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ORIGINAL ARTICLE11-10-2023
Construction and validity of a storyboard about breast cancer for women deprived of liberty
Revista Brasileira de Enfermagem. 2023;76:e20220436
Abstract
ORIGINAL ARTICLEConstruction and validity of a storyboard about breast cancer for women deprived of liberty
Revista Brasileira de Enfermagem. 2023;76:e20220436
DOI 10.1590/0034-7167-2022-0436
Views0See moreABSTRACT
Objectives:
to build storyboards based on health literacy about breast cancer for women deprived of liberty for later production of videos and e-books.
Methods:
a methodological study, construction and validity of storyboards with 10 expert judges. The Educational Content Validation Instrument in Health and the Suitability Assessment of Materials were used. For validity, an agreement criterion greater than 80% was considered, verified from the Content Validation Index, with 40-100% for suitability.
Results:
the storyboards’ overall Content Validity Index was 0.99, combined with the measurement of suitability of 81% and readability percentage of 73.2, categorizing the material as superior and easy to read.
Conclusions:
the educational technology built proved to be valid and reliable, and can be transformed into an e-book and video to promote self-care for women deprived of liberty.
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ORIGINAL ARTICLE11-10-2023
Construction and validity of educational technology in audiovisual media on premature newborn care
Revista Brasileira de Enfermagem. 2023;76:e20220403
Abstract
ORIGINAL ARTICLEConstruction and validity of educational technology in audiovisual media on premature newborn care
Revista Brasileira de Enfermagem. 2023;76:e20220403
DOI 10.1590/0034-7167-2022-0403
Views0See moreABSTRACT
Objectives:
to construct and validate an educational video storyboard about care for premature newborns at home.
Methods:
a methodological study, with the construction of an educational video storyboard, validated with 14 judges. Content was selected from scoping review. For data collection, a validated instrument was used. The criterion for validity was agreement greater than 80%, analyzed using the Content Validity Index.
Results:
the storyboard construction was guided by the Cognitive Theory of Multimedia Learning theoretical framework. Construction and validity took place from May to December 2020. The storyboard’s final version lasted 10 minutes, and was validated in terms of objective, structure, presentation and relevance, with a Content Validity Index of 0.9.
Conclusions:
the storyboard of the educational video proved to be valid and adequate for health promotion in developing care for premature newborns at home.
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11-10-2023
ERRATA
Revista Brasileira de Enfermagem. 2023;76(5):e2023n5e04
Abstract
ERRATA
Revista Brasileira de Enfermagem. 2023;76(5):e2023n5e04
DOI 10.1590/0034-7167.20237605e04pt
Views0No artigo “Primeira graduada do Mestrado em Enfermagem em Prática Avançada em Oncologia no Chile”, com número DOI: , publicado no periódico Revista Brasileira de Enfermagem, 2023; 2023(Suppl 4):e76suppl401, no segundo parágrafo:Onde se lia:[…]See more -
ERRATUM11-10-2023
ERRATUM
Revista Brasileira de Enfermagem. 2023;76(5):e2023n5e04
Abstract
ERRATUMERRATUM
Revista Brasileira de Enfermagem. 2023;76(5):e2023n5e04
DOI 10.1590/0034-7167.20237605e04
Views0In the article “First graduate of the Master of Nursing in Advanced Practice in Oncology in Chile”, with DOI number: , published in Revista Brasileira de Enfermagem, 2023(Suppl 4):e76suppl401, in the second paragraph:Where it read:[…]See more -
11-10-2023
Time to act sustainably: Why can’t we wait any longer?
Revista Brasileira de Enfermagem. 2023;76(5):e20220813
Abstract
Time to act sustainably: Why can’t we wait any longer?
Revista Brasileira de Enfermagem. 2023;76(5):e20220813
DOI 10.1590/0034-7167-2022-0813
Views0See moreABSTRACT
Objectives:
to raise reflections on the need for health services and professionals to implement sustainable actions, aiming at their own survival and that of the planet.
Methods:
reflective essay based on international reports regarding the impact of climate change on people’s health and the role of institutions in this context.
Results:
the article focused on three fundamentals: climate change continues to be a threat to the health and well-being of all beings on Earth; the institutions that should contribute to health are great agents of contamination of the environment and emission of gases that aggravate the greenhouse effect; and there are several benefits for health institutions to act sustainably.
Final Considerations:
we cannot wait any longer; we must develop policies and management models aimed at environmentally responsible, economically viable, and socially more collaborative healthcare.
