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ERRATUM01-01-2016
ERRATUM
Revista Brasileira de Enfermagem. 2016;69(5):1002-1002
Abstract
ERRATUMERRATUM
Revista Brasileira de Enfermagem. 2016;69(5):1002-1002
DOI 10.1590/0034-7167.20166905e01
Views0Article “Alcohol and alcoholism: attitudes of nursing students”, with number of DOI: http://dx.doi.org/10.1590/S0034-71672013000100013, published in the journal Revista Brasileira de Enfermagem, v66(1):84-9, page 89 that read: “18. Miranda SP, Vargas D. Satisfação de pacientes de um centro de atenção Psicossocial álcool e drogas com o atendimento do enfermeiro. SMAD, Rev Eletrônica Saúde Mental Alcool Drog […]See more -
REVIEW01-01-2016
Research methodology for nursing and health: a book review
Revista Brasileira de Enfermagem. 2016;69(5):1000-1001
Abstract
REVIEWResearch methodology for nursing and health: a book review
Revista Brasileira de Enfermagem. 2016;69(5):1000-1001
DOI 10.1590/0034-7167-2015-0135
Views1For those interested in nursing and health, the book entitled “Research methodology for nursing and health: from theory to practice”() was released in October 2015, at the 67th Brazilian Congress of Nursing, sponsored by National ABEn. The interest emerged from two organizers: Dr. Maria Ribeiro Lacerda (UFPR) and Dr. Regina Gema Santini Costerano (UNIFRA). Forty-seven […]See more -
REFLECTION01-01-2016
Violence in the workplace in Nursing: consequences overview
Revista Brasileira de Enfermagem. 2016;69(5):996-999
Abstract
REFLECTIONViolence in the workplace in Nursing: consequences overview
Revista Brasileira de Enfermagem. 2016;69(5):996-999
DOI 10.1590/0034-7167-2015-0133
Views0See moreABSTRACT
Objective:
to reflect on the consequences of workplace violence experienced by nursing professionals.
Methods:
this is a reflection paper based on recent publications related to the subject, particularly researches carried out in Brazil and in other countries.
Results:
exposure to workplace violence has been associated with health problems in nursing professionals, which may be physical damage, emotional manifestations, and psychic disorders. It also affects the employee performance, his or her family and social interactions.
Conclusion:
this phenomenon is potentially noxious and costly, for it leads to suffering, illness, absence from work, and even death. This reflection calls attention moreover to the importance of a safe and adequate health care work environment.
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REFLECTION01-01-2016
Construcción de la enfermera de práctica avanzada en Catalunya (España)
Revista Brasileira de Enfermagem. 2016;69(5):991-995
Abstract
REFLECTIONConstrucción de la enfermera de práctica avanzada en Catalunya (España)
Revista Brasileira de Enfermagem. 2016;69(5):991-995
DOI 10.1590/0034-7167.2016690507
Views0RESUMEN
El desarrollo de la enfermera de práctica avanzada (EPA) ha supuesto un reto para las enfermeras en países como EE.UU., Canadá, Gran Bretaña y Australia, entre otros, y desde hace escasos años está siendo considerada en Catalunya y España como un sistema para desarrollar nuevos roles que aporten eficacia y eficiencia al sistema sanitario. El presente artículo pretende conceptualizar la EPA y los modelos de referencia así como contextualizar y reflexionar sobre la EPA en Catalunya, desde el punto de vista de formación y de la implantación de los denominados nuevos roles de enfermería, asimilándolos a la práctica avanzada.
Keywords:Competencia ClínicaEnfermeríaEnfermería de Práctica AvanzadaPráctica ProfesionalRol de la EnfermeraSee more -
REFLECTION01-01-2016
Developing the Advanced Practice Nurse in Catalonia
Revista Brasileira de Enfermagem. 2016;69(5):991-995
Abstract
REFLECTIONDeveloping the Advanced Practice Nurse in Catalonia
Revista Brasileira de Enfermagem. 2016;69(5):991-995
DOI 10.1590/0034-7167.2016690507
Views0See moreABSTRACT
The development of advanced practice nurses (APN) has proved a challenge for nurses in countries such as the USA, Canada, Great Britain, and Australia among others. It is only in recent years that the system has been considered in Catalonia and Spain as a way to develop new roles to bring effectiveness and efficiency to the health system. From the standpoint of training and implementation of the above-mentioned new nursing roles, the following article aims to conceptualise APN and its reference models, as well as to contextualise and reflect on APN in Catalonia in order to assimilate them into advanced practice.
