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ORIGINAL ARTICLE12-16-2024
Construction and validation of an educational game on biosafety in the central sterile supply department
- Tatiana Nemoto Piccoli Moraes
, - Fernanda Moura D’Almeida Miranda ,
- Rafaela Danta de Sousa ,
- Luciana Schleder Gonçalves ,
- Maria de Fatima Mantovani , [ … ],
- Jenira Priscila dos Anjos
Abstract
ORIGINAL ARTICLEConstruction and validation of an educational game on biosafety in the central sterile supply department
Revista Brasileira de Enfermagem. 2024;77(6):e20230478
DOI 10.1590/0034-7167-2023-0478
- Tatiana Nemoto Piccoli Moraes ,
- Fernanda Moura D’Almeida Miranda ,
- Rafaela Danta de Sousa ,
- Luciana Schleder Gonçalves ,
- Maria de Fatima Mantovani ,
- Jenira Priscila dos Anjos
Views0See moreABSTRACT
Objectives:
to construct and validate an educational game on biosafety in the Central Sterile Supply Department of a hospital in Curitiba, PR.
Methods:
the study was conducted using a quantitative approach, employing applied and technological research with an exploratory design. The process was divided into six stages, from the definition of the theme to the validation and application of the game. The study was carried out from May to August 2022, involving 17 nursing professionals from a Central Sterile Supply Department during day and night shifts, as well as 9 judges.
Results:
the study resulted in the construction of a board game named by the authors as “My Health First.”
Conclusions:
the research achieved its objective of constructing and validating an educational game. By reflecting on professional practice and correlating the occupational risks present, the professionals were able to list safe actions, identify problems, and seek solutions.
- Tatiana Nemoto Piccoli Moraes
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ORIGINAL ARTICLE12-16-2024
Health literacy development of Primary Health Care patients: qualitative research
Revista Brasileira de Enfermagem. 2024;77(6):e20240154
Abstract
ORIGINAL ARTICLEHealth literacy development of Primary Health Care patients: qualitative research
Revista Brasileira de Enfermagem. 2024;77(6):e20240154
DOI 10.1590/0034-7167-2024-0154
Views0See moreABSTRACT
Objectives:
to identify the process of health literacy development among primary care patients, relating it to their self-care practices.
Methods:
qualitative, prospective research with 22 patients from two Family Health Strategy units. Data were obtained through individual semi-structured interviews, examined through descriptive statistics and thematic content analysis.
Results:
the results discuss how participants learn about health and how this resonates in their behaviors, culminating in two thematic categories: “Health knowledge construction”; and “Dialogue between health knowledge construction and patient care actions”.
Final Considerations:
health knowledge is developed mainly through interpersonal relationships, mediated by health professionals through bonding and communication. Community educational actions and training of health professionals in communication can promote health literacy and self-care among patients.
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ORIGINAL ARTICLE12-16-2024
Analysis of omission of antimicrobial doses in Intensive Care Units
- Isabelle Ribeiro Machado ,
- Danielle de Mendonça Henrique ,
- Flávia Giron Camerini ,
- Vanessa Galdino de Paula ,
- Cintia Silva Fassarella , [ … ],
- Lucas Rodrigo Garcia de Mello
Abstract
ORIGINAL ARTICLEAnalysis of omission of antimicrobial doses in Intensive Care Units
Revista Brasileira de Enfermagem. 2024;77(6):e20240102
DOI 10.1590/0034-7167-2024-0102
- Isabelle Ribeiro Machado ,
- Danielle de Mendonça Henrique ,
- Flávia Giron Camerini ,
- Vanessa Galdino de Paula ,
- Cintia Silva Fassarella ,
- Lucas Rodrigo Garcia de Mello
Views0See moreABSTRACT
Objectives:
to analyze the rate of antimicrobial dose omission in intensive care units.
Methods:
cross-sectional study carried out between March 1 and September 30, 2023, in intensive care units of a University Hospital in Rio de Janeiro.
Results:
the sample consisted of 452 prescriptions and 1467 antimicrobial doses. The dose omission rate was 4.29%. Each antimicrobial prescribed increased the chance of omission by 51%. The strategy of double-checking prescriptions helped prevent 30% of antimicrobial dose omissions (p=0.0001).
Conclusions:
monitoring the omission of antimicrobial doses can guide nursing actions to improve quality and patient safety, contributing to the prevention of medication errors, antimicrobial stewardship and the fight against antimicrobial resistance.
