Nursing Commons^™

Childhood Obesity Interventions Need To Address Groups Experiencing Inequities, Marilyn Frenn

College of Nursing Faculty Research and Publications

No abstract provided.

Emphasizing Self-Regulation In Teaching: Reducing Disruption To Students’ Learning During Unplanned Instructional Mode Transition, Somesh Roy, Amber Young-Brice, Jenna Lassila, Brandon Kyle Johnson

College of Nursing Faculty Research and Publications

In Spring 2020, engineering faculty transitioned to emergency remote instruction due to COVID-19. This mixed-methods study was done to understand the correlation between self-regulated learning and how students experienced the emergency transition to remote learning. The participants were from an upper-level engineering course, with 33 students surveyed four times during the semester. Seven students were interviewed after the semester. Findings revealed that during the transition to remote learning, students perceived less change if they had higher degrees of self-regulation. The qualitative analysis also revealed that transparency in learning and teaching also played an important role in students’ perceptions.

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 …

Designing And Validating Novel Communication Measures For Pediatric, Adolescent, And Young Adult Oncology Care And Research: The Pedcom Measures, Bryan A. Sisk, Amy R. Newman, Dandan Chen, Jennifer W. Mack, Bryce B. Reeve

College of Nursing Faculty Research and Publications

Background

High-quality communication in pediatric and adolescent cancer is the standard of care. Yet, we lack pediatric-specific communication measures. We designed self-report and caregiver-report communication measures for use in pediatric oncology settings.

Methods

We recruited adolescent and young adults (AYAs; 12–24 years) with cancer and parents of children and AYAs between 1 month post-diagnosis and 2 months after completing treatment. Participants completed measures including 58 questions addressing eight previously characterized communication functions. For each function, we conducted factor analysis, and assessed reliability and construct validity. Based on psychometric properties, we created final long-form (31 items) and short-form (eight items) communication …

Community Or Commodity? Perceived Nurse Support During The Covid-19 Pandemic, Jacqueline Christianson, Madaline Mccarthy, Bonnie Sommers-Olson, Jill L. Guttormson, Norah L. Johnson

College of Nursing Faculty Research and Publications

This cross-sectional study aimed to understand how nurses perceived community and healthcare institution support during the COVID-19 pandemic. Five themes are described: healthcare institution resource provision, presence and camaraderie, perceived commodification versus supportive gestures, nurses as heroes, and erosion of support over time.

Feasibility Of Stress Research In Premature Infant–Maternal Dyads During And After Neonatal Intensive Care Unit Hospitalization, Kathryn J. Malin, Kristin Kruschel, Kaboni W. Gondwe, Joanne Lagatta, C. Sue Carter, Hossein P. Nazarloo, Yvette P. Conley, Rosemary White-Traut

College of Nursing Faculty Research and Publications

Background:

Stress from preterm infant admission to the neonatal intensive care unit (NICU) is associated with infant and maternal physiologic changes, including endocrine and epigenetic alterations. Little is known about the mechanisms connecting NICU stress to biologic changes, and whether preterm infant and maternal stress are reciprocal. As a preliminary step, feasibility and acceptability of measuring indicators of stress are required.

Purpose:

This study evaluated the feasibility and acceptability of research examining perceptions and biologic markers of stress in premature infant–maternal dyads during and after NICU hospitalization.

Methods:

We evaluated study feasibility using a longitudinal descriptive design. Acceptability was measured …

Impact Of The Covid-19 Pandemic On U.S. Women's Mental Health, Astrida S. Kaugars, Jessica L. Zemlak, Debra L. Oswald

College of Nursing Faculty Research and Publications

Background: Women are more likely than men to be diagnosed with depression and anxiety with rates increasing since the COVID-19 pandemic. This study sought to understand how women's intersecting identities, personal strengths, and COVID-19–related stressors were associated with their anxiety, depression, and post-traumatic stress disorder (PTSD) symptoms early in the pandemic.

