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The decreasing number of cigarettes during psychiatric hospitalization: intervention or punishment?
Revista Brasileira de Enfermagem. 2015;68(1):76-83
01-01-2015
Abstract
The decreasing number of cigarettes during psychiatric hospitalization: intervention or punishment?
Revista Brasileira de Enfermagem. 2015;68(1):76-83
01-01-2015DOI 10.1590/0034-7167.2015680111p
Views0See moreObjective:
To identify the mental disorders carriers’ perception, the smokers ones, about the decreasing number of cigarettes during psychiatric hospitalization.
Method:
Exploratory study with 96 hospitalized carriers of mental disorders who are smokers: G1 (34 subjects hospitalized when was allowed one cigarette by hour) and G2 (62 subjects hospitalized when it was reduced to eight cigarette by day). Semi-structured questionnaire. Thematic content analysis.
Results:
The G1 admitted satisfaction with the restriction – smoking during hospitalization as entitlement. The G2 resists the restriction change occurred without dialogue or support. In spite of the difficulties, some attitude changes about the cigarette were noticed such as increase of the responsibility, discovery of the ability to reduce smoking and the meaning of its role.
Conclusion:
Some subjects understand the smoking health policy change as punishment, while others as opportunity to think about the role of cigarette in their life.
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Family functionality in oldest old household residents
Revista Brasileira de Enfermagem. 2015;68(1):68-75
01-01-2015
Abstract
Family functionality in oldest old household residents
Revista Brasileira de Enfermagem. 2015;68(1):68-75
01-01-2015DOI 10.1590/0034-7167.2015680110p
Views0See moreObjective:
the aim of this study was to identify factors associated with family functionality of non-institutionalized long-lived subjects, who were residents in Goiânia (GO), Brazil.
Method:
this was a population-based epidemiological study with cross-sectional outline. Evaluation scales of the functional and cognitive capacities were used. Family dynamics was measured using the Adaptation, Partnership, Growth, Affection, and Resolve (APGAR) instrument by making home interviews with 131 long-lived individuals.
Results:
there was prevalence of the female gender, average of age of 83.87 years old, widowhood condition, and residence in a big family, primary schooling, and self-perception of regular health. A great amount showed independence for self-care and partial dependence for daily life instrumental activities. Family functionality prevailed with score average of 9.06 points.
Conclusion:
in conclusion, family functionality in long-lived subjects is associated with self-perception of poor/bad health, osteoporosis, and fall. Results allowed characterizing long-lived subjects’ family functionality with the aim of valuing and prioritizing family as a caregiver.
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Prevalence of non-adherence to antihypertensive pharmacotherapy and associated factors
Revista Brasileira de Enfermagem. 2015;68(1):60-67
01-01-2015
Abstract
Prevalence of non-adherence to antihypertensive pharmacotherapy and associated factors
Revista Brasileira de Enfermagem. 2015;68(1):60-67
01-01-2015DOI 10.1590/0034-7167.2015680109i
Views0See moreObjective:
the aim of the study was to determine the prevalence of non-adherence to antihypertensive drug treatment and its association with factors bio-socio-economic and welfare.
Method:
it was a descriptive, cross-sectional study, performed with 422 hypertensive individuals. Data were collected through home interviews, conducted between December 2011 and March 2012.
Results:
the results showed that the respondents were mostly female, married, elderly, low income and little time of diagnosis. Were considered non adherent to medication 42.65% of participants. Non-Caucasian hypertensive patients, with fewer than eight years of schooling, who did not regularly attend doctor’s appointments, took more than two anti-hypertensive medications and did not have private health insurance, showed higher likelihood of not complying with the drug treatment.
Conclusion:
these findings suggest that hypertensive patients with unfavorable socioeconomic characteristics and difficulty of access to the service require different interventions in order to encourage them to adhere to medication treatment.
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Adherence and knowledge about the use of personal protective equipment among manicurists
Revista Brasileira de Enfermagem. 2015;68(1):52-59
01-01-2015
Abstract
Adherence and knowledge about the use of personal protective equipment among manicurists
Revista Brasileira de Enfermagem. 2015;68(1):52-59
01-01-2015DOI 10.1590/0034-7167.2015680108i
Views0See moreObjective:
this study aimed to assess adherence and knowledge of manicures/pedicures on the use of Personal Protective Equipment (PPE).
