Communication Skills in Nursing

Dr. Hoda Ibrahim Ibrahim Rizk

Assistant professor of public health and
community Medicine
Faculty of Medicine,Cairo University

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1. Introduction

Communication is the basic element of human interactions that allows

people to establish, maintain and improve contacts with others.

Effective interpersonal communication skills between health care providers

and client/patients are one of the most significant factors for improving
client/patients’ satisfaction, compliance and overall health outcome

It is essential that nurses develop and maintain an understanding of the

methods and skills of communication in order to meet the needs of the
client/patient.

Nurses have an important role in the care of client/patients in a variety of

healthcare settings. Therefore, every point of contact can be an opportunity
to improve client/patient care and relationships using effective
communication

The quality of care provided is dependent on the quality of communication

that exists between the nurses and their client/patients

When nurses communicate effectively with interest, listen actively and

demonstrate compassion, client/patients may be more likely to report their
experiences as positive, even at times of distress and ill health

The clients who understand details of their illness and treatment, whom
perceive and believe the provider is concerned about their well-being, often
show greater satisfaction with the care received and are more likely to
follow with treatment regimes.

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2. Definition of Communication

The word communication originates from ‘communis’, a Greek word,

meaning ‘to make common’. Communication is “a process by which people
exchange ideas, facts, feelings or impressions in ways that each gains a
‘common understanding’ of meaning, intent and use of a message.

In general, communication refers to the reciprocal exchange of information,

ideas, facts, opinions, beliefs, feelings & attitudes through verbal or
nonverbal means between people

It includes listening and understanding with respect, as well as expressing

views and ideas and passing information to other in a clear manner

Communication is an art, and like any art it is a learning skill influenced by

the presence of special talent in some persons

3. Why communication is important?

 Effective communication is the basis of mutual understanding & trust.

 Gets your point across.
 Informs and Educates.
 Helps in rapport building
 Helps in Co-operation in treatment and rehabilitation.
 Stimulates new ideas
 On the other hand Poor communication causes a lot of
misunderstanding, hinders work & productivity.

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4. Elements of Communication

1-Sender:

•A sender is a person who encodes & sends the message to the expected
receiver through an appropriate channel.

The impact of the message will depend on sender's communication skill,

social status (authority), knowledge, attitude and prestige in the community.

2-Message:

•The message is the content of communication & may contain verbalor

nonverbal language.

•Perception & personal factors of the sender and receiver may sometimes
distort this element so the intended outcome of communication may not be
achieved.

For example, the same message may be communicated or perceived

differently by two individuals.

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3-Channel:

•A channel is a medium through which a message is sent or received

between two or more people.

•Several channels can be used to send or receive the message, i.eseeing,

hearing, touching, and smelling, writing &feeling.

•While selecting channels of communication, several factors must be

considered: availability of channels, purpose, suitability, types of receivers,
types of message, preference of sender & receivers, communication skills of
the sender, cost, etc.

Classification of channels of communication:

•Visual channel: Facial expression, body language, posture, gestures,

pictures & written words, electronic mails, mass media, etc.

•Auditory channel: Spoken words, sounds, telephone or mobile

communications, delivering audio content (radio, voicemail), etc.

•Tactile channel: Touch sensations, therapeutic touch, etc.

•Combined channel: Audiovisual media, consoling a person with touch &

spoken words.

Every channel of communication has its advantages and limitations.

The proper selection and use of channels results in successful

communication

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4-Receiver:

•A receiver is an individual or a group of individuals intended to receive,

decode & interpret the message sent by the sender/source of message and
give feedback.

• He is expected to have the ability & skills to receive, decode & interpret
the message

•A receiver also known as decoder.

• Communication has only taken place if the message being sent was
accurately received

5-Feedback:

 It is a return message sent by the receiver to the sender.

 It is most essential element of the communication process as it shows that
the receiver has understood the primary message sent by the sender.
 A successful communication must be a two-way process where the sender
sends the message & receives feedback from the receiver.
 The feedback cold be positive or negative
 Positive feedback: the receiver accepted the concept of the message.
 Negative feedback: the receiver resisted the concept of the message.

6-Effect

The effect of communication is the end results of the communication process

(s) which could be emotional, cognitive or physical.

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 Settings of Communication

1-Intrapersonal: it is communication that occurs in your own mind. It is the

basis of your feelings, biases, and beliefs. E.g. the person communicates
with himself through thinking

2-Interpersonal:people in a face to face

 Person to person
 Small group communication 3-15 usually share a common purpose
 Public speaking one person and audiences in public setting, lecture
hall,etc.

