Answer:

This discussion looks at the life of Emma Gee and the relevance of implementing a Strengths-Based Nursing (SBN) plan in her healthcare as she struggled to recover from a stroke. Emma Gee was an energetic young therapist whose life was turned around after suffering a stroke. Due to the presence of an arteriovenous malformation (AVM), doctors scheduled a brain surgery for Emma. It was during the high-risk surgery procedure that Emma developed complications and suffered a stroke. Doctors immediately put Emma into an induced coma after the surgery. She later woke up unable to move or even speak. Through nursing and healthcare efforts from Dalcross Hospital, Royal Talbot Rehabilitation Centre and her family, Emma was able to recover and she is now a renowned motivational speaker and occupational theapist.The discussion looks at Emma’s healthcare experiences after she regained consciousness and during her rehabilitation. Based on her experiences, the discusion suggests how implementing a Strenths-Based Nursing and Healthcare approach could have made a difference in Emma’s recovery.

Overview Of Strengths-Based Principles

Strength-based nursing and health care (SBNC) is an approach that aims to create conditions whereby patients experience healing in their lifespan through the promotion of health and optimisation of their wellbeing and functioning. SBNC is about discovering, uncovering, understanding, and releasing social, interpersonal, intrapersonal, and biological strengths to meet healthcare and personal goals while dealing with the challenges. SBN is based on the guiding principles of collaborative partnership, relational care, empowerment and movement, person and family-centered care, and holistic care (Gottlieb, Gottlieb and Shamian, 2012). These principles provide hope, self-efficacy, and empowerment. It means that there should be a collaboration between the healthcare team and the patient while empowering him/her and the family to find meaning and attain their objectives. It also requires the health care team to understand the individual in whole by facilitating personalized care, holistic care, and whole-person nursing care.The principles aim to ensure the affected individual is responsible and takes charge of his or her healing and recovery process. Gottlieb (2012) outlined eight values that underly SBN. These include self-determination, person and environment are integral, subject reality and created meaning, holism, and embodiment, uniqueness, health and healing, collaborative partnership, learning, timing, and readiness. According to Gottlieb (2012), practicing a SBN model of health care promotes the quality of life, health behaviors, and brings hope to stroke survivors such as Emma Gee. It is especially important in Australia’s healthcare system whereby there are over 440,000 Australians directly affected by the effects of stroke (Rosamond et al., 2008). The National Stroke Foundation which is among the leading stroke support group in Australia approximates that over $44 million is needed to tackle the effects of stroke over a four year period.

Implementation Of Strengths-Based Nursing In Emma’s Case

This discussion looks at a case study on Emma Gee and investigates on the most appropriate ways in which a SBNC approach could have been implemented to assist Emma during her journey after suffering a life-changing stroke. After suffering a stroke at such a young age, Emma faced a lot of challenges in her new way of life. Being an active girl as evidenced by her various outdoor activities such as running and netball, Emma was devastated after the stroke and she had to accept her new reality. While in the induced coma, after regaining consciousness, during her rehabilitation, and in her integration back to the community, Emma had various health care needs. Implementing a SBN approach during her recovery journey could have greatly impacted the healthcare outcome and facilitated her wholesome recovery. Most importantly, a SBNC approach would have empowered and ensured collaboration between Emma, her family, and her healtcare providers. There are various challenges Emma encountered in her journey that could have been better addressed using a SBN model. These challenges range from dysphagia, balance and mobility complications, loneliness, environmental irritation, dysarthria, double incontinence, societal issues, to dependency. Furthermore, it is important to empower patients and ensure that they participate in their well being by involving them in decisin making activities.

Relationships In Nursing Practice

SBNC provides a guidance framework for nurses and other healthcare professionals. It facilitates the expansion of a nurse’s imaginary horizon and the providence of innovative solutions that solve long-term health care problems. While delivering medical services, healthcare professionals should have put themselves in Emma’s shoes. It would have ensured they understand what she went through physically, mentally, emotionally, and even spiritually (Kobau et al., 2011). According to Lietz (2007), SBNC broadens healthcare focus to include the well being, quality of life, healing and health of the whole person. It encourages a shift from analyzing the outcomes of health care as assessed by health practitioners to focusing on client-based outcomes. It is all about patients and the health care system combining effort to get the most of what is both meaningful and important to them.Such an approach would ensure the suffering experienced by stroke victims is minimised. While in hospital, Emma experienced double incontinence meaning she had lost control of her bowels and therefore needed to use a catheter. The nurses showed little or no empathy for her as evidenced by how they treated and acted towards her care. Emma even often felt embarrassed by the situation. Involving her parents or sister in cleaning up Emma would have made her feel more comfortable. Collaboration between her family and the nurses would have ensured Emma recovered from this stage of her journey in a personalized manner. Generally, nurses should have taken a personalized approach aimed at empowering Emma while collaborating with her family.

