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Risk for acute kidney injury in primary health care
Revista Brasileira de Enfermagem. 2018;71(1):20-25
Abstract
Risk for acute kidney injury in primary health care
Revista Brasileira de Enfermagem. 2018;71(1):20-25
DOI 10.1590/0034-7167-2016-0551
Views0See moreABSTRACT
Objective:
To identify hypertensive and diabetic patients at risk for developing acute kidney injury in the primary health care setting.
Method:
Observational, longitudinal, prospective study. Sample of 56 diabetic and hypertensive individuals. A semi-structured questionnaire was adopted for data collection. For the description of results, were calculated dispersion measures and the Spearman test was used for statistical analysis. The result was considered significant when p <0.05.
Results:
Of the total sample, 23.2% of users evolved with renal impairment, of which 19.6% with risk for renal injury, and 3.6% with kidney injury itself. Age and body mass index were associated with worsening of renal function (p = 0.0001; p = 0.0003), respectively.
Conclusion:
A quarter of the health system users, hypertensive and diabetic, evolved with impaired renal function, more specifically to stages of risk for renal injury and kidney injury according to the RIFLE classification.
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Validation of virtual learning object to support the teaching of nursing care systematization
Revista Brasileira de Enfermagem. 2018;71(1):11-19
Abstract
Validation of virtual learning object to support the teaching of nursing care systematization
Revista Brasileira de Enfermagem. 2018;71(1):11-19
DOI 10.1590/0034-7167-2016-0537
Views0ABSTRACT
Objective:
to describe the content validation process of a Virtual Learning Object to support the teaching of nursing care systematization to nursing professionals.
Method:
methodological study, with quantitative approach, developed according to the methodological reference of Pasquali’s psychometry and conducted from March to July 2016, from two-stage Delphi procedure.
Results:
in the Delphi 1 stage, eight judges evaluated the Virtual Object; in Delphi 2 stage, seven judges evaluated it. The seven screens of the Virtual Object were analyzed as to the suitability of its contents. The Virtual Learning Object to support the teaching of nursing care systematization was considered valid in its content, with a Total Content Validity Coefficient of 0.96.
Conclusion:
it is expected that the Virtual Object can support the teaching of nursing care systematization in light of appropriate and effective pedagogical approaches.
Keywords:Educational TechnologyNursing ProcessesTeaching MaterialsTechnical Education in NursingValidation StudiesSee more -
Deontological aspects of the nursing profession: understanding the code of ethics
Revista Brasileira de Enfermagem. 2018;71(1):3-10
Abstract
Deontological aspects of the nursing profession: understanding the code of ethics
Revista Brasileira de Enfermagem. 2018;71(1):3-10
DOI 10.1590/0034-7167-2016-0565
Views0See moreABSTRACT
Objective:
to investigate nursing professionals’ understanding concerning the Code of Ethics; to assess the relevance of the Code of Ethics of the nursing profession and its use in practice; to identify how problem-solving is performed when facing ethical dilemmas in professional practice.
Method:
exploratory descriptive study, conducted with 34 (thirty-four) nursing professionals from a teaching hospital in João Pessoa, PB – Brazil.
Results:
four thematic categories emerged: conception of professional ethics in nursing practice; interpretations of ethics in the practice of care; use of the Code of Ethics in the professional practice; strategies for solving ethical issues in the professional practice.
Final considerations:
some of the nursing professionals comprehend the meaning coherently; others have a limited comprehension, based on jargon. Therefore, a deeper understanding of the text contained in this code is necessary so that it can be applied into practice, aiming to provide a quality care that is, above all, ethical and legal.
