Introduction Nearly a third of all patients who suffer from epilepsy experience seizures despite the presence of advanced epilepsy management tools (Bethesda National Institute of Neurological Disorders and Stroke 1). Many researchers agree that the development of advanced techniques to detect seizures before they happen is an effective way for...
Introduction Nursing is one of the most important areas in the management of patients. This field of healthcare is based on the cumulative evidence on the best care for patients with different conditions. Many procedures that entail nursing care include injections that form the bulk of this profession. Therefore, the...
Introduction Owing to its huge workforce and adaptive capability, the nursing profession has the capability to trigger far-reaching shifts in the health care system if stakeholders focus increased attention to the realities beneath the findings of a 2010 report detailing the future place of nursing in the United States (Institute...
Interpretation of the Article The article on nursing and management issues ‘Shared governance models: The theory, practice, and evidence’ by Mary K. Anthony are aimed at analyzing the effectiveness of the shared governance model applied to the nursing staff members as reported in different studies. Through the reorganization of the...
The article under the study is A home-based nurse-coached inspiratory muscle training intervention in heart failure written by Cynthia A. Padula, Evelyn Yeaw and Saurabh Mistry. This study concerned itself with the effect of 3-month nurse-coached inspiratory muscles training program on dyspnea observed among people with heart failure. Heart failure...
Introduction Nursing has become one of the most competitive professions globally. Providers of nursing education worldwide encounter numerous challenges in crafting effective learning experiences and providing constructive, objective evaluation of knowledge and skills in learners (Oermann, 2006). The Public tends to have an enhanced understanding of the safety of patients....
Introduction Patient education refers to the process of imparting behavioral and psychological knowledge to patients to facilitate their participation in the provision of health care. Nurses are the primary educators for the patients since they are directly involved in the provision of medical care. In that regard, they are aware...
Introduction: Patients’ Needs in the OR Environment Background Working in the environment of an operating room (OR) invites a plethora of challenges for a nurse as the patients in the specified area are especially vulnerable to the effects of external factors. Particularly, the fact that the patients are exposed to...
Introduction The concept of nursing’s multiple paradigms is one that has continued to attract varying controversies over the years, and no singular paradigm may be said to have a dominant effect on the nursing discipline. The continuity with the controversy may be based on the fact that there seems to...
Introduction Over the years, many theories have been developed concerning leadership. These theories try to explain the qualities that distinguish leaders from followers, and which leadership styles are the most suitable to apply in any situation. As the leader of a team, it is one’s duty to ensure that the...
Introduction The purpose of this study is to promote the use of an evidence-based patient-falls-reduction protocol. The proponent of the study will use the Re-Aim framework to determine evidence-based patient-falls-reduction protocol to reduce the incidence of patient-falls in hospitals. The proponent of the study is considering the use of hourly...
Introduction Mental disorder is one of the most recognized health issues in Australia (Andrews et al, 1999). This literature review focuses on three peer-reviewed journals to get an insight into this issue. The first journal in the Australian Journal of Advanced Nursing deals with the mental health issues within the...
Introduction The level of emergency preparedness of a community determines its capacity to deal with emergency issues (Carroll, 2003). The issues presented with this case study on the roles and responsibilities that have been undertaken by the hospital, senior center, school, and Bley household. In brief, the events illustrated in...
Introduction The field of the advanced nursing actively develops in the United States because advanced practice nurses (APNs) can perform the variety of functions and activities similar to the tasks of health care practitioners, and the quality of the care delivery increases. Among the APNs roles, Clinical Nurse Specialists (CNSs)...
Introduction Houston, Texas has the highest number of adults with obesity than most regions in the United States. One in every five children in Houston is overweight. Among adults, about 30% are obese. Obesity is described as a Body Mass Index (BMI) above 30 (Centre for Disease Control and Prevention,...
Abstract Nurses work as lifelines, caretakers, and educators of the patients. The working condition in the nursing profession leads to a majority of nurses experiencing physical, emotional and mental fatigue, otherwise referred to as burnout. Burnout leads to a high rate of employee turnover in the nursing industry. Nursing burnout...
Introduction Ever since the early 1990s, the National Organization of Nurse Practitioner Faculties, NONPF, has been overseeing the classification of advanced practice nurse competencies. Core competencies are very essential for all nurses as they signify the admittance into practice following completion of their education course (Hamric & Hanson, 2013). In...
