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REVIEW11-27-2023
Educational interventions for cervical cancer prevention: a scoping review
Revista Brasileira de Enfermagem. 2023;76(5):e20230018
Abstract
REVIEWEducational interventions for cervical cancer prevention: a scoping review
Revista Brasileira de Enfermagem. 2023;76(5):e20230018
DOI 10.1590/0034-7167-2023-0018
Views0ABSTRACT
Objectives:
to identify, map and describe characteristics of educational interventions for cervical cancer prevention in adult women.
Methods:
a scoping review conducted on eleven databases and the gray literature, including studies that described educational interventions aimed at preventing cervical cancer in adult women.
Results:
thirty-three articles with 151,457 participants were analyzed. The most used educational strategies were participatory discussions and educational leaflets. Most of the interventions took place in a single session, ranging from 40 to 60 minutes. The most used theoretical model in interventions to improve women’s compliance with Pap smear was the Health Belief Model.
Conclusions:
group discussions, lectures and educational brochures can increase knowledge and reduce barriers to cervical cancer prevention. Theory-based and culturally sensitive interventions can have a positive impact on women’s health.
Keywords:Health EducationMass ScreeningPapanicolaou TestPrimary Health CareUterine Cervical NeoplasmsSee more -
ORIGINAL ARTICLE11-27-2023
Validation of the hospital resources assessment scale for the preservation of urinary continence in the elderly
Revista Brasileira de Enfermagem. 2023;76(5):e20220805
Abstract
ORIGINAL ARTICLEValidation of the hospital resources assessment scale for the preservation of urinary continence in the elderly
Revista Brasileira de Enfermagem. 2023;76(5):e20220805
DOI 10.1590/0034-7167-2022-0805
Views0See moreABSTRACT
Objectives:
to validate the internal structure of the Hospital Resources Assessment Scale for the Preservation of Urinary Continence in the Elderly.
Methods:
validation study of the internal structure of a scale constructed based on the Donabedian conceptual model and an integrative review, with prior content validation. The scale was applied to the target population, and 124 nurses responded to the questionnaire. Exploratory Factor Analysis was performed using the FACTOR software, employing multiple techniques.
Results:
a factorial model with 11 items organized into two dimensions (support for human resources and material resources) was obtained. The “physical structure” dimension was removed from the initial model and adopted as a complementary checklist to the instrument, as it was not possible to obtain a factorable model with this dimension.
Conclusions:
we provide a valid scale that can measure indicators, identifying weaknesses and/or strengths related to hospital resources for the preservation of urinary continence in the elderly.
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EXPERIENCE REPORT11-27-2023
Implementación de estrategia de enfermería para autotrascendencia en adulto mayor: relato de experiencia
Revista Brasileira de Enfermagem. 2023;76(5):e20220745
Abstract
EXPERIENCE REPORTImplementación de estrategia de enfermería para autotrascendencia en adulto mayor: relato de experiencia
Revista Brasileira de Enfermagem. 2023;76(5):e20220745
DOI 10.1590/0034-7167-2022-0745es
Views0RESUMEN
Objetivos:
relatar la experiencia de la implementación de una estrategia de enfermería para promover la autotrascendencia en adultos mayores que acuden a un centro de primer nivel de atención en salud.
Métodos:
relato de experiencia sobre implementación de una estrategia abordando la Teoría de Autotrascendencia por enfermería a adultos mayores de una unidad de salud de primer nivel, en San Luis Potosí, México, de octubre-noviembre del 2022.
Resultados:
participaron 14 adultos mayores y tres enfermeros. A partir de la expresión de sentimientos, charlas sobre autotrascendencia, fomento de espiritualidad y actividad física, la estrategia resultó satisfactoria. Se observaron cambios emocionales, cognitivos y espirituales en las diferentes dimensiones de la Teoría de Autotrascendencia.
Consideraciones Finales:
la estrategia de enfermería sobre autotrascendencia permitió plasmar momentos significativos que ayudaron a identificar puntos clave en los que se encontraban los adultos mayores; esto ayudó para intervenir desde una perspectiva del cuidado de persona a persona.
