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01-01-2016
Prevalence and factors associated with frailty in non-institutionalized older adults
Revista Brasileira de Enfermagem. 2016;69(3):435-442
Abstract
Prevalence and factors associated with frailty in non-institutionalized older adults
Revista Brasileira de Enfermagem. 2016;69(3):435-442
DOI 10.1590/0034-7167.2016690304i
Views0See moreABSTRACT
Objective:
to investigate the prevalence and factors associated with frailty in non-institutionalized older adults living in northern Minas Gerais, Brazil.
Method:
data were collected in their homes, in 2013, based on a census cluster sampling. Demographic and socioeconomic variables, morbidities, utilization of health care services, and scores on the Edmonton Fragility Scale were analyzed. The adjusted prevalence ratios were obtained using the Poisson regression multiple analysis with robust variance.
Results:
the prevalence of frailty was 41.3%. The variables associated with frailty were: female gender, very old age, education of less than four years, not having been hospitalized in the last 12 months, having a caregiver, falling in the prior year, diabetes mellitus, cardiac disease, and osteoarticular disease.
Conclusion:
the prevalence of frailty was high. Some factors consist of modifiable conditions, which should encourage health actions aimed at this group.
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01-01-2016
“To be a nurse”: a professional choice and the construction of identity processes in the 1970s
Revista Brasileira de Enfermagem. 2016;69(3):428-434
Abstract
“To be a nurse”: a professional choice and the construction of identity processes in the 1970s
Revista Brasileira de Enfermagem. 2016;69(3):428-434
DOI 10.1590/0034-7167.2016690303i
Views0See moreABSTRACT
Objective:
to analyze the factors that influenced the choice for nursing made by graduates from the first class of the Undergraduate Nursing and Obstetrics Course of the Federal University of Rio Grande do Norte in the 1970s and to understand the senses and meanings of being a nurse when choosing this profession.
Method:
a qualitative socio-historical study was performed, using oral history to collect data.
Results:
the analysis generated the following categories: “To be a nurse: a professional choice” and “The ideal of being a nurse: senses and meanings”. The senses of “being a nurse” are associated with graduates’ perspective of this profession and the meanings included the traditional conceptions that have historically affected it.
Conclusion:
professional choice was influenced by family and work expectations and the nursing course had an effect on the construction of nurses’ professional identity.
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01-01-2016
Nurses’ knowledge and practice on social participation in health
Revista Brasileira de Enfermagem. 2016;69(3):421-427
Abstract
Nurses’ knowledge and practice on social participation in health
Revista Brasileira de Enfermagem. 2016;69(3):421-427
DOI 10.1590/0034-7167.2016690302i
Views0See moreABSTRACT
Objective:
to identify nurses’ knowledge and practice in the framework of the Family Health Strategy program with regard to social participation in health.
Method:
qualitative study which had the Family Health Units in a municipality of Minas Gerais as setting. Nine nurses participated in the study, and they were interviewed individually in July and August 2014. Data were collected and analyzed according to the content analysis technique and interpreted in the light of Paulo Freire’s ontology and critical pedagogy.
Results:
the analyzed statements showed that nurses bring along conceptual and behavioral inconsistencies which need to be equalized, so their knowledge and practice can mediate the challenging construction of participatory management in health.
Conclusion:
an improvement in nurses’ training is suggested, both academically and professionally, aiming at strengthening their political role in the process of consolidation of social participation in the Brazilian Unified Health System.
