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ORIGINAL ARTICLE
Construction and validation of an educational booklet for patients in the postoperative period of cardiac surgery: a methodological study
- Sônia Regina Barcellos
, - Alexandre do Rosário Joras ,
- Angelita Paganin Constanzi ,
- Emiliane Nogueira de Souza
12-04-2023
Abstract
ORIGINAL ARTICLEConstruction and validation of an educational booklet for patients in the postoperative period of cardiac surgery: a methodological study
Revista Brasileira de Enfermagem. 2023;76(6):e20220621
12-04-2023DOI 10.1590/0034-7167-2022-0621
- Sônia Regina Barcellos ,
- Alexandre do Rosário Joras ,
- Angelita Paganin Constanzi ,
- Emiliane Nogueira de Souza
Views0See moreABSTRACT
Objective:
to construct and validate an educational booklet for self-care of patients in the postoperative period of cardiac surgery
Methods:
methodological study, including bibliographic survey, construction of the booklet and validation with judges and the target audience. For validation with judges, the Health Educational Content Validation Instrument was used, and with the target audience, an instrument was used with questions related to organization, writing style, appearance and motivation. To analyze the judges’ answers, the content validation index was used
Results:
the booklet was prepared with 14 topics. The content validation index among the eight judges was 1 and the concordance index among the ten patients was above 80%. The final version of the material was made available in printed format
Conclusion:
the educational booklet was developed and validated by judges and the target audience, serving as an educational support tool for self-care of patients in the postoperative period of cardiac surgery.
- Sônia Regina Barcellos
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ORIGINAL ARTICLE
Assessment of the components of sarcopenia and quality of life perceived of individuals on hemodialysis
Revista Brasileira de Enfermagem. 2023;76(6):e20220677
12-04-2023
Abstract
ORIGINAL ARTICLEAssessment of the components of sarcopenia and quality of life perceived of individuals on hemodialysis
Revista Brasileira de Enfermagem. 2023;76(6):e20220677
12-04-2023DOI 10.1590/0034-7167-2022-0677
Views0See moreABSTRACT
Objectives:
to evaluate the prevalence of sarcopenia in individuals aged 50 years or older on hemodialysis; to verify the association between sarcopenia and sociodemographic, clinical, anthropometric factors, components of sarcopenia and quality of life (QoL); and to correlate the components of sarcopenia with QoL.
Methods:
Participated 83 individuals on hemodialysis. Sarcopenia was established according to the current European consensus. Dynamometry to determine strength, calf circumference (CC) and appendicular skeletal muscle mass index (ASMMI) to obtain muscle mass and gait speed (GS) for physical performance. For QoL used the WHOQOL-bref.
Results:
the prevalence of sarcopenia was 32.6% (CC) and 18.1% (ASMMI). There was no association between sarcopenia and QoL. Both handgrip strength (r=0.25) and GS (r=0.36) showed a correlation with physical domain.
Conclusions:
sarcopenia was expressive, and the aspects of functionality determine the physical impairment in this population.
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ORIGINAL ARTICLE
Leadership Competencies of the Medical-Surgical Nursing Specialist Nurse
- Marina Filipa Silveira Pires ,
- Romana Silva Lopes ,
- Cláudia Sofia Fernandes Caetano ,
- Liliana Andreia Neves da Mota ,
- Fernanda Maria Príncipe Bastos Ferreira
12-04-2023
Abstract
ORIGINAL ARTICLELeadership Competencies of the Medical-Surgical Nursing Specialist Nurse
Revista Brasileira de Enfermagem. 2023;76(6):e20220721
12-04-2023DOI 10.1590/0034-7167-2022-0721
- Marina Filipa Silveira Pires ,
- Romana Silva Lopes ,
- Cláudia Sofia Fernandes Caetano ,
- Liliana Andreia Neves da Mota ,
- Fernanda Maria Príncipe Bastos Ferreira
Views0See moreABSTRACT
Objective:
To identify the leadership competencies of Medical-Surgical Nursing Specialist Nurses.
Methods:
A quantitative, descriptive study using the Leadership Competencies Questionnaire. 311 Portuguese Medical-Surgical Nursing Specialist Nurses participated. Data analysis involved descriptive and inferential statistical analysis using the Statistical Package for Social Sciences (SPSS), version 22.0.
