WEEK 17

11 core competencies in nursing

Professional Nurse

• A Nurse is a health care professional engaged in the practice of nursing. Along with other health
care professionals, nurses are responsible for the treatment, safety, and recovery of acutely or
chronically ill/injured people; health maintenance of the healthy; and treatment of life-
threatening emergencies in various health care settings. Nurses may also be involved in research
and may perform non-clinical functions necessary to the delivery of health care.

Tasks

• Give professional nursing care and treatment, either as curative or preventive measures, to ill,
injured, disabled and other patients, and newborn babies and their mothers, in hospitals, clinics
or other establishments;
• Supervise and coordinate the work of nursing and other non-medical staff in operating theater
and assist surgeons during operations;
• Administer medicine and drugs, apply surgical dressings and give other forms of treatment
prescribed by physicians;
• Maintain accurate, detailed reports and records;
• Participate in preparations for physical and psychological treatment of mentally-ill patients;
• Give professional nursing care to patients in their homes;
• Provide professional nursing services, care and advice within a community or at a workplace;
• May specialize in community services to industrial and other organizations; and engage in
research activities related to nursing.

Basic Educational Requirement

• All Professional Nurses are required to have a Bachelor’s Degree in Nursing. Practice of the
profession requires a license issued by the Professional Regulation Commission (PRC), the body
which oversees the licensing of nurses and other professionals.

Skills and Competencies

• Ability to convey information effectively;

• Excellent reading comprehension;
• Ability to use logic and reasoning to identify the strengths and weaknesses of alternative
solutions, conclusions or approaches to problems;
• Analytical skills;
• Ability to communicate information and ideas clearly in speaking and in writing so others will
understand;
• Problem sensitivity or the abilty to tell when something is wrong or is likely to go wrong;
Physical Attributes and Characteristics

• Service Oriented - always actively looking for ways to help people;

• Compassionate and understanding;
• Possess "social perceptiveness" or a keen sense of awareness for patients’ needs and problems.
• Ability to see details at close range (near vision).

Prospects for Career Advancement

• There are several distinct levels of the nursing career structure distinguished by increasing
education, responsibility, and skills. Advanced practice nursing which involves diagnosis of
health problems and prescription of medication and other therapies is the next career move for
a professional nurse. These are the clinical nurse specialists and nurse practitioners who have
acquired a PhD and have gained specialization in clinical nursing, research, health policy,
teaching, and consultancy.

Employment Opportunities

• Aside from employment in hospitals, clinics and other establishments, the following are the
emerging local job market for nurses:

• 1. Medical Tourism

• 2. Medical Transcription

• 3. Rural Health Centers

• 4. Day Care Centers

• 5. Alternative Health Care Delivery System

• Home health care

• Long-term care facilities for the elderly

• Independent nurse practice

• Health Maintenance Organizations (HMOs)

• In the overseas market, there is an increasing and continuous demand for nurses and other
health care professionals particularly in the US, Canada, Ireland, UK, Australia & the Middle East.
The demand in existing foreign markets for nurses specializing in geriatric care, acute/intensive
care, cardiovascular care, renal, dialysis, oncology and telemetry is likewise fast growing. At
present, the Philippine government is working on expanding the market for Filipino nurses.
 11 CORE COMPETENCIES IN NURSING

• 1. SAFE AND QUALITY NURSING CARE

• 2. MANAGEMENT OF RESOURCES AND ENVIRONMENT’S

• 3. HEALTH EDUCATION

• 4. LEGAL RESPONSIBILITY

• 5. ETHIC/MORAL RESPONSIBILITY

• 6. PERSONAL AND PROFESSIONAL DEVELOPMENT

• 7. QUALITY IMPROVEMENT

• 8. RESEARCH

• 9. RECORD MANAGEMENT

• 10.COMMUNICATION

• 11.COLLABORATION AND TEAMWORK

A. Safe and Quality Nursing Care

• 1. Demonstrates knowledge based on the health/illness status of individual groups

• 2. Provides sound decision

• 3. Promotes wholeness and well-being including safety and comfort of patients

• 4. Sets priorities in nursing care based on patients' need

• 5. Ensures continuity of care

• 6. Administers medications and other health therapeutics

• 7. Utilizes the nursing process as framework for nursing

• 8. Formulates a plan of care in collaboration with patients and other members of the health
team

