organizational level. Unfortunately, clinical variations permeate various healthcare facilities. Clinical variations refer to the excessive use,...
The provided paper focuses on analyzing a particular experience using Johns’ model of structured reflection. This activity is vital for nursing as it helps to outline possible areas of improvement and plan actions to become a better specialist. For this reason, the paper explains the importance of reflection, describes the...
Summary Care coordination enables health workers to meet patients’ needs and hasten their recovery. The care coordinators yearn for good relationships between the sick and the healthcare employees (Hannigan et al., 2018). They plan and employ techniques that ensure efficient service delivery to those suffering from different illnesses. For instance,...
Introduction Nursing is primarily concerned with medicine and patient care. However, every area of human life is closely intertwined with each other. It follows that a responsible and outstanding nurse can go into politics to control and influence health care with a plan that is relevant to patients. Many politicians...
A computerized assisted coding system (CACS) is called upon to facilitate ICD-10 implementation, compensating for financial losses and a gap in staff competencies. Since ICD-10 codes have a complex nature, they might represent an obstacle to the efficient work of doctors and nurses (Allen, 2020). Thus, the need for comprehensive...
Healthcare organizations, such as American Organization for Nursing Leadership, always try to enhance their performance. For years, this aspiration was reflected in the Triple Aim, combining the population health improvement, better conditions for patients, and lower healthcare costs. Recently a fourth element of improving the experience of providing care was...
Patient-focused care mediations are reliant on many factors. Regardless of far-reaching preparations and tedious work, some interventions do not lead to predetermined outcomes. Elements out of reach and outside the limits of our awareness alter the expected consequences. Wagner (2018, p. 93) states, “this is typical of events in complex...
While every occupation should be driven by the fact that there is always room for improvement, this idea is significantly more relevant to the field of health care. When thinking of Continuous Quality Improvement (CQI), many people perceive this phenomenon as something that solely describes innovative approaches to physical patient...
I agree that the essential characteristic of effective communication is the positive involvement of the targeted audience. However, the techniques chosen for establishing the communication process are different, and it is often challenging to determine the most efficient one in each particular case. For instance, Shonhe (2017) states that communication...
The profession of nursing is similar to puzzles, a multi-layered culture of healthcare that changes with all interactions. It is not ideal to detach from what is known and integrate to flourish in this present atmosphere of globalization. In order to retain its ideals, nursing practices are not and should...
Introduction Nursing has been developing ever since the nineteenth century. Being an evidence-based area of practice, nursing requires a proper research process. Every implied technique or obtained skill must be justified by the evidence. Since the treatment delivered by nurses can be qualified as a holistic health care approach, the...
Nursing specialists are professionals who must rely on the principles of moral conduct and social responsibility when doing their job. The Nursing Code of Ethics developed by the American Nurses Association is a document that guides nurses’ practice and assists them in understanding their professional obligations. Nevertheless, on certain occasions,...
Introduction As a target policy, the SUPPORT for Patients and Communities Act will be analyzed. This policy is an important aspect of the national health program to combat substance use and disorder prevention (“H.R.6,” 2018). Involving junior medical personnel in evaluating the effectiveness of this policy is a meaningful decision...
Coordination Care Programs A quality healthcare system is organized, patient-centered, and has a good communication system. Health care coordination activities involve getting a patient the right care when it is needed through communicating their needs to the involved care providers. For instance, when a patient visits a hospital, they should...
Math skills are a basic requirement for nurses to offer perfect clinical service to their clients. In nursing, the ability to solve problems encountered while on duty is imparted by competency in arithmetic computations while addressing the patients’ needs (Wendel 19). Safety in the process of giving medical treatments against...
Standards of Care Standards of care in Florida are defined in the following way. “Level of care, skill, and treatment which, in light of all relevant surrounding circumstances, is recognized as acceptable and appropriate by reasonably prudent similar health care providers” (Medical Malpractice and Related Matters, 2020, para. 1). Scope...
Introduction There is a negative relationship between professional burnout and patient safety. According to the conducted reaches, once a nurse gets burnout, her patients’ safety level decreases (Garcia et al., 2019). Thus, there is a correlation between these two variables. Therefore, to increase patient safety, nurses’ burnout should be prevented....
Nurses are recommended to forestall infections by performing, observing, and guaranteeing consistence with aseptic work works on; fill in as the essential asset to educate all residents. According to Ragusa et al. (2018), appropriate washing of medical devices and providing a clean environment are a vital mediation in interfering with...