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Library of Congress Cataloging-in-Publication Data
Names: Marquis, Bessie L., author. | Huston, Carol Jorgensen,
author.
Title: Leadership roles and management functions in nursing :
theory and
application / Bessie L. Marquis, Carol J. Huston.
Description: Ninth edition. | Philadelphia : Wolters Kluwer
Health, [2017] |
Includes bibliographical references and index.
Identifi ers: LCCN 2016046163 | ISBN 9781496349798
Subjects: | MESH: Nursing, Supervisory | Leadership | Nurse
Administrators |
Nursing—organization & administration
Classifi cation: LCC RT89 | NLM WY 105 | DDC 362.17/3068—dc23
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I dedicate this book to the two most important
partnerships in my life: my husband, Don Marquis,
and my colleague, Carol Huston.
Bessie L. Marquis
I dedicate this book to my husband Tom,
who has stood by my side for almost 45 years. I love you.
Carol Jorgensen Huston
REVIEWERS
Carol Amann, PhD, RN-BC, FNGNA
Nursing Instructor
Villa Maria School of Nursing
Gannon University
Erie, Pennsylvania
Andrea Archer, EdD, ARNP
Undergraduate Nursing Department
Florida International University
Miami, Florida
Cynthia Banks, PhD
Program Director, RN to BSN
Department of Nursing
Sentara College of Health Sciences
Chesapeake, Virginia
Dana Botz, MSN
Faculty, Department of Nursing
North Hennepin Community College
Brooklyn Park, Minnesota
Sharon Bradley, DNP
Clinical Assistant Professor
Director of Student Success
College of Nursing
University of Florida
Gainesville, Florida
Carolyn Brose, EdD, MSN
Associate Professor
MSN Program Director
Missouri Western State University
St. Joseph, Missouri
Beryl Broughton, MSN, CRNP, CS, CNE
Nursing Instructor, Nursing Education
Aria Health School of Nursing
Trevose, Pennsylvania
Suzette Cardin, PhD
Adjunct Associate Professor
School of Nursing
University of California, Los Angeles
Los Angeles, California
Fran Cherkis, DHSc
Associate Professor
Department of Nursing
Farmingdale State College
Farmingdale, New York
Alice Colwell, MSN
Assistant Professor
Department of Nursing
Kent State University Trumbull Campus
Warren, Ohio
Laura Crouch, EdD, MSN
Associate Clinical Professor
School of Nursing
Northern Arizona University
Flagstaff, Arizona
Karen Davis, DNP
Assistant Professor
College of Nursing
University of Arkansas for Medical Sciences
Little Rock, Arkansas
Karen Estridge, DNP, RN
Assistant Professor
Department of Nursing
Ashland University
Mansfield, Ohio
James Fell, MSN, MBA, BSN, BS
Associate Professor
Director
Department of Nursing
Baldwin Wallace University
Berea, Ohio
Rick García, PhD
Associate Professor
Faculty Fellow
Rory Meyers College of Nursing
New York University
New York, New York
Evalyn Gossett, MSN
Clinical Assistant Professor
School of Nursing
Indiana University Northwest
Gary, Indiana
Debra Grosskurth, PhD(c)
Assistant Chair
Department of Nursing
Salve Regina University
Newport, Rhode Island
Patricia Hanson, PhD
Professor
Department of Nursing
Madonna University
Livonia, Michigan
Tammy Henderson, MSN
Associate Director
Conemaugh School of Nursing
Conemaugh Memorial Medical Center
Johnstown, Pennsylvania
Barbara Hoerst, PhD, RN
Assistant Professor
Department of Nursing
La Salle University
Philadelphia, Pennsylvania
Brenda Kucirka, PhD, RN, PMHCNS-BC, CNE
Assistant Professor
Department of Nursing
Widener University
Chester, Pennsylvania
Coleen Kumar, PhD
College of Nursing
State University of New York Downstate Medical Center
Brooklyn, New York
Kathleen Lamaute, EdD
Professor
Department of Nursing
Molloy College
Rockville Centre, New York
Pamela Lapinski, MSN
Professor
Department of Nursing
Valencia College
Orlando, Florida
Jamie Lee, MSN, RN, CNL
Assistant Professor
Department of Nursing
James Madison University
Harrisonburg, Virginia
Carolyn Lewis, PhD
Assistant Professor
Department of Nursing
Angelo State University
San Angelo, Texas
Bette Mariani, PhD, RN
Assistant Professor
College of Nursing
