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DELOS EBPWearefinallyfinished
DELOS EBPWearefinallyfinished
”
Filipino Nurses Coping through Shortage Crisis
Submitted by:
Layco, Michael P.
Lleva, Aprille Jan C.
Lopez, Yvette Katrina Louise Y.
Mañalac, Royce Myka A.
Miranda, Leslie Pauline B.
Morales, Rikki Mae E.
Padrique, Aurelie Jane P.
Parac, Cristine Jay S.
Prodigalidad, Zxiakira C.
Rodriguez, Gwyn Aaliyah Drew C.
Submitted to
Evelyn A. Constantino, RN, MAN
Page
I. Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
II. Problem Statement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
III. Evidences . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
A. Evidence 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
B. Evidence 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
C. Evidence 3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
D. Evidence 4 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
E. Evidence 5 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
IV. Synthesis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
V. Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
VI. Recommendations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
VII. References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
VIII. Appendices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
IX. Excerpts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
1
I. INTRODUCTION
Despite being the leading global exporter of nurses, the healthcare sector in our country
continues to grapple with the ongoing crisis. According to Professional Regulatory Commission
(2023), there are 951,105 registered nurses but only 509,297 are active. Since pandemic
approximately 40% of nurses working in private hospitals have chosen to resign. As a result, there
is a concern that hospitals in the Philippines might be facing understaffing issues due to the
declining number of nurses during this challenging period (Alibudbud, 2022).
The crisis of nursing shortage and scarcity may appear to be a simple problem, but the
underlying causes and consequences are far more complicated. This pattern represents an ongoing
cycle characterized by growing demand and a continuous decreasing supply of nurses. The effect
of this crisis has profound implications for both healthcare recipients and the healthcare system as
a whole (Salmond, S. & Echevarria, M., 2017). Several factors contributing to this crisis is growing
patient demands, budget constraints, nurses' burnout, and job dissatisfaction.
Most of the existing research indicates that hospitals can benefit financially from
implementing safe staffing practices. When hospitals rely too heavily on temporary nurses and
experience high turnover rates, it raises the average cost per patient discharge and overall operating
expenses. By adopting safe staffing policies, hospitals can enhance the performance of nurses,
lower patient mortality rates, decrease turnover rates, cut staffing costs, and minimize liability
(Barrows, K., 2020).
2
patient outcomes, and maintain the sustainability of private tertiary hospitals in providing high-
quality healthcare services. Furthermore, the purpose of this study is to provide answers to the
following specific questions:
1. How can understaff hospital affects its performance towards patient care?
1.1 Does having enough staff makes a bigger difference in hospital management?
III. Evidences
When the “heroes” “don’t feel The aim of this study is to If these issues are not resolved,
cared for”: The migration and maintain the liberties, rights, and health care employees may quit
resignation of Philippine nurses reasonable living conditions of their profession and
amidst the COVID-19 pandemic healthcare professionals, as organizations to pursue
demonstrated by the status of opportunities where their labor is
Filipino nurses in the Philippine valued and their rights are
healthcare system during the maintained
COVID-19 pandemic.
Managing a Stressful Work The aim of this study was to Along it’s description in the
Environment through Improved describe nurses' experiences of working environment in the
Teamwork - A Qualitative their working environment in emergency departments at a
Content Analysis of Nurses emergency departments at a general hospital in Manila there
Working Environment within general hospital in Manila, are factors that affect the nurses
Emergency Care Philippines. quality of care and one of them is
shortage of staff nurses. In here
3
they also described the strategies
and solutions that they have
implemented to keep the
standard of nursing care high.
Short Staffing Nurses: A Major This paper addresses the problem The negative impact of short
Contemporary Issue in the of short staff nurses, it’s effect on staffed nursing personnel is very
Medical Field the nurses themselves and as a dire and not only affects the
career. nurses themselves but the
institution and quality of patient
care.