Keywords:AncianoEnfermeras y EnfermerosEspiritualidadRelaciones Enfermero-PacienteTeoría de EnfermeríaSee more -
EXPERIENCE REPORT11-27-2023
Implementation of a nursing strategy for self-transcendence in older adults: an experience report
Revista Brasileira de Enfermagem. 2023;76(5):e20220745
Abstract
EXPERIENCE REPORTImplementation of a nursing strategy for self-transcendence in older adults: an experience report
Revista Brasileira de Enfermagem. 2023;76(5):e20220745
DOI 10.1590/0034-7167-2022-0745
Views0See moreABSTRACT
Objectives:
to report the experience of implementing a nursing strategy to promote self-transcendence in older adults attended at a Primary Health Care center.
Methods:
an experience report on the implementation of a strategy addressing the Theory of Self-Transcendence by nursing to older adults in a primary health unit, in San Luis Potosí, Mexico, from October to November 2022.
Results:
fourteen older adults and three nurses participated. From the expression of feelings, speeches about self-transcendence, spirituality and physical activity promotion, the strategy was satisfactory. Emotional, cognitive and spiritual changes were observed in the different dimensions of the Theory of Self-Transcendence.
Final Considerations:
the nursing strategy on self-transcendence made it possible to identify significant moments that helped to identify the key points in which older adults were; it helped to intervene from a person-to-person care perspective.
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ORIGINAL ARTICLE11-27-2023
Analysis of the development of children discharged from the Neonatal Intensive Care Unit from parents’ point of view
Revista Brasileira de Enfermagem. 2023;76(5):e20220717
Abstract
ORIGINAL ARTICLEAnalysis of the development of children discharged from the Neonatal Intensive Care Unit from parents’ point of view
Revista Brasileira de Enfermagem. 2023;76(5):e20220717
DOI 10.1590/0034-7167-2022-0717
Views0See moreABSTRACT
Objectives:
to analyze the development of children discharged from the Neonatal Intensive Care Unit and how hospitalization interferes with child development, from parents’ point of view.
Methods:
a descriptive-exploratory, documentary and qualitative study, carried out with parents of children discharged from the Intensive Care Unit through a telephone survey and supplementation in medical records. Data were analyzed using Bardin’s tool and discussed according to scientific evidence.
Results:
from parents’ point of view, delay in physical development was not observed, however difficulties in breastfeeding and weight gain were reported. Changes in speech and changes in behavior considered abnormal were also delays in child evolution.
Final Considerations:
from parents’ point of view, changes in speech may be associated with hospitalization in an Intensive Care Unit, while difficulties related to breastfeeding and delays in cognition may be altered by conditions of prematurity and low weight at birth.
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ORIGINAL ARTICLE11-27-2023
Urinary incontinence in women: assessment with the aid of standardized nursing terminologies NANDA-I and NOC
Revista Brasileira de Enfermagem. 2023;76(5):e20220714
Abstract
ORIGINAL ARTICLEUrinary incontinence in women: assessment with the aid of standardized nursing terminologies NANDA-I and NOC
Revista Brasileira de Enfermagem. 2023;76(5):e20220714
DOI 10.1590/0034-7167-2022-0714
Views0ABSTRACT
Objectives:
to assess urinary impairment in incontinent women with the aid of standardized nursing terminologies NANDA-I and NOC.
Methods:
a cross-sectional study, carried out with 97 women attending the gynecology outpatient clinic of a university hospital. Data collection took place using a form that contained information about NANDA-I diagnoses related to urinary incontinence and NOC Urinary Continence indicators. Statistical analysis was performed to assess the impairment of NOC indicators in the presence of NANDA-I nursing diagnoses.
Results:
diagnosis Mixed Urinary Incontinence was the most prevalent (43.3%), and, in its presence, the most compromised indicators were voids in appropriate receptacle, gets to toilet between urge and passage of urine and empties bladder completely.
Conclusions:
urinary impairment was worse in women with elements of stress and urge urinary incontinence.
Keywords:Health CareNursing DiagnosisOutcome AssessmentStandardized Nursing TerminologyUrinary IncontinenceWomenSee more -
REVIEW11-27-2023
Vaccination hesitation in children under five years of age: a scoping review
Revista Brasileira de Enfermagem. 2023;76(5):e20220707
Abstract
REVIEWVaccination hesitation in children under five years of age: a scoping review
Revista Brasileira de Enfermagem. 2023;76(5):e20220707
DOI 10.1590/0034-7167-2022-0707
Views0See moreABSTRACT
Objectives:
to synthesize scientific evidence on vaccine hesitancy in children under five years of age and its associated factors.
