NURSING 402X Advanced Nursing Focus. UPEI School of Nursing

Transcription

1 NURSING 402X 2016 Advanced Nursing Focus UPEI School of Nursing

2 2 NURSING 402X 2016 Contents Course Description... 3 Context... 4 Year Four Expectations... 5 Course Objectives... 6 Schedule... 7 Learning Activities... 8 Classroom Content Evaluation Methods Assignments Personal Learning Plan & Letter to Preceptor Clinical Logs HESI Case Study Preceptor Self Study HESI Exit Exam (Version 2) Materials Related to Preceptored Experience Arrangements for Clinical Practice: Roles of Preceptors and Faculty advisors: Preceptorship Information APPENDIX A: Policies Regarding Student Experiences in Clinical Settings... 17

3 3 NURSING 402X 2016 Course Description This course provides a final opportunity for students to synthesize their knowledge, skills, and professional values in a selected nursing practice setting. Emphasis is on the complexity of comprehensive nursing care and the significance of health promotion measures. Placement is dependent on the availability of appropriate clinical experience. Students work with selected clients (individuals, families, and/or aggregates) to enhance their current level of health and maximize their active participation within various facets of health care. PREREQUISITE: Nursing 401 or for Accelerated Program: Nursing 310 and admission to the Accelerated Program Semester hours of credit: 6 Four Year Program: Lecture/Seminar: 2 hours/wk. Other: Clinical Practice: 320 hours in total Accelerated Program: Lecture/Seminar: 2 hours/wk. Other: Clinical Practice: 320 hours in total. Faculty Course Coordinator: Patrice Drake RN, MN Work: Home: mpdrake@upei.ca FAX: Faculty Advisors: Jillian Mosher BN, RN Work: jmosher@upei.ca Angela Hunter RN, MN Work: ahunter@upei.ca

4 4 NURSING 402X 2016 Context Curriculum Design: The nursing curriculum at UPEI is focussed on wellness promotion and illness prevention based on the concept of primary health care. Students are learning to base their care on the philosophy and principles of primary health care. The graduate of this program will: Characteristics of the Graduate of the UPEI School of Nursing 1. Practice within a primary health care framework; 2. Provide promotive, preventive, supportive, curative and rehabilitative services in partnerships with individuals, families, groups and/or communities to assist them to reach their optimal level of health; 3. Use critical thinking skills; 4. Apply knowledge from nursing and other disciplines; 5. Communicate effectively; 6. Practice competently to provide holistic and culturally appropriate care to clients; 7. Value persons as individuals; 8. Practice with clients in order to promote the development of healthy individuals, families, and communities; 9. Use research evidence to enhance nursing practice; 10. Demonstrate leadership skills; 11. Take responsibility for life-long learning; 12. Use nursing theory to guide practice; 13. Practice in accordance with the nursing code of ethics.

5 5 NURSING 402X 2016 Year Four Expectations By the end of Year Four the student is expected to: 1. Use interdisciplinary and intersectoral collaboration to promote Primary Health Care using a population health approach. 2. Critically evaluate research studies, use research as evidence to guide practice, and incorporate research findings into scholarly work. 3. Analyse and evaluate observed health care delivery and nursing practice, and propose realistic strategies for their improvement on the basis of theory, research, and effective and efficient utilization of resources. 4. Act as an advocate for research utilization and communicate relevant research findings with peers/colleagues. 5. Work in partnerships with individuals, families, groups, and communities in promoting wellness and preventing illness. 6. Analyze relationships with clients and implement strategies to enhance client participation in care. 7. Demonstrate a scholarly and professional approach when communicating verbally and in writing. 8. Design and evaluate learning experiences and strategies to enrich own practice. 9. Demonstrate an inquiring approach to learning and demonstrate a commitment to own professional development. 10. Demonstrate increasing independence when working in increasingly complex situations. 11. Demonstrate leadership through participation in planning, implementing and evaluating changes that affect nursing practice, client care and the practice environment. 12. Analyze ethical dilemmas and intervene according to the code of ethics and standards of nursing practice. 13. Demonstrate initial competencies in community development strategies. 14. Compare application of selected nursing theories in practice. 15. Analyze and demonstrate roles of the nurse in working with individuals, families, groups, and communities within interdisciplinary/intersectoral teams utilizing a primary health care framework.

