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TECHNOLOGICAL INNOVATION03-18-2024
Nursing rights in comics: educational technological innovation report
Revista Brasileira de Enfermagem. 2024;77:e20230438
Abstract
TECHNOLOGICAL INNOVATIONNursing rights in comics: educational technological innovation report
Revista Brasileira de Enfermagem. 2024;77:e20230438
DOI 10.1590/0034-7167-2023-0438
Views0ABSTRACT
Objectives:
to report an educational technology construction on nursing professionals’ rights.
Methods:
an experience report on educational technology construction during the crediting of university extension hours in an undergraduate nursing course at a Brazilian public university, between March and June 2023. The Deming cycle was used as a procedural method.
Results:
four meetings were held between students and extension workers. Eight comic books were produced based on the Code of Ethics for Nurses, addressing professional autonomy, fair remuneration, risk-free work, denial of exposure in the media and others. The Deming cycle proved to be an important strategy for constructing products.
Conclusions:
nursing professionals’ rights must be discussed and improved. Educational technologies, such as comic books, provide playful and reflective learning.
Keywords:Education, NursingEthics, NursingGraphic NovelNursingTechnological Development and Innovation ProjectsSee more -
ORIGINAL ARTICLE03-18-2024
Nurses’ workload during the COVID-19 pandemic: potential for experiences of moral distress
Revista Brasileira de Enfermagem. 2024;77:e20230200
Abstract
ORIGINAL ARTICLENurses’ workload during the COVID-19 pandemic: potential for experiences of moral distress
Revista Brasileira de Enfermagem. 2024;77:e20230200
DOI 10.1590/0034-7167-2023-0200
Views0See moreABSTRACT
Objectives:
to understand nurses’ experiences of moral distress related to work overload during the COVID-19 pandemic in Brazil.
Methods:
qualitative research, whose data collection occurred through individual interviews with 19 nurses who worked on the front line of COVID-19 in health services in southeastern Brazil. Data were analyzed using thematic content analysis.
Results:
work overload proved to be a powerful source of experiences of moral distress due to excessive working hours during vaccination, double working hours, a troubled relationship due to pressure from managers and the population and physical and mental exhaustion, which prevented nurses from act according to their judgment.
Final Considerations:
nurses’ work overload reflects on quality patient care and prevents nurses from acting in accordance with their moral principles, generating moral distress in nurses.
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ORIGINAL ARTICLE03-15-2024
Cultural adaptation and validity evidence of the Student Nurse Stressor-15 (SNS-15) Scale for Brazil
Revista Brasileira de Enfermagem. 2024;77(1):e20230356
Abstract
ORIGINAL ARTICLECultural adaptation and validity evidence of the Student Nurse Stressor-15 (SNS-15) Scale for Brazil
Revista Brasileira de Enfermagem. 2024;77(1):e20230356
DOI 10.1590/0034-7167-2023-0356
Views0See moreABSTRACT
Objectives:
to carry out the cultural adaptation and evaluation of validity evidence of the Student Nurse Stressor-15 (SNS-15) Scale for use in Brazil.
Methods:
psychometric study, conducted from the stages of translation, synthesis, back-translation, review by a committee of seven experts, pre-test and evaluation of measurement properties with 32 and 238 nursing students, respectively. Descriptive statistics, Exploratory Factor Analysis (EFA), and Confirmatory Factor Analysis (CFA) were performed. The reliability of the instrument was estimated using McDonald’s Omega (ω).
Results:
EFA subsidized the distribution of the fifteen SNS-15 items into four factors. Using AFC, satisfactory fit indices were achieved (Comparative Fit Index = 0.94; Tucker-Lewis Index = 0.93; Root Mean Square Error of Approximation = 0.06; Standardized Root Mean Square Residual = 0.16) and ω = 0.86.
Conclusions:
the Brazilian version of the SNS-15 presents evidence that confirms its validity and reliability.
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ORIGINAL ARTICLE03-15-2024
Health Management of an HIV Testing and Counseling Center: Nursing Contributions
Revista Brasileira de Enfermagem. 2024;77(1):e20230217
Abstract
ORIGINAL ARTICLEHealth Management of an HIV Testing and Counseling Center: Nursing Contributions
Revista Brasileira de Enfermagem. 2024;77(1):e20230217
DOI 10.1590/0034-7167-2023-0217
Views0See moreABSTRACT
Objectives:
to analyze the role of nursing in the establishment of an HIV/AIDS Testing and Counseling Center in a Brazilian municipality.
