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1.
J Clin Nurs ; 29(21-22): 4148-4160, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32757394

RESUMO

AIMS AND OBJECTIVES: To explore how workplace bullying influences nurses' abilities to provide patient care. BACKGROUND: Nurses' experiences of workplace bullying undermine nursing work environments and potentially threaten patient care. Although there is a link between nurses' experiences of workplace bullying and poor patient care, additional exploration is necessary as current evidence remains underdeveloped and inconclusive. DESIGN: Qualitative descriptive study. METHODS: Fifteen inpatient staff nurses who have experienced workplace bullying while working in one hospital located in the southern region of the USA participated in individual, semi-structured interviews. Inductive thematic analysis was used to analyse interview transcripts in NVivo 12 software. The COREQ checklist for qualitative studies has been used in reporting this study. RESULTS: Three themes, and respective subthemes, were generated from data analysis: (a) workplace bullying as part of the nursing work environment, (b) workplace bullying's influence on nurses and (c) workplace bullying's influence on patient care. Workplace bullying was perceived to be inherent in the nursing work environment; nurses felt that they were targets of workplace bullying because (a) they were new nurses, (b) there was an abuse of power, or (c) the nature of the work occasioned it. Nurses were mentally and emotionally influenced by the bullying. Some nurses perceived that workplace bullying did influence their ability to provide patient care; however, others did not. CONCLUSIONS: Organisations must support new nurses and manage relational attributes of the nursing work environment to reduce workplace bullying. Nursing leaders should receive education on fostering and sustaining favourable nursing work environments and be held accountable for behavioural expectations of the organisation. RELEVANCE TO CLINICAL PRACTICE: Understanding how nurses perceive the work environment to influence their experiences of workplace bullying informs the development of organisational interventions to reduce the behaviour. Furthermore, exploring how nurses' experiences of workplace bullying influences their abilities to provide patient care increases our understanding of workplace bullying implications.

2.
Curr Pharm Teach Learn ; 12(10): 1171-1179, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32739053

RESUMO

INTRODUCTION: Microaggressions are commonplace indignities that communicate slights to marginalized persons. Microaggressions have been shown to negatively impact student well-being and academic performance. We describe the experiences of students in relation to the occurrence of microaggressions within the learning environment of a college of pharmacy (COP). METHODS: Students in a COP were interviewed regarding their experiences of microaggressions. Interviews were audio-recorded and transcribed verbatim. Transcripts were analyzed using a conventional content analysis method. RESULTS: Thirteen pharmacy students participated in the study. Six (46%) identified as women. Six (46%) identified as Black, Asian, or multi-racial. Experiences were first-hand, witnessed, or stories they heard. Three themes arose from the data: (1) feeling othered; (2) power, pain, pollution, and pervasiveness of microaggressions; and (3) responsibility of academic community to mitigate microaggressions. Microaggressions were described based on race, religion, gender, sexuality, age, English proficiency, and others. Students expressed confusion with responding to microaggressions, microaggressions disguised as jokes, divisiveness related to the 2016 presidential election, unawareness of biases, dismissal of their concerns, hopelessness for change, and centering dominant groups in the curriculum. Recommendations from participants to address microaggressions included longitudinal cultural competency in the curriculum, cultural competency training for faculty, guidance on conflict management, and open discussions related to diversity and inclusion. CONCLUSIONS: Students are unsure how to identify, address, and mitigate microaggressions. Actions are needed to reduce these incidents, facilitate healing of individuals who have experienced past microaggressions, and promote a diverse and inclusive learning environment.