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01-01-2016
As dificuldades do ensino de enfermagem dos Estados Unidos para atender necessidades locais, regionais e globais
Revista Brasileira de Enfermagem. 2016;69(3):417-418
Abstract
As dificuldades do ensino de enfermagem dos Estados Unidos para atender necessidades locais, regionais e globais
Revista Brasileira de Enfermagem. 2016;69(3):417-418
DOI 10.1590/0034-7167.2016690301i
Views0A Liga Nacional de Enfermagem (NLN, National League for Nursing), a voz do ensino de enfermagem, está comprometida com o preparo de profissionais de enfermagem exemplares que valorizam e incorporam a riqueza das diferenças e a inclusão com vistas à evolução da saúde da nação e da comunidade global. Com sua população acima de 320 […]See more -
01-01-2016
The challenges of USA nursing education to meet local, regional and global need
Revista Brasileira de Enfermagem. 2016;69(3):417-418
Abstract
The challenges of USA nursing education to meet local, regional and global need
Revista Brasileira de Enfermagem. 2016;69(3):417-418
DOI 10.1590/0034-7167.2016690301i
Views1The National League for Nursing (NLN), the voice for nursing education, is committed to the education of an exemplary nursing workforce that values and incorporates the richness of difference and inclusion to advance the health of the nation and the global community. With its population of over 320 million people, the United States of America […]See more -
01-01-2016
Interventions that facilitate adherence to Pap smear exam: integrative review
Revista Brasileira de Enfermagem. 2016;69(2):404-414
Abstract
Interventions that facilitate adherence to Pap smear exam: integrative review
Revista Brasileira de Enfermagem. 2016;69(2):404-414
DOI 10.1590/0034-7167.2016690226i
Views0See moreABSTRACT
Objective:
to identify scientific productions showing relevant interventions to implement the Cervical Uterine Cancer Prevention Program increasing adherence to exams.
Method:
integrative literature review through an online search in the following databases: LILACS, SciELO, and PubMed® comprising articles published from 2009 to 2014.
Results:
thirty-eight articles made up the study’s final sample. Results showed the following interventions: use of case manager; telephone call; invitation letter; educational activities; media outreach work; community health agents; partnerships; population database screening; and multiple interventions.
Conclusion:
studies are mainly focused on women from developing countries and interventions are efficacious to increase women’s knowledge about and adherence to prevention of cervical uterine cancer.
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01-01-2016
Anxiety in the preoperative period of heart surgery
Revista Brasileira de Enfermagem. 2016;69(2):397-403
Abstract
Anxiety in the preoperative period of heart surgery
Revista Brasileira de Enfermagem. 2016;69(2):397-403
DOI 10.1590/0034-7167.2016690225i
Views0See moreABSTRACT
Objective:
to characterize the patients’ anxiety in the preoperative period of heart surgery.
Method:
We conducted a cross-sectional study in which 106 patients, between one and five days from the date of surgery, were interviewed using a socio-demographic questionnaire and the Beck Anxiety Inventory.
Results:
The evaluated patients accounted for 59.4% (63) in minimal anxiety and 19.8% (21) in the range considered severe, and the sample had a mean in the mild anxiety level (15.8±19.79). The women had scores (22.13±23.41) significantly (p=0.003) higher than men (10.76±14.71); as well as patients who had undergone previous heart surgery (24.4±28.05 X 13.14±15.74). There was no significant difference between older adults and younger patients, nor in terms of weight variations, presence of diabetes, or alcoholism.
Conclusion:
We reinforces the importance of nurses in recognizing the preoperative anxiety and intervene through strategies of health education and nursing visits.
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01-01-2016
Suicidal behavior among drug addicts
Revista Brasileira de Enfermagem. 2016;69(2):389-396
Abstract
Suicidal behavior among drug addicts
Revista Brasileira de Enfermagem. 2016;69(2):389-396
DOI 10.1590/0034-7167.2016690224i
Views0See moreABSTRACT
Objective:
to describe the profile of drug addicts attended in a mental health service, the frequency of suicidal behavior among the participants and the associations between these two problems.
Method:
an exploratory, retrospective and descriptive study based on a quantitative approach, and data collected from medical records of patients with F10-F19 diagnoses according to the ICD-10 treated in this service in 2013. We expected to identify a possible association between independent variables (family, psychiatric and personal history) and the dependent variable (suicidal behavior).
