Home Health Care Nursing Information and Overview

Home health care is allowing the patient and their family to maintain dignity and independence. According to the National Association for Home Care, there are more than 7 million individuals in the United States in need of home health care nurse services because of acute illness, long term health problems, permanent disability or terminal illness.

Home Health Care Basics

Nurses practice in a number of venues: Hospital settings, nursing homes, assisted living centers, and home health care. Home health care nursing is a growing phenomenon as more patients and their families desire to receive care in their homes. The history of home health care stems from Public Health Nursing where public health nurses made home visits to promote health education and provide treatment as part of community outreach programs. Today academic programs train nurses in home care and agencies place home health care nurses with ailing individuals and their families depending on the nurse’s experience and qualifications. In many cases there is a shared relationship between the agency and the academic institution.

Many changes have taken place in the area of home health care. These include Medicare and Medicaid, and Long Term Care insurance reimbursement and documentation. It is important for the nurse and nursing agency to be aware of the many factors involved for these rules and regulations resulting from these organizations. Population and demographic changes are taking place as well. Baby boomers approaching retirement and will present new challenges for the home health care industry. Technology and medical care in hospitals has lead to shorter inpatient stay and more at-home rehabilitation. Increases in medical outpatient procedures are also taking place with follow-up home care. This has resulted in the decrease of mortality rate from these technologies and medical care has lead to increases in morbidity and chronic illness that makes the need for home health care nursing a greater priority.

Home Health Care Nurse Job Description

Through an array of skills and experience, home health care nurses specialize in a wide range of treatments; emotional support, education of patients who are recovering from illnesses and injury for young children and adults, to women who have experienced recent childbirth, to the elderly who need palliative care for chronic illness.

A practicing nurse must have the skills to provide care in a unique setting such as someone’s home. The nurse is working with the patient and the family and must understand the communication skills for such dynamics. Rapport is evident in all nursing positions, but working in a patient’s own living space needs a different level of skill and understanding. There is autonomous decision making as the nurse is no longer working as a team with other nurses in a structured environment, but is now as a member of the “family” team. The host family has cultural values that are important and are different for every patient and must be treated with extreme sensitivity. Other skills include critical thinking, coordination, assessment, communication, and documentation.

Home health care nurses also specialize in the care of children with disabilities that requires additional skills such as patience and understanding of the needs of the family. Children are living with disabilities today that would have resulted in mortality just twenty years ago. Genetic disorders, congenital physical impairments, and injury are just a few. Many families are familiar with managing the needs of the child, but still need expert care that only a home health care nurse can provide. It is important that a home health care nurse is aware of the expertise of the family about the child’s condition for proper care of the child. There are many complexities involved, but most important, a positive attitude and positive reinforcement is of utmost importance for the development of the child.

Medication coordination between the home health care nurse, doctor, and pharmacist, ensures proper management of the exact science behind giving the patient the correct dose, time of administration, and combinations. Home health care nurses should be familiar with pharmacology and taught in training about different medications used by patients in the clinical setting.

Many advanced practicing nurses are familiar with medication regiments. They have completed graduate level programs. Home health care agencies believe that a nurse should have at least one year of clinical experience before entering home health care. Advanced practicing nurses can expedite that training by helping new nurses understand the home health care market and teaching.

Employment and Salary

According to the United States Department of Labor, there were 2.4 million nurses in America, the largest healthcare occupation, yet many academic and hospital organizations believe there is a gross shortage in nursing staff. The shortage of nurses was 6% in 2000 and is expected to be 10% in 2010. The average salary for hospital nursing is $53,450 with 3 out of 5 nursing jobs are in the hospital. For home health care, the salary is $49,000. For nursing care facilities, they were the lowest at $48,200.

Training and continuing education

Most home health care nurses gain their education through accredited nursing schools throughout the country with an associate degree in nursing (ADN), a Bachelor of Science degree in nursing (BSN), or a master’s degree in nursing (MSN). According to the United States Department of Labor, in 2004 there were 674 BSN nursing programs, 846 ADN programs. Also, in 2004, there were 417 master’s degree programs, 93 doctoral programs, and 46 joint BSN-doctoral programs. The associate degree program takes 2 to 3 years to complete, while bachelors degrees take 4 years to complete. Nurses can also earn specialized professional certificates online in Geriatric Care or Life Care Planning.