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REVIEW11-10-2023
Applying Lean Healthcare in the hospitalization and patient discharge process: an integrative review
Revista Brasileira de Enfermagem. 2023;76(5):e20220751
Abstract
REVIEWApplying Lean Healthcare in the hospitalization and patient discharge process: an integrative review
Revista Brasileira de Enfermagem. 2023;76(5):e20220751
DOI 10.1590/0034-7167-2022-0751
Views0See moreABSTRACT
Objectives:
to identify scientific evidence regarding the use of Lean Healthcare approach in the hospitalization and patient discharge process.
Methods:
this is an Integrative Review conducted in the PubMed, LILACS, SCOPUS, CINAHL, Web of Science, and Embase databases.
Results:
out of 904 records identified, three were included in this review. The studies demonstrated that when applied to discharge planning, the Lean philosophy brings favorable results, promoting improvements in the communication process, as well as assisting in workflow organization, with a reduction in length of stay and improvement in the quality of care.
Final Considerations:
although the Lean methodology presents positive results, it is considered that the application of the philosophy in healthcare institutions is still not sustainable, as it is often restricted to specific departments or services. Thus, to maximize the success of implementation, the Lean philosophy needs to be incorporated into the organizational culture, representing the greatest challenge.
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11-10-2023
A eficácia do uso de livros interativos multimodalidade em enfermagem pediátrica na implementação do programa Merdeka Belajar
Revista Brasileira de Enfermagem. 2023;76(5):e20220599
Abstract
A eficácia do uso de livros interativos multimodalidade em enfermagem pediátrica na implementação do programa Merdeka Belajar
Revista Brasileira de Enfermagem. 2023;76(5):e20220599
DOI 10.1590/0034-7167-2022-0599
Views0See moreRESUMEN
Objetivos:
analizar la efectividad del uso de libros interactivos multimodales en enfermería pediátrica sobre los resultados de aprendizaje de los estudiantes en la implementación del Programa Merdeka Belajar.
Métodos:
investigación cuasi-experimental con un diseño de grupo de control posterior a la prueba. En este estudio, la muestra incluyó 52 estudiantes de enfermería del cuarto semestre del Instituto de Ciencias de la Salud Suaka Insan Banjarmasin que recibieron el curso de Enfermería Pediátrica. Fue utilizada la técnica de muestreo total y la prueba t dependiente en el análisis de datos.
Resultados:
el libro interactivo multimodal de enfermería pediátrica fue efectivo en la mejora del logro de aprendizaje de los estudiantes de cuarto semestre con un valor de significancia de 0,015 < 0,05. Hay una diferencia en el valor promedio de los cursos de enfermería pediátrica para la clase A y la clase B, que es de 3,173.
Conclusiones:
el uso de libros multimodales interactivos es muy bueno para que los profesores los apliquen en la enseñanza para ayudar a los estudiantes a comprender el material que están aprendiendo.
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ORIGINAL ARTICLE11-10-2023
The effectiveness of using interactive multimodality books in pediatric nursing in implementing Merdeka Belajar program
Revista Brasileira de Enfermagem. 2023;76(5):e20220599
Abstract
ORIGINAL ARTICLEThe effectiveness of using interactive multimodality books in pediatric nursing in implementing Merdeka Belajar program
Revista Brasileira de Enfermagem. 2023;76(5):e20220599
DOI 10.1590/0034-7167-2022-0599
Views0See moreABSTRACT
Objectives:
to analyzing the Effectiveness of Using Interactive Multimodality Books in Pediatric Nursing on Student Learning Outcomes in Implementing the Merdeka Belajar Program.
Methods:
the research design used a quasi-experimental approach with a posttest control group design. The sample in this study was the fourth-semester nursing students of Institute of Health Science Suaka Insan Banjarmasin who received the Pediatric Nursing course, a total of 52 students. The sampling technique used is total sampling. Data analysis used the dependent t-test.
Results:
the interactive multimodality pediatric nursing book was effective in improving the learning achievement of fourth-semester students with a significance value of 0.015 < 0.05. There is a difference in the average value of pediatric nursing courses for class A and class B, which is 3.173.
Conclusions:
the use of interactive multimodality books is very good for lecturers to apply in teaching to help students understand the material they are learning.
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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
Views0See moreABSTRACT
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.
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ORIGINAL ARTICLE01-13-2024
Social representations of oncologic surgery for patients with cancer
Revista Brasileira de Enfermagem. 2024;77(6):e20230273
Abstract
ORIGINAL ARTICLESocial representations of oncologic surgery for patients with cancer
Revista Brasileira de Enfermagem. 2024;77(6):e20230273
DOI 10.1590/0034-7167-2023-0273
Views0See moreABSTRACT
Objectives:
to analyze the social representations of patients with cancer regarding oncologic surgery.
