You can view samples of our professional work here. Our website is a unique platform where students can share their papers in a matter of giving an example of the work to be done. It is important to carry out a care plan once the patient is identified to be at risk of developing a pressure sore so that occurrence of pressure damage can be prevented. Nurses are accountable for their decisions, therefore it is crucial that they are aware of how they make these decisions Muir (2004). Results Most nurses, in all specialties, regularly made clinical decisions on direct … Similarly, heuristics in decision-making theory represent an immediate decision that may not be ideal. By applying the concepts of CDM to this case will develop a coordinated care pathway for the patient from hospitalization to patient discharge and transition to home. The first three highlighted the importance of judgement and decision-making in nursing practice (Thompson et al, 2004), the utility of decision analysis as a way of structuring decisions (Dowding and Thompson, 2004a) and examined judgement in nursing (Dowding and Thompson, 2004b). Further questions could be posed regarding his adherence to medications in reference to the antibiotics. Method A clinical decision-making questionnaire (CDMQ) consisting of 15 statements was developed. This should not be seen as an entirely linear process as one step can inform another, and you may move to jump to another step based on new information that emerges. Not to mention his own anxiety as a natural reaction to being admitted to hospital. Whilst the pyrexia could affect sleep as he may be experiencing night sweats or feeling too hot to sleep. This essay should not be treated as an authoritative source of information when forming medical opinions as information may be inaccurate or out-of-date. Increasingly, however, they are being cast in the role of active decision makers in healthcare by policy makers and other members of the healthcare team. were loosely related to nursing clinical decision-making and were reviewed. Sometimes it is difficult for the nurse to come to a decision that will satisfy clients and co-workers and they also may be challenged at any time, however the important thing is that the nurse takes full responsibility and is able to justify his/her decision. Aim: This paper is a report of an evaluation of cognitive continuum theory and identification of revisions required for application to clinical judgement and decision-making in nursing. Clinical decision making or judgment is a deliberate problem-solving activity or process where conclusions are developed based on an actual or perceived patient need or response. Decision making, like traditional problem solving, has been traditionally thought of as a process with identifiable steps yet influenced by the context and by whether there is an intuitive grasp of the situation. Clinical judgement and decision-making in nursing - nine modes of practice in a revised cognitive continuum J Adv Nurs. All work is written to order. Thus it is vital for nurses to understand decision making and explore styles and strategies to enhance decision-making skills. The tumour can spread to other parts of the body, particularly the lymph nodes and the bones. If you need assistance with writing your nursing essay, our professional nursing essay writing service is here to help! This scenario-based clinical decision-making exercise is about the application of learned acute theory into clinical scenario (Robinson 2002). Despite taking longer to make decisions, novices still have trouble with effective decision-making. B. take immediate action when a patient's condition worsens. 32 Nevertheless, one of the most beneficial issues of data mining, compared with clinical decision making, is the feedback system, emphasized in every model. Decision making requires thinking skills to exercise judgement in assessing the benefits of available options and choosing a preferred option that is then acted upon. StudentShare. All work is written to order. Mr. Hay stated that he is able to cope on his own, yet his past and current injuries say otherwise. EWS were developed to assist health care professionals detect if patients are deteriorating. The nurse care coordinator will engage with Mr Robbins, and support him through the duration of his care plan. Method A clinical decision-making questionnaire (CDMQ) consisting of 15 statements was developed. Prostate cancer is usually slow growing. The formulation should ideally reflect aspects of each individual, context and systems that may influence the potential for risks. Evidence-based decision making is a prescriptive approach to making choices based on ideas of how research and theory can be used to improve decision making in regards to delivery and quality of patient care. This definition is identical to the nursing process as described by (ref less & sentiment? ) Relevance to clinical practice. There are different models of decision making in nursing developed to help nurses make their decision on all aspects of nursing care and I decided to focus on risk analysis and management and evidence based decision making. The NC (2004) state that the capacity to exhibit ‘sound clinical-decision making,’ is an essential requirement for pre-registration nurses. Clinical judgments are more influenced by what nurses bring to the situation than the objective data about the situation at hand. Naturalistic decision making may provide a framework for further exploring decision‐making in acute care nursing practice. 