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Articles 991 - 1020 of 15019
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Staff Education To Implement Routine Use Of Hamilton Depression Rating Scale On The Identification And Severity Classification Of Adult Depression In Primary Care, Christencia Nkechi Obinna-Igbokwe
Staff Education To Implement Routine Use Of Hamilton Depression Rating Scale On The Identification And Severity Classification Of Adult Depression In Primary Care, Christencia Nkechi Obinna-Igbokwe
Walden Dissertations and Doctoral Studies
This Doctor of Nursing practice (DNP) project was a quality improvement initiative focused on staff education to standardize the workflow and documentation of the Hamilton depression rating scale (HAM-D). The goal was to enhance measurement-based care and mitigate inconsistencies in depression severity assessments that could potentially delay treatment modifications, follow-up planning, and safety decisions. The practice-focused inquiry examined whether a concise staff education program, in conjunction with a HAM-D clinical practice guideline, would enhance staff knowledge and preparedness to administer and document the HAM-D for routine severity monitoring in adults exhibiting depressive symptoms. Employing rapid-cycle plan–do–study–act (PDSA) methodologies, five members …
Preventing Burnout In School-Based Behavioral Health Clinicians: Organizational Strategies For Mitigating Work-Related Mental Health Impairment, Virginia W. Lee
Preventing Burnout In School-Based Behavioral Health Clinicians: Organizational Strategies For Mitigating Work-Related Mental Health Impairment, Virginia W. Lee
Walden Dissertations and Doctoral Studies
This is a qualitative case study on Organization X that used the Baldrige Framework to investigate employee burnout, a growing concern associated with staff turnover, reduced job satisfaction, depression, and disengagement. The goal was to examine how organizational leaders assess the effectiveness of burnout prevention strategies, identify organizational factors and leadership practices that either mitigate or increase burnout, and discover key factors that contribute to burnout. Semi-structured interviews, guided by the Baldrige Framework, were conducted with three leaders at Organization X. The themes resulting from interviews included burnout, open-ended communication, team cohesion, real-time protection, ethical leadership and authenticity, restoring norms, …
Program Proposal For A Nurse Led Pre-Procedure Readiness Program, Walter Magramo
Program Proposal For A Nurse Led Pre-Procedure Readiness Program, Walter Magramo
Walden Dissertations and Doctoral Studies
Same-day outpatient procedural cancellations represent a persistent challenge for healthcare organizations, negatively affecting patient safety, access, operational efficiency, and financial performance. This Doctor of Nursing Practice (DNP) executive leadership project proposes the implementation of a nurse-led, artificial intelligence (AI)–enhanced preprocedural readiness program within an outpatient procedural department. The initiative integrates standardized nurse-led readiness checklists, AI-supported clinical decision support embedded in the electronic health record, structured nurse-led outreach, and standardized patient and staff education to proactively identify and address preventable barriers to procedural readiness. Internal organizational data identified a sustained same-day cancellation rate of approximately 22%, with most cancellations attributable to …
Trauma Coping Mechanisms Among Police In Small Departments, Peter Michael Ungaro
Trauma Coping Mechanisms Among Police In Small Departments, Peter Michael Ungaro
Walden Dissertations and Doctoral Studies
Mental health services are available to police officers, but many do not utilize these resources due to stigma, shame, and fear of job loss. This reluctance often forces officers to handle mental health issues alone, frequently leading to unhealthy coping strategies that negatively impact their well-being and job performance. While advancements in mental health support exist, they primarily serve larger departments, leaving the needs of small departments largely unmet. The foundation of the study was rooted in resilience theory, which holds that the impact of trauma on an individual is determined not by the event itself but by the coping …
Staff Education On Integrating Holistic And Herbal Therapies For Adults With Depression, Kettelene P. Mcmorris
Staff Education On Integrating Holistic And Herbal Therapies For Adults With Depression, Kettelene P. Mcmorris
Walden Dissertations and Doctoral Studies
Adults with depression frequently use or inquire about holistic and herbal therapies; however, inconsistent and non-standardized staff education regarding the safe, evidence-based integration of these therapies may contribute to variable counseling practices and potential patient safety risks. The purpose of this Doctor of Nursing Practice (DNP) quality improvement project was to implement and evaluate a structured staff education intervention focused on integrating holistic and herbal therapies for adults with depression in an outpatient behavioral health practice. The practice-focused question examined whether staff education would improve staff knowledge related to commonly used holistic and herbal therapies and associated safety considerations. A …