Methods:
a qualitative study based on Social Representation Theory was conducted with 126 participants between October 2021 and May 2022 in a public hospital in Rio de Janeiro. A characterization questionnaire, free evocations of the inducing term “surgery”, and semi-structured interviews with 60 participants were applied. Data were analyzed using Microsoft Excel® and IRaMuTeQ.
Results:
the central core of the representation is composed of fear, cure, hope, and removing the disease. The analysis of interviews resulted in six classes that highlight the social changes caused by treatment as well as the need for a support network to cope with the surgical process.
Final Considerations:
the representations reflect fear and hope towards the procedure and the desire to remove the disease, thus translating the cure through surgery.
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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
Views0See moreABSTRACT
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.
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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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ORIGINAL ARTICLE10-06-2023
Nursing students’ professional values for reinforcing the professional identity
Revista Brasileira de Enfermagem. 2023;76:e20220338
Abstract
ORIGINAL ARTICLENursing students’ professional values for reinforcing the professional identity
Revista Brasileira de Enfermagem. 2023;76:e20220338
DOI 10.1590/0034-7167-2022-0338
Views0See moreABSTRACT
Objectives:
to understand the nursing students’ professional values in different Brazilian universities and verify a correlation between the “Professional Value” and the sociodemographic variables.
Methods:
quantitative, cross-sectional, and descriptive study conducted through an electronic questionnaire with a Professional Values Scale (NPVS-3). Participants were Nursing students of all semesters from three universities – two in the Southeast region and one in the North region.
Results:
of the 337 participating Nursing students, 282 were female. The Caring dimension presented the highest score (mean=46.61), and Professionalism, the lowest score (mean=34.65). A statistically significant association was detected between the Caring dimension, “university where is attending,” and “gender.”
Conclusions:
the results indicate the Caring dimension as the one containing the most scored professional values since the nurses’ training, and the relation of those values in such dimension is more significant in the female sample.
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10-06-2023
Pesquisa Translacional em Saúde: para onde vamos?
Revista Brasileira de Enfermagem. 2023;76(5):e760501
Abstract
Pesquisa Translacional em Saúde: para onde vamos?
Revista Brasileira de Enfermagem. 2023;76(5):e760501
DOI 10.1590/0034-7167.2023760501pt
Views0Os contributos das pesquisas científicas são incontestáveis para o avanço da ciência e para a sociedade. Por isso, cada vez mais reflexões acerca dos impactos e da aplicabilidade dos estudos têm permeado o centro das discussões em nível global, sobretudo diante do aumento crescente da produção de conhecimentos. Nesse cenário, a translação da pesquisa (TP) […]See more -
10-06-2023
Translational Health Research: where are we going?
Revista Brasileira de Enfermagem. 2023;76(5):e760501
Abstract
Translational Health Research: where are we going?
Revista Brasileira de Enfermagem. 2023;76(5):e760501
DOI 10.1590/0034-7167.2023760501
Views0The contributions of scientific research are undeniable for the advancement of science and for society. Therefore, more and more reflections on the impacts and applicability of studies have permeated the center of discussions at a global level, especially considering the growing increase in knowledge production. In this scenario, research translation (RT) has a notable importance […]See more -
10-06-2023
Advanced Practice Nursing: “Training” Pillar in Supporting the Proposal in Brazil
Revista Brasileira de Enfermagem. 2023;76(5):e20230118
Abstract
Advanced Practice Nursing: “Training” Pillar in Supporting the Proposal in Brazil
Revista Brasileira de Enfermagem. 2023;76(5):e20230118
DOI 10.1590/0034-7167-2023-0118
Views0See moreABSTRACT
Objectives:
to present the pillars that support what has been called Advanced Practice Nursing and discuss the necessary training for its implementation.
Methods:
elements contained in assessment documents for graduate programs proposals, reports of presentations by international professors in countries and selected scientific publications were gathered to compose the argument.
Results:
practice/competency (adds broad and in-depth knowledge about health processes and scientific evidence, clinical reasoning and clinical skills for therapeutic indications); 3) professional regulation (corresponding legislation and monitoring); and 4) funding (broad training and professional practice policy).
Final Considerations:
the agenda for implementing Advanced Practice Nursing in Brazil involves joining efforts to identify stakeholders for a work to legitimize their importance in the country’s health and education overview.