In addition, for those nurses who choose to pursue advancement into administrative positions or research, consulting, and teaching, a bachelor’s degree is often essential. A bachelor’s degree is also important for becoming a clinical nurse specialist, nurse anesthetists, nurse midwives, and nurse practitioners (U.S. Department of Labor, 2004).

All home health care nurses have supervised clinical experience during their training, but as stated earlier advanced practicing nurses hold master’s degrees and unlike bachelor and associate degrees, they have a minimum of two years of post clinical experience. Course work includes anatomy, physiology, chemistry, microbiology, nutrition, psychology, and behavioral sciences and liberal arts. Many of these programs have training in nursing homes, public health departments, home health agencies, and ambulatory clinics. (U.S. Dep. of Labor, 2004).

Whether a nurse is training in a hospital, nursing facility, or home care, continuing education is necessary. Health care is changing rapidly and staying abreast with the latest developments enhances patient care and health procedures. Universities, continuing education programs, and internet sites, all offer continuing education. One such organization that provides continuing education is the American Nurses Association (ANA) or through the American Nurses Credentialing Center (ANCC).

Conclusion

There are many rewards to becoming a home health care nurse. Some rewards include the relationship with a patient and their family, autonomy, independence, and engaging in critical thinking. The 21st Century brings with it many opportunities and challenges. We must meet these challenges head on – there is an aging baby boomer population, a growing morbidity factor due to increased medical technology and patient care, and the growing shortage in nursing care.

It can be extremely overwhelming to have a family member that requires constant care. A lot of us simply don’t have the time or the facilities to be on-hand at all times even though we might want to. You may experience feelings of guilt that you can’t do all that your family member needs and can’t be with them all the time. However, you are not alone. Today, millions of adults across the word are finding themselves in a position where they are juggling taking care of older relatives or parents and their own lives and career. Many people struggle so you shouldn’t feel ashamed or guilty about your inability to do everything.

It can be hard to get the balance right between doing all you can for your elderly relative and looking after your own needs and this is why many people turn to home health care to help lighten the load. Home health care is a great way to ensure that you get the respite you need while making sure that your relative or parent is still looked after. In many cases, home health care is a necessity for families as it allows the career to get enough rest to ensure that they will be able to look after the elderly relative properly in the future.

There are many benefits involved in hiring home health care. The main advantage is that the person in question will be receiving the very best care possible. These people are trained medical staff and now how to look after your relative or parent properly. They will have years of experience and a wealth of expertise in dealing with emergency health situations so you really can trust them.

As well as providing essential medical care, home health care professionals will give the social interaction that your loved one really craves. No-one likes to be left on their own for long periods of time, and as much as they will love talking to you, they will also really enjoy interacting with other people. For some, home health care is their only connection to the world and without they feel lost.

The chances are you won’t always be available to help your loved one with their meals. If you worry that they aren’t eating nutritiously, that they aren’t eating at all or that they are skipping their medication then home health care could help. A member of staff can help your loved one with meal times and ensure that take their medication at the right times throughout the day.

Home health care workers can also help with any transport issues you may be having with your loved one. If you can’t get to them to take them to the doctors or any other appointment then they can do this for you and make sure that they get their safely.

There are so many more benefits to hiring home health care but the main one being that some of the pressure is taken off you and you can get back on track with your own life and responsibilities. Home health care really is a practical alternative to attempting to take on everything yourself. Home health care really can be a godsend for those people who don’t need continuous nursing help but who want to be cared for in the comfort of their own home. Most people feel most comfortable at home as it is the place where their family and friends can come and visit them and sometimes familiar surroundings can help aid recovery time. Home health care services vary depending on the personal needs of the person needing the care. For some, they just need some companion care whilst other suffer from more serious illnesses and require more complex medical monitoring.

There is a good divergence of opinion among doctors on the number of food that we must always take. One doctor holds that we must always eat to the utmost of our capability, and he has calculated the quantities of various sorts of food that we are able to take. Another holds the read that the food of laborers ought to take issue in amount moreover as in quality from that of persons engaged in mental work, whereas a 3rd doctor contends that the aristocrat and therefore the peasant ought to eat precisely the same amount of food. This much, however, is going to be usually admitted, that the weak cannot eat even as very much like the robust. In the same means, a lady chuck but a person, and youngsters and recent men eat but young men. One author goes to date on say that, if solely we’d masticate our food totally well, so each particle of its mixed with the spit, then we should not have to eat more than five or ten of food. This he says on the premise of multitudinous experiments, and his book has been sold in thousands. All this shows that it’s futile to consider prescribing the number of food for men.