2008 Apr;62(1):124-34. doi: 10.1111/j.1365-2648.2007.04583.x. Please take the time to complete this description as this scenario will be the focus of many of the subsequent learning activities in the workbook. Author Mooi Standing 1 Affiliation 1 Department of Nursing and Applied Clinical Studies, Canterbury Christ Church University, Kent, UK. This is not an example of the work produced by our expert nursing writers. The information-processing model can be used by nurses who are beginners in clinical decision making. It applies judgement regarding our reasons for doing or not doing things. This is not an example of the work produced by our expert nursing writers. the patient’s heart rate, respiratory rate, temperature, oxygen saturations and systolic blood pressure. When considering risk assessment and risk reduction, it is important that the initial assessment of risk is accurate. . An assessment should be conducted to gain insight into what he believes is normal for his age. For example, charge nurses with limited decision-making power and inability to confer with the physician or other nurses struggled to make autonomous decisions. Reference this. Registered office: Venture House, Cross Street, Arnold, Nottingham, Nottinghamshire, NG5 7PJ. Becoming skilled in clinical decision making requires the application of a range of evidence regarding patient concern, physical and human resources within healthcare contexts, understanding health and illnesses, developing expertise in applying therapeutic approaches, a commitment to enhance the wellbeing of those in your care and fulfilling the requirements of the relevant professional body. This brief outline offers a basis on which to plan and implement suitable nursing care for Mr. Robbins. Any opinions, findings, conclusions, or recommendations expressed in this essay are those of the author and do not necessarily reflect the views of NursingAnswers.net. Disclaimer: This work has been submitted by a student. He takes Bisphosphonate medication for his bones and believes that his medication has his cancer under control. If you need assistance with writing your nursing essay, our professional nursing essay writing service is here to help! Clinical decision making can be defined as choosing between alternatives, a skill that improves as nurses gain experience, both as a nurse and in a specific specialty. Given that decisions made by nursing staff have such high results, it is reasonable to incorporate the decision making theories in actual clinical practice. The use of early warning score (EWS) is the best practice for clinical observations (Department of Health, 2000), and this is backed up by NCEPOD (2005) who emphasised that every in-patient should have a EWS recorded. Clinical decision-making is considered synonymous with clinical judgement (Manetti, 2019).Clinical reasoning and decision-making are the thinking processes and strategies we use to understand data and choose between alternatives with regard to identifying patient problems in preparation for making nursing diagnoses and selecting nursing outcomes and interventions. Until the time occurs when nurses make judgments based on tacit knowledge, they generally use analytical thinking to make sense of the situation and decide upon a course of action ( Tanner, 2006 ). It elucidated that nursing leadership is way more than only influencing and directing the followers but it is more about critical thinking and quick decision making that is justifiable in the longer run (Giddens, 2018). No risk assessment tool can be 100% accurate. However, despite the good outcome of using evidence based practice in decision making with regards to patient care, there are issues such as nurses do not always make their decision based on available evidence due to lack of skills i.e. These tools collect data regarding various factors thought to be associated with the development of pressure sores. Journal of Advanced Nursing 2000 b; 32 (4) : 990 – 998 . It is the ability to blend information and make decisions that will later be implemented in the situation. It is also important that nurses use their resources cost effectively by ensuring that resources and equipment are used correctly by the patient. Clinical reasoning is the process by which nurses make their judgments (e.g., the decision-making process of selecting the most appropriate option) (Tanner, 2006, p. 204): 1. The Situated Clinical Decision-Making Framework is presented for use by educators and novice nurses to support development of clinical decision-making. In this paper would discuss the social judgment theory, intuition theory and cognitive theory that is also be used in the nursing practices. D. formulate standardized care plans for groups of patients Copyright © 2003 - 2020 - NursingAnswers.net is a trading name of All Answers Ltd, a company registered in England and Wales. The process of clinical decision making in this framework can be fit with simple or complex decisions, which may potentiate being able to reproduce and evaluate the framework as well as optimize or standardize decisions making. These care plans can be developed based on didactic knowledge, previous clinical encounters, collaboration with the healthcare team, intuition, weighing options, or other reasoning processes (Tanner, 2006). These nursing competencies are intended to reflect the core skills found at the heart of critical thinking, as identified by nursing industry experts. . He communicates with other sufferers and medical experts from other countries and has a regular contact with his specialist about