Methods:
it was a survey with 235 manicures/pedicures in salons, Belo Horizonte/Brazil. Data were analyzed with the software Statistical package for the social sciences (17.0), using descriptive statistics, chi-square and logistic regression.
Results:
the adherence and the knowledge of the professional were evaluated using the median of the results, obtaining 52% and 63% respectively. The professionals younger than 31 were more likely (2.54 times) to adhere to PPE and those who claimed to have done biosafety course and to use uniform during work, had better chance of understanding (2.86 and 3.12 times, respectively). The majority (83.4 %) stated that the use of PPE should occur for all procedures, meanwhile 71.5 % cited not use them.
Conclusions:
the results indicate the poor adherence to PPE, strengthen occupational biological risk and need for training of these professionals.
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Predictive value of the Manchester Triage System: evaluation of patients’ clinical outcomes
Revista Brasileira de Enfermagem. 2015;68(1):45-51
01-01-2015
Abstract
Predictive value of the Manchester Triage System: evaluation of patients’ clinical outcomes
Revista Brasileira de Enfermagem. 2015;68(1):45-51
01-01-2015DOI 10.1590/0034-7167.2015680107i
Views0See moreObjective:
to analyze the predictive value of the Manchester Triage System in relation to clinical outcome of patients.
Methods:
prospective observational study of 577 patients admitted to the ER and subjected to risk classification. The Therapeutic Intervention Scoring System-28 (TISS-28) was used to measure the severity of patients (primary outcome) and secondary outcomes: high / transfer, death, and length of hospital stay. Descriptive and univariate analyzes were conducted.
Results:
patients classified as red are 10.7 times more likely to have scores above 14 in TISS-28 in relation to others. Patients classified as red have 5.9 times more chance of progression to death compared to others. Patients of high priority service are 1.5 times more likely to be hospitalized over five days than low priority.
Conclusions:
STM proved a good predictor of clinical outcomes.
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Entrepreneurship in Nursing: overview of companies in the State of São Paulo
Revista Brasileira de Enfermagem. 2015;68(1):40-44
01-01-2015
Abstract
Entrepreneurship in Nursing: overview of companies in the State of São Paulo
Revista Brasileira de Enfermagem. 2015;68(1):40-44
01-01-2015DOI 10.1590/0034-7167.2015680106i
Views0See moreObjective:
the present study aimed to identify and characterize nursing companies managed by entrepreneur nurses registered at the Commercial Registry of São Paulo by 2011.
Method:
it’s a descriptive, exploratory study, whose data collection, made throughout January 2012, was carried out on the Commercial Registry of Sao Paulo website. This non-governmental body has the function of registering the opening of companies and supervising their trade situation.
Results and conclusion:
this study allowed us to identify that the entrepreneur nurse is a growing reality through the identification of 196 companies opened by these professionals. Afterwards, it was analyzed their time of functioning, the main economic activity of the company, capital value, percentage of nurse partners and the distribution of companies by region of Sao Paulo State.
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Knowing blood donation surroundings: Implications for nurse service in hemotherapy
Revista Brasileira de Enfermagem. 2015;68(1):32-39
01-01-2015
Abstract
Knowing blood donation surroundings: Implications for nurse service in hemotherapy
Revista Brasileira de Enfermagem. 2015;68(1):32-39
01-01-2015DOI 10.1590/0034-7167.2015680105i
Views0See moreObjective:
the study aims at discussing the significations apprehended by the non-blood donators, considering the context and the consequences of the acting of the nurse in hemotherapy.
Method:
it is a qualitative approach, with theoretical frame of Symbolic Interactionism and Grounded Theory method. The data production was carried out by intensive interview with subjects of three sample groups of a University Hospital of Rio de Janeiro City.
Results:
the phenomenon originated two analysis categories: “Perceiving the blood matter” and “Reflecting about the blood donation campaigns”. It was observed that the environment of the donor is not composed by contact with the other and the information that it can achieve, including the media.
Conclusion:
these were the main basis for the knowledge of blood donation according to their beliefs, culture and values. Therefore, all these aspects must be considered by the nurse acting on donors capture.
