Closing the Theory-Practice Gap in Nursing With Video Assessment

Hillary Gamblin:

Hello, thank you for joining today’s workshop on using video assessment to close the theory practice gap in nursing. My name’s Hillary Gamblin. I’m a GoReact employee, and I will be hosting the workshop today. And I’m sure you signed up for today’s workshop because you’re aware the studies that say something like 4% of all new nurses are comfortable performing all procedures after having been hired, or new nurses contribute up to 50% of all hospital patient mistakes. So to help us tackle this issue, we’ll be interviewing Dr. Ali Galindo. Ali, do you want to introduce yourself?

Dr. Ali Galindo:

Yes. Hi everyone. It’s a pleasure to be here today. My name is Dr. Galindo and I have been using GoReact for a few years now. Wonderful, wonderful tool. I started my nursing career about 31 years ago. I’m a family nurse practitioner, and I started teaching in academia in around 2004 as a clinical adjunct professor and full-time in 2009. And GoReact with something I had been waiting for and looking for and I can’t wait to show you some of the features that may assist you with your teaching styles.

Hillary Gamblin:

Perfect. Thank you. We’re so glad to have you. Now, for those of you who are new to GoReact workshops, let me outline quickly how we structure these virtual events. For the first 30 minutes or so I’m going to be asking Dr. Galindo how she plans and has used video assessment to help better prepare her students for clinical practice. And then after that interview, we’re going to do a live Q&A for about 15 minutes. If you’d like to submit a question for the Q&A, there is a tab just below the video feed. And if you see a question that you really like, and you also want it answered, there is a brilliant up vote feature. So you can vote for those questions. Don’t forget to use the chat feature. It’s on the right side of the video feed. It’s where attendees can discuss ideas, share resources, exchange personal information, and get together and connect after the workshop. Don’t miss out. It’s kind of a party in there.

Hillary Gamblin:

Right next to the ask of question is a polling feature. And we actually like to start off today with a quick poll to get to know everyone a little bit better. So the polling question is, do you believe video assessment can significantly help bridge the academic practice gap in nursing? The options are no, maybe, but I need proof, yes. Don’t have an opinion yet. Please be honest. We want to know where you are on this topic. So we’ll give you a few seconds to answer that and get the results. Okay.

Hillary Gamblin:

Mostly yes. Oh, we love to hear that. That’s great. A few unsures, a few unsures. Well, for those of you that are unsure, we’re really hoping by the end of this workshop, you will see video assessment in a new light, that an invaluable tool to help increase nurse readiness in your program. We know that there’s no one tool that can solve this complex and systemic issue. That’s not practical, that’s not possible. But we do want you to see video assessment as an invaluable tool to help you tackle and bridge this gap. And for those of you that said yes, we wanted to give you tangible takeaways today to help you close that gap. So actually Dr. Galindo is going to specifically address three problematic areas for new nurses, sterile techniques, safety procedures, and therapeutic communication. So by going into these three areas, we’re hoping that you can have actionable and specific use cases that you can incorporate in the next few semesters. So now that we’ve covered the technical details, we know more about you and we’ve outlined the goals, let’s get started.

Hillary Gamblin:

So, Dr. Galindo, as you said, you’ve been using GoReact with your nursing students for a few years. And even before that, when we were brainstorming, you mentioned that you used other video tools to help prepare your students. Now, after the pandemic, it seems that many of us are going to have video fatigue. We’re a little Zoomed out. And so many of us are going to be tempted to turn off our cameras now, as we’re entering the end of the pandemic here in the US. But you are still convinced that nursing programs need to keep using video assessment to close that theory practice gap. What is it about video assessment that better prepares students for that first day on the job as a nurse?

Dr. Ali Galindo:

All right. So definitely I think that even though we are back on campus, we have to remember that we have supplemental tools that can help with learning when the students are outside of the classroom. So I pulled out a quote from Ben Franklin, smart dude this guy. “Tell me, and I forget. Teach me and I may remember. Involve me and I learn.” And that’s what we want. We want an opportunity for students to have time during nursing school to have formative learning and building blocks. So to answer your question, what do know about what leads to that summative amount of knowledge that students can walk away from? We know that they need hands on practice. We know that there is positing the literature on how adopting certain technologies affects students’ learning. And we know that there’s evidence supporting that applied learning opportunities, hands on, experiential learning, do exist to augment student learning.