Methods:
a scoping review, conducted according to the methodological structure proposed by the JBI. Searches were carried out in the Latin American and Caribbean Center on Health Sciences Information, Scientific Electronic Library Online and PubMed databases, including gray literature. Studies in English, Spanish and Portuguese were included, without temporal delimitation. Editorials, studies that did not address vaccine hesitancy in children under five years of age and were not aligned with the objective and research question were excluded. The sample consisted of 18 articles.
Results:
misinformation, concern about adverse effects, distrust about efficacy, affliction regarding administration simultaneously, and insecurity in relation to the laboratories were the reported reasons.
Conclusions:
strategies are needed to combat the lack of information about immunobiological agents, as misinformation was the main factor in parents’ vaccine hesitation.
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ORIGINAL ARTICLE11-27-2023
ICNP® terminological subset for people with diabetic foot ulcer in primary health care
Revista Brasileira de Enfermagem. 2023;76(5):e20220668
Abstract
ORIGINAL ARTICLEICNP® terminological subset for people with diabetic foot ulcer in primary health care
Revista Brasileira de Enfermagem. 2023;76(5):e20220668
DOI 10.1590/0034-7167-2022-0668
Views0ABSTRACT
Objectives:
to elaborate an ICNP® terminological subset for people with diabetic foot ulcers in Primary Health Care.
Methods:
this is a methodological study that followed five steps: 1) Identification of relevant terms for the patients through an integrative literature review and official documents in the area; 2) Mapping of terms identified with ICNP® terms; 3) Construction of statements of nursing diagnoses, outcomes and interventions; 4) Structuring of a terminological subset with the Self-Care Deficit Theory; and 5) Content validity of statements constructed with nurses from a programmatic area in Rio de Janeiro.
Results:
the subset developed is composed of 81 diagnoses/outcomes and 583 nursing interventions, organized into universal, change and development requirements.
Conclusions:
the subset on screen was predominantly composed of statements inserted in self-care requirements related to health changes, reinforcing the importance of quality of life and recovery.
Keywords:Diabetes MellitusDiabetic FootNursing ProcessPrimary Health CareStandardized Nursing TerminologySee more
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ORIGINAL ARTICLE01-10-2024
Nursing students and the internet: a reflection of digital ethics
Revista Brasileira de Enfermagem. 2024;77:e20230459
Abstract
ORIGINAL ARTICLENursing students and the internet: a reflection of digital ethics
Revista Brasileira de Enfermagem. 2024;77:e20230459
DOI 10.1590/0034-7167-2023-0459
Views0See moreABSTRACT
Objectives:
to identify how first-year nursing students use cyberspace and propose an orientation guide with criteria guiding the use of cyberspace.
Methods:
qualitative and descriptive research, carried out with 24 nursing students from a federal public institution in Rio de Janeiro. Data collection was carried out through semi-structured interviews. Data analysis occurred using IRAMUTEQ®. The research was approved by the institution’s Research Ethics Committee.
Results:
students use cyberspace to communicate, study, find “cool things”, share photos and memories. Furthermore, they are concerned about hate speech, intolerance and fake news. The good and bad sides and the types of technologies most used were also portrayed.
Final considerations:
the moral and ethical values of physical coexistence, together with awareness of individual responsibility, are the pillars for using cyberspace. The guide comes as an awareness tool.
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ORIGINAL ARTICLE01-10-2024
Maternity behind and beyond bars: analysis from the perspective of protection bioethics
Revista Brasileira de Enfermagem. 2024;77:e20220576
Abstract
ORIGINAL ARTICLEMaternity behind and beyond bars: analysis from the perspective of protection bioethics
Revista Brasileira de Enfermagem. 2024;77:e20220576
DOI 10.1590/0034-7167-2022-0576
Views0See moreABSTRACT
Objective:
to analyze how motherhood is expressed in female prison units from the perspective of Bioethics of Protection.
Method:
qualitative research with an ethnographic approach, developed in two women’s prison units. Participantes were: six mothers deprived of liberty, 15 health professionals, and nine prison officers. For data collection, semi-structured interviews and descriptive observation were used. Data analysis was based on the Content Analysis technique, thematic category.