3.
West J Nurs Res ; 42(12): 1031-1041, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32419655

RESUMO

Extreme chronotype and circadian disrupting work hours may increase nurse disease risks. This national, cross-sectional study of nurses (N = 527) had three hypotheses. When chronotype and shift times are incongruent, nurses will experience increased likelihood of (1) obesity, (2) cardiovascular disease/risk factors, and (3) obesity or cardiovascular disease/risk factors when theoretically linked variables exist. Chronotype mismatched nurses' (n = 206) average sleep (6.1 hours, SD = 1.2) fell below 7-9 hours/24-hours sleep recommendations. Proportion of male nurses was significantly higher chronotype mismatched (12.3%) than matched (6.3%). Analyses found no direct relationship between chronotype match/mismatch with outcome variables. Exploratory interaction analysis demonstrated nurses with mismatched chronotype and above average sleep quality had an estimated 3.51 times the adjusted odds (95% CI 1.52,8.17; p = .003) of being obese. Although mechanism is unclear, this suggests sleep quality may be intricately associated with obesity. Further research is needed to inform nurses on health risks from disrupted sleep, chronotypes, and shift work.

4.
Public Health Nurs ; 37(3): 453-460, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-31899558

RESUMO

Greenness such as trees, plants, and shrubs may positively influence mental and physical health, but the relationship between greenness and asthma is poorly understood. Because asthma is the most prevalent child respiratory disease internationally, elucidating the role of greenness may substantially benefit public health. The purpose of this systematic review was to synthesize findings related to effects of greenness on asthma in children. Following PRISMA guidelines, six databases were searched for international publication of primary research results relevant to the relationship between greenness and child asthma. Of 82 initial results, seven articles remained after removal of duplicates and applying exclusion criteria. Six reported no direct association between greenness and child asthma, while one found increased greenness protective for asthma. None found a negative direct association between greenness and child asthma. Evidence supported benefits of greenness on child asthma through mediation of factors such as exposure to tobacco smoke, high traffic volume, and difficult family relationships. Even without a direct association, greenness can be considered a public health asset as it may mediate other factors contributing to asthma in children. Public health nurses can use these findings to educate clients and partners while advocating for policies to protect greenness.

5.
Clin Nurs Res ; 29(2): 97-107, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-30295057

RESUMO

We aimed to compare salient characteristics and antecedents of quality of life (QOL) in adolescents and young adults with implantable cardioverter-defibrillators (ICDs) from qualitative methods with quantitative measurement of QOL and correlations between QOL (PedsQL) and measured participant characteristics. Concurrent parallel mixed methods design was used to collect survey data from the PedsQL electronic health record, demographic questionnaire, and semistructured interview data. A convenience sample of 16 individuals with ICDs, aged 13 to 25 years, was obtained from a tertiary pediatric facility. Overall QOL and subdomains of physical, psychosocial, and academic/work were examined by PedsQL and visual analog scale. Select demographics were collected to develop a participant profile. Females with ICDs appear to be at risk of poor QOL given some unknown factors. Financial status of the individual and the family was positively related to QOL. For new ICD persons involved in physical activities that must be stopped, peer support appears to improve QOL.

6.
Curr Pharm Teach Learn ; 11(4): 382-393, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-31040014

RESUMO

BACKGROUND AND PURPOSE: Health equity attainment requires dismantling implicit bias and structural racism. Mitigating bias in clinical interventions and implementing structural interventions to impact where people live, work, play, and eat fosters optimal patient outcomes. Consequently, pharmacy students need exposure to these concepts. The objective of this project was to evaluate an elective course focused on exposing students to the root causes of health disparities, contemporary factors that perpetuate disparities, and evidence-based policies to reduce health disparities. EDUCATIONAL ACTIVITY AND SETTING: This three-credit course emphasized critical thinking, robust discussions, and learning challenging constructs through self-discovery. Nine second-year and third-year learners were assessed by short-answer exams, learning management system discussion threads, weekly reflections, participation, and a class project. A qualitative descriptive design was used for this study. Weekly reflections were subjected to thematic analysis using a constant comparative analysis method to generate themes. FINDINGS: Five themes were derived from the data underlying strategies to facilitate this course: (1) create and maintain a welcoming and inclusive learning environment; (2) utilize experiential learning for personal awareness development and knowledge expansion; (3) incorporate intergroup diversity to empower learners to create change; (4) anticipate and acknowledge emotions to facilitate learning; and (5) provide students with an opportunity to complete a final self-reflection paper. SUMMARY: This course provided pharmacy learners with unique, differential skill sets and knowledge, potentially adding depth to their careers and impacting the way they will practice pharmacy.


