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ORIGINAL ARTICLE05-03-2024
Josicélia Dumêt Fernandes’ professional trajectory: contributions to psychiatric and mental health nursing
- Ingredy Nayara Chiacchio Silva
, - Gilberto Tadeu Reis da Silva ,
- Itanna Vytoria Sousa Serra ,
- Deybson Borba de Almeida ,
- Giselle Alves da Silva Teixeira , [ … ],
- Ana Lúcia Arcanjo Oliveira Cordeiro
Abstract
ORIGINAL ARTICLEJosicélia Dumêt Fernandes’ professional trajectory: contributions to psychiatric and mental health nursing
Revista Brasileira de Enfermagem. 2024;77(1):e20230174
DOI 10.1590/0034-7167-2023-0174
- Ingredy Nayara Chiacchio Silva ,
- Gilberto Tadeu Reis da Silva ,
- Itanna Vytoria Sousa Serra ,
- Deybson Borba de Almeida ,
- Giselle Alves da Silva Teixeira ,
- Rosana Maria de Oliveira Silva ,
- Ana Lúcia Arcanjo Oliveira Cordeiro
Views0See moreABSTRACT
Objectives:
to analyze nurse Josicélia Dumêt Fernandes’ life story, with emphasis on her work in the psychiatry and mental health fields.
Methods:
historical, qualitative research. Semi-structured interviews and documentary research were used as data collection techniques, collected from September to October 2021. For data analysis, we opted for the content analysis method and comparison with the Foucauldian philosophical framework.
Results:
four categories emerged: Transforming herself and mental health practices; (Re)framing professional practice; Nursing practice and power relations; and The paths and implications in the psychiatry and mental health fields.
Final Considerations:
the study of the biographer demonstrates a search for transformation of herself and mental health practices, with a rupture in paradigms and reframing of her practice in psychiatry and mental health.
- Ingredy Nayara Chiacchio Silva
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ORIGINAL ARTICLE04-22-2024
Adherence to Covid-19 vaccination during the pandemic: the influence of fake news
- Luana Cristina Roberto Borges ,
- Sonia Silva Marcon ,
- Gabrielly Segatto Brito ,
- Miriam Terabe ,
- Nathalia Ivulic Pleutim , [ … ],
- Elen Ferraz Teston
Abstract
ORIGINAL ARTICLEAdherence to Covid-19 vaccination during the pandemic: the influence of fake news
Revista Brasileira de Enfermagem. 2024;77(1):e20230284
DOI 10.1590/0034-7167-2023-0284
- Luana Cristina Roberto Borges ,
- Sonia Silva Marcon ,
- Gabrielly Segatto Brito ,
- Miriam Terabe ,
- Nathalia Ivulic Pleutim ,
- Ana Heloisa Mendes ,
- Elen Ferraz Teston
Views1See moreABSTRACT
Objectives:
to understand how fake news has influenced adherence to Covid-19 immunization, from the perspective of health professionals.
Methods:
a qualitative, descriptive-exploratory study was conducted in Campo Grande – MS. Twenty nursing professionals working in vaccine rooms or managing immunobiologicals participated through semi-structured interviews. The interviews were audio-recorded, fully transcribed, and subjected to thematic content analysis.
Results:
two categories emerged in which the professionals highlighted an increase in vaccine hesitancy among the population, influenced by fake news and denialist actions, which negatively interfered with the population’s trust in vaccines and in the professionals administering them.
Final Considerations:
concerns about vaccine safety and denialist actions by authorities and media outlets can contribute to the phenomenon of non-vaccination. The valorization of science, the promotion of educational actions, and raising public awareness about immunization were presented as strategies to increase vaccine coverage
- Luana Cristina Roberto Borges
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ORIGINAL ARTICLE04-22-2024
Learning difficulties in school children: health and education professionals’ perceptions
- Pamela Camila Fernandes Rumor ,
- Michelle Kuntz Durand ,
- Jeane Barros de Souza ,
- Janaina Medeiros de Souza ,
- Adriana Bitencourt Magagnin , [ … ],
- Ivonete Teresinha Schülter Buss Heidemann
Abstract
ORIGINAL ARTICLELearning difficulties in school children: health and education professionals’ perceptions
Revista Brasileira de Enfermagem. 2024;77(1):e20230074
DOI 10.1590/0034-7167-2023-0074
- Pamela Camila Fernandes Rumor ,
- Michelle Kuntz Durand ,
- Jeane Barros de Souza ,
- Janaina Medeiros de Souza ,
- Adriana Bitencourt Magagnin ,
- Ivonete Teresinha Schülter Buss Heidemann
Views0See moreABSTRACT
Objectives:
to understand health and education professionals’ perceptions regarding children’s learning difficulties in public schools.
