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RESEARCH01-01-2017
Assessing the adequacy of workload measurement tools using a quality-based methodology
Revista Brasileira de Enfermagem. 2017;70(1):39-46
Abstract
RESEARCHAssessing the adequacy of workload measurement tools using a quality-based methodology
Revista Brasileira de Enfermagem. 2017;70(1):39-46
DOI 10.1590/0034-7167-2016-0246
Views0See moreABSTRACT
Objective:
determine which tool (NEMS and NAS) is most suitable for use in intensive care units using a quality-based methodology.
Method:
after identifying the opportunity for improvement “Inadequacy of the NEMS for determining nursing workload in the intensive care unit (ICU)”, we assessed the NEMS and the NAS, as a proposed improvement to the NEMS, using quality improvement cycles methodology based on the following criteria: measurement of daily nursing workload on a daily and shift basis; the tool encompasses all nursing activities undertaken in the ICU; and workload assessed per patient and unit.
Results:
there was no significant difference in level of compliance for the NEMS (67%). The comparison NEMS-NAS showed that there was a statistically significant improvement for all criteria except criterion 1. The NEMS only assesses criterion 1 (64.22%); while the NAS assessed all four criteria, obtaining a compliance rate of 64.74% for criteria 1, 2, and 4, and 100% for criterion 3.
Conclusion:
the NAS is more suitable for measuring nursing workload in UCIs.
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RESEARCH01-01-2017
Educational nursing intervention to reduce the hyperphosphatemia in patients on hemodialysis
Revista Brasileira de Enfermagem. 2017;70(1):31-38
Abstract
RESEARCHEducational nursing intervention to reduce the hyperphosphatemia in patients on hemodialysis
Revista Brasileira de Enfermagem. 2017;70(1):31-38
DOI 10.1590/0034-7167-2016-0015
Views0See moreABSTRACT
Objective:
to evaluate the effectiveness of an educational nursing intervention to reduce hyperphosphataemia in chronic renal patients on hemodialysis.
Method:
quasi-experimental study with 63 hyperphosphatemic patients on hemodialysis. The intervention consisted of developing and providing a printed and illustrated manual to patients containing information on disease control. The participant was asked to complete a daily checklist with the aim to reinforce aspects provided in the manual. Laboratory tests and itching intensity were analyzed at the beginning of the study, and at 30 and 60 days after the educational intervention.
Results:
the mean age of participants was 58±13.1 years, with a treatment time of 51.1±44.7 months. A reduction in serum phosphorus values of 7.06 ± 1.43 to 5.80 ± 1.53 (p <0.001) and the intensity of itching after the intervention was observed.
Conclusion:
the educational nursing intervention was effective in reducing phosphate and decreasing itching in hyperphosphatemic patients.
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RESEARCH01-01-2017
Filial care and the relationship with the elderly in families of different nationalities
Revista Brasileira de Enfermagem. 2017;70(1):22-30
Abstract
RESEARCHFilial care and the relationship with the elderly in families of different nationalities
Revista Brasileira de Enfermagem. 2017;70(1):22-30
DOI 10.1590/0034-7167-2015-0050
Views0See moreABSTRACT
Objective:
identify how filial care and the relationship with the elderly occur in families of different nationalities.
Method:
qualitative study carried out in a town on the triple frontier of Paraná, comprising 33 elderly people of five different nationalities, adopting the Symbolic Interactionism and the Grounded Theory as theoretical-methodological strategy.
Results:
among Lebanese people, the Muslim religion teaches children to obey and respect parents; among French, distant family relationships and institutions for the elderly stand out. Paraguayans hold close family relationships; Chinese people consider filial care as a tacit obligation; Brazilians, in turn, tend to embrace and take care of their parents in old age.
Conclusion:
family care prevailed, but the traditions of each society lead the actions of that care, demanding health professionals’ capacity of recognizing in which context the elderly is inserted.
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RESEARCH01-01-2017
Excesso de volume de líquidos: análise clínica e sociodemográfica em pacientes de hemodiálise
Revista Brasileira de Enfermagem. 2017;70(1):15-21
Abstract
RESEARCHExcesso de volume de líquidos: análise clínica e sociodemográfica em pacientes de hemodiálise
Revista Brasileira de Enfermagem. 2017;70(1):15-21
DOI 10.1590/0034-7167-2015-0138
Views0See moreRESUMEN
Objetivo:
analizar las características definitorias y los factores relacionados con el diagnóstico enfermero de exceso de volumen líquido y su relación con variables sociodemográficas y clínicas en pacientes de hemodiálisis.