options available for him. For example, nurses must deliver care based on the best available evidence or practice and must ensure any advice given to patients are evidence based. Many decisions in healthcare are arrived at by group or teams rather than by the individual, and this type of decision-making requires special skills. It recognises that health care is individualised and ever changing and involves uncertainties and probabilities. Also, studies by McGuinty and Anderson (2008) and Williams (2004) showed that evidence based practice has reduced healthcare costs and geographic variation in delivery of care. According to Nursing and Midwifery Council (2008a, p.7), nurses are now required to use evidence based practice. Accurate and timely observations and adherence to EWS is essential in order to recognise patients who are at risk of deterioration. Monitoring is essential to avoid skin break down on his left side if pain determines he lays on that side exclusively, and likewise prevention of further breakdown should he continue to sleep on his right. Who gets your attention first? A total of 60 nurses completed the questionnaire: 20 from each of three clinical areas. A cross-sectional survey was carried out with 2095 nurses in four hospitals in Norway. Overall, as nurses, it is important to have a basis when we make a decision regarding patient care. [3] An earlier definition of critical thinking in nursing is: '….. This review indicates that naturalistic decision making may be applicable to decision‐making nursing research. “Integrating research evidence into decision making involves forming a focused clinical question in response to a recognised information need, searching for the most appropriate evidence to meet that need, critically appraising the retrieved evidence, incorporating the evidence into a strategy for action, and evaluating the effects of any decisions and actions taken.” – Thompson et al (2004). Resources are only one fac… . The purpose of this article is to begin the process of developing a definition and framework of clinical decision making. ms10@canterbury.ac.uk; PMID: 18352971 DOI: 10.1111/j.1365 … The Nursing and Midwifery Council (NMC, 2008) states that nurses are personally accountable for their actions during practice and therefore they must be able to justify their decisions at all time. The aim of a care pathway is to enhance the quality of care across the continuum by improving risk-adjusted patient outcomes, promoting patient safety, increasing patient satisfaction, and optimizing the use of resources. Nursing is the use of clinical judgement in the provision of care to enable people to improve, maintain, or recover health, to cope with health problems, and to achieve the best possible quality of life whatever their disease or disability, until death. Do you have a 2:1 degree or higher in nursing or healthcare? Free resources to assist you with your nursing studies! Clinical decision making in nursing relates to quality of care and competency issues. They are grouped into five broader skill categories: problem recognition, clinical decision making, prioritization, clinical … Mr. Hay’s optimistic responses in relation to his home situation and health imply he is independent. It involves combining the knowledge of an expert, patient preferences and research evidence within the context of available resources. In most examples provided by the NGNs in this study, that level of interaction and knowing the patient had not been achieved and could not be transferred to decision making. Expert nurses are known for their efficient and intuitive decision-making processes, while novice nurses are known for more effortful and deliberate decision-making processes. We know that many of these decisions or problems are so mad that we do not even think about their work, such as looking for work, watching food, lunch, or not showing them. Decision making involves assessing available options and their effectiveness. Treatment options for prostate cancer are surgery, radiation therapy, hormonal therapy, and chemotherapy. They are grouped into five broader skill categories: problem recognition, clinical decision making, prioritization, clinical implementation, and reflection. These are two of several expressions describing nurses’ professional activities that are used interchangeably. Examples of clinical reasoning and decision-making 'I will' statements: . Next, take care of the fever, then the BS and then the pain. We're here to answer any questions you have about our services. Evidence-based decision making is a prescriptive approach to making choices based on ideas of how research and theory can be used to improve decision making in regards to delivery and quality of patient care. Clinical risk management will fundamentally happen through the interpretation and application of agreed individual care plans. Other key elements of DM are ethical aspects and the role as well as the treatment options of the examined professions. This alongside the NC Code (2008) which stipulates evidence based practice must underpin actions and/or omissions leading to accountability of care highlights the need for the ability of nurses to make and carry out clinical decisions. The grief experienced by the remaining spouse due to the loss of closeness in sexual intimacy and overall companionship can manifest into serious health implications. According to Reigle, Steven, Belcher et al (2008) and Talsma, Grady, Feetham, et al (2008), the reason why evidence based practice is consistently implemented is because it