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Uma crise que não gera mudanças não é uma crise em sua essência
Revista Brasileira de Enfermagem. 2018;71(1):1-2
Abstract
Uma crise que não gera mudanças não é uma crise em sua essência
Revista Brasileira de Enfermagem. 2018;71(1):1-2
DOI 10.1590/0034-7167.2018710101
Views0A CRISE ECONÔMICAAs dificuldades político-econômicas que o Brasil atravessa nos últimos três anos, com cortes frequentes e sistemáticos de recursos nas mais diversas áreas, incluindo educação, saúde, ciência e tecnologia, repercutem diretamente na produção científica brasileira. Como parte integrante desse sistema, a produção científica da enfermagem passa a experimentar uma fase de declínio quantitativo na […]See more -
It is not a crisis itself, if does not promote changes
Revista Brasileira de Enfermagem. 2018;71(1):1-2
Abstract
It is not a crisis itself, if does not promote changes
Revista Brasileira de Enfermagem. 2018;71(1):1-2
DOI 10.1590/0034-7167.2018710101
Views1ECONOMIC CRISISBrazil has been going through crisis in the past three years, due to often and systemic cuts in funds in multiple fields of society, such as education, health, science and technology, affecting directly on Brazilian scientific production. The nursing scientific production – as being an integrative part – now experiences a phase of quantitative […]See more -
ERRATUM01-01-2017
ERRATUM
Revista Brasileira de Enfermagem. 2017;70(6):1348-1348
Abstract
ERRATUMERRATUM
Revista Brasileira de Enfermagem. 2017;70(6):1348-1348
DOI 10.1590/0034-7167.20177006e02
Views0Article “Nursing appointment and cardiometabolic control of diabetics: a randomized clinical trial”, with number of DOI: , published in the journal Revista Brasileira de Enfermagem, v70(3):468-7, on page 468:Where it read:[…]See more -
ERRATUM01-01-2017
ERRATUM
Revista Brasileira de Enfermagem. 2017;70(6):1347-1347
Abstract
ERRATUMERRATUM
Revista Brasileira de Enfermagem. 2017;70(6):1347-1347
DOI 10.1590/0034-7167.20177006e01
Views0Article “Physical and psychological violence against the elderly: prevalence and associated factors”, with number of DOI: , published in the journal Revista Brasileira de Enfermagem, v68(6):727-33, on page 732, it is added:“FUNDING[…]See more -
REFLECTION01-01-2017
Theory of communicative action: a basis for the development of critical thinking
Revista Brasileira de Enfermagem. 2017;70(6):1343-1346
Abstract
REFLECTIONTheory of communicative action: a basis for the development of critical thinking
Revista Brasileira de Enfermagem. 2017;70(6):1343-1346
DOI 10.1590/0034-7167-2016-0383
Views0See moreABSTRACT
Reflections on some assumptions of the theory of Communicative Action and the development of Critical Thinking in the context of training students in undergraduate nursing courses. The perspective is based on concepts of Jürgen Habermas, as a possibility for the development of critical thinking among the students of these courses. Communication is therefore understood as inherent in the training of nurses in a continuous, dynamic, dialogical process, with interventions that are related to the context of the students and that have meaning for them, in order to contribute to the promotion of Critical Thinking.
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ORIGINAL ARTICLE07-29-2024
Evidence of validity of the Risk Self-Medication Questionnaire focused on Health Literacy
Revista Brasileira de Enfermagem. 2024;77(3):e20230386
Abstract
ORIGINAL ARTICLEEvidence of validity of the Risk Self-Medication Questionnaire focused on Health Literacy
Revista Brasileira de Enfermagem. 2024;77(3):e20230386
DOI 10.1590/0034-7167-2023-0386
Views0See moreABSTRACT
Objectives:
to analyze the validity evidence of the internal structure of the Risk Self-Medication Questionnaire Focused on Health Literacy.
Methods:
a psychometric study with 499 adults. The internal structure was assessed with exploratory and confirmatory factor analysis to prove the adjustment. Internal consistency was measured by composite reliability and McDonald’s omega coefficient (ω).
Results:
the parameters revealed a model of 35 items distributed across four factors, explaining 56% of the total variance, with factor loadings ranging from 0.31 to 0.85 and adequate communalities. Accuracy (0.79
Conclusions:
an instrument was obtained with good evidence of structural validity for measuring self-medication.