Emotion Regulation And Stress In Adult Learning Through Social Media Platforms, Jennifer Irocky
Emotion Regulation And Stress In Adult Learning Through Social Media Platforms, Jennifer Irocky
Walden Dissertations and Doctoral Studies
Social media platforms have become significant contexts for informal learning among adults, offering access to information and peer exchange outside of formal educational settings. These platforms are also emotionally complex environments in which stress and emotion regulation may shape learning outcomes. The purpose of this quantitative, nonexperimental study was to examine the relationship between social media use and informal learning in adults, with perceived stress and emotion regulation examined as moderating variables. Secondary data from the Stress in America: The State of Our Nation, 2007–2018 surveys were analyzed, using binary logistic regression with moderation while controlling for age, gender, and …
The Importance Of Timely Documentation Of Updates On Patients’ Records In Improving Documentation Accuracy And Reducing Clinical Errors At The Home Health Agency, Sandra Aigbekaen
The Importance Of Timely Documentation Of Updates On Patients’ Records In Improving Documentation Accuracy And Reducing Clinical Errors At The Home Health Agency, Sandra Aigbekaen
Walden Dissertations and Doctoral Studies
Timely and accurate documentation is essential to patient safety, care coordination, and risk reduction in home health care. In this Doctor of Nursing Practice project, I implemented an evidence-based educational intervention to improve documentation practices among clinicians at a pediatric home health agency in the southwest United States. Guided by the analyze, design, develop, implement, and evaluate (ADDIE) instructional design model, I conducted the project to evaluate whether focused education would improve documentation accuracy, consistency, and timeliness. A targeted literature review on electronic health record (EHR) best practices, structured documentation, and patient safety informed the development of five training modules …
Multimodal Interventions To Assist In Reducing No Show Rates In An Outpatient Primary Care Setting, Amelia Barber
Multimodal Interventions To Assist In Reducing No Show Rates In An Outpatient Primary Care Setting, Amelia Barber
Walden Dissertations and Doctoral Studies
This Doctor of Nursing Practice (DNP) incorporated a Clinical Practice Guideline (CPG) approach to address a practice issue of increased no show rates of patients scheduled for follow-up appointments in an adult outpatient primary care setting. Missed appointments symbolize a long-standing practice problem in ambulatory care, exacerbating challenges like healthcare expenses, fragmented care, inefficient resource utilization, and delayed treatment often resulting in negative patient outcomes. The project’s purpose was to develop an evidence-based CPG with integrated multimodal patient outreach strategies, including patient portal, text messaging, transportation support, and live reminder calls within Electronic Health Record (EHR) system to prevent and/or …
Early Childhood Teachers’ Experiences Establishing Positive School-Home Relationships, Jayme Michelle Doyle
Early Childhood Teachers’ Experiences Establishing Positive School-Home Relationships, Jayme Michelle Doyle
Walden Dissertations and Doctoral Studies
The problem in this study was that at Windland Elementary School (WES; pseudonym) early childhood teachers experienced a 16% decrease in parent satisfaction with the school's ability to eliminate or reduce barriers to parent engagement. Framed by six types of activities that encompass family engagement from Epstein et al., the purpose of this study was to explore early childhood teachers' experiences in establishing and maintaining school-home relationships at WES. Data were collected through semistructured interviews with 10 Kindergarten through Grade 3 teachers who had at least 3 years’ teaching experience at WES. Thematic analysis using open coding yielded four key …
Leadership Strategies To Promote Employee Engagement In Therapeutic Agencies, Paris Sim'mone Lewis
Leadership Strategies To Promote Employee Engagement In Therapeutic Agencies, Paris Sim'mone Lewis
Walden Dissertations and Doctoral Studies
This study investigates the persistent decline in employee engagement among behavioral health clinicians working within community-based therapeutic agencies, focusing specifically on Behavioral Health Organization A (BHOA). The purpose of this qualitative study is to explore how leadership style, communication practices, and organizational structure affect clinician engagement at BHOA. Grounded in the Baldridge Performance Excellence Framework and supported by transformational leadership theory, the study examines how leadership behaviors and communication pipelines shape motivation, burnout, and workforce alignment. Semi-structured interviews with organizational leaders, secondary data, and internal documents were collected and analyzed using Braun and Clarke’s thematic analysis approach. Themes revealed communication …