Assuntos
Educação em Farmácia/métodos , Disparidades nos Níveis de Saúde , Racismo/psicologia , Viés de Seleção , Educação em Farmácia/normas , Educação em Farmácia/estatística & dados numéricos , Estudos de Avaliação como Assunto , Humanos , Percepção , Racismo/prevenção & controle , Estudantes de Farmácia , Inquéritos e Questionários
7.
Int Emerg Nurs ; 43: 61-66, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30392922

RESUMO

OBJECTIVES: While threats to pregnancy such as vaginal bleeding are common, half will miscarry. The ED environment is not always conducive to the emotional and psychological needs of women grieving the loss of a pregnancy. Healthcare providers have a great impact on the women's experience of pregnancy loss. This study describes the perspectives of women experiencing a pregnancy loss in the ED. METHODS: The study used a qualitative descriptive research design interviewing women diagnosed with a pregnancy loss in the ED. Data analysis consisted of descriptive statistics of the sample and content analysis of interviews. RESULTS: Eight participant interviews generated five themes related to the ED as part of the crossroads of motherhood and pregnancy loss. The themes were (a) Decisions to get help, (b) The environment of emergency care, (c) Not knowing, (d) Finally knowing and moving on, (e) Assisting with the grieving process. CONCLUSIONS FOR PRACTICE: Understanding the needs of women diagnosed with pregnancy loss allows emergency nurses and providers to provide more holistic, compassionate care. Knowledge of pregnancy loss experiences will assist in the improvement of future patient care, and may positively impact recovery and transition to normalcy.


Assuntos
Aborto Espontâneo/psicologia , Satisfação do Paciente , Pacientes/psicologia , Aborto Espontâneo/enfermagem , Adulto , Serviço Hospitalar de Emergência/organização & administração , Feminino , Humanos , Meio-Oeste dos Estados Unidos , Gravidez , Pesquisa Qualitativa
8.
Ind Health ; 56(6): 512-523, 2018 Nov 21.
Artigo em Inglês | MEDLINE | ID: mdl-29973467

RESUMO

Shift workers are at risk for developing serious health issues due to short sleep. One cause of short sleep is circadian misalignment: sleep time is not synchronized with the body's natural circadian rhythms. Although circadian rhythms are strongly driven by the light/dark cycle, humans have individualized sleep time preferences (chronotypes) based on genetics, development, and external influences. Evening chronotype individuals fall asleep later than average and have a higher risk for developing various noncommunicable diseases. What is unclear is the association between chronotype, shift work, and risks for acquiring chronic conditions. This review is focused on shift worker chronotype and associations with obesity. Because of the paucity of research, other health issues connected with circadian misalignment were included, allowing for a total of 21 research studies. Evidence from this review supports chronotype and certain health issues are associated with shift work, even after adjusting for short sleep duration. In addition, there is evidence to support future research on how shift worker chronotype matched with shift timing impacts worker health. Through better understanding of this interface, occupational health providers can provide more comprehensive worker education on the risks associated with shift work and sleep disturbances.


Assuntos
Doença Crônica/epidemiologia , Transtornos do Sono do Ritmo Circadiano/epidemiologia , Tolerância ao Trabalho Programado/fisiologia , Ritmo Circadiano , Humanos , Saúde Mental , Doenças Musculoesqueléticas/epidemiologia , Neoplasias/epidemiologia , Obesidade/epidemiologia , Saúde do Trabalhador , Sono , Fatores de Tempo
9.
J Nurs Care Qual ; 33(4): 375-381, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29319593

RESUMO

For 130 million people seeking emergency treatment in the United States, incomplete or inaccurate triage examination can result in delays, which could compromise patient outcomes. The purpose of this study was to identify triage interruptions and determine how interruptions affect the triage process. A significant difference was seen in triage duration between interrupted and uninterrupted interviews. Understanding the impact of interruptions on patient outcomes will allow nurses and other health care providers to develop interventions to mitigate the impact.


