Nursing

Courses

NUR-101: Orientation to Nursing Professional Practice I

Credits 1
This seminar course introduces nursing students to the major. Students will engage in learning activities to promote success in the program by familiarizing themselves with career options related to the major. The course will include a broad overview of current issues related to healthcare in the United States as well as provide a survey of concepts and practice areas related to nursing.

NUR-102: Orientation to Professional Practice II

Credits 1
This interdisciplinary seminar course provides an overview of the foundational concepts and principles of health and human services. It aims to introduce students to the fundamental knowledge, skills, and practice benefits of an interdisciplinary approach to care. By integrating various perspectives, students will gain an introductory understanding of the roles, responsibilities, and collaborative nature of the professions in promoting health, well-being, and functional independence.

NUR-250: Nursing Fundamentals

Credits 6
This is a theory and practicum nursing course which explores fundamental nursing concepts and professional role development to ensure a solid educational foundation. Through the use of the nursing process, the student will interact and perform basic nursing and communication skills with diverse human families in a variety of laboratory and health care settings.

NUR-295: Introductory Topics in Nursing

Credits 1 3
An introductory study of a specific topic in Nursing. Intended for freshmen and sophomores, or for students with little or no background in the subject. The student may repeat the course, but not the same topic.

NUR-305: Historical and Theoretical Foundations

Credits 4
This course explores the history of nursing, nursing theories, and the current practice of professional nursing worldwide. Leaders and innovators in the field of nursing are studied within their historical context, and emphasis is placed on their impact on current nursing practice. Selected nursing theories are examined and appraised. Current trends and issues in the profession are identified and analyzed. Professional ethics and responsibilities are examined, and means to attain lifelong professional nursing citizenship are formulated. The meaning of nursing as a caring profession is examined, and a personal mission, vision and philosophy of nursing is developed.

NUR-311: Genetics in Nursing

Credits 3
This course provides the nurse of the future with a basic understanding of the principles of human genetics. Major content areas include the human genome project, cross-cultural issues in human genetics, and genetic conditions across the life span. Students begin to evaluate the inherent ethical dilemmas that this expanding knowledge poses for modern health care providers.

NUR-318: Nursing Research and Evidence-Based Practice

Credits 4
This course is an introduction to the principles of nursing research and evidence-based practice. Building on a liberal arts foundation, students learn principles of scientific inquiry and subsequent application to clinical practice. All phases of research methodology are explained and interpreted, and scholarly research as a foundation for safe and effective clinical practice is examined. Current models of evidence-based practice are compared, and use in the clinical setting assessed. Critical appraisal skills are developed as students critique quantitative and qualitative nursing research. Use of digital technology as a research tool is explored. Implications of the research process and principles of evidence-based practice for professional nursing practice are explored.

NUR-345: Pathophysiology and Pharmacology

Credits 4
This course explores the pathophysiology of select acute and chronic disease processes across the lifespan using a systems approach. With a focus on the major body systems, students will analyze clinical manifestations of disease and their relationship to pathophysiological processes. Concepts of pharmacotherapy, including precision medicine are discussed. Use of technological tools to maximize patient safety and identify potential quality issues related to pharmacotherapy is introduced. Non-pharmacological, complementary, and/or alternative therapies are explored as both treatment modalities and enhancers of wellness. Holistic patient education is emphasized.

NUR-353: Holistic Health Assessment Across the Lifespan

Credits 4
This is a theory and practicum nursing course which explores holistic health assessment and professional role development to ensure a solid educational foundation. Using the nursing process as a framework, the student learns and practices holistic interview, physical assessment, and documentation skills. Special emphasis is placed on reflective practice and a collaborative team approach to provide holistic care across the lifespan.

NUR-362: Acute Care of the Adult I

Credits 6
This is a theory and practicum course which explores concepts of acute and chronic nursing care including but not limited to disorders of the cellular, cardiovascular, respiratory, immune, gastrointestinal, renal, hormonal regulation, metabolism, and reproductive systems. Professional role development will also be addressed to ensure a solid educational foundation. Basic concepts of medical-surgical nursing will be applied to adult clients across the healthcare continuum.

NUR-365: Nursing History and Theory

Credits 4
This is a theory based nursing course which explores the history of nursing, nursing and related theories, and professional role development. Leaders and innovators in the field of nursing are studied within their historical context. Current trends and issues in the profession are identified and analyzed.