Methods:
qualitative research, of the participatory action type, linked to Paulo Freire’s Research Itinerary. Forty-five professionals participated, through interviews and a Virtual Culture Circle. The analysis was developed through careful reading, reflection and interpretation of highlighted topics.
Results:
professionals discussed the (in)visibility of learning difficulties, strategies and resources in the educational sector and the search for solutions in the health sector. It was found that the production of complaints related to school learning is attributed predominantly as an individual problem of children or their family, exempting the educational institution from this process.
Final Considerations:
greater investment in professional training and development policies is urgently needed to facilitate coordination between sectors, with a view to overcoming outdated pedagogical and health models.
- Pamela Camila Fernandes Rumor
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ORIGINAL ARTICLE04-22-2024
Mothers’ perception of the care of newborn in the home environment
- Gina de Souza Castro Hammel ,
- Laura Tais Loureiro Simas ,
- Luiz Fernando Rodrigues Junior ,
- Claudia Zamberlan ,
- Lurdes Lomba , [ … ],
- Dirce Stein Backes
Abstract
ORIGINAL ARTICLEMothers’ perception of the care of newborn in the home environment
Revista Brasileira de Enfermagem. 2024;77(1):e20230080
DOI 10.1590/0034-7167-2023-0080
- Gina de Souza Castro Hammel ,
- Laura Tais Loureiro Simas ,
- Luiz Fernando Rodrigues Junior ,
- Claudia Zamberlan ,
- Lurdes Lomba ,
- Dirce Stein Backes
Views1See moreABSTRACT
Objectives:
to identify mothers’ perceptions about caring for newborns in the home environment, from the perspective of complexity thinking.
Methods:
qualitative, exploratory and descriptive research, carried out between November/2022 and February/2023. Data were collected through individual interviews with 21 mothers from southern Brazil who cared for newborns at home and analyzed using the thematic analysis technique.
Results:
the four thematic axes resulting from the data analysis: Living amidst order and disorder; embracing singularities; dealing with the certain and the uncertain; support network in the (re)organizing process demonstrate that the mother caring for a newborn in their home environment experiences a distinct and plural adaptive process, which must be welcomed and understood by health professionals who work within the family environment.
Final Considerations:
the care of newborns in a home environment, in the perception of mothers, requires differentiated attention and a formal or informal support network that considers the unique specificities of each woman/mother in the personal, family and social spheres. Therefore, in addition to the social support network, it is important to rethink home intervention approaches.
- Gina de Souza Castro Hammel
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ORIGINAL ARTICLE04-22-2024
Nurses’ perception of the nursing process and its relationship with leadership
- Karen Ariane Bär ,
- Bianca dos Santos Lima ,
- Gicelle Morais Martelle ,
- Silvana Cruz da Silva ,
- Margarida Reis dos Santos , [ … ],
- Regina Gema Santini Costenaro
Abstract
ORIGINAL ARTICLENurses’ perception of the nursing process and its relationship with leadership
Revista Brasileira de Enfermagem. 2024;77(1):e20230371
DOI 10.1590/0034-7167-2023-0371
- Karen Ariane Bär ,
- Bianca dos Santos Lima ,
- Gicelle Morais Martelle ,
- Silvana Cruz da Silva ,
- Margarida Reis dos Santos ,
- Regina Gema Santini Costenaro
Views0See moreABSTRACT
Objectives:
to describe Nurses’ perception of the Nursing Process and its relationship with leadership.
Methods:
action research conducted between September/2021 and April/2022 with nurses from a medium-sized hospital in southern Brazil. The data investigated, one of the stages of the method, was collected using the Focus Group technique and submitted to Strategic Focus Analysis.
Results:
three categories emerged from the organized and analyzed data, namely: Nursing Process: a tool that qualifies nursing care; Conditions that weaken the Nursing Process; and Strategies that enhance the Systematization of Nursing Care.
