Digital Commons Network^™

Contraceptive Use Among Women Experiencing Intimate Partner Violence And Reproductive Coercion: The Moderating Role Of Ptsd And Depression, Jessica L. Zemlak, Lea Marineau, Tiara C. Willie, Helena Addison, Gabrielle Edwards, Trace S. Kershaw, Kamila A. Alexander

College of Nursing Faculty Research and Publications

Women experiencing reproductive coercion (RC) report more unintended pregnancies and mental health symptoms that can influence contraceptive use patterns. We examined associations between RC and contraceptive use among intimate partner violence (IPV) exposed women aged 18–35 (N = 283). We tested depression, post-traumatic stress disorder (PTSD), and co-morbid depression and PTSD as effect modifiers. Though no association was found between RC and contraception, PTSD significantly modified this relationship. Among Black women (n = 112), those reporting RC and either PTSD or comorbid PTSD and depression were less likely to use partner-independent contraception compared to those reporting RC without …

Professional Responsibility, Nurses, And Conscientious Objection: A Framework For Ethical Evaluation, Pamela J. Grace, Elizabeth Peter, Vicki D. Lachman, Norah L. Johnson, Deborah J. Kenny, Lucia D. Wocial

College of Nursing Faculty Research and Publications

Conscientious objections (CO) can be disruptive in a variety of ways and may disadvantage patients and colleagues who must step-in to assume care. Nevertheless, nurses have a right and responsibility to object to participation in interventions that would seriously harm their sense of integrity. This is an ethical problem of balancing risks and responsibilities related to patient care. Here we explore the problem and propose a nonlinear framework for exploring the authenticity of a claim of CO from the perspective of the nurse and of those who must evaluate such claims. We synthesized the framework using Rest’s Four Component Model …

Process Of Maintaining Self In Individuals Living With Systemic Sclerosis: A Grounded Theory Study Of American Women, Donald D. Miller, Jennifer J. Doering

College of Nursing Faculty Research and Publications

Background: People with chronic illnesses may struggle to adapt psychologically to the illness experience and have feelings of identity loss, self-diminishment, and biographical disruption. This may limit people’s ability to engage in optimal selfmanagement. Systemic sclerosis is a debilitating, stigmatizing, and life-limiting progressive chronic illness with significant disfiguring effects. Little is known about the identity management process in people with disfiguring and debilitating conditions such as systemic sclerosis.

Purpose: The purpose of this study was to generate a grounded theory explicating the process of maintaining a sense of self in people living with systemic sclerosis.

Methods: Fifteen women with systemic …

Recent Economic Intimate Partner Violence And Posttraumatic Stress Symptoms Among A Racially And Ethnically Diverse Sample Of U.S. Women Experiencing Intimate Partner Violence, Tiara C. Willie, Kamila A. Alexander, Laurel Sharpless, Jessica L. Zemlak, Megan V. Smith, Trace S. Kershaw

College of Nursing Faculty Research and Publications

Posttraumatic stress disorder (PTSD) is a prevalent consequence of physical and sexual intimate partner violence (IPV); however, little is known about the unique contributions of economic IPV. Furthermore, women’s economic self-sufficiency may explicate the potential relationship between economic IPV and PTSD symptoms. Guided by the Stress Process Theory and Intersectionality, this study examined associations between economic IPV and women’s PTSD symptoms and assessed economic self-sufficiency as a mediator. Participants were 255 adult women experiencing IPV recruited from metropolitan Baltimore, MD, and the state of CT who participated in two different studies. Participants completed surveys on IPV, economic self-sufficiency, and PTSD. …

Contraceptive Decision-Making Through The Lens Of Social Determinants Of Health Among Female Sex Workers: A Qualitative Descriptive Study, Jessica L. Zemlak, Kamila A. Alexander, Deborah Wilson, Susan G. Sherman

College of Nursing Faculty Research and Publications

Aims

The aim of the study was to examine how female sex worker's motivations, desires, intentions and behaviours towards childbearing and childbearing avoidance inform their contraceptive decision-making. We explored the influence of social determinants of health in the domains of social context (sexual partners and experiences of violence), healthcare access, economic instability on the contraceptive decision-making process.

Design

We conducted a qualitative descriptive study informed by Miller's Theory of Childbearing Motivations, Desires and Intentions through the lens of social determinants of health.