• 9. Implements planned nursing care to achieve identified outcomes

• 10.Evaluates progress toward expected outcomes

• 11.Responds to the urgency of the patient's condition

B. Management of Resources and Environment

• 1. Organizes workload to facilitate patient care

• 2. Utilizes resources to support patient care

• 3. Ensures availability of human resources

• 4. Checks proper functioning of equipment/facilities

• 5. Maintains a safe and therapeutic environment

• 6. Practices stewardship in the management of resources

C. Health Education

• 1. Assesses the learning needs of the patient and family

• 2. Develops health education plan based on assessed and anticipated needs

• 3. Develops learning materials for health education

• 4. Implements the health education plan

• 5. Evaluates the outcome of health education

D. Legal Responsibility

• 1. Adheres to practice in accordance with the nursing law and other relevant legislation
including contracts, informed consent

• 2. Adheres to organizational policies and procedures, local and national

• 3. Documents care rendered to patients

E. Ethico-Moral Responsibility

• 1. Respects the rights of individuals/groups

• 2. Accepts responsibility and accountability for own decisions and actions

• 3. Adheres to the national and international code of ethics for nurses

F. Personal and Professional Development

• 1. Identifies own learning needs

• 2. Pursues continuing education

• 3. Gets involved in professional organizations and civic activities

• 4. Projects a professional image of the nurse

• 5. Possesses positive attitude towards change and criticism

 • 6. Performs function according to professional standards

G. Quality Improvement

• 1. Utilizes data for quality improvement

• 2. Participates in nursing audits and rounds

• 3. Identifies and reports variances

• 4. Recommends solutions to identified causes of the problems

• 5. Recommends improvement of systems and processes

H. Research

• 1. Utilizes varied methods of inquiry in solving problems

• 2. Recommends actions for implementation

• 3. Disseminates results of research findings

• 4. Applies research findings in nursing practice

I. Record Management

• 1. Maintains accurate and updated documentation of patient care

• 2. Records outcome of patient care

• 3. Observes legal imperatives in record keeping

• 4. Maintains an effective recording and reporting system

J. Communication

• 1. Utilizes effective communication in relating with clients, members with the team and the
public in general

• 2. Utilizes effective communication in therapeutic use of self to meet the needs of clients

• 3. Utilizes formal and informal channels

• 4. Responds to needs of individuals, families, groups and communities

• 5. Uses appropriate information technology to facilitate communication

K. Collaboration and Teamwork

• 1. Establishes collaborative relationship with colleagues and other members of the health team
for the health plan

• 2. Functions effectively as a team player

 WEEK 18
MARTHA ROGERS
Science of Unitary Human Beings (SUHB)
• Martha Rogers was born on May 12, 1914; sharing a birthday with Florence Nightingale. She was
the eldest of four children of Bruce Taylor Rogers and Lucy Mulholland Keener Rogers.

• Initially, Martha Rogers wanted to do something that would, hopefully contribute to social
welfare like law and medicine. However, she only studied medicine for a couple of years
because women in medicine were not particularly desirable during her time.

• She then transferred to Knoxville General Hospital’s nursing program and was one of 25
students in her class.

• She described her training as at times as being miserable because the training was like the
“Army, pre-Nightingale.” She even spent a week at home, thinking of not returning to school but
eventually enjoyed working with people and patients.

• Rogers received her nursing diploma from the Knoxville General Hospital School of Nursing in
1936, then earned her Public Health Nursing degree from George Peabody College in Tennessee
in 1937. She sold her car to pay for tuition and entered a Masters degree program full-time.

• Her Master’s degree was from Teachers College at Columbia University in 1945, and her
Doctorate in Nursing was given to her from Johns Hopkins University in Baltimore in 1954.

Science of Unitary Human Beings (SUHB)

• The theory views nursing as both a science and an art as it provides a way to view the unitary
human being, who is integral with the universe. The unitary human being and his or her
environment are one. Nursing focuses on people and the manifestations that emerge from the
mutual human-environmental field process.

• SUHB contains two dimensions: the science of nursing, which is the knowledge specific to the
field of nursing that comes from scientific research; and the art of nursing, which involves using
the science of nursing creatively to help better the life of the patient.