Methods:
a historical study utilizing primary sources, including documents and oral accounts, involving a total of ten participants. The study encompasses the years 1997 and 1998. The research took place at the Testing and Counseling Center in São João de Meriti. Data was collected from March to May 2022.
Results:
nursing made significant contributions through the development of training initiatives led by nurses, who were also responsible for individual and group counseling, as well as HIV testing requests.
Final Considerations:
nursing played a crucial role in the center and in the management of Sexually Transmitted Infections, being involved in all stages of treatment in accordance with current public health policy.
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REVIEW03-15-2024
Factors associated with increased lactate levels in cardiac surgeries: scoping review
Revista Brasileira de Enfermagem. 2024;77(1):e20230117
Abstract
REVIEWFactors associated with increased lactate levels in cardiac surgeries: scoping review
Revista Brasileira de Enfermagem. 2024;77(1):e20230117
DOI 10.1590/0034-7167-2023-0117
Views0See moreABSTRACT
Objectives:
to map the factors associated with increased lactate levels in the postoperative period of cardiac surgery using extracorporeal circulation.
Methods:
this is a scoping review carried out in December 2022, across ten data sources. It was prepared in accordance with the recommendations of the Joanna Briggs Institute and the Preferred Reporting Items for Systematic Reviews and Meta Analyses Extension for Scoping Reviews checklist.
Results:
the most recurrent findings in studies regarding the factors responsible for the increase in lactate were: tissue hypoperfusion, cardiopulmonary bypass time and use of vasoactive drugs. In 95% of studies, increased lactate was related to increased patient mortality.
Conclusions:
discussing the causes of possible complications in cardiac surgery patients is important for preparing the team and preventing complications, in addition to ensuring quality recovery.
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REVIEW03-15-2024
Use of podcasts for health education: a scoping review
Revista Brasileira de Enfermagem. 2024;77(1):e20230096
Abstract
REVIEWUse of podcasts for health education: a scoping review
Revista Brasileira de Enfermagem. 2024;77(1):e20230096
DOI 10.1590/0034-7167-2023-0096
Views0See moreABSTRACT
Objectives:
to map the scientific evidence related to the characteristics, themes, and outcomes of using health education podcasts aimed at individuals over 18 years of age in intra or extrahospital environments.
Methods:
a scoping review, based on the Joanna Briggs Institute method, conducted in 11 databases, including studies from 2004 to 2022.
Results:
11 studies were selected, categorized, highlighting the characteristics, evaluated outcomes, areas, and conditions of podcast application, indicating it as an effective tool for promoting behavioral change, health promotion, and social interaction, demonstrating its potential to improve well-being, quality of life, and user/client autonomy.
Conclusions:
the use of podcasts proves to be an effective, innovative, and low-cost tool, with a significant social impact, being effective for behavioral change, satisfaction, and social interaction. However, the lack of comprehensive studies on podcast development methodologies represents challenges to be overcome.
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REVIEW03-15-2024
Resources for health literacy among caregivers of prematurely born children: a scoping review
Revista Brasileira de Enfermagem. 2024;77(1):e20230062
Abstract
REVIEWResources for health literacy among caregivers of prematurely born children: a scoping review
Revista Brasileira de Enfermagem. 2024;77(1):e20230062
DOI 10.1590/0034-7167-2023-0062
Views0See moreABSTRACT
Objectives:
to map the available evidence on resources used to promote health literacy among caregivers of prematurely born children during outpatient follow-up.
Methods:
the Joanna Briggs Institute’s scope review protocol was utilized. The search encompassed six databases, incorporating studies from 2012 to 2022.
Results:
the three included publications revealed that the resources employed are: mobile applications, phone calls, individual counseling, videos, educational pamphlets, and group discussions. Implementing an education protocol during the transition home enhances scientifically grounded health promotion rates.
Conclusions:
there is limited literature addressing the health literacy of these caregivers. The nursing team plays a crucial role in health education and in developing resources applicable to these families.