Método:
estudio transversal, realizado mediante un formulario y examen físico, con una muestra de 100 pacientes, entre diciembre de 2012 y abril de 2013 en un hospital universitario y una clínica de diálisis.
Resultados:
se encontraron 10 asociaciones estadísticamente significativas entre las características definitorias, factores relacionados de volumen de exceso de líquido y las variables sociodemográficas y clínicas.
Conclusión:
las características definitorias y los factores relacionados de exceso de volumen líquido podrían estar influenciados por variables sociodemográficas y clínicas en clientes de hemodiálisis.
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RESEARCH01-01-2017
Excess fluid volume: sociodemographic and clinical analysis in haemodialysis patients
Revista Brasileira de Enfermagem. 2017;70(1):15-21
Abstract
RESEARCHExcess fluid volume: sociodemographic and clinical analysis in haemodialysis patients
Revista Brasileira de Enfermagem. 2017;70(1):15-21
DOI 10.1590/0034-7167-2015-0138
Views0See moreABSTRACT
Objective:
To analyse the defining characteristics and related factors in the nursing diagnosis Excess fluid volume and its relationship to sociodemographic and clinical variables in haemodialysis patients.
Method:
Cross-sectional study, conducted using a form and physical examination, with a sample of 100 patients, between December 2012 and April 2013 at a university hospital and a dialysis clinic.
Results:
It was found 10 significant statistical associations between the defining characteristics/ related factors of Excess fluid volume and the sociodemographic and clinical variables.
Conclusion:
The defining characteristics and related factors of Excess fluid volume could be influenced by sociodemographic and clinical variables in haemodialysis clientele.
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EDITORIAL01-01-2017
Facing challenges in times of adversity
Revista Brasileira de Enfermagem. 2017;70(1):1-2
Abstract
EDITORIALFacing challenges in times of adversity
Revista Brasileira de Enfermagem. 2017;70(1):1-2
DOI 10.1590/0034-7167.2017700101
Views0At the confluence of tradition, respect for history and a critical approach to the issues inherent to the development of the nursing profession, the Brazilian Nursing Association (ABEn) has been consolidating an exemplary trajectory in Brazilian society. Throughout its history, the reflections, discussions and decisions on pertinent and urgent subjects of the profession have made […]See more -
EDITORIAL01-01-2017
Enfrentando desafios em tempos de adversidades
Revista Brasileira de Enfermagem. 2017;70(1):1-2
Abstract
EDITORIALEnfrentando desafios em tempos de adversidades
Revista Brasileira de Enfermagem. 2017;70(1):1-2
DOI 10.1590/0034-7167.2017700101
Views0Na confluência da tradição, do respeito pela história e da abordagem crítica das questões inerentes ao desenvolvimento da profissão de enfermagem, a Associação Brasileira de Enfermagem (ABEn) vem consolidando uma trajetória exemplar na sociedade brasileira. Ao longo da sua história, as reflexões, discussões e decisões sobre assuntos pertinentes e prementes da profissão têm possibilitado intervenções […]See more -
REFLECTION01-01-2016
Epistemology of nursing care: a reflection on its foundations
Revista Brasileira de Enfermagem. 2016;69(6):1240-1245
Abstract
REFLECTIONEpistemology of nursing care: a reflection on its foundations
Revista Brasileira de Enfermagem. 2016;69(6):1240-1245
DOI 10.1590/0034-7167-2016-0331
Views0See moreABSTRACT
Objective:
to reflect on nursing care and its epistemology from its historical, theoretical, philosophical, spiritual dimensions and as a social practice.
Method:
discussions originated in the discipline “Epistemology of caring”, from the graduate nursing program of the School of Nursing, Federal University of Minas Gerais, and in critical analysis of nursing literature together with the professional practice of the authors.
Results:
we identified the necessity of developing a critical conscience on health care provision, research, and teaching, as well as on challenges in maintaining high standards of working interpersonal relationships, which has a profound impact on population health.
Conclusion:
we suggest the rescue of integrality, humanization, unity, and spirituality in researches and practices of individual, familiar, and community care, as an advance in incorporating epistemology of caring in nursing.