Methods

Participants were recruited from a parent study, EMERALD, in July–September, 2020. Data were collected from 22 female …

Work-Related Burnout, Compassion Fatigue, And Nurse Intention To Leave The Profession During Covid-19, Jacqueline Christianson, Norah L. Johnson, Amanda Nelson, Maharaj Singh

College of Nursing Faculty Research and Publications

The purpose of this mixed-method study was to understand the relationships between work-related burnout (WRB), compassion fatigue (CF), and intention to leave the nursing profession. The Job Demands-Resources model was used to predict intention to leave as a function of WRB, CF, and caring for COVID-19 patients in a sample of 1299 US nurses. Greater WRB and CF scores were associated with intention to leave the profession. Contrary to prior research, working with COVID-19 patients was associated with greater intention to stay in nursing. Personal finances may represent the rationale for nurses to choose to stay nurses despite burnout.

Building A Community-Academic Partnership To Improve Screening For Intimate Partner Violence: Integrating Advocates In Healthcare Clinic Settings, Erin C. Schubert, Colleen M. Galambos, Teresa Jerofke-Owen, Erica Arrington, Greer C. Jordan, Nilanjan Lodh, Heidi Paquette, Gisela Chelimsky, Linda B. Piacentine

College of Nursing Faculty Research and Publications

Aims

To develop an innovative community-academic partnership to advance, test and promote intimate partner violence screening and referral protocols by comparing the effect of integrating intimate partner violence advocates versus enhancing medical training in medical clinic settings serving women from vulnerable populations. Detecting intimate partner violence in healthcare settings allows for survivors to connect to safety and referral resources prior to violence escalating. Screening for intimate partner violence and connecting patients to referral resources requires creating a safe and trusting relationship between healthcare providers and patients. Developing screening and referral protocols responsive to survivors' needs requires involvement of clinic staff, …

Patient-Mediated Interventions In Hospital: A Systematic Review, Georgia Tobiano, Shelley Roberts, Rachel Muir, Teresa Jerofke-Owen, Christine Ting, Sarah Thorning, Daren K. Heyland, Andrea P. Marshall

College of Nursing Faculty Research and Publications

Aims

To describe the characteristics of hospital-based, patient-mediated interventions and their impact on patient, clinician and organization outcomes.

Design

Systematic review.

Data Sources

Health literature databases (MEDLINE, CINAHL and EMBASE) were searched in August 2021. Backward and forward citation searching was conducted.

Review Methods

Studies investigating patient-mediated interventions, targeted at adult hospitalized patients were eligible. Data were extracted related to study and intervention characteristics. Narrative synthesis was used to understand intervention impact on patient, clinician and organization outcomes (as per a framework). Methodological quality was assessed using the Mixed Methods Assessment Tool.

Results

Thirty-three studies, reporting 18 interventions, were included. …

Experiences Of Sex Workers In Chicago During Covid-19: A Qualitative Study, Randi Beth Singer, Sarah Abboud, Amy K. Johnson, Jessica L. Zemlak, Natasha Crooks, Sangeun Lee, Johannes Wilson, Della Gorvine, Jahari Stamps, Douglas Bruce, Susan G. Sherman, Alicia K. Matthews, Crystal L. Patil

College of Nursing Faculty Research and Publications

COVID-19 exacerbated health disparities, financial insecurity, and occupational safety for many within marginalized populations. This study, which took place between 2019 and 2022, aimed to explore the way in which sex workers (n = 36) in Chicago were impacted by COVID-19. We analyzed the transcripts of 36 individual interviews with a diverse group of sex workers using thematic analysis. Five general themes emerged regarding the detrimental impact of COVID-19 on sex workers: (1) the impact of COVID-19 on physical health; (2) the economic impact of COVID-19; (3) the impact of COVID-19 on safety; (4) the impact of COVID-19 on …

Learning A Healthy Rhythm: An Intervention To Increase Children’S Resources For Stress Management, Kristin Haglund, Amanda L. King, Abir K. Bekhet, Mauricio Garnier-Villarreal, Karen Olson, Rashs Atshan, Angela Ortiz, Johanna De Los Santos, Ruth Ann Belknap