NUR-368: Nutrition and Metabolism

Credits 4
This theory course builds upon knowledge gained from previous science courses to deepen the student's understanding of energy metabolism and physiologic and pathophysiologic processes that interfere with these metabolic processes. Dietary needs for persons experiencing various physiologic and pathophysiologic stressors are explored. Nutrigenomics and nutrigenetics are discussed and reflect diversity of susceptibility to disease and the role of nutrition in the prevention and management of disease.

NUR-369: Bioenergetics and Metabolism

Credits 4
This course provides an in-depth study of the chemical structure and function of biomolecules (nucleic acids, proteins, carbohydrates, lipids) as well as vitamins/cofactors, enzymes, hormones, and their roles in bioenergetic processes and the regulation of metabolic pathways. Epidemiological principles and ecological factors that guide appropriate screening and education, as well as evidence-based approaches to the care of persons experiencing disorders of metabolism will be explored.

NUR-371: Evidenced-Based Practice and Nursing Research

Credits 4
This is a theory based nursing course which explores principles of nursing research, evidence based practice, and professional role development to ensure a solid educational foundation. The student learns principles of scientific inquiry and its application to nursing practice.

NUR-374: Maternal Child Health

Credits 3
This is a theory and practicum course which explores maternal-child nursing concepts and professional role development to ensure a solid educational foundation. Nursing's unique body of knowledge is used to implement evidence-based care for persons (individuals, families and communities) during antepartum, intrapartum and postpartum periods.

NUR-377: Pediatric Nursing

Credits 3
This is a theory and practicum nursing course which explores the care of children and professional role development to ensure a solid educational foundation. Nursing's unique body of knowledge is used to apply evidence-based care to the pediatric population. Partnering with caregivers, students integrate concepts of wellness and primary prevention, as well as, the care of acute and chronic conditions.

NUR-382: Mental Health Nursing

Credits 3
This is a theory and practicum nursing course which explores mental health concepts and professional role development to ensure a solid educational foundation. Nursing's unique body of knowledge is used to apply and implement evidence-based care for persons (individuals, families and communities) with mental health issues, including psychosocial concepts; cultural, ethical, spiritual and legal influences.

NUR-389: Pathophysiology and Pharmacology

Credits 4
This is a theory based nursing course which explores the pathophysiology of select disease processes across the lifespan. Using a systems approach, the student will be immersed in the concepts of pharmacotherapeutics and its safe and effective use in the treatment of common acute and chronic diseases. Non-pharmacologic integrative therapies are also explored. Special emphasis is placed on reflective practice and a collaborative team approach to provide holistic care across the lifespan.

NUR-401: Holistic Health Assessment

Credits 4
This course provides experience in the theory and practice of holistic health assessment of patients across the lifespan. With an emphasis on normal findings, the student practices skills of patient interview, physical assessment and documentation. The goal of completing a systematic health assessment is accomplished through both didactic course content and hands-on experiential learning. Students conduct a comprehensive health history and perform a head to toe physical assessment. Supervised practice sessions allow the student to further develop assessment skills. Technological advances in patient assessment are explored. Patient safety strategies, inter-professional collaboration and effective communication skills are explored and applied, and holistic assessment of the patient's social and environmental milieu is emphasized.

NUR-416: Population Health

Credits 4
This course investigates the theory and practice of population health. Students identify the myriad of health beliefs, values, and practices of families and communities, and recognize the importance of culturally specific care. Basic epidemiological concepts and methods are examined, with emphasis on the health status and health needs of a population, levels of prevention, and health promotion strategies. General methods introduced include epidemiological measures, sources of data, descriptive components, strategies for screening, and surveillance in the community. The science of public health nursing and its contributions to health at the local, state, national, and global levels are analyzed. Current global health initiatives are examined. Emphasis is placed on the community-as-client to critically evaluate a population-within a geographic community, along with application to nursing practice.

NUR-430: Professional Practice Issues

Credits 2
In this capstone senior seminar, students are encouraged to critically analyze societal trends and health issues that influence professional nursing practice. Students provide leadership for selecting, planning, implementing, and evaluating seminars. Knowledge and skills from other nursing courses are integrated as the student is challenged to explore current employment opportunities and to make projections for the changing roles of the nurse in the 21st century. Individual student portfolios are completed during this course.