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ORIGINAL ARTICLE06-17-2024
Quality of life associated with nursing professionals’ individual resources and work
Revista Brasileira de Enfermagem. 2024;77(3):e20230476
Abstract
ORIGINAL ARTICLEQuality of life associated with nursing professionals’ individual resources and work
Revista Brasileira de Enfermagem. 2024;77(3):e20230476
DOI 10.1590/0034-7167-2023-0476
Views0See moreABSTRACT
Objectives:
to assess the physical and mental components of nursing professionals’ quality of life and associate them with individual, health and work characteristics.
Methods:
cross-sectional research, with nursing professionals from a university hospital in São Paulo. Own questionnaire and validated instruments were applied.
Results:
the overall quality of life was compromised. The physical component was lower in relation to low family income and among those who perceived greater control/pressure at work, and better for those who practiced physical activity and had support of leader and organization. The mental component was lower in professionals who reported dissatisfaction with work, worse self-rated physical health and were older. Scores for both components reduced due to work-related illnesses, worse work ability and increased daytime sleepiness.
Conclusions:
quality of life was statistically associated with controllable institutional factors and individual resources that, except age, can be promoted.
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ORIGINAL ARTICLE06-17-2024
Giving meaning to internalized violence throughout life by older adults living in rural areas
Revista Brasileira de Enfermagem. 2024;77(3):e20230163
Abstract
ORIGINAL ARTICLEGiving meaning to internalized violence throughout life by older adults living in rural areas
Revista Brasileira de Enfermagem. 2024;77(3):e20230163
DOI 10.1590/0034-7167-2023-0163
Views0See moreABSTRACT
Objectives:
to understand the meanings of violence internalized throughout life by older adults living in rural areas.
Methods:
a qualitative study, anchored in the Symbolic Interactionism theoretical framework and the Grounded Theory methodological framework in the constructivist aspect. Data collection occurred through individual interviews. Data were coded using the Atlas.ti software.
Results:
it was possible to identify that the context of rural areas strengthens patriarchy culture as well as contributing to violence silence and naturalization. It was also found that violence is a product of social inequality and gender inequality.
Final Considerations:
older adults living in rural areas internalized the violence suffered in a unique way, and this scenario’s specific aspects can increase intra-family abuse, as there is a patriarchal culture that promotes social and gender inequality.
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ERRATUM06-14-2024
ERRATUM
Revista Brasileira de Enfermagem. 2024;77(2):e2024n2e06
Abstract
ERRATUMERRATUM
Revista Brasileira de Enfermagem. 2024;77(2):e2024n2e06
DOI 10.1590/0034-7167.20247702e06
Views0In the article “Is there scientific relevance to the plot of films and documentaries about eating disorders?”, with DOI number: , published in Revista Brasileira de Enfermagem, 2024;77(1):e20220547, page 7:Where it read:[…]See more -
ERRATUM06-14-2024
ERRATUM
Revista Brasileira de Enfermagem. 2024;77(2):e2024n2e05
Abstract
ERRATUMERRATUM
Revista Brasileira de Enfermagem. 2024;77(2):e2024n2e05
DOI 10.1590/0034-7167.20247702e05
Views0In the article “Educational technologies used to promote self-care for people with diabetes mellitus: integrative review”, with DOI number: , published in Revista Brasileira de Enfermagem, 2023;76(Suppl 4):e20230049, in the title:Where it read:[…]See more -
REVIEW06-14-2024
Lean and/or Six Sigma for process optimization in the perioperative period: an integrative review
Revista Brasileira de Enfermagem. 2024;77(2):e20230431
Abstract
REVIEWLean and/or Six Sigma for process optimization in the perioperative period: an integrative review
Revista Brasileira de Enfermagem. 2024;77(2):e20230431
DOI 10.1590/0034-7167-2023-0431
Views0See moreABSTRACT
Objective:
To analyze the evidence on the influence of Lean and/or Six Sigma for process optimization in the perioperative period.
Methods:
Integrative review carried out in the MEDLINE (PubMed), Web of Science, EMBASE, CINAHL, Scopus and LILACS databases on the use of Lean and/or Six Sigma to optimize perioperative processes. The studies included were analyzed in three thematic categories: flow of surgical patients, work process and length of stay.