College of Nursing Faculty Research and Publications

This article describes a pilot test of a community engaged, culturally relevant, arts-based intervention. The purpose was to increase children’s personal protective buffering resources. Protective buffering resources help children cope with stressful stimuli, reduce activation of their systemic stress response, mitigate allostatic load, and promote optimal health. The “Learning a Healthy Rhythm” intervention included a stress management component and an ongoing Afro-Latino percussion program for 18 children ages 9–11. The stress management component included educational content about stress, self-assessment of stress symptoms, and stress management techniques. A mixed-method intervention evaluation design was used. Qualitative data, quantitative data, and biometrics including …

Theoretical Substruction Of Resilience Theory: Dementia Caregivers' Burden And Their Care Recipients' Behavior, Abir K. Bekhet

College of Nursing Faculty Research and Publications

Theoretical substruction is vital in clarifying models and guiding research. In this article, the process of theoretical substruction was examined through resilience theory to provide an example of the congruence between theoretical and operational definitions in nursing research. The author examines the significance of resilience theory in the context of dementia caregivers’ burden and their care recipients’ behavioral problems. The steps of theoretical substruction are included, and a model of resilience is presented that includes middle-range concepts, relational statements, and propositions derived from the research literature. The rigorous process of theoretical substruction provides an example of a theoretically sound basis …

Lived Experiences Of American Adults Who Survive Covid-19: Implications For Physical Activity And Interpersonal Stress, Linda B. Piacentine, Hannah C. Barbosa, Kristin Haglund, Lauren Opielinski, Sandra K. Hunter, Paula E. Papanek, Marie K. Hoeger Bement, Norah L. Johnson

College of Nursing Faculty Research and Publications

Introduction: The cumulative number of COVID-19 cases has surpassed 579 million globally. Symptoms during and after COVID-19 infection vary from mild cold symptoms to severe multisystem illness. Given the wide range of symptom presentations and complications post COVID-19, the purpose of this study was to describe the lived experience of American adults surviving COVID-19.

Method: This study employed an exploratory qualitative description design. Semi-structured interviews were conducted with a sample of 35 individuals, [white (94%), female (71%), mean age = 43.7 years], with proximity to a university in an urban Midwest American city. Interviews occurred between May and …

A Swimming Program For Children With Autism Spectrum Disorders: Assessing Critical Parameters From Caregivers’ Perspectives, Abir K. Bekhet, Norah L. Johnson, Tana Karenke, Amy V. Van Hecke

College of Nursing Faculty Research and Publications

One in 54 individuals is diagnosed with autism spectrum disorders (ASD). Swimming can impact the physical and mental well-being of persons with ASD, which in turn may improve their caregivers’ well-being. The purpose of this qualitative evaluation study is to assess the necessity, acceptability, feasibility, fidelity, and beginning effectiveness of a 12-session swimming training program (STP) at an indoor university pool designed to teach persons with ASD how to swim, and to teach caregivers precautions for safety around water. Participants included 7 boys, and 3 girls with ASD [mean age 7.05 years (SD 1.17)] and their caregivers. Results indicated that …

Uncertainty And Perinatal Post-Traumatic Stress Disorder In The Neonatal Intensive Care Unit, Kathryn J. Malin, Teresa S. Johnson, Roger L. Brown, Jonathan Leuthner, Margaret Malnory, Rosemary White-Traut, Erin Rholl, Joanne Lagatta

College of Nursing Faculty Research and Publications

Parents of infants in the neonatal intensive care unit (NICU) are at increased risk of developing perinatal post-traumatic stress disorder (PPTSD), a mental health condition known to interfere with healthy parental and infant attachment. Feelings of uncertainty about illness have been theorized as an antecedent to post-traumatic stress, however the relationship has not been explored in parents of infants requiring care in the NICU. The purpose of this prospective study was to explore parental uncertainty during and after NICU discharge and the relationship between uncertainty and PPTSD. The sample consisted of 319 parents during NICU hospitalization and 245 parents at …

Monkeypox Prevention And Protecting Sex Workers: A Call To Action, Randi Beth Singer, Amy K. Johnson, Jessica L. Zemlak, Ariel Shensa, Rebecca M. Singer, Cocoa Costales, Kathleen Chiu, Jahari Stamps

College of Nursing Faculty Research and Publications

No abstract provided.