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Quality of life and physical activity in intensive care professionals from middle São Francisco
Revista Brasileira de Enfermagem. 2015;68(1):26-31
01-01-2015
Abstract
Quality of life and physical activity in intensive care professionals from middle São Francisco
Revista Brasileira de Enfermagem. 2015;68(1):26-31
01-01-2015DOI 10.1590/0034-7167.2015680104i
Views0Objective:
the objective was to assess the level of physical activity (LPA) and the quality of life QL of the professionals who work in ICU.
Method:
this was a cross-sectional study carried out in Adult ICUs. LPA was assessed by the International Questionnarie of Physical Activity – short form (IQPA-SF) and the QL by the Medical Outcomes Study 36 (SF-36) questionnaire.
Results:
it was classified active 50.89% out of a total of 59 professionals. Nursing technicians were considered the most active with 60.6%. The QL of the professionals who were considered active were better when compared to inactives, with statistical differences to the category of physical aspects limitation, social aspects and mental health. The working hours were higher than recommend, the physicians were higher than the physical therapist, nurses and technicians nurses (p = 0.046).
Conclusion:
physically active professionals who work in ICU had higher quality of life probably why have lower hours of work and consequently more free time to engage in physical activity.
Keywords:Burnout ProfessionalHumanization of Hospital ServicesIntensive Care UnitPhisycal ActivityQuality of LifeSedentary LifestyleSee more
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ORIGINAL ARTICLE
Development of an appearance validity instrument for educational technology in health
Revista Brasileira de Enfermagem. 2020;73:e20190559
12-21-2020
Abstract
ORIGINAL ARTICLEDevelopment of an appearance validity instrument for educational technology in health
Revista Brasileira de Enfermagem. 2020;73:e20190559
12-21-2020DOI 10.1590/0034-7167-2019-0559
Views1ABSTRACT
Objectives:
to develop and evaluate the convergence of the instrument for the appearance validity of educational technologies in health.
Methods:
methodological study conducted in two steps. In step 1, the instrument items were developed, with subsequent content validity by nine specialists in the development of educational technologies in health. In step 2, the convergent validity between another instrument and the appearance instrument was performed. Correlation results above r> 0.3 and p <0.05 were considered as plausible convergent validity.
Results:
the ten items of the initial version of the appearance instrument were submitted to content validity that resulted in a final version with 12 items (Content Validity Index = 0.93). The correlation indexes were strong with the objective and appearance domains; moderate with motivation, organization and total; and weak with writing style.
Conclusions:
the appearance instrument demonstrated content validity and convergent validity, in addition to a strong correlation with the other instrument.
Keywords:Educational TechnologyHealth EducationMethodological Research in NursingTechnological DevelopmentValidation StudiesSee more -
REVIEW
Middle range theory for the nursing diagnosis Excess Fluid Volume in pregnant women
Revista Brasileira de Enfermagem. 2020;73:e20190334
09-21-2020
Abstract
REVIEWMiddle range theory for the nursing diagnosis Excess Fluid Volume in pregnant women
Revista Brasileira de Enfermagem. 2020;73:e20190334
09-21-2020DOI 10.1590/0034-7167-2019-0334
Views1See moreABSTRACT
Objective:
To stablish a middle range theory for the understanding of the causal mechanisms and clinical consequentes of the nursing diagnosis Excess Fluid Volume (00026) among pregnant women.
Method:
The Middle Range Theory was constructed in five stages: defining of construction approach, establishing main concepts, elaborating propositions, developing a pictorial diagram, and establishing the causal relationships and evidence for practice of the Middle Range Theory.
Results:
We identified 14 clinical indicators and 6 causal factors of Excess Fluid Volume. A pictorial diagram was developed and relationships between Excess Fluid Volume elements were established with 6 propositions for them.
Conclusion:
The Middle Range Theory included both physiological and pathological conditions to explain Excess Fluid Volume. This Middle Range Theory might help in the better understanding of interactions between causal factors and clinical indicators of Excess Fluid Volume.
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ORIGINAL ARTICLE
Nurses’ work process in an emergency hospital service
Revista Brasileira de Enfermagem. 2020;73(5):e20180923
07-06-2020
Abstract
ORIGINAL ARTICLENurses’ work process in an emergency hospital service
Revista Brasileira de Enfermagem. 2020;73(5):e20180923
07-06-2020DOI 10.1590/0034-7167-2018-0923
Views1ABSTRACT
Objectives:
to analyze the nurses’ work process in an Emergency Hospital Service.