- Isabelle Ribeiro Machado
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REVIEW12-16-2024
Recommendations for guidelines for promoting mental health in the workplace: an umbrella review
- Evelin Daiane Gabriel Pinhatti ,
- Amanda Salles Margatho do Nascimento ,
- Regina Celia Bueno Rezende Machado ,
- Rosangela Aparecida Pimenta ,
- André Estevam Jaques , [ … ],
- Maria do Carmo Fernandez Lourenço Haddad
Abstract
REVIEWRecommendations for guidelines for promoting mental health in the workplace: an umbrella review
Revista Brasileira de Enfermagem. 2024;77(6):e20240086
DOI 10.1590/0034-7167-2024-0086
- Evelin Daiane Gabriel Pinhatti ,
- Amanda Salles Margatho do Nascimento ,
- Regina Celia Bueno Rezende Machado ,
- Rosangela Aparecida Pimenta ,
- André Estevam Jaques ,
- Maria do Carmo Fernandez Lourenço Haddad
Views1See moreABSTRACT
Objectives:
to summarize the recommendations of guidelines for promoting mental health in the workplace.
Methods:
an umbrella review, according to Joanna Briggs Institute and Preferred Reporting Items for Systematic reviews and Meta-Analyses methodological assumptions. Data collection was carried out in January 2021 and updated in July 2023 in the American Psychological Association, Cochrane Library, EMBASE, National Library of Medicine, and Scopus databases. Systematic reviews that assessed guidelines with recommendations for mental health care for workers were included. PROSPERO registration CRD42023461845.
Results:
four systematic reviews published between 2015 and 2018 were identified. The abstracts highlighted actions that facilitate and inhibit the recommendations as well as three categories of intervention: primary prevention – worker protection; secondary prevention – promoting workers’ mental health; and tertiary prevention – supporting, monitoring and rehabilitating workers upon returning to work.
Conclusions:
the interventions are based on prevention, promotion and early recognition, support and rehabilitation of mental health problems.
- Evelin Daiane Gabriel Pinhatti
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ORIGINAL ARTICLE12-16-2024
Psychometric analysis of ProQOL-BR in nursing: building hospital safety and protection
- Frederico Marques Andrade ,
- Lanuza Borges Oliveira ,
- Igor Monteiro Lima Martins ,
- Maria Eduarda Borges Rodrigues ,
- Carla Silvana de Oliveira e Silva
Abstract
ORIGINAL ARTICLEPsychometric analysis of ProQOL-BR in nursing: building hospital safety and protection
Revista Brasileira de Enfermagem. 2024;77(6):e20240085
DOI 10.1590/0034-7167-2024-0085
- Frederico Marques Andrade ,
- Lanuza Borges Oliveira ,
- Igor Monteiro Lima Martins ,
- Maria Eduarda Borges Rodrigues ,
- Carla Silvana de Oliveira e Silva
Views0See moreABSTRACT
Objectives:
to analyze the psychometric properties of the ProQOL-BR instrument in hospital nursing professionals.
Methods:
a methodological study to validate the ProQOL-BR. Confirmatory factor analysis, assessment of local and global adjustment quality, Pearson hypothesis testing and Cronbach’s alpha internal consistency analysis were used.
Results:
a total of 490 professionals participated. The model presents adequate quality due to factor weights (λ≥ 0.40), acceptable overall fit quality and adequate chi-square ratio and degrees of freedom (χ2/g.1=2.51) for the parameters of CFI (0.923), GFI (0.902), TLI (0.914) and RMSEA (0.042). In terms of validity, it was shown to be adequate with CC=0.89. The internal consistency obtained by standardized Cronbach’s alpha was 0.761. Criterion validity was shown to be favorable with significant correlations (0.001).
Conclusions:
the instrument was validated regarding content, criteria and reliability. Three questions were removed from the original instrument, ProQOL-BR, leaving the final instrument with 25 questions.
- Frederico Marques Andrade
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12-16-2024
GerenciaDOR™: development of digital technology by nurses for the assessment of patients with chronic pain
Revista Brasileira de Enfermagem. 2024;77(6):e20240050
Abstract
GerenciaDOR™: development of digital technology by nurses for the assessment of patients with chronic pain
Revista Brasileira de Enfermagem. 2024;77(6):e20240050
DOI 10.1590/0034-7167-2024-0050
Views0See moreABSTRACT
Objectives:
to develop a digital technological solution (prototype) for assessing patients with chronic pain.
