What comparisons can be found between the GCU Mission and Domains/CON Mission and Program Competencies (for your selected specialty track, links located in the Course Materials) with the AACN’s Essentials for Master’s Education for Advanced Practice Nursing (link located in the Week 1 Topic Materials)?

NUR-502|Theoretical Foundations for Nursing Ro…

MODULE 1

A

What comparisons can be found between the GCU Mission and Domains/CON Mission and Program Competencies (for your selected specialty track, links located in the Course Materials) with the AACN’s Essentials for Master’s Education for Advanced Practice Nursing (link located in the Week 1 Topic Materials)? Explain your rational.

https://www.gcu.edu/about-gcu/university-snapshot.php

https://www.gcu.edu/college-of-nursing-and-health-care-professions.php

According to this week’s lecture note, The Evolution of the Nursing Profession and Discipline , Baker stated that nursing is not a profession in progress.  The article then states that after licensure that nursing enter into a profession.  What are your thoughts on these statements in relation to your specialty track of study?  Do you consider nursing as an established profession or a profession in progress with consideration of all aspects of the article?

B

Name one recommendation from the IOM Future of Nursing Report. What is its importance relative to Advanced Practice Nursing? Support your answer.

Resources

Textbook

1. Advanced practice nursing: Essential Knowledge for the Profession

Read Chapters 1-3 and 18.

2. Theoretical Basis for Nursing

Read Chapter 1.

Electronic Resource

1. The APRN Consensus Model

Read “APRN Consensus Model,” located on the NCSBN website.

https://www.ncsbn.org/Consensus_Model_for_APRN_Regulation_July_2008.pdf

2. The Essentials of Baccalaureate Education for Professional Nursing Practice

Study “The Essentials of Baccalaureate Education for Professional Nursing Practice,” located on the American Association of Colleges of Nursing website.

http://www.aacnnursing.org/Portals/42/Publications/BaccEssentials08.pdf

3. The Essentials of Master’s Education for Advanced Practice Nursing

Study “The Essentials of Master’s Education for Advanced Practice Nursing,” located on the American Association of Colleges of Nursing website.

http://www.aacnnursing.org/Portals/42/Publications/MastersEssentials11.pdf

4. The Future of Nursing: Leading Change, Advancing Health

Read “The Future of Nursing: Leading Change, Advocating Health,” located on the National Academies of Sciences, Engineering, and Medicine website.

 

Read the IOM report “The future of nursing: Leading change, advocating health,” located on the Institute of Medicine’s website.

http://www.nationalacademies.org/hmd/Reports/2010/The-Future-of-Nursing-Leading-Change-Advancing-Health.aspx

Website

1. American Academy of Nurse Practitioners

Explore the American Academy of Nurse Practitioners website.

http://www.aanp.org

2. American Nurses Association

Explore the American Nurses Association website.

http://nursingworld.org

3. American Organization of Nurse Executives

Explore the American Organization of Nurse Executives website.

http://www.aone.org

4. National Association of Clinical Nurse Specialists

Explore the National Association of Clinical Nurse Specialists website.

http://www.nacns.org

5. National Council of State Boards of Nursing

Explore the National Council of State Boards of Nursing website.

http://www.ncsbn.org

6. National League for Nursing

Explore the National League for Nursing website.

http://www.nln.org

7. National Nursing Staff Development Organization

Explore the National Nursing Staff Development Organization website.

http://www.nnsdo.org

Other

1. Master’s Prepared Nurse Interview Guide

Review “Master’s Prepared Nurse Interview Guide.”

NUR502.v10R.MastersPreparedNurseInterviewGuide_student.docx

MODULE 2: Professional Communication and Practice

A

Discuss several aspects of professional communication as it relates to the use of language in terms of form (e.g., clarity, accuracy) and content (culture and/or ethics). Cite the references you used to compose your response (from required readings).

B

Name one recommendation from the IOM Future of Nursing Report. What is its importance relative to Advanced Practice Nursing? Support your answer..

Resources

extbook

1. Advanced practice nursing: Essential Knowledge for the Profession

Read Chapters 23-27.