Methods:
a qualitative, exploratory and descriptive research conducted with 17 nurses from the emergency service of a high complexity hospital in southern Brazil. Data were collected through interviews, focus group and document analysis. Data analysis followed the thematic content analysis framework.
Results:
four categories emerged: Work environment characteristics; Assistance dimension; Management dimension; Care management.
Final Considerations:
the nurses’ work process in Emergency Hospital Service is characterized by the peculiarities of the setting, with centrality in care and care management aiming at quality care and safety to patients.
Keywords:Emergency NursingEmergency Service, HospitalHealth ManagementNurse's RoleProfessional PracticeSee more -
ORIGINAL ARTICLE
Quality of life at work in a central sterile processing department
Revista Brasileira de Enfermagem. 2020;73(2):e20180792
03-09-2020
Abstract
ORIGINAL ARTICLEQuality of life at work in a central sterile processing department
Revista Brasileira de Enfermagem. 2020;73(2):e20180792
03-09-2020DOI 10.1590/0034-7167-2018-0792
Views1See moreABSTRACT
Objectives:
to evaluate the quality of life of nursing professionals who work in a central sterile processing department.
Methods:
a descriptive, quantitative, exploratory study, conducted with 82 nursing professionals working in the Central Sterile Processing Department of a University Hospital, from September to November 2017. A semi-structured instrument and the questionnaire “Medical Outcomes Study Short-Form 36” were used. Results: most of the participants were female, married, aged 31-40 years; 47.6% with 6-10 years of profession, and 82.9% reported working in CSPD for 1-5 years. The most affected quality of life domains were Pain, Vitality, General Health Status and Social Aspects.
Conclusions:
This study showed a need for rethinking and re-creating the labor dynamics in CSPD to improve the quality of life of these nursing professionals.
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ORIGINAL ARTICLE
Care complexity in hospitalized elderly according to cognitive performance
Revista Brasileira de Enfermagem. 2019;72:134-139
12-05-2019
Abstract
ORIGINAL ARTICLECare complexity in hospitalized elderly according to cognitive performance
Revista Brasileira de Enfermagem. 2019;72:134-139
12-05-2019DOI 10.1590/0034-7167-2018-0357
Views1See moreABSTRACT
Objective:
to investigate possible differences in care complexity, functional performance and biopsychosocial and health system aspects among hospitalized elderly with or without cognitive decline.
Method:
quantitative, cross-sectional and analytical study in which was used the INTERMED method and cognitive and functional screening scales. We investigated 384 elderly patients admitted to a medical and surgical clinic of a University Hospital located in São Paulo/SP.
Results:
cognitive decline was present in 40.1% of the sample, most of them were longer-lived elderly individuals with less schooling and income, more dependent in activities of daily living and had greater vulnerability in different domains of INTERMED. After adjustments, the elderly with cognitive decline presented greater vulnerability in the psychological domain.
Conclusion:
the relationship between cognitive decline and psychological vulnerability highlights the need to adopt long-term care based on involvement of the family, health team and different services, thereby maximizing the quality of care.
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ORIGINAL ARTICLE
Spatial analysis on tuberculosis and the network of primary health care
Revista Brasileira de Enfermagem. 2019;72(5):1197-1202
09-16-2019
Abstract
ORIGINAL ARTICLESpatial analysis on tuberculosis and the network of primary health care
Revista Brasileira de Enfermagem. 2019;72(5):1197-1202
09-16-2019DOI 10.1590/0034-7167-2017-0897
Views1See moreABSTRACT
Objective:
to analyze the spatial distribution of new cases of tuberculosis compared to the location of the Primary Healthcare Units that performed the compulsory notification.
Method:
ecological study conducted in Belém, Pará, with 5,294 new cases of tuberculosis notified to Sistema de Informação de Agravos de Notificação for the period from 2010 to 2014. The cases were georeferenced using the software applications ArcGis 10.2 and TerraView 4.2.2. The techniques of Kernel density and global Moran geostatistics were used.
Results:
the incidence of tuberculosis cases did not vary significantly between the years studied, however there was a variation in incidence between neighborhoods. Health units that exhibited higher number of notifications can suffer great influence of migration from nearby neighborhoods.
Conclusion:
the spatial dynamics of tuberculosis associated with health services allows to know the areas with increased risk of tuberculosis and the density of notifications of health units.