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ORIGINAL ARTICLE03-15-2024
Effects of training Community Health Agents on dementia: a quasi-experimental study
Revista Brasileira de Enfermagem. 2024;77(1):e20230027
Abstract
ORIGINAL ARTICLEEffects of training Community Health Agents on dementia: a quasi-experimental study
Revista Brasileira de Enfermagem. 2024;77(1):e20230027
DOI 10.1590/0034-7167-2023-0027
Views1See moreABSTRACT
Objectives:
to evaluate the knowledge of Community Health Agents about dementia before and after the training workshop for detecting signs of the disease.
Methods:
a quasi-experimental study with 33 community agents, in which sociodemographic information and knowledge about dementia were collected and assessed using the Alzheimer’s Disease Knowledge Scale before and after the workshop. There were 10 weekly, online, synchronous meetings. The Student’s t-test for related samples was used, and the effect size was calculated.
Results:
while the average score on the initial assessment, using the measurement instrument, was 16.3, it was 21.24 in the final assessment. An increase in the scale score was observed after participating in the workshop, with a value of 4.94.
Conclusions:
it is urgent to invest in the ongoing education of these professionals for greater awareness in the timely detection of dementia cases in primary care and awareness of potentially modifiable factors.
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ORIGINAL ARTICLE07-19-2024
Validation of an instrument for assessing leprosy care in children and adolescents
Revista Brasileira de Enfermagem. 2024;77(2):e20230344
Abstract
ORIGINAL ARTICLEValidation of an instrument for assessing leprosy care in children and adolescents
Revista Brasileira de Enfermagem. 2024;77(2):e20230344
DOI 10.1590/0034-7167-2023-0344
Views0See moreABSTRACT
Objectives:
to validate the content of an instrument for assessing leprosy care in individuals under 15 years old in the context of Primary Health Care.
Methods:
methodological study of content validation, based on the evaluation of essential and derived attributes in primary care, in the professional version. For data analysis, the Content Validation Index (CVI ≥ 0.8) and Cronbach’s Alpha were calculated.
Results:
a higher percentage of judges among nurses (61.5%) was observed; with a doctorate (46.2%), and engaged in teaching and research (77%). The overall Content Validation Index of the instrument was 0.98. In the analysis of Cronbach’s Alpha of the instrument, the assigned value was 0.717.
Conclusions:
the instrument represents an advancement in the measurement of health evaluation policies and can significantly contribute to improving the quality of care provided to children and adolescents with leprosy.
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ORIGINAL ARTICLE07-19-2024
Validation of the Brazilian Version of the Modified Scale for Delineating Advanced Practice Nursing Roles
Revista Brasileira de Enfermagem. 2024;77(2):e20230211
Abstract
ORIGINAL ARTICLEValidation of the Brazilian Version of the Modified Scale for Delineating Advanced Practice Nursing Roles
Revista Brasileira de Enfermagem. 2024;77(2):e20230211
DOI 10.1590/0034-7167-2023-0211
Views0See moreABSTRACT
Objectives:
to validate the Brazilian version of the Modified Scale for Delineating Advanced Practice Nursing Roles.
Methods:
this was a methodological study for the clinical validation of an instrument, conducted with 207 nurses working in primary care. Exploratory and confirmatory factor analysis, Cronbach’s alpha test, and z-test for proportion comparison were used.
Results:
the internal reliability of the scale was 0.944, with alpha greater than 0.80 in most domains, except for Education (0.786). In the exploratory factor analysis, considering the criterion of eigenvalue greater than one, eight factors were identified, explaining 79.38% of the variance. In the comparison of proportions, the adequate responses (≥ 2) in the domain of Comprehensive Direct Care, in both analyzed groups, were statistically equal. This domain had the highest score of adequate responses, followed by Education and Systems Support. Insufficient scoring was observed in the domains of Publication and Professional Leadership.
Conclusions:
the instrument demonstrated stability and reliability to be used in the evaluation of advanced nursing practice.
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REVIEW07-19-2024
Nursing care for hospitalized older adults – fall accidents versus safe mobility: a scoping review
Revista Brasileira de Enfermagem. 2024;77(2):e20230180
Abstract
REVIEWNursing care for hospitalized older adults – fall accidents versus safe mobility: a scoping review
Revista Brasileira de Enfermagem. 2024;77(2):e20230180
DOI 10.1590/0034-7167-2023-0180
Views0See moreABSTRACT
Objectives:
to map the constituent elements of the safe mobility concept present in hospital care for older adults.