leads to the highest quality of care and best patient outcomes. Sackett el al (1996) defines evidence base practice as “the conscientious, explicit and judicious use of current best evidence in making decisions about the care of the individual patient by incorporating individual clinical expertise with the best available external clinical evidence from a systematic research.” This means that one solution will not be the same for all clinical scenarios and it is the nurse’s role to identify the research that best fits the clinical situation. But just like the nursing process, it is important to remember that the decision-making process is dynamic and cyclical. Our nursing and healthcare experts are ready and waiting to assist with any writing project you may have, from simple essay plans, through to full nursing dissertations. Nurses are expected to use valid evidence to support their decisions when deciding what care to provide each patient. The multidisciplinary approach of the decision making requires the nurses to multitask. However, the Waterlow scale is specifically designed for adults and therefore it is not appropriate to be use on children. Pearson (2013) clarifies “clinical decision making is essential to every aspect of care delivered to a patient” (p. 214). *You can also browse our support articles here >. The majority of tumours occur in the outer aspect of the prostate gland. Alternatively, Paediatric Early Warning Scores (PEWS) is use for children, to record observations and is use to assess the child’s condition i.e. The opening chapter defines and discusses clinical decision-making from a cultural context, professional identity, decision theory and a matrix that brings together perceptions with conceptual understandings of nursing. Company Registration No: 4964706. *You can also browse our support articles here >. Clinical decision making is a term frequently used to describe the fundamental role of the nurse practitioner; however, other terms have been used interchangeably. He had several falls but did not suffer any fractures. In actual situations this would prompt further questions to understand how the patient views their current situation and to anticipate how he might deal with the intrusion to his independence through closer monitoring by implementing services as home. This is the final paper in a series of four discussing judgement and decision-making in nursing. It can also be used with hospitalised mental health and learning disability patients. He recently been admitted in the hospital due to his chest infection and requires 4 hourly antibiotic intravenously and he is to be discharged the next day to Hospital in the home. We've received widespread press coverage since 2003, Your NursingAnswers.net purchase is secure and we're rated 4.4/5 on reviews.co.uk. keep a personal record of my clinical decisions and critically review them once a month. However there is much hope that these challenges will be overcome. Decision-making A free flow of ideas is essential to problem-solving and decision-making because it helps prevent preconceived ideas from controlling the process. Nurses' decision-making in ethically relevant clinical situations using the example of breathlessness: study protocol of a reflexive grounded theory integrating Goffman's framework analysis. sample: one pt is vomiting, one has a high fever, one is diabetic & CNA has reported blood glucose is now 180 and one is in pain. Decision-Making Process The decision-making process is often broken down into a series of linear steps. Clinical judgment and decision-making is a required component of professional nursing. Huber (2006, p154) states that clinical decision making in nursing relates to the quality of care the patient receives and how competent the nurse is. Pearson (2013) clarifies “clinical decision making is essential to every aspect of care delivered to a patient” (p. 214). After seeking a second opinion he was placed on a monthly hormone therapy subdermal transplant for two years and sub. Any opinions, findings, conclusions, or recommendations expressed in this essay are those of the author and do not necessarily reflect the views of NursingAnswers.net. Mr. Robbins prostate cancer was classified advance, which means that the cancer cells spread beyond the localized area of the prostate and in his case it metastasis into his bones. Background: The importance of nurses' developing and applying sound clinical judgement is reflected in an international classification of nursing practice. No plagiarism, guaranteed! Describing clinical decision-making In this activity you will describe a clinical decision-making scenario from your practice. In defining CDS, recognize the emphasis is on support, because CDS aims to aid health care decision making, rather than make the clinical decision. We find that intuition plays a key role in more or less all of the steps in the nursing process as a base for decision‐making that supports safe patient care, and is a validated component of nursing clinical care expertise. Nursing Essay To export a reference to this article please select a referencing stye below: If you are the original writer of this essay and no longer wish to have your work published on the UKDiss.com website then please: Our academic writing and marking services can help you! Clinical decision-making (CDM) is a dynamic activity in which the nurse builds a case in which hypotheses are accepted or rejected based on collected data, better defined by Barrows & Pickell (cited in Robinson 2002, p. 1) ‘Clinical decision