NURS FPX 5007 Assessment 3 Intervention Strategy

Name

Capella University

NURS-FPX 5007 Leadership for Nursing Practice

Prof. Name

Date

Intervention Strategy

Leadership is essential in directing group efforts toward achieving shared goals, particularly in the complex healthcare environment. To cultivate effective leadership within this setting, various leadership philosophies can be tailored to meet specific challenges. It is vital to develop strategies that inspire employees to work together toward common objectives. A successful leadership style, along with effective change management, is fundamental for the sustainability and success of healthcare organizations. At its core, leadership involves the actions of individuals or groups responsible for guiding the activities of others in pursuit of collective aims. In healthcare, this responsibility often includes overseeing the work of physicians, nursing staff, and other medical professionals to ensure that patients receive high-quality care. An essential component of effective healthcare leadership is establishing processes and structures that promote teamwork and collaboration among employees. This is achieved by creating clear communication channels, setting shared goals, and fostering a culture that values teamwork and cooperation (Bass, 2019).

Analyzing Case Study

The case study titled “Sleeping on the Job: A Managerial Challenge” focuses on a nurse named Marty, who has faced personal challenges during her three years in an office setting. The responsibility of caring for her aging parents has significantly reduced her personal time after work. Colleagues have expressed concerns regarding Marty’s job performance, reporting instances of tardiness, early departures, and even sleeping on the job, attributing her behavior to health issues. Additionally, she has been absent from work due to personal matters, including family deaths and injuries. Unfortunately, her manager has not provided any assistance or sought solutions to support her.

To support Marty, her manager should assess potential strategies that could benefit both her and the entire team. One effective approach might involve implementing transformational leadership, characterized by open and honest communication with Marty. Through this dialogue, both parties can identify obstacles that hinder her success and collaboratively create a plan for improvement. The manager should encourage Marty to share her insights and perspectives on overcoming these challenges. Furthermore, discussing her career aspirations and exploring ways to achieve them is crucial. This approach necessitates ongoing communication and collaboration among all involved parties (Alrowwad et al., 2020).

Leadership Strategy

In navigating the complexities of the healthcare landscape, a variety of leadership models can be employed. Some managers may opt for the transformational leadership model, which emphasizes empowering staff members to work together towards common objectives (Collins et al., 2020). In contrast, others might prefer a transactional leadership style that focuses on setting clear goals and providing rewards for achieving them (Kelly & Hearld, 2020).

Transformational leadership can be particularly effective in healthcare settings, as it highlights the importance of teamwork, collaboration, and communication. This style empowers individuals to take ownership of their work and fosters a collective sense of responsibility for achieving shared goals. By promoting a positive and inclusive work environment, transformational leaders create a culture of trust and respect that enhances employee engagement and job satisfaction—an essential factor in healthcare, where staff frequently operate in high-stress, emotionally charged environments (Espinoza et al., 2018).

Applying Leadership Strategy

In addressing Marty’s situation, two primary concerns require attention: her inadequate job performance and the negative impact it has on the nursing team. Transformational leadership is the most suitable approach for resolving these issues, as it focuses on inspiring and motivating employees to reach their full potential (Akdere & Egan, 2020). Given the circumstances described, it appears that Marty’s personal challenges are influencing her work performance. Consequently, a transformational leader can leverage motivation and inspiration to enhance her productivity.

Once a plan is established to address Marty’s performance issues, the department leader can then concentrate on rebuilding trust within the team. Transformational leadership encourages employees to assume responsibility for their roles and make decisions that contribute to overall success. Management and staff can collaboratively define clear departmental goals and principles, fostering an environment that promotes open communication. This will enable nurses to effectively connect and collaborate in addressing departmental objectives and patient needs.

Organizational Change Model and its Influence

The ADKAR model can serve as a valuable framework for implementing change, whether applied to an individual or an entire organization. The five stages of the ADKAR model—awareness, desire, knowledge, ability, and reinforcement—provide a structured approach to guide individuals through the transformation process.

In Marty’s case, the first step involves engaging her in a one-on-one conversation to review her past actions and their effects on the organization. This meeting aims to raise her awareness of the necessity for change and to discuss how these changes can benefit her, the department, the organization, and the patients they serve. The second step is to cultivate a desire for change, which can be achieved by discussing the organization’s mission, vision, values, and policies with Marty. This dialogue can inspire her to embrace changes that align with the organization’s objectives.