2. Publication Manual of the American Psychological Association

Read Chapters 2 and 3.

Electronic Resource

1. A Nurse’s Guide to the Use of Social Media

Read “A Nurse’s Guide to the Use of Social Media,” located on the NCSBN website.

https://www.ncsbn.org/NCSBN_SocialMedia.pdf

2. Code of Ethics for Nurses with Interpretive Statements

Read “Code of Ethics for Nurses With Interpretive Statements,” located on the American Nurses Association website.

http://www.nursingworld.org/MainMenuCategories/EthicsStandards/CodeofEthicsforNurses/Code-of-Ethics-For-Nurses.html

3. Purnell Model for Cultural Competence

Read “Purnell Model for Cultural Competence,” by Purnell, from the Journal of Multicultural Nursing and Health (2005).

https://lopes.idm.oclc.org/login?url=http://search.proquest.com.lopes.idm.oclc.org/docview/220301419?accountid=7374

4. Status of Cultural Competence in Nursing Education: A Literature Review

Read “Status of Cultural Competence in Nursing Education: A Literature Review,” by Grant and Letzring, from the Journal of Multicultural Nursing & Health (2003).

https://lopes.idm.oclc.org/login?url=http://search.proquest.com.lopes.idm.oclc.org/docview/220302543?accountid=7374

e-Library Resource

1. Culture Care Theory: A Proposed Practice Theory Guide for Nurse Practitioners in Primary Care Settings

Read “Culture Care Theory: A Proposed Practice Theory Guide for Nurse Practitioners in Primary Care Settings,” by McFarland and Eipperle, from Contemporary Nurse (2008).

https://lopes.idm.oclc.org/login?url=http://search.proquest.com.lopes.idm.oclc.org/docview/203172654?accountid=7374

2. Defining End of Life Care from Perspectives of Nursing Ethics

Read “Defining End of Life Care from Perspectives of Nursing Ethics,” by Izumi, Nagae, Sakurai, and Imamura, from Nurse Ethics (2012).

https://lopes.idm.oclc.org/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=a9h&AN=82506601&site=ehost-live&scope=site

3. Developing Ethical Skills: From Sensitivity to Action

Read “Developing Ethical Skills: From Sensitivity to Action,” by Robichaux, from Critical Care Nurse (2012).

https://lopes.idm.oclc.org/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=a9h&AN=74306541&site=ehost-live&scope=site

4. Interventions to Improve Cultural Competency in Healthcare: A Systematic Review of Reviews

Read “Interventions to Improve Cultural Competency in Healthcare: A Systematic Review of Reviews,” byTruong, Paradies and Priest, from BCM Health Services Research (2014).

https://bmchealthservres.biomedcentral.com/articles/10.1186/1472-6963-14-99

5. Moral Courage and the Nurse Leader

Read “Moral Courage and the Nurse Leader,” by Edmonson, from OJIN: The Online Journal of Issues in Nursing (2010).

https://lopes.idm.oclc.org/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=a9h&AN=56593216&site=ehost-live&scope=site

Website

1. ANA’s Social Networking Principles Toolkit

Explore the Social Networking Principles Toolkit page of the ANA website.

http://www.nursingworld.org/socialnetworkingtoolkit.aspx

2. Cultural Profiles of Countries

Explore the “The World Factbook” website.

https://www.cia.gov/library/publications/the-world-factbook/

3. Diversity Rx

Explore the Diversity Rx website.

http://www.DiversityRx.org

4. MinorityNurse.com: The Career and Education Resource for Minority Nursing Professionals, Students, and Faculty

Explore the MinorityNurse.com: The Career and Education Resource for Minority Nursing Professionals, Students, and Faculty website.

http://www.minoritynurse.com

MODULE 3

A

Discuss the value of nursing theory to the profession of nursing. Identify one way in which you could use nursing theory to improve your practice (present or future role). Provide a reference for your response.

B

Read the AACN documents for essentials of baccalaureate versus master’s education and identify the competencies that reflect use of theory and knowledge. Compare and contrast the competencies for baccalaureate and master’s level.