With technological innovations entering the world daily, more and more people have to change their roles within their professions. For instance, at present, nurses have also acquired the role of knowledge workers because they have to learn daily how to use new technologies and to apply this knowledge in practice....
Abstract The thesis study aims at demonstrating that a career community pharmacist can practice as an effective clinician in a prescribing role treating patients in a primary care setting. The introduction of advanced and enhanced community pharmacy services enhances the need for pharmacists to integrate into primary care medical services....
Introduction Since HIV was discovered in the 1980s, nations have been trying to come up with measures to prevent its spread and reduce the cases of new infections to zero. One of the ways that have been used by many governments globally is the use of voluntary HIV counseling and...
Introduction Obesity has become a major cause of concern for healthcare professionals in many countries, including Kuwait. The studies carried out in Kuwait indicate that more than 50 percent of the Kuwaiti population suffer from overweight, obesity, or metabolic syndrome (Al Rashdan & Nesef 2010, p. 42). It has also...
Introduction One guarantee thatcannot be given to patients is that they will not be harmed by the system meant to look after them. Individual stories of suffering caused by the healthcare system are moving and can be terrifying. Recently, a shocking story that affected the lives of more than seven...
Introduction Nurses provide health care based on directions from physicians. Indeed, this old-fashioned nursing function has molded the famous public outlook of health officials as caregivers. However, most authorities allow nurses to exercise autonomously in an assortment of locations, based on their learning capacities. They establish a care strategy, team...
Theory The present paper discusses the nursing care procedures for the patients after the coronary artery bypass graft (CABG). This surgery is conducted for the improvement of the blood flow to the heart that is complicated due to the blockage in the artery. Addressing this problem, an artery graft is...
The report The Future of Nursing issued by the Institute of Medicine (2010) can have significant implications for the functioning of medical institutions. In particular, it is critical to discuss its implication for the education of nurses, their daily practices such as primary healthcare, and their role as leaders. Overall,...
Introduction Application of Evidence-based practice (EBP) gives nurses a chance to be of fundamental influence on making decisions in healthcare and partners with other healthcare givers to improve the quality of services given to patients. EBP goes beyond professionalism because it gives nurses an opportunity to make practice more realistic...
Introduction The paper introduces a sophisticated analysis of the maternity-related issues as well as childbearing policies in the USA. The American documentary “Born in the USA” serves as a material for the study. The film reveals some crucial specifications of pregnancy, giving birth to a child and raising an offspring...
Indeed, the leadership theory that describes my leadership skills is a transformational theory. This theory has both professional and personal domains. Leadership in nursing is about understanding how to make visions become reality. Transformational leadership is depicted to be the process where leaders and followers motivate each other to make...
The basis for the objectives The widespread lack of nursing informatics skills and technological expertise among nurses has been areas of concern in the healthcare sector. Although technologies have reached healthcare facilities and learning institutions, some nursing professionals and students lack competencies to use them in safe, effective and competent...
Summary In spite of the fact that roles of a nurse administrator, a nurse executive, and a nurse manager are discussed as administrative in their nature, nurses need to develop different competencies and skills in order to succeed in performing associated tasks. On the one hand, ‘nurse administrator’ is a...
One of the most outstanding attributes of professional practice is the concept of reflective practice, which entails the ability to reflect one’s actions with the main objective of engaging in constant professional learning (Bolton, 2010). Reflective practice in the context of the nursing profession lays more emphasis on the consideration...
Introduction Learning and acquisition of the necessary skills is perhaps the most important undertaking when it comes to the provision of healthcare (Akbarov, 2011). In essence, the proficiency of a practitioner depends on his or her mastery of these skills. As such, it is critically difficult to develop healthcare provision...
Introduction The unending demand for quality healthcare services by the population subjects nursing to serious challenges that affect the quality of services offered. The Institute of Medicine (IOM) was mandated to research to expose the challenges facing this profession and propose measures to correct the issues arising from the findings...
Introduction Nursing workload based strategies are used to forecast staffing requirements. Staffing on the level of acuity enables nursing managers to schedule nurses units’ shifts by emphasizing the actual needs and requirements of the patients. This strategy of staffing has since replaced the traditional methods of establishing nurse staffing needs...