A systematic review study on This study aimed to determine The various factors
the factors affecting shortage factors that influence the influencing the nursing
of nursing workforce in the nursing workforce shortage workforce shortage, such as
hospitals and their impact on nurses. policy and planning barriers,
barriers to training and
enrolment.
Reasons and Potential The aim of this scientific The German hospital
Solution Approaches for the paper is to find out the reason approaches the problem by
Shortage of Nursing Staff in why they are short staffed in establishing various financial
German Hospitals German and provide a supports for hospitals, the
solution to approach the financial status of the hospital
problem. is improved, making it simpler
for hospitals to train
apprentices and hire nurses.
4
Evidence 1: When the “heroes” “don’t feel cared for”: The migration and resignation of
Philippine nurses amidst the COVID-19 pandemic
Strengths:
• Despite our nurses not being valued, the nurses are still willing to do their duties in order
to give medical attention and provide care to their patients.
Weakness:
• Nonetheless, even though there has been a solution to the problem there still met with
confusion, dismay, and disappointment in the implementation.
Opportunities:
• Improvements have been done by increasing the daily allowance of the health care
workers for the patients with COVID-19.
Threats:
• It has been said that if these were not addressed then the health care workers may seek
other opportunities where they are valued, and their rights are upheld.
Strengths:
Weakness:
• Faster familiarization of different team strategies in providing high quality health care.
Threats:
Evidence 3: Short Staffing Nurses: A Major Contemporary Issue in the Medical Field
Strengths:
• The first step is to preserve the ones that we already have, by advocating for our fellow
nurses and spreading the word that short staffing would just aggravate the situation.
Weakness:
• Low staff nurse results in higher patient to nurse ratio. Which can make more chances to
have an error in time of medication administration.
Opportunities:
• Multimedia initiative to promote careers in nursing and polish up the image of nursing.
And cooperate with other medical institutions to expand the capacity of schools to accept
nursing students.
Threats:
• Increased workload with no added benefits can lead to burnout and resignation of staff
nurses.
6
Evidence 4: A systematic review study on the factors affecting shortage of nursing workforce
in the hospitals
Strengths:
• As the lack of nurses continues patient outcomes and clinical care will be challenged.
Weakness:
Opportunities:
Threats:
• Age and environment can contribute to the shortage of the nursing workforce.
Evidence 5: Reasons and Potential Solution Approaches for the Shortage of Nursing Staff in
German Hospitals
Strengths:
• To summarize, the hospitals focus on the main problems that need to be addressed
properly.
Weakness:
• Low job salaries, high amounts of stress, having no time with family, and missing more
opportunities are the main reasons for short staff.
Opportunities:
7
• The hospital improved their shortage of nurses by introducing various forms of financial
assistance to hospitals, which makes it simpler for them to train apprentices and hire
nurses. Additionally, minimum nursing staff standards have been implemented in some
wards and will be implemented in more wards in the future.
Threats:
• Additional problems, like the unsatisfactory Work-Life Balance, are more challenging to
resolve since they are more difficult to change.
IV. Synthesis
A. SWOT Analysis
SWOT ANALYSIS
Strengths Weakness
• Nonetheless, even though there has
• Despite our nurses not being valued, been a solution to the problem there
the nurses are still willing to do their still met with confusion, dismay, and
duties in order to give medical attention disappointment in the implementation.
and provide care to their patients. • Less personal time and unequal work-
• Implementation of efficient teamwork life balance.
to facilitate high-quality care and • Low staff nurse results in higher patient
improved skills inventory of the nurses. to nurse ratio. Which can make more
More cohesiveness and relation with chances to have an error in time of
each other resulting in improved medication administration.
communication for faster care of the • Poor planning from the management,
patients. incompetent implementation of plans
8
• The first step is to preserve the ones and inadequate workforce planning and
that we already have, by advocating for recruitment.
our fellow nurses and spreading the • Low job salaries, high amounts of
word that short staffing would just stress, having no time with family, and
aggravate the situation. missing more opportunities are the
• As the lack of nurses continues patient main reasons for short staff.
outcomes and clinical care will be
challenged.