NUR-449: Basic Organizational Systems Leadership

Credits 4
Building on a liberal arts foundation, this course focuses on the role of the nurse as both leader and manager in a rapidly changing global health care environment. Relevant theories, scholarly evidence, industry best practice standards, and practice exemplars that support the creation of a positive work environment for safe and high-quality patient care are explored and applied, and basic business and entrepreneurial skills are integrated. Using relevant data, analysis of the health care landscape within a global context is emphasized. Topics include: theories and models of leadership, industry business trends and skills, organizational and change theories, political, legal and ethical ramifications of leading patient care, budgeting, marketing, planning, problem solving and decision making. Strategies to maximize effective group work from a leadership perspective are identified.

NUR-451: End of Life

Credits 3
This is a theory based course which explores end-of-life issues with a cultural perspective. These quality of life issues include physical, psychological, and spiritual aspects of dying. Ethical and legal issues, public policy and individual considerations at the end of life are examined. Special emphasis is placed on reflective practice and a collaborative team approach to provide holistic care across the lifespan.

NUR-456: Population Health Nursing

Credits 5
This is a theory and practicum nursing course which explores the care of populations and professional role development to ensure a solid educational foundation. The focus is on population health with specific emphasis on two components: population health science, with its roots in epidemiology and the art and science of nursing within the community setting. Special emphasis is placed on reflective practice in a collaborative team approach to provide holistic care across the lifespan.

NUR-462: Acute Care of the Adult II

Credits 6
This is a theory and practicum course where students examine increasingly complex concepts of acute and chronic nursing care. Professional role development is explored to ensure a solid educational experience. Advanced approaches to medical-surgical nursing in critical care areas will be applied to adult clients across the healthcare continuum.

NUR-467: Foundational Concepts of Nursing Leadership and Healthcare Management

Credits 4
This is a theory based nursing course which focuses on concepts related to the role of the nurse as a leader and manager of care in a rapidly changing environment. This course focuses on evidence based strategies that foster quality patient care across the care continuum. Analysis of the healthcare landscape within a global context is explored. Special emphasis is placed on reflective practice using a collaborative interdisciplinary team approach to provide holistic care across the lifespan. Topics include: models of leadership, industry business trends and skills, organizational and change theories, political legal and ethical ramifications of leading patient care, budgeting, marketing, planning, problem solving and decision making.

NUR-491: Nursing Field Period

Credits 3
This course is based in experiential learning and enables students to build on generalist education as they integrate new knowledge and skills while meeting program outcomes and attaining professional nursing competencies. Under the direction of nursing faculty, students design and implement a college and community health fair. Nursing students work with faculty and community agencies to schedule, advertise, design and implement health screening and health education interventions for the college and local communities. There is opportunity to work with faculty and students in other disciplines. Health screening examples include: blood pressure screening, blood glucose screening and lipid profiling. Health education examples include nutrition and stress management techniques. Application of principles of leadership, inter-professional collaboration to enhance the health of college and community residents, and a systems approach are emphasized as students develop, plan, and implement interventions. Students begin this course with development of a field period contract, spend 150 hours fulfilling the objectives of their contract, and ultimately share their field period experience in seminar format in the classroom setting. Incorporation of evidence-based practice, relevant health care policy, and information technology is expected.

NUR-495A: Nursing Field Period and Senior Seminar I

Credits 2
This course centers around experiential learning, and enables students to build on generalist education as they integrate new knowledge and skills. Throughout the course, students will build on growth in nursing program outcomes, while also attaining professional nursing proficiencies. Real world application of principles of leadership, inter-professional collaboration to enhance quality of patient care and safety (QSEN), and a systems approach are emphasized. Students begin this course at the onset of the nursing program through development of their nursing Field Period experience, and spend 140 hours fulfilling the objectives of their Field Period contract. Through subsequent participation in a senior level seminar, students provide evidence of attainment of baccalaureate level nursing competencies through application their Field Period learning. Incorporation of evidence based practice, relevant health care policy, and information technology is expected as the student presents documentation of growth in the nursing graduate outcomes, and through creation of a professional mission, vision, values and goal statement along with a personal plan for lifelong learning and professional citizenship.