The third stage entails re-educating Marty about the components and expectations of her role, accomplished through open discussions that address any knowledge gaps and provide resources to improve her performance amidst departmental enhancements. The fourth phase centers on helping Marty translate her understanding and knowledge into practical abilities. Consistent communication with her during this implementation phase is critical to assess her progress and make necessary adjustments. Finally, the reinforcement phase is essential to prevent Marty from reverting to her previous behaviors characterized by substandard productivity. Positive reinforcement—through feedback, recognition, rewards, and performance metrics—can effectively support her in maintaining productivity and achieving her goals (Wong et al., 2019; Cronshaw et al., 2021).

Implication of Care Policy and Legislation

Nurses possess a unique ability to influence public health policy development due to their direct interactions with patients and deep understanding of their communities. The American Nurses Association (ANA) asserts that nurses have significant influence over healthcare policy at various levels. The ANA’s “Healthy Nurse. Healthy Nation” initiative emphasizes health and safety policies, advocating for regulations that promote nurses’ well-being. This program encourages action in five key areas: fitness, sleep, lifestyle quality, safety, and nutrition, aimed at enhancing the health and well-being of the nation’s four million nurses. Through this initiative, nurses and managers gain access to a platform with resources, data, and connections with employers and organizations to improve their health and well-being (Nolan et al., 2020).

This movement can positively impact Marty, who has been struggling with poor job performance due to personal issues affecting her mental and physical health. Colleagues have raised concerns regarding her sleep patterns and medical conditions such as sleep apnea. The “Healthy Nurse. Healthy Nation” campaign can provide Marty with resources to build a support system at home, alleviating her caregiving burden and enabling her to prioritize her physical and mental well-being. By addressing these underlying issues, Marty’s job performance can improve, allowing her to care for her patients more effectively. The ANA’s advocacy for nurses’ health and safety is vital in empowering nurses to realize their full potential and enhance healthcare for all.

Conclusion

Effective leadership is essential for the success of an organization, including specific departments. Leaders who understand the organizational structure recognize that employee job satisfaction and motivation are crucial to achieving success. Transformational leaders inspire employees to strive for the organization’s greater good while continually seeking improvement. Effective leaders also excel at managing change, guiding employees through challenges, and fostering growth within their departments. In the healthcare sector, strong leadership is fundamental to enhancing patient outcomes.

References

Alrowwad, A. A., Abualoush, S. H., & Masa’deh, R. E. (2020). Innovation and intellectual capital as intermediary variables among transformational leadership, transactional leadership, and organizational performance. Journal of Management Development, 39(2), 196-222. https://doi.org/10.1108/jmd-02-2019-0062

Akdere, M., & Egan, T. (2020). Transformational leadership and human resource development: Linking employee learning, job satisfaction, and organizational performance. Human Resource Development Quarterly, 31(4), 393-421. https://doi.org/10.1002/hrdq.21404

Bass, B. L. (2019). What is leadership?. Leadership in Surgery, 1- 10. https://doi.org/10.1007/978-3-030-19854-1_1

NURS FPX 5007 Assessment 3 Intervention Strategy

Collins, E., Owen, P., Digan, J., & Dunn, F. (2020). Applying transformational leadership in nursing practice. Nurs Stand, 35(5), 59-66. https://doi.org/10.7748/ns.2019.e11408

Cronshaw, A., Boddye, E., Reilly, L., Boardman, R., Portas, L., Hagen, J., & Marufu, T. C. (2021). Engaging the nursing workforce to achieve a culture of excellence: Nottingham Children’s Hospital ANCC Pathway to Excellence® Journey. https://doi.org/10.7748/nm.2021.1980

NURS FPX 5007 Assessment 3 Intervention Strategy Espinoza, P., Peduzzi, M., Agreli, H. F., & Sutherland, M. A. (2018). Interprofessional team member’s satisfaction: a mixed methods study of a Chilean hospital. Human Resources for Health, 16(1), 1-12. https://doi.org/10.1186/s12960-018-0290-z

Kelly, R. J., & Hearld, L. R. (2020). Burnout and leadership style in behavioral health care: A literature review. The Journal of Behavioral Health Services & Research, 47(4), 581- 600. https://doi.org/10.1007/s11414-019-09679-z

Nolan, S., Carpenter, H., Cole, L., & Fitzpatrick, J. (2020). The HealthyNurse [R] Leader: How do the health behaviors of nurse leaders measure up?. American Nurse Journal, 15(1), 30-32. https://www.myamericannurse.com/the-healthynurse-leader/

Wong, Q., Lacombe, M., Keller, R., Joyce, T., & O’Malley, K. (2019). Leading change with ADKAR. Nursing management, 50(4), 28-35.