• The issue of the shortage of nurses
must be addressed because of
improving the way patients respond to
these treatments.
• To summarize, the hospitals focus on
the main problems that need to be
addressed properly.
Opportunities Threats
• Improvements have been done by • It has been said that if these were not
increasing the daily allowance of the addressed then the health care workers
health care workers for the patients may seek other opportunities where
with COVID-19. they are valued, and their rights are
• Faster familiarization of different team upheld.
strategies in providing high quality • Managing a stressful work
heath care. environment that is an imbalanced
• Multimedia initiative to promote ratio of nurses to patients.
careers in nursing and polish up the • Increased workload with no added
image of nursing. And cooperate with benefits can lead to burnout and
other medical institutions to expand the resignation of staff nurses.
9
capacity of schools to accept nursing • Age and environment can contribute
students. to the shortage of the nursing
• A detailed review of the factors that can workforce.
be used as a guide. • Additional problems, like the
• The hospital improved their shortage of unsatisfactory Work-Life Balance, are
nurses by introducing various forms of more challenging to resolve since they
financial assistance to hospitals, which are more difficult to change.
makes it simpler for them to train
apprentices and hire nurses.
Additionally, minimum nursing staff
standards have been implemented in
some wards and will be implemented in
more wards in the future.
Furthermore, developing good strategies where nurses can be influenced to work within
the hospital may address the crisis of understaffed nurses. The issue regarding this should be
addressed immediately to improve the way patients respond to the treatments. Studies suggested
that preserving what we already have, advocating for our fellow nurses, and disseminating news
about the shortage of nurses in tertiary hospitals would be able to help them in sorting out the
problem. The public's access to healthcare would improve if methods were developed to resolve
the shortage of nurses as they would be more motivated and passionate in providing standard of
patient care. It is advisable to acknowledge the issue that contributes to the shortage of nurses
while addressing it in order to decide on a measure that will help to resolve the problem. Instances
such as multi-media campaigns to promote career opportunities for nursing graduates and improve
nurses' credibility. Working together with other medical organizations to increase the total number
of nursing students that universities can acknowledge would be gladly recognized in order to
response on expanding understaffed nurses in tertiary hospitals. Additionally, the hospital may
introduce different forms of financial assistance to hospitals to make it simpler for them to train
apprentices and hire nurses.
V. Conclusion
Overall data shows that Philippines’ hospitals are in crisis of understaffed especially
during the pandemic. This factor affects not only the performance of the hospital but also the
workers who worked for exceeded time due to lacking staff. Fortunately, fellow Filipino nurses
drawn resilience upon the situation. This implies that the hospital should open to such critics in
systematic distribution of roles of staffs and the government to take action with regards to this
matter.
Even though every year a lot of fresh graduates of BS Nursing in the Philippines yet choose
to migrate and work abroad. Efforts of some hospitals in strategic ways to influence work in the
11
hospital is one of the possible ways to dealt understaffing under healthcare industry. However,
factors such increased workload, less benefits, underpaid, and less communication within the
patients and colleagues could lead to resignation of some of the nurses, increasing unemployment
rate in healthcare industry. This can also contribute towards the care of the patient to be not in good
shape.
VI. Recommendations
This evidence-based practice had drawn recommendations upon means to amends the needs of the
Filipino Nurses in serving the community.
FOR STUDENT NURSES. Don’t be afraid to volunteer in government programs such as Red
Cross first aid training and online presentations about communicable diseases for community
awareness for example. This will sharpen nursing skills and thinking.
FOR THE HOSPITAL. The study shows that hospitals that are understaffed affects service to the
people. Suggestive to enhance strategic staff distribution as well as a program such “Kamusta ka?”
as a way to also check the staffs’ mental health.
FOR THE GOVERNMENT. This study implies the Filipino nurses cry in surge of understaffed
hospitals in the Philippines. Suggestive measures such laws, seminars for newly registered nurses
on coping and instill programs for fresh graduates to allow them to take assistive jobs in the
hospital as temporary before passing board exams.