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ORIGINAL ARTICLE07-29-2024
Nurses’ perspectives on nurses’ work methods
Revista Brasileira de Enfermagem. 2024;77(3):e20230374
Abstract
ORIGINAL ARTICLENurses’ perspectives on nurses’ work methods
Revista Brasileira de Enfermagem. 2024;77(3):e20230374
DOI 10.1590/0034-7167-2023-0374
Views0See moreABSTRACT
Objectives:
To analyze nurses’ perspectives on nurses’ work methods in the hospital context.
Methods:
A descriptive study with a qualitative approach was conducted in a hospital in northern Portugal, involving 17 nurses. Semi-structured interviews were used for data collection. Data collected between May and June 2023 underwent content analysis, supported by Atlas.ti software.
Results:
Three thematic areas emerged: “Nurses’ work methods in a hospital context,” highlighting the conception and components of work methods and the methods in use; “Implementation of nurses’ work methods,” emphasizing influencing factors and challenges to implementation; and “Impact of nurses’ work methods on patients, nurses, and institutions.”
Final Considerations:
Nurses’ work methods constitute the structure of nursing care. Some factors influence and some challenges arise in the implementation of these methods, producing impacts on patients, nurses, and institutions.
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ORIGINAL ARTICLE07-29-2024
Nursing Process for institutionalized older adults: contributions from knowledge awareness workshop
Revista Brasileira de Enfermagem. 2024;77(3):e20230349
Abstract
ORIGINAL ARTICLENursing Process for institutionalized older adults: contributions from knowledge awareness workshop
Revista Brasileira de Enfermagem. 2024;77(3):e20230349
DOI 10.1590/0034-7167-2023-0349
Views0See moreABSTRACT
Objective:
To analyze the knowledge of professionals working in a Nursing Home about the Nursing Process before and after the awareness workshop.
Methods:
This is strategic action research, developed with nursing professionals and managers of a Nursing Home in Rio Grande do Sul, Brazil. Data were collected between January and June 2023, through semi-structured interviews before and after an awareness workshop. Discursive textual analysis of the data was carried out.
Results:
The central category “Understanding about the Nursing Process in Nursing Homes” emerged, which was unitized into two units of meaning and three categories of analysis.
Conclusion:
Data revealed non-use and lack of knowledge of the Nursing Process before awareness raising. Afterwards, a deeper understanding of the topic and its importance was identified. Awareness-raising workshops contribute to transformation of knowledge.
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ORIGINAL ARTICLE07-29-2024
Excessive daytime sleepiness in nursing technicians: association with sleep quality and memory
Revista Brasileira de Enfermagem. 2024;77(3):e20230332
Abstract
ORIGINAL ARTICLEExcessive daytime sleepiness in nursing technicians: association with sleep quality and memory
Revista Brasileira de Enfermagem. 2024;77(3):e20230332
DOI 10.1590/0034-7167-2023-0332
Views0See moreABSTRACT
Objective:
to investigate excessive daytime sleepiness prevalence among nursing technicians and the association with sleep quality and memory.
Methods:
a cross-sectional, inferential study, carried out in a hospital unit in the state of Goiás between December 2020 and January 2021. Assessments were carried out using the Epworth Sleepiness Scale, the Pittsburgh Sleep Quality Index and the Prospective and Retrospective Memory Questionnaire, instruments validated for the Brazilian context. Bivariate and multivariate logistic regression analyzes were performed.
Results:
the sample consisted of 189 nursing technicians with a 40.9% excessive daytime sleepiness prevalence. In multivariate models, excessive daytime sleepiness was not associated with sleep quality, however there was a significant association with overall memory failures.
Conclusions:
study results demonstrate a high excessive daytime sleepiness occurrence, an association with overall memory failures and the need for psychosocial interventions for nursing technicians.
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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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ORIGINAL ARTICLE07-29-2024
Fuzzy Logic: vulnerability of women who have sex with women to sexually transmitted infections
Revista Brasileira de Enfermagem. 2024;77(3):e20230271
Abstract
ORIGINAL ARTICLEFuzzy Logic: vulnerability of women who have sex with women to sexually transmitted infections
Revista Brasileira de Enfermagem. 2024;77(3):e20230271
DOI 10.1590/0034-7167-2023-0271
Views0ABSTRACT
Objective:
To describe the possibility of applying Fuzzy Logic in analyzing the vulnerability of Women Who Have Sex with Women to Sexually Transmitted Infections/HIV/AIDS.