6 6 NURSING 402X 2016 Course Objectives The student will: 1. Demonstrate safe competent nursing practice; 2. Demonstrate the integration of knowledge, attitudes and skills required to practice nursing within increasing complex clinical situations; 3. Analyse some of the current nursing frameworks, models, theories and research relevant to nursing practice; 4. Use a critical thinking approach to analyze and integrate nursing knowledge and concepts and principles of primary health care into nursing practise; 5. Identify researchable questions and uses research literature to enhance clinical practice; 6. Evaluate the impact of factors (cultural/demographic/economic/social/political) affecting health and health care. 7. Communicate with clients and colleagues at an appropriate level of intervention in a caring and deliberative manner; 8. Assume a leadership role in a project or special activity within the practice unit; 9. Demonstrate an understanding of, and accountability for, own professional development within a changing health care system; 10. Demonstrate responsibility for identifying personal learning needs and actively seeking learning experiences to meet those needs; 11. Participate in the design and evaluation of learning experiences and strategies to enrich own practice and actively seek expediencies to promote professional development; 12. Establish and maintain open communication with their preceptor and faculty advisor; 13. Advocate for access to health information, health care, and healthy environments within the clinical practice setting; 14. Demonstrate a collaborative approach with members of the health care team in planning and delivery of care; 15. Demonstrate increasing knowledge and greater ability in performing psychomotor skills; 16. Consistently demonstrate awareness of the impact of personal (facilitative or non-facilitative) communication with clients, families and/or colleagues. 17.

7 7 NURSING 402X 2016 Schedule Classroom Content: Monday, June 27, 2016 to Thursday, June 30, 2016, Health Sciences 105 Each student will need to set aside time for personal learning activities to: Identify personal learning objectives that will be priority for this practice. Identify current resources needed to meet course objectives. Consider what evidence would confirm that the objectives have been met. Review and practise specific clinical skills in preparation of advanced learning. Tuesday, September 6, 2016 Complete HESI Exit #2 exam. Facilitated group discussion Complete course evaluation for course and clinical experience. Clinical Experience Monday, July 4, 2016 to Friday, September 2, 2016 Students will have 9 weeks to complete 320 hours of clinical arranged according to the preceptor s working rotation. There MAY be extra hours available depending on the preceptor s schedule for students to arrange time off for a summer break o Students MUST negotiate this with their preceptor and their faculty advisor to ensure that that they have the correct number of clinical hours.

8 8 NURSING 402X 2016 Learning Activities The student will: Share clinical experiences with colleagues to encourage reflective learning through linking theory and practice. Complete the clinical performance evaluation with the faculty advisor and preceptor. Prior to the midterm and final evaluation, the student will meet to discuss the evaluation with her/his preceptor. Each student will complete the evaluation form and complete a written self-evaluation summary and review these at the mid-term and final evaluation. Submit required written assignments to faculty advisor. Organization At the beginning of the experience the student and preceptor will review the student's priority learning objectives and identify how they plan to meet their identified clinical indicators. The student and preceptor will work closely so that the student can reach her/his objectives with the preceptor's guidance, while the faculty advisor will be available to help discuss the experience and evaluate the student's performance. Students and preceptors are encouraged to contact the faculty advisor at any time throughout the experience. Expectations The focus of this experience is on the roles of the nurse in the health care system. Included in the practice experience is the expectation that each student will: Clinical Time o Take on a student leadership role within the regular activities of the clinical setting. o Critically analyse nursing and health care within that setting using solid references from the literature. The clinical component of this course requires 320 hours of experience. The configuration of time will vary among students but the basic principle is that each student will be engaged in some aspect of their clinical experience during the hours in which their preceptor is working.