A Comparative Analysis of PCR Results between the Bacteriology Department and the Nursing Home Isolates Sequence type 131 of E. coli is one of the deadliest groups of pathogens that colonise the gut of human beings and other mammals. The pathogens are known to produce CTX-M-15 ESBL. This pathogenic development...
Introduction In every piece of research, there must be a clear methodology that a researcher uses to gather and analyse data in order to generate relevant information on the topic under investigation. In this study, the focus was to determine the effectiveness of Manuka honey on wounds. The researcher conducted...
Introduction The following paper looks at the issues and concerns of a frail elder from my clinical placement. Based on the discussions presented in respective sections, the paper also analyzes nursing roles that would help him cope with his health conditions. In order to protect the confidentiality of this resident,...
Introduction The philosophy of nursing is a set of values and beliefs that stimulate one for productive work. According to Denehy (2007), modern educational programs that specialize in the subject include the strategy of writing the statement one personal philosophy. Due to the author, this practice assists the workers in...
Introduction The problem identified and requires intervention is the issue of poor hand hygiene among healthcare workers. It requires education and collaboration with all healthcare workers to adopt methods that can facilitate adoption of best practices in hand hygiene. The proposed interventions would involve developing evidence-based education programs on hand...
Introduction Nursing is one of the fastest-growing segments of the healthcare sector. It is an exciting yet complex field that aims to build proficiency on the ability of learners to be excellent care providers. Skills in social interactions, decision-making, and problem-solving form part of developing a competent nurse. Curriculum development...
The health promotion concept has been used for many decades to grant people proper health. Health promotion is the process of enabling individuals to increase control of their health to improve their livelihood. In general, the concept of health promotion revolves around various activities, mostly aimed at decreasing the threats...
Nursing practice involves four fundamental perceptions, which are also recognized as metaparadigms. The four metaparadigms of nursing are an individual or customer, surroundings, wellbeing, and nursing (Kozier, 2008). An individual or customer is the receiver of nursing care. Surroundings are the interior or exterior environs that have an impact on...
The theoretical framework is a significant basis for nursing practice. Theories allow specialists to interact, creating universally understandable concepts in nursing. Nevertheless, problems often arise from the imbalance between theories and practice, which makes theories difficult to use for practitioners. To eliminate this contradiction, theories need to be made less...
Introduction Anemia is a hematological disorder that occurs when there is a reduction in the concentration of red blood cells in the blood. The reduced concentration of red blood cells affects the physiological transport of oxygen in the body. According to Kassebaum et al. (2014), anemia contributes 8.8% of disability...
Research Design The problem is clinically significant and relevant to the nursing profession. The main focus of the study is to determine the strategies required to improve end-of-Life decision making strategies. Thus, it is an important research question that requires immediate answers. Nevertheless, the purpose of the research was not...
This paper aims to review the article by Shifaza, Evans, and Bradley (2014) titled, “Nurses’ Perceptions of Barriers and Facilitators to Implement EBP in the Maldives.” Relevance of the Title The title of the article is simple, clear, and a true representation of the actual content and the objectives of...
Despite the individual’s occupation, there are a number of health risk issues that a person may face. However, the risks vary from one occupation to another. This calls for further investigation to determine how human life is affected by his/her workplace. According to National Health Services (NHS), risk assessment refers...
Abstract Essentially it is noted that inter-professional training is a crucial approach of teaching healthcare providers, especially in the nursing profession. In this regard, the inter-professional training that takes place in OR becomes of even greater importance since it facilitates observational learning and sharing ideas. Although there are such great...
Introduction As human beings live in a diverse environment, they own distinct senses, which enable them to live and interact with the world efficiently. All human beings’ actions are usually a replica of what their senses perceive (Olivers 37). Senses guide people in picking items from their surroundings depending on...
Abstract Organizations have different ways of finding the best way to solve their problems. The medical industry is one that requires very close observations. The nursing career needs hospitals to provide the best environment for completing tasks. One of the ways to do this is through hourly rounding. The 48...
Summary Tracheal suctioning is now a common procedure for many patients with artificial airways. The process, however, presents risks and may cause deterioration in patients if not used effectively. Current literature suggests that suctioning procedure can be improved through evidence-based practices. An implementation plan, therefore, relies on the best available...