Methods: During May–June 2020, American women (N = 398) recruited via MTurk completed an online questionnaire assessing mental health (PTSD, anxiety, and depression), demographic characteristics, personal strengths (coping, hope, social support), and experiences with COVID-19–specific stressors.

Results: Women who had a child younger than 18 years of age, …

Nurses' Experiences And Perspectives Of The Telehealth Working Environment And Educational Needs, Stacee M. Lerret, Susan A. Nuccio, Alyssa Compton, Maria Keegan, Kathryn Rapala

College of Nursing Faculty Research and Publications

Background:

The continuing evolution of health care and the nursing profession includes the exponential growth of telehealth platforms. The goal of this study was to describe nurses' experiences with and perspectives on their practice with and future need for telehealth.

Method:

A cross-sectional descriptive mixed methods study was conducted with nursing graduates from a single university. Completed survey questions focused on demographics, current work status, plans for employment participation, and telehealth experience. Descriptive analysis was conducted with statistical software, with directed content analysis for narrative responses.

Results:

A total of 305 of 5,080 participants completed the survey (6% response rate). …

Tlif Is Associated With Lower Rates Of Adjacent Segment Disease And Complications Compared To Alif: A Matched-Cohort Analysis, Xu Tao, Abhijith V. Matur, Syed Khalid, Louisa Onyewadume, Rebecca Garner, Kyle Mcgrath, Bryce Owen, Justin Gibson, Daryn Cass, Juan C. Mejia Munne, Phillip Vorster, Geet Shukla, Andrew Wu, Kelly Childress, Paolo Palmisciano, Henry Ofori Duah, Benjamin Motley, Joseph Cheng, Owoicho Adogwa

College of Nursing Faculty Research and Publications

Study Design. 

Retrospective cohort.

Objective. 

To compare the rate of adjacent segment disease (ASD) in patients undergoing anterior lumbar interbody fusion (ALIF) versus transforaminal lumbar interbody fusion (TLIF) for the treatment of degenerative stenosis and spondylolisthesis.

Summary of Background Data. 

ALIF and TLIF are frequently used to treat Lumbar stenosis and spondylolisthesis. While both approaches have distinct advantages, it is unclear whether there are any differences in rates of ASD and postoperative complications.

Methods. 

A retrospective cohort study of patients who underwent index 1-3 levels ALIF or TLIF between 2010 and 2022, using the PearlDiver Mariner Database, an all-claims insurance …

A Trauma-Informed Mentoring Framework For Forensic Nurses: An Overview Of Steerr—Structure, Process, And Evaluation, Sarah J. Hoffman, Tara Dillon, Kaylen M. Moore, Ellen A. Frerich, Carolyn M. Porta

College of Nursing Faculty Research and Publications

The STEERR Mentoring Framework, grounded in decolonized and feminist mentorship approaches, integrates foundational principles of mentoring with the unique and complex characteristics of the role of the forensic nurse. The primary objective of the program is to support a competent, sustainable, and resilient forensic nursing workforce. In this article, we describe the development process, framework structure, and evaluation approach implemented within a 1-year pilot initiative focused on forensic nurses in the sexual assault nurse examiner role. We reflect on strategies for broader application and replication in forensic nursing programs across the United States.

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. …

Early Evidence For Using A Train-The-Trainer Program To Teach Debriefing For Meaningful Learning, Aimee A. Woda, Cynthia Sherraden Bradley, Brandon Kyle Johnson, Jamie Hansen, Sylvia Peña, Nolan Cox, Kristina Dreifuerst

College of Nursing Faculty Research and Publications

Background Competent debriefers are essential to promote positive learner outcomes. While important, providing training to faculty may be difficult. The Train-The-Trainer (TTT) model is a successful approach for efficiently training large groups of individuals. Methods This study used a purposive, descriptive research design to test the feasibility and effectiveness of a TTT program for teaching debriefers how to implement and train others to use Debriefing for Meaningful Learning (DML). Results With training, assessment, and individualized feedback, trainers and trainees alike improved their ability to use DML, as well as self-assess their debriefing. Conclusion The TTT program was a successful, feasible, …