3- Mass communication: large mass people don't know each other &
usually not in the same place radio or television or the internet.

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5. Types of Communication

A) Verbal communication:

•It occurs through the medium of spoken or written words.

•A combination of several words is used & each word conveys a specific

meaning.

•Some important elements of verbal communication are

Appropriate and Clear language, vocabulary building, clarity,

consciousness, preciseness, comprehension, briefness, timing &
relevance

Words should be meaningful and suitable to the listeners, consider the

demographic factors: age, sex, education and interest of target group

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 B) Non-Verbal Communication:

The term non-verbal communication is used to describe all human

communication that is not written or spoken, refers to an exchange of
information without the exchange of spoken words (facial expressions, body
language, etc.).

 This communication occurs without words; where the five senses &
whole range of body movements, posture, gesture, facial expressions &
silence are used for sending & receiving the message.
 Nonverbal communication is a more accurate way of communication
because it convey the true & intended meaning of the message
 Body Languagespeaks louder than words. A person will generally pay
more attention to what you do than what you say
 Nonverbal communication may be accomplished by the following means:

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 Physical appearance:

- When you deliver a speech, your appearance conveys a powerful

visual message to the audience
- Enhance your appearance through proper clothing, grooming, and
physical conditioning.

 Facial expression

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 Eye contact
- After your voice, your eyes are your most powerful tool for
communication.
- Eye contact has very much in face-to-face communication.
- It builds the rapport between the speaker & the listener.
- Absence of eye contact shows lack of interest & understanding.
- The speaker must look in to the eyes of the audience this will built up
the confidence & eliminate the nervousness.
- The speaker must read the eye cues

- Maintain proper eye contacts level

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  Touch: it is a powerful mean of communications for elderly and
children

 Posture and gesture

A gesture is a specific bodily movement that reinforces a verbal message

or conveys a particular thought or emotion. Although gestures may be
made with the head, shoulders, or even the legs and feet, most are made
with the hands and arms

 Putting the hands on the head = confusion

 Rubbing the forehead = deep thinking

 Open relaxed fists = trust, confidence

 Nods & shades of the head convey agreement & disagree

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  Finger and hand movement:
How you hold and move your hands and fingers are particularly
insightful in reading people.

 Distance
o Intimate (touching to 45cm)
o Personal (45cm to 1.2m)
o Social (1.2m to 3.6m)
o Public (3.7m to 4.5m)

 Para Language: Non-verbal aspects of speech:

 Pitchof voice
 Volume: highness or lowness of voice
 Rate or Speed of speech: rapid rate-++ interest or confusion

 Silence: It can be used to express a wide range of feelings(listen to silence

)
Using silencefor

 Organize thoughts, prepare for the next

 Encouraging the client/patient to communicate "open up."
 Allowing client time to revise what has been said

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  Allow client time to collect thoughts
 Allow client time to consider alternatives
 Look interested
 Uncomfortable silence should be broken

 Functions of Non-Verbal Communication

1. Reinforces the verbal message
2. Complements the verbal message
3. May replace the verbal message
4. It may contradict the verbal message
5. Improving Non-Verbal Communication
6. Observe non-verbal communication of others

Effective communication
 Effective communication is the communication which produces
intendedor desired result
 Effective communication helps to connect well with others and
understand a person or situation in a betterway.
 It enables us to solve the differences, build trust and respect in
theorganization.
 Sometimes our message is misunderstood or we misunderstand the
receivedmessage, effective communication helps us to resolve these
problems.
 It helps us in decision making.

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  The 7cs of effective communication

1. Completeness

•The information conveyed in the message should be complete to do

effective Communication.

•The sender must take into consideration the receiver’s mind set and
convey the message accordingly.

•Complete information always gives additional information wherever

required; it leaves no question in the minds of the receiver.

2- Conciseness

•Conciseness means communicating what you want to convey in the

least possible words.

•Concise communication provides short and essential message in limited

words.

•Concise message is more appealing and comprehensive to the audience.

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3- Consideration

•Effective communication must take audience into consideration by

knowing the viewpoints, back ground, mindset, educational level, etc.

•Consideration implies stepping into the shoes of others.

•Consider the needs and requirements of the audience to achieve

effective communication.

4-Clarity

•Clarity implies emphasizing on a specific goal or objective at a time,

rather than trying to move away from track.

•Clarity helps to understand the message easily.

•Clarity comes with the use of exact, appropriate and concrete words.