Florence Nightingale is seen as a pioneer in the sphere of nursing. She was also one of the first theorists of nursing that contributed greatly to the development of the nursing practice (McEwen, & Wills, 2014). She also developed the so-called, environmental theory that is still utilized in many settings...
Visual Map I work in a level one trauma center where bullets and gunshots are the diagnosis codes. The healthcare organization uses a HIT system that helps to coordinate the sharing and usage of healthcare data across departments. Healthcare technology is aimed to improve the quality of healthcare offered to...
Social responsibility refers to specific guidelines for enforcing ethical behavior among professionals. It also promotes values that require organizations and professionals to strike a balance between making profits and creating sustainable ecosystems (Wilmot, 2012). Accordingly, social responsibility promotes values such as supporting welfare of the community and environmental conservation. The...
Introduction Advanced Role Practitioners (ARPs) must possess unique competencies in order to achieve their goals. Many ARPs have unique skills depending on their specialties. This approach will make it easier for them to focus on the best practices. The “core competencies of Nurse Practitioners (NPs) encourage them to support the...
Introduction Nursing practice requires proper maintenance of patient records to ensure that accurate information is shared among the health workers. The status of a patient should be described in depth to boost understanding about their conditions among nurses and other clinical specialists. This method of recording patient information involves the...
To the Editor In your article, Immigrant Nurses Face New Hurdles with Ontario’s’ Licensing Changes, you assert that about 75% of immigrant nurses fail new screening exams for registered nurses because they have gaps in their careers, yet they do not find bridging programs to fill these gaps. Your assertion...
Introduction Many professionals “define nursing as a science” (Laschinger & Fida, 2014, p. 22). Nurse Practitioners (NPs) acquire knowledge and skills through continued experimentation. This argument explains why nursing is an evidence-based science. The occurrence of obstacles is something common in this profession. Nursing should therefore “be a problem-solving practice...
Introduction Advanced nursing education makes it easier for caregivers to offer competent care to different patients. A master’s degree in nursing education equips individuals with appropriate skills. Such skills encourage them to provide effective health care. AACN monitors the development and evolution of these roles in order to achieve the...
Nurse understaffing has been cited in the mainstream scholarly literature as leading to a number of adverse effects including poor patient outcomes, increase in nurse workload and job dissatisfaction, as well as financial cost implications for healthcare institutions (Martin, 2015). This paper reports on the findings of interviews held with...
Personal Values and Beliefs Effective nursing leaders not only know their leadership values and beliefs, but they also pursue and apply them in decision-making. Kouzes and Posner (2012) state that clarity of leadership values enables a leader to make good choices and remain committed to his or her chosen course...
Support Strategies The selected healthcare organization for this exercise is a nursing home. This organization “offers effective care to individuals who cannot cope with their daily activities” (Ginter, Duncan, & Swayne, 2013, p. 28). The best value-added service that can support many patients is the provision of quality nursing services....
Problem Statement All human beings can commit errors; however, errors committed by nurses during their practice are on the rise. Whenever people are tired, their concentration level decreases considerably, hence, there is a very high probability of them committing errors. In most cases, nurses are forced to work for extra...
The problem of obesity in children did not just happen by accident, fundamental changes in society are the main causes of the increase in incidences. Similarly, there is a recorded increase in incidences of cardiovascular diseases and type II diabetes mellitus among children with obesity being the leading predisposing factor....
The practical purpose of the nursing theory is to prepare the highly qualified professional, who has a good understanding of this subject. The nursing practice is a multifarious variety of situations, where a huge amount of theoretical knowledge. In their daily activity, the practicing nurses have to provide the patient...
Introduction A theory is integral in nursing because it enables nurses to conceptualize their duties and perform them systematically. Essentially, a nursing theory comprises concepts, ideas, principles, models, assumptions, and propositions, which elucidate a given phenomenon in nursing. Given that nursing practice involves diverse activities, a nursing theory acts as...
Introduction Doctorate programs have been offered in colleges for centuries. However, Bennett (2006) asserts that it was not until the 20th century that the education about doctorate degrees in nursing began in the USA. Nursing doctoral programs in America started during the 20th century as a sub-faculty of other fields....
Introduction Exercising leadership and intrinsic management in the nursing environment is critical towards handling different patient cases within the code of guideline for practicing nursing. Specifically, it is important to integrate the code of nursing practice with different environments to ensure that ethical dilemmas do not arise (Casey & Wallis...