Dr. Ali Galindo:

So a few years ago I came across GoReact, believe it or not, on Facebook. And I was looking at it and I was like, “Oh my God, this is exactly what I’ve been looking for.” I had been having students post videos on YouTube. I was teaching fully remote at the time. And what I found was students had a hard time knowing how to upload information, how to keep it as an unlisted number versus a private. To make a long story short, when I piloted GoReact that very first semester, I couldn’t believe how quick, easy, user friendly the platform was. My students could reach their goals. I could reach my goals. And I discovered that video assessment enhances the students’ experience. It enhanced their engagement. They were so eager to get my feedback, to see where they could improve their skills. So why feedback? Hillary, I think you had a question for me about what-

Hillary Gamblin:

Yeah, this is a great lead in. So when we were brainstorming this, you kept talking about how important feedback is. It was almost like the secret sauce, if you will. So if our audience really wants to use video assessment to help better prepare their students for clinical practice, you think that they need to take advantage of feedback. Why is feedback the key?

Dr. Ali Galindo:

Feedback is the key specifically because the students crave it. They want to know where they’re going wrong and what they can do to improve either a skill. We use GoReact quite a bit for the fundamental skill level. We use it in health assessment all the way up to the graduate level. I’ve used it in health assessment for graduate nurses that are becoming nurse practitioners. And other than the feedback, students will tell you, “I didn’t realize I was doing this and I didn’t realize I was doing that.” So I want you to hear for a moment from a particular student that I interviewed about this particular point.

Dr. Ali Galindo:

When you submitted your video and you would receive constructive criticism back, how was that like?

Alice:

So actually, for one of my fundamentals courses, I had a pretty tough professor who would grade me. She had asked me to redo a few videos and she would be like, “This is where you went wrong.” But I think the neat part of GoReact is that she can pinpoint exactly the minute and the second of where she thought I went wrong or I needed more improvement. And she would be like, “Alice, this is exactly where you need to be more aware of this, or more aware of that.” And then I was able to go back, watch it and make sure that I don’t make the same mistake. So I was able to really learn that way.

Dr. Ali Galindo:

Okay. So you can see that, that feedback mode and the ability to provide a timestamped feedback of this is where you went wrong, is what assists with students’ learning.

Hillary Gamblin:

Perfect. Now we are going to go over those three specific areas that new nurses struggle with. And for each of those areas, we’re going to provide a specific use case, an example, and hopefully give some examples of what effective feedback should look like, so what you should be trying to model. The first up is sterile techniques. So how can nursing programs use video assessment to better ensure sterile techniques stick with their graduates?

Dr. Ali Galindo:

All right. So with sterile techniques, we know that students learn from the onset of their fundamental courses. And we talk about sterile technique, we talk about the chain of infection and the principles associated with this chain of infection. And we try and teach students to recognize when and if they break sterile technique. So in this next video, we have our student, Alice, one of our top students, learning how to dawn on sterile gloves. And let’s see if you can pick up.

Dr. Ali Galindo:

Now, this is some of the feedback that she received from her instructor. And I want to show you as if I am grading her right now out, or assessing her, because again, this is formative learning. There are various options. I can text right in the chat box, and I will do that. If I find that I’m having typing fatigue or I really want to stress something, I can hit the audio button and provide feedback that way. So I’m going to do that throughout here. And I’m also going to show you how to do the slow motion option, which allows me to rewind here with the back 10 seconds, there with the forward 10 seconds and slow down the speed so I can really assess if the sterile field was broken.

Alice:

I will obtain my sterile gloves and make sure that this is a clean surface containing my sterile gloves. And I will open them and be mindful that I am only touching one inch of the outer corners.

Dr. Ali Galindo:

So now I am typing in, good point about the one inch border. And notice that the video stopped so that it allows me to type so I can make sure I don’t have any typos. And as soon as I hit enter, you’re going to see that the video will continue to play and it’ll show up on the screen.

Alice:

And since I’m right hand dominant, I will be gloving my right hand first. So I will pinch the inside of the glove with my left hand and place my right hand in.

Dr. Ali Galindo:

Now, if I want to give an audio response, “Great point, you’re using your dominant hand,” I could hit this audio button. I don’t want to do it right now for the purpose of not mixing my speaker and my microphone, but it basically will have a little icon that will show up that’ll say record. You can record a message. And then on the feedback screen, you’ll see a little speaker show up there. So now I want you to pay close attention and see if you can see any break in sterile technique.