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EXPERIENCE REPORT01-01-2016
International academic mobility in nursing education: an experience report
Revista Brasileira de Enfermagem. 2016;69(5):986-990
Abstract
EXPERIENCE REPORTInternational academic mobility in nursing education: an experience report
Revista Brasileira de Enfermagem. 2016;69(5):986-990
DOI 10.1590/0034-7167-2015-0128
Views0See moreABSTRACT
Objective:
report the experience of international academic mobility in Ireland through the program Science Without Borders during undergraduate education in nursing.
Method:
a report of experience presented in chronological order, with a descriptive nature.
Results:
the opportunity to know and be able to discuss questions regarding health and nursing in Ireland allowed the review of concepts and a more reflective perspective regarding nursing practices. Additionally, the exchange promoted personal strengthening regarding the confrontation and solution of problems, development of technical and scientific abilities, improvement of linguistic competences and construction of personality, independence and maturity.
Conclusion:
regarding such constructive and enriching experience that this mobility provides to students, to the governing authorities, to the population and to Brazilian nursing, sharing this experience is expected to serve as encouragement for those who search for new horizons, with the objective of adding knowledge for their personal and professional life.
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EXPERIENCE REPORT01-01-2016
Online training for health professionals in three regions of Brazil
Revista Brasileira de Enfermagem. 2016;69(5):981-985
Abstract
EXPERIENCE REPORTOnline training for health professionals in three regions of Brazil
Revista Brasileira de Enfermagem. 2016;69(5):981-985
DOI 10.1590/0034-7167.2016690506
Views0See moreABSTRACT
Objective:
to describe online training experience aimed at professionals working in the public health service in 27 Neonatal and Pediatric Intensive Care Units, and to reflect concerning the training process and possible improvements in this process.
Method:
this is an experience report study about the online training with multidisciplinary content, planned from the situational diagnosis of 27 institutions. The training target set was 10 participants per institution and per module, including the following topics: Indicators of Quality as a Management Tool, Hand Hygiene, Patient Safety, Intravenous Therapy and Patients’ Chart Record.
Results:
a total of 2,071 active students in the modules, with 1,046 approved. The mean of 76 students per module exceeded the target set.
Conclusion:
experience has shown that online training is comprehensive as a potential tool for the professional technical development and digital inclusion. The online learning system becomes weakened if participants are unaware of the technological resources.
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REVIEW01-01-2016
Technologies in intensive care: causes of adverse events and implications to nursing
Revista Brasileira de Enfermagem. 2016;69(5):972-980
Abstract
REVIEWTechnologies in intensive care: causes of adverse events and implications to nursing
Revista Brasileira de Enfermagem. 2016;69(5):972-980
DOI 10.1590/0034-7167.2016690505
Views0See moreABSTRACT
Objective:
to identify the causes of adverse events affecting clients resulting from the use of equipment in intensive care services; to point out the main recommendations for clinical practice to minimize these events and, then, discuss the implications to nursing care.
Method:
integrative and descriptive review on the SciELO, Medline, LILACS, and PubMed databases. Articles were selected based on the inclusion criteria and the structured instrument was applied.
Results:
altogether, 11 articles were selected where three evidence units were outstanding: Equipment failure; inadequate use of equipment; and team failure. Permanent education of professionals; evaluation of production and availability of equipment; and use of checklists are recommended.
Conclusion:
preventing adverse events related to equipment is one of the nursing responsibilities and requires the establishment of defensive barriers to prevent these.