NURS FPX 5007 Assessment 2 Managing the Toxic Leader

Name

Capella University

NURS-FPX 5007 Leadership for Nursing Practice

Prof. Name

Date

Managing Toxic Leadership: An APA-Formatted Rewrite

Importance of Effective Leadership

Effective leadership is crucial for the success of any organization. Competent leaders possess the skills necessary to empower their teams, boost productivity, and accomplish organizational goals. They are responsible for formulating and executing long-term plans, collaborating with colleagues, identifying challenges, setting targets, and establishing deadlines to ensure desired outcomes. Successful organizations flourish when employees cooperate and work towards shared objectives. In a healthcare context, such as a hospital, leadership significantly influences workplace culture. Effective management requires collaboration with the team and maintaining open communication during both successes and failures (Monroe, 2019). It is essential for leadership to create a supportive environment that enables healthcare workers to meet benchmarks and elevate nursing practice and care delivery standards.

The primary goal is to enhance working conditions and cultivate a productive, collaborative work culture among nursing staff. Stress is a significant concern for nursing professionals who often endure extended, unscheduled shifts with insufficient support and minimal breaks. Without adequate administrative support, nurses may struggle to address these challenges. While nurses advocate for healthier lifestyles and well-being, they frequently neglect their own health while on duty. Research indicates that healthcare facilities that promote healthier lifestyles, productive work environments, and collaborative workspaces experience higher employee satisfaction, increased engagement, and improved patient care (Miles & Scott, 2019).

Case Study: Head Nurse Performance Evaluation

The psychiatry unit initially implemented a primary healthcare nursing model to optimize patient experience and care quality. Achieving these goals necessitated collaboration and the formation of interdisciplinary professional teams. The healthcare facility, healthcare workers, and patients would benefit from the head nurse’s support in promoting collaboration and coordination among administration, supervisors, and executives. Unfortunately, the nurse manager’s leadership style in this case study is at odds with the facility’s established guidelines. Jackie, the Nurse Manager, leads patient care conferences but seldom attends the thrice-weekly sessions designed to address complex cases and foster cooperation for effective patient-centered care.

In addition to her frequent absences, Jackie’s unprofessional behavior includes failing to communicate schedule changes to her team. This conduct undermines the quality of nursing practices and disregards the team’s efforts, negatively affecting their morale and productivity. Jackie’s habitual lateness further impedes care delivery, as staff must wait to consult with her, causing delays in patient care. Additionally, she does not respond to emails from nursing professionals, and her attire at work lacks professionalism, often including revealing clothing, large hoop earrings, and high heels. Moreover, her inappropriate interactions with a staff member named Martin violate the American Nurses Association (ANA) regulations and standards of professional conduct, which encompass evaluation, diagnosis, goal setting, strategy development, and care coordination (Monroe, 2019).

NURS FPX 5007 Assessment 2 Managing the Toxic Leader

Jackie’s behavior appears to contravene two specific elements of the ANA’s code of ethics: professional responsibilities and relationships with co-workers, as well as patient responsibility. According to the ANA, healthcare professionals must establish boundaries and maintain professional interactions with colleagues, superiors, and patients. They should foster supportive and caring relationships with all colleagues, treating them fairly and respectfully. This entails making compromises that uphold dignity and addressing conflicts constructively.

Jackie’s actions in this context demonstrate a lack of leadership, professional conduct, commitment to her medical team, and empathy towards her staff (Monroe, 2019). The ANA defines professional boundaries as the acceptable, ethical, and social limits that practitioners recognize and respect, which can be particularly challenging due to the interpersonal nature of caregiving. Healthcare professionals must ensure that these limits are established and maintained (Aghamohammadi et al., 2021).