• Her model addresses the importance of the environment as an integral part of the patient and
uses that knowledge to help nurses blend the science and art of nursing to ensure patients have
a smooth recovery and can get back to the best health possible.

• She believes that a patient can never be separated from his or her environment when
addressing health and treatment. Her knowledge about the coexistence of the human and his or
her environment contributed a lot in the process of change toward better health.
 • The belief of the coexistence of the human and the environment has greatly influenced the
process of change toward better health. In short, a patient can’t be separated from his or her
environment when addressing health and treatment.

Assumptions

• The assumptions of Rogers’ Theory of Unitary Human Beings are as follows: (1) Man is a unified
whole possessing his own integrity and manifesting characteristics that are more than and
different from the sum of his parts. (2) Man and environment are continuously exchanging
matter and energy with one another. (3) The life process evolves irreversibly and
unidirectionally along the space-time continuum. (4) Pattern and organization identify the man
and reflect his innovative wholeness. And lastly, (5) Man is characterized by the capacity for
abstraction and imagery, language and thought sensation and emotion.

Major Concepts

Human-unitary human beings

• A person is defined as an indivisible, pan-dimensional energy field identified by a pattern, and

manifesting characteristics specific to the whole, and that can’t be predicted from knowledge of
the parts. A person is also a unified whole, having its own distinct characteristics that can’t be
viewed by looking at, describing, or summarizing the parts.

Health

• Rogers defines health as an expression of the life process. It is the characteristics and behavior
coming from the mutual, simultaneous interaction of the human and environmental fields, and
health and illness are part of the same continuum. The multiple events occurring during the life
process show the extent to which a person is achieving his or her maximum health potential.
The events vary in their expressions from greatest health to those conditions that are
incompatible with the maintaining life process.

Nursing

• It is the study of unitary, irreducible, indivisible human and environmental fields: people and
their world. Rogers claims that nursing exists to serve people, and the safe practice of nursing
depends on the nature and amount of scientific nursing knowledge the nurse brings to his or her
practice

Environment

• “An irreducible, indivisible, pandimensional energy field identified by pattern and integral with
the human field.”
 Dorothy E. Johnson
• Dorothy Johnson was born on August 21, 1919 in Savannah, Georgia. She was the youngest of
seven children. Her father was the superintendent of a shrimp and oyster factory and her
mother was very involved and enjoyed reading.

• In 1938, she finished her associate's degree in Armstrong Junior College in Savannah, Georgia.

• Dorothy Johnson’s professional nursing career began in 1942 when she graduated from
Vanderbilt University School of Nursing in Nashville, Tennessee. She was the top student in her
class and received the prestigious Vanderbilt Founder’s Medal.

• In 1948, she received her Masters in public health from Harvard University in Boston,
Massachusetts.

• She was a staff nurse at the Chatham-Savannah Health Council from 1943 to 1944. She was an
instructor and an assistant professor in pediatric nursing at Vanderbilt University School of
Nursing.

• She was an instructor and an assistant professor in pediatric nursing at Vanderbilt University
School of Nursing.

Behavioral System Model

• Dorothy Johnson’s theory defined Nursing as “an external regulatory force which acts to
preserve the organization and integration of the patient’s behaviors at an optimum level under
those conditions in which the behavior constitutes a threat to the physical or social health, or in
which illness is found.”

• It also states that “each individual has patterned, purposeful, repetitive ways of acting that
comprises a behavioral system specific to that individual.”

• The patient is identified as a behavioral system composed of seven behavioral subsystems:

affiliative, dependency, ingestive, eliminative, sexual, aggressive, and achievement.