Results:
The final sample consisted of ten studies, which covered all operative periods. Lean and/or Six Sigma make a significant contribution to optimizing perioperative processes.
Final considerations:
Lean and/or Six Sigma optimize perioperative processes to maximize the achievement of system stability indicators, making it possible to identify potential problems in order to recognize them and propose solutions that can enable the institution of patient-centered care.
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ORIGINAL ARTICLE06-14-2024
Strategies used by nurses regarding underreporting of rural work accidents due to pesticide use
Revista Brasileira de Enfermagem. 2024;77(2):e20230384
Abstract
ORIGINAL ARTICLEStrategies used by nurses regarding underreporting of rural work accidents due to pesticide use
Revista Brasileira de Enfermagem. 2024;77(2):e20230384
DOI 10.1590/0034-7167-2023-0384
Views0See moreABSTRACT
Objective:
To learn the strategies used regarding underreporting of pesticide use in rural areas.
Methods:
A qualitative study was carried out in eight primary healthcare units in rural areas and two emergency care units in a municipality in southern Brazil. Data collection took place in 2023 through interviews. Twenty professional nurses participated. The data was submitted to content analysis.
Results:
The strategies identified were lifelong and continuing education for the professionals who carry out the notification, active search and training of workers who deal directly with this type of substance, computerizing the notification by filling in the forms online, and carrying out research on the subject.
Final considerations:
Nurses play an important role in reporting occupational accidents caused by the use of pesticides, improving occupational safety in rural areas.
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ORIGINAL ARTICLE06-14-2024
Teoria de médio alcance do diagnóstico de enfermagem sobrepeso
Revista Brasileira de Enfermagem. 2024;77(2):e20230372
Abstract
ORIGINAL ARTICLETeoria de médio alcance do diagnóstico de enfermagem sobrepeso
Revista Brasileira de Enfermagem. 2024;77(2):e20230372
DOI 10.1590/0034-7167-2023-0372
Views0See moreRESUMEN
Objetivo:
Construir una teoría de rango medio para el diagnóstico de enfermería Sobrepeso en adolescentes y adultos jóvenes.
Métodos:
Estudio metodológico a la luz de los marcos teóricos de Roy y de Lopes, Silva y Herdman. Un total de 3.925 artículos fueron recuperados y evaluados utilizando el software State of the Art Through Systematic Review. La muestra final fue de 28 artículos.
Resultados:
Los resultados convergieron en 3 atributos esenciales, 13 antecedentes y 7 consecuencias. Se construyó una teoría de rango medio compuesta por un diagrama ilustrado, 11 proposiciones y 12 relaciones causales.
Consideraciones finales:
A partir de la creación de la teoría, fue posible comprender mejor el diagnóstico de enfermería Sobrepeso en el contexto de adolescentes y adultos jóvenes. La comprensión de los fenómenos de enfermería contribuye para el avance y fortalecimiento de la ciencia de enfermería.
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RESEARCH01-01-2016
Avaliação do risco de úlceras por pressão em pacientes hospitalizados com HIV/Aids
Revista Brasileira de Enfermagem. 2016;69(1):96-101
Abstract
RESEARCHAvaliação do risco de úlceras por pressão em pacientes hospitalizados com HIV/Aids
Revista Brasileira de Enfermagem. 2016;69(1):96-101
DOI 10.1590/0034-7167.2016690113i
Views0RESUMEN
Objetivo:
evaluar el riesgo de desarrollar úlceras por presión en pacientes hospitalizados con VIH/SIDA.
Método:
estudio cuantitativo descriptivo con 35 pacientes. Caracterización epidemiológica y clínica de los pacientes en un instrumento mediante la Escala de Braden. Las variables se realizaron en forma descriptiva simple, por números absolutos.
Resultados:
la incidencia de la PU observada en 2 pacientes, y las comorbilidades fueron neumocistosis pneumocisti carinii y tuberculosis pulmonar. Se reveló que la subescala de fricción y fuerza de deslizamiento obtuvo una puntuación más baja, seguido por actividad y la nutrición, la movilidad y la humedad. La percepción sensorial obtuvo la puntuación más alta. Dos pacientes fueron clasificados como de “alto riesgo” a 6 de “alto riesgo”, 3 para “bajo riesgo” y el otro “ningún riesgo”.