9 9 NURSING 402X 2016 Evaluation Students will practice in a clinical setting under the guidance of a preceptor. It is imperative that the student demonstrate safe, competent nursing practice. The student, faculty advisor, and preceptor will meet together near the midterm of the clinical experience and at, or just before, the end of the experience to conduct evaluations of student performance. Additional meetings may be required based on student s progress. Please book these meetings at the start of the student experience with the telephone number and location where faculty advisor can meet. Each faculty advisor will meet by telephone or in person with the student and preceptor two times during the nine week experience. These meetings will be at a time convenient to the preceptor and student s schedule. For out of province students, the faculty advisor will organize contact with the student wherever possible and conduct the midterm and final evaluations during a three way teleconference at the School of Nursing s expense. Performance will be evaluated on a pass/fail system using the course objectives, the student's selected objectives and the fourth year clinical evaluation as evidence of performance. (See Clinical Evaluation Form)

10 10 NURSING 402X 2016 Classroom Content hr Lecture Topic Orientation to N 402 Welcome Course review Clinical rotation, assignments, grading, work ethic Moodle Resources Required Reading Monday, June 27, 2016 N402X Course Syllabus National Council of State Boards of Nursing 2016 NCLEX-RN Detailed Test Plan (Candidate Version) NCLEX Examination Candidate Bulletin hr PEI Nurse s Union Mona O Shea RN President, PEINU hr Overview of NCLEX-RN hr Association of Registered Nurses of PEI Paul Boudreau RN MN Registrar, ARNPEI hr Tuesday, June 28, 2016 Readings and notes for Pharmacology review to be posted prior to class. Pharmacology Review Terri Kean RN NP CDE hr Fetal Health Surveillance Katelyn Smallwood BScN RN Clinical Educator, Unit 4 QEH For Fetal Health Surveillance: Murray, S.S. & McKinney, E.S. (2014). Foundations of Maternal-Newborn and Women s Health Nursing. St. Louis, MI. Elsevier. pp Students can review Fetal Health Surveillance 1-3 as posted on Moodle. These will be used to guide the discussion. Wednesday, June 29, 2016

11 11 NURSING 402X hr Introduction of ECG interpretation Tanya Matthews BN, RN Terri Kean RN, NP Palatnik, A.M. (2009). Too fast, too slow, too ugly: Dysrhythmias that every nurse should recognize. Nursing 2009, Sept., Upchurch, S., Henry, T., Pine, R., & Rickles, A. (Eds.). (2014). Comprehensive Review for the NCLEX-RN Examination. St. Louis, MI: Elsevier; p.39-44; Norris, C. & Clark, A.M. (2010). Management of Patients with Dysrhythmias & Conduction Problems. In Day, R.A, Paul, P., Williams, B., Smeltzer, S., & Bare, B. (Eds), Brunner & Suddarth s textbook of Canadian medical-surgical nursing (pp ). Philadelphia, PA: Lippincott. Thursday, July 2, hr Self Study hr Communication Lab Topic: Delegation Learning Resource Center Developing Delegation Skills ANAPeriodicals/OJIN/TableofContents/Vol152010/No2May2010/Deleg ation-skills.html A Mindful Communication: A Novel Approach to Improving Delegation and Increasing Patient Safety ANAPeriodicals/OJIN/TableofContents/Vol152010/No2May2010/Mindf ul-communication-and-delegation.html Helping New Nurses with the Fine Art of Delegation content_id=233639&oc_id=602 Monday July 4, 2016 Preceptor Workshop Students doing placements on PEI will join us on campus in Health Sciences Building 105 to meet their preceptor and participate in the workshop. Tuesday, September 6, hr HESI Exit Exam Version Group Discussion & Course Evaluations

12 12 NURSING 402X 2016 Evaluation Methods All assignments will be due at 1600hr. Assignments will be deposited in the assignment s drop box on Moodle. UPEI School of Nursing Policy for late submission of assignments will apply. Please see this policy at Activity Value Due Date Personal Learning Plan 15% June 30, 2016 Letter to Preceptor 15% June 30, 2016 Preceptor Self Study 10% July 8, 2016 Clinical Logs 50% #1 July 15, 2016 #2 July 29, 2016 #3 August 12, 2016 #4 August 26, 2016 HESI Case Study 10% September 2, 2016 Clinical Evaluation Pass/Fail Completed by September 2, 2016