Clinical Practice Guideline For Structured Communication In A Pediatric Outpatient Psychiatry, Stella Uzoamaka Ihesiaba
Clinical Practice Guideline For Structured Communication In A Pediatric Outpatient Psychiatry, Stella Uzoamaka Ihesiaba
Walden Dissertations and Doctoral Studies
This doctoral project focused on developing and evaluating a clinical practice guideline (CPG) to address the lack of standardized interdisciplinary communication between psychologists and psychiatric mental health nurse practitioners (PMHNPs) in a pediatric outpatient psychiatric setting. Inconsistent communication practices, including informal conversations, delayed documentation, and unstructured messaging, contributed to fragmented care and inefficient treatment coordination. To address this gap, an evidence-based, structured communication framework was developed to guide interdisciplinary collaboration. The guideline was developed using the Johns Hopkins Evidence-Based Practice model and supported by a review of 14 evidence sources spanning Levels I to V of the literature. A four-member …
The Perspective Of Rural Secondary Vocational Education Instructors On Employability Skills, Unqualified Advancement, And Expulsion To Reduce Delinquency And Justice System Contact, Stacy Lynn
Walden Dissertations and Doctoral Studies
In this study, the problem in Tennessee and across the United States where the skills of employability, which are used in the reduction of recidivism, are not being emphasized at the secondary level to prevent delinquency and initial justice system contact was highlighted. The purpose of this study was to explore the perspective of rural secondary vocational educators on student unqualified advancement, expulsion, and program employability skills of students participating in vocational education, referencing the reduction of delinquency and justice system contact. Bandura’s social learning theory and subsequent social cognitive theory were the theoretical frameworks for thematic analysis using interpretative …
Development Of A Comfort Care Clinical Practice Guideline And Standardized Comfort Care Kits In Adult Home Hospice, Kelly Miller
Development Of A Comfort Care Clinical Practice Guideline And Standardized Comfort Care Kits In Adult Home Hospice, Kelly Miller
Walden Dissertations and Doctoral Studies
This Doctor of Nursing Practice (DNP) project focused on the development and expert appraisal of a clinical practice guideline (CPG) to improve home-based comfort care in hospice settings. Terminally ill patients frequently experience distressing symptoms such as pain, dyspnea, and nausea, yet inconsistent symptom management and documentation practices persist across hospice care (Henson et al., 2020). A CPG was developed to evaluate a comfort care kit for patients. The CPG was independently reviewed by a three-member expert panel using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) instrument, which consists of 23 items that are organized into …
Developing A Comprehensive Program Plan For Postpartum Mental Health Assessment And Follow-Up Care, Kimberly Osborne
Developing A Comprehensive Program Plan For Postpartum Mental Health Assessment And Follow-Up Care, Kimberly Osborne
Walden Dissertations and Doctoral Studies
This Doctor of Nursing Practice project was an executive leadership proposal to develop an evidence-based program plan for standardized postpartum mental health screening and structured referral processes within an obstetric clinic. The practice problem was inconsistent postpartum mental health screening and follow up. Internal organizational data demonstrated elevated no-show and cancellation rates among obstetric patients referred for mental health services, reflecting gaps in care coordination, particularly for rural and underserved populations. The purpose of this project was to develop a comprehensive program plan guided by the following practice-focused question: Will a standardized postpartum mental health screening and structured referral program …
Citizen Perceptions Of Law Enforcement Use Of Facial Recognition Technology, Helena Raye Weiskittel
Citizen Perceptions Of Law Enforcement Use Of Facial Recognition Technology, Helena Raye Weiskittel
Walden Dissertations and Doctoral Studies
Use of facial recognition technology (FRT) in criminal investigations is potentially controversial in terms of privacy rights. This study involved examining public perceptions regarding police officers’ use of FRT in criminal investigations. A qualitative research method and descriptive design were used to explore participants’ perceptions of FRT. The procedural justice theory and a pragmatic paradigm guided this general qualitative research. The target population for the study was 10 participants from the United States. Results of this study showed privacy concerns involved a lack of public anonymity and the risk of data breaches due to facial recognition. This shows use of …