Alice:

And using my four fingers with my thumb up, I will cuff the outside of the other glove and place my hand in.

Dr. Ali Galindo:

Did you catch that? So if I rewind and I go half speed, I want you to notice when she pulls up the gloves, the four fingers flap and touch that one inch forward. So this would be a good opportunity for me to provide feedback, to pull the glove up higher and she can go back and assess that video and make the necessary changes.

Alice:

I will cup the outside of the other glove and place my hand in.

Dr. Ali Galindo:

All right. So that’s case number one.

Hillary Gamblin:

Fantastic. Thank you for sharing these examples with real student videos. I love it. So next seems particularly important even in the midst of the pandemic as it’s coming down, and that safety procedures. So how can nursing programs use video assessment to help new nurses apply what they’ve learned in safety procedures when they get on the job?

Dr. Ali Galindo:

This is a very important area and it’s well known in the healthcare industry that medication errors occur and they occur are often. Nurses are overworked, we are stressed. We are tackling so many things at one time and there are many distractions. So one of the things that we found in the literature is that our goal is to try and build our new graduates sense of resilience to workplace stress, because we know that workplace stress exists. So we drill into them, I know you know this, the rights of medication administration.

Dr. Ali Galindo:

So the following video demonstrates how students can break it up slowly, this whole ability to break up the rights of medication administration through verbal communication, and also through demonstrating how they, for example, do a subcutaneous or an intramuscular injection. So you can just look here at the feedback that was provided. And I want to show you another feature. Sometimes we’ll have an extended timed video. This one, for example, is 11 minutes, 32 seconds. We can put it in a faster speed just to make sure that we look through the video, we look again, and we may want to go a little bit faster.

Alice:

Today, we’re going to be doing the subcutaneous and the intramuscular medication administration. So the first thing I’m going to be doing is accessing the medication administration records to determine which medications to give. And it states that I’m giving regular insulin and the flu vaccine today. So I will assess if there’s any data that needs to be collected prior to administration. And because I’m giving regular insulin, I will need to get a finger stick blood glucose. So I will consult the drug guide pharmacist as needed. And I will perform hand hygiene and put gloves on to a use the medication distribution system to obtain my medication.

Dr. Ali Galindo:

So you can see that you can fast forward just to make sure. And then once the student gets to the point where they’re actually performing. So I wanted to go to this timestamp here about date and time, please. It’s a reminder to the student that some activities have to be performed multiple times.

Alice:

Preparation for the insulin. So now to prepare for the flu vaccine. Once again, I’m going to be taking the syringe and attaching the needle.

Dr. Ali Galindo:

And you can see a little bit of hesitancy there, but she’s being cautious.

Alice:

And I’m going to be taking the top off of the flu vaccine and cleansing it. And since I’m giving 0.5 milliliters, I’m going to place 0.5 milliliters into the syringe and take the cap off the needle, input 0.5 milliliters of air, then completely invert it and take out 0.5 milliliters of the vaccine.

Dr. Ali Galindo:

Now I wanted to bring up another point and that is something called markers, which I think I have, possibly in the final video. Markers will show up right here. They’re little tabs that can have predesignated pieces of advice, camera. Right now, she’s off camera. So you may just put camera, the view, you weren’t able to assess that particular task and the student may need to resubmit, or you just tell them to move on, et cetera. So that’s an example of utilizing this platform to really get students ready for medication administration.

Hillary Gamblin:

I love this example, because I think it was last night, I was reading the story about the nurse that gave someone six doses of the vaccine by accident because they got distracted. So just a real life example, and there we had the flu vaccine. So that’s perfect.

Dr. Ali Galindo:

Yes.

Hillary Gamblin:

So finally, new nurses struggle with therapeutic communication. When we think of video assessment, a lot of the times we of psychomotor skills, using it to assess what they’re doing with their hands and their body. But it also can be used to help assess those soft skills that are really needed with new nurses. So what type of exercises can programs do with video assessment to ensure their graduates are effectively communicating with their coworkers or their patients?