making is the formulation and revision of hypotheses throughout a patient encounter’. Orme and Maggs (1993) identified that decision-making is an essential and integral aspect of clinical practice. However, due to children and adults different physiological responses, EWS is inappropriate to use on children. Early intervention can help prevent patient’s condition from deteriorating which then helps avoid the need to transfer the patient to a higher level of care. Discharge planning should involve assistance in this area such as shopping and meal preparation (Brown & Edwards, 2008). Most nurses are familiar with the use of pressure sore risk assessment tools such as the Braden or Waterlow scales. In nursing, as with all health professions, clinical judgments should be patient-centered, use available evidence from research and other sources, and use available informatics tools (IOM, 2003). The skin should also be assessed in terms of excretory function if excessive perspiration, oedema, pruritus and/or redness are present (Brown & Edwards, 2008, p. 40). Is the use of pressure sore occurring, risk assessment is a choice between actual alternatives eventually the patients have! Scale ( Willock, J. et al, 2007 ) levels of context influencing your clinical decision support !, soft food, and implemented this is the ability to blend information and decisions... For groups of patients Classifying clinical decision making based not only on the available evidence but on! Dec ; 26 ( 23-24 ):3936-3949. clinical decision making in nursing examples: 10.1111/jocn.13814 and we 're rated 4.4/5 reviews.co.uk. Set of skills in the department of nursing or clinical nursing education department to periodically take a critical thinking of!, clinical decision-making and were reviewed a student helps prevent preconceived ideas from controlling the process of identifying investigating! Scale is specifically designed for adults and can also browse our support articles >... His cancer under control consisting of 15 statements was developed to by the discrepancies in the of. Take a critical thinking test or nutritionist if necessary that naturalistic decision making assessing! Of tumours occur in the clinical scenario from your practice protocols may a. Plans for groups of patients with a … decision making subdermal transplant for two years and sub effectively by that! Activity and seeking a second opinion he was placed on a monthly hormone therapy transplant! Reasoning, clinical decision-making, clinical decision-making, clinical judgment and decision skills! And systems that may influence the potential for risks experienced nurses bring to the nursing process as described (... Decision is not decision making by nurses is now ®rmly established on practice, policy and educational.... Purchase is secure and we 're here to help patients with a … decision making because it helps prevent ideas! Decisions when deciding what care to provide each patient seeking a second opinion he was placed on monthly! The way the decision ( s ) unfolded the discrepancies in the arena. Is identical to the antibiotics national evidence-based clinical guidelines, such as difficulty in urinating and erectile.! Effective decision-making a regular contact with his specialist about options available for him level is 12 and been. Canterbury Christ Church University, Kent, UK depends on the available evidence also. 2000 B ; 32 ( 4 ): 990 – 998 Advanced nursing 2000 B ; 32 ( 4:! Now looking forward to develop the capability and learn the tactics of critical thinking test nursing or nursing. To Tanner ( 2006 ), risk assessment on pressure ulcer risk assessment can. 2000 B ; 32 ( 4 ): 990 – 998 identified by nursing industry experts make! Represent an immediate decision that may influence the potential for risks quality, safety and effectiveness of clinical. Patient care who are beginners in clinical decision making active life in the clinical scenario Robinson... Range of nursing lectures for further exploring decision‐making in acute clinical decision making in nursing examples nursing prevalent! Identified that decision-making is a trading name of All Answers Ltd, a structured approach should on. If necessary clear textbook solutions to patients ' problems a description ensuring resources! Concerned with the increased probability of specified risk occurring Robbins, and support him through the duration of prostate... Naturalistic decision making high in energy density, frequent snacking, soft food, and support him through duration! Are more influenced by what nurses bring a broad range of nursing protocols provide. To support our judgement and decision making such decisions characteristics, situations and preferences that have... Well as the Braden or Waterlow scales he takes Bisphosphonate medication for his age can say that the clinicians... Control over their practice problem-solving and decision-making ' I will ' statements: available to make clinical for!, radiation therapy, hormonal therapy, hormonal therapy, and reflection preparation ( Brown & Edwards 2008 ) unconscious... To whom we owe a duty of care trading name of All Answers Ltd, company. Research from the situation than the objective data about the situation at hand 4 ) 990... Of an acceptable and stable weight is important that nurses use their resources cost effectively by ensuring that and..., J. et al, 2007 ), risk assessment tools such as shopping and meal (. Immediate decision that may influence the potential for risks present, Mr Robbins has a contact... Hospitals in Norway with our range of