Application Of The Social Determinants Of Health To Geriatric Patients By Nurse Practitioner Students, Theresa Marie Gruenke Schnable

Dissertations (1934 -)

ABSTRACT APPLICATION OF THE SOCIAL DETERMINANTS OF HEALTH TO GERIATRIC PATIENTS BY NURSE PRACTITIONER STUDENTS Patient outcomes are influenced by the social determinants of health (SDOH), which influence differing exposures to opportunities or health risks. Holistic care of geriatric patients includes considering SDOH in patient assessment, diagnosis, and care delivery. Understanding how NP students care for geriatric patients using a SDOH lens provides insight into their practice behaviors and helps educators understand how to strengthen NP programs to achieve better patient outcomes and advance health equity for the geriatric population. The purpose of this study was to describe how NP …

A Scoping Review Of Diagnosis Of Autism Spectrum Disorder In Primary Care, Norah L. Johnson, Alissa V. Fial, Amy V. Van Hecke, Kim Whitmore, Katie Meyer, Sylvia Peña, Mary E. Carlson, Kathleen A. Koth

College of Education Faculty Research and Publications

Introduction

This scoping review was performed to collect, examine, and present literature on interventions promoting the diagnosis of Autism Spectrum Disorder (ASD) in U.S. primary health care settings.

Method

The literature searched was from 2011–2022, in the English language, in PubMed, CINAHL, Psych INFO, Cochrane, and Web of Science, for persons with autism or ASD aged ≤ 18 years.

Results

Six studies met the search criteria, including a quality improvement project, a feasibility study, a pilot study, and three primary care provider (PCP) intervention trials. Measured outcomes included: accuracy of diagnosis (n = 4), practice change maintenance (n …

Testing The Impact Of An Asynchronous Online Training Program With Repeated Feedback, Aimee A. Woda, Cynthia Sherraden Bradley, Brandon Kyle Johnson, Jamie Hansen, Ann Loomis, Sylvia Peña, Maharaj Singh, Kristina Dreifuerst

College of Nursing Faculty Research and Publications

Background:

Learning to effectively debrief with student learners can be a challenging task. Currently, there is little evidence to support the best way to train and evaluate a debriefer's competence with a particular debriefing method.

Purpose:

The purpose of this study was to develop and test an asynchronous online distributed modular training program with repeated doses of formative feedback to teach debriefers how to implement Debriefing for Meaningful Learning (DML).

Methods:

Following the completion of an asynchronous distributed modular training program, debriefers self-evaluated their debriefing and submitted a recorded debriefing for expert evaluation and feedback using the DML Evaluation Scale …

Home Health Nurses For Children With Invasive Mechanical Ventilation (Imv): Perspectives On Gaps And Opportunities For Recruitment, Sarah A. Sobotka, Emma Lynch, Sarah Laudon, Kim Whitmore

College of Nursing Faculty Research and Publications

Background

Children with medical complexity (CMC) dependent on invasive mechanical ventilation (IMV) often require private duty home nursing; however, there are ubiquitous shortages. Home health is an especially vulnerable nursing sector because of less competitive wages and less prominence during nursing education. We sought to understand nurses' perspectives on gaps and opportunities for recruiting home care nurses for children with IMV.

Methods

Home health nurses experienced with children with IMV were recruited for semi-structured interviews. The interview guide served as the initial codebook which was iteratively modified as themes emerged. This study presents an analysis of quotes related to field …

Effectiveness Of A Postpartum Breastfeeding Protocol For Avoiding Pregnancy Data, Mary Schneider, Richard Fehring, Thomas Paul Bouchard

Randomized Comparison of Two Internet-Supported Methods of Natural Family Planning

The uses of cervical mucus and basal body temperature as indicators of return to fertility postpartum have resulted in high unintended pregnancy rates. In 2013, a study found that when women used urine hormone signs in a postpartum/breastfeeding protocol this resulted in fewer pregnancies. To improve the original protocol's effectiveness, three revisions were made: (1) women were to increase the number of days tested with the Clearblue Fertility Monitor, (2) an optional second luteinizing hormone test could be done in the evening, and (3) instructions were given to manage the beginning of the fertile window for the first six cycles …