Transition Points

When formulating a SBN care plan, it is crucial to involve the patients, their families, and carers to facilitate procedures, clear health care expectations, investigations, and discharge of the patients in a collaborative manner. This helps in empowering the patient and helping him/her take charge of their recovery. A strength-based nursing care plan must consider verbal communication with the patient and family, previous documentation on the patient, clinical handover, and an assessment of the patient.

Regaining Consciousness

This discussion presents a SBN care plan following Emma regaining consciousness and focuses on collaboration between Emma, her family and other healthcare professionals involved in Emma’s case. For clinical documentation of Emma’s case, the study will adopt a multidisciplinary team approach and a SOAP framework to provide collaborated health care and communicate information on Emma’s progress to everyone invested in her recovery (Donohoe, 2015).After Emma regained consciousness, she faced various deficits such as trouble swallowing, vertigo, double incontinence, diplopia, left-side paralysis, right-side facial paralysis, mobility and balance issues among others. To facilitate her recovery, it is crucial to implement a SBN care plan that propagates collaboration between Emma, her family and healthcare professionals. The first step in developing the SBN care plan is to assess existing medical and personal information on Emma. It includes her emotional, social, family, mental, and physical history. To help her successfully transition and recover after the coma, it is important to determine and understand the factors surrounding her current condition. The next step of the care plan would be to observe the real-time progress of Emma. It includes Emma’s current condition such as her inability to swallow food. Through collaboration between Emma, her family members and the multidisciplinary team consisting of nurses under the guidance of a speech therapist, Emma’s situation can be analyzed, and appropriate interventions applied. This care plan would encompass educating and involving Emma’s family in assisting her with her swallowing complications. The outcome of the procedure would then be analyzed, and appropriate changes implemented based on Emma’s response to the intervention. Aside from educating and sensitizing them on the importance of collaborative healthcare approach, Emma’s family would constantly be updated on her progress and response. The care plan would further ensure that Emma’s family are consulted before, and present during any landmark decisions and progress on Emma’s recovery journey in the hospital.

Rehabilitation

SBN practices during a patient’s  rehabilitation should be geared towards helping the patient bounce back from their unfortunate scenario. A SBN care plan for Emma while at the Royal Talbot Rehabilitation Centre should have been focussed on empowerng Emma to take active part in her rehabilitation process. It was the responsibility of the nurses and Emma’s parents to work together with Emma and give her the motivation she needed. Under a SBN care plan, Emma’s nurses such as Fran, should have used a person-centered approach while rehabilitating Emma. A SBN care plan would include a multidisciplinary team comprised of nurses and specialists to help in the therapy process of Emma. This team would focus on making Emma feel valued in order to motivate and empower her to perform. The care plan would follow a carefully formulated therapy scheduleas determined by the input of Emma, her parents and the therapists at Talbot. It is also important to ensure patients are rehabilitated in a condusive environment. Unlike the brisk and careless attitude experienced at Talbot, a warm and nurturing approach to give Emma a sense of belonging would have been better suited to Emma’s situation. Such an environment would foster a feeling of comfort synonymous with having a family. Emma often felt dependent and powerless as a result off the care plan practiced at Talbot. This only made Emma feel vulnerable instead of empowered. Emma’s family and friends clearly supported her as evidenced in their unannouced visits and even the ‘RUN to GEE’ fundraiser to support Talbot. This kind of support compliments a SBN care plan by fuelling the recovery of a patient.

