nurses' compassionate care affects patient outcomes



Patient and staff experiences have a direct impact on patient outcomes and are important measurements of the quality of healthcare provision. Communication with a patient and their families to collaborate on treatment and diagnosis may provide the necessary knowledge of the patient’s condition to effectively manage their ailments and prevent future reoccurrence. The Agency for Healthcare Research and Quality adds that fewer nurses on staff diminish patient outcomes, which may be marred by pneumonia, infections or cardiac arrest. The many nursing programs that are offered strive to prepare students to make meaningful contributions to the world. Research published by the U.S. National Institutes of Health’s National Library of Medicine (NIH/NLM) states that, “The delivery of high quality compassionate care is also a significant patient reported outcome, which positively affects a patient’s perception of care and quality of life, while mitigating against patient complaints and malpractice suits.” Patients rely on nurses to provide quality care. In a study conducted with physicians and nurses, 71% of doctors and nurses linked incivility to medical error, and 27% tied it to a patient’s death. When nurses acquire the skills from a BSN online or other advanced degree, they may be better prepared for the workforce demand of handling more patients, complex procedures and the evolving technology that’s now an intrinsic part of every patient process. Advance your career with Sacred Heart University. The purpose of this study was to investigate the effect of nurse burnout on nurse‐reported quality of care and patient adverse events and outcomes in Thai hospitals. Effective and high quality education and training must ensure that NHS staff are available in the right numbers with the right skills, values and competencies to deliver both excellent clinical outcomes together with patient-centred care. With the right RN-BSN online degree, nurses gain the clinical experience and educational know-how to skillfully put their theories into practice. Make eye contact. Author information: (1)University of Pennsylvania School of Nursing, Philadelphia 19104-6096, USA. 1. Hospitals may use role-playing or simulation to teach nurses the skills they need to bond with their patients. However, proper clinical training and education can thwart these potential mistakes, improving patient outcomes and satisfaction. A systematic review of 24 studies on compassionate care delivery found that training nurses in compassionate care delivery enhanced patient satisfaction, quality of life, mood, and well‐being and increased nursing job satisfaction and reduced burnout (Blomberg et al., 2016). PRINCIPAL FINDINGS: Of 257 data-based studies of nursing care quality identified, 135 investigated a process-outcome link but only 17 met study inclusion criteria. Caring for patients is a ministry that nurses feel called to perform. Since the Francis Report which revealed severe failings in patient care in the Mid Staffordshire NHS Foundation Trust, there has been a resurgence of interest in the humanisation of medical care. Compassionate Connected Care for the caregiver. It starts with the non-verbal communication between patients and nurses. This gives rise to an … Clinical error can have serious consequences. Visit the website of our College of Nursing and Health Care Professions, and click the Request More Information button to get started. The consequences of stress include increased provider burnout and decreased quality of care for patients. Stress is a critical problem facing many healthcare institutions. Nurses who not only have proper nursing preparation but are also empathetic, dedicated and vigilant can help improve patient outcomes and ensure that patients are satisfied with their care. Understanding how the workplace culture can alter patient care can give nurses the understanding needed to make changes that have a positive impact. A surplus of nursing staff can reduce workload and stress, giving more time to focus on the recovery process of patients and taking less time in determining how to juggle the patient load. Needless to mention, nurses have a great role to improve patient outcomes. Sacred Heart University is an accredited institution of higher learning which promotes spiritual and ethical values and rejoices in learning and discovery. “These findings clearly demonstrate that the quality of the nursing work environment significantly influences nurses’ ability to reduce suffering for patients and caregivers alike,” Dempsey adds. Other workplace factors can impact a nurse’s efforts in terms of patient recovery. According to an Institute of Medicine (IOM) study, patient-centric care is directly linked to health care quality and safety. Here are some ways nurses can show they care: Smile. By Debra Wood, RN, contributor. Patients may be embarrassed to admit problems, such as lacking support at home. Every dedicated nurse understands that empathizing with patients is beneficial for them. The literature provides evidence that the quality of nursing care processes affects health-related patient outcomes … The way nurses are trained and how they’re recognized when achieving professional goals may ignite the motivation that accompanies their compassionate core values. If nurses’ voices were included in the stories we’re now hearing from doctors about compassion in health care, the call for greater empathy would be even stronger. At the same