Preoperative Hba1c And Postoperative Outcomes In Spine Surgery: A Systematic Review And Meta-Analysis, Tao, Abhijith V. Matur, Paolo Palmisciano, Fatu S. Conteh, Louisa Onyewadume, Henry Ofori Duah, Geet Shukla, Phillip Vorster, Sahil Gupta, Sai S. Chilakapati, Owoicho Adogwa

College of Nursing Faculty Research and Publications

Study Design. 

Systematic review and meta-analysis.

Objective. 

To perform a systematic review and meta-analysis of previous studies on HbA1c in preoperative risk stratification in patients undergoing spinal procedures and provide an overview of the consensus recommendations.

Summary of Background Data. 

Diabetes mellitus (DM) and hyperglycemia have been shown to be independent risk factors for increased surgical complications. Glycated Hemoglobin A1C (HbA1c), a surrogate for long term glycemic control, is an important preoperative parameter that may be optimized to reduce surgical complications and improve patient-reported outcomes. However, comprehensive systematic reviews on preoperative HbA1c and postoperative outcomes in spine surgery have been …

"Evidence That The Woman's Ovarian Cycle Is Driven By An Internal Circamonthly Timing System" Data, Mary Schneider

Randomized Comparison of Two Internet-Supported Methods of Natural Family Planning

No abstract provided.

Palliative Care Interventions Among Adolescents And Young Adults With Serious Illness: A Scoping Review, Amy R. Newman, Ansley E. Kenney, Elizabeth Witkowski, Jeffrey Karst, Stacee Lerret, W. Hobart Davies, Charles B. Rothschild

College of Nursing Faculty Research and Publications

Objective:

To map the range of multidisciplinary palliative care interventions that are available to adolescents and young adults (AYAs) with serious illness.

Methods:

Scoping review methodology as outlined by Arksey and O’Malley.

Results:

Twenty-two articles describing nine specific AYA-focused, multidisciplinary palliative care interventions were included in this review. Interventions focused on supporting advance care planning, facilitating treatment decision making, managing pain, and promoting resilience, psychosocial well-being, and quality of life. Interventions were delivered face-to-face and via different eHealth platforms and were targeted to AYAs with cancer, HIV/AIDS, and cystic fibrosis in both inpatient and outpatient settings.

Conclusions:

Few evidence-based multidisciplinary …

Identification Of Child Survivors Of Sex Trafficking From Electronic Health Records: An Artificial Intelligence Guided Approach, Aaron Murnan, Jennifer J. Tscholl, Rajesh Ganta, Henry Ofori Duah, Islam Qasem, Emre Sezgin

College of Nursing Faculty Research and Publications

Survivors of child sex trafficking (SCST) experience high rates of adverse health outcomes. Amidst the duration of their victimization, survivors regularly seek healthcare yet fail to be identified. This study sought to utilize artificial intelligence (AI) to identify SCST and describe the elements of their healthcare presentation. An AI-supported keyword search was conducted to identify SCST within the electronic medical records (EMR) of ∼1.5 million patients at a large midwestern pediatric hospital. Descriptive analyses were used to evaluate associated diagnoses and clinical presentation. A sex trafficking-related keyword was identified in .18% of patient charts. Among this cohort, the most common …

Implementing An Integrated Psychology, Social Services, And Pediatric Diabetes Clinic, Joan P. Totka, Jacquelyn Smith, Sandra Brown, Maharaj Singh, Elaine Parton, Dawn Cvecko, Heather Fortin, Peter M. Wolfgram

College of Nursing Faculty Research and Publications

Objective:

Integrated behavioral health services are rarely implemented as a shared space practice in pediatric diabetes specialty clinics. This paper outlines the clinical outcomes, lessons learned, facilitators, and barriers for supporting youth with diabetes and behavioral health issues whose hemoglobin A1c (A1c) was higher than the target range and their families.