Reflection Of Emma’s Experience

Although Emma had caring parents and an identical twin sister who understood her, she felt lonely and sad while in admitted in the hospital, during rehabilitation and even after being integrated back into the community. The best approach would have been to sensitize her family and friends on the importance of communal support in facilitating the recovery process of a stroke victim (Wells et al., 2014). Emma needed to be emotionally motivated and supported to ensure her quick recovery, health, and quality of life. It is important to have a sense of belonging and a hand to help you through such a difficult time (Havens, Wood and Leeman, 2006). It was of grave importance for her family and friends to be actively involved in her recovery by visiting her a frequent as possible and showing her that they cared and supported her along her journey. Knowing she had the support of her family and medical staff would have fostered resilience in Emma throughout her recovery journey.

Before the unfortunate incident, Emma had been fond of food and cuisines as seen in her association of family time and visitors with food and other gifts.It however, took a negative turn since she started showing symptoms that were later diagnosed as an Arteriovenous malformation (AVM). The situation only worsened when she suffered a stroke and upon gaining consciousness, experienced dysphagia. Due to the difficulties faced by Emma while trying to swallow food, tubes were shoved down her throat to help her. During her recovery process in the hospital, Emma’s speech therapist taught her feeders to encourage the food downwards by stroking her neck although Emma found the idea quite unpleasant. By facilitating a SBN approach focused on empowering Emma while ensuring family involvement, it would have been more prudent to involve Emma’s parents or sister in this particular process. By providing her with the understanding yet familiar touch of her family, Emma would have been more comfortable. This familiarity coupled with her evident determination to recover and return to normal eating habits would have benefitted both Emma’s well being and functioning.

Emma was greatly disturbed by sound and visual irritations. Her communication and mobility challenges made it hard for her to do anything about these irritations. It is important for health facilities to incorporate a holistic approach to their health care services. Such an approach would ensure the outcome of the health services focus on the patient and his family by considering all their needs. By proving a conducive environment, hospitals and rehabilitation facilities enhance a patient’s quality of life. In Emma’s case, the hospital admitting her should have ensured the hospital facility and the rooms of sensitive patients such as Emma are located in a secure location with minimum irritants. 

 Due to dysarthria developed as a result of the stroke, Emma had difficulties in communicating and the people around could not understand her. This challenge plagued her both in the medical facilities and in the community. While in hospital, it would have been pivotal if all concerned parties collectively participated in Emma’s speech and mobility therapy.It would have encouraged self-dependency in Emma by motivating her. Their collaboration would make it easier and faster to understand Emma’s communication attempts. While back in the community, Emma found it difficult to relay information to others effectively and she was even occasionally misunderstood. Such scenarios could have been mitigated by the use of a SBNC approach that sensitized the community on how to take care of stroke patients. Additionally, Emma’s family would be able to accompany her at times and help her around. The outcome of this approach will be a community that is united in the health and general well being of stroke victims.

Promotion of self-efficacy is among the main principles underlying SBNC. Individuals under SBNC need to be self-dependent and in control certain aspects of their health and healing process Family and health care professionals play a great part in eliciting positivity and self-efficacy in a patient. This was however not the case in Emma’s journey. Emma frequently felt dependent on the medical staff for her day to day routine activities to a point she felt helpless and that the health professionals dominated her life. This feeling of dependence manifested itself even after she was released from hospital whereby she felt useless in her parents’ house. Her twin sister further reminded Emma of the life she had before she suffered the stroke. The society must also be involved in supporting stroke patients. Incidences such as people directing piercing looks or avoiding Emma in the pool should be mitigated to cultivate self-confidence. An effective SBNC approach would ensure that those around Emma such as the nurses, her family, and other people in the community elicit positivity. This positive attitude would, in turn, reflect on Emma and give her an inner drive to take charge and responsibility of her health and healing journey (Resnick, 2011).

Conclusion

In conclusion, it is important to ensure the individuals have a sense of purpose and are adequately empowered to make their own decisions.SBN can help achieve patient and family empowerment, health promotion, and partnerships in Australian healthcare by facilitating a healthcare system in which the community is actively involved and sensitive to patients and their needs. SBN considers the resources and strengths possessed by the individual and his family and uses these strengths to alleviate the existing deficits and problems. Organizations such as the Borrondara Stroke Support Group (BSSG) and the National Stroke Foundation enhance strength-based care in Australia through their various events and activities. These interventions collectively work to promote the well being of stroke patients, enhancing their resilience, and softening their suffering. SBN’s guiding principles of collaborative partnership, relational care, empowerment and movement, person and family-centered care, and holistic care provide hope, partnership, self-efficacy and empowerment to stroke victims in Australia.