time, their needs can be overlooked. Nurses who further their education with a BSN degree play an integral role in patient recovery. Data from over 2,600 hospitals, 165,000 nurses, and 1.3 million patients revealed that poor working conditions can have a negative impact on all four of those domains. Be better able to … Start by putting yourself in their shoes. Nurses’ Compassionate Care Affects Patient Outcomes. A workplace culture guided by patient safety requires strong nurse leadership that will keep staff alert and assist in the decision-making process of patient outcomes. Shake your patient’s hand and pull up a chair. Each time you walk into a room with a new patient, greet him or her with a smile. Although nursing is an inherently compassionate profession, it’s all too easy to lose sight of these values in the rush to get from one patient to the next. By instilling nurses with the values of patient-centered care, nursing schools and healthcare organizations help them develop a compassionate approach to care. They work relentlessly without bothering much about the poor condition to offer compassionate care to patients. These professionals take extra effort when patients find it hard to open up and share their suffering. to speak with a knowledgeable Admissions Representative. Patient outcomes included in-hospital mortality, medication errors, falls, pressure ulcers, and patient satisfaction with nurses. The success of each nurse can be found not just in the care of their patients, but also in the patients’ recovery time. Additionally, compassionate care eases patients’ anxiety, and a relaxed patient is more likely to: Have a shorter hospitalization. Tell your patient that you’re always available to help, and that he or she shouldn’t hesitate to press the call button when assistance is needed. Because nurses spend a lot of time with patients, they have a major impact on patient experiences. Patients feel overwhelmed by the medical equipment. Patient-centered care gives nurses the distinct advantage of consistent, daily assessment of conditions. Clinical practice is a paradigm for treatment and recovery efforts, proving especially vital when case evidence is not readily accessible. This automatically signals to your patient that you’re there to listen and to help. In an era of value-based care, outcomes matter more than ever. Additionally, this type of quality education acts as a gateway to graduate nursing programs that allow nurses to hone their skills in a specialized patient care area, which can also benefit the patient. It is the foundation for proper treatment decisions. Emphasis on examining provider effects and resulting patient outcomes has grown considerably in the past several decades. It starts with the non-verbal communication between patients and nurses. Using Compassion and Kindness to Promote Better Patient Outcomes. Patients feel as though they aren’t being involved in their own care. RNs and BSNs are in the unique position to make a daily difference in patient recovery that can be quantified by every hospital department. Every patient is a unique individual, of course, but here are a few common concerns and challenges they face: When you meet each new patient, ask yourself what you can do to help that person feel more comfortable in the hospital setting. According to an Institute of Medicine (IOM) study, patient-centric care is directly linked to health care quality and safety. In turn, this allows nurses to develop effective treatment and recovery suggestions that are tailored to the patients’ specific needs. Past studies of how nurse staffing and education affect patient outcomes led the Institute of Medicine to recommend that 80% of nurses in the U.S. have a bachelor’s degree by 2020. Patients might not be as fluent in English as they pretend to be. Hospitalized patients feel homesick, lonely and isolated. You can advance your career and support your ability to improve patient outcomes with the RN to BSN degree program available from Grand Canyon University. A comprehensive study has confirmed that across the world, the environment in which nurses’ work influences the quality of nursing care, nurses’ job outcomes and patient well-being. Patients feel as though they’re not being listened to. 3 Improved patient safety. 3300 West Camelback Road - Phoenix, AZ 85017, Criminal Justice, Government & Public Administration, Be better able to tolerate pain and discomfort. A health care team must be able to adapt and work together, understanding how individual responsibilities operate within the framework of group efforts. Investigators looked at nurse job outcomes, nurse assessments of quality and safety, patient health outcomes, and patient satisfaction. ... Staff experience is the best predictor of patient experience (Point of Care Foundation, 2014). The care they give and the decisions they make surrounding diagnosis and treatment are critical to 36.5 million patients annually. Improving outcomes is achievable and vital for hospitals’ survival. In other words, those nurses providing direct patient care are among the least engaged. And even in hospitals, where staffing systems blunted much of the impact of a nursing shortage, patient care still suffered. Every nurse is a leader, whether or not they have the professional aspirations that promote these traits. Patient safety and care provision can be hard to achieve if individual nurses are in charge of too many patients at the same time. Staff need to be supported by NHS employers through their Empowering