13 13 NURSING 402X 2016 Assignments 1. Personal Learning Plan & Letter to Preceptor Due: June 30, 2016 The purpose of the personal learning plan and letter to the preceptor is to provide the preceptor with information that you want to share with them about you and your learning needs for this preceptored experience. A. Personal learning plan: 1. Review the clinical evaluation form and course objectives and characteristics of the graduate to identify areas for development and growth. 2. Select 3 specific learning objectives (based on indicators from your clinical evaluation) that you wish to put particular emphasis during the clinical experience; 3. Identify the resources you currently have available to help you meet these identified learning needs (expertise and materials); 4. Identify potential strategies to help you achieve your selected objectives; 5. Identify criteria or indicators or standards by which your performance can be evaluated; 6. Format the learning plan as a landscape table with the following headings: Objective Resources Strategies Evaluation Measures/Success Indicators B. Letter to Preceptor Prepare an introductory letter for the preceptor that will provide the preceptor with information that you want to share with them about you and your learning needs for this preceptor experience. This is a formal letter that you will prepare ready for mailing (or as attached letter to an ). Consider how the objectives you identified in your learning plan fit into what you want to accomplish during your clinical experience. Consider what your strengths are in general: strengths in the clinical area; areas where you want to improve; and areas that have challenged you in previous clinical experiences. Your learning style; your response to feedback and how you prefer to receive feedback; how you handle stress; uncertainty etc. This assignment is completed by the student and submitted electronically to your faculty advisor. After this assignment has been graded, the student will make revisions and submit the introductory letter about themselves, along with this personal learning plan to their preceptor with a final copy to the faculty advisor.

14 14 NURSING 402X Clinical Logs Due Dates and Content: July 15, 2016 July 29, 2016 Knowledgeable PHC Practitioner & Critical Thinker Effective Communicator August 12, 2016 Self-directed Learner August 26, 2016 Evolving Professional The purpose of the clinical logs is for students to complete an analysis of their practice in relation to how they are meeting the clinical objectives for the course, the expectations of a fourth year student and ultimately the characteristics of a graduate. Process: 1. Four (4) clinical logs will be submitted the student s faculty advisor. These will be submitted electronically via the assignment Dropbox on Moodle. 2. Each log will focus on one or two objectives from the UPEI School of Nursing 402X clinical evaluation form. 3. From the specified objective, the student will identify the specific clinical indicators that they would like to address and discuss this plan with their preceptor prior to the week the log is due. a. Students can decide with the support of their preceptor what indicators they would like to work on specifically. They may also have demonstrated growth in an area (s) or an area may have challenged the student and they may choose indicators to demonstrate either of these or both. b. Students must address a minimum of 3-4 indicators in each log. 4. The student will write a maximum of 900 word log describing how they have been able to meet the identified objective and corresponding indicators. Students will use the chosen indicators and use the following questions to write a synthesis to describe how they were able to meet the indicator(s) or what challenges them to meet the indicator; i. What occurred/ happened, what went well? ii. What did not work so well and why? iii. What theoretical evidence was used to support the student s actions? What theoretical evidence was used to enhance the experience? iv. What would the student do differently in the future and what theory or evidence supports these recommendations? 5. In addition to the questions above, the student will reflect on their growth in reaching the expectations of the fourth year student and ultimately in meeting the characteristics of a graduate. a. This section requires students to consider the expectations of a fourth year student and the characteristics of graduate that are found in the syllabus. Students need only to choose the characteristics that apply to the indicators they chose above and be sure the characteristics are reflected in their discussion. b. Students will include a minimum of 1 from each list.

15 15 NURSING 402X Grading of the Journals will be based on student s reflection and analysis of their ongoing learning and how that is linked to their clinical objectives and applied knowledge. A key element of the reflection will be the ability of the student to link theory based evidence to their reflection. a. Students are expected to demonstrate integration of theory that reflects the knowledge and skill of a fourth year students. Students are expected to use theory/evidence/research to support your experience and observation. Course faculty are available to help students with this. 7. Format: Students are expected to include their name, the date, and the number of the indicator or indicators with a brief synopsis of what the indicator is for. This is not included in the word count. Students are expected use in-text citations to reference work that is not their own and to provide an appropriate reference page for the in-text citations. APA format is expected for both. A sample is posted on Moodle. 8. These assignments will be graded by the N402X faculty advisors. A rubric will be provided for students to follow in preparing the assignment and faculty will be using this rubric to assign grades. 3. HESI Case Study Due: September 2, 2016 Students will complete the Pre-eclampsia case found in their HESI Case Studies for Maternity. These can be found in student s Evolve account. Students will be graded on this assignment and will have one attempt to complete. Students may do this assignment together but each student must submit their own answers via their individual Evolve account. 4. Preceptor Self Study Due: July 8, 2016 At the beginning of their clinical placement students will complete select modules from an online preceptor program. This is offered through the University of Western Ontario and is called the Preceptor Education Program (PEP). It can found at the following URL Students will complete the following modules: Orientation and Preparation Learning Objectives Feedback Conflict Evaluation Each module provides the option for students to obtain a certificate of completion. These certificates are to be forwarded to the course coordinator, Patrice Drake, on or before the due date. 5. HESI Exit Exam (Version 2) Completed on Sept. 6, 2016