Results:
three categories emerged: women and children violated behind bars (inequities); mothers and children in prison exacerbating imbalances, tensions and conflicts; and limits and references for resocialization.
Final Considerations:
the Bioethics of Protection proposal appears as a valid tool for the analytical direction of the process of confronting issues in the scope of public health in prison units, considering vulnerable groups and aiming at equity and human dignity.
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ORIGINAL ARTICLE01-10-2024
Self-harm in the two years of greatest restrictions during the covid-19 pandemic: a cross-sectional study
Revista Brasileira de Enfermagem. 2024;77:e20240289
Abstract
ORIGINAL ARTICLESelf-harm in the two years of greatest restrictions during the covid-19 pandemic: a cross-sectional study
Revista Brasileira de Enfermagem. 2024;77:e20240289
DOI 10.1590/0034-7167-2024-0289
Views0See moreABSTRACT
Objective:
to analyze occurrence of self-harm, sociodemographic profile of victims and referrals in the first 24 months of the COVID-19 pandemic in São Paulo.
Method:
cross-sectional study carried out by the Notifiable Diseases Information System with data on self-harm in São Paulo. The period outlined was March 2020 to February 2022. R (4.0.2) software and chi-square test were used.
Results:
there were 15,946 incidents. Victims were young, white, single, heterosexual women. There was high incidence of people with previous mental disorders more than once and without clear motivation. The method used was poisoning/intoxication. There was a considerable number of referrals to the health network, although not totalitarian.
Conclusion:
the years of greater insecurity in relation to the pandemic have given rise to self-harm cases with peculiar characteristics. Agile health policies must be applied in atypical conditions, such as pandemics, especially for adolescents/young people with previous mental disorders.
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REVIEW01-10-2024
Health of quilombola children as a challenge for the Sustainable Development Goals: a scoping review
Revista Brasileira de Enfermagem. 2024;77:e20240106
Abstract
REVIEWHealth of quilombola children as a challenge for the Sustainable Development Goals: a scoping review
Revista Brasileira de Enfermagem. 2024;77:e20240106
DOI 10.1590/0034-7167-2024-0106
Views0See moreABSTRACT
Objective:
to map the literature on quilombola children’s health and its relationship with the Sustainable Development Goals.
Method:
a scoping review, which followed the JBI protocol and the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews. Searches were conducted in the LILACS, BDENF, Web of Science, Scopus, MEDLINE databases and Google Scholar platform. The research protocol was registered in the Open Science Framework.
Results:
eighteen articles out of 2,055 studies were selected as relevant for this study. The articles were grouped into four axes: Access to healthcare services; Nutritional aspects of quilombola children; Health problems of quilombola children; and Care for quilombola children. The relationship between these articles and SDGs 1, 3, 4, 6 and 10 was observed.
Final considerations:
the study provided an extremely important mapping of the theme of quilombola children’s health and themes related to the Sustainable Development Goals.
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REVIEW01-10-2024
Prevalence and exposure variables of latent infection by mycobacterium tuberculosis in healthcare workers
Revista Brasileira de Enfermagem. 2024;77:e20240052
Abstract
REVIEWPrevalence and exposure variables of latent infection by mycobacterium tuberculosis in healthcare workers
Revista Brasileira de Enfermagem. 2024;77:e20240052
DOI 10.1590/0034-7167-2024-0052
Views0See moreABSTRACT
Objectives:
To identify in the scientific literature the prevalence, diagnostic methods, and exposure variables of latent infection by Mycobacterium tuberculosis in healthcare workers.
Methods:
An integrative review of the scientific literature based on the following review question: What are the available scientific evidence in the literature that address the prevalence of latent infection by Mycobacterium tuberculosis in healthcare workers and its association with possible risk factors among these workers?
Results:
Being a physician or nurse, being older, and being male were generally associated with higher prevalences. The study also showed that interferon-gamma release assays were more commonly used as a diagnostic method compared to skin tests.
Conclusions:
More studies are needed regarding the epidemiology of latent infection by Mycobacterium tuberculosis in the context of healthcare workers, aiming for higher impact actions that contribute to the reduction of tuberculosis worldwide.