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ERRATUM01-13-2024
ERRATUM
Revista Brasileira de Enfermagem. 2024;77(6):e2024n6e08
Abstract
ERRATUMERRATUM
Revista Brasileira de Enfermagem. 2024;77(6):e2024n6e08
DOI 10.1590/0034-7167.20247706e08
Views0In the article “Brazilian nursing specific situation, middle and micro-range theories: a bibliometric study”, with DOI number: , published in Revista Brasileira de Enfermagem, 2024;77(4):e20230520, Chart 1:Where it read:[…]See more -
ERRATUM01-13-2024
ERRATA
Revista Brasileira de Enfermagem. 2024;77(6):e2024n6e07
Abstract
ERRATUMERRATA
Revista Brasileira de Enfermagem. 2024;77(6):e2024n6e07
DOI 10.1590/0034-7167.20247706e06pt
Views0No artigo “Crenças e atitudes de pais ou responsáveis legais sobre a vacinação infantil: revisão de escopo”, com número DOI: , publicado no periódico Revista Brasileira de Enfermagem, 2024;77(4):e20240126, página 5:Onde se lia:[…]See more -
ORIGINAL ARTICLE01-13-2024
Indicators associated with severity and mortality in hospitalized people with HIV: A retrospective cohort
Revista Brasileira de Enfermagem. 2024;77(6):e20240204
Abstract
ORIGINAL ARTICLEIndicators associated with severity and mortality in hospitalized people with HIV: A retrospective cohort
Revista Brasileira de Enfermagem. 2024;77(6):e20240204
DOI 10.1590/0034-7167-2024-0204
Views0See moreABSTRACT
Objectives:
to compare the sociodemographic and clinical severity indicators of hospitalized people with HIV in relation to clinical outcomes and urgent hospital admission.
Methods:
a retrospective cohort study was conducted with 102 medical records of HIV-infected individuals hospitalized in a hospital in southern Brazil. In addition to descriptive analysis, Fisher’s exact test, Pearson’s Chi-square, and logistic regression were used.
Results:
the data showed a significant direct effect on severity indicators in the following variables: male sex (p=0.013), skin color (p=0.023), level of education (p=0.000), urgent admissions (p=0.000), late diagnosis (p=0.001), diabetes mellitus (p=0.001), hypertension (p=0.004), kidney disease (p=0.002), high viral load (p=0.006), CD4+ count below 200 (p=0.005), fever (p=0.016), weight loss (p=0.013), co-infection with hepatitis C (p=0.004), and mortality (p=0.007).
Conclusions:
three sociodemographic and thirteen clinical markers were identified as being associated with the risk of clinical deterioration in hospitalized people with HIV.
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ORIGINAL ARTICLE01-13-2024
Nurses’ perspectives on the use of telemonitoring in the management of people with diabetes and hypertension
Revista Brasileira de Enfermagem. 2024;77(6):e20230481
Abstract
ORIGINAL ARTICLENurses’ perspectives on the use of telemonitoring in the management of people with diabetes and hypertension
Revista Brasileira de Enfermagem. 2024;77(6):e20230481
DOI 10.1590/0034-7167-2023-0481
Views1See moreABSTRACT
Objectives:
to understand the perspective of nurses on the use of telemonitoring in the management of people with type 2 diabetes mellitus and arterial hypertension in primary care.
Methods:
this qualitative research involved sixteen nurses from eight municipalities in Paraná. Data were collected between November 2022 and January 2023 through inperson or remote interviews, which were audio-recorded and subjected to content analysis.
Results:
according to the nurses, telemonitoring enhances users’ knowledge about these conditions, communication and connection with the team, and productivity. However, the lack of electronic resources and equipment, high staff turnover, low user adherence, and the limited availability of professional time present significant challenges.
Final Considerations:
the effective implementation and operation of telemonitoring in the management of people with diabetes and hypertension involve both potential benefits and barriers. It is essential to have the availability of human and technological resources, managerial support, and the commitment of professionals and users.
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ORIGINAL ARTICLE01-13-2024
Knowledge, Attitudes, and Practices of nurses regarding blood culture collection
Revista Brasileira de Enfermagem. 2024;77(6):e20230424
Abstract
ORIGINAL ARTICLEKnowledge, Attitudes, and Practices of nurses regarding blood culture collection
Revista Brasileira de Enfermagem. 2024;77(6):e20230424
DOI 10.1590/0034-7167-2023-0424
Views0ABSTRACT
Objectives:
to investigate the knowledge, attitudes, and practices of nurses regarding blood culture collection.
Methods:
a cross-sectional study was conducted in five Brazilian public hospitals with 112 nurses. Data were collected using an adapted questionnaire and analyzed through descriptive and inferential statistics.
Results:
nurses who did not consider themselves capable of collecting blood cultures had a 72% lower chance of performing the collection at the recommended site and an 83% lower chance of using the same needle for blood inoculation into the vials. Nurses working in the emergency department had a 75% lower chance of knowing the international benchmark for blood culture contamination rates, and those with less than 5 years in the position decreased their chance of accuracy in this matter by 79%.