Results:
Study participants had an above-average self-perception on the scale (mean = 3.5) in all leadership roles, recognizing their leadership competencies. The leadership competencies of Medical-Surgical Nursing Specialist Nurses are balanced across all roles: Mentor (5.80 ± 1.02); Coordinator (5.53 ± 0.86); Facilitator (5.38 ± 1.04); Innovator (5.34 ± 0.88); Director (5.31 ± 1.10); Producer (5.30 ± 0.98); Monitor (5.15 ± 1.00); Corrector (4.79 ± 1.29)
Conclusions:
Specialized nursing practice enhances nurses’ self-perceived leadership competencies. Nurses see themselves as leaders focused on internal support and facilitation of collective effort and opportunities for skill development.
- Marina Filipa Silveira Pires
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Maternal Concerns in Home Care for the Premature Newborn: An Integrative Review
- Thaís Emanuele da Conceição ,
- Maria Helena do Nascimento Souza ,
- Rafael Braga Esteves ,
- Patrícia Lima Pereira Peres ,
- Donatella Valente , [ … ],
- Antonella Nespoli
12-04-2023
Abstract
Maternal Concerns in Home Care for the Premature Newborn: An Integrative Review
Revista Brasileira de Enfermagem. 2023;76(6):e20220769
12-04-2023DOI 10.1590/0034-7167-2022-0769
- Thaís Emanuele da Conceição ,
- Maria Helena do Nascimento Souza ,
- Rafael Braga Esteves ,
- Patrícia Lima Pereira Peres ,
- Donatella Valente ,
- Antonella Nespoli
Views0See moreABSTRACT
Objective:
To identify and analyze the scientific literature, both national and international, concerning the primary maternal concerns about caring for premature newborns at home.
Methods:
This integrative review is based on the guiding question: “What scientific publications from 2012 to 2021 address maternal concerns about the care of premature newborns at home?”. Searches were conducted in the electronic databases: Embase, Medline, Web of Science, Lilacs, Scielo, and Cochrane Library.
Results:
A total of 21 articles were identified. The qualitative analysis showed that maternal concerns pertained to breastfeeding, hygiene, sunbathing practices, managing infant colic, identifying signs, symptoms, and clinical changes, temperature control, and the third phase of the kangaroo method.
Conclusions:
Maternal uncertainties underscore the importance of enhancing strategies focused on supporting families and ensuring continued care for neonates at home.
- Thaís Emanuele da Conceição
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ORIGINAL ARTICLE
A longitudinal study of burden among spouse and non-spouse caregivers of older adults with stroke-induced-dependency
- Carolina Baltar Day ,
- Carla Cristiane Becker Kottwitz Bierhals ,
- Fernanda Laís Fengler Dal Pizzol ,
- Gail Low ,
- Naiana Oliveira dos Santos , [ … ],
- Lisiane Manganelli Girardi Paskulin
12-04-2023
Abstract
ORIGINAL ARTICLEA longitudinal study of burden among spouse and non-spouse caregivers of older adults with stroke-induced-dependency
Revista Brasileira de Enfermagem. 2023;76(6):e20230052
12-04-2023DOI 10.1590/0034-7167-2023-0052
- Carolina Baltar Day ,
- Carla Cristiane Becker Kottwitz Bierhals ,
- Fernanda Laís Fengler Dal Pizzol ,
- Gail Low ,
- Naiana Oliveira dos Santos ,
- Lisiane Manganelli Girardi Paskulin
Views0See moreABSTRACT
Objective:
to assess the burden of spouse and non-spouse caregivers of older adults with stroke-induced-dependency after discharge from a university hospital’s Specialized Care Stroke Unit in southern Brazil.
Methods:
a longitudinal survey. The sample consisted of 48 consenting caregivers, among which 20 were spouse caregivers. Data were collected between May 2016 and July 2018. One week after discharge, caregivers completed a sociodemographic profile, the Functional Independence Measure, and the Caregiver Burden Scale. Burden was also measured two months after discharge. Data were analyzed using Multivariate Analyses of Variance.
Results:
regarding time 1, non-spouse caregivers experienced greater burden with respect to social isolation (p = .01). Along with a persistently greater sense of isolation (p=.04), non-spouse caregivers felt far greater general strain (p =.01).
Conclusion:
statistically significant differences in burden over time highlight the importance of assessing caregiver burden after discharge and the need for a formal support program.
