A brief summary of the problem including the potential middle-range theory that could be applied.

PURPOSE:

It is important to understand how borrowed theory can help you in your everyday environment as a nurse. In the previous assignment, you identified a practical problem that emerged from the evidence in the extant literature or professional practice, and you explored how middle-range theory could be applied to solve the problem. In this assignment, you will explore and apply borrowed theory to solve the specific problem that you identified previously, and you will synthesize the applications of the middle-range theory and the borrowed theory into the most appropriate solution to the problem.

DIRECTIONS:

Consider the problem that you described in the previous assignments and the instructor feedback about those assignments.

Write a paper (1,750 to 2,000 words) that describes how borrowed theory can be applied to the identified problem. The paper should include the following:

  1. A brief summary of the problem including the potential middle-range theory that could be applied.
  2. A description of a borrowed theory that could be applied to the problem. Is this borrowed theory appropriate to your identified problem?
  3. A brief history of the borrowed theory’s origins.
  4. A discussion of how the borrowed theory has been previously applied.
  5. A discussion of the application of the borrowed theory to the identified problem. How would your practice change by incorporating this theory?
  6. A discussion of how application of both the borrowed theory and the middle-range theory can be integrated to create the most appropriate solution to the identified problem.

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

 

Please read the previous 2 essay and apply it to this assignment, apa format, at least 1700 to 2000 word, 3 reference

 

1 previous essay

 

Neuman’s System Model and Use in Psychiatric Facilities

Student’s Name:

Institution Affiliation:

 

 The problem description summary

Psychiatric and mental health nursing deals with the care of the patients with emotional and mental health problems that include and not limited to depression, anxiety, mood disorders, addictions, and stress and various developmental disorders (Phillips, 2016). In this case, the nursing professionals play a significant role in offering both nursing and medical care to the individuals, groups, communities, and even families to promote emotional and mental health. The primary problem experienced in a psychiatric nursing workplace setting is the patient violence that significantly affects the quality of care given and the nursing management outcome (Phillips, 2016). The patient violence particularly occurs in the acute setting of the psychiatric facilities and is believed to result from the nature of the patient condition. This problem remains a global concern and mainly affects the nurses because they remain the primary care givers in the psychiatric facilities and have long hours exposed to the mentally ill patients. A research conducted by Phillips (2016), indicates that over 20%of all psychiatric patients possess violent behavior in a variety of ways ranging from verbal to physical abuse. Various triggers are believed to precipitate the violent behavior and hence proper training, administration, policy making, and proper practice development remain pillars of early detection and prevention of patient violence (Phillips, 2016).

Betty Neuman’s systems model

Middle range theories are highly useful in addressing various nursing problems especially the vulnerable groups, families, or even individuals. In this case, the Betty Neuman’s system model gives a comprehensive system based and holistic approach to nursing with an element of flexibility. This theory primarily focuses on the patient’s response to the existing potential environmental stressors and the utilization of the primary, secondary and the tertiary nursing prevention interventions for maintenance of patient system wellness (Neuman & Fawcett, 2002).

The Neuman’s system theory has various assumptions to put into consideration in its application. The model assumes that a patient system is a unique with composite factors, existence of many universal stressors influencing the patient system stability, each patient has range of responses to the environment, and the interrelations of the patient with care givers at any time can affect the degree to which the client is protected (Neuman & Fawcett, 2002). The model also assumes that the client remains a dynamic system of interrelationships of the existing variables in either state of wellness or illness. In addition, a secondary prevention relates to the symptoms following a behavior or even a reaction and appropriate measuring of the priorities of the intervention and the treatment offered reduces their bad or noxious effects. The primary concepts applied in this model include a person, health, environment, and nursing. This model is highly useful in my identified problem of patient violence in the psychiatric facilities. In this case, the systematic nature of this theory can help the nursing team to do thorough patient management and help reduce the cases of mentally ill patient’s violence against nurses (Neuman & Fawcett, 2002).