Most doctors admit that ninety nine of mortals eat over is required. Indeed, this is a fact of everyday experience, and does not require to be proclaimed by any doctor. There is no worry in the least of men ruin their health by uptake too little; and also the nice would like is for a discount within the amount of food that we generally take. As for mentioned higher than, it is of the utmost importance to masticate the food completely well. By so doing, we shall be able to extract the maximum of nutrition from the minimum of food. Experienced persons point out that the faces of a man whose food is wholesome, and who does not eat too much, will be small in quantity, quite solid and smooth, dark in color, and free from all foul smell. The man WHO doesn’t have such faces ought to perceive that he has eaten up an excessive amount of nauseous food, and has did not masticate it well. Also, if a man does not get sleep at night, or if his sleep be troubled by dreams, and if his tongue be dirty in the morning, he should know that he has been guilty of excessive uptake. And if he has to get up several times at night to make water, it means that he has taken too much liquid food at night.

By these and different tests, every man can arrive at the exact quantity of food that is needed for him.
Many men suffer from foul breath that shows that their food has not been well digestible. In many cases, again, too much eating gives rise to pimples on the face, and in the nose; and many people suffer from wind in the stomach. The root of these troubles is, to place it plainly, that we have converted our stomach into a latrine, and we carry this latrine about with us. When we contemplate the matter during a sober lightweight, we cannot help feeling an unmixed contempt for ourselves. If we want to avoid the sin of over-eating, we should take avow and never to have anything to do with feasts of all kinds. Of course, we must always feed those that return to U.S. as guests, but only so as not to violate the laws of health.

Do we ever think of inviting our friends to clean their teeth with us, or to take a glass of water? Is not uptake as strictly a matter of health as these things? Why, then, ought to we tend to create such a lot fuss regarding it? We have become such gluttons by habit that our tongues square measure ever probing for abnormal sensations. Hence we predict it a sacred duty to cram our guests with made food, and we cherish the hope that they will do likewise for us, when their turn comes! If, an hour after eating, we ask a clean-bodied friend to smell our mouth, and if he should tell us his exact feelings, we should have to hide our heads in utter shame!

But those individuals area unit so unblushing that they take purgatives before long once feeding, that they could be able to eat still a lot of or they even vomit out what they have eaten up so as to take a seat down once more to the feast at once! Since even the best of us are more or less guilty of over-eating, our wise forefathers have prescribed frequent fasts as a religious duty. Indeed, simply from the purpose of read of health, it will be highly beneficial to fast at least once a fortnight. Many pious Hindus take just one meal every day throughout the season. This is a follow based mostly upon the soundest hygienically principles. For, once the air is damp and also the sky cloudy, the digestive organs are weaker than usual, and hence there should be a reduction in the quantity of food.

And now we will consider how meals we may take in the day may. Numberless people in India are content with only two meals. Those who do onerous labor take 3 meals, but a system of four meals has arisen after the invention of English medicines! Of late, many societies are fashioned in European country and in America so as to exhort the folks to require solely 2 meals every day. They say that we should always not take a breakfast early within the morning, since our sleep itself serves the purpose of the breakfast. As presently as we tend to arise within the morning we should always prepare to figure instead of to eat. We should take our meal solely when operating for 3 hours. Those who hold these views take solely 2 meals every day, and do not even take tea in the interval.

I may say from my expertise that there’s fully not have to be compelled to eat over doubly, for a person WHO has passed the amount of youth, and whose body has attained its fullest growth.

Home health care is just what the name suggests – health care services that can be taken care of in your home. There are quite a number of these possible home-based services, and they can be cheaper, as useful, and more convenient than the services you could get in a hospital or other nursing facility.

The point of this is to take care of an illness, injury, or other ailment. The idea is to get your independence, confidence, and self-sufficient behavior back on target as quickly as possible in your own environment.