Dr. Ali Galindo:

So the platform is really that, it’s a platform. It’s how the faculty, and that’s one of the things I found in the literature, how does the faculty implement the assignment to reach the objectives for the course and then the end of program outcomes. So essentially, we know that with this pandemic, one of the biggest struggles we’ve had is that lack of ability to communicate with a real person. We’ve done so many things virtually and we can still help the students with not just the theoretical and didactic portion of what is important in therapeutic communication, but have them practice either on a friend on the phone. I had some students do that. If they didn’t have family members or a friend that they could do a health history on.

Dr. Ali Galindo:

In this particular example, I’m going to show you a nurse practitioner, student doing a health history. It’s a mental health history. They’re going to talk about anxiety and depression and she’s going to be screening this particular student. And you can see that even as analysis case, when a student does very, very well, there are always cases where we can still give constructive feedback. And the students crave this. They really want this feedback. So let’s listen real quickly to where I say, “Give me a little bit more information,” here at the timestamp of 1:17.

Speaker 4:

Just more anxious.

Speaker 5:

Anxious.

Speaker 4:

Yeah.

Speaker 5:

Have you ever felt so discouraged?

Dr. Ali Galindo:

She’s moving on now to assess if the patient is feeling depressed and kind of left anxiety in the back. Now, it’s important to get to that point, but we have a process in our interviewing where the patient gives us a key anxiety and we want to address a little more, how high is the anxiety on a scale of one to 10? How often are you anxious, et cetera, et cetera. And I want to show you something funny. We all know about mental health assessment. I found this here and I’m like, I don’t remember why I said something about her expression. So let’s go to 2:47.

Speaker 4:

Donald Trump.

Speaker 5:

World backwards.

Speaker 4:

D L R O W.

Speaker 5:

Can you count from a hundred backwards by sevens. 100, 93.

Speaker 4:

It’s going to take a while. I’ll have to use my fingers.

Dr. Ali Galindo:

Have to use her fingers, it’s going to take a while. So I commented, in a real time way, her expression is priceless. That would be mine too. Oh my gosh, let me use my fingers. And maybe smaller integers would be better if you have somebody where math is not their strong suit. Sometimes we ask them to count backwards by three. So you can see how this provides a formal and informal environment to tell the student you’re doing great, you’re doing good, good job, this patient was just really funny and she was acting a role. She wasn’t really being forthcoming. And just even if they’re doing well, certain things, don’t forget to ask them if you’re asking them about smoking, about vaping as well. And why are these part of the mental health assessments? Now I had a question here for the student. The student can go back and actually ponder the question or even respond to the instructor, which is really nice. It’s like a chat box also, between the student and the instructor.

Hillary Gamblin:

Okay.

Dr. Ali Galindo:

And I just wanted to say one more thing. The faculty utilizing this platform have had really good things to say. There is a learning curve, but they say how user friendly it is. But what I consistently hear from our adjunct faculty, and this is from Professor Silva, who performed the evaluations on our fundamental students initially. “This platform provides me an opportunity to watch that one student intently so I don’t miss anything, as is sometimes the case in a lab environment. I can evaluate students around my own schedule when it is convenient.” It’s not just for the student’s benefit, it’s also for the faculty benefit.

Hillary Gamblin:

Thank you for sharing all of those examples. Now, all those three examples you’ve been showing the GoReact interface and features. There are other tools and you use them before you found GoReact to do video assessment. Why do you use GoReact? Why is that your tool now?

Dr. Ali Galindo:

First and foremost, it is the most user friendly, well thought out platform for this purpose. And like I said before, it is a fabulous way to have that formative assessment as you’re guiding students to improve in their skills. And we also use it as a summative tool. So last semester, when we were not able to be on campus, the students were able to do their skills via a GoReact video. Our health assessment students were also able to use the GoReact platform for their final head to toe. This semester, we had a little bit of opening of the campus in small numbers in the Boston area. And even though we had students coming in once a week for lab, of course they were COVID tested and we kept social distancing, we still utilized the GoReact platform for their summative head to toe because of the sheer number of students that we have in the nursing program at Mass College.

Dr. Ali Galindo:

And it just worked great. It really was a great opportunity for us to provide us summative evaluation. Furthermore, it has a feature where you can build into the actual platform, a rubric, and it shows up right on the side. So as they are doing their task and they’re meeting their objectives, you can be grading them along the way. And the feedback that, like I said, we’ve talked a lot out about that is greatly appreciated. We have those features like the markers, which I mentioned, audio text, straight audio and video. There were even cases where I really wanted to boost a student’s confidence level and I would provide a little video at the end and just being really positive. Because a lot of times when we’re constantly looking for errors, it can have a negative implication to the student feeling, “Oh my gosh, I’m never going to get this right” or “I’m not good at this.”