When these values are compromised, healthcare practitioners must seek support from superiors or take necessary measures to prevent similar situations (Olson, 2021). This principle applies to inter-professional and interdisciplinary relationships, extending beyond nursing practice and encompassing nurse-patient interactions (Warshawsky & Cramer, 2019). To address Jackie’s ethical breaches and enhance her performance as a nurse manager, a Performance Improvement Plan (PIP) must be developed, outlining specific initiatives and timelines. This plan aims to help Jackie exhibit professionalism and commitment (Monroe, 2019).

Organizational Mission, Vision, and Goals

Jackie’s behavior is at odds with the healthcare facility’s mission, goals, and objectives. The organization’s primary goal is to deliver exceptional patient care in a compassionate environment, significantly improving the well-being of the communities it serves. Healthcare providers work collaboratively to create a healthcare continuum that enhances societal health and well-being. However, Jackie’s irresponsible actions and inability to collaborate with her team negatively impact patients and contradict the institution’s mission (Huang et al., 2021). The healthcare facility’s vision focuses on better healthcare performance, improved care delivery, enhanced patient experiences, and increased employee satisfaction.

Jackie’s actions and unprofessional demeanor do not align with the core values and objectives articulated by the organization. Her behavior fails to ensure optimal patient care or experiences and detracts from the quality of healthcare services and treatment she provides. The organization’s ultimate aim is to prioritize patients and their values, but Jackie’s leadership does not support the goals of her team or the healthcare facility. According to the case study, she prioritizes personal matters over attending healthcare staff discussion sessions, obstructing progress toward creating a positive, collaborative, and productive workplace with dedicated professionals focused on patient care. Jackie’s actions jeopardize the high-quality care expected from the healthcare institution she represents, undermining its ability to achieve its mission, goals, and objectives (Huang et al., 2021).

Action Plan to Improve Leadership Performance

Effective nursing leadership inspires transformation by motivating colleagues and co-workers to pursue organizational and individual goals. Nursing leadership demands specific characteristics and abilities, and every nurse possesses the potential to be a leader in some capacity. Whether influencing patients to adhere to treatment plans, serving as role models for less experienced nurses, or managing a nursing team, developing leadership skills is essential for advancing in a nursing career and attaining both personal and organizational goals. Various strategies can bolster nursing leadership skills and enable nurses to become effective leaders within their organizations.

During the implementation of the Performance Improvement Plan (PIP), the Assistant Head Nurse will assume the role of Acting Nurse Manager for the psychiatric unit. The Acting Nurse Manager will lead conferences and address all complaints from team members. Jackie is required to arrive at work within the designated time frame specified in her employment agreement, which ranges from 07:55 to 08:15 on the clock. Should she arrive late three times, one unpaid absence will be recorded, along with further organizational consequences.

NURS FPX 5007 Assessment 2 Managing the Toxic Leader

All staff communications must be addressed within 24 hours. Jackie is expected to respond promptly to all correspondence and emails from her team. Additionally, she should inform the team in advance of any postponed or canceled events or conferences to facilitate effective preparation and schedule adjustments. Jackie must adhere to the clothing and dress code guidelines outlined in the employee manual, dressing professionally and wearing appropriate formal attire at work. She should schedule her appointments and meetings after work hours or at times that do not interfere with her work schedule or performance. Jackie must follow workplace ethics as defined in the employee manual and avoid any unethical or improper interactions with other employees.

This action plan will be implemented over the next month, during which Jackie will work in alignment with the healthcare facility’s mission, objectives, and goals to ensure the highest quality care, improved outcomes, and enhanced patient satisfaction. Evidence-based collaboration techniques will be employed to promote teamwork and cooperation, cultivating highly effective healthcare workers who maximize knowledge, staff, and resources for optimal results (Miles & Scott, 2019). This approach will serve as a guiding principle for her work, with the Team STEPPS (Team Strategies and Tools to Enhance Performance and Patient Safety) framework supporting psychiatric unit performance and clinical outcomes (Cooke & Valentine, 2021).

At the conclusion of the PIP period, the Human Resources (HR) representative will arrange a meeting between Jackie and her supervising manager to review and assess her performance (Oberle, 2022). Jackie’s progress and outcomes will determine her ability to resume her role as a nurse manager. Her leadership will be closely monitored by her team, and the performance of the Acting Nurse Manager will also be evaluated to assess suitability for other leadership positions.