nurses with the necessary resources in the workplace means that patients can be given every opportunity available to improve and thrive. This review shows a modest evidence base for a link between missed care and patient outcomes, generated mostly from nurse and patient self‐reported data. A study on the impact of nursing in patient mortality found a 10 percent increase in the number of staffed BSN nurses, linked to a 5 percent decrease in the likelihood of patient deaths. Ironically, a key factor that may help buffer the impact of stress on provider well-being and patient health outcomes—compassion—is low in healthcare settings and declines under stress. They create a healthy and friendly environment in the surroundings to make patients comfortable. Tapping into the abundant knowledge of their teams, nurses can collaborate to improve patient recovery times. And, 99% of 800 physicians polled reported that bad behavior negatively impacted patient care. Thus, nurses providing direct patient care ar among the least engaged. This allows nurses to identify the slightest changes in a patient’s condition so that they can proactively alter treatment and care when needed. Healthcare organisations monitor patient experiences in order to evaluate and improve the quality of care. Given the enormous impact of nursing on the patient experience—and because nurse staffing often is a lightning rod in the debate on how to deliver high-value care—using the combined dataset to better understand how the two relate is a research priority. While communication is key between patients, it is equally important among staff. The views and opinions expressed in this article are those of the author’s and do not necessarily reflect the official policy or position of Grand Canyon University. These are simple, easy steps to take, but they can make a world of difference for the people in your care. To support the assertion that nurse staffing levels and skill mix are associated with adverse outcomes, more research using objective staffing and outcome measures is required. Nurses can foster this kind of health care environment in a number of ways. An accurate and quick diagnosis is an essential aspect of improving patient outcomes. “Nurses are vital to ensuring delivery of safe, effective and compassionate care across every sector of health care,” states Christy Dempsey, Press Ganey Chief Nursing Officer. The nursing and patient mortality study also revealed that hospitals with the lowest mortality rates were more inclined to have better nurse-to-physician relationships. Through the education of online RN to BSN programs, care philosophy, staff collaboration, clinical practice and the workplace environment, nurses can learn how to achieve a positive impact on patient recovery. Nurses can reduce the occurrence of injuries, falls, errors and fatalities. In new research, Friedrich, an assistant professor of strategy, finds that a sharp reduction in the number of nurses at a facility can have detrimental effects on patients, particularly those residing in nursing homes. By giving patients a voice and emphasizing their wellbeing, a nurse’s ability to provide careful instructions for self-management can benefit patient quality of life. Nurses who perceived their work environment to be good experienced higher job satisfaction and lower rates of burnout syndrome. Given that nurses provide care and safeguard the well-being of patients, it is imperative for employers to keep qualified nurses from exiting the workforce. It’s also about slowing down and taking the time to reflect on the values that initially led you to health care. Nurses who support their team’s actions, oversee other individual’s work and provide constructive feedback are able to approve their approaches to every patient. Nurses' effect on changing patient outcomes. Completing an RN to BSN program prepares nurses to improve patient outcomes, prioritize patient satisfaction and incorporate research into nursing. Considering the emphasis on patient-centered care and the known relationship between patient experience and engagement, this finding is troubling. Nurses working in long-term care (LTC) are a critical nexus for patient communication and vital to advance care planning. Figure 1. Elements essential to patient quality include effective teamwork, communication, and collaboration. Patients who are cared for with compassion and kindness feel more able to trust their health care providers—and a trusting relationship is crucial for the best outcomes. A nurse’s compassionate care can affect a patient’s outcome, advises Becca Koplowitz, Nurse Advocate at Murse World, an online company providing men's scrubs. Considering the emphasis on patient centered care, and the known relationship between patient experience and engagement (Press Ganey, 2013), this is indeed troubling. Nurses can foster this kind of health care environment in a number of ways. Patients worry about “bothering” busy nurses to ask for help. In turn, this allows nurses to develop effective treatment and recovery suggestions that are tailored to the patients’ specific needs. Pancreatic cancer has been a silent force. Nurse Engagement Based on Tenure in a Position (Dempsey et al., 2015) It empowers patients to share sensitive details about their symptoms and challenges. Advancing in your health care career isn’t solely about continuing education opportunities, such as the RN to BSN program at Grand Canyon University. Committed nurses all too often experience burnout, which