Methods:
a scoping review of 35 articles searched in databases and gray literature – BDENF/VHL, Scopus, CINAHL/EBSCO, Embase, Web of Science, PEDro, MEDLINE/PubMed and CAPES Theses and Dissertations Catalog. No time or language cut-off was established.
Results:
none of the studies presented a clear safe mobility concept, however its constituent elements involve factors related to patient (behavioral factors, conditions, diseases, signs and symptoms, nutritional status, age, balance, strength, gait quality, sleep), the institution (environment, treatment devices, guidelines, medications and polypharmacy, material and human resources and clothing/shoes) and the nature of the interventions (related to the patient, institution and family).
Final Considerations:
the constituent elements of safe mobility express hospital units’ capacity to guarantee care and protection from fall accidents for hospitalized older adults.
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REVIEW07-19-2024
Drug-resistant tuberculosis: integrative review of nursing care in primary health care
Revista Brasileira de Enfermagem. 2024;77(2):e20230097
Abstract
REVIEWDrug-resistant tuberculosis: integrative review of nursing care in primary health care
Revista Brasileira de Enfermagem. 2024;77(2):e20230097
DOI 10.1590/0034-7167-2023-0097
Views0See moreABSTRACT
Objectives:
to identify, in the scientific literature, the care that should be provided to individuals with drug-resistant tuberculosis by nurses in primary health care.
Methods:
integrative review, using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses study selection flowchart. Data collection was conducted in November 2022, across ten databases.
Results:
six studies emphasized that nurses should perform directly observed treatment; two highlighted the importance of integrated care management between tuberculosis and human immunodeficiency virus; two demonstrated comprehensive nursing consultation using the nursing process; one emphasized person-centered care, with discharge planning and improved hospital communication with primary health care services.
Final Considerations:
the care that nurses should provide to individuals with drug-resistant tuberculosis in primary health care, for care resolution, is evidence-based.
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ORIGINAL ARTICLE07-19-2024
Translation and cross-cultural adaptation of the MISSCARE Survey-Ped into Brazilian Portuguese
Revista Brasileira de Enfermagem. 2024;77(2):e20230060
Abstract
ORIGINAL ARTICLETranslation and cross-cultural adaptation of the MISSCARE Survey-Ped into Brazilian Portuguese
Revista Brasileira de Enfermagem. 2024;77(2):e20230060
DOI 10.1590/0034-7167-2023-0060
Views0See moreABSTRACT
Objectives:
to translate and cross-culturally adapt the MISSCARE Survey-Ped for use in Brazil.
Methods:
a methodological study proposed by translation, synthesis of translations, back-translation, assessment by a committee of experts and pre-testing with the target population.
Results:
two direct translations of the instrument were carried out, followed by a consensual version between them. This synthetic version was back-translated and analyzed by a committee of five experts in pediatric nursing and patient safety, obtaining a Content Validity Index (CVI) of 0.95 and Cronbach’s alpha of 0.804. The final version was sent for pre-testing with 254 Brazilian pediatric nurses, with 44 (17.3%) analyzing the instrument for understanding (CVI 0.866; Content Validity Ratio (CVR) 0.773), relevance (CVI 0.931; CVR 0.864) and relevance (CVI 0.977; CVR 0.955).
Conclusions:
the MISSCARE Survey-Ped Brasil was considered suitable for application in pediatric nurses’ clinical practice in the country.