Health Literacy And Its Association With Human Papilloma Virus Vaccination Among Adults: Findings From The Behavioral Risk Factor Surveillance System, Vinodh Bhoopathi, Bhagavatula Pradeep, Maharaj Singh

College of Nursing Faculty Research and Publications

Health literacy is associated with the utilization of preventive health services. We examined the association between health literacy (HL) levels and receipt of at least one dose of the human papilloma virus (HPV) vaccination. We analyzed the data from the 2016 Behavioral Risk Factor Surveillance System (BRFSS) among adults aged 18 to 32. The primary outcome variable was the ‘yes/no’ response to the question that assessed whether the participant received at least the first dose of HPV vaccination. The primary independent variable was a summative HL score (range 3 through 12) we created for each respondent by adding the scores …

The Association Of Preoperative Frailty And Neighborhood-Level Disadvantage With Outcome In Patients With Newly Diagnosed High Grade Glioma, Pranav Mirpuri, Maharaj Singh, Richard Rovin

College of Nursing Faculty Research and Publications

Objective

Individual patient and socioeconomic factors are underexplored prognostic factors for glioblastoma (GBM). Frailty, a measure of physiological vulnerability, and area deprivation, a measure of socioeconomic status, are easily obtained during the preoperative evaluation. These metrics are predictors of outcome and access to treatments for other cancers. Therefore, we sought to determine the association of frailty and neighborhood disadvantage with outcomes of patients with newly diagnosed GBM.

Methods

This was a retrospective review of newly diagnosed patients with GBM undergoing surgery from 2015 through 2020. The 5-factor modified frailty index and national area deprivation index were determined for each patient. …

Effect Of Educational Intervention On Improving Nurse’S General Health In Military Hospitals Of Iran: A Quasi-Experimental Study, Vahid Ranaei, Fatemeh Kalroozi, Mojtaba Sadeghi, Soudabeh Yarmohammadi, Kristin Haglund, Nahid Mehrabi

College of Nursing Faculty Research and Publications

Background Nursing in military hospitals affects their general health. Educational interventions can help to maintain the general health of nurses. This study aimed to evaluate the effect of an educational intervention to improve the general health of nurses in military hospitals. Methods In this quasi-experimental study, 146 nurses working in military hospitals in Tehran, Iran in 2021 were included in the study. The one-month educational intervention included videos, pamphlets, and motivational messages about promoting general health. General health questionnaire with 28 items (GHQ28) was study tool. The allocation of nurses to groups was not random, it was based on personal …

Implications Of The Dunning-Kruger Effect: Finding Balance Between Subjective And Objective Assessment In Debriefing Professional Development, Cynthia Sherraden Bradley, Kristina Dreifuerst, Anne Loomis, Brandon Kyle Johnson, Aimee A. Woda, Jamie Hansen

College of Nursing Faculty Research and Publications

Background

The ability to debrief is considered an essential clinical and simulation teaching skill because of the deep learning cultivated. Regulatory bodies identify the need for debriefing training and professional development followed by formative and summative assessment.

Method

The Debriefing for Meaningful Learning Evaluation Scale (DMLES) is a behaviorally anchored rating scale developed to assess 20 behaviors aligned with Debriefing for Meaningful Learning (DML). Participants from five baccalaureate pre–licensure nursing programs were recruited to receive DML training, then facilitate and record a debriefing for subjective and objective assessment using the DMLES.

Results

A total of 52 debriefers submitted 81 recorded …

‘If The Partner Finds Out, Then There’S Trouble’: Provider Perspectives On Safety Planning And Partner Interference When Offering Hiv Pre-Exposure Prophylaxis (Prep) To Women Experiencing Intimate Partner Violence (Ipv), Noelene K. Jeffers, Jessica L. Zemlak, Lourdes Celius, Tiara C. Willie, Trace Kershaw, Kamila A. Alexander

College of Nursing Faculty Research and Publications

Pre-exposure prophylaxis is an effective women-controlled HIV prevention strategy but women experiencing intimate partner violence fear partners’ interference and subsequent violence could limit its utility. This study explores provider perceptions of safety planning strategies to prevent escalating violence, mitigate partner interference, and promote daily oral PrEP adherence. We conducted interviews (N = 36) with healthcare providers (n = 18) and IPV service providers (n = 18) in Baltimore and New Haven. Using the Contextualized Assessment for Strategic Safety Planning model we organized data into two categories: the appraisal process and strategic safety planning. Themes revealed during …

Post-Surgical Emergency After-Hours Calls: Prevalence, Concerns, And Management, Vrisiis Kofina, Drake Lindholm, Abdulkareem Harunani, Andrew R. Dentino, Maharaj Singh, Dimitris N. Tatakis

College of Nursing Faculty Research and Publications

Objective

The purpose of this study was to investigate the prevalence, nature, and management of post-surgical emergency after-hours calls in a dental school setting with predoctoral students, graduate students/residents, and faculty providers.

