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RESEARCH01-01-2017
Functional health literacy and knowledge of renal patients on pre-dialytic treatment
Revista Brasileira de Enfermagem. 2017;70(1):155-162
Abstract
RESEARCHFunctional health literacy and knowledge of renal patients on pre-dialytic treatment
Revista Brasileira de Enfermagem. 2017;70(1):155-162
DOI 10.1590/0034-7167-2015-0169
Views0See moreABSTRACT
Objective:
to analyze the functional health literacy (FHL), i.e., understanding and knowledge about chronic renal disease of 60 patients in pre-dialytic treatment.
Method:
this is a cross-sectional study. FHL was measured by B-TOFHLA; and the knowledge, by questionnaire. Pearson correlation and Chi-square tests were carried out as well as linear regression models.
Results:
all respondents presented inadequate FHL, and most showed insufficient knowledge about the disease and treatment. Low schooling was a predictive factor for worst FHL scores. Insufficient knowledge was related to age and compromised cognition.
Conclusion:
although association between predictive variables has not been found, limited capability to obtain and use health-related information and insufficient knowledge about their own condition and treatment can contribute to worse outcomes for CKD. Appropriate intervention strategies are necessary to deal with limited FHL and also greater knowledge and ability of professionals to deal with the matter.
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RESEARCH01-01-2017
Patient safety in nursing paths in Brazil
Revista Brasileira de Enfermagem. 2017;70(1):146-154
Abstract
RESEARCHPatient safety in nursing paths in Brazil
Revista Brasileira de Enfermagem. 2017;70(1):146-154
DOI 10.1590/0034-7167-2015-0139
Views0See moreABSTRACT
Objective:
summarize the dissertations and theses produced by nurses available in the Catalog of Theses and Dissertations of the Brazilian Nursing Association, from volume XIX to XXXII, that address patient safety.
Method:
this is a documentary study. After data collection, the following variables were analyzed: academic level, educational institutions, year, place, type of service, study object, study method, subjects, priority protocol of patient safety, implications and final recommendations.
Results:
8,720 abstracts were found, 53 (0.61%) of which were analyzed. There was a predominance of dissertations (n=19; 35.85%) regarding the reduction of risks for fall and pressure ulcer (n=24; 45.28%), of descriptive type (n=21; 39.62%), quantitative type (n=16; 30.19%), in hospital environments (n=16; 30.19%), using scales and protocols (n=6; 11.32%).
Conclusion:
there is a tendency towards the development of studies related to patient safety in hospital environments, with an emphasis on the reduction of risk for pressure ulcer.
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RESEARCH01-01-2017
Social representations of fishermen with spinal cord injury: impacts and life trajectory
Revista Brasileira de Enfermagem. 2017;70(1):139-145
Abstract
RESEARCHSocial representations of fishermen with spinal cord injury: impacts and life trajectory
Revista Brasileira de Enfermagem. 2017;70(1):139-145
DOI 10.1590/0034-7167-2016-0436
Views0See moreABSTRACT
Objective:
analyze social representations in the life trajectory of artisanal fishermen with spinal cord injury caused by diving on the north coast of Rio Grande do Norte.
Method:
a descriptive, qualitative study was conducted with 31 fishermen between October 2013 and August 2014, using a semi-structured interview. A lexicographic analysis and descending hierarchical classification of texts were performed (with software ALCESTE), in the perspective of the social representations.
Results:
social representations of fishermen with spinal cord injury presented experiences with physical limitations and expectations regarding retirement, which appeared as a distant reality from the requirements in Brazilian labor laws.
Conclusion:
measures are required for the promotion, prevention and rehabilitation of the health of fishermen with spinal cord injury, as well as safe and decent fishing conditions, with the commitment of health authorities.
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RESEARCH01-01-2017
Factors associated with occupational exposure to biological material among nursing professionals
Revista Brasileira de Enfermagem. 2017;70(1):133-138
Abstract
RESEARCHFactors associated with occupational exposure to biological material among nursing professionals
Revista Brasileira de Enfermagem. 2017;70(1):133-138
DOI 10.1590/0034-7167-2016-0472
Views0ABSTRACT
Objective:
to identify factors associated with occupational exposure to biological material among nursing professionals.
Method:
a cross-sectional study was conducted in a high complexity hospital of a city in the state of São Paulo, Brazil. Nursing professionals were interviewed from March to November 2015. All ethical aspects were observed.