NUR-495B: Nursing Field Period and Senior Seminar II

Credits 2
This course centers around experiential learning, and enables students to build on generalist education as they integrate new knowledge and skills. Throughout the course, students will build on growth in nursing program outcomes, while also attaining professional nursing proficiencies. Real world application of principles of leadership, inter-professional collaboration to enhance quality of patient care and safety (QSEN), and a systems approach are emphasized. Students begin this course at the onset of the nursing program through development of their nursing Field Period experience, and spend 140 hours fulfilling the objectives of their Field Period contract. Through subsequent participation in a senior level seminar, students provide evidence of attainment of baccalaureate level nursing competencies through application their Field Period learning. Incorporation of evidence based practice, relevant health care policy, and information technology is expected as the student presents documentation of growth in the nursing graduate outcomes, and through creation of a professional mission, vision, values and goal statement along with a personal plan for lifelong learning and professional citizenship.

NUR-500: Organizational and Systems Leadership

Credits 4
This course provides an overview of the advanced nursing roles and responsibilities in the healthcare system. The differentiated needs of the client being served and the range of specialized services offered will be explored. The course begins with an overview of the economic and financial aspects of the healthcare delivery system, including specific issues across the system and their relevance to nursing, healthcare finance and control, and the evolving role of the masters prepared nurse. Utilizing research and technology, the masters prepared nurse assesses changes in healthcare delivery informed by the principles of related theories. Integration of such advanced understanding is analyzed related to the ability to deliver evidence-based and value- based nursing care. Ethical considerations and legal professional responsibilities surrounding the delivery of healthcare are explored in an ever-changing environment.

NUR-510: Nursing Theory and Research

Credits 4
This course presents a foundation for understanding the discipline and development of nursing knowledge as an essential component of scholarly practice for the Masters Prepared Nurse. This course provides the student with a better understanding of how evidence-based practice is translated into the healthcare environment. The research process is presented as students develop an appreciation for the thought processes used to formulate a research problem and purpose. Quantitative, qualitative, and outcomes research are examined in an effort to investigate a variety of research problems and purposes. Published studies are separated into their component parts to evaluate the logical consistency of the theoretical system and its interaction with the study methodology. Quantitative, qualitative, and mixed methods of research are reviewed through performance of critiquing skills. Methodology, implementation, and data analysis/evaluation are stressed as the processes of statistical analyses are presented. Relevant theories highlight the application of nursing research aimed at providing evidence-based nursing care across a variety of patient care settings. The interrelationship of nursing theory, research, and practice is explored using best practice models. This course includes the theoretical basis of outcomes research, a brief history of emerging attempts to examine outcomes, the importance of outcomes research designed to examine nursing practice, and methodologies used in outcomes research.

NUR-520: Nursing Informatics

Credits 3
This course extends and integrates the nurse's knowledge of nursing science, nursing interventions and evidenced based practice with computer science, informatics science and technology. Students examine and critique a variety of healthcare information sources and technologies focused on improving patient care outcomes by navigating and evaluating their reliability and validity. Patient care is considered relative to technology teaching tools, particularly as it aims to improve standards of care. The utilization and management of various information and communication technologies will be evaluated with attention to the ethical and legal ramifications. Those technologies that are most appropriate to enhance the delivery of patient care and to improve patient outcomes will be identified.

NUR-530: Health Care Policy: Advanced Practice Nurse

Credits 3
This course provides the student with a greater understanding of the health of the world population. The course begins with an overview of the political aspects of the healthcare delivery system, including the relevance of the political process in nursing, and information describing how one can become informed. Social, political, and economic considerations are discussed within the delivery of global healthcare. Health policy is studied in relation to relevant theories and principals of patient centered care. Research and theory are integrated as students consider potential strategies for change as leaders within the profession of nursing. Issues discussed include the controversy over the appropriate educational preparation for entry into practice. Information about the role of law and policy are explained in relation to legal issues in nursing practice. Leadership and management principles are further developed to give the masters prepared nurse the tools needed to perform in an international leadership role.