Methods:
We developed a Fuzzy Logic system with 17 input variables and one output variable, using data related to vulnerability in a municipality located in the Midwest region of the State of São Paulo, Brazil.
Results:
The factor with the greatest positive impact was the confirmation that a low understanding of Sexually Transmitted Infections/HIV/AIDS is associated with higher vulnerability. Conversely, the statement “Not disclosing sexual activity to healthcare professionals,” where individuals do not admit to having sex with women, had the least impact.
Conclusions:
Fuzzy Logic facilitates the identification of vulnerability, expressed through the analysis of interaction between variables in each dimension. This makes it a promising method to assist in analyzing the vulnerability of specific populations.
Keywords:Fuzzy LogicHealth VulnerabilityReproductive HealthSexually Transmitted DiseasesWomen Who Have Sex With WomenSee more -
ORIGINAL ARTICLE07-29-2024
University Student Depression Inventory, Brazilian Version, Construct Assessment
Revista Brasileira de Enfermagem. 2024;77(3):e20230232
Abstract
ORIGINAL ARTICLEUniversity Student Depression Inventory, Brazilian Version, Construct Assessment
Revista Brasileira de Enfermagem. 2024;77(3):e20230232
DOI 10.1590/0034-7167-2023-0232
Views0See moreABSTRACT
Objectives:
to assess the University Student Depression Inventory, Brazilian version (USDI-BR), construct.
Methods:
a methodological study carried out with a snowball probabilistic sample, consisting of 334 undergraduate and graduate students. Confirmatory factor analysis, reliability using McDonald’s omega coefficient and Cronbach’s alpha were performed. Principal component analysis was performed using the varimax rotation and oblimin rotation, using the Kaiser-Meyer-Olkin criteria, Bartlett’s test of sphericity and scree plot.
Results:
the USDI-BR presented an internal consistency of items of ω = 0.95 and remained with 30 items, with the addition of 1 factor (Death wish and social withdrawal), totaling 4 factors.
Conclusions:
the USDI-BR has evidence that points to its validity and also its internal consistency, deserving that new studies be carried out to expand the evidence of its psychometric properties.
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ORIGINAL ARTICLE07-29-2024
Family refusal of skin donation for transplantation: trends and associated factors
Revista Brasileira de Enfermagem. 2024;77(3):e20230209
Abstract
ORIGINAL ARTICLEFamily refusal of skin donation for transplantation: trends and associated factors
Revista Brasileira de Enfermagem. 2024;77(3):e20230209
DOI 10.1590/0034-7167-2023-0209
Views0See moreABSTRACT
Objectives:
to analyze the trends and factors associated with family refusal of skin donation for transplantation.
Methods:
this cross-sectional study was conducted in the State of São Paulo, with family authorization terms collected from 2001 to 2020. The variables analyzed included year, age, gender, cause of death, and type of institution. Data were analyzed using linear and multiple logistic regression, with the Odds Ratio estimated at p<0.05 for statistical significance.
Results:
1,355 individuals refused skin donation. The trend of refusals decreased between 2001 and 2009 in the age groups of 0-11 years and 12-19 years, but increased in the group aged ≥60 years. This trend continued to decrease in the 0-11 years group from 2010 to 2020, and increased in the 20-40 years group. Males and the age groups of 20-40 years, 41-59 years, and ≥60 years exhibited 27%, 34%, 47%, and 53% lower chances of refusal, respectively.
Conclusions:
there is an urgent need for measures to mitigate the high number of refusals associated with skin donation.
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ORIGINAL ARTICLE11-22-2024
Safe practices for prevention and management of antineoplastic agent extravasation: development of an educational video
Revista Brasileira de Enfermagem. 2024;77(5):e20240172
Abstract
ORIGINAL ARTICLESafe practices for prevention and management of antineoplastic agent extravasation: development of an educational video
Revista Brasileira de Enfermagem. 2024;77(5):e20240172
DOI 10.1590/0034-7167-2024-0172
Views0ABSTRACT
Objectives:
to develop, validate, and evaluate an educational video on the prevention and management of antineoplastic agent extravasation, aimed at nursing professionals.