Resources

Textbook

1. Advanced practice nursing: Essential Knowledge for the Profession

Read Chapters 18-22.

2. Theoretical Basis for Nursing

Read Chapters 1, 2, and 12.

Electronic Resource

1. Initial Course Survey

In an effort for continuous improvement, Grand Canyon University would like you to take this opportunity to provide feedback about your experience  with the university. Your participation is appreciated. Click on the link to begin the survey.

http://survey.gcu.edu/initial_course_survey/initial_course_survey.htm?q0.a=20358461​

2. Notes on Nursing: What It Is, and What It Is Not

Read “Notes on Nursing: What It Is, and What It Is Not,” located on the Penn Libraries website.

http://digital.library.upenn.edu/women/nightingale/nursing/nursing.html

e-Library Resource

1. Beyond Rhetoric to Role Accountability: A Practical and Professional Model of Practice

Read “Beyond Rhetoric to Role Accountability: A Practical and Professional Model of Practice,” by O’Rourke, from Nurse Leader (2006).

https://lopes.idm.oclc.org/login?url=http://dx.doi.org.lopes.idm.oclc.org/10.1016/j.mnl.2006.04.011

2. Career Pathways in Nursing: Entry Points and Academic Progression

Read “Career Pathways in Nursing: Entry Points and Academic Progression,” by Raines and Taglaireni, from OJIN: The Online Journal of Issues in Nursing (2008).

https://lopes.idm.oclc.org/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=a9h&AN=37604851&site=ehost-live&scope=site

3. Development of a Professional Nursing Framework: The Journey Towards Nursing Excellence

Read “Development of a Professional Nursing Framework: The Journey Towards Nursing Excellence,” by Mensik, Maust, Scott, and Horton, from the Journal of Nursing Administration (2011).

https://lopes.idm.oclc.org/login?url=http://gateway.ovid.com.lopes.idm.oclc.org/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&AN=00005110-201106000-00007&D=ovft&PDF=y

Website

1. Academic Center for Evidence-Based Practice (ACE)

Explore the Academic Center for Evidence-Based Practice (ACE) website.

http://www.acestar.uthscsa.edu

2. Nursing Theory

Explore the Nursing Theory Link website, including the “Nursing Theories and Models” and “Nursing Theorists” tabs.

http://www.nursing-theory.org/

3. The Nursing Theory

Explore The Nursing Theory website.

http://www.sandiego.edu/nursing/research/nursing-theory-research.php

MODULE 4

A

Explain, in your own words, the difference between the three paradigms: human needs, interactive, and unitary process. Which of these best fits your philosophy of nursing?

B

Select one of the grand or middle-range nursing theories. How does the theory demonstrate evidence of the utilization of social, behavioral, or bioscience theories?

Resources

Textbook

1. Theoretical Basis for Nursing

Review Chapters 2 and 3-5.

e-Library Resource

1. A Cross-Cultural Comparison of a Clinical Nurse Competency Path Model

Read “A Cross-Cultural Comparison of a Clinical Nurse Competency Path Model,” by Sportsman, Hamilton, and Schumacker, from International Journal of Nursing Education (2014).

https://lopes.idm.oclc.org/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=103820896&site=ehost-live&scope=site

2. Complex Adaptive Systems: Concept Analysis

Read “Complex Adaptive Systems: Concept Analysis,” by Holden, from the Journal of Advanced Nursing (2005).

https://pdfs.semanticscholar.org/2a8d/746a53c232bbb490ad5e9679f7092214a913.pdf

3. Concept Analysis of Professional Socialization in Nursing

Read “Concept Analysis of Professional Socialization in Nursing” from Nursing Forum (2013).

https://lopes.idm.oclc.org/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=2011915624&site=ehost-live&scope=site

4. Developing and Testing a Middle-Range Theory of the Well-Being Supportive Physical Environment of Home-Dwelling Elderly

Read “Developing and Testing a Middle-Range Theory of the Well-Being Supportive Physical Environment of Home-Dwelling Elderly,” by Satu, Maria, Arja, and Helvi, from the The Scieintific World Journal (2013).