5- Concreteness

•Concrete communication implies being particular and clear rather

being fuzzy and general.

•Concrete communication shows good level of confidence.

•Concrete information cannot be misinterpreted

6-Courtesy

•Courtesy means being polite, kind, enthusiastic and convincing.

•Courtesy reflects the nature and character of the sender of the

message.

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 •It is the same as give respect and then expects the same.

7- Correctness

• Correct information includes the precision and accurateness of facts

and figures used in the message

• Free from grammatical errors and use of appropriate and correct

language.

•Correctness in the communication implies that the correct

information is conveyed through message.

•Correct communication boosts up the confidence level of the sender.

•Correct information has greater impact on the audience.

 Skills of Effective communication

A-Skills that support in keeping the focus on the client:

 Looking and listening for cues.

Cues are hints and can be words, gestures or body language. Noticing
verbal and non-verbal cues is important to understanding the
client/patient’s needs.

 Asking relevant questions

 Ask open & closed ended questions

 Ask open questions as much as possible(esp. at the start)

For example: ‘How are you?’

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 Asking open directive questions: for example: ‘How are you since
I last saw you? ‘You said you are not with it, can you tell me more
about that?’

 Ask probing questions

 Clarify : What do you mean by that
 Justify : What makes you think of that
 Check accuracy : you definitely took 3 tab /day
 AVOID
 Talk more than the client/patient
 confusing & complicated questions
 Ignoring questions of the client/patient

 Psychological focus
 Asking the clients open ended questions about feelings.
 Recognizing and responding to emotions, feelings and
concerns.
 Client/patients appreciate healthcare professionals asking about
their feelings.
 Using pauses and silence
Pauses and silence provide a slower pace and will help the person to
engage in the conversation and give them time to think what they
want to say.

 Using minimal prompts.

Use small, encouraging words and gestures. For example, nodding or
saying ‘go on’.

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  Screening
For example: asking the question ‘Is there something else?’ before
continuing with the discussion.

 Clarifying
For example: asking the question ‘you said you are not with it, from
what you say, it sounds like it is hard to concentrate?’

 Negotiating
Negotiating and asking permission. For example: ‘Would it be okay to
talk about what is worrying you?’

B- Skills that support effective listening:

 Active listening
- Most important yet most difficult

- Demonstrating that you are actively listen

* Eye contact

* Lean forward facing client/patient

“Yes I understand – please continue”

- Helping the client/patient to be relevant

- Interrupt at appropriate point & try to redirect the interview

E.g. what you just told me about your job is very interesting but I
would like to hear more about the headache you have been having.

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 - You must read between the lines. Pick up the underlying meaning of
the message (intent); don't rely entirely upon the obvious or superficial
meaning (content) but pick up the nonverbal cues.

o Facial expressions (smile, frown, blank look, grimace).

o Gestures/mannerisms (fidgeting, toe tapping, clenched fists).
o Eye behaviors (avoiding eye contact, staring, wide eyes).
o Posture (erect, leaning toward/away from someone).

 Reflecting.
- Repeating the client’s message Verbal or nonverbal
- Reflecting content repeats client’s statement, May be misused
or overused
- Reflecting feelings
- Verbalizing implied feelings in client’s comment
- Encourages client to clarify

 Acknowledging.
Showing a response to what you are noticing or hearing. For example:
‘I can see you are very upset about this.’
 Summarizing.
- Never be afraid to summaries what the client/patient has told you
- Summarize & Check accuracy
e.g. “I would like to make sure that I have been understanding you
correctly, you told me that ……..“

“What I hear from you is that … Did I get that right?”

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 - Highlighting the main ideas expressed
- Conveys understanding
- Reviews main themes of conversation
- Use at different times during interaction

 Empathizing.
- Empathy means putting yourself in other person's place
- Empathy is neither sympathy (feeling sorry for another person) nor
compassion (that quality of love or tenderness that causes one person
to suffer along with another).
- Respond to the client/patients' emotional questions and tell the
client/patient everything about his/her case even if he/she does not ask
- Saying something to show you appreciate (not sympathize) how the
other person seems to be feeling.
For example: ‘Everything has happened so fast, no wonder you are
finding it difficult to take in.

 Paraphrasing.
Put the focus of the paraphrase on what the other person implied,
not on what you wanted him/her to imply, e.g., don’t say, “I
believe what you meant to say was …”. Instead, say “If I’m
hearing you right, you conveyed that …?”

C- Skills that help with giving information:

 Checking what information the person knows already.