Results:
Most of the individuals were men, single, with a low educational attainment, unemployed and aged between 15 and 45 years; 43.90% had a record of suicidal behavior.
Conclusion:
drug addicts with suicidal behavior are young people under the age of 30 presenting psychiatric comorbidity, mood disorders and/or depression, presence of family conflict, important dates coinciding with the suicidal behavior and mothers with psychiatric history.
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ORIGINAL ARTICLE12-04-2023
Burnout, ethical climate and work organization in covid-19 intensive care units: mixed method study
Revista Brasileira de Enfermagem. 2023;76:e20220684
Abstract
ORIGINAL ARTICLEBurnout, ethical climate and work organization in covid-19 intensive care units: mixed method study
Revista Brasileira de Enfermagem. 2023;76:e20220684
DOI 10.1590/0034-7167-2022-0684
Views0See moreABSTRACT
Objectives:
to analyze the association between burnout and the perception of the ethical climate in nursing professionals in the covid-19 Intensive Care Unit and the relationship with the organization of work from the perspective of managers of these units.
Methods:
mixed method study conducted in three university hospitals in southern Brazil from December 2021 to March 2022. A cross-sectional study was developed with 110 nursing professionals, followed by an exploratory-descriptive study through semi-structured interviews with six managers. Descriptive and analytical statistics and discursive textual analysis were used.
Results:
the prevalence of burnout was 10% and the perception of negative ethical climate was 24.5%. The association between burnout and ethical climate revealed overload and fatigue during working hours, related to tension, fear, and stress that emerged from the consequences of the organization and relations of work in the covid-19 Intensive Care Unit.
Conclusions:
there was an association between burnout and ethical climate and elements of the work organization.
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ERRATUM02-26-2024
ERRATUM
Revista Brasileira de Enfermagem. 2024;77(1):e20160061
Abstract
ERRATUMERRATUM
Revista Brasileira de Enfermagem. 2024;77(1):e20160061
DOI 10.1590/0034-7167.20247701e03
Views2In the article “Nurses in the labor market: professional insertion, competencies and skills”, with DOI number: , published in Revista Brasileira de Enfermagem, 2017;70(6):1220-6, on page 1225:Include before REFERENCES:[…]See more -
ERRATUM06-14-2024
ERRATUM
Revista Brasileira de Enfermagem. 2024;77(2):e2024n2e06
Abstract
ERRATUMERRATUM
Revista Brasileira de Enfermagem. 2024;77(2):e2024n2e06
DOI 10.1590/0034-7167.20247702e06
Views2In the article “Is there scientific relevance to the plot of films and documentaries about eating disorders?”, with DOI number: , published in Revista Brasileira de Enfermagem, 2024;77(1):e20220547, page 7:Where it read:[…]See more -
ORIGINAL ARTICLE07-29-2024
Educational technology for multidisciplinary training for managing waiting lists for elective patients
Revista Brasileira de Enfermagem. 2024;77(3):e20230299
Abstract
ORIGINAL ARTICLEEducational technology for multidisciplinary training for managing waiting lists for elective patients
Revista Brasileira de Enfermagem. 2024;77(3):e20230299
DOI 10.1590/0034-7167-2023-0299
Views1See moreABSTRACT
Objectives:
to construct and assess an educational technology for managing patient waiting lists for multidisciplinary training.
Methods:
study supported by Instructional Design – ADDIE model, whose stages of construction of educational technology were developed in the form of a multi-professional training course. Its respective content assessment was carried out by a committee of experts from 2021 to 2022. The analysis occurred based on the proportion of content adequacy with 95% Confidence Interval.
Results:
seventeen products were created as educational technology learning objects: five storyboards; four videos; three comic books; two pedagogical action plans; a mind map; and a YouTube® playlist. Nine experts assessed content adequacy, which reached 0.89.
Conclusions:
this educational technology contributes to the performance of professionals who manage waiting lists by reducing inequalities, alleviating differences, in addition to promoting equity in care and good health for patients in the Brazilian Health System.