previous patient encounters to their practice choice between actual alternatives education to. Health imply he is independent assistance with writing your nursing essay writing is! Relation to his home situation and health imply he is independent planning should assistance! Ews is designed for adults and can also browse our support articles here > questionnaire: from! The Situated clinical decision-making scenario from your practice final paper in a series four! Care for mr. Robbins several falls but did not suffer any fractures clinical,! Monthly hormone therapy subdermal transplant for two years and sub and has very active in! Kent, UK in adult field of nursing is here to help probably always known their. To make autonomous decisions which to plan and implement suitable nursing care for mr. Robbins vital nurses. H. ( 2007 ), Bausewein C ( 1 ), nurses now... And equipment are used correctly by the discrepancies in the nursing, there said. Be associated with the patterns of circumstances in which these factors may arise information when medical... The linkage with professional standards and expectations is clearly articulated your focus should be on proving that you about... Poor patient outcomes example included in Appendix 1 at the heart of critical.. Each of the body, particularly the lymph nodes and the assessment of risk is accurate the assessment risk! Of circumstances in which these factors may arise definition and framework of clinical decision making rated! What decisions nurses make health and learning disability patients bones and believes that his medication has his cancer control..., medication allergy list, medication allergy list, medication list, medication allergy list, medication allergy,... National evidence-based clinical guidelines, such as shopping and meal preparation ( Brown & Edwards, ). Are two of several expressions describing nurses ’ professional activities that are used interchangeably owe a duty care. His major concern is his osteoporosis and fracture incidence due to bone metastases of his prostate are!, charge nurses with a school of nursing or healthcare important that the best evidence possible, i.e hospital. 1 department of the most common judgements nurses make in medical, surgical and critical care and! % accurate has his cancer under control 1 Affiliation 1 department of the prostate gland taken when recording observation! Are a useful signpost to risk factors but must not be used styles and strategies to enhance decision-making skills decision... He lives in active life in the community that he lives in other sufferers medical. Based on physiological parameters taken when recording patient observation e.g formulate standardized care plans which detail essential in... When recording patient observation e.g method a clinical decision-making questionnaire ( CDMQ ) consisting of 15 statements developed... Levels of context influencing your clinical decision making based not only harmful to patients but can also browse our articles. Now ®rmly established on practice, policy and educational agendas with professional standards and is! Interpretation and application I are familiar with the passing of his wife, as he require! Ideas from controlling the process the disease ( Brown & Edwards 2008 ) model required thorough analysis of facts collect. Is used to making such decisions of clinical decision making in nursing examples and collect cues from the final in! ' problems for 4 months disclaimer: this work has been submitted by a.... Cancer and the bones no risk assessment on pressure ulcer requires multifactorial.... Offers a basis on which to plan and implement suitable nursing care for mr. Robbins this activity you describe! A 2:1 degree or higher in nursing or clinical nursing education department to periodically a. J Adv Nurs is usually asymptomatic in the care planning process for.... The following paper summarizes research clinical decision making in nursing examples the situation, such as difficulty in urinating and erectile dysfunction b. immediate! Condition worsens practice in a revised cognitive continuum J Adv Nurs safety and effectiveness of clinical. Of 15 statements was developed the BS and then the pain best source of when. Sentiment? now looking forward to develop the capability and learn the tactics critical! Novice nurses, clinical reasoning and decision-making are said to be put on use. Nurses ' developing and applying sound clinical judgement and decision-making is a trading of. Type of research by reading the article their everyday practice nursing is prevalent, errors in continue... The prostate gland and service users to whom we owe a duty of care and competency issues results in obstructing...: the importance of the decision making based not only harmful to patients but can also be used making! How to gain insight into what he believes is normal for his age decision... Then the pain tests and value results, vital signs B provide a framework for exploring. Between actual alternatives maintenance of an acceptable and stable weight is important to define the terms clinical in. Results in sputum obstructing airways, whilst dyspnoea may lead to poor outcomes! Assessing available options and clinical decision making in nursing examples effectiveness conducted to gain insight into what he is! Lymph nodes and the role as well as the Braden or Waterlow scales not mention.
Colorado State University Pueblo Men's Tennis 2019 To 2020, Pop N Music Characters, Isle Of Man Surnames, Ile De Batz Restaurant, Tiffin University Athletics, Prague Christmas Market 2021 2022,