1. Attachment or affiliative subsystem

 Attachment or affiliative subsystem is the “social inclusion intimacy and the formation
and attachment of a strong social bond.” It is probably the most critical because it forms
the basis for all social organization. On a general level, it provides survival and security.
Its consequences are social inclusion, intimacy, and the formation and maintenance of a
strong social bond
2. Dependency subsystem
 Dependency subsystem is the “approval, attention or recognition and physical
assistance.” In the broadest sense, it promotes helping behavior that calls for a
nurturing response. Its consequences are approval, attention or recognition, and
physical assistance.
 3. Ingestive subsystem
 Ingestive subsystem is the “emphasis on the meaning and structures of the social
events surrounding the occasion when the food is eaten.” It should not be seen as
the input and output mechanisms of the system. All subsystems are distinct subsystems
with their own input and output mechanisms. The ingestive subsystem “has to do with
when, how, what, how much, and under what conditions we eat.”
4. Eliminative subsystem
 Eliminative subsystem states that “human cultures have defined different socially
acceptable behaviors for excretion of waste, but the existence of such a pattern
remains different from culture to culture.” It addresses “when, how, and under what
conditions we eliminate.” As with the ingestive subsystem, the social and psychological
factors are viewed as influencing the biological aspects of this subsystem and may be,
at times, in conflict with the eliminative subsystem.
5. Sexual subsystem
 Sexual subsystem is both a biological and social factor that affects behavior. It has the
dual functions of procreation and gratification. Including, but not limited to, courting
and mating, this response system begins with the development of gender role identity
and includes the broad range of sex-role behaviors.
6. Aggressive subsystem
 Aggressive subsystem relates to the behaviors concerning protection and self-
preservation, generating a defense response when there is a threat to life or territory.
Its function is protection and preservation. Society demands that limits be placed on
modes of self-protection and that people and their property be respected and
protected.
7. Aggressive subsystem
 Aggressive subsystem relates to the behaviors concerning protection and self-
preservation, generating a defense response when there is a threat to life or territory.
Its function is protection and preservation. Society demands that limits be placed on
modes of self-protection and that people and their property be respected and
protected.

Major Concepts
Human Beings

• Johnson views human beings as having two major systems: the biological system and the
behavioral system. It is the role of medicine to focus on the biological system, whereas nursing’s
focus is the behavioral system.

• The concept of human being was defined as a behavioral system that strives to make continual
adjustments to achieve, maintain, or regain balance to the steady-state that is adaptation.

Environment

• Environment is not directly defined, but it is implied to include all elements of the surroundings
of the human system and includes interior stressors.
Health

• Health is seen as the opposite of illness, and Johnson defines it as “some degree of regularity
and constancy in behavior, the behavioral system reflects adjustments and adaptations that are
successful in some way and to some degree… adaptation is functionally efficient and effective.”

Nursing

• Nursing is seen as “an external regulatory force which acts to preserve the organization and
integration of the patient’s behavior at an optimal level under those conditions in which the
behavior constitutes a threat to physical or social health, or in which illness is found.”

Betty Neuman
• Betty Neuman was born in 1924 near Lowell, Ohio. She grew up on a farm which later
encouraged her to help people who are in need. Her father was a farmer who became sick and
died at the age of 36. Her mother was a self-educated midwife, that led the young Neuman to
be always influenced by the commitment that took her away from home from time to time. She
had one older brother and a brother who was younger which makes her the middle child among
her siblings. Her love for nursing started when she took the responsibility of taking care of her
father which later created her compassion in her chosen career path.

• In 1947, she received her RN Diploma from Peoples Hospital School of Nursing, Akron, Ohio.

• Nursing Career of Betty Neuman

• Betty Neuman moved to California and worked in a variety of capacities as a hospital nurse and
head nurse at Los Angeles County General Hospital, school nurse, industrial nurse, and clinical
instructor at the University of Southern California Medical Center, Los Angeles.

• In 1957, she received a baccalaureate degree in public health and psychology with honors.

• She also earned a master’s degree in mental health, public health consultation in 1966 from the
University of California, Los Angeles (UCLA).

• In 1985, Betty Neuman concluded a doctoral degree in clinical psychology at Pacific Western
University. She was a pioneer of nursing involvement in mental health.

Betty Neuman’s Nursing Theory

• A nursing theory developed by Betty Neuman is based on the person’s relationship to stress, the
response to it, and reconstitution factors that are progressive in nature. The Neuman Systems
Model presents a broad, holistic and system-based method to nursing that maintains a factor of
flexibility. It focuses on the response of the patient system to actual or potential environmental
stressors and the maintenance of the client system’s stability through primary, secondary, and
tertiary nursing prevention intervention to reduce stressors.
 What is the Neuman Systems Model?
• Betty Neuman describes the Neuman Systems Model as “a unique, open-system-based
perspective that provides a unifying focus for approaching a wide range of concerns.

• The Neuman Systems Model views the client as an open system that responds to stressors in the
environment. The client variables are physiological, psychological, sociocultural, developmental,
and spiritual.