 Giving small amounts of information at a time, using clear terms and
avoiding jargon.
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  Avoiding detail unless it is requested – do not assume people want to
know.
 Checking understanding using an open question. For example: ‘I have
gone through some difficult information, what sense have you made
of it?’
 Pausing and waiting for a response to what you have said before
moving on.
 Checking, with sensitivity, the effect of the information you have
given on the clientFor example: ‘There has been a lot of information
to take in today, how are you feeling?

Communication Barriers

I. personal perceptionbarriers

• Misunderstanding
•Poor retention due to memory problem
•Lack of attention
•Discomfort due to illness
•Hearing problems
•Poor listening skills
•Information overload
•Gender physiological differences
•Level of intelligent
II. Environmental barriers

•Loud background noise

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 •Poor lightingand Lack of ventilation
•Uncomfortable setting
•Unhygienic surrounding & bad odor
•Very hot or cold room
•Distance
•Lack of privacy
III. Psychological barriers

•Distrust & unhappy emotions

•Emotional disturbances
•Psychotic or neurotic illness
•Worry & emotional disturbances
•Fear, anxiety & confused thinking
•Negative attitude towards the communicator:
o Client thinks that he/she knows everything
o Client feels embarrassed as he/she cannot comply with
the advice due to financial constraints.
IV. Social barriers

•Differences in social norms, values & behavior

•Social taboos
•Different social strata
V. Cultural barriers

•Ethnic, religious & cultural differences

•Cultural tradition, Belief, values& behavior
•Level of knowledge & understanding
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 • Language
VII. Organizational barriers

•Organizational policy, rules & regulation

•Technical failure
•Time pressure
•Complexity of organization structure due to hierarchy
VIII. Communication process-related barriers

•Unclear & conflicting message

•Stereotypical approach
•Inappropriate channels
•Lack of or poor feed
•Contradictory messages:
When the client gets different messages from different sources
Methods to overcome barriers of communication
I.Methods to overcome physiological barriers

•Keep in each other’s retention & recollection abilities.

•Pay attention during the sharing of information
•Ensure each other comfort.
•Ensure the intactness of sensory perception.
•The limitation of hearing abilities must keep in mind.
•Active listening.
• avoid Information overload

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II. Methods to overcome environmental barriers

•Good lighting must be ensured to facilitate nonverbal communication.

•A comfortable seating arrangement.
•A hygienic &odor-free environment
III. Methods to overcome psychological barriers

•Happy & trustworthy manner

•Should not harbor negative emotions
•Avoid feeling of prejudice, resentment & antagonism.
•Free from fear, anxiety & confusion
IV. Methods to overcome social barriers

•The difference in social norms, values & behavior must be give

consideration.
•Social beliefs must be kept in mind.
V. Methods to overcome cultural barriers

•Consider cultural differences

•Consider cultural traditions, values & behavior.
VII. Methods to overcome organizational barriers

•Considered Organizational policy, rules & regulation.

•Organization structure must be simple & noncomplex
•Large organization must divided into smaller subset

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VIII. Methods to overcome communication process-related barriers

•An appropriate channel must be used.

•A stereotypical approach must be avoided in communication.
•The message must be clear &noneconflicting
•Proper feedback must be ensured by the recipient.

Importance Of Communication In Nursing

Effective communication is a core skill for all healthcare professionals and

nursing staff in particular, since nurses spend more time with client/patients
and relatives than any other healthcare professional.

A critical component of nursing practice is Good communication skills as it

has the following advantages:

 It Generates trust between nurse and clients.

 It provides professional satisfaction.
 Itis a means for bringing about change, i.e. nurse listens, speaks and
acts to negotiate changes that promote client’s well-being.
 It helps to promote managerial efficiency.
 It Provides basis for leadership action.
 It Provides means of co-ordination.
 It is an essential element of client/patient safety and quality hospital
care.
 It is the foundation of the relationship between the nurse and other
members of the health team

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  It affects all aspects of the nursing job and the client/patient
experience as it involves everyone the nurse interact with, including:

 Communication with nurse managers and administrators

 Nurse-to-nurse communication
 Nurse-to-physician communication, plus interactions with other
staff
 Nurse–client/patient communication, and communication with their
family
Guidelines for effective nurse Communication with Client/patients

The following tips can enhance nurse–client/patient communication in

most settings

A. Establishing the Setting.

 Provide a comfortable environment (lighting, temperature,

furnishings).
 Establish a relaxed, unhurried setting.
 Sit down when speaking to the client/patient.
 Face the speaker and maintain eye contact and proper eye level.
 Keep privacy and confidentiality.
 Avoid interruptions and other distracting influences.