Conclusions:
there are gaps in the knowledge, attitudes, and practices of nurses regarding blood culture collection. Standardization of the technique, periodic education, supervision and guidance of the collection team, and process auditing are recommended coping strategies.
Keywords:Blood CultureBlood Specimen CollectionHealth Knowledge, Attitudes, PracticeNursing CareQuality of Health CareSee more -
ORIGINAL ARTICLE01-13-2024
Evaluation of care for people with HIV in Primary Health Care: construct validation
Revista Brasileira de Enfermagem. 2024;77(6):e20230190
Abstract
ORIGINAL ARTICLEEvaluation of care for people with HIV in Primary Health Care: construct validation
Revista Brasileira de Enfermagem. 2024;77(6):e20230190
DOI 10.1590/0034-7167-2023-0190
Views0ABSTRACT
Objectives:
to verify the construct validation of an instrument for evaluating care for people living with HIV in Primary Health Care.
Methods:
methodological study carried out in 2021 with 260 health professionals in Recife, PE. Validation based on the internal structure was carried out at this stage using exploratory and confirmatory factor analysis, and validity based on item response theory.
Results:
the validation determined the retention of five factors and 63 items. The instrument’s internal consistency and quality of fit was 0.90, the Tukey-Lewis index was 0.915 and the comparative fit index was 0.918 in the confirmatory factor analysis. The indication for the absolute majority of items is adequate fit.
Conclusions:
the instrument has construct validity, making it possible to use it to evaluate the decentralization process and care for People Living with HIV in Primary Health Care.
Keywords:Acquired Immunodeficiency SyndromeComprehensive Health CareHIVPrimary Health CareProgram EvaluationSee more -
ORIGINAL ARTICLE01-10-2024
Inventory of ethical problems in mobile pre-hospital care
Revista Brasileira de Enfermagem. 2024;77:e20230539
Abstract
ORIGINAL ARTICLEInventory of ethical problems in mobile pre-hospital care
Revista Brasileira de Enfermagem. 2024;77:e20230539
DOI 10.1590/0034-7167-2023-0539
Views0See moreABSTRACT
Objective:
to construct and validate the content of an inventory of ethical problems experienced by nurses in mobile pre-hospital care.
Method:
a psychometric approach study, developed with the following stages: (1) instrument construction through a theoretical matrix based on deliberative bioethics, scoping review and online qualitative research; (2) content validity by judges; (3) pre-testing with Mobile Emergency Care Service nurses in various Brazilian states. For content validity analysis, the Content Validity Ratio was calculated (CVR>0.45 for judges and CVR>0.35 for the target population).
Results:
the instrument had 44 items, distributed across four dimensions.
Final considerations:
the constructed instrument presented sources of evidence of content validity, providing good psychometric measurements and constituting a useful tool for nurses’ practice in the pre-hospital setting.
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RESEARCH01-01-2017
Unna’s boot: experience of care of people with venous ulcers
Revista Brasileira de Enfermagem. 2017;70(2):349-356
Abstract
RESEARCHUnna’s boot: experience of care of people with venous ulcers
Revista Brasileira de Enfermagem. 2017;70(2):349-356
DOI 10.1590/0034-7167-2016-0219
Views0See moreABSTRACT
Objective:
to understand the experience of care of people with venous ulcers using an Unna’s boot.
Method:
a qualitative study, based on the social phenomenology by Alfred Schütz, was carried out with 12 adults interviewed in 2015. The statements were analyzed and organized in thematic categories.
Results:
the following categories emerged: “Unna’s boot annoyance versus wound improvement”, “Difficulties for accessing care with the Unna’s boot”, “Care for healing and preventing recurrence”, and “Receiving more attention from the healthcare professional”.
Conclusion:
the experience of care of people using an Unna’s boot revealed the annoyance caused by this device, which was overcome due to the wound improvement. However, access to care was compromised by the lack of structure at the service, frustrating the patients’ expectations regarding wound healing. The issues of these people’s intersubjective universe should be considered in the management of care of venous ulcers.