Staff Education Of Fall Prevention Intervention In The Emergency Department, Jonathan Jaramillo
Staff Education Of Fall Prevention Intervention In The Emergency Department, Jonathan Jaramillo
Walden Dissertations and Doctoral Studies
Patient falls remain a significant patient safety concern in emergency departments (EDs) despite the routine use of fall risk screening tools. At the project site, continued fall events suggested a gap in staff knowledge, confidence, and consistent application of evidence-based fall prevention strategies. This Doctor of Nursing Practice (DNP) quality improvement project evaluated whether a targeted staff education intervention would improve ED nursing staff's knowledge, confidence, and intent to identify fall risk, implement prevention strategies, and respond appropriately to patient falls. Guided by the Analyze, Design, Develop, Implement, and Evaluate (ADDIE) instructional design model, an evidence-based educational intervention was developed …
Staff Education To Address Financial Barriers In Outpatient Psychiatric Care, Yvette Taffou Kamayou
Staff Education To Address Financial Barriers In Outpatient Psychiatric Care, Yvette Taffou Kamayou
Walden Dissertations and Doctoral Studies
This staff education project addressed financial barriers that prevent psychiatric outpatients from accessing consistent care. High no-show rates in outpatient psychiatry, often 20–40%, stem largely from costs such as co-pays, transportation, and medication, leading to missed appointments, poorer outcomes, and increased healthcare costs. The practice-focused question was “In an outpatient psychiatric clinic, does a targeted staff education program on non-judgmental financial discussions, sliding-scale fees, and telehealth options improve staff knowledge, confidence, and patient referral rates to resources over 8 weeks?” The purpose was to implement and evaluate a structured educational intervention to equip staff with tools for addressing financial barriers, …
Development Of An Evidence-Based Educational Intervention Designed To Increase Staff Knowledge And Competence In Comprehensive Fall-Prevention Practices, Jacqueline U. Becerra
Development Of An Evidence-Based Educational Intervention Designed To Increase Staff Knowledge And Competence In Comprehensive Fall-Prevention Practices, Jacqueline U. Becerra
Walden Dissertations and Doctoral Studies
Inpatient falls continue to represent a significant nurse-sensitive quality indicator associated with patient injury, extended hospital stays, and increased healthcare costs. Despite the presence of established fall-prevention protocols, inconsistent completion of fall-risk assessments and uneven application of prevention strategies contributed to ongoing fall events at the project site. The practice problem addressed in this Doctor of Nursing Practice (DNP) project was the lack of consistent staff knowledge and application of evidence-based fall-prevention practices. The purpose of this evidence-based quality improvement project was to implement and evaluate a structured fall-prevention staff education program to increase inpatient staff knowledge related to fall-prevention …
Optimizing Telehealth Staff Education To Improve Medication Adherence In Adults With Ptsd, Omotayo Abdul
Optimizing Telehealth Staff Education To Improve Medication Adherence In Adults With Ptsd, Omotayo Abdul
Walden Dissertations and Doctoral Studies
This Doctor of Nursing Practice project was a staff education quality improvement initiative designed to optimize telehealth training for nurses to improve medication adherence in adults with posttraumatic stress disorder (PTSD). Telehealth has become an essential modality for delivering mental health care, yet its effectiveness depends heavily on nurses’ ability to communicate effectively, build trust, and engage patients in treatment discussions. Medication nonadherence remains a significant challenge in PTSD care and is closely linked to the quality of clinician communication and patient engagement during care encounters. The practice-focused question guiding this project asked how a staff education project on PTSD …
Incarceration’S Impact On Young Adults’ Psychological Development, Well-Being, And Reintegration Into Society, Monica Murrell
Incarceration’S Impact On Young Adults’ Psychological Development, Well-Being, And Reintegration Into Society, Monica Murrell
Walden Dissertations and Doctoral Studies
This qualitative phenomenological study explored how individuals who experienced incarceration during emerging adulthood understood and made meaning of their developmental, emotional, and psychosocial experiences. Emerging adulthood, defined as ages seventeen through twenty-five, is a critical developmental stage, and incarceration during this period may disrupt identity formation and emotional maturation. The purpose of the study was to examine the perspectives and coping mechanisms of individuals incarcerated during this stage to better understand how early adult imprisonment shapes trauma responses, identity development, and reintegration. Social learning theory served as the conceptual framework. Data was collected through interviews with six formerly incarcerated adults …