Assuntos
Continuidade da Assistência ao Paciente , Serviço Hospitalar de Emergência , Triagem , Adulto , Enfermagem em Emergência/métodos , Feminino , Humanos , Masculino , Estudos Prospectivos , Fatores de Tempo , Estados Unidos
10.
J Emerg Nurs ; 44(2): 146-155, 2018 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29203048

RESUMO

INTRODUCTION: Women frequently seek ED care for complications in early pregnancy, including loss of pregnancy. This review evaluates the current literature and discusses the care of patients experiencing loss of pregnancy in the emergency department. METHODS: A review of pertinent studies identified through multiple database searches was conducted to determine the existing body of knowledge for the care of ED patients diagnosed with loss of pregnancy. Each of the studies was examined for inclusion criteria and a subsequent analysis of the included studies identified themes related to the care of the women. RESULTS: Thirty-two original research articles and systematic reviews published between 1990 and 2016 were included in the review. Eleven articles addressed recommendations for clinical practice, 5 reported statistics related to pregnancy outcome and clinical presentation, 4 discussed the use of speculum examinations, 4 discussed interventions to decrease ED length of stay, and 3 investigated the use of ultrasound in the emergency department. Only 5 of the articles reviewed discussed emotional support and/or experiences of women with loss of pregnancy in the emergency department. CONCLUSION: Although there are multiple recommendations for the clinical management of loss of pregnancy in the emergency department, the psychological and emotional support of women was addressed infrequently. Additional studies investigating holistic care would be beneficial for ED providers in the management of early loss of pregnancy.


Assuntos
Aborto Espontâneo/psicologia , Enfermagem em Emergência/métodos , Serviço Hospitalar de Emergência , Satisfação do Paciente , Adulto , Feminino , Humanos , Gravidez
11.
Adv Emerg Nurs J ; 39(4): 280-287, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-29095179

RESUMO

Women often come to the emergency department (ED) with signs and symptoms suggesting an early pregnancy loss; yet, little is known about their experience and how it relates to future outcomes. To improve patient outcomes and experiences of women seeking care for a pregnancy loss, research is required. However, recruitment of participants experiencing an event such as a pregnancy loss is challenging. The purpose of this article is to discuss the application of an electronic medical record (EMR)-based participant screening tool recruiting women seeking care for a pregnancy loss in the ED. This study implemented an EMR-based prompt to assist participant screening completed by ED nurses: (a) The prompts were based on criteria built into triggers that activated a recruitment screening form to print upon discharge; (b) nurses completed the form with patients, asking for willingness to be contacted at home; and (c) participants were subsequently contacted and enrolled in the study. Our research screening program was implemented continuously in 2 EDs: a large, urban, academic medical center and a community academic hospital. Data were analyzed through descriptive statistics of reports built within the EMR. These reports signaled when the screening tool flagged participants and subsequently tied the corresponding information to the completed forms. The recruitment tool fired 1,169 times, with 61% (n = 714) screened. Fifty percent (n = 37) of women experiencing an early pregnancy loss were willing to be contacted at home for research recruitment. Of those approached after discharge (n = 24), 33% (n = 8) enrolled in the study. Of note, at one site, 14% (81/577) of potential participants with early pregnancy loss symptoms left before seeing a provider, with 26% (150/577) of these encounters were repeat visits. Staff education, nurse reluctance to approach potential participants, and patients who left without being seen led to barriers in participant screening.


Assuntos
Aborto Espontâneo , Pesquisa Biomédica , Registros Eletrônicos de Saúde , Enfermagem em Emergência , Serviço Hospitalar de Emergência , Papel do Profissional de Enfermagem , Seleção de Pacientes , Sujeitos da Pesquisa , Adulto , Feminino , Humanos , Gravidez
13.
J Nurs Educ Pract ; 7(7): 11-21, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28781715

RESUMO

Bullying is a known and ongoing problem against nurses. Interventions are needed to prepare nursing students to prevent and mitigate the bullying they will experience in their nursing practice. The purpose of this article is to describe the development process and utility of one such intervention for use by nursing faculty with nursing students prior to their students' entry into the profession. The educational program was critiqued by an advisory board and deemed to be relevant, clear, simple, and non-ambiguous indicating the program to have adequate content validity. The program then was pilot tested on five university campuses. Faculty members who implemented the educational program discussed (1) the program having value to faculty members and students, (2) challenges to continued program adoption, and (3) recommendations for program delivery. The proposed multicomponent, multiyear bullying educational program has the potential to positively influence nursing education and ultimately nursing practice. Findings from the pilot implementation of the program indicate the need to incorporate the program into additional nursing courses beginning during the sophomore year of the nursing curricula.