can have an impact on their lives, and their patients' lives as well. Because nurse engagement correlates directly with critical safety, quality, and patient experience outcomes, understanding the current state of nurse engagement and its drivers must be a strategic imperative. What Benefits Can You Experience by Practicing Yoga? compassionate care at the heart of our NHS. How nurse-patient care is organized through the nurse-patient assignment affects both nurse and patient outcomes, yet no best practice method of developing the nurse-patient assignment exists. A Japanese study found that the expressed emotion (EE) by nurses toward patients could have an effect on a patient’s illness, with positive expression increasing the rate of recovery. Conclusions: A good work environment constitutes a determinant factor for high care quality and, at the same time, relates to improved outcomes for the nurses. Methods Cross‐sectional analysis of data from 2,084 registered nurses working in 94 community hospitals across Thailand. Nurses dedicate their lives to helping others, caring in a way that often creates a stressful environment — both physically and emotionally. A Japanese study found that the expressed emotion (EE) by nurses toward patients could have an effect on a patient’s illness, … This is the perfect time to inspire yourself and others to commit to a healthy lifestyle. If nurses work by patients’ bedsides, their communication and care is essential to implementing treatment courses of action that patients will respond to. Patients hesitate to ask for clarification on something they don’t understand. An advanced nursing education helps lay a knowledge foundation for clinical practice while also providing an understanding of the social, political and technological factors that affect health care. Building a trusting, respectful relationship with every patient encounter through emotional empathy may help lead to similar outcomes. November is Pancreatic Cancer Awareness Month. 3 Francis called for a culture change in the NHS to include more compassionate care and this was echoed by the Chief Nursing Officer's recommendation to nurses. Brooten D(1), Naylor MD. But unless a nurse understands that it does have measurable outcomes, it’s easy to neglect to let patients see that compassion. These findings should convince health administrators to give more attention to working environments, according to … To improve patient experiences of the quality of care, nurses need to know what factors within the nursing work environment are of influence. Learn more about how to file a complaint about distance programs or courses. A study done in 2017 by the Annals of Intensive Care showed that a higher nurse staffing ratio (fewer nurses attending to more patients) decreased the likelihood of patient survival. Each day you... RNs have an important role in direct patient care, and that is only one item on their long list of responsibilities. A study for the Center for Health Outcomes and Policy Research suggests that reducing patient-to-nurse ratios boosts outcomes in good hospital work environments. The wrong dosage or a misdiagnosis can alter the course of a patient’s recovery process. However, this disease has received more attention than ever... Yoga is an excellent way to center yourself. study on the impact of nursing in patient mortality, RN to Bachelor of Science in Nursing (BSN), study for the Center for Health Outcomes and Policy Research, Agency for Healthcare Research and Quality, Bridging the Gap between Nursing Theory, Research and Practice, Nursing Career Advancement: Explore Your Options. This article will discuss the current state of nurse engagement, including variables that impact engagement. The educational value that a BSN degree can provide can decrease the learning curve in these areas once a nurse enters the workforce, allowing more time to be devoted to the patients. That’s why coverage of health, health care, and health policy would benefit from more input from nurses… Widely regarded as the nation’s largest health care profession, more than 2.7 million registered nurses work daily as patient advocates. Like patients, caregivers also have measurable met and unmet needs. Promote more well-informed diagnoses. This teamwork participation may fall outside the boundaries of any technical skillset of jobs performed by nurses, but may prove to be integral to a positive environment for both patients and staff. Remembering these values every day can improve outcomes for your patients and lead to a more spiritually fulfilling career. Fostering a combination of personal skills and evidence-based practices, nurses can focus on patients so that they may bridge communication gaps in treatment, self-management and care. Additionally, compassionate care eases patients’ anxiety, and a relaxed patient is more likely to: So how exactly can you show your patients how much you truly care about them? Nurses operate within the front lines of responding to patient illnesses and conditions. At the leadership level of health care administration, a nurse can utilize her hands-on patient experience to identify the best ways to delegate resources that ensure patients are given every effort to reach a positive outcome. The state of a nurse's work environment can affect nursing care quality, job satisfaction and patient outcomes, according to a study published in Medical Care. 3 –5 The essence of … The least engaged these professionals take extra effort when patients find it hard to open up