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ORIGINAL ARTICLE
Pain assessment in pediatrics
Revista Brasileira de Enfermagem. 2020;73:e20190109
07-31-2020
Abstract
ORIGINAL ARTICLEPain assessment in pediatrics
Revista Brasileira de Enfermagem. 2020;73:e20190109
07-31-2020DOI 10.1590/0034-7167-2019-0109
Views0See moreABSTRACT
Objectives:
to investigate how the pain assessment and management process in pediatric patients is performed and suggestions for its improvement.
Methods:
exploratory, qualitative study. Nine professionals from the nursing team of a pediatric hospital unit in Porto Alegre/RS participated in the study. A sociodemographic questionnaire and semi-structured interviews were used with content analysis.
Results:
the results reinforced the importance of pain assessment with family participation and the need to use tools and process improvements in the training and sensitization of professionals.
Final Considerations:
after the study was concluded, there was a clear need to address the issue, highlighting its relevance for pain resolution in pediatric patients.
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Validity and reliability of Kessler Psychological Distress Scale for Brazilian elderly: a cross-sectional study
Revista Brasileira de Enfermagem. 2021;74:e20200365
03-19-2021
Abstract
Validity and reliability of Kessler Psychological Distress Scale for Brazilian elderly: a cross-sectional study
Revista Brasileira de Enfermagem. 2021;74:e20200365
03-19-2021DOI 10.1590/0034-7167-2020-0365
Views0See moreABSTRACT
Objective:
to verify the validity and reliability of the Psychological Distress Scale for screening mental distress.
Methods:
a cross-sectional study with 75 elderly people. Psychological Distress scale and Self Reporting Questionnaire were used. Criterion validity was verified using Spearman’s correlation and diagnostic accuracy measures. Cronbach’s alpha coefficient was used to investigate reliability.
Results:
the total internal consistency of the Psychological Distress Scale was α=0.844. Concurrent validity between this instrument and the Self Reporting Questionnaire was ρ=0.722 (p<0.001). The best cut-off point for screening mental distress among elderly people was a total score greater than 14, with sensitivity equal to 75.47% and specificity equal to 85.0%.
Conclusions:
the scale was robust for screening mental distress, given its high reliability, in terms of homogeneity, and adequate criterion validity, whose best cut-off point for screening was a score greater than 14.
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ORIGINAL ARTICLE
Hand hygiene: knowledge and skill of caregivers in the hematopoietic stem cell transplantation
Revista Brasileira de Enfermagem. 2019;72(6):1653-1662
10-21-2019
Abstract
ORIGINAL ARTICLEHand hygiene: knowledge and skill of caregivers in the hematopoietic stem cell transplantation
Revista Brasileira de Enfermagem. 2019;72(6):1653-1662
10-21-2019DOI 10.1590/0034-7167-2018-0788
Views0ABSTRACT
Objective:
to identify the knowledge and ability of caregivers on hand hygiene in hematopoietic stem cell transplantation.
Method:
a prospective cross-sectional study. A questionnaire was used to identify the knowledge and it was observed the hygiene technique performance. Data were collected in two units (autologous and allogeneic transplant).
Results:
the 37 participants recognized the importance of hand hygiene and 95.5% related to removal of dirt or infection prevention. 91.9% stated that it was important to clean their hands with soap and water when entering and leaving the room, and 64.9% understood that it was necessary to apply alcoholic solution after washing. On average, the caregivers scored 6.16 steps, when demonstrating the washing technique and 3.91 steps in the friction with alcoholic solution.
Conclusion:
although they recognize the importance of the procedure, there are deficits related to the moment and the correct way of doing it, evidencing the need for strategies aimed at improving this process.
Keywords:Bone Marrow TransplantationCaregiversHand DesinfectionHand hygieneHematopoietic Stem Cell TransplantationSee more -
EXPERIENCE REPORT
(In)visibility of children with special health needs and their families in primary care
Revista Brasileira de Enfermagem. 2020;73:e20190071
07-31-2020
Abstract
EXPERIENCE REPORT(In)visibility of children with special health needs and their families in primary care
Revista Brasileira de Enfermagem. 2020;73:e20190071
07-31-2020DOI 10.1590/0034-7167-2019-0071
Views0See moreABSTRACT
Objectives:
to discuss the (in)visibility of children with special healthcare needs and their families in the Primary Health Care scenario.