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RESEARCH01-01-2017
Impact of home visits on the functional capacity of patients with venous ulcers
Revista Brasileira de Enfermagem. 2017;70(2):287-293
Abstract
RESEARCHImpact of home visits on the functional capacity of patients with venous ulcers
Revista Brasileira de Enfermagem. 2017;70(2):287-293
DOI 10.1590/0034-7167-2016-0291
Views0See moreABSTRACT
Objective:
to compare the impact of home visits, before and after instructions, on the functional capacity of adult and elderly patients with venous ulcers, by means of the KATZ-EIAVD Scale.
Method:
experimental, clinical, randomized, non-blind and controlled study, developed with 32 patients (case and control groups). The research settings were the Wound Care Clinic of the University Hospital Antonio Pedro, and the homes of patients assisted in this clinic. Data collection took place from February to June 2014, by means of a health unit evaluation tool, the KATZ-EIAVD Scale, and a script of instructions to be given to the research subjects that had received a home visit.
Results:
the studied population present excellent independence for activities of daily living, with no significant variation among them.
Conclusion:
the studied groups have functional capacity with similar progress.
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RESEARCH01-01-2017
The elderly recognizing themselves as vulnerable to falls in the concreteness of the femoral fracture
Revista Brasileira de Enfermagem. 2017;70(2):279-286
Abstract
RESEARCHThe elderly recognizing themselves as vulnerable to falls in the concreteness of the femoral fracture
Revista Brasileira de Enfermagem. 2017;70(2):279-286
DOI 10.1590/0034-7167-2016-0392
Views0See moreABSTRACT
Objectives:
understand the experience of the elderly with falls followed by femoral fracture and elaborate theoretical model of this process of lived experience.
Method:
qualitative research with theoretical saturation through analysis of the ninth nondirected interview of elderly who underwent such experience. Interviews were recorded, transcribed, and analyzed according to Grounded Theory.
Results:
three categories emerged (sub-processes): evaluating signs and symptoms of fracture after the fall; feeling sad and insecure with the new condition; and finding oneself susceptible to fractures. From realignment of these categories (sub-processes) we could abstract the central category (process), recognizing oneself as vulnerable to falls in the concreteness of the fracture.
Conclusion:
the theoretical model considering the Symbolic Interactionism signals the implementation of continued program for fall prevention, with teaching strategies that encourage the elderly to reflect on the concreteness of contexts in which there is risk of occurring injury to their health.
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RESEARCH01-01-2017
Self-esteem and health-related quality of life in ostomized patients
Revista Brasileira de Enfermagem. 2017;70(2):271-278
Abstract
RESEARCHSelf-esteem and health-related quality of life in ostomized patients
Revista Brasileira de Enfermagem. 2017;70(2):271-278
DOI 10.1590/0034-7167-2016-0161
Views0See moreABSTRACT
Objective:
to assess self-esteem (SE) and health-related quality of life (HRQoL) in ostomized patients due to colorectal cancer.
Method:
cross sectional research with a quantitative approach. Three instruments were used for data collection: one instrument containing sociodemographic and clinical data, Rosenberg’s Self-Esteem Scale, and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire.
Results:
SE and HRQoL were considered satisfactory. Significant statistical difference was found in the social function domain and marital status, ostomy duration, location, and time; global health scale and ostomy type; cognitive function and pain in the ostomy site. There was a correlation between self-esteem and all the functional scales and the global health scale.
Conclusion:
knowing SE and HRQoL levels, in addition to the variables that influence them, supports ostomized patients’ care planning, rehabilitation, and social autonomy.
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RESEARCH01-01-2017
Quality of life of patients who undergone myocardial revascularization surgery
Revista Brasileira de Enfermagem. 2017;70(2):257-264
Abstract
RESEARCHQuality of life of patients who undergone myocardial revascularization surgery
Revista Brasileira de Enfermagem. 2017;70(2):257-264
DOI 10.1590/0034-7167-2016-0201
Views0See moreABSTRACT
Objective:
to evaluate the quality of life of patients who underwent revascularization surgery.
Method:
a descriptive, cross sectional study, with quantitative approach carried out with 75 patients. The questionnaire WHOQOL-Bref was used to evaluate the quality of life (QOL).