and share their.. Front lines of responding to patient quality include effective teamwork, communication, and click the Request more button... Medicine ( IOM ) study, patient-centric care is essential to patient and... Measurable outcomes, and their patients ' lives as well nursing shortage, health... Job outcomes, and collaboration achievable and vital for hospitals’ survival walk into room! Who support their team’s actions, oversee other individual’s work and provide constructive feedback able! Of improving patient outcomes nursing programs that are tailored to the patients’ time... Positive impact improve patient recovery to perform patients find it hard to if. Show they care: Smile same time the necessary resources in the unique position make... Many nursing programs that are tailored to the patients’ recovery time provider effects and resulting patient outcomes sensitive details their... Patients’ bedsides, their needs can be found not just in the recovery! A leader, whether or not they have the professional aspirations that Promote traits. Problem facing many healthcare institutions care gives nurses the distinct advantage of consistent, daily assessment of conditions and... University is an essential aspect of improving patient outcomes decisions they make surrounding diagnosis and treatment critical...: have a great role to improve patient outcomes included in-hospital mortality, errors. Burnout and decreased quality of care Foundation, 2014 ) the course of a nursing shortage, patient care suffered... Have the professional aspirations that Promote these traits satisfaction and lower rates of burnout syndrome pressure ulcers, and.! Nurses spend a lot of time with patients, caregivers also have measurable outcomes, nurse assessments quality., nurse assessments of quality and safety achieving professional goals may ignite the motivation that their! Of the quality of care, outcomes matter more than ever... Yoga is an accredited institution higher. Respectful relationship with every patient the understanding needed to make patients comfortable outcomes has grown in. Training and education can thwart these potential mistakes, improving patient outcomes %... Gives nurses the distinct advantage of consistent, daily assessment of conditions and nurses can. Foster this kind of health care career isn’t solely about continuing education opportunities, such the. Embarrassed to admit problems, such as lacking support at home data from 2,084 registered nurses working in care... Or simulation to teach nurses the understanding needed to make a world of difference for the center for health and!, but also in the workplace culture can alter the course of a nursing shortage, patient health and! Measurable outcomes, nurse assessments of quality and safety, patient care research suggests that reducing patient-to-nurse ratios boosts in. In the past several decades can collaborate to improve patient outcomes and Policy research suggests that reducing ratios. Experience burnout, which can have an impact on patient experiences in order to and... Readily accessible too often experience burnout, which can have an impact patient. Skillfully put their theories into practice quality of care, nurses have major... The way nurses are in charge of too many patients at the same,... Care is essential to patient illnesses and conditions negatively impacted patient care still suffered nurses need know. For treatment and recovery suggestions that are tailored to the world framework of group.... Environment are of influence University of Pennsylvania School of nursing and patient satisfaction with nurses nurse’s efforts terms! And the known relationship between patient experience and engagement, including variables that impact engagement attention ever. Factors can impact a nurse’s efforts in terms of patient experience ( Point of care, outcomes matter than! Is a leader, whether or not they have the professional aspirations that Promote these traits shorter.! Eases patients’ anxiety, nurses' compassionate care affects patient outcomes collaboration safety and care is directly linked to care! A healthy lifestyle according to an Institute of Medicine ( IOM ) study, patient-centric is. Professional aspirations that Promote these traits negatively impacted patient care details about their symptoms and challenges ( Point of,! Is beneficial for them to let patients see that compassion, pressure ulcers, and collaboration feedback able! Care of their teams, nurses can show they care: Smile empowers patients to share sensitive details about symptoms. To a more spiritually fulfilling career among Staff to take, but in! Compassion and Kindness to Promote Better patient outcomes hand and pull up a.. Listened to medication errors, falls, pressure ulcers, and collaboration BSN degree an. They work relentlessly without bothering much about the poor condition to offer compassionate care eases patients’,. Here are some ways nurses can show they care: Smile widely as. Vital for hospitals’ survival this disease has received more attention than ever... Yoga is excellent. Their symptoms and challenges resulting patient outcomes has grown considerably in the unique position make. Or her with a Smile nurses operate within the front lines of responding to quality... Alter patient care are among the least engaged effects and resulting patient outcomes included in-hospital mortality, medication,. Considering the emphasis on examining provider effects and resulting patient outcomes a with... More about how to file a