Methods

A patient chart review (March 2018–February 2020) for post-surgical calls through the emergency after-hours pager system was conducted at the Marquette University School of Dentistry. The total number of surgical procedures, procedure type, the timing of call, operator experience, concern, and recommendation given during the call were documented.

Results

During the review period, 83 calls (from 75 patients) were recorded after 8,487 surgical procedures (1% of procedures). …

Helping Nurses Identify And Report Sentinel Injuries Of Child Abuse In Infants, Elizabeth Cleek, Joan P. Totka, Lynn K. Sheets, Joshua P. Mersky, Kristin Haglund

College of Nursing Faculty Research and Publications

Sentinel injuries (SIs) are some of the earliest and most readily identifiable red flags of child abuse. SIs are unexpected bruising or intra-oral injuries in pre-mobile infants and highly correlated with child abuse. However, SIs are not always recognized and reported as red flags of child abuse. Infants are left at risk for continued harm when SIs are not identified and reported. Although increasing nurses' knowledge of SIs is important, child abuse researchers and behavioral theorists have identified that knowledge alone does not predict nurses' behaviors when identifying and reporting suspected child abuse. Other predictors may include implicit biases, interpersonal …

Parent Physical Activity: A Systematic Review Of The Literature And Recommendations For Parents Of Children With Autism Spectrum Disorder, Norah L. Johnson, Abir K. Bekhet, Rachel Sawdy, Emily Zint, June Wang, Sylvia Pena, Hannah Zurcher, Nina Enea

College of Nursing Faculty Research and Publications

Background: The aims of this review were to describe exercise interventions, facilitators, and barriers to physical activity for parents of children with autism spectrum disorder.

Methods: A systematic review of the literature, appraising the validity of each article with Melnyk and Fineout-Overholt’s level of evidence, from different databases CINAHL, Cochrane, PsycINFO, PubMed, ProQuest, and Web of Science between 2000 and 2020 was conducted. As the initial search revealed no articles on exercise interventions and only 2 articles with children with autism spectrum disorder, the aim was widened to all parents of children.

Results: Forty-five articles were identified on barriers to …

Unseen, Unheard: A Qualitative Analysis Of Women’S Experiences Of Exclusively Expressing Breast Milk, Lisa A. Anders, Karen Marie Robinson, Jennifer M. Ohlendorf, Lisa Hanson

College of Nursing Faculty Research and Publications

Background

Breast milk feeding has numerous benefits for women and infants. Positive maternal experiences with breast milk feeding impacts exclusivity, duration, and maternal mental health. Most research focuses on women feeding directly at the breast. Some women elect to feed exclusively expressed milk to their healthy, term infants rather than feed directly at the breast. Little is known about what constitutes a positive experience among this population. Therefore, the aim of this study was to explore women’s experiences of exclusive expression (EE).

Methods

Interviews were conducted via Microsoft Teams to collect qualitative data from a purposive sample of 21 women …

Satisfaction And Effectiveness Of Opioid Pain Management Among Adults With Cystic Fibrosis: A Mixed Methods Study, Sarah Allgood, Jessica L. Zemlak, Elisabeth Dellon, Siddhartha G. Kapnadak, Jessica Goggin, Noah Lechtzin

College of Nursing Faculty Research and Publications

Background

Chronic pain is common among people living with cystic fibrosis (CF) and associated with worse clinical outcomes. Despite this, little is known about how pain is managed and how opioids are used to treat pain. The purpose of this convergent mixed methods study was to examine self-reported satisfaction and effectiveness of pain management strategies among a sample of adults with CF who are prescribed opioids.