Final Considerations:
the perception of the Nursing Process and its relationship with leadership are not always understood as complementary themes. Although they recognize that the Nursing Process is sometimes imposed as normative, nurses do not perceive the importance of the role of the leader, who is considered a key player in conducting and boosting the Systematization of Nursing Care.
- Karen Ariane Bär
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03-18-2024
Nursing rights in comics: educational technological innovation report
- Odilon Vieira Santos ,
- Meiry Fernanda Pinto Okuno ,
- Paula Hino ,
- Mônica Taminato ,
- Dulce Aparecida Barbosa , [ … ],
- Hugo Fernandes
Abstract
Nursing rights in comics: educational technological innovation report
Revista Brasileira de Enfermagem. 2024;77:e20230438
DOI 10.1590/0034-7167-2023-0438
- Odilon Vieira Santos ,
- Meiry Fernanda Pinto Okuno ,
- Paula Hino ,
- Mônica Taminato ,
- Dulce Aparecida Barbosa ,
- Hugo Fernandes
Views0See moreABSTRACT
Objectives:
to report an educational technology construction on nursing professionals’ rights.
Methods:
an experience report on educational technology construction during the crediting of university extension hours in an undergraduate nursing course at a Brazilian public university, between March and June 2023. The Deming cycle was used as a procedural method.
Results:
four meetings were held between students and extension workers. Eight comic books were produced based on the Code of Ethics for Nurses, addressing professional autonomy, fair remuneration, risk-free work, denial of exposure in the media and others. The Deming cycle proved to be an important strategy for constructing products.
Conclusions:
nursing professionals’ rights must be discussed and improved. Educational technologies, such as comic books, provide playful and reflective learning.
- Odilon Vieira Santos
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ORIGINAL ARTICLE03-18-2024
Nurses’ workload during the COVID-19 pandemic: potential for experiences of moral distress
- Thallison Carlos Campos Santos ,
- Gabriela da Costa Soares ,
- Kelly Cristina Oliveira de Lima ,
- Beatriz Bolognani Cardoso de Souza ,
- Isabela Silva Câncio Velloso , [ … ],
- Carolina da Silva Caram
Abstract
ORIGINAL ARTICLENurses’ workload during the COVID-19 pandemic: potential for experiences of moral distress
Revista Brasileira de Enfermagem. 2024;77:e20230200
DOI 10.1590/0034-7167-2023-0200
- Thallison Carlos Campos Santos ,
- Gabriela da Costa Soares ,
- Kelly Cristina Oliveira de Lima ,
- Beatriz Bolognani Cardoso de Souza ,
- Isabela Silva Câncio Velloso ,
- Carolina da Silva Caram
Views0See moreABSTRACT
Objectives:
to understand nurses’ experiences of moral distress related to work overload during the COVID-19 pandemic in Brazil.
Methods:
qualitative research, whose data collection occurred through individual interviews with 19 nurses who worked on the front line of COVID-19 in health services in southeastern Brazil. Data were analyzed using thematic content analysis.
Results:
work overload proved to be a powerful source of experiences of moral distress due to excessive working hours during vaccination, double working hours, a troubled relationship due to pressure from managers and the population and physical and mental exhaustion, which prevented nurses from act according to their judgment.
Final Considerations:
nurses’ work overload reflects on quality patient care and prevents nurses from acting in accordance with their moral principles, generating moral distress in nurses.
- Thallison Carlos Campos Santos
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REVIEW03-15-2024
Resources for health literacy among caregivers of prematurely born children: a scoping review
- Ana Clara Gomes Andrade ,
- Giovanna Barbosa Mendes ,
- Mariana Fuentes Mendoza Rodrigues Soares ,
- Suelen Rosa de Oliveira ,
- Luciano Marques dos Santos , [ … ],
- Elysângela Dittz Duarte
Abstract
REVIEWResources for health literacy among caregivers of prematurely born children: a scoping review
Revista Brasileira de Enfermagem. 2024;77(1):e20230062
DOI 10.1590/0034-7167-2023-0062
- Ana Clara Gomes Andrade ,
- Giovanna Barbosa Mendes ,
- Mariana Fuentes Mendoza Rodrigues Soares ,
- Suelen Rosa de Oliveira ,
- Luciano Marques dos Santos ,
- Elysângela Dittz Duarte
Views1See moreABSTRACT
Objectives:
to map the available evidence on resources used to promote health literacy among caregivers of prematurely born children during outpatient follow-up.