References

Aghamohammadi, F., Imani, B., & Koosha, M. M. (2021). Operating room nurses’ lived experiences of ethical codes: a phenomenological study in Iran. International Journal of Nursing Sciences, 8(3), 332-338. https://doi.org/10.21203/rs.3.rs-121826/v1

Cooke, M., & Valentine, N. M. (2021). Improving teamwork and communication in schools of nursing: a quality improvement approach using TeamSTEPPS. Journal of Nursing Care Quality, 36(3), 285-290. https://doi.org/10.1097/ncq.0000000000000513

Huang, N., Qiu, S., Yang, S., & Deng, R. (2021). Ethical leadership and organizational citizenship behavior: mediation of trust and psychological well-being. Psychology Research and Behavior Management, 655-664. https://doi.org/10.2147/prbm.s311856

Miles, J. M., & Scott, E. S. (2019). A new leadership development model for nursing education. Journal of Professional Nursing, 35(1), 5-11. https://doi.org/10.1016/j.profnurs.2018.09.009

Monroe, H. A. (2019). Nurses’ professional values: influences of experience and ethics education. Journal of Clinical Nursing, 28(9-10), 2009-2019. https://doi.org/10.1111/jocn.14806

NURS FPX 5007 Assessment 2 Managing the Toxic Leader

Olson, L. (2021). Envisioning an ethical climate in nursing education programs. Online Journal of Issues in Nursing, 26(1

), 1-10. https://doi.org/10.3912/ojin.vol26no01man07

Warshawsky, N., & Cramer, E. (2019). Describing nurse manager role preparation and competency: findings from a national study. JONA: The Journal of Nursing Administration, 49(5), 249-255. https://doi.org/10.1097/nna.0000000000000746

NURS FPX 5007 Assessment 1 Leadership Styles Application

Name

Capella University

NURS-FPX 5007 Leadership for Nursing Practice

Prof. Name

Date

Leadership Styles Application

The role of leadership is complex and often depends on varying circumstances. In the healthcare sector, leaders play a crucial role in improving care quality, which directly affects patient outcomes. Effective leadership is necessary for managing organizational processes, ensuring employee satisfaction, promoting information sharing, and enhancing clinical outcomes. Furthermore, leaders help in cultivating strong and positive organizational cultures. Leadership roles also require guiding and refocusing employees to maintain a productive and safe workplace environment. Healthcare recognizes several leadership styles, and making informed decisions and planning for potential challenges is essential (Cummings et al., 2021).

Case Study

In examining a workplace challenge, we consider the case of Marty, an African American healthcare worker with over six years of experience in rehabilitation care at a university healthcare facility. Marty works independently, providing care to patients across various hospitals. Additionally, she has been employed in an office role for over two years, typically working weekdays. Three years ago, Marty’s mother was diagnosed with dementia, and Marty has since become her primary caregiver. She assists her mother during her off-time, creating work-related challenges.

Marty’s performance has been negatively affected by her caregiving responsibilities. She has been consistently arriving late to work and leaving early for over a year. This pattern has led to frustration among her colleagues. When confronted, Marty disclosed that she has a sleep disorder known as apnea but refuses to use a CPAP machine.

Nursing professionals have expressed concerns, accusing Marty of neglecting her responsibilities and using her mother’s illness as an excuse for early departures. Marty has also taken extended leaves for reasons such as mourning the loss of a sibling and recovering from chronic back pain. Colleagues and staff have reported her behavior to her supervisor, suggesting the need for additional staffing to compensate for her lack of participation. Although Marty is currently on Family and Medical Leave Act (FMLA), her supervisor is aware of the situation but has taken no action (Cummings et al., 2021).

Relevant Leadership Styles and Practices

Three significant leadership styles applicable to this scenario are democratic, transactional, and transformational leadership. Transformational leadership involves inspiring change, fostering trust, encouraging creativity, and empowering team members. This style leads to improved team performance, psychological empowerment, and increased motivation while reducing burnout, which boosts productivity. Leaders using this approach can assess team members’ strengths and assign tasks based on these strengths to reduce social loafing (Robbins & Davidhizar, 2020).

Transactional leadership focuses on routine tasks, short-term goals, rewards, and intervention when necessary. It sets clear objectives and responsibilities, making it suitable for healthcare environments. Combining transactional leadership with transformational leadership can result in improved care delivery, clinical skills, and better task management (Richards, 2020).