https://www.ncbi.nlm.nih.gov/pubmed/23766727

5. Enhancing Methodological Clarity: Principle-based Concept Analysis

Read “Enhancing Methodological Clarity: Principle-based Concept Analysis,” by Penrod and Hupcey, from the Journal of Advanced Nursing (2005).

https://lopes.idm.oclc.org/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=a9h&AN=16719550&site=ehost-live&scope=site

6. From Practice to Midrange Theory and Back Again: Beck’s Theory of Postpartum Depression

Read “From Practice to Midrange Theory and Back Again: Beck’s Theory of Postpartum Depression,” by Lasiuk and Ferguson, from Advances in Nursing Science (2005).

https://lopes.idm.oclc.org/login?url=http://gateway.ovid.com/ovidweb.cgi?T=JS&NEWS=N&PAGE=fulltext&AN=00012272-200504000-00005&LSLINK=80&D=ovft

7. Fundamental Patterns of Knowing in Nursing

Read “Fundamental Patterns of Knowing in Nursing,” by Barbara Carper, from Advances in Nursing Science (1978).

https://lopes.idm.oclc.org/login?url=http://gateway.ovid.com.lopes.idm.oclc.org/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&AN=00012272-201001000-00003&D=ovft&PDF=y

8. Patterns of Knowing: Review, Critique, and Update

Read “Patterns of Knowing: Review, Critique, and Update,” by White, from Advances in Nursing Science (1995).

https://lopes.idm.oclc.org/login?url=http://gateway.ovid.com.lopes.idm.oclc.org/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&AN=00012272-199506000-00007&LSLINK=80&D=ovft

9. The Living Tree of Nursing Theories

Read “The Living Tree of Nursing Theories,” by Tourville and Ingalls, from Nursing Forum (2003).

https://lopes.idm.oclc.org/login?url=https://search-proquest-com.lopes.idm.oclc.org/docview/195013387?accountid=7374

MODULE 5

A

All nursing theories are developed in space and time, and are not value free. Select one nursing theorist and explain the factors that influenced development of the theory (history, scientific paradigm, and personal experiences–mentoring, education, practice, other). Provide reference(s) for your response.

B

Select three theories and compare the definition of person/human being. Comment regarding which definition best fits with your own thinking.

Resources

Textbook

1. Theoretical Basis for Nursing

Read Chapters 6-9 and 17-18.

Electronic Resource

1. A Multidimensional Analysis of the Epistemic Origins of Nursing Theories, Models, and Frameworks

Read “A Multidimensional Analysis of the Epistemic Origins of Nursing Theories, Models, and Frameworks,” by Beckstead and Beckstead, from the International Journal of Nursing Studies (2006).

https://lopes.idm.oclc.org/login?url=http://dx.doi.org.lopes.idm.oclc.org/10.1016/j.ijnurstu.2004.09.021

e-Library Resource

1. Evolution of the Science of Unitary Human Beings: The Conceptual System, Theory Development, and Research and Practice Methodologies

Read “Evolution of the Science of Unitary Human Beings: The Conceptual System, Theory Development, and Research and Practice Methodologies,” by Fawcett, from the Visions: THe Journal of Rogerian Nursing Science (2015).

https://lopes.idm.oclc.org/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=111299017&site=ehost-live&scope=site

2. The Evaluation of Nursing Theory: A Method for Our Madness

Read “The Evaluation of Nursing Theory: A Method for Our Madness,” by Dudley-Brown, from the International Journal of Nursing Studies (1997).

https://lopes.idm.oclc.org/login?url=http://dx.doi.org/10.1016/S0020-7489(96)00024-7

3. Toward a North-South Dialogue: Revisiting Nursing Theory (From the South)

Read “Toward a North-South Dialogue: Revisiting Nursing Theory (From the South),” by Salas, from Advances in Nursing Science (2005).

https://lopes.idm.oclc.org/login?url=http://gateway.ovid.com/ovidweb.cgi?T=JS&NEWS=N&PAGE=fulltext&AN=00012272-200501000-00003&LSLINK=80&D=ovft

MODULE 6

A

Choose one of the middle-range theories. How could you use this theory to direct care in a nursing unit if you were the manager? Share your results.