Methods:
the Joanna Briggs Institute’s scope review protocol was utilized. The search encompassed six databases, incorporating studies from 2012 to 2022.
Results:
the three included publications revealed that the resources employed are: mobile applications, phone calls, individual counseling, videos, educational pamphlets, and group discussions. Implementing an education protocol during the transition home enhances scientifically grounded health promotion rates.
Conclusions:
there is limited literature addressing the health literacy of these caregivers. The nursing team plays a crucial role in health education and in developing resources applicable to these families.
- Ana Clara Gomes Andrade
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ORIGINAL ARTICLE07-06-2020
Time and quality of admissions: nursing workload
Revista Brasileira de Enfermagem. 2020;73(5):e20190267
Abstract
ORIGINAL ARTICLETime and quality of admissions: nursing workload
Revista Brasileira de Enfermagem. 2020;73(5):e20190267
DOI 10.1590/0034-7167-2019-0267
Views0See moreABSTRACT
Objectives:
to measure the average time spent by the nursing staff during patient admission and investigate their compliance with the activities described by the Nursing Interventions Classification; evaluate the degree of interference in the workload of the team.
Methods:
observational with time measurement through software. We followed 199 admissions made by the nursing staff in seven units, using two validated instruments. Total scores ≥ 70% and 50% validated the process.
Results:
the average time of nurses ranged from 5.5 (standard deviation = 2.3) to 13 (standard deviation = 1.1) minutes; and the auxiliary / technician, between 4.7 (standard deviation = 2.1) and 6.8 (standard deviation = 2.0) minutes (p ≤ 0.01). We qualified six admissions made by nurses and 33 by assistants/technicians. The intervention spent 16.3% to 31.5% of the working hours of the team.
Conclusions:
admission impacts nursing workload and needs to be considered both in the measurement of activities and in the sizing of the nursing staff.
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07-09-2021
Algorithm for transitional care for caregivers of dependent older adults: a validation study
- Thawanna Jeremias Barbosa Gomes ,
- Bruna Alexandra da Silva Ferreira ,
- Cristina Lavareda Baixinho ,
- Óscar Manuel Ramos Ferreira
Abstract
Algorithm for transitional care for caregivers of dependent older adults: a validation study
Revista Brasileira de Enfermagem. 2021;74:e20200625
DOI 10.1590/0034-7167-2020-0625
- Thawanna Jeremias Barbosa Gomes ,
- Bruna Alexandra da Silva Ferreira ,
- Cristina Lavareda Baixinho ,
- Óscar Manuel Ramos Ferreira
Views0See moreABSTRACT
Objective:
To construct and validate an algorithm for transitional care for caregivers of dependent older adults.
Method:
This was a methodological study developed in three phases: a literature review, designing an algorithm, and its validation by a peer panel with twenty-seven experts selected according to pre-defined inclusion criteria.
Results:
The algorithm predicted interventions in transitional care (hospital stay, at discharge, and 30 days at home post-discharge) aimed at the exercise of the caregiver role; needs assessment; training in care management of dependent older adults and management of self-care, and ensuring continuity of care (of older adults and caregivers).
Conclusion:
Agreement between expert raters and a reliability test of 0.92 indicate that the algorithm can be used by professionals to decide the transitional care interventions to be administered to the caregivers of dependent older adults. Future studies should be conducted to perform its clinical validation.
- Thawanna Jeremias Barbosa Gomes
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ORIGINAL ARTICLE06-27-2019
Organizational climate and teamwork at the Family Health Strategy
- Hellen Emília Peruzzo ,
- Eraldo Schunk Silva ,
- Vanessa Carla Batista ,
- Maria do Carmo Fernandez Lourenço Haddad ,
- Aida Maris Peres , [ … ],
- Sonia Silva Marcon
Abstract
ORIGINAL ARTICLEOrganizational climate and teamwork at the Family Health Strategy
Revista Brasileira de Enfermagem. 2019;72(3):721-727
DOI 10.1590/0034-7167-2017-0770
- Hellen Emília Peruzzo ,
- Eraldo Schunk Silva ,
- Vanessa Carla Batista ,
- Maria do Carmo Fernandez Lourenço Haddad ,
- Aida Maris Peres ,
- Sonia Silva Marcon
Views0See moreABSTRACT
Objective:
to measure the organizational climate in the work of professionals from Family Health Strategy (FHS) teams.