Villanova University
Villanova, Pennsylvania
David Martin, MSN
Director
RN-BSN & Shared Curriculum Programs
School of Nursing
University of Kansas
Kansas City, Kansas
Donna McCabe, DNP, APRN-BC, GNP
Clinical Assistant Professor
Department of Nursing
Rory Meyers College of Nursing
New York University
New York, New York
Theresa Miller, PhD
Associate Professor, Nursing Education
OSF Saint Francis Medical Center College of Nursing
Peoria, Illinois
Donna Molyneaux, PhD
Associate Professor
Department of Nursing
Gwynedd Mercy University
Gwynedd Valley, Pennsylvania
LaDonna Northington, DNS
Professor, Traditional Undergraduate Nursing Program
University of Mississippi School of Nursing
Jackson, Mississippi
Sally Rappold, MSN, BSN
Assistant Teaching Professor
Department of Nursing
Montana State University
Missoula, Montana
Karen Ringl, MSN
Faculty
Department of Nursing
California State University, Fullerton
Fullerton, California
Joyce Shanty, PhD, RN
Associate Professor
Nursing and Allied Health Professions
Indiana University of Pennsylvania
Indiana, Pennsylvania
Jean Short, MSN
Assistant Professor
Division of Post-Licensure Nursing
School of Nursing
Indiana Wesleyan University
Marion, Indiana
Jennifer Sipe, MSN, CRNP
Assistant Professor
School of Nursing and Health Sciences
La Salle University
Philadelphia, Pennsylvania
Ana Stoehr, PhD, MSN
Faculty
Department of Nursing
George Mason University
Fairfax, Virginia
Patricia Thielemann, PhD
Professor
College of Nursing
St. Petersburg College
Pinellas Park, Florida
Charlene Thomas, PhD, MSN, BSN
Associate Professor
School of Nursing and Allied Health
Aurora University
Aurora, Illinois
Nina Trocky, DNP, RN
Assistant Professor
Department of Organizational Systems and Adult Health
School of Nursing
University of Maryland
Baltimore, Maryland
Brenda Tyczkowski, DNP, RN, RHIA
Assistant Professor
Professional Program in Nursing
University of Wisconsin Green Bay
Green Bay, Wisconsin
Dannielle White, MSN
Associate Professor
School of Nursing
Austin Peay State University
Clarksville, Tennessee
Mary Williams, MS
Associate Professor
School of Nursing and Health Science
Gordon State College
Barnesville, Georgia
Connie Wilson, EdD
Professor Emeritus
School of Nursing
University of Indianapolis
Indianapolis, Indiana
Kelly Wolgast, DNP
School of Nursing
Vanderbilt University
Nashville, Tennessee
Renee Wright, EdD
Assistant Professor
Department of Nursing
York College, City University of New York
New York, New York
Judith Young, DNP
Clinical Assistant Professor, Community and Health Systems
School of Nursing
Indiana University
Indianapolis, Indiana
PREFACE
Legacy of Leadership Roles and Management Functions in Nursing
This book’s philosophy has evolved over 35 years of teaching
leadership and management. We entered
academe from the acute care sector of the health-care
industry, where we held nursing management
positions. In our first effort as authors, Management
Decision Making for Nurses: 101 Case Studies,
published in 1987, we used an experiential approach and
emphasized management functions appropriate
for first-and middle-level managers. The primary audience for
this text was undergraduate nursing
students.
Our second book, Retention and Productivity Strategies for
Nurse Managers, focused on leadership
skills necessary for managers to decrease attrition and increase
productivity. This book was directed at
the nurse-manager rather than the student. The experience of
completing research for the second book,
coupled with our clinical observations, compelled us to
incorporate more leadership content in our
teaching and to write this book.
Leadership Roles and Management Functions in Nursing was also
influenced by national events in
business and finance that led many to believe that a lack of
leadership in management was widespread. It
became apparent that if managers are to function effectively
in the rapidly changing health-care industry,
enhanced leadership and management skills are needed.