Potential home health service options include caring for wounds, physical therapy, occupational therapy, speech-language therapy, patient and care-giver education, intravenous and nutrition therapy, injections, and monitoring serious illness and unstable health status. There is also health aid, to help with things like getting into and out of bed, getting dressed, baths, eating, and bathroom activities. This is also considered things like housekeeping duties, laundry, shopping, and cooking.

There are lists of agencies that do home health care work. Check your local phone book, or look up information on the internet to find local places and check what services they actually provide. Some health insurers like Medicare will only cover the costs of this if the home health agency has been certified by them.

When present, the staff will check what you’re eating and drinking, check things like blood pressure, temperature, heart rate, and breathing, make sure that you are taking your prescriptions, drugs, and other treatments appropriately, check if you’re in pain, be aware of the safety in your home, teach you to care for yourself over time, and coordinate your care with you, your doctor, and others who treat you.

It’s very important that you understand how your plan of care works. An agency member will consult with you and your doctor to make this happen. The plan of care includes what services you need, which care professionals should give those services, how often those services are required, what medical equipment is needed, and what results you expect. All involved will review this plan as often as required to do the job properly.

If you are getting home health care, you should ask yourself questions regularly to make sure you’re be treated appropriately. For instance, if the staff is polite, if they explain everything to you in a way you can understand, if they respond quickly to your requests, if they check in with you physically and emotionally with each visit, and if they regularly suggest changes to improve your situation.

With all these things in mind, now you know enough to get started researching to determine if home health care is the right decision for you and your family.

If you are not interested in buy xanax online without perscription , then you have already missed a lot.

Despite popular belief, you don’t have to be in a hospital or nursing facility to have a staff of professionals take care of you – the is an alternative called home health care. Essentially, many of the same type of services offered at hospitals can be offered to you at your home through specialized agencies, and often it’s more convenient and less expensive for you in the end.

You know that health care, ultimately, is to take care of you after you’ve been injured or sick. Now, if you can do this at your home, and gain your strength and self-sufficiency back in an environment where you’re more comfortable, that would be a great option to exercise.

Some home health care services include: wound care, patient education, nutrition therapy, injections, intravenous therapy, and speech-language therapy. Staff can also monitor serious illness and unstable health status, as well as helping with getting you into and out of bed, helping you bathe and use the bathroom, and doing things like light housekeeping, cooking, shopping, and laundry.

To find agencies available for this type of work, do an internet search and find out if there is anything local, and find out if they provide the exact service to the specifications that you require. Be aware that there are arrangements made between insurers and the agencies, so always ask questions before deciding who to hire.

So when they’re there, what should you expect from a home health care team? They should be aware of your diet, your amount of exercise, your blood pressure and heart rate, your breathing, your temperature, and all of your vitals. They should know your medication routines and have them all up to date. They should check on your pain levels and your mental and physical condition every day, if not more often. They will make sure that your home is safe, and they will teach you how to take care of yourself as the process moves forward.

They’ll also explain to you what your plan of care is. It’s essentially a list of everything you need – what services, by what type of care professional, what equipment they need, how often they need to take care of what parts of your health, and what you should expect when the treatments are complete.

And be sure to ask yourself questions while you are under care. Are they treating you respectfully? Are they explaining why they are doing what they’re doing? Are they continually suggesting ways to improve your treatment? Are they putting your mental and physical health first with regard to the service?

Home health care services may just be the assistance you need for your aged parents. But you need to understand that the term itself is so diverse. There are different kinds of professionals who can provide home health care assistance to you. Just the same, there are also different types of institution where such care can be provided.

The most common health care personnel you might have encountered are registered nurses. They are also considered the most skilled because they don’t just care for the basic needs of their patients. They can also be made to supervise monitoring for vital signs as well as giving the right medication for the patient. RNs and experts in using health equipments.

Another type of home health care personally are home care aides. They are a good choice for a health companion because they can provide assistance to basic living skills such as bathing and dressing up. They can also provide a nutritional diet for your aged loved ones as well as do some light cleaning to avoid the spread of illnesses at home.

Then there are also the homemakers or home companions. However, these people are not exactly schooled or formally skilled with caring for aged people. But they can be expected to take care of the home where your aged loved ones live and also make sure that some of their basic necessities are being cared for.

Getting the type of home health care is something that you should talk over with the whole family. If your parents are still good enough to comprehend the situation, it would be best to also involve them during the decision-making process. This way you can prevent having any problems between the caregiver and the care recipient because the latter actually resents having someone else to tend to him.