- Carolina Baltar Day
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ORIGINAL ARTICLE
Psychometric Properties of an Instrument for Assessing University Administrators’ Knowledge on Gender-Based Violence
Revista Brasileira de Enfermagem. 2023;76(6):e20220770
12-04-2023
Abstract
ORIGINAL ARTICLEPsychometric Properties of an Instrument for Assessing University Administrators’ Knowledge on Gender-Based Violence
Revista Brasileira de Enfermagem. 2023;76(6):e20220770
12-04-2023DOI 10.1590/0034-7167-2022-0770
Views0ABSTRACT
Objective:
To evaluate the factorial structure of the instrument measuring university administrators’ knowledge of gender-based violence.
Methods:
This cross-sectional methodological study was conducted from August to November 2020 with 101 university administrators. Data on demographic and functional characteristics were collected, and the “QUEST VBG UNIV” instrument was applied. Descriptive analysis was performed, the structure of the questionnaire was assessed using exploratory factor analysis (EFA), and the stability of the factors was verified through ORION and FDI tests.
Results:
Of the original 38 items across the 4 sections of the questionnaire, 19 were retained within 2 factors, with appropriate factor loadings. Factor 1 had an explained variance of 15.69%, and Factor 2 had an explained variance of 9.10%. The reliability was deemed satisfactory (ORION > 0.900, FDI > 0.900).
Conclusions:
The questionnaire presented a valid and reliable factorial structure for measuring knowledge about gender-based violence, thereby representing a suitable option for situational assessments in universities.
Keywords:Factor AnalysisGender-Based ViolencePsychometricsStatisticalValidation StudyWorkplace violenceSee more
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ORIGINAL ARTICLE
Effects of auriculotherapy on anxiety and biomarkers in Primary Health Care: a clinical trial
- Carina da Silva ,
- Letícia Siqueira ,
- Lívia Crespo Drago ,
- Elisa Mitkus Flores Lins ,
- Daniel Fernandes Martins , [ … ],
- Franciane Bobinski
12-04-2023
Abstract
ORIGINAL ARTICLEEffects of auriculotherapy on anxiety and biomarkers in Primary Health Care: a clinical trial
Revista Brasileira de Enfermagem. 2023;76(6):e20220728
12-04-2023DOI 10.1590/0034-7167-2022-0728pt
- Carina da Silva ,
- Letícia Siqueira ,
- Lívia Crespo Drago ,
- Elisa Mitkus Flores Lins ,
- Daniel Fernandes Martins ,
- Franciane Bobinski
Views0See moreABSTRACT
Objective:
to assess the effects of auriculotherapy on anxiety and brain-derived neurotrophic factor (BDNF), neuron-specific enolase (NSE) and S100 calcium-binding protein B (S100B) serum levels in adults assisted in Primary Health Care.
Methods:
a pre-experimental pilot clinical trial. Information was obtained from 19 patients using the State-Trait Anxiety Inventory (STAI) and analysis of BDNF, NSE and S100B serum levels.
Results:
the pre-intervention anxiety score in the IDATE-Trait was 52.11±6.691 (CV 12.84%) and the assessment after auriculotherapy was significantly lower (43.72±8.141; CV 18.62%; P=0.0007). S100B levels were significantly reduced after auriculotherapy (from 64.03±72.18 to 54.03±68.53 pg/mL; CV 126.8%; P=0.0023).
Conclusion:
auriculotherapy effectively reduced anxiety levels. It proved to be safe and easy to apply, allowing nurses to perform this technique autonomously. A reduction of S100B was also evidenced, demonstrating possible prevention of neuronal damage.
- Carina da Silva
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TECHNOLOGICAL INNOVATION
Web App for prediction of hospitalisation in Intensive Care Unit by covid-19
Revista Brasileira de Enfermagem. 2023;76(6):e20220740
12-04-2023
Abstract
TECHNOLOGICAL INNOVATIONWeb App for prediction of hospitalisation in Intensive Care Unit by covid-19
Revista Brasileira de Enfermagem. 2023;76(6):e20220740
12-04-2023DOI 10.1590/0034-7167-2022-0740
Views0See moreABSTRACT
Objective:
To develop a Web App from a predictive model to estimate the risk of Intensive Care Unit (ICU) admission for patients with covid-19.