Dr. Ali Galindo:

And that’s not the case. We want to balance it and be as positive as we can. There is always room for growth. And I mentioned that because that third video that I showed you was for a graduate program I was working on and I realized that we probably need to incorporate more therapeutic communication activities in our undergraduate program, maybe through scripts of a difficult patient, perhaps, of a patient who in conducting an interview, closes up, et cetera, to teach the student how to navigate that. So this platform gives you the opportunity to do all of that and more. It has an option, for example, called peer to peer review, where you can pair students up and they can work together collaboratively and critique each other before they actually submit an assignment. So the program and the platform itself just keeps growing and improving, and it really has made it a wonderful tool to supplement our efforts to graduate nurses and be ready for practice when the time comes.

Hillary Gamblin:

Perfect. Thank you for answering all of my questions. I feel bad that I’ve been asking so many. So we are going to turn the time over to our participants that have been putting in their questions throughout this. So we’ll take the next 10 to 15 minutes to do that live Q&A. You still have time to submit a question if you haven’t done so. There is that tab just below the video feed. My colleagues have been monitoring your questions and have selected a few that we can ask Dr. Galindo. So the first one is, “When doing a summative assessment with GoReact, have you had to create policies about academic honesty and no external aids just off of camera?”

Dr. Ali Galindo:

Yeah. That’s a hard one. We do have policies. You can tell when you are viewing the video, if it has been stopped or paused, and we want them to just streamline right through. Again, I’ve used this with students who are taking online classes. Now, part of the way I feel about maybe having a prompt or something to remind them not to forget a particular cranial nerve, remember as a nurse you had in your pocket, your little cheat sheets, so to speak. It’s pretty evident on a, and I want to mention something too that will help you be comfortable with the platform. You can tell if they’re looking away. The other thing too is GoReact has a feature where you can use two cameras. So you can actually have one camera that is focused on the student and another camera that actually has a view of the room. So it allows for a little bit more of that academic integrity and keeping the standards high.

Hillary Gamblin:

There also, I think is, you can make an assignment where it’s a one take and it’s timed and they submit it once and they submit what they did. So that’s another way to ensure that there’s no cheating, if you want to do more of like a quiz type situation too. The next question is, “We assess videos of head to toe assessments. Is there a time limit on how long the students can tape?”

Dr. Ali Galindo:

That is really determined by you, the faculty. And it depends on if we are doing a focused assessment, if it’s a case scenario, for example, and a patient has let’s say pneumonia, where you want them to do a head to toe, but you want them to then zone in on the respiratory system, for example. For the most part, I think across the board, in undergraduate nursing, we cap it 30 minutes. And in the graduate departments that I’ve worked at, we cap it between 20 and 30 minutes. And that’s because that’s realistic with how much time you’re going to do a full head to toe. Now this is all cranial nerves, assessing all joints.

Dr. Ali Galindo:

One of the things that we do that actually helps save time is you can tell them other than, for example, a neurological assessment where you have to compare one side with the other musculoskeletal, et cetera, they could do just one side of the body. They don’t have to actually do both if they’re assessing joints and things like that. For the most part, 30 minutes is the cap. It could be more, it could be less, it depends on your student and it depends on your program, how much time students had to prepare, et cetera.

Hillary Gamblin:

Yeah. And that’s when that fast forward and slow motion and all that comes into play. When you have a long video, you can really focus on the moments that need to be focused on and maybe go a little faster in some of the areas where you don’t need to pay attention to what they’re doing as much or what they’re saying or the prep work. So that’s really useful too. The next question is, “Our students voice that they don’t like to be recorded with videos and increases their anxiety? What’s the best approach for educators to help ease students into the video platform?” That’s a great question.

Dr. Ali Galindo:

That’s an excellent question. And I found in my research, and this is something that I’ve heard in my own experience, they will say flat out, “Professor, I hate to be recorded. I hate being on camera.” My personal thought is they’re going to be going into a patient’s room and the patient is going to be seeing them. So this is an opportunity for them to really assess where they feel confident and where they don’t feel confident. Now, I will say that we know that anxiety has been on the rise with nursing students across the board. Many students work while they go to school. The times are crazy right now. I think a way to decrease anxiety, number one, is to put yourself on camera. Be confident in that what you’re teaching them, you’re not asking them to do anything that you wouldn’t do for them.