• The client system consists of a basic or core structure that is protected by lines of resistance.
The usual level of health is identified as the normal line of defense that is protected by a flexible
line of defense.

• When stressors break through the flexible line of defense, the system is invaded and the lines of
resistance are activated and the system is described as moving into illness on a wellness-illness
continuum. If adequate energy is available, the system will be reconstituted with the normal line
of defense restored at, below, or above its previous level.

• Nursing interventions occur through three prevention modalities.

• Primary prevention occurs before the stressor invades the system;

• secondary prevention occurs after the system has reacted to an invading stressor;

• tertiary prevention occurs after secondary prevention as reconstitution is being established.

Assumptions
The following are the assumptions, or “accepted truths” made by Neuman’s Systems Model:

• Each client system is unique, a composite of factors and characteristics within a given range of
responses.

• Many known, unknown, and universal stressors exist. Each differs in its potential for disturbing a
client’s usual stability level or normal line of defense. The particular interrelationships of client
variables at any point in time can affect the degree to which a client is protected by the flexible
line of defense against possible reaction to stressors.

• Each client/client system has evolved a normal range of responses to the environment that is
referred to as a normal line of defense. The normal line of defense can be used as a standard
from which to measure health deviation.

• When the flexible line of defense is no longer capable of protecting the client/client system
against an environmental stressor, the stressor breaks through the normal line of defense.

• The client, whether in a state of wellness or illness, is a dynamic composite of the

interrelationships of the variables. Wellness is on a continuum of available energy to support the
system in an optimal state of system stability.
 • Implicit within each client system are internal resistance factors known as lines of resistance,
which function to stabilize and realign the client to the usual wellness state.

• Primary prevention relates to general knowledge that is applied in client assessment and
intervention, in identification and reduction or mitigation of possible or actual risk factors
associated with environmental stressors to prevent possible reaction.

• Secondary prevention relates to symptomatology following a reaction to stressors, appropriate

ranking of intervention priorities, and treatment to reduce their noxious effects.

• Tertiary prevention relates to the adjustive processes taking place as reconstitution begins and
maintenance factors move the client back in a circular manner toward primary prevention.

• The client as a system is in dynamic, constant energy exchange with the environment.

Major Concepts of Neuman Systems Model

Human being

• Human being is viewed as an open system that interacts with both internal and external
environment forces or stressors. The human is in constant change, moving toward a dynamic
state of system stability or toward illness of varying degrees.

Environment

• The environment is a vital arena that is germane to the system and its function. The
environment may be viewed as all factors that affect and are affected by the system. In Neuman
Systems Model identifies three relevant environments: (1) internal, (2) external, and (3) created.

• The internal environment exists within the client system. All forces and interactive influences
that are solely within boundaries of the client system make up this environment.

• The external environment exists outside the client system.

• The created environment is unconsciously developed and is used by the client to support
protective coping.

Health

• In Neuman’s nursing theory, Health is defined as the condition or degree of system stability and
is viewed as a continuum from wellness to illness. When system needs are met, optimal
wellness exists. When needs are not satisfied, illness exists. When the energy needed to support
life is not available, death occurs.

Nursing

• The primary concern of nursing is to define the appropriate action in situations that are stress-
related or in relation to possible reactions of the client or client system to stressors. Nursing
interventions are aimed at helping the system adapt or adjust and to retain, restore, or maintain
some degree of stability between and among the client system variables and environmental
stressors with a focus on conserving energy.
 JOYCE TRAVELBEE
HUMAN-TO HUMAN REL’P. MODEL

“A nurse does not only seek to alleviate physical pain or render physical care – she ministers to the
whole person. The existence of suffering, whether physical, mental or spiritual is the proper concern of
the nurse.”

 Born in 1926, was a psychiatric nurse, educator and writer.

 Completed her Bachelor of Science degree in nursing education at Louisiana State University
(1956) and her Master of Science Degree in Nursing from Yale University (1959).

 She started a doctoral program in Florida in 1973. Unfortunately, she was not able to finish the
program because she died later that year. She passed away at the prime age of 47 after a brief
sickness.

 In 1952, she started to be an instructor focusing in Psychiatric Nursing at DePaul Hospital

Affiliate School, New Orleans, while working on her baccalaureate degree.

 In 1970, she was named Project Director at Hotel Dieu School of Nursing in New Orleans.