VII. References
Getzzg. (2022). When the “heroes” “don’t feel cared for”: The migration and resignation of
03011
12
GMA News Online & GMA News. (2023, March 27). PRC: Only 59.7% of Philippines’ doctors
Online. https://www.gmanetwork.com/news/topstories/nation/865188/prc-only-59-7-of-
philippines-doctors-practicing-nurses-only-53-
55/story/#:~:text=In%20his%20presentation%2C%20Enad%20showed,percent%20or%2
064%2C475%20are%20practicing.
Salmond, S. & Echevarria, M. (2017). Healthcare Transformation and Changing Roles for
Nursing. Orthopedic nursing, 36(1), 12.
Philippines is nursing a crisis. (2017) | Asian Pacific Post | Chinese newspaper -Vancouver,
(n.d.). https://www.asianpacificpost.com/article/8108-philippines-nursing-crisis.html
Barrows, K. (2020). Safe Staffing: Critical for Patients and Nurses — Department for
CIO. https://www.dpeaflcio.org/factsheets/safe-staffing-critical-for-patients-and-nurses
VIII. Appendices
B. Journals
C. Other Materials
13
Machitidze, M., & B. (n.d.). Biomedgrid. Biomedgrid. https://biomedgrid.com/index.php
Short Staff Nurses Emily Helm | PDF | Medical Error | Nursing. (n.d.). Scribd.
https://www.scribd.com/document/394636459/short-staff-nurses-emily-helm
Tamata, A. T., & Mohammadnezhad, M. (2022, October 27). A systematic review study
on the factors affecting shortage of nursing workforce in the hospitals. Nursing Open, 10(3),
1247–1257. https://doi.org/10.1002/nop2.1434
Siegfried, P. (2022, February 11). Reasons and Potential Solution Approaches for the
Shortage of Nursing Staff in German Hospitals. Reasons and Potential Solution Approaches for
the Shortage of Nursing Staff in German Hospitals by Patrick Siegfried :: SSRN.
https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3980139
14
Name: Michael P. Layco
Address: 03 Road 39 North Daang Hari, Taguig City, 1630
OBJECTIVES
• To contribute my performance in any available position in the field of work and to serve the company where
my skills and capabilities will be explored.
PERSONAL DATA
I hereby declared that the above information are true and correct in the best of my knowledge.
MICHAEL P. LAYCO
15
Name: Aprille Jan C. Lleva
Address: Block 6 Lot 3 Broadway Street, Northwind Subdivision,
OBJECTIVES
• To secure a position as a nursing professional, leveraging my skills, knowledge, and passion for healthcare
to provide compassionate patient care and contribute to the well-being and recovery of individuals in need.
PERSONAL DATA
Civil Status: Single
Nationality: Filipino
Religion: Agnostic
Birth Date: April 9, 2003
Place of Birth: Legazpi City
Height: 4’11
Weight: 60 kg.
Age: 20 years’ old
EDUCATIONAL BACKGROUND
I hereby declared that the above information are true and correct in the best of my knowledge.
16
Name: Yvette Katrina Louise Y. Lopez
Address: 1927 Dr. M Carreon St. Sta Ana Manila
Contact #: 0908-362-2568
OBJECTIVES
• To secure a challenging role in a professional environment, utilizing my educational background, strong work
ethic, and willingness to take on new responsibilities to contribute to the success of the company.
PERSONAL DATA
I hereby declared that the above information are true and correct in the best of my knowledge.
17
Name: MAÑALAC, ROYCE MYKA A.
Address: 426 Dandan St, Tondo, Manila, Metro Manila 1012
OBJECTIVES
● To get an opportunity to contribute my skills and knowledge in effective communication and Flexibility
where I can launch my career and build a valuable skill set.
PERSONAL DATA
EDUCATIONAL BACKGROUND
I hereby declared that the above information are true and correct to the best of my knowledge.
18
Name: Miranda, Leslie Pauline B.