B

Choose one of the middle-range theories. What impact would this theory most likely have on your individual practice? Give specific examples.

Resources

Textbook

1. Theoretical Basis for Nursing

Read Chapters 10 and 11.

e-Library Resource

1. Comparison Between Two Nursing Theories: Rogers and Leddy

Read “Comparison Between Two Nursing Theories: Rogers and Leddy,” by Rahim, from Journal on Nursing (2016).

https://lopes.idm.oclc.org/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=116359098&site=ehost-live&scope=site

2. Experiencing Transitions: An Emerging Middle-Range Theory

Read “Experiencing Transitions: An Emerging Middle-Range Theory,” by Meleis, Sawyer, Im, Hilfinger Messias, and Schumacher, from Advances in Nursing Science (2000).

https://lopes.idm.oclc.org/login?url=http://gateway.ovid.com/ovidweb.cgi?T=JS&NEWS=N&PAGE=fulltext&AN=00012272-200009000-00006&LSLINK=80&D=ovft

3. Integrating the Synergy Model for Patient Care at Children’s Hospital of Wisconsin

Read “Integrating the Synergy Model for Patient Care at Children’s Hospital of Wisconsin,” by Gralton and Brett, from the Journal of Pediatric Nursing (2012).

https://www-sciencedirect-com.lopes.idm.oclc.org/science/article/pii/S0882596311004854

4. The Relationship of Nursing Students’ Spiritual Care Perspectives to Their Expressions of Spiritual Empathy

Read “The Relationship of Nursing Students’ Spiritual Care Perspectives to Their Expressions of Spiritual Empathy,” by Chism, from the Journal of Nursing Education (2009).

https://lopes.idm.oclc.org/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=2010466955&site=ehost-live&scope=site

5. Using Symptom Management Theory to Explain How Nurse Practitioners Care for Children with Asthma

Read “Using Symptom Management Theory to Explain how Nurse Practitioners Care for Children with Asthma,” by Newcomb, from the Journal of Theory Construction & Testing (2010).

https://lopes.idm.oclc.org/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=2011017880&site=ehost-live&scope=site

MODULE 7

A

The influence of consequential ethics as an ethical framework (the greatest good for the greatest number) opposes the ethical principle of deontology (i.e., the rightness of an act itself determines what is right). Both of these impact the nursing profession. Modern social exchange theories are based on the principle of utility. Read the assumptions of social exchange theory and consider how these would affect the nurse-patient relationship, compared to how these impact the nurse within the health care environment. To what extent are all theories ethical? Is social exchange theory compatible with the values of the nursing profession?

B

Which among the learning theories provided you with new information? How would you apply this in your practice?

Resources

Textbook

1. Theoretical Basis for Nursing

Read Chapters 12 – 20.

Electronic Resource

1. A Syndrome Produced by Diverse Nocuous Agents

Read “A Syndrome Produced by Diverse Nocuous Agents,” by Selye, from Nature (1936), located on the Psychiatry Online website.

http://neuro.psychiatryonline.org/doi/full/10.1176/jnp.10.2.230a

2. Kurt Lewin: Groups, Experiential Learning and Action Research

Study the Kurt Lewin: Groups, Experiential Learning and Action Research page of the Infed website.

http://www.infed.org/thinkers/et-lewin.htm

3. Learning Theories

Explore the Learning Theories page on the Instructional Design website.