Methods:
this methodological study was developed according to Falkembach’s theoretical framework, which outlines five phases in the production of educational video materials: analysis and planning, modeling, implementation, evaluation, and distribution.
Results:
content validation demonstrated agreement above the minimum threshold stipulated. The overall Content Validity Index was 90.8%, and it was 94.2% among the content and technical evaluation judges, respectively. The target audience evaluated the video positively, highlighting the importance of the content, the clarity of the language used, and the understanding of the information pertinent to the topic.
Conclusions:
the video proved to be an appropriate strategy for instructing interventions on the prevention and management of extravasation, with the potential to improve educational practices among nursing professionals.
Keywords:Antineoplastic AgentsEducational TechnologyExtravasation of Diagnostic and Therapeutic MaterialsInstructional Film and VideoNursingSee more -
REVIEW11-22-2024
Telenursing contributions in Primary Health Care in the COVID-19 pandemic context: an integrative review
Revista Brasileira de Enfermagem. 2024;77(5):e20240093
Abstract
REVIEWTelenursing contributions in Primary Health Care in the COVID-19 pandemic context: an integrative review
Revista Brasileira de Enfermagem. 2024;77(5):e20240093
DOI 10.1590/0034-7167-2024-0093
Views1See moreABSTRACT
Objective:
to identify telenursing contributions in Primary Health Care during the COVID-19 pandemic.
Methods:
an integrative literature review, conducted between January and August 2022 in the PubMed, CINAHL, LILACS, BDENF, Scopus, WoS, EMBASE and SciELO databases. A total of 493 studies was found, 62 were read in full, and of these, 16 were selected. For analysis, a dynamic reading of the studies and synthesis of the main results were carried out.
Results:
the main results highlighted telenursing practice as a challenge for professionals and the population. Among the contributions and positive points and aspects that require improvement, practice showed promise when considered in a post-pandemic scenario.
Final considerations:
through telenursing, the population’s access to Primary Health Care was guaranteed in the face of the COVID-19 pandemic. However, a critical look at current technological advances in healthcare is necessary.
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Percepções de pessoas com deficiência física sobre acessibilidade e condições sociais: intervenções para enfermagem de reabilitação
Revista Brasileira de Enfermagem. 2024;77(5):e20240005
Abstract
Percepções de pessoas com deficiência física sobre acessibilidade e condições sociais: intervenções para enfermagem de reabilitação
Revista Brasileira de Enfermagem. 2024;77(5):e20240005
DOI 10.1590/0034-7167-2024-0005
Views0RESUMEN
Objetivos:
analizar las experiencias de personas con discapacidad física adquirida en cuanto a accesibilidad y condiciones sociales; identificar intervenciones de rehabilitación dirigidas por enfermeras para la accesibilidad y condiciones sociales; determinar indicadores sensibles a la enfermería para mejorar la accesibilidad y condiciones sociales.
Métodos:
estudio cualitativo descriptivo-exploratorio utilizó entrevistas semiestructuradas con personas con discapacidad física adquirida mediante muestreo intencionado en bola de nieve para cumplir con todos los objetivos. El análisis de datos siguió los principios del análisis de contenido de Bardin. Los objetivos 2 y 3 se lograron mediante un enfoque teórico reflexivo.
Resultados:
los 27 participantes informaron desafíos de accesibilidad, que impactan las actividades de la vida diaria y las condiciones sociales. Esto influye en la enfermería de rehabilitación, dando lugar a tres campos de intervención: Evaluar la capacidad para realizar actividades diarias y los factores que influyen; Desarrollar e implementar capacitación para la realización de actividades diarias; Promover la movilidad, la accesibilidad y la participación social.
Consideraciones Finales:
a partir de las experiencias de los participantes, identificamos intervenciones de rehabilitación dirigidas por enfermeras para promover la accesibilidad y condiciones sociales.