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REVIEW11-22-2024
Spirituality and religiosity in children, adolescents and their families in a vulnerable context: a scoping review
Revista Brasileira de Enfermagem. 2024;77(5):e20230425
Abstract
REVIEWSpirituality and religiosity in children, adolescents and their families in a vulnerable context: a scoping review
Revista Brasileira de Enfermagem. 2024;77(5):e20230425
DOI 10.1590/0034-7167-2023-0425
Views1See moreABSTRACT
Objective:
to map evidence in the literature on the spirituality and religiosity of children, adolescents and their families in social vulnerability.
Methods:
this is a scoping review based on the JBI methodology, with the search without delimiting the time period, in English, Portuguese and Spanish, in the Virtual Health Library, PubMed, Embase, Cochrane Library, Scopus and Web of Science databases.
Results:
twenty-two studies were identified. The most studied population were adolescents, followed by children and their families. Regarding the setting, the context of vulnerability related to the low socioeconomic level experienced by these populations was highlighted. Furthermore, spirituality and religiosity were considered important for coping, social support, purpose and strength.
Conclusion:
there is an influence of spirituality and religiosity in the lives of children, adolescents and families, being a protective factor and a source of comfort, playing essential tools for living in context.
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ORIGINAL ARTICLE12-13-2024
Stress in nursing workers caring for people with COVID-19
Revista Brasileira de Enfermagem. 2024;77(5):e20230542
Abstract
ORIGINAL ARTICLEStress in nursing workers caring for people with COVID-19
Revista Brasileira de Enfermagem. 2024;77(5):e20230542
DOI 10.1590/0034-7167-2023-0542
Views1See moreABSTRACT
Objectives:
to analyze stress from the perspective of nursing workers caring for people with COVID-19 in a public hospital in the Recôncavo region of Bahia.
Methods:
this is an exploratory qualitative study, conducted through semi-structured interviews. The data were analyzed using word clouds, similarity trees, and content analysis.
Results:
nursing workers were exposed to stress while attending to patients with COVID-19. The reported stressors in the workplace included: work overload, lack of planning, speed in performing tasks, fatigue, lack of participation in decision-making, lack of support from management, technological changes, excessive responsibility without preparation, interpersonal conflicts, and professional undervaluation.
Conclusions:
exposure to these stressors leads to emotional exhaustion and demotivation, which were intensified during the COVID-19 pandemic.
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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
Views2See 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 ARTICLE01-10-2024
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
Views1See 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 ARTICLE05-09-2022
The meaning of patient safety for nursing students
Revista Brasileira de Enfermagem. 2022;75(5):e20210567
Abstract
ORIGINAL ARTICLEThe meaning of patient safety for nursing students
Revista Brasileira de Enfermagem. 2022;75(5):e20210567
DOI 10.1590/0034-7167-2021-0567
Views0See moreABSTRACT
Objective:
To understand the meanings attributed to patient safety by nursing students.
Methods:
Descriptive study of qualitative approach, based on the theoretical-methodological proposal of Symbolic Interactionism, conducted with 12 students completing the nursing course of a public higher education institution in a city in the state of Amazonas. The data were collected through a semi-structured interview. For interpretation of the results, it was used thematic analysis.
Results:
The meanings attributed by the students to patient safety are: the reduction of harm, the guarantee of the integrity of the patient, family members, and health professionals, the promotion of health through the knowledge acquired in the academy, the attitude of the professional and the practice. Final considerations: The meanings originated are in line with the literature produced; however, the students have knowledge gaps that enable patient safety development in their academic training and as nurses.