Betty Neuman’s systems model origins

Betty Neuman’s theorist was born in the year 1924 in Ohio. She completed her bachelor’s degree in nursing in 1957 and, master’s degree in mental health public health consultation in 1966 from UCLA and hold a doctorate degree in psychology (Neuman & Fawcett, 2002). Neuman started the development of her health system model while a community health nursing lecturer at the University of California in Los Angeles (Neuman & Fawcett, 2002). In this case, the model was published in 1972 involving the teaching of total patient problems approach in the nursing research where it was refined in 1974 and published in the first edition of conceptual models for the nursing practice. This theory was influenced by various philosophers and finally contributed to the body of knowledge validated through research (Neuman & Fawcett, 2002).

Neuman’s systems model previous application

The systems theory has previously been utilized by professionals in the management of various patient conditions. In this case, the professionals focus on the use of the primary, secondary, and the tertiary prevention interventions and have viewed the nursing practice based on the degree of reaction to stressors. The model utilizes the six steps involved in patient management that include the assessment, nursing diagnosis, setting goals, planning, and implementation using the three levels of intervention (Neuman & Fawcett, 2002). Finally, an evaluation is conducted and state of balance restored.  Previously, the model has been utilized in the United States intensive care units. In this case, intensive care has very sick patients who need to be considered holistically by involving their families for quality system functioning. The nurses in such units do a comprehensive patient assessment to come up with the most accurate and correct diagnosis that will help improve the care given to the patient. Proper assessment helps in offering the best prevention intervention to the patient, families, and even the communities. This systematic model prevents the nurses from exhaustion, burn out and psychological trauma (Neuman & Fawcett, 2002).

Use of Neuman’s model in psychiatric facilities

In nearly all instances, violence erupts with some warning signs displayed by the psychiatric patients. In this case, the nursing professional working at the mental health facilities can utilize the Neuman’s systems model to reduce the cases of violence in such facilities (Richter & Whittington, 2006).  The systems model provides guidelines to use that utilizes the three classes of prevention interventions. Thorough patient assessment holistically helps in early detection of any warning signs or identifying all the precipitators of patient violence. In this case, the nursing care givers identify the patient stressors and address the whole person and hence the holistic perspective (Richter & Whittington, 2006).

According to Neuman and Fawcett (2002), the nurse perception must be assessed in addition to assessing the patient because it influences the kind of care plan that he or she makes for a patient. It views the function of the nurse based on reactions to the stressors and the use of all the prevention interventions outlined by this model. After comprehensive assessment to identify the stressors, warning signs, and symptoms of violence, the nurse is required to make a nursing diagnosis, set goals, planning of care, intervening, and finally doing an evaluation of the care given (Neuman & Fawcett, 2002). The primary intervention of this model is the prevention intervention. In this case, prevention of patient violence is essential and can be achieved through proper training, comprehensive attitude, and perception towards the care, proper policy making can aid in the prevention of the patient violence (Neuman & Fawcett, 2002).

References

Neuman, B. M., & Fawcett, J. (2002). The Neuman systems model. Pearson Education, Incorporated.

Phillips, J. P. (2016). Workplace violence against health care workers in the United States. New England journal of medicine, 374(17), 1661-1669.

Richter, D., & Whittington, R. (2006). Violence in mental health settings: Causes, consequences, management. New York: Springer.

 

2 previous essay

 

PSYCHIATRIC PATIENT VIOLENCE AND RESEARCH

Diane Boll

Grand Canyon University: NUR 502

08-30-2017

 

                                                            Problem description

The nurses working in psychiatric units experience various problems. In this case, these problems impact significantly on the quality of care given by such professionals. One of the problems faced in the psychiatric workplace setting is patient violence that influences and affects the outcome of nursing management (Arnetz et al, 2015). These cases mostly happen in the acute psychiatric settings. The patient violence against the nursing professionals in their work areas remains a global problem and happens particularly in the mental health care facilities. In this case, the violence results from the nature of the patient condition that results in harm to the self and others. This problem is prevalent to nurses because, it is the nurses who take care of the patient and exposed for long hours (Arnetz et al, 2015). Nurse professional is the first and the primary health care provider in psychiatric facilities and hence a high risk of violence. The violence varies from physical to non-physical violence. A research indicates that about 20% of patients admitted to the psychiatric facilities possess violent behaviors in a variety of ways. The violence behaviors may be associated with various triggers that the only the nurses who has known the patient for a long time can understand (Arnetz et al, 2015).