Keywords:Acessibilidade ArquitetónicaCondições SociaisEnfermagem em ReabilitaçãoObjetivos de Desenvolvimento SustentávelPessoas com DeficiênciaSee more -
Rondas a beira leito no ambiente hospitalar na perspectiva de equipes multiprofissionais de saúde
Revista Brasileira de Enfermagem. 2024;77(5):e20230493
Abstract
Rondas a beira leito no ambiente hospitalar na perspectiva de equipes multiprofissionais de saúde
Revista Brasileira de Enfermagem. 2024;77(5):e20230493
DOI 10.1590/0034-7167-2023-0493
Views0RESUMEN
Objetivo:
Analizar la configuración de las relaciones de poder entre el equipo multiprofesional en el proceso de rondas de cabecera en el hospital.
Método:
Investigación cualitativa con datos analizados a través del análisis del discurso, basado en el marco teórico de Michel Foucault. De septiembre a diciembre de 2022, realizamos entrevistas y observaciones de campo con el equipo multiprofesional de un hospital de Belo Horizonte, Minas Gerais, Brasil, así como entrevistas cualitativas semiestructuradas con 37 profesionales.
Resultados:
Los participantes señalaron que las experiencias de los profesionales involucrados en las rondas de cabecera dependen de cómo el médico conduce el proceso, y el proceso centrado en el médico dificulta la participación de otros profesionales del equipo.
Consideraciones finales:
La forma en que los hospitales organizan las rondas de cabecera no promueve la articulación del conocimiento de sus profesionales. Además, dificulta la circulación del poder y perjudica el trabajo interdisciplinario en un proceso que mantiene al médico como actor principal de las decisiones clínicas.
Keywords:Conhecimentos, Atitudes e Prática em SaúdeEquipe de Assistência MultidisciplinarHospitaisPrática ProfissionalRelações InterprofissionaisSee more -
ORIGINAL ARTICLE11-22-2024
Bedside rounds in the hospital environment from the perspective of multiprofessional health teams
Revista Brasileira de Enfermagem. 2024;77(5):e20230493
Abstract
ORIGINAL ARTICLEBedside rounds in the hospital environment from the perspective of multiprofessional health teams
Revista Brasileira de Enfermagem. 2024;77(5):e20230493
DOI 10.1590/0034-7167-2023-0493
Views0ABSTRACT
Objective:
To analyze the configuration of power relations among the multiprofessional team in the bedside round process in the hospital.
Methods:
Qualitative research with data analyzed through discourse analysis, based on Michel Foucault’s theoretical framework. From September to December 2022, we conducted interviews and field observations with the multiprofessional team at a hospital in Belo Horizonte, Minas Gerais, Brazil, as well as qualitative, semi-structured interviews with 37 professionals.
Results:
The participants pointed out that the experiences of the professionals involved in bedside rounds depend on how the physician conducts the process, and the physician-centered process makes it difficult for other professionals in the team to participate.
Final considerations:
The way hospitals organize bedside rounds does not promote knowledge articulation for their professionals. It hinders the circulation of power and harms interdisciplinary work in a process that maintains the physician as the main actor in clinical decisions.
Keywords:Health Knowledge, Attitudes, PracticeHospitalsInterprofessional RelationsPatient Care TeamProfessional PracticeSee more -
REVIEW11-22-2024
Transition to family parenting in the face of the first child: a scoping review
Revista Brasileira de Enfermagem. 2024;77(5):e20230487
Abstract
REVIEWTransition to family parenting in the face of the first child: a scoping review
Revista Brasileira de Enfermagem. 2024;77(5):e20230487
DOI 10.1590/0034-7167-2023-0487
Views1See moreABSTRACT
Objectives:
to identify and summarize the elements that characterize the family transition process in relation to the first child.
Methods:
a scoping review was carried out based on JBI methodology, in six databases, following the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews checklist.
Results:
ten articles were included with factors characterizing the transition, such as hindering/facilitating conditions that influence the process, important support structures in adaptation and strategies/responses used in the transition process.
Final Considerations:
elements characterizing the transition process in relation to the first child were identified. However, no theoretical explanation for this was identified. Further research should be carried out to obtain a deeper understanding of this process.
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