Methods:
this is a methodological and technological development study based on the Human-Centered Design framework and the principles of Patient-Centered Care. The prototype guides patients through a body diagram and directs them to an evaluation using specific instruments that address the multidimensional aspects of chronic pain.
Results:
the GerenciaDOR* project enables navigation through the Web App screens, providing access to pain assessment features up to the presentation of results.
Final Considerations:
the study describes a systematic approach to pain assessment and expands nurses’ knowledge in pain management. Additionally, it can promote the development of other digital technologies for chronic pain assessment and contribute to a multidisciplinary, patient centered treatment.
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ORIGINAL ARTICLE12-16-2024
Respectful care for postpartum women with sickle cell disease: a netnographic study
- Zannety Conceição Silva do Nascimento Souza ,
- Luana Gabriella Pinheiro Barrêto ,
- Paulo Roberto Lima Falcão do Vale ,
- Elysangela Dittz Duarte ,
- Cristiane dos Santos Silva , [ … ],
- Evanilda Souza de Santana Carvalho
Abstract
ORIGINAL ARTICLERespectful care for postpartum women with sickle cell disease: a netnographic study
Revista Brasileira de Enfermagem. 2024;77(6):e20230545
DOI 10.1590/0034-7167-2023-0545
- Zannety Conceição Silva do Nascimento Souza ,
- Luana Gabriella Pinheiro Barrêto ,
- Paulo Roberto Lima Falcão do Vale ,
- Elysangela Dittz Duarte ,
- Cristiane dos Santos Silva ,
- Evanilda Souza de Santana Carvalho
Views1See moreABSTRACT
Objectives:
to analyze principles of respectful maternity care in narratives of postpartum women with sickle cell disease, relating them to Sustainable Development Goals.
Methods:
netnographic study, with two videos published in 2020. Deductive iconographic and thematic analysis by Respectful Maternity Care Charter, organized in MAXQDA.
Results:
principles identified were the right to: freedom from harm and ill-treatment; information, informed consent, refusal of medical procedures, and respect for their choices and preferences including companion; be considered a person from birth, with dignified and respectful treatment; health at the highest possible level; newborns being with their parents or guardians. The Sustainable Development Goals for women by 2030 were not positively contemplated in postpartum women’s experience.
Final Considerations:
it is appropriate that health workers qualify themselves to provide respectful maternity care, with qualified listening, understanding, and resolution of unique demands of postpartum women with sickle cell disease, seeking equality in care for women.
- Zannety Conceição Silva do Nascimento Souza
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REVIEW12-16-2024
Strategies for expanding vaccination coverage in children in Brazil: systematic literature review
- Janaina Fonseca Almeida Souza ,
- Thales Philipe Rodrigues da Silva ,
- Camila Kümmel Duarte ,
- Anna Luiza de Fatima Pinho Lins Gryschek ,
- Elysângela Dittz Duarte , [ … ],
- Fernanda Penido Matozinhos
Abstract
REVIEWStrategies for expanding vaccination coverage in children in Brazil: systematic literature review
Revista Brasileira de Enfermagem. 2024;77(6):e20230343
DOI 10.1590/0034-7167-2023-0343
- Janaina Fonseca Almeida Souza ,
- Thales Philipe Rodrigues da Silva ,
- Camila Kümmel Duarte ,
- Anna Luiza de Fatima Pinho Lins Gryschek ,
- Elysângela Dittz Duarte ,
- Fernanda Penido Matozinhos
Views1See moreABSTRACT
Objectives:
to identify the strategies found in the literature for increasing vaccination coverage among children in Brazil. It is justified mainly by the current scenario of falling vaccination coverage.
Methods:
systematic literature review. The search was carried out in the Pubmed (MEDLINE), Embase and Scopus databases, following the PRISMA guidelines.
Results:
initially, 4,824 results were returned. In the end, 6 studies were included for narrative synthesis using the SWiM methodology. Of these, 50% dealt with studies related to the Bolsa Família Program (PBF). The others explored strategies for approaching parents directly, Rapid Vaccination Monitoring (MRV) and the Community Health Agents Program (PACS). The PBF did not guarantee compliance with the conditionality of keeping vaccinations up to date. The MRV and PACS are effective strategies, especially because they allow active search for absentees.
Conclusions:
we conclude that more publications are needed on strategies to increase vaccination coverage among children in Brazil.