                                Literature supported rationale for significance of the problem

According to Richter and Whittington (2006), patient violence significantly affects both the health professionals and the quality of health they receive. The results of these violent behaviors translate to longer hospital stay and readmission. It also results to work related stress, blame, fear, post traumatic events and the feeling of abuse and insult. The patient violence against the health professional has a great significance and can be used to help manage the problem and prevent its future occurrence (Richter & Whittington, 2006).

A study conducted by Richter and Whittington (2006), offers a significant administration, nursing education, practice development, and policy making. More training and proper practice development are associated with helping in dealing with the violent patients. In this case, the training and proper practice offer the nurses and other health professionals to understand the triggers and the signs of violence that psychiatric patient may display for the anticipation of care. Policy making was found to be of great significance in psychiatric nursing. Overburdening of health facilities, overcrowding and climates of cynicism were found to be great causes of violence in such patients. The De-escalation techniques dealing with fewer skills of physical restraints and focus more on competent and skilled interactions respecting the patient perspectives (Richter & Whittington, 2006).

Violence rarely erupts or happens without any warning, the staff need or require optimal training of pre-planned care criteria of when to set various limits because patients remain optimal in any intervention (Phillips, 2016). Detecting and monitoring early warnings and signs helps in allowing for early detection and intervention while the frustration level of the frustration is still low. This remains an empirical evidence because recidivist clients show warning signs prior to performing acts of violence in the psychiatric wards (Phillips, 2016). The violence prevention benefits largely from comprehensive accurate and proper monitoring of patients and violence precipitators (Phillips, 2016).

In conclusion, the current research plays an essential role in various aspects of violence prevention in the psychiatric facilities. In this case, literature has indicated that preventing the violence against staff can be reduced through proper administration, comprehensive training for triggers and warning signs detection, practice development and proper policy making remain the pillars of reducing and managing the patient violence of all types in the psychiatric facilities.

References

Arnetz, J. E., Hamblin, L., Essenmacher, L., Upfal, M. J., Ager, J., & Luborsky, M. (2015). Understanding patient‐to‐worker violence in hospitals: a qualitative analysis of documented incident reports. Journal of advanced nursing, 71(2), 338-348.

Phillips, J. P. (2016). Workplace violence against health care workers in the United States. New England journal of medicine, 374(17), 1661-1669.

 

Richter, D., & Whittington, R. (2006). Violence in mental health settings: Causes, consequences, management. New York: Springer.

 

 

  Analyze the problem scenario that you have chosen, and organize your analysis into sections that correlate to each step in the selected problem-solving strategy.

When faced with a problem, what do you do to solve it? In this SLP assignment you will apply a systematic approach to problem solving. SLP 1 is divided into two parts. In Part I of the assignment, you will read three articles that present variations on step-by-step problem-solving strategies, and then select one of these strategies. You will engage in pre-writing to develop a solution to a problem scenario. In Part II of the assignment, you will present a synthesis of your ideas about solving the problem. As Voltaire said, “No problem can withstand the assault of sustained thinking.”

Part I

Preparation and Pre-writing: Follow the steps below to explore a problem through reading and writing –

1.    Choose one of the problem scenarios as a topic choice for your paper.

Scenario 1: You have worked at your company for 11 years. You have returned to college to earn a Bachelor’s degree in order to increase your chances for a promotion. You are nearly finished with your degree; a supervisor’s position in a competing company becomes available in another state. The start date is in two weeks, during your final exam period for your courses. The position offers a $15,000 per year salary increase, a car allowance, and relocation expenses. Your former supervisor works for the company and is recommending you for the position based on your outstanding job performance; if you want the job, it’s yours. All of the other supervisors at this level in the company have Master’s degrees. You know that you would be expected to earn your Bachelor’s degree and continue on to a Master’s degree. Your present company offers tuition reimbursement, but the new company does not.

Scenario 2: Your child comes home from school with an assignment sheet for a school project. He/she is very excited about the project and begins work immediately, doing research on the Internet and gathering materials. You read over the assignment sheet and notice that your child is not including all of the required items in the project, and you have some ideas for how to improve the quality of the presentation. You recently read an article in a parenting magazine about the importance of a child developing responsibility for his/her own learning. You recall the many ways in which your parents took over your school projects. You, on the other hand, want to encourage your child’s confidence in his/her ability to complete a project independently. The next day, you are at the grocery store when you see a parent of a student in your child’s class. That parent has spent over $30 in supplies for the science project and is taking a day off of work to put the pieces of the project together.