NUR-550: Advanced Health Assessment

Credits 3
This course provides the adult learner with the opportunity to develop advanced health assessment skills. Using the nursing process, the adult learner will obtain and interpret health histories and conduct thorough physical examinations with diverse populations across the lifespan. Normal aging is compared to and contrasted with pathological history and examination findings. An introduction to the process of diagnostic reasoning is provided. Health promotion and risk reduction concepts are stressed throughout the course. Primary, secondary, and tertiary prevention strategies are explored in light of the various predictors of health (i.e. genomics, socioeconomic situation, culture, and spiritual beliefs). The adult learner is expected to engage in experiential hands-on learning. The students have an opportunity to apply theoretical knowledge and evidence-based knowledge while practicing health assessment skills in assigned teams.

NUR-560: Advanced Pathophysiology

Credits 4
Using a systems approach, this course provides the adult learner with the opportunity to develop critical thinking skills and share knowledge related to the management of common pathophysiologic processes occurring within diverse populations across the lifespan. Systems to be explored include: cardiac, vascular, respiratory, and immune. Concepts of pharmacotherapy are presented including pharmacodynamics, pharmacokinetics, and pharmacogenomics. In addition, non-pharmacologic, complementary, and/or alternative therapies are explored. Economic implications and their effects on the ethics of healthcare decision making are discussed and explored. Identification and management of co-morbidities will be addressed, with a strong emphasis on the importance of support from caregivers and/or family. Availability of community resources is explored. The adult learner is expected to engage in experiential hands-on learning. The adult learners have an opportunity to apply theoretical knowledge and evidence based knowledge while practicing health promotion strategies in selected community settings.

NUR-570: Advanced Pharmacology

Credits 3
Using a systems approach, this course provides the adult learner with the opportunity to develop critical thinking skills and share knowledge related to the management of common pathophysiologic processes occurring within diverse populations across the lifespan. Systems to be explored include: renal, gastrointestinal, genitourinary, endocrine, neurological, musculoskeletal and integumentary. Concepts of pharmacotherapy are presented including pharmacodynamics, pharmacokinetics, and pharmacogenomics. In addition, non-pharmacologic, complementary, and/or alternative therapies are explored. Economic implications and their effects on the ethics of healthcare decision making are discussed and explored. Identification and management of co-morbidities will be addressed, with a strong emphasis on the importance of support from caregivers and/or family. Availability of community resources is explored. The adult learner is expected to engage in experiential hands-on learning. The adult learners have an opportunity to apply theoretical knowledge and evidence based knowledge while practicing health promotion strategies in selected community settings.

NUR-580: Evaluation of Adult/Gerontology Health for the Advanced Practice Nurse

Credits 4
This course focuses on the assessment of adult health status and application of clinical reasoning and evidence-based practice in the management of health status deviations. Clinical reasoning using advanced health assessment skills and knowledge of advanced pathophysiology and pathopharmacology leads to the formulation of comprehensive differential diagnosis. Use of appropriate diagnostic tools and timely referral is explored. Formulation of treatment plan using best evidence and system resources is introduced. Emphasis on professional role socialization and functioning within the interdisciplinary health care team prepares the practitioner for the advanced practice role within the current health care system. Scope of practice and legal aspects of the advanced practice role are examined including New York State and federal laws related to prescriptions and record-keeping.

NUR-620: Philosophy/Theories Teaching/Learning

Credits 3
This course introduces future nurse educators to major theories of adult learning and development. Students analyze seminal and current educational models and theories as they inform effective curriculum design, learning environments, teaching practices, and student development.  Current research in nursing education and higher education is explored as the foundation for implementing evidence-based teaching practices that support adults' intellectual development and professional formation. Students  reflect on their experiences as adult learners through the lens of educational theory and identify those theories that resonate  with their emerging philosophy of teaching.

NUR-630: Teaching/Learning Environment/Governance

Credits 3
This course focuses on the role of the nurse educator in creating  effective learning environments that promote student learning and professional formation. Students construct learning objectives that align with and support course and program outcomes.  Learners examine the multicultural, gendered, generational, educational, and experiential influences on learning and design a teaching plan relevant to their students' needs and identified learning outcomes.  Best practices in assessment and evaluation of student learning in classroom, clinical, and simulated settings are explored. Specialized accreditation guidelines are reviewed as they impact the structure, culture, and governance of the nursing program.