14.
Nurs Outlook ; 65(3): 278-288, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28363356

RESUMO

BACKGROUND: Managing diversity dynamics in academic or clinical settings for men in nursing has unique challenges resulting from their minority status within the profession. PURPOSE: The purpose of this study was to share challenges and lessons learned identified by male scholars in the Robert Wood Johnson Foundation Nurse Faculty Scholars program and suggest strategies for creating positive organizations promoting inclusive excellence. METHODS: Multiple strategies including informal mentored discussions and peer-to-peer dialogue throughout the program, formal online surveys of scholars and National Advisory Committee members, and review of scholar progress reports were analyzed as part of the comprehensive evaluation plan of the program. DISCUSSION: Diversity dynamic issues include concerns with negative stereotyping, microaggression, gender intelligence, and differences in communication and leadership styles. CONCLUSION: Male nurse faculty scholars report experiencing both opportunities and challenges residing in a predominately female profession. This article attempts to raise awareness and suggest strategies to manage diversity dynamics in service of promoting the development of a culture of health that values diversity and inclusive excellence for both men and women in academic, research, and practice contexts.


Assuntos
Diversidade Cultural , Docentes de Enfermagem/educação , Docentes de Enfermagem/psicologia , Fundações/organização & administração , Mentores/psicologia , Papel do Profissional de Enfermagem , Enfermeiros/psicologia , Adulto , Idoso , Atitude do Pessoal de Saúde , Currículo , Docentes de Enfermagem/estatística & dados numéricos , Fundações/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Desenvolvimento de Programas , Avaliação de Programas e Projetos de Saúde , Estados Unidos
15.
ANS Adv Nurs Sci ; 40(3): 278-288, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-27930402

RESUMO

The movement toward community-engaged research is well aligned with nursing's strong tradition of engaging individuals, families, and communities in designing and evaluating nursing care. As such, nurse scientists should consider engaging the recipients of care in the research process. Community advisory boards are a common way in which communities are engaged in research. The purpose of this article is to provide a framework for effectively working with community advisory boards in diverse communities that is informed by evidence and experiences of the Robert Wood Johnson Foundation Nurse Faculty Scholars. Recommendations can serve as a blueprint for nurse scientists as they engage communities in research promoting health equity.

16.
Online J Issues Nurs ; 21(3): 8, 2016 Aug 10.
Artigo em Inglês | MEDLINE | ID: mdl-27857181

RESUMO

Workplace bullying (WPB) behaviors are pervasive in some healthcare organizations leading to difficult work environments for registered nurses. We conducted an exploratory quantitative dominant (QUANT/qual) mixed method design study to determine the differences in respondents in three Midwestern states on psychological distress symptoms using WPB exposure levels and select nurse characteristics. This article discusses background information and WPB consequences. We report on the study purpose, methods, and Phase I qualitative results, including significant differences with perceived stress, anxiety, and posttraumatic symptoms reported by persons with frequent to daily WPB behavior exposure. The discussion section considers significant differences found between respondents related to age and posttraumatic stress symptoms. Narrative analysis on strategies used after bullying also illuminates the discussion. Finally, we examine implications for nurse leaders and empowerment of their direct reports to resolve minor interpersonal conflicts and move swiftly to resolve escalating bullying.