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The first step of the evidence-based practice process is to evaluate a nursing practice environment to identify a nursing problem in the clinical area. When a nursing problem is discovered, the nurse researcher develops a clinical guiding question to address that nursing practice problem.

For this assignment, you will create a clinical guiding question know as a PICOT question. The PICOT question must be relevant to a nursing practice problem. To support your PICOT question, identify six supporting peer-revised research articles, as indicated below. The PICOT question and six peer-reviewed research articles you choose will be utilized for subsequent assignments.

Use the “Literature Evaluation Table” to complete this assignment.

1. Select a nursing practice problem of interest to use as the focus of your research. Start with the patient population and identify a clinical problem or issue that arises from the patient population. In 200–250 words, provide a summary of the clinical issue. ( Problem: staff shortage in nursing)
2. Following the PICOT format, write a PICOT question in your selected nursing practice problem area of interest. The PICOT question should be applicable to your proposed capstone project (the project students must complete during their final course in the RN-BSN program of study).
3. The PICOT question will provide a framework for your capstone project.
4. Conduct a literature search to locate six research articles focused on your selected nursing practice problem of interest. This literature search should include three quantitative and three qualitative peer-reviewed research articles to support your nursing practice problem.

Note: To assist in your search, remove the words qualitative and quantitative and include words that narrow or broaden your main topic. For example: Search for diabetes and pediatric and dialysis. To determine what research design was used in the articles the search produced, review the abstract and the methods section of the article. The author will provide a description of data collection using qualitative or quantitative methods. Systematic Reviews, Literature Reviews, and Metanalysis articles are good resources and provide a strong level of evidence but are not considered primary research articles.  Therefore, they should not be included in this assignment.

While APA style is not required for the body of this assignment, solid academic writing is expected, and documentation of sources should be presented using APA formatting guidelines, which can be found in the APA Style Guide, located in the Student Success Center. 

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are not required to submit this assignment to LopesWrite

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Based on “Case Study: Fetal Abnormality” and other required   topic study materials, write a 750-1,000-word reflection that answers   the following questions:

1. What is the Christian view of the nature of human     persons, and which theory of moral status is it compatible with? How     is this related to the intrinsic human value and dignity?
2. Which theory or theories are being used by Jessica, Marco,     Maria, and Dr. Wilson to determine the moral status of the fetus?     What from the case study specifically leads you to believe that they     hold the theory you selected?
3. How does the theory determine     or influence each of their recommendations for action?
4. What     theory do you agree with? Why? How would that theory determine or     influence the recommendation for action?

Remember to support your responses with the topic study materials.

While APA style is not required for the body of this assignment,   solid academic writing is expected, and documentation of sources   should be presented using APA formatting guidelines, which can be   found in the APA Style Guide, located in the Student Success Center.

This assignment uses a rubric. Please review the rubric prior to   beginning the assignment to become familiar with the expectations for   successful completion.

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Write a critical appraisal that demonstrates comprehension of two qualitative research studies. Use the “Research Critique Guidelines – Part 1” document to organize your essay. Successful completion of this assignment requires that you provide rationale, include examples, and reference content from the studies in your responses. Use the practice problem and two qualitative, peer-reviewed research article you identified in the Topic 1 assignment :” The prevalence of pressure ulcer and pressure injury  in the Hospital and Skilled nursing Facility” to complete this assignment. In a 1,000–1,250 word essay, summarize two qualitative studies, explain the ways in which the findings might be used in nursing practice, and address ethical considerations associated with the conduct of the study. Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required. This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion. You are required to submit this assignment to LopesWrite. Refer to the LopesWrite Technical Support articles for assistance