Factors That Contribute To Lone-Wolf Terrorist Attacks In The United States, Kevin Klatte
Factors That Contribute To Lone-Wolf Terrorist Attacks In The United States, Kevin Klatte
Walden Dissertations and Doctoral Studies
Within the United States, current strategies aimed to prevent terrorism focus on terrorist organizations and international terrorism. The predominant literature on lone-wolf terrorism has focused mainly on quantitative data, and the qualitative studies that have been conducted do not uncover all factors that led to the individual committing the attack. Lone-wolf terrorism, while less frequent than international terrorism, has a significantly higher number of victims per attack and is extremely difficult to predict and prevent. The existing qualitative literature has heavily focused on the mental state, emotional status, and cognitive ability of the offender. This study explored why an individual …
Staff Education To Improve Accuracy And Consistency Of Depression Assessment Through Structured Education On The Zung Self-Rating Depression Scale, Janenita D. Chukwu
Staff Education To Improve Accuracy And Consistency Of Depression Assessment Through Structured Education On The Zung Self-Rating Depression Scale, Janenita D. Chukwu
Walden Dissertations and Doctoral Studies
Inaccurate and inconsistent administration and interpretation of standardized depression screening instruments can destabilize clinical accuracy and patient safety. Despite routine administration of the ZSDS during nursing intake, informal observation and documentation review indicated a gap in nurses' understanding of how to compute raw scores, convert them to index scores, and define the severity levels. The aim of the project was to determine whether a structured staff education intervention would enhance nurses' knowledge of ZSDS administration, scoring, and interpretation. Informed by the Johns Hopkins Evidence-Based Practice model, an educational intervention based on existing evidence on the accuracy and implementation fidelity of …
Challenges To Completion Of Workforce Adult Education Classes Among New Americans, Damon Grew Peter Syphers-Wilkins
Challenges To Completion Of Workforce Adult Education Classes Among New Americans, Damon Grew Peter Syphers-Wilkins
Walden Dissertations and Doctoral Studies
The problem which was addressed through this study was New American groups face challenges in the completion of workforce adult education classes. The purpose of this qualitative study was to explore New Americans’ challenges, needs, and cultural challenges to complete workforce adult education classes. The conceptual frameworks that guided this study were Knowles’ model of andragogy and Wlodkowski and Ginsberg’s motivational framework for culturally responsive teaching. Freire’s pedagogy of hope can inform future research focused on strengthening the model of andragogy and the motivational framework for culturally responsive teaching. For this phenomenological design, 10 semistructured telephone interviews were conducted with …
Impact Of Electronic Immunization Record On Accurate Clinical Decision-Making In Ghana, Jacob B. Arhin
Impact Of Electronic Immunization Record On Accurate Clinical Decision-Making In Ghana, Jacob B. Arhin
Walden Dissertations and Doctoral Studies
The increasing complexity of healthcare delivery in Ghana highlighted the need for accurate and timely data-driven decision-making in clinical settings. The study examined how implementation affects the accuracy of immunization records, the speed of clinical decision-making, and overall immunization coverage rates in Ghanaian healthcare facilities. A quasi-experimental, cross-sectional design was used to compare clinical encounters in facilities that implemented the EIR with those that continued using paper-based systems. The Technology Acceptance Model guided the assessment of how healthcare providers’ perceptions of the EIR affected system utilization, while the Data-Driven Decision-Making framework and Anderson’s Behavioral Health Theoretical Model provided additional conceptual …
Increasing Knowledge And Awareness In Mental Health Assessments Among Nurses, Valerie Jiles-Brown
Increasing Knowledge And Awareness In Mental Health Assessments Among Nurses, Valerie Jiles-Brown
Walden Dissertations and Doctoral Studies
Mental health conditions affect 59 million individuals annually in the United States, translating to one in every four adults. Given this, mental health has emerged as a critical component of an individual’s overall health and well-being, with nurses being pivotal in identifying and addressing mental health concerns. However, research indicates that nurses often lack the knowledge and awareness to conduct mental health assessments. Thus, the purpose of this Doctor of Nursing Practice (DNP) project was to determine if an educational intervention focused on mental health assessments increased knowledge and awareness among nurses working in a local organization. A total of …