Scenario 3: You have two jobs—one during the week from 9:00 am to 6:00 pm, and one on Saturday from 3:00 pm to 11:00 pm. You are taking two classes—one that meets from 6:00 to 10:00 pm, and one class online. You have two kids—one who plays soccer, and one who is in band. You have two elderly parents who no longer drive. You have two siblings—one who lives two miles away, and one who lives in another state. You have two papers due in your classes the same week that one of your children has a soccer tournament, and the other child has a band concert. You are coaching the soccer team, and you are in charge of fundraising for the band. You have a goal to complete your degree in two years. Your doctor tells you that your blood pressure, your cholesterol, and your weight are too high and recommends several medications that cost you nearly $200 per month after your insurance co-pay.

Scenario 4: You are a sales representative for a company that encourages staff to log time in the field and away from the office. You are expected to begin and end your day at the office. You notice that each day when you arrive and return another co-worker is already there, and you wonder whether this person spends most of his/her time at the office. At your weekly sales meeting, you are informed of your co-workers’ outstanding sales performance. You suspect that this co-worker is spending more time flattering the boss instead of working leads in the field, and as a result is getting the best client referrals. Your own sales numbers have steadily decreased since this other sales representative was hired.

2.    Read the following articles:

3.    Select one of the step-by-step problem-solving strategies outlined in one of the articles. Using the chosen problem-solving strategy as a model, brainstorm ideas for each of the steps to develop a solution to the problem scenario you chose.

Part II

Synthesizing and Writing: Now that you have developed a solution to the problem by pre-writing about your ideas –

Write a paper in which you:

1.    Analyze the problem scenario that you have chosen, and organize your analysis into sections that correlate to each step in the selected problem-solving strategy.

2.    Apply each step within the selected problem-solving strategy to related elements of the scenario that you have chosen.

3.    Suggest alternative actions to the situation(s) within the scenario that correspond to each of the steps within the selected problem-solving strategy.

4.    Speculate on whether or not the same problem-solving strategy would be effective if used with different scenarios.

SLP Assignment Expectations

The paper should follow guidelines for clear and organized writing:

  • Using complete sentences, write at least one paragraph for each of 1-4 above.
  • Address main ideas in body paragraphs with a topic sentence and supporting sentences.
  • Adhere to standard rules of English grammar, punctuation, mechanics, and spelling.
  • After you have reread and edited your paragraphs, add an introductory paragraph and concluding paragraph.
  • Your introductory paragraph should begin with a broad sentence such as “There are many approaches to solving any problems…” or “When faced with a problem I find…” Then continue with more specific information about what you will discuss in your paper.
  • Your concluding paragraph should summarize your problem-solving approach and reflect on the things you have learned from the assignment.
  • Submit the completed work to your SLP Dropbox by the module due date.

Your assignment must follow these formatting requirements:

  • The paper should be typed and double-spaced, using Times New Roman font (size 12), with one-inch margins on all sides; citations and references must follow APA Style format. Check with your professor for any additional instructions.
  • Include a cover page with the title of the assignment, the student’s name, the professor’s name, the course title, and the date. The cover page and the reference page are not included in the required assignment page length.

The specific course learning outcomes associated with this assignment are:

  • Recognize the hindrances to the decision-making process in order to apply problem-solving skills to a variety of situations.
  • Write clearly and concisely about critical thinking using proper writing mechanics.
  • Use technology and information resources to research issues in critical-thinking skills and informal logic.

·       How you found your websites/references on Problem Solving and how you applied the key guidelines to identifying credible Internet sources.

Module 1 Case Assignment

 

Writing Guide Link: https://mytlc.trident.edu/files/Writing-Guide_Trident_2014.pdf

 

Homework Assignment

 

Skim the entire document, and focus your reading on pages 16-18.  When looking for references on the Internet, review the questions posed under “Identifying Credible and Reliable Sources” before using any Internet sources for this and all of your assignments requiring research.   If you can answer all of the questions posed positively when looking at a particular site, then you can be pretty sure you have located a good reference; if it doesn’t measure up one way or another, it’s probably a site to avoid. The key to the whole process is to think critically about what you find on the Internet; if you want to use it, you are responsible for ensuring that it is reliable and accurate.