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ORIGINAL ARTICLE10-06-2023
Quality of health care in Primary Care: perspective of people with Diabetes Mellitus
Revista Brasileira de Enfermagem. 2023;76(5):e20230008
Abstract
ORIGINAL ARTICLEQuality of health care in Primary Care: perspective of people with Diabetes Mellitus
Revista Brasileira de Enfermagem. 2023;76(5):e20230008
DOI 10.1590/0034-7167-2023-0008
Views0See moreABSTRACT
Objectives:
to identify how people with diabetes assess the care offered by Primary Care teams.
Methods:
a cross-sectional study based on structured interviews with the application of the Patient Assessment of Chronic Illness instrument to people with Type 2 Diabetes Mellitus. Data were submitted to statistical analysis.
Results:
451 individuals participated in the study, more than half aged 60 years or older (64.0%); 63.9% had been diagnosed for more than five years; and 23.9% used insulin. The average score obtained was 2.5, which indicated little involvement in self-care and low support for the care of the chronic condition by the Family Health Strategy team, and was higher among women and people with a partner.
Conclusions:
people with diabetes consider that they do not receive individualized treatment, with dialogue and discussion for setting goals, and that they are not prepared for self-managing their health condition.
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REVIEW10-06-2023
Nursing theories in the care of stroke patients: a scoping review
Revista Brasileira de Enfermagem. 2023;76(5):e20220791
Abstract
REVIEWNursing theories in the care of stroke patients: a scoping review
Revista Brasileira de Enfermagem. 2023;76(5):e20220791
DOI 10.1590/0034-7167-2022-0791
Views0See moreABSTRACT
Objectives:
to map and synthesize nursing theories and conceptual frameworks that have been applied in the practice of nursing care for stroke patients in hospital settings.
Methods:
a scoping review was conducted in October 2022 using the MEDLINE (accessed via PubMed), CINAHL, Scielo, and Web of Science databases, following The Joanna Briggs Institute guidelines.
Results:
nine studies incorporated six nursing theories and three conceptual frameworks, which were employed to enhance stroke patient care. The objective of these theories and conceptual frameworks was to facilitate the identification of the patient’s psychobiological, psychosocial, and psychospiritual needs, elucidate the nurse’s role and expand their perspective on rehabilitation, and acknowledge the survivor’s process of transition.
Final Considerations:
this mapping exercise identified major nursing theories, middle-range theories, and conceptual frameworks applied to the care of stroke patients.
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ORIGINAL ARTICLE10-06-2023
Learning strategies of undergraduate nursing students during the COVID-19 pandemic
Revista Brasileira de Enfermagem. 2023;76(5):e20220764
Abstract
ORIGINAL ARTICLELearning strategies of undergraduate nursing students during the COVID-19 pandemic
Revista Brasileira de Enfermagem. 2023;76(5):e20220764
DOI 10.1590/0034-7167-2022-0764
Views0See moreABSTRACT
Objectives:
to analyze the learning strategies used by nursing students from a public university, in remote teaching, during the COVID-19 pandemic.
Methods:
a cross-sectional study developed with nursing students who attended remote teaching classes. The sample was obtained by convenience and data were collected online, with 112 participants. Student and Mann-Whitney tests were performed for data analysis.
Results:
the most frequently used learning strategies were self-regulatory and cognitive. There was moderate use of interpersonal help-seeking and emotional control strategies. Male students, with a private study environment and good internet connection, used emotional control strategies more frequently.
Conclusions:
self-regulatory and cognitive learning strategies, appropriate for higher education, were frequently used by nursing students, which is an important tool for adapting these students to the university context.
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ORIGINAL ARTICLE10-06-2023
Nursing, history, and orthopedics in manuals (1875-1928)
Revista Brasileira de Enfermagem. 2023;76(5):e20220567
Abstract
ORIGINAL ARTICLENursing, history, and orthopedics in manuals (1875-1928)
Revista Brasileira de Enfermagem. 2023;76(5):e20220567
DOI 10.1590/0034-7167-2022-0567
Views0See moreABSTRACT
Objectives:
to discuss the content of manuals, with emphasis on orthopedics, in support of the development of nursing care culture.
Methods:
cultural-historical method articulated with document analysis technique. The sources were nursing manuals – Portuguese, French, English, and Spanish – from 1875 to 1928.
Results:
this study pointed to 12 works – 6 authored by physicians, 2 by nurses, 3 institutional, and 1 by a Sister of Charity – that presented, in a transversal way, the professionalization process initiated in Europe. The manuals addressed first aid care and immobilization methods, from the simplest, such as improvised splints, to the application of plaster casts.
Conclusions:
the nurses’ work, even in a limited capacity, showed that they were able to observe warning signs so that doctors could act, with some exceptions.
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