Result:
among the 226 professionals interviewed, 17.3% suffered occupational exposure to potentially contaminated biological material, with 61.5% being percutaneous. Factors such as age (p=0.003), professional experience in nursing (p=0.015), and experience at the institution (p=0.032) were associated with the accidents with biological material.
Conclusion:
most accidents with biological material among nursing professionals were percutaneous. Age, professional experience, and experience at the institution were considered factors associated with occupational exposure.
Keywords:Exposure to Biological AgentsNursing, TeamOccupational ExposureOccupational HealthOccupational RisksSee more -
RESEARCH01-01-2017
Discourses on short-coursetherapy for tuberculosis control
Revista Brasileira de Enfermagem. 2017;70(1):126-132
Abstract
RESEARCHDiscourses on short-coursetherapy for tuberculosis control
Revista Brasileira de Enfermagem. 2017;70(1):126-132
DOI 10.1590/0034-7167-2016-0463
Views0See moreABSTRACT
Objective:
to analyze the meanings produced through the experiences and perceptions of healthcare professionals on the implementation of the strategy of directly observed treatment short course for tuberculosis control.
Method:
qualitative study carried out in Mozambique with 15 healthcare professionals. Inclusion criteriawerehaving acted in the Tuberculosis Control Program for more than one year, and exercising professional activity at the time of interview. A semi-structured script was used for data collection, and individual interviews were recorded.
Results:
three discursive units emerged: patient treatment procedures; community health agent and family roles; difficulties in the application of directly observed treatment short course.
Conclusion:
treatment of tuberculosis requires constant involvement of the family, community, and especially the State in the creation and implementation of personnel training policies and infrastructure improvement.
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RESEARCH01-01-2017
Coping with child violencein primary care: how do professionals perceive it?
Revista Brasileira de Enfermagem. 2017;70(1):119-125
Abstract
RESEARCHCoping with child violencein primary care: how do professionals perceive it?
Revista Brasileira de Enfermagem. 2017;70(1):119-125
DOI 10.1590/0034-7167-2016-0009
Views0See moreABSTRACT
Objective:
to know the perception of health professionals working in primary care about child violence, since this has increased progressively in the world, requiring every effort to intervene.
Method:
this is a qualitative, descriptive and exploratory study performed through interviews with professionals in primary care in a health district of São Paulo. The Alceste tool was used for analysis of data from the speeches.
Results:
perceptions of professionals point to the limits and difficulties of the care network with coping; need for intersectoral action; violence situations identified within the caresetting; and causes and effects of violence on child development.
Conclusion:
there is need for qualified training of workers, health network organization for the provision of quantity and quality of care services, and financial resources for coping with child violence.
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RESEARCH01-01-2017
Predictors for the functional incapacity of the elderly in primary health care
Revista Brasileira de Enfermagem. 2017;70(1):112-118
Abstract
RESEARCHPredictors for the functional incapacity of the elderly in primary health care
Revista Brasileira de Enfermagem. 2017;70(1):112-118
DOI 10.1590/0034-7167-2016-0046
Views0See moreABSTRACT
Objectives:
to assess the predictors for the functional incapacity of the elderly in primary health care.
Method:
cross-sectional study, of which 388 older people participated, conducted in three Primary health care Units, using the Katz index and Lawton’s scale. The research project was approved by the Research Ethics Committee.
Results:
regarding the degree of dependency for Basic Activities, 90.2% were less independent for dressing themselves; and for Instrumental Activities, 77.1% of the elderly were less independent for doing handwork. The functional incapacity for basic activities was associated with age and color; for instrumental activities, with age, education, income of the elderly and self-assessment of health.
Conclusion:
attention should be paid to the overall assessment of the elderly person, in order to tailor care plans geared towards the preservation of their autonomy and the promotion of active ageing.
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RESEARCH01-01-2017
Fetal and neonatal deaths of children of patients classified as near miss
Revista Brasileira de Enfermagem. 2017;70(1):104-111
Abstract
RESEARCHFetal and neonatal deaths of children of patients classified as near miss
Revista Brasileira de Enfermagem. 2017;70(1):104-111
DOI 10.1590/0034-7167-2016-0405
Views0See moreABSTRACT
Objective:
identify the epidemiological aspects of early fetal and neonatal deaths in children of patients classified with near miss and the factors associated with this outcome.
Method:
a cross-sectional study of 79 women identified with near miss and their newborns. The variables were analyzed using Fisher’s exact test. Risk factors were estimated based on unadjusted and adjusted odds ratios, and by means of multiple correspondence analysis, with significance for p <0.05.