STEP 2: Review and bookmark the following website for Word tutorials:

Word 2013 training courses, videos and tutorials

https://support.office.com/en-us/article/Word-2013-training-courses-videos-and-tutorials-14807f76-d2b5-44d6-af11-9c880c44e551?ui=en-US&rs=en-US&ad=US

Word 2010 training courses, videos and tutorials

https://support.office.com/en-us/article/Word-2010-training-courses-videos-and-tutorials-cfa75118-e522-4ea5-963e-2b56d25fb9a5?ui=en-US&rs=en-US&ad=US

Word for Mac Training

https://support.office.com/en-us/article/Word-for-Mac-2011-training-b88f4636-7395-4dcc-b56c-af99307df723

STEP 3: Write a 2- to 3-page paper reviewing how you researched Problem Solving using the Internet. Find two websites on Problem Solving to use in writing your paper. Using Dr. Timothy Mullen’s Trident University Writing Style Guide, determine the reliability and validity of the two websites on Problem Solving.

Mullen, Timothy.  2014. Trident University Writing Guide. Accessed on July 28, 2015 at https://mytlc.trident.edu/index.php

Your paper should discuss the following:

·       How you found your websites/references on Problem Solving and how you applied the key guidelines to identifying credible Internet sources.

·       Compare the two methods of Problem Solving that you found and comment on which you think is most useful to you.

·       Report any issues you had conducting your research and/or formatting your document in Microsoft Word.

STEP 4: Format your paper to the Assignment Expectations below.

Assignment Expectations

Format your paper using the following parameters:

1.     Center the title, your name, and date on a separate page. Use Times New Roman, 14 point

a.     Bold the title only

2.     Set Left and Right margins at 1 inch

3.     Number the pages

4.     Insert a footer

5.     Introduction:

b.     Left justified

c.     Times New Roman, 12 point

d.     Line spacing at 1½

6.     Middle Paragraphs

e.     Use bulleted list in one paragraph

f.      Insert a picture or chart

7.     Conclusion

g.     Right justified

h.     Times New Roman, 11 point

i.      Line spacing at single

8.     Complete a word count of the entire document and report it at the end of your document before the References section.

9.     Include a References section using the guidelines from the Trident University Writing Style Guide provided above. Include this site as a reference in addition to the two sites you found on Problem Solving.

10.  Upload your document as a Word doc or pdf into the Case drop box by the module due date.

What principal factors are involved in the relationship between drugs and crime?

Textbook: Drugs and Society

 

Why do Americans use so many legal drugs (e.g., alcohol, tobacco and OTC drugs)? What do think is primarily responsible for such extensive nonmedical and recreational drug use?

 

What principal factors are involved in the relationship between drugs and crime?

 

Define the terms addiction, tolerance, dependence, and withdrawal.

 

Is the relationship between drug abuse and mental illness important? Why or why not?

 

 

Identify the principal legislative initiatives that mandate that drugs be proven safe or effective.

 

What are the principal advantages and disadvantages of switching products from prescription to OTC status?

 

Would decriminalization of illicit drug use increase or decrease drug-related social problems? Justify your answer.

Discuss the potential for increased revenue, the front-end and back-end financial consideration, and the ability to increase patients’ quality of care (with improved outcomes).

Within the Discussion Board area, write 400–600 words that respond to the following questions with your thoughts, ideas, and comments. This will be the foundation for future discussions by your classmates. Be substantive and clear, and use examples to reinforce your ideas:

You have been part of the orthopedic center for 5 years. In that time, you have seen the center grow and the need for expansion.

  • Discuss how you can influence the chief executive officer (CEO) to consider expansion and new technology.
  • Discuss the potential for increased revenue, the front-end and back-end financial consideration, and the ability to increase patients’ quality of care (with improved outcomes).
  • What are some of the barriers you might encounter from the CEO?
  • Would other stakeholders in the center agree or disagree with your position? Why?

What is the role of the National Labor Relations Board (NLRB)?

Within the Discussion Board area, write 400–600 words that respond to the following questions with your thoughts, ideas, and comments. This will be the foundation for future discussions by your classmates. Be substantive and clear, and use examples to reinforce your ideas.