After that is cleared, the next important thing would be to clearly define what the caregiver tasks should be. Do this in accordance with your aged loved ones current medical conditions. It would even be best if the tasks are actually advised by the doctor. If you can also include an actual daily schedule for the caregiver to follow, then that would be much better.

When the decision-making process to hire a caregiver and the actual tasks are done, then you will now be ready to find the best homecare services. It would be best to look for one within your area so you can easily compare their fees and requirements.

When choosing your home health care services, make sure that you get from an agency duly certified by the government. It would also help to engage in the services of an agency whom you can pay through your insurance coverage.

As a writer and editor for an online self help store, I frequently encounter the common misconception that self help, self improvement and personal development products are only sought out by those who are, ironically, unable to help themselves.

Nothing could be further from the truth.

The individuals who find themselves browsing through the virtual shelves of the online self-help marketplace are anything but weak, anything but helpless.

Think about it. First of all, by deciding that they need a helping hand, that they need advice and tools to improve one or more areas of their life, they are demonstrating considerable self-awareness and perceptiveness. That takes strength of character. Consider those who occupy the other end of the spectrum, the there’s-nothing-wrong-with-me, it’s-everybody-else’s-fault, I’m-not-to-blame types. Which is the weaker, those individuals who demonstrate a complete lack of self-awareness and self-critical faculty, or those who are willing to list their faults and seek out remedies? It’s a no-brainer, isn’t it?

Now, consider for a moment the will power it must take to set out on that journey of self discovery and self improvement. Surely, it would be easier to just curl up on the couch and watch TV? How can any quest for personal development be an indication of weakness? The very idea is ridiculous.

So, far from being weak and helpless, the individual making their first tentative steps into the self help, self improvement and personal development marketplace, is a person of strong character, someone with formidable self-awareness and the will power to confront and do something about their faults and imperfections.

Through self-help books one teaches oneself to be economically, emotionally and intellectually mature and independent. The whole process has a lot of psychological as well as spiritual base.

Self help books inculcate in the reader the spirit of self-reliance. There are of course likeminded support groups to lean on. It is not a partnership of dependence but of co-operation. Examples can be given of self-help legal practice, homespun advices and many more. In course of time self-help books are leading guides in the field of education as well as business. Psychology plays an important part in the writings of these self-help books. These books have led to self-help movements.

According to prominent psychiatrists the self-help books are quite distinct from the professional counterparts. The latter cannot provide friendship, emotional prop up, first hand experimental knowledge, self-identity, roles in life with a meaning and above all a sense of being belonged. Self-help books links people with any kind of health condition. It is especially applicable to those who are mentally unstable. However everything does not work for everyone. The same applies to these self-help books. People going through similar travails form lobby groups and by sharing problems many knots are untied. Actually self-help books bring about link with like minded people – contact between peers.

The self-help books are based on an ancient concept of autosuggestion. It is repeating to one self the magic words of ‘I can! I can!’ The books are getting worldwide acclaim from humble beginnings. Self-help legal services are also expanding. The Internet is now an invaluable tool for the popularizing of self-help books. On a gigantic scale free information is being provided leading to self-empowerment.

The self-help concept, now being codified in books, has a long history. It goes back to 2,500 BC when we first come across the advice poems of Hesiod. It is an adaptation of Eastern philosophy and thought. The Stoics of Greece offered similar advice of awakening the powers of the self. The ideas are expressed in ancient proverbs of different cultures of the world from time immemorial. The word self-help found a place in legal parlance when it came to be acknowledged that a person has the right to plead his own case in court of law.

Nothing talks about self-help more lucidly than the famous saying ‘Heaven helps those who help themselves’. Samuel Smiles in the late 19th century authored the first book on personal development. The title was Self Help. This principle of self-help or autosuggestion is used widely in the treatment of curing alcoholics and the like. It is the self that cures and the self that destroys. It is a question of awakening the self. These self-help books advise certain techniques to achieve this goal.

In this field of work Dale Carnegie is a famous name in the first half of the 20th century. In 1936 he published his all time best seller – How to Win Friends and Influence People. It reflected his own successful battle against repeated failures. So far 50 million copies have been sold and continues to sell captivating each new generation. Think and Grow Rich by Napoleon Hill also hit the market inspiring people about the power of thought.