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EDITORIAL07-15-2024
Invisibilidade do trabalho da enfermagem: tecnologia como via de combate
Revista Brasileira de Enfermagem. 2024;77:e77suppl0301
Abstract
EDITORIALInvisibilidade do trabalho da enfermagem: tecnologia como via de combate
Revista Brasileira de Enfermagem. 2024;77:e77suppl0301
DOI 10.1590/0034-7167.202477suppl0301pt
Views0Na concepção comum, o trabalho é comumente associado a uma atividade remunerada em uma sociedade mercantil e de direito, refletindo a visão moderna que o limita ao tempo trocado por salário. Essa perspectiva, influenciada pelos princípios da Revolução Industrial, estabelece uma dicotomia entre o trabalho e o tempo fora dele, segmentando a vida em esferas […]See more -
EDITORIAL07-15-2024
Invisibility of nursing work: technology as a means of combat
Revista Brasileira de Enfermagem. 2024;77:e77suppl0301
Abstract
EDITORIALInvisibility of nursing work: technology as a means of combat
Revista Brasileira de Enfermagem. 2024;77:e77suppl0301
DOI 10.1590/0034-7167.202477suppl0301
Views0In the common conception, work is commonly associated with a paid activity in a commercial and legal society, reflecting the modern view that limits it to time exchanged for wage. This perspective, influenced by Industrial Revolution principles, establishes a dichotomy between work and time outside of work, segmenting life into professional and private spheres. However, […]See more
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ERRATUM01-01-2016
ERRATUM
Revista Brasileira de Enfermagem. 2016;69(5):1002-1002
Abstract
ERRATUMERRATUM
Revista Brasileira de Enfermagem. 2016;69(5):1002-1002
DOI 10.1590/0034-7167.20166905e01
Views0Article “Alcohol and alcoholism: attitudes of nursing students”, with number of DOI: http://dx.doi.org/10.1590/S0034-71672013000100013, published in the journal Revista Brasileira de Enfermagem, v66(1):84-9, page 89 that read:“18. Miranda SP, Vargas D. Satisfação de pacientes de um centro de atenção Psicossocial álcool e drogas com o atendimento do enfermeiro. SMAD, Rev Eletrônica Saúde Mental Alcool Drog 2019;5(2):1-15”.[…]See more -
REVIEW01-01-2016
Research methodology for nursing and health: a book review
Revista Brasileira de Enfermagem. 2016;69(5):1000-1001
Abstract
REVIEWResearch methodology for nursing and health: a book review
Revista Brasileira de Enfermagem. 2016;69(5):1000-1001
DOI 10.1590/0034-7167-2015-0135
Views0For those interested in nursing and health, the book entitled “Research methodology for nursing and health: from theory to practice”() was released in October 2015, at the 67th Brazilian Congress of Nursing, sponsored by National ABEn. The interest emerged from two organizers: Dr. Maria Ribeiro Lacerda (UFPR) and Dr. Regina Gema Santini Costerano (UNIFRA). Forty-seven […]See more -
REFLECTION01-01-2016
Violence in the workplace in Nursing: consequences overview
Revista Brasileira de Enfermagem. 2016;69(5):996-999
Abstract
REFLECTIONViolence in the workplace in Nursing: consequences overview
Revista Brasileira de Enfermagem. 2016;69(5):996-999
DOI 10.1590/0034-7167-2015-0133
Views0See moreABSTRACT
Objective:
to reflect on the consequences of workplace violence experienced by nursing professionals.
Methods:
this is a reflection paper based on recent publications related to the subject, particularly researches carried out in Brazil and in other countries.
Results:
exposure to workplace violence has been associated with health problems in nursing professionals, which may be physical damage, emotional manifestations, and psychic disorders. It also affects the employee performance, his or her family and social interactions.
Conclusion:
this phenomenon is potentially noxious and costly, for it leads to suffering, illness, absence from work, and even death. This reflection calls attention moreover to the importance of a safe and adequate health care work environment.
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REFLECTION01-01-2016
Construcción de la enfermera de práctica avanzada en Catalunya (España)
Revista Brasileira de Enfermagem. 2016;69(5):991-995
Abstract
REFLECTIONConstrucción de la enfermera de práctica avanzada en Catalunya (España)
Revista Brasileira de Enfermagem. 2016;69(5):991-995
DOI 10.1590/0034-7167.2016690507
Views0RESUMEN
El desarrollo de la enfermera de práctica avanzada (EPA) ha supuesto un reto para las enfermeras en países como EE.UU., Canadá, Gran Bretaña y Australia, entre otros, y desde hace escasos años está siendo considerada en Catalunya y España como un sistema para desarrollar nuevos roles que aporten eficacia y eficiencia al sistema sanitario. El presente artículo pretende conceptualizar la EPA y los modelos de referencia así como contextualizar y reflexionar sobre la EPA en Catalunya, desde el punto de vista de formación y de la implantación de los denominados nuevos roles de enfermería, asimilándolos a la práctica avanzada.