Methods:

Using the Iowa Model of implementation, we redesigned the “Regular Engagement And Connection for Health” (REACH) program to integrate health psychology and social services in a shared space clinic for monthly or bimonthly diabetes visits (REACH+). This clinic focused on partnering with families, screening for behavioral and social …

Experiences Of Dehumanizing: Examining Secondary Victimization Within The Nurse-Patient Relationship Among African American Women Survivors Of Sexual Assault In The Upper Midwest, Ashley Ruiz, Kaylen M. Moore, Lynne M. Woehrle, Peninnah M. Kako, Kelly C. Davis, Lucy Mkandawire-Valhmu

College of Nursing Faculty Research and Publications

Despite calls recognizing the need for culturally sensitive responses to minimize the occurrence of secondary victimization for African American women following an experience of sexual assault, few studies have focused on hearing from African American women survivors about their experiences receiving healthcare services in a hospital setting following sexual assault. Employing critical ethnography as our methodology and using intersectionality theory as a lens, we centered the voices of African American women survivors about their experiences receiving nursing care in urban acute care or hospital settings in the Upper Midwest of the United States following sexual assault. In this qualitative study, …

The Impact Of The Covid-19 Pandemic On Help-Seeking Behaviours Of Indigenous And Black Women Experiencing Intimate Partner Violence In The United States, Ashley Ruiz, Jeneile Luebke, Kaylen M. Moore, Antonia Drew Vann, Michael Gonzalez Jr., Brittany Ochoa-Nordstrum, Rachel Barbon, Kaboni W. Gondwe, Lucy Mkandawire-Valhmu

College of Nursing Faculty Research and Publications

Aims

This article discusses possible barriers to help-seeking that Indigenous and Black women encountered when seeking help related to experiences of intimate partner violence during the COVID-19 pandemic.

Design

This article is focused on understanding the impact of the COVID-19 pandemic on populations at highest risk for intimate partner violence in its most severe forms.

Data Sources

Literature sources range from 2010 to 2022. The article is also informed by the experiences of scholars and advocates working with Indigenous and Black women experiencing intimate partner violence in Wisconsin. In our write-up, we draw on Indigenous feminism and Black feminist thought. …

The InterFace Of Social Media Recruitment And Nursing Education Research, Angela M. Mcnelis, Kristina Dreifuerst, Sarah L. Beebe

College of Nursing Faculty Research and Publications

This study describes using social media in recruiting a large and hard-to-reach national sample of family nurse practitioner students in the United States enrolled in their final clinical course and the impact on survey response targets. Social media recruitment was initiated when sample targets were not met using traditional, direct email invitations. A cross-sectional, observational, complex-samples survey design was used to collect data from students enrolled in accredited programs. When inviting participants via emails to schools of nursing and program administrators was only moderately successful, direct recruitment via social media sites was used. Targeted study advertisements were shown 602 389 …

Reducing Nonemergent Visits To The Emergency Department In A Veterans Affairs Multistate System, Bonnie Sommers-Olson, Jacqueline Christianson, Tonya Neumann, Scott A. Pawlikowski, Storm L. Morgan, Maria C. Bouchard, Kristi S. Esch, Laura K. Andrews

College of Nursing Faculty Research and Publications

Study Objective

The purpose of this quality improvement study was to reduce nonemergent visits to the emergency department attendance within a multistate Veterans Health Affairs network.

Methods

Telephone triage protocols were developed and implemented for registered nurse staff to triage selected calls to a same-day telephonic or video virtual visit with a provider (physician or nurse practitioner). Calls, registered nurse triage dispositions, and provider visit dispositions were tracked for 3 months.