Conclusión:
la calificación de riesgo, mediante el uso de escalas proporciona información objetiva para la toma de decisione de enfermería a un modo específico.
Keywords:Cuidados de EnfermagemDoença CrônicaFatores de RiscoSíndrome da Imunodeficiência AdquiridaÚlcera por PressãoSee more -
RESEARCH01-01-2016
Assessment of the risk of pressure ulcer development among hospitalized HIV/Aids patients
Revista Brasileira de Enfermagem. 2016;69(1):96-101
Abstract
RESEARCHAssessment of the risk of pressure ulcer development among hospitalized HIV/Aids patients
Revista Brasileira de Enfermagem. 2016;69(1):96-101
DOI 10.1590/0034-7167.2016690113i
Views0See moreABSTRACT
Objective:
to assess the risk of pressure ulcer development among hospitalized HIV/Aids.
Metod:
study quantitative descriptive with 35 patients admitted to an infectious diseases hospital in Curitiba-PR-BR. Characterized clinical and epidemiological of patients using a data collection instrument and the Braden Scale. Data was compiled using Excel® and a simple descriptive analysis.
Results:
two patients were found to have pressure ulcers and the most common comorbidities associated with HIV/Aids were pneumocystis pneumonia, caused by pneumocisti cariini (16), and pulmonary tuberculosis (13). The lowest scores were obtained in the friction and shear subscale, followed by the activity, nutrition, mobility and moisture subscales. The highest score was obtained in the sensory perception subscale. Two patients were classified as ‘very high risk’, six as ‘high risk’, three as ‘low risk’, and the rest as ‘no risk’.
Conclusion:
risk assessment using scales provides objective information to assist with systemized and targeted nursing decision-making.
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RESEARCH01-01-2016
Children with special health needs and family: implications for Nursing
Revista Brasileira de Enfermagem. 2016;69(1):88-95
Abstract
RESEARCHChildren with special health needs and family: implications for Nursing
Revista Brasileira de Enfermagem. 2016;69(1):88-95
DOI 10.1590/0034-7167.2016690112i
Views0See moreABSTRACT
Objective:
to understand the family experience of children and adolescents with myelomeningocele by the discovery of chronic illness and their daily life in the realization of needed care to these people.
Method:
qualitative study, developed from October 2013 to February 2014, with family, in a pediatric hospital in Fortaleza. Data were collected through interviews and checked by analysis thematic category.
Results:
it was found that the diagnosis after the birth of the child caused fear and anguish to the families in front of the unknown and the unexpected and that over the years they started to deal with many challenges conducting the daily care due to the disease sequelae.
Conclusion:
nursing plays an important role in the lives of families, children and adolescents, through emotional support, guidelines and care inserted in the health care network.
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RESEARCH01-01-2016
Evaluation of the care program implementation to people with high blood pressure
Revista Brasileira de Enfermagem. 2016;69(1):79-87
Abstract
RESEARCHEvaluation of the care program implementation to people with high blood pressure
Revista Brasileira de Enfermagem. 2016;69(1):79-87
DOI 10.1590/0034-7167.2016690111i
Views0See moreABSTRACT
Objective:
to evaluate the implementation of the care program for people with hypertension in Maringá-PR.
Method:
it is an evaluative research of cross-sectional design. Data were collected through structured interviews with 63 nurses between April and June 2013.
Results:
as missing or insufficient, there were: transportation for outside activities; work equipment; educational materials; training resources; inclusion of the family in the care plan; risk classification of individuals; determination of therapy from the risk classification and referral of the patient to medical and/or specialized tests.
Conclusion:
in addition to qualifying structure, there are: the need to identify people with hypertension as risk factors, perform risk stratification and systematic care planning, establishing an advanced clinical practice, such as support for self-care and management cases, accomplish with existing protocols and develop collective actions based on information systems.
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RESEARCH01-01-2016
Evaluation of quality of life of visually impaired
Revista Brasileira de Enfermagem. 2016;69(1):72-78
Abstract
RESEARCHEvaluation of quality of life of visually impaired
Revista Brasileira de Enfermagem. 2016;69(1):72-78
DOI 10.1590/0034-7167.2016690110i
Views0ABSTRACT
Objective:
to evaluate the quality of life of visually impaired using WHOQOL-100.
Method:
exploratory, descriptive, and quantitative study, performed between April and May 2013 with 20 visually impaired of the Blind Association of Ceará, through interviews.