Staff Education To Improve Timely Intake Response And Follow-Up Communication, Evelyn Noel
Staff Education To Improve Timely Intake Response And Follow-Up Communication, Evelyn Noel
Walden Dissertations and Doctoral Studies
A lack of staff knowledge regarding timely intake response and follow-up communication processes resulted in inconsistent management of client follow-up at the private mental health clinic in Florida. This gap in practice guided the practice-focused question: Does educating mental health clinical staff on timely intake response and follow-up communication improve staff knowledge in managing client follow-up processes in a private mental health clinic, as evidenced by pre- and post-surveys? This educational initiative employed the analysis, design, development, implementation, and evaluation (ADDIE) model, the Johns Hopkins evidence-based practice (JHEBP) model, the Walden University DNP Project Checklist, and the DNP Project Process …
The Predicting Value Of Grit And Helicopter Parenting On Relational Satisfaction, Ashley Ann Puga
The Predicting Value Of Grit And Helicopter Parenting On Relational Satisfaction, Ashley Ann Puga
Walden Dissertations and Doctoral Studies
Helicopter parenting has been extensively studied within the emerging adult population. However, previous studies have recruited their participants solely from a university setting. The current literature on grit and emerging adults is limited. Therefore, this study sought to add to the current literature by recruiting emerging adults through multiple platforms, such as multiple social media platforms, to allow non-university participants. This study also sought to add to the current literature on emerging adults and grit. Utilizing the theories of social learning theory and self-determination theory, the purpose of this quantitative, correlational study was to determine if helicopter parenting and grit …
Resilience Education To Increase Staff Knowledge Regarding Stress Management, Patricia Ngozi Egwu
Resilience Education To Increase Staff Knowledge Regarding Stress Management, Patricia Ngozi Egwu
Walden Dissertations and Doctoral Studies
This doctoral project implemented a staff education program to promote nursing knowledge of resilience training and stress management at an outpatient mental health clinic. Workplace stress contributes to medication errors and to poor Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) Nurse Communication scores, both of which undermine patient safety. The practice-based question was: Does resilience education enhance stress management strategy knowledge from pre- to post-education? The purpose was to evaluate whether structured resilience education improved nursing knowledge of stress management, guided by the analysis, design, development, implementation, and evaluation (ADDIE) model. Using the Johns Hopkins evidence-based practice (JHEBP) …
Perceived Retirement Preparedness Of Gen X Women Participating In Employer-Sponsored Retirement Plans, Tammie Moore Parran
Perceived Retirement Preparedness Of Gen X Women Participating In Employer-Sponsored Retirement Plans, Tammie Moore Parran
Walden Dissertations and Doctoral Studies
As Generation X (GenX) women near full retirement age, concerns about retirement preparedness have increased due to limited time to save and greater dependence on employer-sponsored retirement plans. The purpose of this qualitative single case study was to explore Gen X women’s perceptions of their retirement preparedness and to identify themes that influence effective retirement planning. Life cycle theory, the theory of reasoned action, and vested interest theory ground the conceptual framework for this study, which together explain how individuals anticipate future needs and engage in intentional financial behaviors. The study primarily focused on participants’ perceptions of retirement preparedness and …
A Quality Improvement Staff Education To Reduce Mental Health Stigma Among Healthcare Professionals, Chinwe Anthonia Chukwumerije
A Quality Improvement Staff Education To Reduce Mental Health Stigma Among Healthcare Professionals, Chinwe Anthonia Chukwumerije
Walden Dissertations and Doctoral Studies
Mental health stigma among healthcare professionals remains a barrier to help-seeking behaviors, workforce well-being, and psychological safety. This Doctor of Nursing Practice project addressed a practice gap by providing standardized, evidence-based staff education to reduce mental health stigma. The practice-focused question examined whether implementing an evidence-based staff education guideline improved healthcare professionals’ knowledge, attitudes, and confidence regarding mental health stigma. An evidence-based educational intervention was developed using the ADDIE instructional design model and informed by an integrative literature review. The intervention was delivered through structured staff education sessions and evaluated using pre- and post-intervention design. Results demonstrated improved knowledge of …