What we attempted to do, then, was to combine these two very
necessary elements: leadership and
management. We do not see leadership as merely one role of
management nor management as only one
role of leadership. We view the two as equally important and
necessarily integrated. We have attempted
to show this interdependence by defining the leadership
components and management functions inherent in
all phases of the management process. Undoubtedly, a few
readers will find fault with our divisions of
management functions and leadership roles; however, we felt
it was necessary first to artificially separate
the two components for the reader, and then to integrate the
roles and functions. We do believe strongly
that adoption of this integrated role is critical for success
in management.
The second concept that shaped this book was our commitment
to developing critical thinking skills
through the use of experiential learning exercises. We propose
that integrating leadership and management
can be accomplished through the use of learning exercises.
The majority of academic instruction continues
to be conducted in a teacher-lecturer–student-listener
format, which is one of the least effective teaching
strategies. Few individuals learn best using this style.
Instead, most people learn best by methods that
utilize concrete, experiential, self-initiated, and real-world
learning experiences.
In nursing, theoretical teaching is almost always accompanied
by concurrent clinical practice that
allows concrete and real-world learning experience. However, the
exploration of leadership and
management theory may have only limited practicum experience,
so learners often have little first-hand
opportunity to observe middle-and top-level managers in
nursing practice. As a result, novice managers
frequently have little chance to practice their skills before
assuming their first management position, and
their decision making thus often reflects trial-and-error
methodologies. For us, then, there is little question
that vicarious learning, or learning through mock experience,
provides students the opportunity to make
significant leadership and management decisions in a safe
environment and to learn from the decisions
they make.
Having moved away from the lecturer–listener format in our
classes, we lecture for only a small
portion of class time. A Socratic approach, case study debate,
and small and large group problem solving
are emphasized. Our students, once resistant to the
experiential approach, are now enthusiastic
supporters. We also find this enthusiasm for experiential
learning apparent in the workshops and seminars
we provide for registered nurses. Experiential learning
enables management and leadership theory to be
fun and exciting, but most important, it facilitates
retention of didactic material. The research we have
completed on this teaching approach supports these findings.
Although many leadership and management texts are available,
our book meets the need for an
emphasis on both leadership and management and the use of an
experiential approach. More than 280
learning exercises, representing various health-care settings
and a wide variety of learning modes, are
included to give readers many opportunities to apply theory,
resulting in internalized learning. In Chapter
1, we provide guidelines for using the experiential learning
exercises. We strongly urge readers to use
them to supplement the text.
New to This Edition
The first edition of Leadership Roles and Management
Functions in Nursing presented the symbiotic
elements of leadership and management, with an emphasis on
problem solving and critical thinking. This
ninth edition maintains this precedent with a balanced
presentation of a strong theory component along
with a variety of real-world scenarios in the experiential
learning exercises.
Responding to reviewer recommendations, we have added and
deleted content. In particular, we have
attempted to strengthen the leadership component of the book
while maintaining a balance of management
content. We have also attempted to increase the focus on
quality and safety as well as health-care finance,
and used outpatient/community settings as the location for
more learning exercises.
We have also retained the strengths of earlier editions,
reflecting content and application exercises
appropriate to the issues faced by nurse leader-managers as they
practice in an era increasingly
characterized by limited resources and emerging technologies.
The ninth edition also includes
contemporary research and theory to ensure accuracy of the
didactic material.
Additional content that has been added or expanded in this
edition includes the following:
26 new learning exercises, further strengthening the
problem-based element of this text.
Over 200 displays, figures, and tables (17 of which are new)
help readers visualize important
concepts, whereas photographs of nurses in leadership and
management situations help students
relate concepts to real-world practice.
An expanded focus on evidence-driven leadership and
management decision making
Time management and productivity apps
Newer care delivery models focused on ambulatory care and
outpatient settings (primary care nurse
coordinator in medical homes, nurse navigators, clinical
nurse leaders [CNLs], leaders in patient-
centered care)
Impact of the 2010 Patient Protection and Affordable Care Act
(PPACA) on quality and health-care
finance in this country
The shifting in health-care reimbursement from volume to
value
Personality testing as an employment selection tool
Electronic health records and meaningful use
Reflective practice and the assessment of continuing
competency
Civility, healthy workplaces, and bullying
Interprofessional collaboration and workgroups
Working with diverse workforces and patient populations
Social media and organizational communication
New quality Initiatives put forth by the Centers for Medicare
& Medicaid Services, The Joint
Commission, and other regulatory bodies
Sentinel events
Lean Six Sigma methodologies
Medication reconciliation
Self-appraisal, peer review, and 360-degree evaluation as
performance appraisal tools
The Text
Unit I provides a foundation for the decision-making,
problem-solving, and critical-thinking skills as
well as management and leadership skills needed to address
the management–leadership problems
presented in the text.
Unit II covers ethics, legal concepts, and advocacy, which we
see as core components of leadership
and management decision making.
Units III–VII are organized using the management processes of
planning, organizing, staffing, directing,
and controlling.
Features of the Text
The ninth edition contains many pedagogical features designed
to benefit both the student and the
instructor:
Examining the Evidence, appearing in each chapter, depicts new
research findings, evidence-based
practice, and best practices in leadership and
management.
Learning Exercises interspersed throughout each chapter foster readers’ critical-thinking skills and
promote interactive discussions. Additional learning exercises
are also presented at the end of each
chapter for further study and discussion.
Breakout Comments are highlighted throughout each chapter,
visually reinforcing key ideas.
Tables, displays, figures, and illustrations are liberally
supplied throughout the text to reinforce
learning as well as to help clarify complex information.
Key Concepts summarize important information within every
chapter.
The Crosswalk
A crosswalk is a table that shows elements from different
databases or criteria that interface. New to the
eighth edition was a chapter crosswalk of content based on
the American Association of Colleges of
Nursing (AACN) Essentials of Baccalaureate Education for
Professional Nursing Practice (2008), the
AACN Essentials of Master’s Education in Nursing (2011), the
American Organization of Nurse
Executives (AONE) Nurse Executive Competencies (updated
September 2015), and the Quality and
Safety Education for Nurses (QSEN) Competencies (2014). For
this edition, the newly revised Standards
for Professional Performance from the American Nurses
Association (ANA) Nursing Scope and
Standards of Practice (2015) have been included. This
edition, then, attempts to show how content in
each chapter draws from or contributes to content identified
as essential for baccalaureate and graduate
education, for practice as a nurse administrator, and for
safety and quality in clinical practice.
In health care today, baccalaureate education for nurses is
being emphasized as of increasing
importance, and the number of RN-MSN and BSN-PhD programs is
always increasing. Nurses are being
called on to remain lifelong learners and move with more
fluidity than ever before. For these reasons, this
textbook includes mapping to Essentials, Competencies, and
Standards not only at the baccalaureate level
but also at the master’s and executive levels, so that nurses
may become familiar with the competencies
expected as they continue to grow in their careers.
Without doubt, some readers will disagree with the author’s
determinations of which Essential,
Competency, or Standard has been addressed in each chapter, and
certainly, an argument could be made
that most chapters address many, if not all, of the
Essentials, Competencies, or Standards in some way.
The crosswalks in this book then are intended to note the
primary content focus in each chapter, although
additional Essentials, Competencies, or Standards may well be
a part of the learning experience.
The American Association of Colleges of Nursing Essentials of
Baccalaureate
Education for Professional Nursing Practice
The AACN Essentials of Baccalaureate Education for
Professional Nursing Practice (commonly called
the BSN Essentials) were released in 2008 and identified the
following nine outcomes expected of
graduates of baccalaureate nursing programs (Table 1).
Essential IX describes generalist nursing practice
at the completion of baccalaureate nursing education and
includes practice-focused outcomes that
integrate the knowledge, skills, and attitudes delineated in
Essentials I to VIII. Achievement of the
outcomes identified in the BSN Essentials will enable
graduates to practice within complex health-care
systems and to assume the roles of provider of care;
designer/manager/coordinator of care; and member
of a profession (AACN, 2008) (Table 1).
TABLE 1 AMERICAN ASSOCIATION OF COLLEGES OF NURSING
ESSENTIALS OF BACCALAUREATE EDUCATION FOR PROFESSIONAL
NURSING PRACTICE
Essential I: Liberal education for baccalaureate generalist
nursing
practice
• A solid base in liberal education provides the cornerstone
for the practice
and education of nurses.
Essential II: Basic organizational and systems leadership for
quality
care and patient safety
• Knowledge and skills in leadership, quality improvement,
and patient
safety are necessary to provide high-quality health care.
Essential III: Scholarship for evidence-based practice
• Professional nursing practice is grounded in the
translation of current
evidence into one’s practice.
Essential IV: Information management and application of
patient-care
technology
• Knowledge and skills in information management and
patient-care
technology are critical in the delivery of quality patient
care.
Essential V: Health-care policy, finance, and regulatory
environments
• Health-care policies, including financial and regulatory,
directly and
indirectly influence the nature and functioning of the
health-care system
and thereby are important considerations in professional
nursing practice.
Essential VI: Interprofessional communication and collaboration
for
improving patient health outcomes
• Communication and collaboration among health-care
professionals are
critical to delivering high quality and safe patient
care.
Essential VII: Clinical prevention and population health
• Health promotion and disease prevention at the individual
and population
level are necessary to improve population health and are
important
components of baccalaureate generalist nursing practice.
Essential VIII: Professionalism and professional values
• Professionalism and the inherent values of altruism,
autonomy, human
dignity, integrity, and social justice are fundamental to the
discipline of
nursing.
Essential IX: Baccalaureate generalist nursing practice
• The baccalaureate graduate nurse is prepared to practice
with patients,
including individuals, families, groups, communities, and
populations
across the lifespan and across the continuum of health-care
environments.
• The baccalaureate graduate understands and respects the
variations of
care, the increased complexity, and the increased use of
health-care
resources inherent in caring for patients.
The American Association of Colleges of Nursing Essentials of
Master’s Education
in Nursing
The AACN Essentials of Master’s Education in Nursing
(commonly called the MSN Essentials) were
published in March 2011 and identified the following nine
outcomes expected of graduates of master’s
nursing programs, regardless of focus, major, or intended
practice setting (Table 2). Achievement of these
outcomes will prepare graduate nurses to lead change to
improve quality outcomes, advance a culture of
excellence through lifelong learning, build and lead
collaborative interprofessional care teams, navigate
and integrate care services across the health-care system,
design innovative nursing practices, and
translate evidence into practice (AACN, 2011).
TABLE 2 AMERICAN ASSOCIATION OF COLLEGES OF NURSING
ESSENTIALS OF MASTER’S EDUCATION IN NURSING
Essential I: Background for practice from sciences and
humanities
• Recognizes that the master’s-prepared nurse integrates
scientific findings
from nursing, biopsychosocial fields, genetics, public
health, quality
improvement, and organizational sciences for the continual
improvement
of nursing care across diverse settings.
Essential II: Organizational and systems leadership
• Recognizes that organizational and systems leadership are
critical to the
promotion of high quality and safe patient care. Leadership
skills are
needed that emphasize ethical and critical decision making,
effective
working relationships, and a systems perspective.
Essential III: Quality improvement and safety
• Recognizes that a master’s-prepared nurse must be
articulate in the
methods, tools, performance measures, and standards related
to quality, as
well as prepared to apply quality principles within an
organization.
Essential IV: Translating and integrating scholarship into
practice
• Recognizes that the master’s-prepared nurse applies
research outcomes
within the practice setting, resolves practice problems,
works as a change
agent, and disseminates results.
Essential V: Informatics and health-care technologies
• Recognizes that the master’s-prepared nurse uses
patient-care technologies
to deliver and enhance care and uses communication
technologies to
integrate and coordinate care.
Essential VI: Health policy and advocacy
• Recognizes that the master’s-prepared nurse is able to
intervene at the
system level through the policy development process and to
employ
advocacy strategies to influence health and health care.
Essential VII: Interprofessional collaboration for improving
patient and
population health outcomes
• Recognizes that the master’s-prepared nurse, as a member
and leader of
interprofessional teams, communicates, collaborates, and
consults with
other health professionals to manage and coordinate care.
Essential VIII: Clinical prevention and population health for
improving
health
• Recognizes that the master’s-prepared nurse applies and
integrates broad,
organizational, client-centered, and culturally appropriate
concepts in the
planning, delivery, management, and evaluation of
evidence-based clinical
prevention and population care and services to individuals,
families, and
aggregates/identified populations.
Essential IX: Master’s level nursing practice
• Recognizes that nursing practice, at the master’s level, is
broadly defined
as any form of nursing intervention that influences
health-care outcomes for
individuals, populations, or systems. Master’s-level nursing
graduates
must have an advanced level of understanding of nursing and
relevant
sciences as well as the ability to integrate this knowledge
into practice.
Nursing practice interventions include both direct and
indirect care
components.
The American Organization of Nurse Executives Nurse Executive
Competencies
In 2004 (updated in 2015), the AONE published a paper
describing skills common to nurses in executive
practice regardless of their educational level or titles in
different organizations. While these Nurse
Executive Competencies differ depending on the leader’s
specific position in the organization, the AONE
suggested that managers at all levels must be competent in
the five areas noted in Table 3 (AONE, 2015).
These competencies suggest that nursing leadership/management
is as much a specialty as any other
clinical nursing specialty, and as such, it requires
proficiency and competent practice specific to the
executive role.
TABLE 3 AMERICAN ORGANIZATION OF NURSE EXECUTIVES NURSE
EXECUTIVE COMPETENCIES
1. Communication and relationship building
• Communication and relationship building includes effective
communication, relationship management, influencing
behaviors,
diversity, community involvement, medical/staff
relationships, and
academic relationships.
2. Knowledge of the health-care environment
• Knowledge of the health-care environment includes clinical
practice
knowledge, delivery models and work design, health-care
economics
and policy, governance, evidence-based practice/outcome
measurement
and research, patient safety, performance
improvement/metrics, and risk
management.
3. Leadership
• Leadership skills include foundational thinking skills,
personal journey
disciplines, systems thinking, succession planning, and
change
management.
4. Professionalism
• Professionalism includes personal and professional
accountability,
career planning, ethics, and advocacy.
…
Week 6: What you should know #11
Chap 21—Conflict, Workplace Violence, and Negotiation
1. Define conflict and describe the benefits and risks of too much/too little conflict in an organization
2. What are the commons sources of conflict in an organization?
3. What types of conflict might a nurse see In a healthcare organization?
4. What are the stages occurring in conflict resolution?
5. What are the anticipated conflict resolution outcomes?
6. Name and define with an example of the 6 common resolution strategies
7. What are common causes of organizational conflict, as in a healthcare org.?
8. What are three strategies in conflict resolution that you have tried or can anticipate in your first nursing job?
9. Define bullying and incivility within the nursing profession (Lateral violence—also workplace violence)
10. What is negotiation as it relates to concerns in healthcare?
11. Name negotiating strategies that lead to conflict resolution
12. What are some destructive tactics that can damage a successful negotiation session?
13. Name three alternatives to negotiation…how do they work?
14. Describe the importance of consensus as a conclusion to conflict management
Chapter 24—Performance Appraisal
1. Describe the performance appraisal process, naming important factors to consider
2. Describe the factors influencing an effective appraisal—why are these important?
3. Describe salient strategies for a successful performance appraisal—why is implicit bias such an important criterion to master?
4. Define the terms associated with errors made in performance appraisals
5. Describe different types of performance appraisals—which would you prefer and why?
6. Describe the features of a successful performance appraisal session
7. Define and describe the management by objectives approach to performance appraisals
8. How does peer review work for performance appraisals? What are the potential downfalls?
9. Define strategies for being a successful coach to others
Chap 25—Problem Employees: Rule Breakers, Marginal Employees and the Chemically or Psychologically Impaired
1. What are the “do’s and don’t’s” of Rules in an organization?
2. Define, compare and contrast “Constructive Discipline” and “Destructive Discipline”
3. Name the criteria that must be present to make disciple fair and a growthful experience
4. Define strategies that create an atmosphere of self-discipline, the best approach to well- functioning organizations
5. Name the four common steps in Progressive Discipline
6. Describe a successful disciplinary conference for an employee
7. Describe the main elements in a termination/separation meeting
8. Define the formal grievance process? When is this most often used?
9. Define the rights and responsibilities of those involved in the grievance process (be sure to use your ATI reference)
10. Define and compare the disciplinary process for unionized employees
11. Chemical impairment—define and provide a profile of a chemically impaired nurse
12. What are the recommended ways to confront and support a chemically impaired employee?
13. What are the reentry guidelines for a previously chemically impaired nurse to return to practice?











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