Results:
patients’ QOL evaluation presented a moderate result, with need of improvement of all domains. Low income patients had the worst evaluation of QOL in the domain environment (p=0,021), and the ones from Recife/metropolitan area, in the domain social relationship (p=0,021). Smoker (p=0,047), diabetic (p=0,002) and alcohol consumption (p=0,035) patients presented the worst evaluation of the physical domain. Renal patients presented the worst evaluation of QOL in the physical (P=0,037), psychological (p=0,008), social relationship (p=0,006) domains and total score (p=0,009).
Conclusion:
the improvement of QOL depends on the individual’s process of behavioral change and the participation of health professionals is essential to formulate strategies to approach these patients, especially concerning health education.
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RESEARCH01-01-2017
Semiotics and semiology of Nursing: evaluation of undergraduate students’ knowledge on procedures
Revista Brasileira de Enfermagem. 2017;70(2):249-256
Abstract
RESEARCHSemiotics and semiology of Nursing: evaluation of undergraduate students’ knowledge on procedures
Revista Brasileira de Enfermagem. 2017;70(2):249-256
DOI 10.1590/0034-7167-2016-0417
Views0ABSTRACT
Objective:
to assess the knowledge of scholars on Nursing regarding simple hands hygiene (SHH), blood pressure measurement (BP), peripheral venipuncture (PV) with venous catheter and male urethral catheterization delay (UCD) procedures.
Method:
quantitative study carried out between February and May 2014, with 186 undergraduate Nursing students from 5th to 9th period of a public university of Rio Grande do Norte, with application of four questionnaires. One carried out descriptive and analytic analysis.
Results:
the students presented low average percentage of right answers, especially in blood pressure measurement (55.5%); SHH’s average was higher than 70%. The average of correct answers was the highest in SHH (8.6), followed by UCD (7.8), PV (7.4) and BP (6.7). The questions regarding the topic “concepts” showed less correct answers when comparing it to the topic “technique steps”.
Conclusion:
it is necessary to establish knowledge monitoring strategies, in order to stimulate the constant improvement.
Keywords:Education in NursingKnowledgeNursing CareResearch in Nursing EvaluationUndergraduate Nursing StudentsSee more -
RESEARCH01-01-2017
Multi-professional team’s perception of nurses’ competences in liver transplantations
Revista Brasileira de Enfermagem. 2017;70(2):242-248
Abstract
RESEARCHMulti-professional team’s perception of nurses’ competences in liver transplantations
Revista Brasileira de Enfermagem. 2017;70(2):242-248
DOI 10.1590/0034-7167-2016-0223
Views0See moreABSTRACT
Objective
describe the multi-professional team’s perception of nurses’ competences in liver transplantation programs.
Method:
descriptive study with a qualitative approach. Data were collected through a questionnaire. Participants were 12 professionals of the liver transplantation team of a reference hospital. For result interpretation, the thematic analysis technique was employed.
Results:
the professionals assessed the competences employed by nurses as proactive, autonomous, creative, humanized, capable of teamwork, decision-making and conflict management.
Conclusion:
this study made it possible to demonstrate that members of the multi-professional team perceived nurses as professionals capable of coordinating and integrating the skills “knowing, doing, being and co-existing”, enabling quality care for candidates and receivers of liver transplants, as well as for their families and/or caregivers in all perioperative phases.
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RESEARCH01-01-2017
The family in face of the elderly’s reality of living alone
Revista Brasileira de Enfermagem. 2017;70(2):235-241
Abstract
RESEARCHThe family in face of the elderly’s reality of living alone
Revista Brasileira de Enfermagem. 2017;70(2):235-241
DOI 10.1590/0034-7167-2016-0398
Views0See moreABSTRACT
Objective:
to understand the family dynamics in face of the reality of the elderly living alone.
Method:
study of qualitative approach with theoretical reference of symbolic interactionism that involved interviews with families. Data were analyzed by thematic analysis.
Results:
six families participated in the study. The discourse analysis originated the following categories: The family respecting their decision making; The family organizing itself to the process of living alone after the age of 80 years; The family experiencing the freedom of living alone.
Conclusion:
in this study, it was possible to identify the facilitation of the possibility of living alone with preparation and agreements between the family during the family life cycle, leading to the feeling of freedom and quality of life of all members. Nursing, as a science responsible for elaborating care strategies, should work together with families to assist in the planning of care plans based on the individual social reality of the family.
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