16 16 NURSING 402X 2016 Students will write second version of the HESI Exit exam in N402X. It will be the same format as the first HESI exit exam given in Nursing 310. Students are expected to use the remediation from the first exam to prepare for their next exam and to help focus their preparation for the NCLEX-RN. Materials Related to Preceptored Experience

17 17 NURSING 402X 2016 Arrangements for Clinical Practice: Each student will be assigned to a preceptor in a health care agency which can provide experiences to meet the course expectations. Students will share the preceptor's practice and move from observing to being supervised to being independent, as appropriate for the student and the agency. Roles of Preceptors and Faculty advisors: The School of Nursing, through the course co-ordinator and the faculty advisors, will provide ongoing support for the preceptors. The preceptor will act as a role model for the student, share her/his practice, monitor the student's practice and provide the faculty advisor with data for evaluation of the student. The faculty advisors will be responsible for helping the students to develop and meet their objectives, reviewing all written work and evaluating and grading students' practice. The faculty advisors will be in contact with students regularly to meet these responsibilities and may also observe the student in practice. The course coordinator will be in regular contact with the faculty advisors and will be aware of student s progress throughout the course. The course coordinator will also participate in meetings regarding student progress particularly those related to the evaluation process. The faculty advisor will be in contact with the preceptors working with her students at the beginning of the experience, midway through the experience and at the end of the experience. The faculty advisor and/or preceptor and/or student may initiate additional contacts as needed. Preceptorship Information Students have access to the UPEI School of Nursing Guide to Preceptorship electronically via Moodle. Students are expected to review this document to understand the various roles and responsibilities of preceptorship. Preceptors will be provided with this document as well. APPENDIX A: Policies Regarding Student Experiences in Clinical Settings The following guidelines are provided to clarify the expectations of faculty regarding student activities in the hospital setting:

18 18 NURSING 402X 2016 Dress Regulations The expectation is that students will present a professional, well-groomed appearance. Students follow university/hospital/agency dress code. See Moodle for link to dress code policy. Illness When ill, students are to: Notify the clinical agency before the beginning of their assigned shift, noting the name of the person to whom they spoke. Notify their preceptor - ensure that student and preceptor contact information has been shared. Inform their faculty advisor via voice mail or . Students and preceptors should establish plans for the student in the event that the preceptor is unable to come to work (e.g. the student does not report to work or the student is assigned to another preceptor who is knowledgeable about the guidelines for the student placement). Physician Orders All orders (including medication orders) carried out by students must be current and written or cosigned by a physician or resident. Student nurses do not accept telephone orders or verbal orders Psychomotor Skills In addition to learning the basic psychomotor skills associated with safe clinical practice, the students have learned physical assessment skills. Opportunities to practice these skills vary from student to student. Students are expected to use good judgment in assessing the amount of assistance they require with psychomotor and assessment skills and are expected to use the available unit resources and consult with the preceptor for the help they require. Students should inform their preceptors of their strengths and areas requiring further practice using an individualized personal learning plan developed by the student. Under the guidance of the preceptor, students are expected to familiarize themselves with hospital/agency guidelines. Supervision for Medications and Procedures The practice of safe physical care of patients requires that there be some mechanisms for regulating the performance of psychomotor skills by students and inexperienced nurses. Some of these mechanisms may vary from agency to agency. Students are responsible for following Agency and School of Nursing policies, procedures and guidelines. If policies vary between the Agency and the School of Nursing, the student is to follow the more restrictive of the two policies. Generally, students may perform procedures that require supervision according to the following guidelines: The student must be supervised initially by the staff RN for preparation and administration of all medications and any potentially dangerous procedures. Subsequently, the student may administer the medications (except IV) and implement the procedures on their own if the supervising RN thinks the student is capable and safe.