Methods:
experience report about the difficulties faced by researchers from different regions of Brazil to locate children with special healthcare needs in the scope of primary care.
Results:
the main reason for these children and their families to be “unknown” and, therefore, not assisted in PHC, is the fact that they are followed-up by institutions/outpatient clinics and specialized and/or public rehabilitation clinics, or even because they have private health insurance.
Final Considerations:
transferring care responsibility to the Primary Health Care teams to specialized and rehabilitation institutions may be related to the lack of knowledge of the care demands of this group, as well as to the relevance of care centered on rehabilitation and the specialty instead of the long-term care, one of the features of primary health care.
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ORIGINAL ARTICLE
Perception of health professionals about neonatal palliative care
Revista Brasileira de Enfermagem. 2019;72(6):1707-1714
10-21-2019
Abstract
ORIGINAL ARTICLEPerception of health professionals about neonatal palliative care
Revista Brasileira de Enfermagem. 2019;72(6):1707-1714
10-21-2019DOI 10.1590/0034-7167-2018-0842
Views0See moreABSTRACT
Objective:
To identify the perception of health professionals about neonatal palliative care.
Method:
A phenomenological qualitative study, a non-probabilistic sample, of 15 health professionals from a neonatal intensive care unit in northern Portugal. Content analysis was performed.
Results:
Despite their lack of training in palliative care, the health professionals showed concern for the dignity, quality of life and comfort of the newborn and family. They expressed emotional and relational difficulties in following the trajectories of serious illness and death and in the ethical decisions regarding the end-of-life.
Conclusion:
It is emphasized that professionals are sensitive to pain and suffering and reveal dedicated and committed in the care of the newborn and family. They are available to train and embrace the current challenges posed by the constitution of pediatric palliative care teams and to help achieve an organizational culture that advances in such care.
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ORIGINAL ARTICLE
Nursing diagnoses in a home-based program: cross-mapping and NANDA-I Taxonomy
Revista Brasileira de Enfermagem. 2019;72(3):584-591
06-27-2019
Abstract
ORIGINAL ARTICLENursing diagnoses in a home-based program: cross-mapping and NANDA-I Taxonomy
Revista Brasileira de Enfermagem. 2019;72(3):584-591
06-27-2019DOI 10.1590/0034-7167-2018-0323
Views0See moreABSTRACT
Objective:
to identify Nursing diagnoses in patients in home care by cross-mapping terms obtained in the anamnesis and clinical examination, with NANDA-I Taxonomy.
Method:
descriptive exploratory study, transversal type, performed with 131 patients from a home health care program in northern Minas Gerais State. With the aid of an instrument based on the theoretical model of Basic Human Needs, the terms indicators of conditions that required nursing interventions were extracted. The cross-mapping of these terms was also performed with NANDA-I Taxonomy diagnoses.
Results:
378 terms and expressions referring to 49 different diagnoses were identified in 11 of the 13 domains of NANDA-I Taxonomy.
Conclusion:
the profile of identified nursing diagnoses can contribute to care management and organizational processes of nurses who provide care to patients in home care.
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Educational technology for bathing/hygiene of elders at home: contributions to career knowledge
Revista Brasileira de Enfermagem. 2021;74:e20200890
07-05-2021
Abstract
Educational technology for bathing/hygiene of elders at home: contributions to career knowledge
Revista Brasileira de Enfermagem. 2021;74:e20200890
07-05-2021DOI 10.1590/0034-7167-2020-0890
Views0See moreABSTRACT
Objective:
to build and validate an educational booklet for bathing and hygiene of elders at home.
Methods:
a methodological study, developed through data collection in literature and situational diagnosis, booklet construction, material qualification through validation by expert judges (11 nurses) and target audience (30 caregivers). Data were analyzed descriptively. The minimum content validity index of 0.80 was considered.
Results:
in content and appearance validation, experts assigned Content Validity Index global of 0.92, while for assessment of the material’s suitability, the booklet was classified as “superior”, with an average of 90%. In the validation of caregivers, the overall Content Validity Index was 1.0.
Conclusion:
the booklet was successfully validated and can be considered in the context of health education and collaborate with an adequate and safe practice of bathing and hygiene of elders at home.
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