Methods:
An applied technological production research was carried out with the development of Streamlit using Python, considering the decision tree model that presented the best performance (AUC 0.668).
Results:
Based on the variables associated with Precision Nursing, Streamlit stratifies patients admitted to clinical units who are most likely to be admitted to the Intensive Care Unit, serving as a decision-making support tool for healthcare professionals.
Final considerations:
The performance of the model may have been influenced by the start of vaccination during the data collection period, however, the Web App via Streamlit proved to be a feasible tool for presenting research results, due to the ease of understanding by nurses and its potential for supporting clinical decision-making.
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ORIGINAL ARTICLE
Mental health of nursing in coping with COVID-19 at a regional university hospital
- Eduardo Bassani Dal’Bosco ,
- Lara Simone Messias Floriano ,
- Suellen Vienscoski Skupien ,
- Guilherme Arcaro ,
- Alessandra Rodrigues Martins , [ … ],
- Aline Cristina Correa Anselmo
07-13-2020
Abstract
ORIGINAL ARTICLEMental health of nursing in coping with COVID-19 at a regional university hospital
Revista Brasileira de Enfermagem. 2020;73:e20200434
07-13-2020DOI 10.1590/0034-7167-2020-0434
- Eduardo Bassani Dal’Bosco ,
- Lara Simone Messias Floriano ,
- Suellen Vienscoski Skupien ,
- Guilherme Arcaro ,
- Alessandra Rodrigues Martins ,
- Aline Cristina Correa Anselmo
Views0See moreABSTRACT
Objective:
to identify prevalence and factors associated with anxiety and depression in nursing professionals who work to cope with COVID-19 at a university hospital.
Methods:
a cross-sectional observational study using a sociodemographic questionnaire and Hospital Anxiety and Depression Scale, with 88 nursing professionals. Data were analyzed using absolute and relative frequency and Statistical Package for the Social Sciences.
Results:
there was prevalence of anxiety (48.9%) and depression (25%). The majority of the sample consisted of women over 40 years old, married or in a common-law marriage, white, with higher education or graduate degree, with an income above 3,000.00 reais, public servants, working 40 hours a week and working in the hospital from 1 to 5 years.
Conclusion:
we must consider the impact on mental health nursing caused by COVID-19 and intervene with coping strategies to minimize the suffering of professionals.
- Eduardo Bassani Dal’Bosco
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REFLECTION
Thematic content analysis using ATLAS.ti software: Potentialities for researchs in health
Revista Brasileira de Enfermagem. 2020;73(3):e20190250
04-22-2020
Abstract
REFLECTIONThematic content analysis using ATLAS.ti software: Potentialities for researchs in health
Revista Brasileira de Enfermagem. 2020;73(3):e20190250
04-22-2020DOI 10.1590/0034-7167-2019-0250
Views0See moreABSTRACT
Objective:
to describe the most important tools of ATLAS.ti Software and to associate them with the procedures of Thematic Content Analysis.
Method:
It is a theoretical reflection of the Content Analysis phases of Laurence Bardin, associating them with software tools Atlas.ti and showing its usefulness for data analysis in qualitative research.
Results:
historical contextualization and the available resources of Atlas.ti software with presentation of health research involving the phases of thematic content analysis.
Final considerations:
The Atlas.ti software assists in the accomplishment of the thematic content analysis being this promising association in health research.
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REFLECTION
Nursing education: challenges and perspectives in times of the COVID-19 pandemic
- Ana Luisa Brandão de Carvalho Lira ,
- Edlamar Kátia Adamy ,
- Elizabeth Teixeira ,
- Francisca Valda da Silva
10-26-2020
Abstract
REFLECTIONNursing education: challenges and perspectives in times of the COVID-19 pandemic
Revista Brasileira de Enfermagem. 2020;73:e20200683
10-26-2020DOI 10.1590/0034-7167-2020-0683
- Ana Luisa Brandão de Carvalho Lira ,
- Edlamar Kátia Adamy ,
- Elizabeth Teixeira ,
- Francisca Valda da Silva
Views0See moreABSTRACT
Objective:
To discuss the challenges and perspectives of nursing education in times of the COVID-19 pandemic.
Methods:
Reflection study, with theoretical approach based on national and international publications, allied to the experience of researchers in the area of nursing education.