Address: 521 Silencio St. Sta. Mesa , Manila
Contact #: 09214766916
OBJECTIVES
• To succeed in a stimulating and challenging environment that will catered me with advancement opportunities
PERSONAL DATA
I hereby declared that the above information are true and correct in the best of my knowledge.
OBJECTIVES
• Secure a responsible career opportunity to fully utilize my training and skills, while making a significant
contribution to the success of the company.
PERSONAL DATA
Civil Status: Single
Nationality: Filipino
Religion: Roman Catholic
Birth Date: September 28, 2000
Place of Birth: Lubao, Pampanga
Height: 5’4
Weight: 58 kg.
Age: 22 years’ old
EDUCATIONAL BACKGROUND
I hereby declared that the above information are true and correct in the best of my knowledge.
20
Name: Aurelie Jane P. Padrique
Address: 20 Sahing St., Western Bicutan, Taguig City, 1630
OBJECTIVES
• To be a vital part in the success of the organization and build a professionally satisfying and challenging
character, be able to deliver quality of service using my skills and knowledge and provide excellence and
dedication in the entire task assigned to me.
PERSONAL DATA
I hereby declared that the above information are true and correct in the best of my knowledge.
Contact #: 09669921794
OBJECTIVES
● Responsible, empathetic, and dedicated college student seeking a working environment that will
require me to expand my practical experience and enhance my educational and professional skills
in a stable and enthusiastic workplace.
PERSONAL DATA:
Civil Status: Single
Nationality: Filipino
Religion: Roman Catholic
Birth Date: September 8, 2003
Place of Birth: Taguig City
Height: 5’4
Weight: 50 kg.
Age: 19 years’ old EDUCATIONAL BACKGROUND
of Nursing
Foundation School
I hereby declared that the above information are true and correct in the best of my knowledge.
CRISTINE JAY S. PARAC
JUNE 21, 2023
22
Name: Prodigalidad, Zxiakira C.
Address: 100 David P. Jimenez Street, Wawa 1 Rosario, Cavite
Contact #: 0951-528-7351
OBJECTIVES
• To be someone I can be proud of, an icon of passion, competitiveness, perseverance and independency. To
pursue what I dreamt and to go beyond my limits as a person and to educate people I spend time with.
PERSONAL DATA
I hereby declared that the above information are true and correct in the best of my knowledge.
ZXIAKIRA C. PRODIGALIDAD
OBJECTIVES
• To seek opportunities where I can be able to utilize and expand more my knowledge and skills in my chosen
profession, and be able to also share my knowledge with
PERSONAL DATA
I hereby declared that the above information are true and correct in the best of my knowledge.
GWYN C. RODRIGUEZ
24
XI. Excerpts
Evidence 1: When the “heroes” “don’t feel cared for”: The migration and resignation of Philippine nurses
amidst the COVID-19 pandemic
Abstract:
Methods:
Several health care worker organizations have also emphasized how nurses' resignations
were influenced by news coverage and how their supply of personal protective equipment was
irregular and they were required to work excessive hours.
Results:
According to reports, the promised extra pay for healthcare staff was not given out. "Their
working conditions are no longer humane," they claim. Filipino nurses appeared to be domestic
prisoners in their own nation as a result. In most cases, the obstacles to escape are unseen and
manifest as economic, social, and legal subjugation.
Conclusion:
As a result, there is a requirement that initiatives and policies put in place during the
epidemic represent the honor and importance of the health care heroes. Overall, the departure and
25
relocation of Filipino nurses amid the COVID-19 pandemic may be a matter of rights and justice
in addition to health and well-being. Nevertheless, it needs to be resolved.
Abstract:
The aim of this study was to describe nurses' experiences of their working environment in
emergency departments at a general hospital in Manila, Philippines. The working environment
within emergency care is complex and unpredictable and may influence patient safety. Nurses are
challenged by increased patient flow, staff shortages and heavy workload.
Methods:
This study used a qualitative content analysis with an inductive approach based on semi-
structured interviews with nine nurses at emergency departments.