Results:
hypertensive disorders totaled 40.5%; Of these, 58.3% had adverse fetal and neonatal outcome. The newborns admitted to the Neonatal Intensive Care Unit proved to be significant for the outcome (70.8%), gestational age <32 weeks (41.6%), birth weight <2500 (66.7%), neonatal asphyxia (50%) and early respiratory discomfort (72.2%).
Conclusion:
prematurity, neonatal asphyxia, and early respiratory distress were significant characteristics for the outcome among newborns.
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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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RESEARCH01-01-2016
Determining impacts and factors in ventilator-associated pneumonia bundle
Revista Brasileira de Enfermagem. 2016;69(6):1108-1114
Abstract
RESEARCHDetermining impacts and factors in ventilator-associated pneumonia bundle
Revista Brasileira de Enfermagem. 2016;69(6):1108-1114
DOI 10.1590/0034-7167-2016-0253
Views0See moreABSTRACT
Objective:
Assessing the determining impacts and factors in ventilator-associated pneumonia (VAP) bundle.
Method:
descriptive retrospective longitudinal study, with quantitative approach, held at a public teaching hospital. Collection held between May 2014 and April 2015. Patients of the ICU with VAP participated in the research. For organizing data, the Microsoft Excel 2010 program was used. A critical analysis between the data collected and infection rates was performed. The survey was approved under no. 566,136.
Results:
an increase in the incidence of VAP after implementing the bundle was observed; the prevalent pathogens were gram-negative bacteria. Deaths were equal to or greater than 50%. Changes of professionals and lack of supplies were determining factors.
Conclusion:
in this context, the need for permanent qualification of the team is emphasized, with the purpose of promoting the adherence to the protocol and preventing VAP.
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RESEARCH01-01-2016
Multidisciplinary team of intensive therapy: humanization and fragmentation of the work process
Revista Brasileira de Enfermagem. 2016;69(6):1099-1107
Abstract
RESEARCHMultidisciplinary team of intensive therapy: humanization and fragmentation of the work process
Revista Brasileira de Enfermagem. 2016;69(6):1099-1107
DOI 10.1590/0034-7167-2016-0221
Views0See moreABSTRACT
Objective:
to understand the meaning of humanized care in intensive care units considering the experience of the multidisciplinary team.
Method:
descriptive and exploratory qualitative research. For this purpose, we conducted semi-structured interviews with 24 professionals of the heath-care team, and, after transcription, we organized the qualitative data according to content analysis.
Results:
from two main categories, we were able to understand that humanized care is characterized in the actions of health-care: effective communication, team work, empathy, singularity, and integrality; and mischaracterized in the management processes, specifically in the fragmentation of the work process and health-care, in the precarious work conditions, and in differing conceptual aspects of the political proposal of humanization.
Conclusion:
care activities in intensive therapy are guided by the humanization of care and corroborate the hospital management as a challenge to be overcome to boost advances in the operationalization of this Brazilian policy.
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RESEARCH01-01-2016
Humanized Care: insertion of obstetric nurses in a teaching hospital
Revista Brasileira de Enfermagem. 2016;69(6):1091-1098
Abstract
RESEARCHHumanized Care: insertion of obstetric nurses in a teaching hospital
Revista Brasileira de Enfermagem. 2016;69(6):1091-1098
DOI 10.1590/0034-7167-2016-0295
Views0ABSTRACT
Objective:
to evaluate the care provided at an Antepartum, Intrapartum, Postpartum (AIP) unit at a teaching hospital following the inclusion of obstetric nurses.
Method:
transversal study, performed at a AIP unit at a teaching hospital in the capital of the Brazilian state of Mato Grosso. The sample comprised data regarding the 701 childbirths that took place between 2014 and 2016. The data were organized using Excel and analyzed using version 7 of Epi Info software.
Results:
the results suggest that including obstetric nurses contributed towards qualifying the care provided during labor and childbirth, followed by a reduction in the number of interventions, such as episiotomy caesareans sections, and resulting in encouragement to employ practices that do not interfere in the physiology of the parturition process, which in turn generate good perinatal results.
Conclusion:
inserting these nurses collaborated towards humanizing obstetric and neonatal care.