Keywords:Competencia ClínicaEnfermeríaEnfermería de Práctica AvanzadaPráctica ProfesionalRol de la EnfermeraSee more -
REFLECTION01-01-2016
Developing the Advanced Practice Nurse in Catalonia
Revista Brasileira de Enfermagem. 2016;69(5):991-995
Abstract
REFLECTIONDeveloping the Advanced Practice Nurse in Catalonia
Revista Brasileira de Enfermagem. 2016;69(5):991-995
DOI 10.1590/0034-7167.2016690507
Views0See moreABSTRACT
The development of advanced practice nurses (APN) has proved a challenge for nurses in countries such as the USA, Canada, Great Britain, and Australia among others. It is only in recent years that the system has been considered in Catalonia and Spain as a way to develop new roles to bring effectiveness and efficiency to the health system. From the standpoint of training and implementation of the above-mentioned new nursing roles, the following article aims to conceptualise APN and its reference models, as well as to contextualise and reflect on APN in Catalonia in order to assimilate them into advanced practice.
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EXPERIENCE REPORT01-01-2016
International academic mobility in nursing education: an experience report
Revista Brasileira de Enfermagem. 2016;69(5):986-990
Abstract
EXPERIENCE REPORTInternational academic mobility in nursing education: an experience report
Revista Brasileira de Enfermagem. 2016;69(5):986-990
DOI 10.1590/0034-7167-2015-0128
Views0See moreABSTRACT
Objective:
report the experience of international academic mobility in Ireland through the program Science Without Borders during undergraduate education in nursing.
Method:
a report of experience presented in chronological order, with a descriptive nature.
Results:
the opportunity to know and be able to discuss questions regarding health and nursing in Ireland allowed the review of concepts and a more reflective perspective regarding nursing practices. Additionally, the exchange promoted personal strengthening regarding the confrontation and solution of problems, development of technical and scientific abilities, improvement of linguistic competences and construction of personality, independence and maturity.
Conclusion:
regarding such constructive and enriching experience that this mobility provides to students, to the governing authorities, to the population and to Brazilian nursing, sharing this experience is expected to serve as encouragement for those who search for new horizons, with the objective of adding knowledge for their personal and professional life.
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EXPERIENCE REPORT01-01-2016
Online training for health professionals in three regions of Brazil
Revista Brasileira de Enfermagem. 2016;69(5):981-985
Abstract
EXPERIENCE REPORTOnline training for health professionals in three regions of Brazil
Revista Brasileira de Enfermagem. 2016;69(5):981-985
DOI 10.1590/0034-7167.2016690506
Views0See moreABSTRACT
Objective:
to describe online training experience aimed at professionals working in the public health service in 27 Neonatal and Pediatric Intensive Care Units, and to reflect concerning the training process and possible improvements in this process.
Method:
this is an experience report study about the online training with multidisciplinary content, planned from the situational diagnosis of 27 institutions. The training target set was 10 participants per institution and per module, including the following topics: Indicators of Quality as a Management Tool, Hand Hygiene, Patient Safety, Intravenous Therapy and Patients’ Chart Record.
Results:
a total of 2,071 active students in the modules, with 1,046 approved. The mean of 76 students per module exceeded the target set.
Conclusion:
experience has shown that online training is comprehensive as a potential tool for the professional technical development and digital inclusion. The online learning system becomes weakened if participants are unaware of the technological resources.
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REVIEW01-01-2016
Technologies in intensive care: causes of adverse events and implications to nursing
Revista Brasileira de Enfermagem. 2016;69(5):972-980
Abstract
REVIEWTechnologies in intensive care: causes of adverse events and implications to nursing
Revista Brasileira de Enfermagem. 2016;69(5):972-980
DOI 10.1590/0034-7167.2016690505
Views0See moreABSTRACT
Objective:
to identify the causes of adverse events affecting clients resulting from the use of equipment in intensive care services; to point out the main recommendations for clinical practice to minimize these events and, then, discuss the implications to nursing care.
Method:
integrative and descriptive review on the SciELO, Medline, LILACS, and PubMed databases. Articles were selected based on the inclusion criteria and the structured instrument was applied.
Results:
altogether, 11 articles were selected where three evidence units were outstanding: Equipment failure; inadequate use of equipment; and team failure. Permanent education of professionals; evaluation of production and availability of equipment; and use of checklists are recommended.
Conclusion:
preventing adverse events related to equipment is one of the nursing responsibilities and requires the establishment of defensive barriers to prevent these.
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