B. beginning of the interview

 Greeting your client/patient

 Ask client/patient to sit down
 Introduce yourself and address your client/patient by name

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  Create rapport: The harmonious feeling with mutual respect,
acceptance, and understanding.
 Explain the need to take not

C. Main part of the nurse client/patient interview.

 Accept and respect the client/patient despite the symptoms of his

illness.

 Convey to the client/patient and family that they are important to you
and that you want to help them.

 Communicate with each client/patient as an individual not as a case

(In order to do so, you must try to get to know the client/patient,
Listen to him and Put yourself in his place).

 Convey honesty and trustworthiness.

 Look directly at your client/patient, smile, and be conscious of body
language (yours and theirs)

 Use active listening (Stop and listen -- don’t let documentation or

other duties distract you from important cues)

 Use language that is understandable to the client/patient. Avoid

acronyms and medical/nursing jargon

 Speak clearly and slowly; share information in small bites so as not to

overwhelm

 Keep questions brief and simple

 Ask one question at a time and give the client/patient time to answer.

 Clarify client/patient responses to questions, not just for your own use,
but also to let the client/patient know that you are listening and that
you understand.

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 Try not to overwhelm the client/patient with embarrassing or personal
questions. When it is necessary to ask personal questions, explain why
and keep it short and matter-of-fact

 Use the teach-back method, asking client/patients to repeat

information in their own words

 Avoid leading questions. You want the client/patient to tell you what
he is feeling, not what he thinks you want to hear. So avoid putting
words in his mouth. For example, it might be better to ask, "How are
you feeling?" rather than "I suppose you're feeling rested after your
nap."

 Avoid interrupting the client/patient. If you need to ask a question,

wait until he has completed his thought except he is giving irrelevant
information.

 Assess each client/patient’s ability to understand and comply with

instructions; pull in a family member, if needed

 Give a brief explanation of what you are doing and why

 Proper use of the nonverbal communications as silence, empathy…etc

 Nurses present client/patients and families with educational

materials on admission, describing their role in promoting safety

D- Ending the interview

 Enquire if your client/patient would like to add any thing

 Summarize what the patient should do in the meantime.
 Thank your client/patient

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Patient-centered care communication skills

Collaboration between the patient and the healthcare team, patient-centered

care incorporates the patient’s values, beliefs, and preferences regarding
overall health and well-being into the plan of care and implementation of all
care activities.

Key concepts for implementing patient centered care.

1. Respect

- During the initial assessment, encourage patients to share their values,

preferences, and needs related to health care because these will form the
basis of the plan of care.
- Customize care to each patient, ensuring that it’s culturally appropriate.
- To determine the patient’s values, preferences, and needs, you need good
interpersonal and communication skills.

2. Care coordination and integration

Care activities of all disciplines involved in the patient’s care should be

coordinated to heighten the focus on the patient.

3. ProvideInformation, communication, and education

- To help patients understand patient-centered care, provide them with

key information, communication, and education.
- Ask for their help in designing the overall plan of care. Answer their
questions in easy-to-understand terms, not jargon.

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 - To boost patients’ engagement in the patient-centered care process,
tailor your communication to reflect patients’ needs. To do this, ask
open-ended questions to gain insight into their concerns, such as:

 Can tell me how you’re feeling right now?

 What would you like me to do for you at this moment?
 Here’s a list of self-care activities that need to be completed. Do
you have a preference as to which activities should be done
first?

- Healthcare team members should discuss the pros and cons of various
treatment options. Help patients understand the information you’re
presenting by using visual images, analogies, or other means.

4. Comfort

Ensure that the patient is physically and emotionally comfortable so he or

she can actively engage in patient-centered care.

5. Family input

If the patient gives consent, incorporate input from family members into the
design of the overall plan of care.

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- Perry, A., & Potter, P. Clinical nursing skills & techniques, ed 6, Missouri,
Mosby.2006

- Nursing fundamentals accessed from

http://brooksidepress.org/nursing_fundamentals

- Philippa Sully, Joan Dallas.Essential Communication Skills for Nursing

Practice book.2005

- Abraham M, Moretz JG. Implementing patient- and family-centered care:

part I understanding the challenges. Pediatr Nurs. 2012; 38(1):44-7.

- Barry MJ, Edgman-Levitan S. Shared decision making—pinnacle of

patient-centered care. N Engl J Med. 2012; 366(9):780-1.

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extremist. Health Aff (Millwood). 2009; 28(4):w555-65.

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