RUBRIC

Rough Draft Qualitative Research Critique and Ethical Considerations – Rubric         No of Criteria: 10 Achievement Levels: 5          Criteria  Achievement Levels    Description  Percentage      Unsatisfactory             0.00 %                     Less than Satisfactory             75.00 %                     Satisfactory             83.00 %                     Good             94.00 %                     Excellent             100.00 %                                       Content                 75.0                                   Background of Study                15.0         Background of study including problem, significance to nursing, purpose, objective, and research questions is incomplete.         Background of study including problem, significance to nursing, purpose, objective, and research questions is included but lacks relevant details and explanation.         Background of study including problem, significance to nursing, purpose, objective, and research questions is partially complete and includes some relevant details and explanation.         Background of study including problem, significance to nursing, purpose, objective, and research questions is complete and includes relevant details and explanation.         Background of study including problem, significance to nursing, purpose, objective, and research questions is thorough with substantial relevant details and extensive explanation.                      Method of Study               15.0         Discussion of method of study including discussion of conceptual/theoretical framework is incomplete.         Discussion of method of study including discussion of conceptual/theoretical framework is included but lacks relevant details and explanation.         Discussion of method of study including discussion of conceptual/theoretical framework is partially complete and includes some relevant details and explanation.         Discussion of method of study including discussion of conceptual/theoretical framework is complete and includes relevant details and explanation.         Discussion of method of study including discussion of conceptual/theoretical framework is thorough with substantial relevant details and extensive explanation.                      Results of Study               15.0         Discussion of study results including findings and implications for nursing practice is incomplete.         Discussion of study results including findings and implications for nursing practice is included but lacks relevant details and explanation.         Discussion of study results including findings and implications for nursing practice is partially complete and includes some relevant details and explanation.         Discussion of study results including findings and implications for nursing practice is complete and includes relevant details and explanation.         Discussion of study results including findings and implications for nursing practice is thorough with substantial relevant details and extensive explanation.                      Ethical Considerations               15.0         Discussion of ethical considerations associated with the conduct of nursing research is incomplete.         Discussion of ethical considerations associated with the conduct of nursing research is included but lacks relevant details and explanation.         Discussion of ethical considerations associated with the conduct of nursing research is partially complete and includes some relevant details and explanation.         Discussion of ethical considerations associated with the conduct of nursing research is complete and includes relevant details and explanation.         Discussion of ethical considerations associated with the conduct of nursing research is thorough with substantial relevant details and extensive explanation.                      Conclusion               15.0         Conclusion does not summarize a critical appraisal and applicability of findings.         Conclusion is vague and does not discuss importance to nursing.         Conclusion summarizes utility of the research and importance to nursing practice.         Conclusion summarizes utility of the research from the critical appraisal and the findings importance to nursing practice.         Conclusion summarizes utility of the research from the critical appraisal, knowledge learned, and the importance of the findings to nursing practice.                       Organization and Effectiveness                 15.0                                   Thesis Development and Purpose               5.0         Paper lacks any discernible overall purpose or organizing claim.         Thesis is insufficiently developed or vague. Purpose is not clear.         Thesis is apparent and appropriate to purpose.         Thesis is clear and forecasts the development of the paper. Thesis is descriptive and reflective of the arguments and appropriate to the purpose.         Thesis is comprehensive and contains the essence of the paper. Thesis statement makes the purpose of the paper clear.                      Argument Logic and Construction               5.0         Statement of purpose is not justified by the conclusion. The conclusion does not support the claim made. Argument is incoherent and uses noncredible sources.         Sufficient justification of claims is lacking. Argument lacks consistent unity. There are obvious flaws in the logic. Some sources have questionable credibility.         Argument is orderly, but may have a few inconsistencies. The argument presents minimal justification of claims. Argument logically, but not thoroughly, supports the purpose. Sources used are credible. Introduction and conclusion bracket the thesis.         Argument shows logical progressions. Techniques of argumentation are evident. There is a smooth progression of claims from introduction to conclusion. Most sources are authoritative.         Argument is clear and convincing and presents a persuasive claim in a distinctive and compelling manner. All sources are authoritative.                      Mechanics of Writing (includes spelling, punctuation, grammar, language use)               5.0         Surface errors are pervasive enough that they impede communication of meaning. Inappropriate word choice or sentence construction is used.         Frequent and repetitive mechanical errors distract the reader. Inconsistencies in language choice (register), sentence structure, or word choice are present.         Some mechanical errors or typos are present, but they are not overly distracting to the reader. Correct sentence structure and audience-appropriate language are used.         Prose is largely free of mechanical errors, although a few may be present. A variety of sentence structures and effective figures of speech are used.         Writer is clearly in command of standard, written, academic English.                       Format                 10.0                                   Paper Format (use of appropriate style for the major and assignment)               5.0         Template is not used appropriately or documentation format is rarely followed correctly.         Template is used, but some elements are missing or mistaken; lack of control with formatting is apparent.         Template is used, and formatting is correct, although some minor errors may be present.         Template is fully used; There are virtually no errors in formatting style.         All format elements are correct.                      Documentation of Sources (citations, footnotes, references, bibliography, etc., as appropriate to assignment and style)               5.0         Sources are not documented.         Documentation of sources is inconsistent or incorrect, as appropriate to assignment and style, with numerous formatting errors.         Sources are documented, as appropriate to assignment and style, although some formatting errors may be present.         Sources are documented, as appropriate to assignment and style, and format is mostly correct.         Sources are completely and correctly documented, as appropriate to assignment and style, and format is free of error.       Total Percentage 100