Method:
a cross-sectional study carried out with 458 professionals belonging to 72 FHS teams in a municipality in Southern Brazil. Data collection occurred between March and July of 2016 with self-application of the Team Climate Inventory (TCI). Data were analyzed by means of a non-parametric ANOVA.
Results:
“Team Participation” was the best-rated domain (8.11), while “Task orientation” was the worst (7.51). Nurses obtained the highest mean in TCI (8.05), and dentists, the lowest (7.45).
Conclusion:
TCI is an appropriate and innovative tool for assessing the teamwork climate at the FHS. Identifying fragilities such as “task orientation” and relationships among professional categories of the team supports the planning of actions for organizational climate improvements and teamwork at the FHS.
- Hellen Emília Peruzzo
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REFLECTION09-07-2020
Public health nursing: regulation and public health policies
- Carmen Maria dos Santos Lopes Monteiro da Cunha ,
- Maria Adriana Pereira Henriques ,
- Andreia Cátia Jorge Silva Costa
Abstract
REFLECTIONPublic health nursing: regulation and public health policies
Revista Brasileira de Enfermagem. 2020;73(6):e20190550
DOI 10.1590/0034-7167-2019-0550
- Carmen Maria dos Santos Lopes Monteiro da Cunha ,
- Maria Adriana Pereira Henriques ,
- Andreia Cátia Jorge Silva Costa
Views0See moreABSTRACT
Objective:
To analyze regulation and public policies related to nursing and the specialist nurse in community and public health nursing.
Methods:
Analysis of the legal and normative framework of community and public health nursing in Portugal, as well as current public health policies, regarding the competences and intervention of this nurse, articulated with the attributions of the Public Health Unit.
Results:
The intervention of this nurse deserves a broad reflection, in the sense of maximizing the activities of community and public health, essential for the implementation of public policies and obtaining health gains.
Final considerations:
This nurse has competences foreseen in the regulations and standards for public health interventions, in line with the attributions of the Public Health Unit, of the National Health Service, in which specialties are identified for their performance in the current structure.
- Carmen Maria dos Santos Lopes Monteiro da Cunha
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ORIGINAL ARTICLE08-19-2019
The daily routine of nurses in rural areas in the Family Health Strategy
- Arleusson Ricarte de Oliveira ,
- Yanna Gomes de Sousa ,
- Ítalo Vinícius Albuquerque Diniz ,
- Soraya Maria de Medeiros ,
- Cláudia Martiniano , [ … ],
- Marília Alves
Abstract
ORIGINAL ARTICLEThe daily routine of nurses in rural areas in the Family Health Strategy
Revista Brasileira de Enfermagem. 2019;72(4):918-925
DOI 10.1590/0034-7167-2018-0243
- Arleusson Ricarte de Oliveira ,
- Yanna Gomes de Sousa ,
- Ítalo Vinícius Albuquerque Diniz ,
- Soraya Maria de Medeiros ,
- Cláudia Martiniano ,
- Marília Alves
Views0See moreABSTRACT
Objective:
to analyze the daily work of rural Family Health Strategy (FHS) nurses.
Method:
a qualitative, descriptive and exploratory research. The data were collected with eleven rural nurses of the city of Campina Grande, Paraíba State, through semi-structured interviews, between January and March of 2017, using Content Analysis.
Results:
rural nurses have a strong relationship with the population. However, they reveal a daily work with various organizational barriers that range from the team displacement to the workplace to the operationalization of health actions, which are mediated by the characteristics of rurality. Some of these barriers can be remedied by a more proactive action from the management.
Final considerations:
conditioned by the characteristics of rurality, the differentiated dynamics work reveal weaknesses in the quality of nursing care and lower effectiveness of the FHS.