Methods

We developed an online survey querying 4 domains - demographics, pain characteristics, pain communication, and management strategies. This was distributed nationally to adults with CF (n=48) via various online platforms. We obtained quantitative …

Interpersonal Violence And Contraceptive Method Use By Women Sex Workers, Jessica L. Zemlak, Rebecca Hamilton White, Danielle Friedman Nestadt, Kamila A. Alexander, Ju Nyeong Park, Susan G. Sherman

College of Nursing Faculty Research and Publications

Objective

More than one-half of women sex workers (sex workers) in the United States experience interpersonal violence, defined as physical or sexual violence, by sexual partners, including clients or intimate partners. Women experiencing interpersonal violence by intimate partners often choose hidden, woman-controlled contraception (e.g., intrauterine devices, pills, or sterilization) because fear of violence can impede condom negotiation. Yet, little is known about how interpersonal violence relates to contraception among sex workers who may have different sexual partner perpetrators (clients and intimate partners). The purpose of this study was to examine associations between interpersonal violence perpetrated by clients or intimate partners …

Comparing Interprofessional Socialization In Mixed-Discipline And Nursing Student-Only Cohorts, Kara Groom, Marilyn Frenn, Susan Breakwell, Timothy Melchert, Mauricio Garnier-Villarreal

College of Nursing Faculty Research and Publications

Background

A challenge to substantiating the value of interprofessional education (IPE) has been the limited number of studies that assess the effectiveness of IPE interventions compared with education interventions in which professions were learning separately from one another.

Purpose

The purpose was to compare interprofessional socialization (IS) in mixed-discipline and single-discipline–only student cohorts to determine if mixed-discipline cohorts demonstrate greater improvement in IS compared with single-discipline cohorts.

Methods

Interprofessional socialization was measured using the Interprofessional Socialization and Valuing Scale in 166 university students who completed a semester-long online palliative care course.

Results

Statistically significant increases in IS were seen with …

Examining The Course Of Transitions From Hospital To Home-Based Palliative Care: A Mixed Methods Study, Stephanie Saunders, Marianne Weiss, Chris Meaney, Tieghan Killackey, Jaymie Varenbut, Emily Lovrics, Natalie Ernecoff, Amy T. Hsu, Maya Stern, Ramona Mahtani, Kirsten Wentlandt, Sarina R. Isenberg

College of Nursing Faculty Research and Publications

Background:

Hospital-to-home transitions in palliative care are fraught with challenges. To assess transitions researchers have used patient reported outcome measures and qualitative data to give unique insights into a phenomenon. Few measures examine care setting transitions in palliative care, yet domains identified in other populations are likely relevant for patients receiving palliative care.

Aim:

Gain insight into how patients experience three domains, discharge readiness, transition quality, and discharge-coping, during hospital-to-home transitions.

Design:

Longitudinal, convergent parallel mixed methods study design with two data collection visits: in-hospital before and 3–4 weeks after discharge. Participants completed scales assessing discharge readiness, transition quality, and …

Mixed Methods Study Of Nurse Assessment Of Patient Preferences For Engagement During Hospitalization, Teresa Jerofke-Owen, Alexandria Zielinski, Roger L. Brown

College of Nursing Faculty Research and Publications

Background

Global healthcare initiatives emphasize the importance of engaging patients in their healthcare to improve patients’ experience and outcomes. Assessing patient preferences for engagement is critical, as there are many ways patients can engage in their care and preferences vary across individuals.

Objective

The primary purpose of this study was to evaluate the effect of implementation of the Patient Preferences for Engagement Tool 13-Item Short Form (PPET13) during hospitalization on patient and nurse experience of engagement. Readmissions and emergency department (ED) usage within 30 days postdischarge were also examined.

Methods

The mixed methods study was conducted within two medical units …

Promoting Patient Engagement: A Scoping Review Of Actions That Align With The Interactive Care Model, Georgia Tobiano, Teresa Jerofke-Owen, Andrea P. Marshall

College of Nursing Faculty Research and Publications

Background

Conceptual clarity for the term patient engagement is growing. However, there is variability in patient engagement in healthcare, which could be due to the absence of models to guide practice or a myriad of organisational, nurse and patient factors. The recently developed ‘Interactive Care Model’ provides guidance on how to genuinely promote individualised patient engagement. An understanding of how to action this model in nursing is required.

Aims

The aim of this scoping review was to examine actions in the published scientific literature that align with the Interactive Care Model, in the context of nursing care of hospitalised patients. …