Democratic leadership emphasizes inclusive decision-making, valuing employee input, and fostering teamwork. It empowers employees in policy formation and implementation, boosting self-esteem and optimism, which can improve productivity (Oliveira et al., 2020).

Leadership Style Applicable in the Case Study

Given Marty’s situation and her underperformance, a transformational leadership style is most appropriate for her supervisor and colleagues. The supervisor should adopt this leadership style to address the issues affecting the workplace. Despite Marty’s FMLA status, which entitles her to a maximum of 12 weeks of annual leave, she has exceeded this limit due to her medical condition and caregiving responsibilities. This situation has caused distress among her coworkers. Implementing a transformational leadership approach can highlight the workplace issues and help Marty recognize her violations, such as excessive time off, naps during work hours, and frequent lateness or early departures.

The manager must motivate the team, address concerns, and take action to rebuild trust. Addressing these concerns is critical, as Marty’s colleagues’ complaints have been ignored for a long time, allowing her to disregard workplace rules. Through transformational leadership, Marty can receive guidance on her job responsibilities, while open communication might encourage her to adhere to workplace rules.

Introducing this leadership approach can foster a positive workplace environment where employees feel heard and their concerns addressed. However, due to prolonged inaction regarding Marty’s behavior, initially inspiring employee loyalty may be challenging. A reward system with clear goals could change the office culture, motivate performance, and encourage Marty to reduce absences and adhere to her schedule. This incentive program could benefit all employees by promoting exceptional performance and offering additional leave days over a set period (Richards, 2020).

Positive and Negative Implications

The benefits of implementing this leadership approach include recognizing and rewarding extra effort, promoting a healthy work culture, and enhancing employees’ knowledge and experience. However, transactional leadership could cause occupational stress, requiring employees to exceed expectations for rewards. Marty may not respond well to this approach, leading to further dissatisfaction among her colleagues (Nawaz & Khan, 2020).

A democratic leadership style may also be suitable, as it allows employees to express concerns about Marty’s punctuality and work attitude. By engaging in decision-making, Marty may reconnect with her job, regain a sense of purpose, and improve her productivity. Democratic leadership enhances job satisfaction and employee engagement, ensuring that all employees’ needs are met (Oliveira et al., 2020).

Introducing democratic leadership may strengthen relationships among Marty, her colleagues, and her supervisor, improving employee engagement and fostering effective collaboration. However, the downside is that this leadership style requires time and patience to engage employees and gather input, which may be challenging in a busy healthcare setting (Holmgren et al., 2019).

References

Cummings, G. G., Lee, S., Tate, K., Penconek, T., Micaroni, S. P., Paananen, T., & Chatterjee, G. E. (2021). The essentials of nursing leadership: A systematic review of factors and educational interventions influencing nursing leadership. International Journal of Nursing Studies, 115, 103842. https://doi.org/10.1016/j.ijnurstu.2020.103842

Holmgren, J., Paillard‐Borg, S., Saaristo, P., & von Strauss, E. (2019). Nurses’ experiences of health concerns, teamwork, leadership, and knowledge transfer during an Ebola outbreak in West Africa. Nursing Open, 6(3), 824-833. https://doi.org/10.1002/nop2.258

Nawaz, S., & Khan, I. U. (2020). The leadership styles and occupational stress: The mediating role of emotional intelligence. Academic Journal of Social Sciences (AJSS), 4(4), 906-917. https://doi.org/10.54692/ajss.2020.04041198

Oliveira, C. D., Santos, L. C. D., Andrade, J. D., Domingos, T. D. S., & Spiri, W. C. (2020). Leadership in the perspective of family health strategy nurses. Revista Gaucha De Enfermagem, 41. https://doi.org/10.7748/nr.13.4.93.s13

NURS FPX 5007 Assessment 1 Leadership Styles Application

Richards, A. (2020). Exploring the benefits and limitations of transactional leadership in healthcare. Nursing Standard, 35(12), 46-50. https://doi.org/10.7748/ns.2020.e11593

Robbins, B., & Davidhizar, R. (2020). Transformational leadership in health care today. The Health Care Manager, 39(3), 117-121. https://doi.org/10.1097/01.hcm.0000285014.26397.e7