Dr. Ali Galindo:

So if you want to show them one method, because no two people assess the exact same way. And I think that’s important is to set your expectations very clearly and tell them that they’re going to learn to assess as they move into their practice. And the other thing is to reiterate to them that we’re not looking for perfection. No one is perfect, to err is human. So if they are recording and they notice, “Oh my gosh, I just finished my neuro assessment, but I forgot to assess the olfactory nerve,” you could verbalize and you give them the leeway in the rubric to do this. They can jot it down and at the end they can say, “I noticed in my self reflection that I forgot to do this, this and this. I’d like to demonstrate it to you now.”

Dr. Ali Galindo:

So that’s one of the things I’ve done to help students decrease the anxiety, to know that they’re going to have at the end of their submission, within a 30 minute period, those last two to three minutes to think back and say, “Is there anything that I have forgotten?” There are times that I have left the patient’s room and I’m like, “Oh my gosh, did I do this one step? I really kind of want to know that. Okay, I’ll do it the next time the patient gets up to use the bathroom,” for example, if I want to assess something in particular.

Hillary Gamblin:

Well, I actually think we’ve answered everybody’s questions. So we are cruising through. This is great. Thank you for everybody that submitted questions. This makes us a real time learning opportunity, which we’re all craving right now in the middle of a pandemic, as we are hunkered in our homes. Now, before the end, I always like to ask our guests to share three takeaways. So Ali, if you could have those watching this workshop, remember three things, three, four, five months down the road, what would they be?

Dr. Ali Galindo:

Well, I jotted a few things down because I think it’s important that we recognize that even though not all of us are really fond of technology, so to speak, there are technological platforms out there that are user friendly that you can learn to navigate within that one semester. That’s the first thing. The second takeaway I think is that even though students are anxious, they really crave the feedback of your knowledge. You are the content expert. So they really want to hear, “How am I doing? What could I do better?” And this provides a great platform to do that. And thirdly, I can’t speak highly enough of this product, it was something that I just took off running with it. And every semester when I would use it, they would have new features embedded into it.

Dr. Ali Galindo:

So I think GoReact is a great way to get students to start thinking about their dexterity, how are they going to perform skills, how are going to address patients. It’s preparing them for practice. And that’s part of why I think it closes a little bit, that academic practice gap, which is something that we all know that the first few years of nursing is where you’re going to learn the most because you’re actually there every day and you’re doing this. We know that a lot of these cases are simulated, but we need simulation to practice when the real time comes. So those are the biggest takeaways. Technology doesn’t have to be intimidating, students crave feedback and GoReact is wonderful for not just nursing, many other disciplines. We could use this to practice interprofessional communication between physician and nurse and PA and nurse practitioner and radiology, et cetera, et cetera. So there’s many applications that this platform would be beneficial.

Hillary Gamblin:

Thank you so much for sharing your expertise today. You did this workshop voluntarily, and as the people can see with your slides and all of your videos, you took a lot of time to prepare all this information for everybody. So thank you so much for doing that. And to thank everybody that has joined us live, to show our appreciation, we have randomly selected one participant with us to win a pair of AirPod Pros. So congratulations to, and the drum roll, they’re going to give it to me soon, Barbara Sullivan. Barbara Sullivan, you won a pair of AirPod Pros. Welcome to the club, they’re so great. We will reach out to you to get your AirPod Pros. We’re going to be doing these drawings for our monthly workshops in the near future. So if you want to win, watch for our next invite and join us for another chance.

Hillary Gamblin:

We know this workshop will be particularly useful for those that joined us live, or those who are going to want to see recordings. So we’re going to be sending an email today with the recording of today’s workshop and all the slides. So watch for that in your inbox. And if you know someone that you would like to recommend to be a guest, we have a recommendation form link that we’re sharing in the chat. There’s so many experts and experiences out there, and we want to be a megaphone for the pressing ideas and topics in nursing education. So if you know someone, please submit that idea to us. We would love to hear that. But that’s it for today. Thank you to those that are participating, those that are working behind the scenes, and of course, our guests, Dr. Ali Galindo. We will see you next time.