Keywords:Hospitals, TeachingHumanization of CareHumanized ChildbirthNatural ChildbirthObstetric NursesSee more -
RESEARCH01-01-2016
Normative grounds of health care practice in Brazilian nursing
Revista Brasileira de Enfermagem. 2016;69(6):1082-1090
Abstract
RESEARCHNormative grounds of health care practice in Brazilian nursing
Revista Brasileira de Enfermagem. 2016;69(6):1082-1090
DOI 10.1590/0034-7167-2016-0228
Views0See moreABSTRACT
Objective:
to understand the normative grounds of health care practice in Brazilian nursing.
Method:
qualitative study with the use of document research, carried out based on resolutions of the Federal Nursing Council. From a total of 263 resolutions, in the period from 1975 to 2015, 38 which were in accordance with the objective of the study were selected.
Results:
three analytical categories were systematized: Normative grounds of health care practice by the nursing team, under coordination/supervision of the nurse; Normative grounds of the care performed privately by the nurse; and Management and administrative aspects which affect and permeate the practice of health care in nursing.
Conclusion:
the set of normative grounds of health care practice by the nursing team leads to the reflection on the possible overlapping of attributions between professional levels and requires expansion to the other fields of nursing which are coherent with the health care network model.
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RESEARCH01-01-2016
Multi-professional intervention in adults with arterial hypertension: a randomized clinical trial
Revista Brasileira de Enfermagem. 2016;69(6):1067-1073
Abstract
RESEARCHMulti-professional intervention in adults with arterial hypertension: a randomized clinical trial
Revista Brasileira de Enfermagem. 2016;69(6):1067-1073
DOI 10.1590/0034-7167-2016-0320
Views0See moreABSTRACT
Objective:
assess the influence of an intervention, comprised of counseling related to health and aerobic physical training for lowering pressure values, in anthropometric indicators and in the adjustment of biochemical parameters in individuals with hypertension.
Method:
intervention study of the randomized clinical trial variety, with 42 individuals. The intervention-group followed the protocol of health counseling, nutrition and physical activity.
Results:
two intervention groups were considered: intervention-group (a) and intervention-group (b). Intervention-group (a) showed significant decrease in measurements of systolic and diastolic arterial pressure, of high-density lipoprotein parameters, hip circumference values and waist-hip ratio. Intervention-group (b) presented significant decrease in systolic arterial pressure values.
Conclusion:
it was found that the health intervention in conjunction with physical activities were effective in decreasing and/or controlling values for pressure, biochemical and anthropometric indicators.
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RESEARCH01-01-2016
Clinical Caritas Processes in workshops for caregivers of institutionalized elderly people
Revista Brasileira de Enfermagem. 2016;69(6):1059-1066
Abstract
RESEARCHClinical Caritas Processes in workshops for caregivers of institutionalized elderly people
Revista Brasileira de Enfermagem. 2016;69(6):1059-1066
DOI 10.1590/0034-7167-2016-0359
Views0See moreABSTRACT
Objective:
to describe the use of the Clinical Caritas Processes in workshops for caregivers of institutionalized elderly people, aimed at analyzing these professionals’ perception on humane care towards the institutionalized elderly.
Method:
a convergent care research was conducted with 18 caregivers of a long-term care institution for elderly people in the state of Paraíba, Brazil. Data were collected from June to November 2013, consisting of two months of interaction with the care service and ten meetings conducted in workshops for caregivers. Data were based on the theoretical framework of the Clinical Caritas Processes. Data analysis was based on content analysis and produced ten thematic categories based on the Caritas factors of caring.
Conclusion:
it was found that the use of the ten Caritas factors of caring were useful for humanistic formations when introducing the group to the conceptions of caring that value the self of the people providing the care and of the ones-being cared for.
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RESEARCH01-01-2016
Technological innovation for peripheral venipuncture: ultrasound training
Revista Brasileira de Enfermagem. 2016;69(6):1052-1058
Abstract
RESEARCHTechnological innovation for peripheral venipuncture: ultrasound training
Revista Brasileira de Enfermagem. 2016;69(6):1052-1058
DOI 10.1590/0034-7167-2016-0125
Views0See moreABSTRACT
Objective:
to evaluate the training of nurses in the use of ultrasound in peripheral venipuncture.
Method:
descriptive research of quantitative approach performed with nurses as part of an analytical cross-sectional study in two patient care centers: an intensive care unit and an adult emergency center.
Results:
the results showed contributions of training for professional skill and visibility of nurses, requiring, however, more time for complete assimilation of this technological innovation as a safer clinical practice.
Conclusion:
as the use of this technology represents an innovation aimed to facilitate difficult venipuncture and to provide subsidies to the most appropriate clinical decision-making, it is urgent to qualify nurses for its use.
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