- Janaina Fonseca Almeida Souza
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REVIEW06-17-2020
Prevention and conduct against the Extravasation of antineoplastic chemotherapy: a scoping review
- João Marcos Alves Melo ,
- Patrícia Peres de Oliveira ,
- Raíssa Silva Souza ,
- Deborah Franscielle da Fonseca ,
- Thaís Fonseca Gontijo , [ … ],
- Andrea Bezerra Rodrigues
Abstract
REVIEWPrevention and conduct against the Extravasation of antineoplastic chemotherapy: a scoping review
Revista Brasileira de Enfermagem. 2020;73(4):e20190008
DOI 10.1590/0034-7167-2019-0008
- João Marcos Alves Melo ,
- Patrícia Peres de Oliveira ,
- Raíssa Silva Souza ,
- Deborah Franscielle da Fonseca ,
- Thaís Fonseca Gontijo ,
- Andrea Bezerra Rodrigues
Views0See moreABSTRACT
Objectives:
to identify and synthesize scientific evidence on prevention and management of extravasation of antineoplastic agents in adult patients by nurses.
Methods:
scoping review, according to Joanna Briggs Institute and PRISMA-ScR. Research was conducted in five electronic databases, Cochrane Library and eight catalogs of theses and dissertations. Data collection occurred from April to July 2018, with no time limit. The extracted data were analyzed and synthesized in a narrative way.
Results:
a total of 3,110 records were retrieved and 18 studies were kept for review. Most publications (66.6%) had a qualitative approach and addressed both aspects, i.e., prevention and management of extravasation of chemotherapy in adult patients.
Conclusions:
the implementation of protocols based on scientific evidence on prevention and management of extravasation of antineoplastic agents is paramount in order to provide patient safety and support to the nursing staff.
- João Marcos Alves Melo
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ORIGINAL ARTICLE06-01-2020
Paulo Freire’s research itinerary: contributions for promoting health in the teaching profession
Revista Brasileira de Enfermagem. 2020;73(4):e20190164
Abstract
ORIGINAL ARTICLEPaulo Freire’s research itinerary: contributions for promoting health in the teaching profession
Revista Brasileira de Enfermagem. 2020;73(4):e20190164
DOI 10.1590/0034-7167-2019-0164
Views0See moreABSTRACT
Objectives:
examine Paulo Freire’s research itinerary as a theoretical-methodological framework and its contributions for promoting health in the teaching profession.
Methods:
qualitative participatory action research coordinated with Paulo Freire’s itinerary, carried out in culture circles, from April 18, 2018 to June 26, 2018. It involved the participation of 21 teachers from a federal teaching institution.
Results:
the method that was used promoted dialogue and reflection among the participants, enabling a health promotion intervention. It facilitated self-knowledge and reflection, resulting in significant changes in the participants, in a process in pursuit that seeks transformations.
Final Considerations:
Paulo Freire’s research itinerary was opportune, as a possibility for promoting health, mainly in terms of providing a framework that assists in the practical construction of knowledge and encourages participants to examine their reality in the pursuit of enhanced quality of life.
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ORIGINAL ARTICLE07-08-2020
Patient safety: perception of family members of hospitalized children
- Larissa Fernandes Franco ,
- Maria Aparecida Bonelli ,
- Monika Wernet ,
- Mayara Caroline Barbieri ,
- Giselle Dupas
Abstract
ORIGINAL ARTICLEPatient safety: perception of family members of hospitalized children
Revista Brasileira de Enfermagem. 2020;73(5):e20190525
DOI 10.1590/0034-7167-2019-0525
- Larissa Fernandes Franco ,
- Maria Aparecida Bonelli ,
- Monika Wernet ,
- Mayara Caroline Barbieri ,
- Giselle Dupas
Views0See moreABSTRACT
Objectives:
to know the meaning attributed by family members to the health safety of pediatric patients, with attention to the possibilities of their collaboration.
Methods:
this qualitative study was conducted with eighteen family members of children hospitalized in a pediatric unit, from January to July 2018. Symbolic Interactionism was used as a theoretical framework, and Inductive Content Analysis as method.
Results:
child hospitalization poses risks to possible incidents and adverse events. Participants and professionals are responsible for patient safety. Thus, their actions focus on error prevention. Therefore, they seek information and observe in a vigil way professional care in classic aspects of safety. They conceive essential and favoring safety the approach centered on children and family members.
Final Considerations:
family members recognized the chances of errors and care damage, identified themselves as support in minimizing damage and were in partnership with the professional, increasing chances of effecting safety.
- Larissa Fernandes Franco
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05-21-2021
Quality of life and falls in elderly people: a mixed methods study
- Thainara Lopes da Silva ,
- Vanessa Vieira da Motta ,
- Willian José Garcia ,
- