September • October • November • December 2014
Compiled by | Jacqulyn Robison, BSN, RN, GRN Contact | Jacqulyn Robison BSN, RN, GRN P 308.630.1450 E Jacqulyn.Robison@rwmc.net 4021 Avenue B Scottsbluff NE 69361
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Table of Contents A Note From m the Editor
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age From Shirley A Messa
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e Safety Sense
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onall Development Professio
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esidency and Nurse Re
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Cliniical Coach Programs actic ces for Volunteer Best Pra
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Servvicess: Onboarding eakfast with Shirley Coffee & Bre
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ernance Updates Shared Gove
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Intellecttual Nourishment
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“Who Moved My Cheese?” (by Spencer Johnson)
Jacqulyn Robison Jacqulyn Robison, BSN, RN, GRN Survey Preparedness/Magnet Coordinator
We are all creatures of habit. We strive for routine and familiarity. So when someone changes our plans or the weather does not play out for what we expect the season to bring, (and we all know we have that, living in Nebraska) then we begin to panic. We clench and we get pretty defensive if the fork in the road appears. It is the fear of losing control and having our way. We also get complacent and comfortable. However, we can choose to deal with change differently. We can choose, that’s right, I said choose. We can anticipate that change is going to happen and be ready for when change comes about. It might not be the most ideal situation for change or the right timing, but instead of being apprehensive about change, we can embrace it. This change is bound to happen. If you have ever read the book “Who Moved My Cheese?” by Spencer Johnson, then you would understand that there are two types of people who work with change: the ones who embrace it and change with it in anticipation, or the ones who resist and get behind while still bearing feelings of resentment that life is not going the way they feel it should. Meaning they did not want the change, they did not ask for the change, and they certainly do not welcome the change with open arms. Expect that it just happens. However it is not always in our nature to accept it with open arms.
When looking at health care, change is bound to happen. You cannot escape it, you cannot outrun it, and you can definitely not prevent it from happening. If you’re one of those people who resist change, maybe it is time to look at your attitude and see what you can do with yourself and the attitude you have. I remember my father once telling me that VHS would never be replaced by DVDs. I looked at him and thought, “Seriously Dad, you’re crazy! DVDs are going to replace VHS and something else will change that.” Now look, we have blu-ray players, iClouds, Roku, Huluplus, Netflix, and you name it! Want the latest iPhone or android? Okay well once you buy it after six months it will be old news because something else is going to be marketed as better. Health care should be viewed the same way. There are better and better standards being placed with more competitive schools that are educating the different health care professionals. Same goes for insurance companies. It is all competition. So why wouldn’t we change so that we can be the best? Not only would we be the best, but we would be showing our patient population why we provide safe and quality care. If you’re on the fence about how to deal with change or just curious about change in this world, my recommendation would be to read the book, “Who Moved My Cheese?” Are you one who anticipates change or do you resist it? Change is inevitable. Respectfully,
Jacqulyn Robison 4
Hardwiring the Use of Two Patient Identifiers
Shirley Knodel SHIRLE Y KNODEL, MS, RN Chief Nursing Officer Vice President, Patient Care
Recently I was visiting a family member who was hospitalized in a large, well-recognized, and well-respected hospital. While I was in the room, a team of people came to round on my family member. The team was comprised of a surgeon and residents. The surgeon discussed the plan of care with us and left. Soon after, the nurse caring for our family member came in the room and said that due to his complaints of neck pain he would be going to CT to figure out what was causing the pain. We said, “What? Our family member told her he didn’t have neck pain.” We asked the nurse to call and check with the ordering provider and sure enough, the CT was for someone else but had been entered on our family member’s chart.
is far from the only time the two identifiers should be used. If blood is being drawn or given; when entering orders into a medical record; or when performing any type of test, procedure, or treatment, it is crucial to follow the use of at least two patient identifiers. Even when reviewing items in the medical record upon which decisions are based, we need to use two identifiers to make sure we have the right person’s record open. It takes all of us committing to the safety of our patients to hardwire into our practice the use of at least two patient identifiers. We need to cross monitor each other to make sure we are putting patient safety first.
We think of the need for two patient identifiers typically being necessary for use by the nurse when giving medications, but that
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As we head into 2015 we will be focusing on teamwork – how we work together as a team in order to provide safe, quality, and efficient care. In order to do that, we must function well as a team. So, what are some characteristics of a wellfunctioning team? I posed that question to our safety coaches and here are some characteristics they came up with:
Susan Backer SUSAN BACKER, MSN, APRN-CNS, ACNS-BC Patient Safety Officer/Clinical Nurse Specialist
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Clear communication Mutual respect Trust No egos Listening skills Cooperative/collaborative Working toward a common goal
We’ve already started working on the “Team” approach by introducing the MyCRU concept. Take a look at the logo at the beginning of this article. CRU stands for Cooperative, Respectful, Unified. High functioning teams display these characteristics and more. We know that the team approach (CRU approach) enhances reliability in health care organizations. Reliability is providing the right care to every patient, every time. The standard CRU tools are fully compatible and intended to extend the safety tools we already use. CRU tools promote:
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Thinking – Preventing misjudgment and decision-making errors
Thinking together – Anticipating and managing the unexpected; preventing group-think Resiliency – Recognizing when the team is off the success path and getting back on the right path. The CRU toolkit has 5 Tones that help to reduce power distance and manage authority gradient and 5 Tools that are designed to help prevent human error. The 5 Tones are characteristics and behaviors that help us work together more effectively. If we treat others following these tones, it makes it easier for members of the team to ask questions and speak up when something is not right. The 5 Tones are taken from our Standards of Behavior (policy #205.0.01). Respect: Treating others with respect in all situations Caring: Treating others in a caring and empathetic manner Integrity: Demonstrating honesty, trust, and confidentiality in all situations Competency: Maintaining knowledge and skill Teamwork: Positively working together to always do what is best for the patient
Let me explain each one in further depth RESPECT – Respect is honoring and valuing others by being courteous, polite, and civil. It is a formal expression or gesture of greeting or friendship. We treat others with respect in order to manage authority gradient, so all team members feel safe to ask questions and raise concerns. Here are some ways to show respect: • Smile and greet others by their preferred name. • Speak clearly and confidently, make eye contact, say my name, and state my role. • Treat others as I would like to be treated. • Honor each other’s differences as individuals and as departments. • Exercise teamwork. • Make others feel important regardless of how busy I am. • Refrain from swearing or using rude gestures. • Take the time to follow up on concerns promptly. CARING – Caring for others shows honest concern and compassion towards them. Genuine caring helps to build trust and promote positive relations that enhance working together in a cooperative, respectful, and unified manner, whether that be with the patient, family, or co-workers. Here are ways to show genuine caring: • • • •
Take time to focus on the person and listen to what he or she has to say. Make eye contact while offering assistance and showing compassion. Use clear, familiar, easy-to-understand words. Be courteous in verbal, non-verbal, and written communications.
INTEGRITY – A person with integrity displays characteristics such as honesty and respect. People with integrity are dependable and reliable in their work habits and relationships. Integrity builds trust and respect with co-workers, teammates, patients, and families. Integrity is an important characteristic to have in order to work effectively as a team. Ways to show integrity: • Protect privacy and confidentiality. • Listen to teammates’ questions, concerns, and thoughts without interrupting.
• Make no excuses and blame no other person or department. • Project a positive attitude. • Follow through with commitments. COMPETENCY – Possessing the required skills, knowledge, and capacity to perform one’s professional duties. Competency adds value to the team. It enhances my ability to work effectively with the team to provide safe, quality care to patients. Ways to develop and maintain competence: • • • • • • • •
Follow hospital and departmental policies and procedures. Complete mandatory continuing education. Maintain licenses and certifications. Actively participate in department and/or hospital wide activities or committees. Commit to lifelong learning. Support Evidence-Based Practice. Coach and cross monitor team members to be the best they can be. Ask for help when I don’t know.
TEAMWORK – A cooperative or coordinated effort on the part of a group of persons acting together in the interests of a common cause. Effective teamwork provides the safest, highest quality care in the most efficient manner possible. Teamwork characteristics: • Treat others with respect and caring. • Act with integrity in every situation. • Maintain knowledge and skills in my respective profession and job responsibilities. • Coach and cross monitor teammates. So, take time to reflect on the 5 Tones and your behavior within the team (CRU). Identify who your CRU is and the role you play within the CRU. Do you practice each of these ‘tones’ in order to be an effective team member?
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Hope Hansen Hope Hansen previously worked in the OR as a certified scrub tech. She graduated in May from the University of Nebraska Medical Center with her BSN degree. She has been accepted to the UNMC Master’s program. Congratulations Hope! Why did you decide to continue on with college and what do you hope to do in the future? After experiencing a severe family illness that resulted in success only from a surgical procedure, I knew that was the world I wanted to be a part of. I enjoyed working as a Certified Surgical Technologist here at Regional West and was able to observe several nursing roles. I knew I wanted to expand my knowledge and practice in health care, so I decided to go back to school to become a nurse and eventually a nurse practitioner. This fall I started working on my Master’s of Nursing degree in UNMC’s Family Nurse Practitioner program.
What are your hobbies? My hobbies include running or spending time at the YMCA and participating in a local band as the lead singer. What is your background? I am originally from the Sandhills, north of Ashby, Neb. After graduating from Western Dakota Tech. with my Associates in Surgical Technology, I began working in surgery at Regional West Medical Center in 2010. I then completed my Bachelors in Human Science from Chadron State College in 2012 and in May 2014 I graduated from UNMC’s Accelerated BSN program. Currently, I am enjoying my time as an RN in PACU while taking graduate nursing classes from UNMC.
Kim Mann Kim Mann works in the main OR and has been accepted into the MSN LEAD Program provided by the University of Nebraska. Congratulations Kim! Why did you become a nurse? I decided to become a nurse after my dad was admitted to this hospital when I was in high school. The care he received was awesome and really inspired me to take my career path in that direction. What are your hobbies? Right now my hobby is my two year old, Ryleigh! She takes up pretty much the majority of my time when not studying.
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I also am an Independent Designer of Origami Owl, which I really love and it helps me to have some sort of balance in my life outside of work and home. Why did you decide to go on in school? I had always been thinking that some point in my career I wanted to get my MSN degree, so I just decided to go for it. Why wait any longer?!
Dayna Dondelinger Dayna Dondelinger, who works in the main OR, has been accepted into the MSN LEAD Program provided by the University of Nebraska. Congratulations Dayna! What is your background? I have been a surgical nurse for seven years after working as a perioperative assistant while I was in school.
recently implementing healthy lifestyle changes. I also have the privilege of being able to spend time and help take care of my grandparents.
Why did you become a nurse? When I was in junior high, both of my grandfathers were diagnosed with cancer within six months of each other. During that time, I took notice of the wonderful nursing care they both received and knew that I wanted to pursue a career in medicine. Through out my undergraduate college career, I was on the track for med school and worked at the hospital in the sterile processing department where I first discovered the aweinspiring world of surgery. After graduation and through a series of highly orchestrated events that happened in my life, I moved back home, got engaged, and started work as a preoperative assistant in surgery at Regional West Medical Center. During that time I was encouraged by family and co-workers to look into nursing school. I was accepted and during school I continued to work in surgery. I discovered my passion for not only nursing, but for surgery, and realized that surgical nursing is what I was designed to do.
Why did you decide to go on in school? I knew after graduating from nursing school that eventually I would like go back and get my masters degree, but I was unsure what I wanted to do with a masters in nursing. Then last year, an email was sent out about the LEAD program offered by UNMC, which is an online master’s program that can be worked through part time. The LEAD program appealed to me because I thought that it was a logical step to take in my career to continue lifelong learning, to challenge myself, and to see what the future could bring.
What are your hobbies? My hobbies include reading, scrapbooking, and crafting when time allows, working on fixing up our house with my husband, spending time with family and friends, and
What is your background? I have lived in this area all my life. I grew up on our family farm north of Mitchell and attended Mitchell High School. I attended a year of college at Chadron State before transferring to the University of Nebraska at Kearney, where I received my Bachelor of Science degree in Biology, and then I attended UNMC College of Nursing in Scottsbluff where I received my BSN degree. I have been married to my amazingly, supportive husband for 10 years, we live in Gering, and have a little Yorkie dog named Baxter.
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Seedy Sarr Seedy Sarr is a new graduate RN who works on 2 East, Ortho Neuro unit. Congratulations Seedy! Why did you become a nurse? Coming from the county of Gambia in Africa, which continues to struggle in terms of good medical care, I have a strong vested interest in making a difference in the lives of people. In that vein, I believe a quality education in health care will be an ideal venture, and I am convinced that there is no better place to build my potential in a health profession than the United States. I had the opportunity to work as a nurse’s aide, and this helped me develop a great deal of interest in working with people. I believe I can play a positive role in any society I find myself and being a nurse no doubt helps transcend boundaries in providing care to the very diverse and dynamic world we live in. What are your hobbies? My hobbies are playing soccer, watching the news, and spending time with family and friends. Would you consider going on for RN certification or continuing on with your degree? If yes, what are you interested in? My interest right now is to work on my bachelor’s degree and continue to climb the academic ladder of the health profession. I continue to have great interest in maximizing my human potential to be able to play a team role in the well-advanced medical environment found in the
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United States. One day I hope I will be able to export the knowledge, experience, and expertise I have gained to my country and continent, which are well in need of such opportunities. What is your background? I am from The Gambia, the smallest country on mainland Africa. I came to the United States four years ago with a vision to advance my education. I was lucky to earn a soccer scholarship from Western Nebraska Community College and other academic scholarships from some great people of this unique community in helping me get closer to my dreams. I was a teacher in St. Peter’s High School in Gambia, which was located in my home town, Lamin, prior to travelling to the United States. I am from big family where the idea of a family extends beyond the people you are related to, but also encompasses the people you live with. The Gambian culture is very diverse, consisting of at least nine different local languages and unique in a sense that its people are very friendly, earning the name “The smiling coast of Africa.” Coming to America was a big journey in my development as an individual, and I am glad to be part of this great community of people. I am proud and humbled by my achievements in this country, and I am eager to give back to this community that made me what I am today.
Kim Meininger Kim Meininger, BSN, RN Nurse Education Coordinator
Nurse Residency and Clinical Coach Programs Core Curriculum for Clinical Coaching A clinical coach training workshop took place October 16 and 17. People attending this workshop included: Heidi Walker, Shannon Anderson, Lisa Descharme, Cindy McCabe, Debbie Watson-Allen, Shawna Conn, Kim Lilley, Julie Meier, Jake Talley, Janelle Martin, Michelle Cramer, Danielle Dorshorst, Lydia Alvarado, Shannon Hultengren, Shannon Brown, Lynn Clapper, Erin Newens, and Brittany Feagler. The workshop helped existing nursing staff improve their skills in teaching, coaching, and mentoring while providing a supportive workplace environment to assist nursing graduates and other new RN hires in their transition to practice. The preceptor, or clinical coach, is an experienced nurse who orients staff to their unit roles and responsibilities, and also directs the new staff member in the customs, culture, and norms of
their assigned workplace. During the workshop, each clinical coach received information related to teambuilding and group dynamics, conflict management, adult learning theories and learning styles, competency assessment, and how to foster critical thinking in the novice nurse. Storytelling is also part of this program, since we all learn from each other’s experiences and professional growth. The clinical coaches’ roles and responsibilities include being: 1) A role model 2) A protector for staff and patients 3) An educator 4) A socializer 5) An evaluator
time management, leadership skills, patient education, and integrating knowledge with research and evidence-based practice. The clinical coach evaluates each of these eight core competencies in a performance-based outcome manner. This clinical coach development would not be successful without the following nurse educators and nurse leaders: Rhonda Groshans, Tammi White, Julie Schaff, Alicia Kunz, Alice Fillingham, and Summer Parker. Thank you for investing your time into this organization’s staff development.
Each clinical coach utilizes a standardized competency documentation tool, which includes eight core competencies that each nurse is required to perform in a safe and effective manner. These eight core competencies include: assessment and interventions, communication, critical thinking, human caring relationships,
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Janelle Debes Janelle Debes Assistant Director of Volunteer Services and Guest Relations
Best Practices for Volunteer Services: Onboarding Regional West Health Services volunteers are located throughout the hospital, assisting many different departments with a variety of tasks. There are over 300 volunteers who dedicate their time and talents to Regional West Health Services. Volunteers can be found at our main entrances, Gift Shop, Emergency Department, Occupational Health, Human Resources, Acute Rehab Unit, flower den, as well as many other areas. While we see the volunteers every day, do we actually know what it takes to be a volunteer in a health care setting? Across the nation, volunteer programs are being surveyed by The Joint Commission, as well as other agencies. There are quality practice standards that must be achieved to be compliant. In order for volunteers to effectively impact our hospital, they are required to complete an extensive process focusing on proper screening, placement, training, and ongoing education.
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To give you an idea of what a volunteer file audit would consist of by Joint Commission requirements, listed below are the minimum requirements. Keep in mind that once all of this is completed by the volunteer, it is then tracked electronically and stored in his or her volunteer file. • • • • • • • • • • • • •
Application References Interview Background check General orientation (Consists of information about the hospital, policies, procedures, etc.) HIPPA Standards of Behavior Customer service training Infection control Emergency preparedness procedures Service descriptions (like a job description) Health screen Service specific orientation and training
The volunteer onboarding process has to mimic that of the employment process and it doesn’t
stop there. Volunteers are then required to have annual evaluations, annual competency tests, and complete trainings throughout the year. While all the above is necessary, it does not assure that the department will pass a survey. Successful completion of a survey depends on the communication between departments regarding changes that will possibly affect volunteers, the ability to provide documentation, the willingness of the volunteers to complete the mandatory requirements, and much more. An excellent resource to maintain constant readiness for volunteer programs is through the American Hospital Association- Association for Healthcare Volunteer Resource Professionals (AHVRP). This association is helping volunteer programs reach out across the nation to understand and achieve best practices for volunteer services. I encourage everyone to really understand what it takes to volunteer and please thank our volunteers for their willingness to do all of the necessary requirements.
Coffee
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October 28 Attending: Katherine Tuttle, Bobbi Decker, Bette Griffiths, Kailoni Conklin, Lucrecia Spady, Jacqulyn Robison
During coffee with Shirley, the nurses were able to give their input on what qualities they would envision for the Surgery Departments’ new director after current director Janet Lewis retires. These were the top characteristics they shared: a background with clinical experience, someone who is hands-on, they get to know the staff, and have involvement at all levels of the Surgery Departments. They expressed their feelings of seeing Janet Lewis retire, as she has brought so much to the group, but understand that change is inevitable and it will be time to write a new chapter within their surgical crew members.
November 25 Attending: Kari Flom, Nancy Ross, Connie Morrill, Shannon Hultengren, Jacqulyn Robison
During this breakfast, the staff had the chance to speak on the process of building the new EMR system called Paragon. This computer charting system is set to roll out in June 2015. This discussion brought about topics like: hours needed to train on the new system, interfacing the different IT platforms, having the capability
With that, there will be some anticipated changes in hiring new team members for Regional West. There is going to be a new nurse recruiter starting with our organization who will help work on hiring nursing staff for the inpatient areas. He or she will also complete staff surveys and exit interviews on staff when they leave the organization. This role will bring about great opportunities in hiring and retaining hands-on nursing staff. Other topics that usually come to mind during nursing discussions include money. The overall budget will always be something all organizations must look at because it is how we survive as a business and continue to provide excellent care to our patients. This means we look at our equipment contracts, adjust our staffing needs that will not influence patient care, examine the areas where we might waste and figure out a way to reduce those costs, and now we have expanded our nursing float pool. The float pool gives their nurses an opportunity to cross-train and to learn a multitude of skills. The fluidity of these nurses helps to fill the nursing gaps in different areas where peaks and valleys may be seen in the patient census. It creates an efficient environment for the staff to work in as well. of pre-order sets, and realizing that in the beginning of a new system there will be bugs to fix. Change is not easy, especially with a new charting database, but the front-line staff here at Regional West is spending many hours to ensure the new system will fit the needs of the staff and to provide quality patient care. Next there was discussion on expanding the use of LPNs versus nursing assistants. With changes in health care and nursing turnover increasing, there may be advantages in hiring more LPNs within the hospital setting. This would take research and integration of making sure the LPN is practicing within his or her scope of practice under the RN. We know that the acuity of patient care is on the rise as patients get sicker and sicker, but if we can utilize LPNs into the nursing team, it may be an asset.
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Shared Governance Update With Shared Governance there have been new members elected under each council for the 2014-15 year. Each council has a new chair and co-chair. Congratulations to each of you and thank you to each member who served during the 2013-14 year. Coordinating Council Chair: Michelle Powell Chair-elect: Tara Shallenberger Quality & Safety Council Chair: Michelle Powell Chair-elect: Jody Walter Professional Practice Council Chair: Tara Shallenberger Chair-elect: Pam Engelhaupt Care & Practice Council Chair: Liz Ossian Chair-elect: Ellen Otto Night Shift Council Chair: Matt Blaylock Chair-elect: n/a Nurse Finance Council Chair: Vickie Schmall Chair-elect: Kim Smith
The Quality & Safety Council has been working on its health care worker fatigue project. The results have been collected and will be shared with the hospital’s leadership with suggestions on how to cut down on fatigue. There are some recommendations that play a part of how to do this, but it will take time to make suggestions for this project. Some suggestions that have come to mind but have not been set in stone include: encouraging breaks and lunch breaks, as well as limiting the amount of consecutive shifts that are allowed for scheduling. These are just ideas at this time that have been discussed. Professional Practice Council just compiled their color-coded nursing scrub project and has sent off their recommendations for implementing the color-coded scrubs for the nursing positions. This would include RNs, LPNs, and CNAs to wear their respective color to match their title. This will assist patients in identifying who the RN is as well as any faculty working throughout the facility. The recommendations will be posted before the staff and the expectation will be that by June 1, 2015, each nursing title has bought their respective scrub color. They will then wear their assigned color to work in the inpatient areas.
refresher course on documenting intakes/outputs and daily weights. This PowerPoint will be for the nurses and nursing assistants who work on the inpatient units. It will help remind them where to document the correct assessments and what to do with their assessments to provide safe patient care. This will be imperative with some of our patients who present with cardiac or renal diagnoses but are not limited to just these two. The council also hosted the nursing speaker in October. This was a belated Nurse’s Week event that also included an invitation to all staff members throughout the hospital and clinic. Karyn Buxman was the event speaker and has a background in surgery nursing and teaching. She began speaking for audiences of all backgrounds with her target being health care members, and her twist is to add humor to her events. The three sessions were well attended with staff from all across the different departments. There were treats, door prizes, and laughter through the two days of the event. Karyn was well liked and she was able to have employees sit back and enjoy life while she kept them entertained during the 90-minute sessions.
Care and Practice Council has been creating a PowerPoint for SWANK (the online education system for staff) that will be a
Intellectual Nourishment “Everyone you meet is fighting a battle you know nothing about. Be kind. Always.” – Anonymous
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