19 19 NURSING 402X 2016 THE FOLLOWING PROCEDURES MAY BE PERFORMED BY THE STUDENT ONLY WHEN THE RN IS PRESENT and only if the agency permits. administration of approved IV medications to an IV bag or buretrol signing for narcotic and control drugs to administer to a patient THE FOLLOWING PROCEDURES ARE NOT TO BE PERFORMED BY STUDENTS. Drugs and IV'S: preparation and administration of IV chemotherapy counting of narcotic and controlled drugs administration of investigational drugs removal of central line or epidural catheters Administration of blood and blood products (They may assess and monitor patients receiving blood products.) Other vaginal examinations removal of continuous sutures, retention sutures, plastic surgery sutures witnessing consent forms any of the Delegated Medical Functions, so designated by the Agency SKILLS BEYOND ENTRY LEVEL - THE FOLLOWING PROCEDURES* ARE NOT USUALLY PERFORMED BY ALL STUDENTS BUT UNDER CERTAIN CONDITIONS MAY BE PERMITTED. The student may participate in the skill only under the direct supervision of the preceptor. There are several clinical skills which are within the scope of practice of Registered Nurses but are beyond entry level (formerly referred to as shared competencies). Each agency identifies which skills are considered in this category. Students do not normally participate in these skills. However factors such as context of practice and learner readiness/preparation may affect opportunities for student participation. Some agencies have developed policies for student participation in these skills. UPEI School of Nursing Faculty may give permission for individual students to take part in these skills when the following conditions have been discussed (by faculty, student and preceptor) and met: 1. The agency policy allows such participation 2. The identified skill is frequently performed and an integral part of nursing care on the unit. 3. The student is performing well in their clinical experience, according to preceptor and faculty member. 4. The student has successfully completed a learning package for the skill. Although the student must have successfully completed the learning package prior to participation in the skill, it must be recognized that the student is NOT CERTIFIED in the performance of that skill. Usually the student must complete the learning package used by the agency. Students have learned many of these skills in the Learning Resource Center at UPEI School of Nursing - IV initiation, drawing blood, administration of push meds directly into a vein or into an IV line, managing and

20 20 NURSING 402X 2016 monitoring chest tubes, central line dressings and medications, nasogastric tube insertion, feeding & care, and immunizations. Document updated December (Adapted in part with permission from Dalhousie University School of Nursing, 2014) APPENDIX B: University of Prince Edward Island School of Nursing Clinical Skills Curriculum

21 21 NURSING 402X 2016 Year One Year Two Year Three Medical asepsis Surgical asepsis Application of sterile gloves Body mechanics Safe patient handling (Equipment training/ Orientation to TLR (do not complete certification) Range of motion Adult vital signs (temperature, pulse, respirations, BP, pulse oximeter, height and weight, BMI) Bed making Assisting with bowel elimination Assisting with urinary elimination Adult hygiene General theory and principles of medication administration Administration of oral medications to an adult Administration of medications to an adult by other than oral routes (topical, inhalation, installation, suppository) Simple sterile dressing Deep breathing, coughing and leg exercises Oxygen therapy for adult and child Ostomy Care Application of heat and cold Transmission Based Precautions Infant nutrition Infant measurement Measuring vital signs in the child Administering intramuscular, subcutaneous and intradermal injections to adult and child Insulin therapy General theory and principles of intravenous therapy Pediatric IV therapy- general principles Calculation IV infusion rates Blood glucose monitoring Complex sterile dressing (irrigation, packing, wound closure devices, suture and staple removal) Negative Pressure Wound Therapy Calculating safe pediatric doses Administering oral, optic and otic medications to children Traction and cast care Urinary catheterization Specimen collection (sputum, urine, stool) Complete Physical/Health assessment skills Airway maintenance and suctioning techniques (oral, nasopharyngeal, endotracheal airways; tracheostomy care) Administration of intravenous medications to adult Care of patient with a chest tube General principles of enteral nutrition therapy Care of patient with a nasogastric tube/enteral feeding tube Caring for a client with a central venous line or PICC line Caring for a patient receiving TPN Venipuncture and initiating IV therapy Administration of blood and blood products Pediatric IV meds Assessment during Procedural Sedation Newborn Assessment Maternal Assessment ** Students are taught the theory and principles of blood administration but are not permitted to actually administer blood or blood products. They may assess and monitor patients receiving blood products.***