Results:
the analysis showed that males predominated (80%), 41-55 years (40%), students (50%) and personal income than the minimum wage (70%). Participants were self-rated with good quality of life (68.75%). The facets with the highest rates were personal relationships (74.06%), sexual activity (66.88%) and spirituality/religion/personal beliefs (65%). With lower rates were financial (43.44%), physical environment: pollution/noise/traffic/climate (46.88%), physical security and protection (37.19%), transport (35.63%) and medication or treatment dependency (8.25%).
Conclusion:
these results reflect the importance of the nurse to perform health education actions promoting the empowerment, autonomy and guaranteed of access in society for this clientele.
Keywords:Education of Visually Impaired PersonsNursingNursing CareQuality of LifeVisually Impaired PersonsSee more -
RESEARCH01-01-2016
Coping strategies for oncology nurses in high complexity
Revista Brasileira de Enfermagem. 2016;69(1):67-71
Abstract
RESEARCHCoping strategies for oncology nurses in high complexity
Revista Brasileira de Enfermagem. 2016;69(1):67-71
DOI 10.1590/0034-7167.2016690109i
Views0See moreABSTRACT
Objective:
to identify the coping strategies of oncology services of nurses in highly complex hospital care before the person with cancer.
Method:
it is a qualitative research, with 18 nurses in inpatient oncology units and/or outpatient chemotherapy in two cities in southern Brazil, sampled by a snowball and carrying out semi-structured interviews. Data were submitted to thematic analysis.
Results:
three categories emerged that show strategies such as denial and resignation in care, for support in the health team and the plurality and multiplicity of perspectives on the care, including the patient and his family and the search for personal and professional improvement.
Conclusion:
coping strategies are expressed in the cultural understanding of what it means to have cancer or not and management of health institutions for nurses to work with satisfaction. The service in education is a major factor in the development of ethical competence.
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RESEARCH01-01-2016
Implementation of fast tests for syphilis and HIV in prenatal care in Fortaleza – Ceará
Revista Brasileira de Enfermagem. 2016;69(1):62-66
Abstract
RESEARCHImplementation of fast tests for syphilis and HIV in prenatal care in Fortaleza – Ceará
Revista Brasileira de Enfermagem. 2016;69(1):62-66
DOI 10.1590/0034-7167.2016690108i
Views0See moreABSTRACT
Objective:
to describe the implementation of the Fast Test (FT) of syphilis and HIV in prenatal care in primary healthcare units in Fortaleza, Ceará.
Method:
a descriptive study with a quantitative approach. There were training supervisions carried out in 24 units between May and August 2014, and the inclusion criterion was to have at least one trained professional.
Results:
the physical space, the availability, validity and the performance of FT in prenatal were analyzed. The data were presented in simple frequency tables. It was identified adequate space in 79.2% of the units, availability of FT in 62.5%, performing the tests in 37.5%, and of these, 55.6% doing these procedures in routine prenatal care.
Conclusion:
the primary units have difficulties in implementing FT in syphilis and HIV in the prenatal routine. This activity is seen as an effective strategy to reduce vertical transmission of these infections.
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RESEARCH01-01-2016
Evaluating child care in the Family Health Strategy
Revista Brasileira de Enfermagem. 2016;69(1):54-61
Abstract
RESEARCHEvaluating child care in the Family Health Strategy
Revista Brasileira de Enfermagem. 2016;69(1):54-61
DOI 10.1590/0034-7167.2016690107i
Views0See moreABSTRACT
Objective:
to evaluate the healthcare provided to children under two years old by the Family Health Strategy.
Method:
evaluative, quantitative, cross-sectional study that used the Primary Care Assessment Tool – Child Version for measuring the access, longitudinality, coordination, integrality, family orientation and community orientation.
Results:
a total of 586 adults responsible for children under two years old and linked to 33 health units in eleven municipalities of the state of Minas Gerais, Brazil, were interviewed. The evaluation was positive for the attributes longitudinality and coordination, and negative for access, integrality, Family orientation and community orientation.
Conclusion:
there are discrepancies between health needs of children and what is offered by the service; organizational barriers to access; absence of counter-reference; predominance of curative and long-standing and individual preventive practices; verticalization in organization of actions; and lack of good communication between professionals and users.
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