• NRS-433V-RS2-ResearchCritiqueGuidelinesPartI.docx

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Reflective Journal

Write 100-word Reflective Journal on how this clinical scenario enhanced your understanding

of important communication techniques and what would be incorporated into your individual

communication style to improve the nurse-patient/family relationship.

Required criteria

1. 100 word minimum reflection

2. Identifies how this scenario enhanced

understanding of communication techniques

3. Addresses how these communication

techniques will be incorporated into their own

communication style to improve the nursepatient/family relationship

4. Logical reflective flow which follows standard

grammatical rules with minimal (1-2)

misspellings

Case Video Transcript: 

“Let’s discuss your care needs, and I will call Connie, the social worker, to ask her to come talk to you. There might be more options for you.”

Therapeutic. Providing leads is a therapeutic communication technique because the questions will help the client more clearly define any concerns.

Inez touches Mrs. Halvorsen.

Therapeutic. Touch is a therapeutic communication technique because it conveys caring and empathetic feelings by the nurse towards the client.

“Why can’t your daughter help out when she stops by in the evening?”

Nontherapeutic. Asking a “why” question is a nontherapeutic communication technique because it can be perceived as accusatory, causing the client to become defensive and mistrust the person who asked the question.

Nurse Inez nods as Mrs. Halvorsen says, “Our neighbors are really good if we need anything and we can call them.”

Therapeutic. Active listening is a therapeutic communication technique because the nurse takes in information using all the senses while conveying an open attitude towards the client.

“Now Graca, mama’s got to go back to work. You be sure to bundle up for school. I’ll see you when you get home.”

Nontherapeutic. Focusing on self is a nontherapeutic communication technique because it prevents the client’s goals from being perceived as most important.

“It’s unfortunate, but Medicare only covers home health services for clients that are homebound.”

Therapeutic. Clarifying is a therapeutic communication technique because it allows the nurse to validate the message received to ensure that both the nurse and client have a mutual interpretation of the message.

“Here is some information about those services, along with the list of their fees.”

Therapeutic. Credibility supports interprofessional and client communication by conveying confidence, providing accurate information, and acknowledging limitations during nurse-provider and nurse-client interactions.

“I know exactly what you are going through. I had the same experience with my Aunt Jennie.”

Nontherapeutic. Focusing on self is a nontherapeutic communication technique because it prevents the client’s goals from being perceived as most important.

Inez answers the phone.

Nontherapeutic. Dismissive behavior is an ineffective style of interpersonal communication because the nurse indicates that another person’s opinions or presence is not wanted or needed.

“Good morning, Mr. and Mrs. Halvorsen. I am Inez. I will be the nurse caring for you today. How are you?”

Therapeutic. Developing rapport with a client supports the establishment of a therapeutic relationship by sharing mutual feelings of acceptance while maintaining open communication and the development of trust and respect.

“Okay. I have some discharge paperwork to go over with you. You will be discharged home in the care of your husband.”

Therapeutic. Building trust with a client supports the establishment of a therapeutic relationship based on acceptance, empathy, honesty, and reliability.

“Yes, that was Connie, our social worker, who discussed having a bath aide come to your home twice a week.”

Therapeutic. Building trust with a client supports the establishment of a therapeutic relationship based on acceptance, empathy, honesty, and reliability.

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