17.
Adv Emerg Nurs J ; 38(4): 308-319, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27792073

RESUMO

Interruptions contribute to catastrophic errors in health care. Interruptions are breaks in the performance of a human activity initiated by a source internal or external to the recipient. Errors during the initial triage assessment can lead to errors in estimating the acuity of a patient and resources required for appropriate care. To advance the science, a valid and reliable instrument to measure this phenomenon is required. The purpose of this mixed-methods/exploratory sequential study was to develop an instrument sensitive to the uniqueness of the triage assessment that would categorize and measure the number and causes of triage interruptions. The study included 3 phases. Phase 1: Qualitative focus groups were used to qualitatively explore interruptions in triage. In Phase 2: Content Validity Assessment, an online survey was used and a content validity index was calculated for each item to determine which items should be modified or removed. A descriptive correlational design was used to assess interrater reliability in Phase 3. Many of the items identified during the focus group sessions were already on the study instrument; some new items were added. Content validity for the entire instrument was 0.82 and increased to 0.91 once irrelevant items were removed. Interrater reliability for the entire instrument demonstrated substantial agreement at 0.773. The study instrument was shown to have strong psychometrics and can be used in practice to better understand what interruptions are occurring in triage and how they affect the triage process.


Assuntos
Continuidade da Assistência ao Paciente , Enfermagem em Emergência , Serviço Hospitalar de Emergência/organização & administração , Erros Médicos/prevenção & controle , Avaliação em Enfermagem , Avaliação de Processos em Cuidados de Saúde , Triagem , Carga de Trabalho , Humanos , Melhoria de Qualidade , Fatores de Tempo , Estados Unidos
19.
Workplace Health Saf ; 64(7): 337-41, 2016 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-27053288

RESUMO

Workplace bullying (WPB) behaviors negatively affect nurse productivity, satisfaction, and retention, and hinder safe patient care. The purpose of this article is to define WPB, differentiate between incivility and WPB, and recommend actions to prevent WPB behaviors. Informed occupational and environmental health nurses and nurse leaders must recognize, confront, and eliminate WPB in their facilities and organizations. Recognizing, confronting, and eliminating WPB behaviors in health care is a crucial first step toward sustained improvements in patient care quality and the health and safety of health care employees.


Assuntos
Bullying/prevenção & controle , Enfermeiras e Enfermeiros/psicologia , Enfermagem do Trabalho/métodos , Cultura Organizacional , Local de Trabalho/psicologia , Humanos , Relações Interprofissionais , Recursos Humanos de Enfermagem , Saúde do Trabalhador
20.
Acad Pediatr ; 16(4): 327-35, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-26525991

RESUMO

OBJECTIVE: To identify and describe dimensions of family-centered care important to parents in pediatric emergency care and compare them to those currently defined in the literature. METHODS: A qualitative study was conducted involving 8 focus groups with parents who accompanied their child to an emergency department visit at a large tertiary-care pediatric health system. Participants were identified using purposive sampling to achieve representation across demographic characteristics including child's race, insurance status, severity, and participant's relationship to child. Focus groups were segmented by patient age and presence of a chronic condition. They were moderated by a facilitator experienced in health-related topics. A 6-member multidisciplinary team completed a content analysis. RESULTS: Sixty-eight parents participated. They were female (77%); aged 20 to 29 years (19%), 30 to 39 years (47%), more than 40 years (31%); black (44%), white (52%); and married (50%). Their child's characteristics were: public insurance (52%); black (46%), white (46%); and admitted as an inpatient (46%). The analysis resulted in 8 dimensions: 1) emotional support; 2) coordination; 3) elicit and respect preferences, and involve the patient and family in care decisions; 4) timely and attentive care; 5) information, communication, and education; 6) pain management; 7) safe and child-focused environment; and 8) continuity and transition. Compared to those published in the literature, the most notable differences were combining involving family and respect for preferences into a single dimension, and separating physical comfort into 2 dimensions: pain management and safe/child-focused environment. CONCLUSIONS: The resulting dimensions provide a framework for measuring and improving the delivery of family-centered pediatric emergency care.


Assuntos
Pais/psicologia , Pediatria , Grupo com Ancestrais do Continente Africano , Criança , Serviços Médicos de Emergência , Humanos , Cobertura do Seguro
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