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RESEARCH01-01-2017
Spanish version of the scale of attitudes toward alcohol, alcoholism and alcoholics: content validation
Revista Brasileira de Enfermagem. 2017;70(2):342-348
Abstract
RESEARCHSpanish version of the scale of attitudes toward alcohol, alcoholism and alcoholics: content validation
Revista Brasileira de Enfermagem. 2017;70(2):342-348
DOI 10.1590/0034-7167-2015-0149
Views0See moreABSTACT
Objective:
to describe the process of translation and cultural adaptation of the scale of attitudes towards alcohol, alcoholism and alcoholics into the Spanish language.
Methods:
this was a methodological study, which followed the international guidelines for translation and adaptation of measurement scales.
Results:
During the process of translation and cultural adaptation of scale of attitudes towards alcohol, alcoholism and alcoholics to the Spanish language, the items were adjusted based on semantic, idiomatic and conceptual equivalence of the expressions contained in the scale of attitudes towards alcohol, alcoholism and alcoholics. Content validation indicated satisfactory validity indexes, with Intraclass Correlation Coefficient (ICC) (0.97), Content Validity Index (CVI) (0.92), and the Prevalence Adjusted Bias Adjusted Kappa (PABAK) (0.80).
Conclusion:
the scale of attitudes towards alcohol, alcoholism and alcoholics, adapted and translated into the Spanish language, presented content validity with satisfactory indexes, which affirmed that the instrument was adapted for the Colombian context. The next step will be evaluation of its psychometric properties in order to guarantee reliability for its use in Hispanic populations.
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RESEARCH01-01-2017
Nursing care protocol for patients with a ventricular assist device
Revista Brasileira de Enfermagem. 2017;70(2):335-341
Abstract
RESEARCHNursing care protocol for patients with a ventricular assist device
Revista Brasileira de Enfermagem. 2017;70(2):335-341
DOI 10.1590/0034-7167-2016-0363
Views0See moreABSTRACT
Objective:
to develop and validate a nursing care protocol for patients with a ventricular assist device (VAD).
Method:
descriptive study, with a quantitative approach, for an instrument’s methodological validation. Three stages were conducted: development of the instrument; protocol content validation according to the Delphi technique, and agreement among experts and the scientific literature.
Results:
based on the content validation, a care protocol for patients with a VAD was created and assessed by Spanish experts. Of the 15 items evaluated by means of the content validity index (CVI), 10 presented solid evidence of validation, with Kappa ranging between 0.87 and 1.
Conclusion:
the method enabled the validation of interventions that will contribute to qualified and standardized care for patients with a VAD.
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RESEARCH01-01-2017
Nasoenteral tube: factors associated with delay between indication and use in emergency services
Revista Brasileira de Enfermagem. 2017;70(2):326-334
Abstract
RESEARCHNasoenteral tube: factors associated with delay between indication and use in emergency services
Revista Brasileira de Enfermagem. 2017;70(2):326-334
DOI 10.1590/0034-7167-2016-0222
Views0ABSTRACT
Objective:
to know the time between indication and use of a nasoenteral tube (NET) and factors associated with delays.
Method:
A prospective cohort study that followed adults in a Brazilian emergency department, since the indication of the use of a NET, evaluating clinical variables and the work process. The Generalized Estimated Equations model was adopted to identify factors associated with the delays in each stage of the process.
Results:
the time between indication and use of NET was 573 (IQR: 3601,093) minutes, in 150 insertions of NET. Insertions in patients who previously did not use it; delays in the medical, nutrition, and nursing care routine; use of mechanical ventilation; noradrenaline; and fasting were factors for longer time before the use of the tube.
Conclusion:
the time between indication and use of NET was high, exceeding 10 hours in half of the cases. Factors related to the clinical condition of the patient and to the care management would contribute to delays.
Keywords:Emergency Medical ServicesGastrointestinal IntubationNursing CarePatient SafetyTreatment TimeSee more -
RESEARCH01-01-2017
Non-pharmacological measures in preterm newborns submitted to arterial puncture
Revista Brasileira de Enfermagem. 2017;70(2):317-325
Abstract
RESEARCHNon-pharmacological measures in preterm newborns submitted to arterial puncture
Revista Brasileira de Enfermagem. 2017;70(2):317-325
DOI 10.1590/0034-7167-2016-0003
Views0See moreABSTRACT
Objective:
to assess pain in preterm newborns and to compare the neonatal and therapeutic variables with the total scores of the Neonatal Facial Coding System of preterm newborns submitted to arterial puncture exposed to music and 25% oral glucose.