  • What are the historical foundations of the National Labor Relations Act (NLRA)?
  • What is the role of the National Labor Relations Board (NLRB)?
  • Under the National Labor Relations Act (NLRA), provide a real world example of how the act guides the activities of unions and employers.
  • How would someone go about filing a claim with the National Labor Relations Board?

How can the market share be instrumental in deciding on capital expenditures and the creation of new health care programs and services?

You have been part of the orthopedic center for 5 years. In that time, you have seen the center grow and the need for expansion.

Write a paper of 2–3 pages discussing the external forces that can impact the decision-making process for growth.

In your paper, answer the following questions::

  • How will government regulation impact decision making?
  • Will the community’s makeup be a consideration for decision makers?
  • How can the market share be instrumental in deciding on capital expenditures and the creation of new health care programs and services?
  • What is benchmarking, and how does it influence economical organizational decision making?

How can collective bargaining deliver improvements for workers in the organization?

Recently, you have heard rumors that employees would like to unionize. The director of human resources has come to one of your regional managers’ meetings to discuss a couple of things about unions so that managers are equipped with detailed information. In a Word document of at least 600 words with 2 scholarly resources, answer the following questions:

  • What is the process that employees will use to unionize?
  • How can collective bargaining deliver improvements for workers in the organization?
  • What does a union have to consider regarding a state’s right to work laws?

Discuss at least one way that the nursing profession is working toward a resolution of this problem.

Hello i need a Good and Positive Comment related with this argument .A paragraph  with no more  100 words.

 

 

Ijeoma Igbokwe

 

3 posts

 

Re:Topic 1 DQ 1

 

Nurses are the pillars of every health sector, they spend more time with the patients than any health care providers. A shortage of nurses has been projected to rise across the country between 2009 and 2030, mostly in the South and West (American Association of Colleges of Nursing, 2017)

 

The impact of nursing shortage to nursing Profession

 

Nursing is noble profession, nurses use their expertise skills and knowledge to safe patient’s lives and improve the quality of patients’ lives. Even though nursing is one of the fastest-growing profession, (American Association of Colleges of Nursing, 2017) but the impact of nurse’s shortage is felt by other nurses who work longer hours or days to make sure patients are taken care of. Some nurses who cannot handle the stress may either look forward to early retirement or changing to another profession, thereby causing more blow to the situation. Apart from that, a nurse who is tired or burnt out is prone to making medication errors and documentation error, thus putting the lives of the patients at risk, or even risking his or her nursing license and violating the standard of nursing practice.

 

Impact of Projected Nursing Shortage to the public

 

Research has link inadequate hospital nurse staffing to increased risk of adverse patient outcomes like increased mortality, and prolonged patient hospitalization. Patients and the public are the recipients of nursing services; therefore, any shortage of nursing staff affects the public they serve. Nurses help to improve the quality of lives of the public through education, physical assessment, and referrals.  Nurses are involved in preventive healthcare which reduces the rate of hospitalization. In long-term management of chronic diseases and home health settings, nurses use their competencies and knowledge to provide care and ensure safety to their patients. When nurses are over-stressed due to short staff shift, it may be difficult to cooperate with other health care providers, thus impacting patient care, professional relationship, and work environment. (Buerhaus, Donelan, Ulrich, 2005)

 

Discuss at least one way that the nursing profession is working toward a resolution of this problem.

 

The American Nurses Association have advocated that the federal government boost the funding for nursing workforce development programs. (Wolters Kluwer, 2016) This program provides grants for nursing education, provides supports to nursing students and loan forgiveness program for the students. This would not only attract more people to enroll in nursing programs but also serve as a motivating factor for the students.

 

References

 

American Association of Colleges of Nursing (2017) Current and Projected Shortage Indicators. Retrieved September 4th from http://www.aacnnursing.org/News-Information/Fact-Sheets/Nursing-Shortage

 

Buerhaus. P, K. Donelan, B. T Ulrich (2005) Impact of the nurses’ shortage on hospital patient Care: Comparative Perspectives. Health Affairs. Retrieved on September 4th from http://content.healthaffairs.org/content/26/3/853.full

 

Wolters Kluwer (2016) Dire Nursing Shortage: How Will It Affect Patient Care? Nursing Education Blog. Retrieved September 4th from http://nursingeducationsuccess.com/dire-nursing-shortage-how-will-it-affect-patient-care/