Introduction Teaching is a process that involves varying interactions between students and teachers with a view of sharing information. Its primary purpose is to impart knowledge to the learner. However, possession of the required skills does not mandate a person to be a teacher. Teaching competency demands a combination of...
A systematic review entails a comprehensive evaluation of the behavioral social as well as policy frameworks that identify the related and relevant literature (Bowling 2005, p54-63). This paper uses the available information on Enteral feeding as a basis for the creation and development of a framework for conducting an extensive...
Introduction King’s theory of Goal attainment (developed in the 1960’s) outlines a dynamic interpersonal relationship where a patient cultivates certain life goals. The theory has been applied over the years to help patients set health goals and achieve them. This is evident with the enactment of the Patient Self-Determination Act...
Introduction Health care workers may be people who provide different services related to the treatment of illnesses. The work of health professionals and their operations is under the control of national authorities which are controlled by regulatory bodies to ensure that quality services are provided. When combined, they form the...
Background of Study Nursing requires a multitude of medical knowledge, experience, and sufficient communicative skills. Two studies have been conducted exploring the issue of students’ challenges in clinical practice. The first one is “Theory and practice in the construction of professional identity in nursing students: A qualitative study” by Jamshidi...
According to the Joint Commission, medical errors are linked to the death of at least 60,000 patients every year (2012). In addition, health care workers experience a high rate of non-fatal occupational illness and injury (The Joint Commission, 2012). The proponents of this study are in agreement with The Joint...
Autism Management using EEG Approximately 1% of children across the globe have autism. Nevertheless, the diagnosis of autism spectrum conditions is still in the dark times since it remains a perplexing and biased practice where physicians convey their judgment following observation of the behaviors of a child and evaluating past...
Introduction The significance of nurse staffing to the delivery of quality health care to patients was “the most important finding in the Institute of Medicine (IOM) committee report” (Wunderlich, Sloan, and Davis, 1996, p. 92). The report showed that “nursing was a critical factor in determining the quality of care...
Benefits and challenges of health informatics Health informatics is the use of information technology tools in the health profession. Nursing informatics has many applications in the nursing profession because nurses apply information technology tools with the aim of improving nursing care (Cesnik & Kidd, 2010). Health informatics ensures that nursing...
Abstract This paper summarizes the article titled “optimizing the assessment of pain in children who are cognitively impaired through the quality improvement process”. The paper will analyze the methods of the experiment based on the objectives. Consequently, the limitations of the experiment will be documented to improve the research validity....
Abstract Occupational therapists as sometimes described as OTs are the ones who have been known to add a purpose to the lives of disabled people. This list includes the people who have been inflicted with some disease as well the ones who have suffered an accident and are trying to...
Problem Identification While working as a skilled nurse at the Arizona Center for Specialized Treatment, I noted that the greatest risk in post-operation surgery is a decrease in mobility of the patient who is in the process of recovery. As a result of the reduced mobility, patients are exposed to...
Introduction Nurse Practitioners (NPs) and caregivers should support the health needs of their patients. Such NPs must also make accurate and professional decisions to achieve the best healthcare outcomes. Caregivers should be moral agents of positive health practices. Different “nursing leadership theories encourage healthcare professionals to use evidence-based practices and...
Summary Ventilator-associated pneumonia (VAP) is an infection that is acquired in hospitals. It is considered among the most commonly acquired hospital infections, especially among pediatric patients in the intensive care unit. This infection is diagnosed via empiric therapy, which is considered to be around 50% of the antibiotics used in...
Introduction Healthcare-associated infections (HAIs) refer to diseases that patients contract while undergoing medical or surgical treatment (Klevens et al, 2002). HAIs cause many deaths that are preventable if precautionary measures are implemented. Their effects have adverse implications on the health care sector because they lead to increase in health care...
Introduction Sickle cell disease (SCD) entails a group of genetic diseases that result in hemolysis as a result of polymerization of hemoglobin when it is deoxygenated. This disease has a low life expectancy due to associated complications, chronic and episodic pain and reduced quality of life. However, pain is the...
Introduction Errors in healthcare often lead to a variety of negative outcomes which can even result in a patient’s death. It is necessary to note that around 30% of all administration errors are medication errors and nurse practitioners participate in the process of medication prescription (Anderson & Townsend, 2010, p....