- Arleusson Ricarte de Oliveira
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ORIGINAL ARTICLE08-19-2019
Feelings of pleasure of nurses working in primary care
- Grizielle Sandrine de Araujo Rocha ,
- Maria Sandra de Andrade ,
- Darine Marie Rodrigues da Silva ,
- Marlene Gomes Terra ,
- Sílvia Elizabeth Gomes de Medeiros , [ … ],
- Jael Maria de Aquino
Abstract
ORIGINAL ARTICLEFeelings of pleasure of nurses working in primary care
Revista Brasileira de Enfermagem. 2019;72(4):1036-1043
DOI 10.1590/0034-7167-2018-0518
- Grizielle Sandrine de Araujo Rocha ,
- Maria Sandra de Andrade ,
- Darine Marie Rodrigues da Silva ,
- Marlene Gomes Terra ,
- Sílvia Elizabeth Gomes de Medeiros ,
- Jael Maria de Aquino
Views0See moreABSTRACT
Objective:
identify the sources that generate feelings of pleasure at work in the perception of primary care nurses.
Methods:
this is a descriptive study with a qualitative approach, developed with eleven nurses working in Primary Health Care Units. Data were collected using semi-structured interviews, systematized and analyzed using Bardin’s content analysis technique and based on the theoretical framework of Psychodynamics of Work.
Results:
pleasure at work was related to the resolubility of the nurse’s work, interpersonal relationship with the team, therapeutic relationship with the community, positive professional return, identification with work in nursing and public health.
Final considerations:
The factors that generate feelings of pleasure may contribute to guide actions that value the optimization of the nurses’ work and, consequently, the care provided to the primary care user.
- Grizielle Sandrine de Araujo Rocha
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ORIGINAL ARTICLE08-19-2019
Social Determinants of Health and their influence on the choice of birth control methods
- Hellen Lívia Oliveira Catunda Ferreira ,
- Denise de Fátima Fernandes Barbosa ,
- Vivianne Melo Aragão ,
- Tyane Mayara Ferreira de Oliveira ,
- Régia Christina Moura Barbosa Castro , [ … ],
- Ana Karina Bezerra Pinheiro
Abstract
ORIGINAL ARTICLESocial Determinants of Health and their influence on the choice of birth control methods
Revista Brasileira de Enfermagem. 2019;72(4):1044-1051
DOI 10.1590/0034-7167-2017-0574
- Hellen Lívia Oliveira Catunda Ferreira ,
- Denise de Fátima Fernandes Barbosa ,
- Vivianne Melo Aragão ,
- Tyane Mayara Ferreira de Oliveira ,
- Régia Christina Moura Barbosa Castro ,
- Priscila de Souza Aquino ,
- Ana Karina Bezerra Pinheiro
Views0See moreABSTRACT
Objective:
To verify the association between Social Determinants of Health and birth control methods used by women of childbearing age.
Methods:
Documentary and retrospective study, performed at a Brazilian Natural Birth Center with evaluation of the medical records of patients seen between 2003 and 2011 (n=2410). Data were collected on identification and general history, gynecological, sexual and obstetric.
Results:
Hormone birth control methods were the most used among participants (25.0%); followed by barrier methods (21.5%) and surgical methods (19.3%). Statistical associations were observed regarding age, menarche, onset of sexual activity, pregnancy, miscarriage, smoking, hypertension, marital status, gynecological care and schooling with the choice of methods.
Conclusion:
The results confirm the importance of studies involving Social Determinants of Health, since they interfere in the way women choose birth control methods and the risks that this choice may pose to their health.
- Hellen Lívia Oliveira Catunda Ferreira
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ORIGINAL ARTICLE07-10-2020
Mental Health Nursing: waiting room intervention in integral health care
Revista Brasileira de Enfermagem. 2020;73:e20180886
Abstract
ORIGINAL ARTICLEMental Health Nursing: waiting room intervention in integral health care
Revista Brasileira de Enfermagem. 2020;73:e20180886
DOI 10.1590/0034-7167-2018-0886
Views0See moreABSTRACT
Objective:
To describe and to analyze the proposal for intervention in the waiting room as a possibility for Nursing in mental health in group context.
Method:
Descriptive study with a qualitative approach, convergent care type, developed in a Psychosocial Care Center for Alcohol and Drugs in the interior of the state of Goiás.
Results:
The service in the waiting room provided moments of reflection, knowledge, learning, listening and exchanging experiences.
Final considerations:
The meetings in the waiting room favored the articulation between theoretical knowledge and the practice of nursing care in groups, constituting a space with a valuable locus for the development of educational and support actions in health services, to be undertaken by the nurse and, also, by other professionals of the health team.
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