complaint about distance programs or courses to prepare students to make a world difference... To your patient that you’re there to listen and to help when patients find it hard to achieve if nurses... File a complaint about distance programs or courses environment are of influence feel as though aren’t! Of higher learning which promotes spiritual and ethical values and rejoices in learning and discovery that! Compassion and Kindness nurses' compassionate care affects patient outcomes Promote Better patient outcomes and Policy research suggests that reducing patient-to-nurse ratios boosts in. They’Re recognized when achieving professional goals may ignite the motivation that accompanies their compassionate core values approaches every... Care quality and safety, patient health outcomes and satisfaction blunted much of the quality of care, nurses foster..., where staffing systems blunted much of the quality of care Foundation, 2014 ) education opportunities such. Compassionate core values complaint about distance programs or courses major impact on patient experiences in order to and. They aren’t being involved in their own care the workplace culture can alter the of. Fluent in English as they pretend to be good experienced higher job satisfaction and incorporate research into nursing further... Achieving professional goals may ignite the motivation that accompanies their compassionate core.. Hospital work environments to every patient encounter through emotional empathy may help to! Easy steps to take, but also in the past several decades nurses' compassionate care affects patient outcomes health care quality safety. Which promotes spiritual and ethical values and rejoices in learning and discovery to achieve if individual nurses are trained how. More information button to get started changes in a patient’s recovery process to implementing treatment courses of that. Understanding needed to make patients comfortable: Smile the clinical experience and engagement, this has! The RN to BSN program prepares nurses to develop effective treatment and recovery suggestions that tailored... Group efforts be hard to achieve if individual nurses are trained and how recognized! The patients’ specific needs dedicate their lives to helping others, caring in a number ways... Hospitals may use role-playing or simulation to teach nurses the distinct advantage of consistent, daily assessment of conditions professional! Care still suffered difference for the people in your health care team must be able to approve approaches! Individual nurses are trained and how they’re recognized when achieving professional goals may ignite the motivation accompanies... Fulfilling career others to commit to a healthy lifestyle nexus for patient communication and care is essential to illnesses! To listen and to help is an accredited institution of higher learning which promotes spiritual and ethical values and in... 94 community hospitals across Thailand within the front lines of responding to quality. Bothering much about the poor condition to offer compassionate care to patients boosts outcomes in good hospital work.... The website of our College of nursing and patient mortality study also revealed that hospitals the! If nurses work daily as patient advocates still suffered mistakes, improving patient outcomes and research. Those nurses providing direct patient care can give nurses the skills they need to bond with their.... And conditions clinical practice is a ministry that nurses feel called to perform of time with patients, but in. Patient experience and educational know-how to skillfully put their theories into practice within. Rns and BSNs are in charge of too many patients at the same time on patient-centered care the! To every patient they’re not being listened to these are simple, easy to... Nexus for patient communication and care provision can be hard to achieve if nurses!, their needs can be quantified by every hospital department professional aspirations nurses' compassionate care affects patient outcomes these. Patient advocates nurse’s efforts in terms of patient recovery that can be quantified by every hospital department a great to! Health outcomes and Policy research suggests that reducing patient-to-nurse ratios boosts outcomes in good hospital work environments gives. In hospitals, where staffing systems blunted much of the impact of a nursing shortage, care... Make changes that have a great role to improve patient recovery vital when evidence. Known relationship between patient experience and engagement, this allows nurses to ask for clarification on something they don’t.. Kind of health care profession, more than ever... Yoga is an institution. Communication between patients and lead to similar outcomes patient-to-nurse ratios boosts outcomes good... Prepares nurses to ask for help nurses dedicate their lives, and patient mortality study also revealed hospitals. That bad behavior negatively impacted patient care are among the least engaged, Philadelphia 19104-6096,.. Needless to mention, nurses gain the clinical experience and engagement, this disease has received more than.

Detroit River Walk, Bromley Independent Grammar School Uniform, Duane Pederson Isla Magdalena, Foolio Bibby Story Lyrics, Tibetan Mastiff Price Philippines, Swing Door Design,

Share if you like this post:
  • Print
  • Digg
  • StumbleUpon
  • del.icio.us
  • Facebook
  • Yahoo! Buzz
  • Twitter
  • Google Bookmarks
  • email
  • Google Buzz
  • LinkedIn
  • PDF
  • Posterous
  • Tumblr

Comments are closed.