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ORIGINAL ARTICLE12-13-2019
Applying best practices to pregnant women in the obstetric center
Revista Brasileira de Enfermagem. 2019;72:191-196
Abstract
ORIGINAL ARTICLEApplying best practices to pregnant women in the obstetric center
Revista Brasileira de Enfermagem. 2019;72:191-196
DOI 10.1590/0034-7167-2018-0422
Views0See moreABSTRACT
Objective:
To identify the meaning attributed by nursing technicians to good care practices based on scientific evidence used with the pregnant women during the dilation stage of labor.
Method:
A qualitative study, based on Grounded Theory principles. Twelve interviews with nursing technicians attending labor in the obstetric center of two public hospitals, in Florianópolis/SC, were performed, from August of 2016 to March of 2017. Data were analyzed using open, axial coding.
Results:
The implementation of good practices, for nursing technicians, means adequately performing their activities, providing humanized care to the pregnant woman, respecting her autonomy, promoting pain relief, and a peaceful labor.
Final Considerations:
An adequate number of technicians must be determined to maintain quality of care, and to complete nursing records in a more detailed and systematized manner.
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ORIGINAL ARTICLE12-13-2019
Musical educational technology for lactation physiology learning: knowledge translation
Revista Brasileira de Enfermagem. 2019;72:220-226
Abstract
ORIGINAL ARTICLEMusical educational technology for lactation physiology learning: knowledge translation
Revista Brasileira de Enfermagem. 2019;72:220-226
DOI 10.1590/0034-7167-2018-0528
Views1See moreABSTRACT
Objective:
create and validate a musical educational technology for lactation physiology learning for professional training in health.
Method:
methodological study with application of a conceptual framework of Knowledge Translation. In the creation cycle, the knowledge of the physiology of lactation was synthetized in key points to create the lyrics and the melody. In the action cycle, the content of the musical educational technology was validated by judges experts in breast feeding, in the period from September to December 2017.
Results:
18 judges from all Brazilian regions participated in the validation. The content of the technology obtained a global Content Validity Index of 0.94 with one round of validation.
Conclusion:
the musical educational technology is validated to introduce the content of the physiology of lactation in the learning process of students, mediated by the teacher.
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ORIGINAL ARTICLE10-18-2022
Health education for hospitalized patient in nursing care: a conceptual analysis
Revista Brasileira de Enfermagem. 2022;75(2):e20200459
Abstract
ORIGINAL ARTICLEHealth education for hospitalized patient in nursing care: a conceptual analysis
Revista Brasileira de Enfermagem. 2022;75(2):e20200459
DOI 10.1590/0034-7167-2020-0459
Views0INTRODUCTIONOver the years, the development of health education practices is related to the historical moment of society(). The nineteenth and twentieth centuries presented decisive situations in the evolution process that we know today as health education. Nursing began to consider health educational practices after Florence Nightingale initially focused on professional training. Florence contributed to the […]See more -
ORIGINAL ARTICLE04-09-2020
Nursing work and competence in hemotherapy services: an ergological approach
Revista Brasileira de Enfermagem. 2020;73(3):e20180775
Abstract
ORIGINAL ARTICLENursing work and competence in hemotherapy services: an ergological approach
Revista Brasileira de Enfermagem. 2020;73(3):e20180775
DOI 10.1590/0034-7167-2018-0775
Views0See moreABSTRACT
Objetives:
to analyze the ingredients of the competence that the nurses use in the performance of their work in hemotherapy.
Methods:
qualitative study with 22 nurses, accomplished through documentary study, observation and semi-structured interview, with resources of Atlas.ti software based on the foundations of Historical Materialism Dialectic and Ergology. Performed Content Analysis.
Results:
the domain of specific knowledge of hemotherapy and the time of experience in the area, allied to the motivation of the worker and the ability to work in a team favor the competent action in the work activities. On the other hand, the lack of adequate work conditions, especially in relation to adequate materials, equipment and structure, impairs the work of the nurse in hemotherapy.
Final Considerations:
experience gained is critical to successful decision making. In addition, adequate working conditions, updating of knowledge and ability in teamwork favor a scenario of safe practices.