Introduction This exercise aims to comprehend an ethical-legal challenge that I experienced during my clinical attachment at the radiology department at King Fahad Hospital. I applied the theory I learned at Curtin University in this situation. Moreover, I also used a problem-solving and reflective practice approach to complete this task...
Research problem research in caregiving for patients with heart failure is not sufficient to prioritize intervention areas. Records indicate that caregivers of heart failure patients face increased mental and physical health challenges. However, no guiding models or frameworks exist on the caregiving of heart failure. A need for consistent measures...
Introduction Healthcare organizations constantly experience new challenges, which compel them to respond positively through planned change. The respond constitutes planned change as it enables healthcare organizations to overcome their challenges and provide effective, safe, and quality services to the patients. Planned change does not occur accidentally as Marquis and Huston...
Introduction Nursing is a major profession that has employed millions of people worldwide. There are a lot of factors that qualify the nursing career as a profession. These include the fact that an educational background is required before it can be practiced and that members in this field adhere to...
How the nurse should respond to Mrs. Nasser’s Request This case study calls for cultural awareness and competence in nursing. The nurse should begin by agreeing with Mrs. Nasser because she is right about her cultural views. The best thing is to communicate and mentor the client. Mrs. Nasser should...
Summary While following Essential IV: Information Management and Application of Patient Care Technology, it is important to note that the nurses should focus on developing their technical skills and competency in order to respond to the modern trends in nursing. It is stated in the Standard that the nurses’ technical...
Effective Leadership Within a Coalition Leadership is a powerful practice in every nursing coalition. Effective leadership emerges when the right individuals are included in the targeted coalition. Such members should have similar values, expectations, and goals. The leader should “promote powerful practices such as teamwork, effective communication, problem-solving, and decision-making”...
Introduction In the course of completing the practicum project, one has to deal with a number of cases within a day. As a result of this, it may be really difficult for that individual to carry out a comprehensive assessment on every patient seen in the course of the day....
Introduction A fall may be described as the situation whereby an individual finds him or herself on the ground involuntarily. Some of the major issues faced by health care facilities include patient falls. Patient safety is every hospital’s priority and this includes ensuring the prevention of patient falls. However, falls...
Introduction Autism and epilepsy can be serious mental health problems although an early detection of these health complications can lead to proper management and control of the symptoms associated with them (Pop-Jordanova et al. 4). Over the years, autism and epilepsy have been psychological conditions that have persistently subjected families...
Introduction Breast cancer epidemiology According to Breast Cancer Care, about 55,600 persons are confirmed to have breast cancer in the United Kingdom on an annual basis. It is estimated that about 500,000 mortality cases are attributed to breast cancers annually. In comparison to other parts of the world, Europe is...
A summary of the report of the Institute of Medicine Nursing requires rigorous training. The occupation usually aims at improving the quality of life of individuals and communities. Nurses form the biggest section of the health care population in the US. They play critical roles in the achievement of healthcare...
Introduction The issue of criminal prosecution for nurses who fail to observe safety precautions when they are treating patients needs to be examined further. In some instances, nurses are instructed by physicians and pharmacists to offer their patients treatments which are not appropriate for their wellbeing. This paper will discuss...
Introduction The quality revolution is currently transforming the health care sector (Cama, 2009). The health care sector and the public are now informed of the need to improve the health care processes. Equally, increased competition in the sector is now forcing health care institutions to improve the quality and safety...
Introduction Generational breach is an element of current world. It leads to disagreement among individuals in a given generation. Currently, the field of nursing experiences tremendous challenges; nurse leaders have the role of responding to diverse beliefs, attitudes, and habits of other team nurses for success of their career. The...
The article “Sisterhood of the Tent” highlights the importance of teamwork among nursing professionals to ensure safety and efficiency in the provision of healthcare. Collaboration between the five nurses highlights the enhancement in nursing outcomes due to effective communication, improved knowledge among colleagues, sharing of goals and vision, and job...
Introduction Healthy people 2020 provides an outline of the fundamental aspects of community health (Healthy People 2020, 2013). Analysts use the eight subsystems to evaluate a community’s well-being and to determine their social status (Lundy & Janes, 2009). The paper gives recommendations on the areas that need improvement to make...