Results:
One category, barriers to providing a high quality of care, which included two
subcategories, two subcategories managing a stressful work environment and teamwork's impact
in managing complex caring environment, describe nurses' experiences with their work
environment at emergency departments in the Philippines.
Conclusion:
Workload manifests through a high patient ratio and patient safety-affected prioritizations
of patients, which is why basic nursing is limited. Therefore, improved teamwork built upon
26
person-centered care is needed to increase the high quality of care as well as a healthy working
environment.
Evidence 3: Short Staffing Nurses: A Major Contemporary Issue in the Medical Field
Abstract:
Patients suffer as a result of nursing shortages, which increases the likelihood of medication
errors, readmissions, and patient neglect. Patients are also harmed by it. In addition to hospitals
trying to save money by giving nurses more patients, nursing schools have imposed limits on the
number of students they will admit.
Methods:
The study uses a survey and observation method in order to answer the questions regarding
the major problems that we are experiencing such as shortage of nurses.
Results:
When they conducted a survey of nurses to determine the nursing shortage. Future
shortages will increase nurse stress (98%), which will worsen patient care. Quality of care (93%)
and pushing nurses out of the field (93%). Because many people are unaware of short staffing
before entering the nursing field, their careers as nurses may be short-lived or they may work
harder to develop their careers to avoid the negative effects of short staffing on them personally.
Conclusion:
Focusing on their own needs and lending a hand to a friend who is also a nurse when they
seem to be drowning in work will assist address and solve the problem of the nursing shortage.
Short staffing is a significant modern problem that has to be addressed.
27
Evidence 4: A systematic review study on the factors affecting shortage of nursing workforce
in the hospitals
Abstract:
This study aimed to determine factors that influence the nursing workforce shortage and
their impact on nurses.
Methods:
Using Cochrane library guidelines, five electronic databases were systematically searched
(Research 4life-PubMed/Medline, Scopus, Embase, CINAHL) from 2010-2021. The remaining
articles with pertinent information were presented in a data extraction sheet for further thematic
analysis. A Reporting Items for Systematic Reviews and Meta-Analysis Flow Diagram was
adopted and used. The studies published from 2010-2021 and in English language were examined
and included in the systematic review.
Results:
Four themes were identified as factors influencing the nursing workforce shortage,
including Policy and planning barriers, Barriers to training and enrolment, Factors causing nursing
staff turnover and Nurses' stress and burnout. Nursing workforce shortage is a global challenge
that roots in multiple causes such as individual, educational, organizational and managerial and
policy-making factors.
Conclusion:
The study synthesized the findings of forty-two studies. The reasons for the shortage in
nursing workforce and the effects were influenced by many factors that are summarized and
28
categorized into barriers to policy and planning, training and enrolment barriers, nursing staff
turnover and the impacts on the nurses and patient health outcomes.
Evidence 5: Reasons and Potential Solution Approaches for the Shortage of Nursing Staff in
German Hospitals
Abstract:
The purpose of the study was to identify the causes of the nurse staff shortage in German
hospitals and to provide viable solutions. It is clear that finding a solution to the nurse workforce
shortfall would be exceedingly challenging. The future will reveal whether government assistance
will help to increase the attractiveness of the nursing profession to both present and potential new
nurses.
Methods:
Quantitative method was use in two surveys and aim to get to fully comprehend differences
and issues, it is essential to have numerical data regarding the subject of this master's thesis and
the ability to compare those numbers with the findings of the second survey.
Results:
A survey conducted in 2010 and several subsequent research support the findings of this
scientific article survey. and included approximately 4,000 nurses confirms the findings of this
scientific study survey because it was criticized Salary, work-life balance, and labor shortage were
factors that participant reported in relation to their jobs. insufficient time for patients and the
identification of the needs of the nursing personnel during the shifts. hospital administration's and
physicians' efforts.
29
Conclusions:
To boost career chances and increase job satisfaction for nurses, as well as to make the
profession more exciting for those who are considering a fresh starting in their career, the job of a
nurse needs to be evaluated positively.
30