Researches show that self-help books have captured the market in a big way covering a wide variety of topics form weight loss to friendship gain. One can teach oneself how to become even a politician and win laurels. There are critics who say that these are easy answers to difficult questions that cannot be really implemented.

It is true that self-help seminars and workshops can do a lot to help you get a better self esteem. It is also true that going to a life coach or a counselor or psychologist for training can work well for some.

However, the only thing that can accompany you wherever you go is self-help books, and there are many available on the market by renowned authors. Since the problems of low self esteem are not predominant in America alone, but all around the world, it should not be too hard for you to get your hands on a good book, wherever you may be.

Self-help books need not always be on increasing self esteem directly. One look through a book shop’s self-help section will show that you can buy books on hobbies like photography and cooking, and on personal help like doing better at relationships and at work. All these will however help you with better self esteem in the long run. So, there is a self-help book for you, whatever the goals that you set for your self may be.

As human beings, we are superior to all other living things on the planet and one of the things that prove this is our ability to effect change on our surroundings. So do get one on whatever it is that you would like to change, and put what you learn from these books into affect.

Soon you will see a positive change in your life, and the feelings of accomplishment that come with this can work wonders for your self-image. So many self-help books have been published to date that it is not a problem finding one on whatever topic you may have in mind. In fact you may face a bigger problem selecting one or two books out of the dozens to choose from.

They are a great thing to carry if you travel a lot. Not only do they help you pass your time constructively they are easy to carry and store. As sophisticated and miniature that palmtop computers have gotten today, the feel of a good book in your hands can never be replaced by a computer, and any one accustomed to handling books will confirm that.

We may get so preoccupied in our day to day problems that it is not always easy to take out the time to attend a self improvement seminar or lecture. But we can all at least take out the time and money to get a good self-help book. After all, it is for our own improvement that we do this, so do take the time and effort to get your hands on a book of this sort.

One of the main goals that your body has, is to protect you and keep you as healthy as possible. Your body is going to work day and night to help keep you in amazing health all the time. Whatever bumps and illnesses that you may experience on the way, you will find that your body is going to help you overcome them really fast.

When you have a condition such as kidney disease then you need to appreciate that overcoming it is really simple, when you know exactly what you are doing.

You will very easily be able to overcome kidney disease when you get out there and work at it every single day of your life. Keep working hard and believe me soon enough you will see the best results of your life.

But the key thing to keep in mind is that knowledge alone will truly not get you anywhere. The reality is that the number of people that actually have knowledge is far greater than the number of people who do something about that knowledge. You are going to want to do whatever you can to really get your kidneys working again.

Follow the advice that I share below and you will have your kidneys working again in no time.

Drink Water Regularly

The truth is, most of us are just not getting enough water down our system during the day. The reason being is that most of us are busy working during the day, so we are just not able to drink water… and therefore only drink it when we become extremely thirsty.

But let me tell you right now that this really isn’t a pleasant way to look after your long term health.

If you keep up the habit of drinking water when you are really thirsty, you will usually end up drinking a lot more than you need. The truth is that this is just going to lead to you putting a lot of pressure on your kidneys.

If you didn’t already know then your kidneys actually have the job of maintaining the amount of water that runs through your body, hence why the pressure will be turned on when you drink too much water. A massive influx of water at any one time will result in your body, especially your kidneys having to stop what they are currently doing, to actually work on getting rid of the excess water that is in your system. Your kidneys will actually work to create more urine to get rid of the excess water.

The best way to avoid your kidneys having to work more is to just drink smaller amounts of water, regularly throughout the day. I am telling you right now that you are going to feel truly amazing.

Avoid Alcohol

If you happen to have renal disease then you will want to completely avoid alcohol from now on. There are many foods that you are no longer going to be able to eat because you have kidney disease and alcohol is one of them.

Believe me this has to become your number one priority no matter how hard it actually gets. Over the long term your kidneys are going to improve massively.

Now you have all the tips you are ever going to need to get your kidneys into the best condition of their lives.

Truth be told my friend you will never achieve anything if you are just sitting there. Prepare to do some work everyday of your life, and believe me you will get results that most people couldn’t even dream of. You need to push yourself no matter how much you want to give up.

You will end up getting incredible results if you just persist and never give up.