Learning Theories

4. Motivation to Learn: An Overview

Read “Motivation to Learn: An Overview,” located on the Educational Psychology Interactive website.

http://www.edpsycinteractive.org/topics/motivation/motivate.html

5. TQM/CQI Quality Links

Explore the TQM/CQI Quality Links website.

http://www.mytapestry.com/qlinks.html

6. Theories of Pain: From Specificity to Gate Control

Read “Theories of Pain: From Specificity to Gate Control,” by Moayedi from the Journal of Neurophysiology (2013).

http://jn.physiology.org/content/jn/109/1/5.full.pdf

7. What Is Systems Theory?

Read “What Is Systems Theory?” by Heylighen and Joslyn, located on the Principia Cybernetica website.

http://pespmc1.vub.ac.be/SYSTHEOR.html

e-Library Resource

1. Covering Content and Teaching Thinking: Deconstructing the Additive Curriculum

Read “‘Covering Content and Teaching Thinking: Deconstructing the Additive Curriculum,” by Ironside, from the Journal of Nursing Education (2004).

https://lopes.idm.oclc.org/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=2004037207&site=ehost-live&scope=site

2. Evolution of Leadership in Nursing

Read “Evolution of Leadership in Nursing,” by Moiden, from Nursing Management (2002).

https://lopes.idm.oclc.org/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=a9h&AN=7717041&site=ehost-live&scope=site

3. Linking Nursing Theory and Practice: A Critical-Feminist Approach

Read “Linking Nursing Theory and Practice: A Critical-Feminist Approach,” by Georges, from Advances in Nursing Science (2005).

https://lopes.idm.oclc.org/login?url=http://gateway.ovid.com/ovidweb.cgi?T=JS&NEWS=N&PAGE=fulltext&AN=00012272-200501000-00006&LSLINK=80&D=ovft

4. Matching Theory to Practice

Read “Matching Theory to Practice,” by Welford, from Nursing Management (2002).

https://lopes.idm.oclc.org/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=a9h&AN=6921576&site=ehost-live&scope=site

5. The Nursing Contribution to Ethical Decision Making

Read “The Nursing Contribution to Ethical Decision Making” by Dinten-Schmid, Stoffel, Staudacher, McDougall, Baumann-Hölzle, and Spirig, from International Practice Development Journal (2016).

https://lopes.idm.oclc.org/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=119684257&site=ehost-live&scope=site

Website

1. Chaos at UMD

Explore the Chaos at UMD (University of Maryland) website.

http://www.chaos.umd.edu

2. Feminist Theory: Center for Digital Discourse and Culture

Explore the Feminist Theory page on the Center for Digital Discourse and Culture website.

http://www.cddc.vt.edu/feminism/index.html

3. Learning-Theories.com

Explore the Learning-Theories.com website.

Summaries of Learning Theories and Models

4. Six Sigma — What is Six Sigma?

Explore the Six Sigma — What is Six Sigma? website.

http://www.isixsigma.com/sixsigma/six_sigma.asp

5. Society for Chaos Theory in Psychology & Life Sciences

Explore the Society for Chaos Theory in Psychology & Life Sciences website.

http://www.societyforchaostheory.org/

MODULE 8

Comment on the usefulness of Benner’s work in your present or future role. Provide several examples.

Resources

Textbook

1. Advanced practice nursing: Essential Knowledge for the Profession

Read Chapters 28 and 29.

2. Theoretical Basis for Nursing

Read Chapters 21 and 22.

Electronic Resource

1. Economism, Efficiency, and the Moral Ecology of Good Nursing Practice

Read “Economism, Efficiency, and the Moral Ecology of Good Nursing Practice,” by Weiss, Malone, Merighi, and Benner, from the Canadian Journal of Nursing Research (2002), located on the McGill website.

http://digital.library.mcgill.ca/cjnr/pdfs/CJNR_Vol_34_Issue_02_Art_08.pdf

e-Library Resource

1. Individual, Practice, and System Causes of Errors in Nursing: A Taxonomy

Read “Individual, Practice, and System Causes of Errors in Nursing: A Taxonomy,” by Benner, Sheets, Uris, Malloch, Schwed, and Jamison, from JONA: The Journal of Nursing Administration (2002).

https://lopes.idm.oclc.org/login?url=http://gateway.ovid.com/ovidweb.cgi?T=JS&NEWS=N&PAGE=fulltext&AN=00005110-200210000-00006&LSLINK=80&D=ovft

“Get 15% discount on your first 3 orders with us”
Use the following coupon
FIRST15

Order Now