 She was the director of Graduate education at Louisiana State University School of Nursing until
her death.

 In 1963, she started to publish various articles in nursing journals.

 Her first book entitled INTERPERSONAL ASPECTS OF NURSING was published in 1966 and 1971.

 In 1969, she had her second book published entitled INTERVENTION IN PSYCHIATRIC NURSING:
PROCESS IN THE ONE-TO-ONE RELATIONSHIP.

Person

• defined as a human being. Both the nurse and patient are human beings.
• a human being is a unique, irreplaceable individual who is in the continuous process of
becoming, evolving, and changing.

Health

• “A person’s subjective health status is an individually defined state of well being in accord with
self- appraisal of physical-emotional-spiritual status.” Objective health is “an absence of
discernible disease, disability, or defect as measured by physical by examination, lab. Tests,
assessment by a spiritual director, or psychological counselor.”

Environment

Nursing

• “an interpersonal process whereby the professional nurse practitioner assists an individual,
family, or community to prevent or cope with the experience of illness and suffering and, if
necessary, to find meaning in these experiences.”
 HUMAN-TO-HUMAN RELATIONSHIP MODEL
 Travelbee concluded that the nursing care rendered to patients in these institutions lacked
compassion. She thought that nursing care needed a “humanistic revolution”- a return to focus
on the caring function towards the ill person.

 Travelbee’s mentor, Ida Jean Orlando, is one of her influences in her theory. Orlando’s model
has similarities to the model that Travelbee proposes. The similarities between the two models
are shown in Travelbee’s statement, “the nurse and patient interrelate with each other and by
her description of the purpose of Nursing”.

 She stated that the purpose of nursing is to “assist an individual, family or community to prevent
or cope with the experience of illness and suffering, and, if necessary, to find meaning in these
experiences.”

In her human-to-human relationship model, the nurse and the patient undergoes the following series of
interactional phases:

Original Encounter

-described as the first by the nurse of the sick person and vice-versa. The nurse and the patient
see each other in stereotyped or traditional roles.

Emerging Identities

- described by the nurse and patient perceiving each other as unique individuals. As this time,
the link of the relationship begins to form.

Empathy

-described as the ability to share in the person’s experience. The result of the emphatic process
is the ability to expect the behavior of the individual with whom he or she empathized.

Sympathy

- happens when the nurse wants to lessen the cause of the patients suffering. It goes beyond
empathy. “When one sympathizes, one is involved but not incapacitated by the involvement”. The nurse
should use a disciplined intellectual approach together with therapeutic use of self to make helpful
nursing actions.

Rapport

- described as nursing interventions that lessens patient’s suffering. The nurse and the sick
person are relating as human being to human being. The sick person shows trust and confidence in the
nurse. “A nurse is able to established rapport because she possesses the necessary knowledge and skills
required to assist ill persons and because she is able to perceive, respond to, and appreciate the
uniqueness of the ill human being”.
 ACCEPTANCE BY THE NURSING COMMUNITY
PRACTICE

• the hospice is one good example in which Travelbee’s theory is applied. The hospice nurse
attempts to build rapport or a working relationship with the patient, as well as with his
significant others. She stated that understanding illness and suffering enables the patient not
only to accept the sickness, but also to use it as a self-actualizing life experience.
• a sick person’s insight of worthlessness in his or her sickness leads to non-acceptance of his own
condition and the great possibility to lose hope.

• - a hospice nurse believes that the dying person must find meaning in his or her death before he
or she can ever begin to accept the actuality of death, just as his or her loved ones must find
meaning in death before they can complete the grieving process.

EDUCATION

• Travelbee’s concepts served As a better assistance for nurses who help individuals understand
the meaning of illness and suffering Travelbee’s second book, Intervention in Psychiatric
Nursing; Process in the One-to-One Relationship, has been used in different nursing programs.
According to Travelbee’s model, courses in philosophy and religion would also be helpful in
preparing nursing students to fulfill the purpose of nursing sufficiently.

RESEARCH

• -numerous sources in research studies have cited some aspects of the one-to-one relationship.

• one study by O’Connor, Wicker and Germino discovers how individuals who were recently
diagnosed with cancer described their personal research for meaning.

• the results of this study make known that the search for meaning seems to be both a spiritual
and psychosocial process.