Results:
Four sections are identified: Nursing education: current affairs and perspectives; Education and technologies in time of pandemic: acceleration, alteration and paralysis; Difference between emergency, intentional and remote teaching; the return to the “new normality”: new structuring axes and legal norms.
Final considerations:
The conclusion is that longstanding challenges have emerged with the pandemic, and the processes of acceleration, change and paralysis have marked education in these times. Moreover, epidemiological, technological and psychological aspects should be more valued in the return to activities.
- Ana Luisa Brandão de Carvalho Lira
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ORIGINAL ARTICLE
Social determinants of health and COVID-19 infection in Brazil: an analysis of the pandemic
- Alexandre Medeiros de Figueiredo ,
- Daniela Cristina Moreira Marculino de Figueiredo ,
- Luciano Bezerra Gomes ,
- Adriano Massuda ,
- Eugenia Gil-García , [ … ],
- Antonio Daponte
11-13-2020
Abstract
ORIGINAL ARTICLESocial determinants of health and COVID-19 infection in Brazil: an analysis of the pandemic
Revista Brasileira de Enfermagem. 2020;73:e20200673
11-13-2020DOI 10.1590/0034-7167-2020-0673
- Alexandre Medeiros de Figueiredo ,
- Daniela Cristina Moreira Marculino de Figueiredo ,
- Luciano Bezerra Gomes ,
- Adriano Massuda ,
- Eugenia Gil-García ,
- Rodrigo Pinheiro de Toledo Vianna ,
- Antonio Daponte
Views0See moreABSTRACT
Objective:
To analyze the influence of socioeconomic, demographic, epidemiological factors, and the health system structure in the evolution of the COVID-19 pandemic in Brazil.
Methods:
Ecological study with variables extracted from databases, having the incidence and mortality by COVID-19 until August 23, 2020, in Brazilian states, as response variables. The magnitude of the associations was estimated using Spearman’s correlation coefficient and multiple regression analysis.
Results:
In the Brazilian states, 59.8% of variation in the incidence of COVID-19 was justified by income inequality, significant home densification, and higher mortality. In the case of mortality, those same variables explained 57.9% of the country’s variations in federal units.
Conclusion:
Our results indicate that socioeconomic factors influenced the evolution and impact of COVID-19 in Brazil. Thus, we suggest comprehensive actions to ensure economic conditions and strengthening of health networks for populations with socioeconomic vulnerability.
- Alexandre Medeiros de Figueiredo
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ORIGINAL ARTICLE
Validation of a booklet on self-care with the diabetic foot
- Yara Lanne Santiago Galdino ,
- Thereza Maria Magalhães Moreira ,
- Antonio Dean Barbosa Marques ,
- Francisca Alexandra Araújo da Silva
06-27-2019
Abstract
ORIGINAL ARTICLEValidation of a booklet on self-care with the diabetic foot
Revista Brasileira de Enfermagem. 2019;72(3):780-787
06-27-2019DOI 10.1590/0034-7167-2017-0900
- Yara Lanne Santiago Galdino ,
- Thereza Maria Magalhães Moreira ,
- Antonio Dean Barbosa Marques ,
- Francisca Alexandra Araújo da Silva
Views0ABSTRACT
Objective:
to describe the validation of the booklet on self-care with the feet of people with diabetes.
Method:
methodological study, focusing on the validation of a printed booklet. The content and appearance of the booklet was validated by 23 judges divided into three groups: 11 content and appearance, seven technicians and five of the area of design and marketing. The appearance was validated by 30 people with type 2 Diabetes Mellitus.
Results:
the judges in the nursing area allowed the validation of material with a Content Validity Index (CVI) of 0.99, judges in the area of design and marketing with Suitability Assessment of Materials (SAM) of 99.2% and the target audience with concordance index of 99.4%.
Conclusion:
the educational booklet proved to be valid and reliable educational material to be used in order to promote compliance with self-care with the feet of people with Diabetes Mellitus.