NUR-640: Curriculum Development and Evaluation

Credits 3
This course is designed to prepare graduate learners for the nurse educator role specific to curriculum development and evaluation. Building on the principles of higher education and nursing education mastered in previous courses, this course provides the foundation necessary to assess, create, and revise nursing curricula.  Learners will explore current curriculum frameworks and models of education and examine internal and external factors that impact curriculum decisions within academic and clinical  settings. Health care trends and technology will be examined as they impact curriculum planning, design, and systematic program evaluation. Throughout the course learners will examine evidence-based best practices in curriculum development, program evaluation, and accreditation that promote excellence and quality in nursing education.

NUR-645: Pediatric Health

Credits 3
This course focuses on the biological and behavioral phenomena of concern in the care of children and adolescents. Health promotion, clinical presentation, diagnostic reasoning, evaluation, and management of health needs of children and adolescents are explored. Students apply the principles of health assessment, diagnosis and treatment of acute, episodic and chronic health issues of children and adolescents. Patient education, advocacy, and evidence-based practice are incorporated in a holistic family-centered approach to providing comprehensive care.

NUR-650: Primary Care for Adult/Geriatric Patient I

Credits 4
Building upon knowledge and clinical reasoning skills established in NUR-550, 560, 570 and 580, this course focuses on the prevention, diagnosis, treatment and/or management of chronic health conditions and acute exacerbations of illness. Using a systems approach, this course focuses on conditions effecting the eyes, ears, nose, and throat; cardiovascular pulmonary; hematological; and gastrointestinal systems. Opportunities to apply evidence-based knowledge and enhance clinical reasoning skills will be available to the student through unfolding case studies and clinical practicum experiences which include care of the adult and geriatric populations served in acute, chronic care and/or community based settings. Opportunity to utilize relevant technology in determined areas of care will be incorporated.

NUR-655: Gender Inclusive Gynecological Health Care

Credits 3
This course focuses on the biological and behavioral phenomena of concern in the care of persons seeking gynecological care. Health promotion, clinical presentation, diagnostic reasoning, evaluation, and management of health needs from adolescence through older adulthood, including pregnancy, are explored. Principles of health assessment, diagnosis, education, advocacy, and evidence-based practice are incorporated in a holistic gender-inclusive approach to provide comprehensive care.

NUR-660: Primary Care for Adult/Geriatric Patient II

Credits 4
Building upon knowledge and clinical reasoning skills established in NUR 550, 560, 570, 580, and 650, this course focuses on the prevention, diagnosis, treatment, and/or management of chronic health conditions and acute exacerbations of illness. Using a systems approach, this course focuses on conditions effecting the musculoskeletal; neurological; endocrine; genitourinary; reproductive, and integument systems. Opportunities to apply evidence-based knowledge and enhance clinical reasoning skills will be available to the student through unfolding case studies and clinical practicum experiences which include care of the adult and geriatric populations served in acute, chronic care and/or community based settings. Opportunities to utilize relevant technology in determined areas of care will be incorporated.

NUR-670: Advanced Practice Nurse as Community Health Leader

Credits 4
Seminar and practicum focuses on the role of the Adult/Gerontology Primary Care Nurse Practitioner as a community health leader. Nursing science and epidemiology provide the base for examining the spectrum of community health and understanding of the delivery of primary health care to individuals, communities, and populations. Tools for community assessment and diagnosis as well as concepts of health promotion, disease prevention, risk reduction, rehabilitation, and evidence-based practice for the health of groups is presented. Students develop role competencies under the supervision of nurse practitioner preceptors and faculty in a variety of health care settings.

NUR-710: Education Internship

Credits 3
This course provides the opportunity for the direct application of teaching / learning theory, classroom and clinical instruction as well as outcome measurement in a self-selected student teaching experience. Adult learners are encouraged to select a setting that is consistent with their future professional goals as an educator. The internship experience must include a minimum of 80 hours of combined instructional and evaluation preparation. The opportunity for experiential and service learning is provided as students accept accountability and apply concepts learned. Professional and personal development is encouraged throughout the experience as continuous self-evaluation occurs. This course runs concurrently with NUR620, NUR630 and NUR640.

NUR-750: Professional Seminar/Capstone

Credits 2
This course integrates and applies knowledge gained through the core and specialty courses as well as internship/clinical experiences. Current issues and concepts affecting the role of the masters prepared nurse are explored relative to their ability to affect change. Research and theory are integrated as students propose potential strategies for change as leaders within the profession of nursing. The comprehensive exam will be an indicator of having met program outcomes.