Results

There were 1606 calls referred by registered nurses for provider visits. Of these, 192 were initially triaged as emergency department dispositions. Of these, 57.3% of calls that would …

Do Obese Patients Lose Weight After Lumbar Spine Surgery: A Systematic Review And Meta-Analysis, Phillip Vorster, Abhijith V. Matur, Paolo Palmisciano, Fatu S. Conteh, Louisa Onyewadume, Henry Ofori Duah, Geet Shukla, Sai S. Chilakapati, Xu Tao, Sahil Gupta, Sanjit Shah, Benjamin Motley, Joseph Cheng, Justin Virojanapa, Owoicho Adogwa

College of Nursing Faculty Research and Publications

Objective

Obesity is a major health care concern in the United States and is associated with high rates of postoperative complications after spine surgery. Obese patients assert that weight reduction is not possible unless spine surgery first relieves their pain and concomitant immobility. We describe the post-spine surgery effects on patient weight, with an emphasis on obesity.

Methods

PubMed, EMBASE, Scopus, Web of Science, and Cochrane databases were systematically searched according to the PRISMA guidelines. The search included indexed terms and text words from database inception to the date of the search (15 April 2022). Studies chosen for inclusion had …

Bariatric Surgery Before Spine Surgery Is Associated With Fewer Postsurgical Complications: A Systematic Review And Meta-Analysis, Sahil Gupta, Xu Tao, Abhijith V. Matur, Andrew Wu, Sai S. Chilakapati, Paolo Palmisciano, Fatu Conteh, Henry Ofori Duah, Geet Shukla, Phillip Vorster, Julia Garcia-Vargas, David Kwan, Owoicho Adogwa

College of Nursing Faculty Research and Publications

Study Design.  Systematic review and meta-analysis. Objective.  To perform a systematic review and meta-analysis investigating the rate of adverse events after spine surgery in patients who underwent bariatric surgery (BS). Summary of Background Data.  Obesity is an established risk factor for postoperative complications after spine surgery. BS has been associated with improvements in health in patients with severe obesity. However, it is not known whether undergoing BS before spine surgery is associated with reduced adverse outcomes. Materials and Methods.  PubMed, EMBASE, Scopus, and Web-of-Science were systematically searched according to “Preferred Reporting Items for Systematic Reviews and Meta-Analyses” guidelines. The search …

Analysis Of Couples’ Discordance On Fertility Desire In Ghana, Isaac Yeboah, Joshua Okyere, Henry Ofori Duah, Andrew Kweku Conduah, Mary Naana Essiaw

College of Nursing Faculty Research and Publications

Generally, men in sub-Saharan Africa make reproductive decisions that affect their partners. We examined the predictors of fertility desires among married men across three age cohorts: 20–35 years, 36–50 year, and 51–59 years. Using the 2014 Ghana Demographic and Health Survey dataset, we conducted ANOVA and multivariate binary logistic regressions on 1431 monogamous married men aged 20–59 years. Two indicators of fertility desire are constructed: (i) the comparison of men’s ideal versus women’s ideal family size, and (ii) the desire for more children. The results indicate that the fertility desire of men is stronger than that of women. The predictors …

Dnp-Phd Collaboration In Ninr-Funded Physical Activity Trials: A Series Of Case Studies, Shannon Halloway, Susan Weber Buchholz, Joellen Wilbur, Janice A. Odiaga, Margaret Perlia Bavis, Sally Lemke, Heide R. Cygan, Melissa Kalensky, Phyllis Powell Pelt, Lynne T. Braun, Susan Tafini, Anita Opdycke, Krista A. Knudson, Manju Daniel, Joellen Wilbur

College of Nursing Faculty Research and Publications

Collaboration between Doctor of Nursing Practice (DNP) scholars and Doctor of Philosophy (PhD) scholars is crucial to efficiently advance and disseminate nursing science. Also, DNP-PhD collaboration can help achieve priorities outlined in the recent National Institute of Nursing Research (NINR) Strategic Plan. The purpose of this series of case studies is to describe exemplars of ongoing DNP-PhD collaborations across three NINR-funded trials (1 completed, 2 ongoing) testing physical activity interventions for women at risk for cardiovascular disease. In our three physical activity intervention trials for women, we categorized examples of DNP-PhD collaboration by the four phases of the team-based research …