Keywords:Diabetes Mellitus Type 2Diabetic FootEducational TechnologyTeaching MaterialsValidation StudiesSee more
- Yara Lanne Santiago Galdino
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ORIGINAL ARTICLE
Braden Scale in pressure ulcer risk assessment
Revista Brasileira de Enfermagem. 2020;73(6):e20190413
08-10-2020
Abstract
ORIGINAL ARTICLEBraden Scale in pressure ulcer risk assessment
Revista Brasileira de Enfermagem. 2020;73(6):e20190413
08-10-2020DOI 10.1590/0034-7167-2019-0413
Views0See moreABSTRACT
Objective:
To analyze the applicability of the Braden Scale to individuals admitted to an Intensive Care Unit (ICU) with the nursing diagnosis Impaired Physical Mobility, in its prediction potential to develop pressure ulcer (PU).
Methods:
A cross-sectional, quantitative study that evaluated all patients hospitalized in an ICU between November 2016 and February 2017, with the Braden Scale.
Results:
The prevalence of PU was 35.8% (24/67), in male individuals 58.3% (14/24), diagnosed with ischemic CVA 51.9% (12/27), and with hemorrhagic CVA 7.4% (2/27). Among patients classified at severe risk of developing pressure ulcer, 83.3% (20/53) developed it, and 76.7% (33/53) did not develop it.
Conclusion:
The performance of the Braden Scale showed a balance between sensitivity and specificity, confirming it as a better predictive risk assessment instrument in this group of patients.
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ORIGINAL ARTICLE
Prevalence of symptoms and quality of life of cancer patients
- Marina de Góes Salvetti ,
- Caroline Silva Pereira Machado ,
- Suzana Cristina Teixeira Donato ,
- Adriana Marques da Silva
02-27-2020
Abstract
ORIGINAL ARTICLEPrevalence of symptoms and quality of life of cancer patients
Revista Brasileira de Enfermagem. 2020;73(2):e20180287
02-27-2020DOI 10.1590/0034-7167-2018-0287
- Marina de Góes Salvetti ,
- Caroline Silva Pereira Machado ,
- Suzana Cristina Teixeira Donato ,
- Adriana Marques da Silva
Views0See moreABSTRACT
Objectives:
to analyze the prevalence of symptoms and their relationship with the quality of life of cancer patients.
Methods:
this is a cross-sectional study with 107 patients evaluated using a sociodemographic instrument, the hospital anxiety and depression scale (HADS) and the quality of life scale (EORTC-QLQ-C30). Pearson’s correlation test was used to evaluate the relationship between symptoms and quality of life.
Results:
prevalence of female patients (56.1%), 55 years as the mean age and 10 years of schooling. Fatigue (76.6%), insomnia (47.7%), pain (42.1%), loss of appetite (37.4%), anxiety (31.8%) and depression (21.5%) were identified. Anxiety and depression symptoms presented a negative correlation with quality of life and positive correlation with physical symptoms.
Conclusions:
fatigue, insomnia, pain and loss of appetite were the most common and most intense symptoms. Anxiety and depression symptoms presented a negative correlation with quality of life and positive correlation with physical symptoms.
- Marina de Góes Salvetti
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REVIEW
Strategies of active learning methodologies in nursing education: an integrative literature review
- Joyce Fernanda Soares Albino Ghezzi ,
- Elza de Fátima Ribeiro Higa ,
- Monike Alves Lemes ,
- Maria José Sanches Marin
03-24-2021
Abstract
REVIEWStrategies of active learning methodologies in nursing education: an integrative literature review
Revista Brasileira de Enfermagem. 2021;74(1):e20200130
03-24-2021DOI 10.1590/0034-7167-2020-0130
- Joyce Fernanda Soares Albino Ghezzi ,
- Elza de Fátima Ribeiro Higa ,
- Monike Alves Lemes ,
- Maria José Sanches Marin
Views0See moreABSTRACT
Objectives:
to analyze the scientific evidence on the strategies of active learning methodologies used in the training of nurses, as well as their contributions and obstacles in training.
Methods:
integrative literature review conducted with 33 selected articles in the Medical Literature Analysis and Retrieval System Online, Latin American and Caribbean Literature in Health Sciences, Nursing Database, Scopus, Web of Science and Education Resources Information Center databases.
Results:
among the strategies, simulation, problem-based learning and flipped classroom were highlighted. The active search, the integration of theory and practice and group work were examples of contributions to the training of nurses. However, the lack of preparation of the actors and the lack of structural support contribute to the dissatisfaction of the students.
Final Considerations:
the active learning methodology places the student at the heart of the learning process, favors critical thinking and the ability to make decisions.
- Joyce Fernanda Soares Albino Ghezzi
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