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EXPERIENCE REPORT02-10-2020
Overcoming the challenges to offer quality training in psychiatric nursing
Revista Brasileira de Enfermagem. 2020;73(1):e20180208
Abstract
EXPERIENCE REPORTOvercoming the challenges to offer quality training in psychiatric nursing
Revista Brasileira de Enfermagem. 2020;73(1):e20180208
DOI 10.1590/0034-7167-2018-0208
Views0See moreABSTRACT
Objective:
to report the experience of the Psychiatric Nursing professors of the Nursing Undergraduate Course of the Nursing School, Universidade Federal de Minas Gerais (UFMG) and the challenges faced to offer quality training.
Method:
This is an experience report about the experience of Psychiatric Nursing professors of the Nursing Undergraduate Course of the Nursing School, UFMG.
Results:
After losing the workload of 120 hours in the Psychiatric Nursing Undergraduate Course, the area developed elective disciplines with a total of 330-hour load, in addition to extension and research projects.
Final considerations:
the precariousness of the area of Nursing training after curricular restructuring in a higher education institution, whether in relation to hour load or in the allocation of teaching vacancies, is in line with advances of the Brazilian Psychiatric Reform and epidemiological data of psychic illness and drug use.
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ORIGINAL ARTICLE10-25-2022
Clinical characterization, disability, and mortality in people with strokes during 90 days
Revista Brasileira de Enfermagem. 2022;75(2):e20201383
Abstract
ORIGINAL ARTICLEClinical characterization, disability, and mortality in people with strokes during 90 days
Revista Brasileira de Enfermagem. 2022;75(2):e20201383
DOI 10.1590/0034-7167-2020-1383
Views0See moreABSTRACT
Objectives:
to describe clinical characteristics and mortality of people with ischemic cerebrovascular accidents (strokes); to compare disability before the event and 90 days after.
Methods:
longitudinal study with 308 people hospitalized in Salvador-BA. Data collection took place from 03/2019 to 01/2020. Descriptive and inferential statistics were used.
Results:
mean age was 64.8 years, and National Institute of Health Stroke Scale score was 10.7. The median length of stay in the hospital was 11 days. Afro-descendants predominated (84%), elementary educational level (68.4%), income up to three minimum wages (89.1%), arrival within 4.5 hours of symptoms (57.9%) and admission to a specialized unit (71.8%). Prevalence of thrombolysis: 26%. The asymptomatic before the event category predominated (85.3%) as did the moderate/severe disability (41.5%) after 90 days. 19.7% of the sample evolved to death. Conclusions: the high mortality and disability generated by the event have implications for health management and care.
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ORIGINAL ARTICLE03-30-2020
Kangaroo-mother care method: a documentary study of theses and dissertations of the brazilian nurse (2000-2017)
Revista Brasileira de Enfermagem. 2020;73(2):e20180598
Abstract
ORIGINAL ARTICLEKangaroo-mother care method: a documentary study of theses and dissertations of the brazilian nurse (2000-2017)
Revista Brasileira de Enfermagem. 2020;73(2):e20180598
DOI 10.1590/0034-7167-2018-0598
Views0See moreABSTRACT
Objectives:
to characterize theses and dissertations that address Kangaroo-Mother Care Method produced in Brazilian Graduate Nursing Programs from 2000 to 2017.
Methods:
a documentary study of qualitative approach. From a total of 207 papers, 185 were excluded and 22 were selected.
Results:
in 2006 and 2014 there was a higher number of master’s dissertations. In 2001, 2013 and 2017, there were three productions of doctoral theses. Universidade Federal de Santa Catarina (Federal University of Santa Catarina) presented the largest number of publications, with five studies, followed by Universidade Federal da Bahia (Federal University of Bahia), with four.
Final considerations:
Kangaroo-Mother Care Method has been researched in Brazilian Graduate Nursing Programs, mainly from the qualitative approach, highlighting the importance, contributions and difficulties of its application as a public policy.
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