Method:
a comparative study with 48 recordings of preterm newborns – Group 1, music (26); Group 2, glucose 25% (22) – individually analyzed by three trained nurses, after Kappa of at least 80%.
Results:
the variables and the pain scores of the groups did not present statistical significance (p < 0.05) according to the Neonatal Facial Coding System. 80.8% of the preterm infants in Group 1 had a higher quantitative score ≥ 3 in the neonatal variables (gender, type of delivery), and therapeutic variables (type of oxygen therapy, place of hospitalization, type of puncture).
Conclusion:
There was no difference when comparing the music and glucose 25% groups and the variables studied.
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RESEARCH01-01-2017
Moral sensitivity in Primary Health Care nurses
Revista Brasileira de Enfermagem. 2017;70(2):308-316
Abstract
RESEARCHMoral sensitivity in Primary Health Care nurses
Revista Brasileira de Enfermagem. 2017;70(2):308-316
DOI 10.1590/0034-7167-2016-0453
Views0See moreABSTRACT
Objective:
to characterize the profile and describe the moral sensitivity of primary health care nurses.
Method:
this is a quantitative, transversal, exploratory, descriptive study. The data were collected through the Moral Sensitivity Questionnaire translated and adapted to Brazil. 100 primary health care nurses participated, from Rio Grande do Sul, Brazil. The data collection took place during the months of March and July 2016, in an online form. The analysis of the data occurred through descriptive statistical analysis.
Results:
the nurses had an average moral sensitivity of 4.5 (out of 7). The dimensions with the greatest moral sensitivity were: interpersonal orientation, professional knowledge, moral conflict and moral meaning.
Conclusion:
the nurses of Rio Grande do Sul have a moderate moral sensitivity, which may contribute to a lower quality in Primary Health Care.
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RESEARCH01-01-2017
Moral suffering among nurse educators of technical courses in nursing
Revista Brasileira de Enfermagem. 2017;70(2):301-307
Abstract
RESEARCHMoral suffering among nurse educators of technical courses in nursing
Revista Brasileira de Enfermagem. 2017;70(2):301-307
DOI 10.1590/0034-7167-2016-0185
Views0See moreABSTRACT
Objective:
to understand situations of moral suffering experienced at work by nurse educators of technical courses in nursing.
Method:
a qualitative study with discursive textual analysis by means of semi-structured interviews with ten nurse educators at two professional educational institutions in southern Brazil.
Results:
two categories were established: lack of commitment on the part of students to the future profession, expressed through disrespect and disregard for the work of nurse educators, with inappropriate behaviors and attitudes; and lack of commitment to the learning-teaching process, expressed by indifference to the professional profile and lack of interest in lessons and care practices associated with learning gaps.
Conclusion:
these situations have an impact on experiences of moral suffering by nurse educators, and show a need for rethinking their practice, relationships, and educational spaces, and implementing strategies to favor the confrontation of dilemmas and conflicts experienced in educational practice in technical courses in nursing.
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RESEARCH01-01-2017
Knowledge of the nursing team on pressure ulcer prevention
Revista Brasileira de Enfermagem. 2017;70(2):294-300
Abstract
RESEARCHKnowledge of the nursing team on pressure ulcer prevention
Revista Brasileira de Enfermagem. 2017;70(2):294-300
DOI 10.1590/0034-7167-2016-0063
Views0See moreABSTRACT
Objective:
describe and analyze the nursing team’s knowledge about classification, evaluation and measures to prevent pressure ulcers (PU) in patients hospitalized in the ICU of a teaching hospital in the city of Manaus.
Method:
a descriptive and exploratory study was conducted after approval by a research ethics committee. Data were collected using a validated instrument. The study sample was made up of 40 nursing staff members, of whom 14 were nurses and 26 were nursing technicians/aides. Data were analyzed through descriptive statistics and Student’s t-test, with value of p<0.05.
Results:
the overall mean of hits was 63.4% for technicians/aides and 51.4% for nurses, with statistically significant differences between the groups only for the PU prevention category (p<0.001).
Conclusion:
a deficit of knowledge on PU prevention was found among nurses and nursing technicians/aides, demanding the training of these professionals.
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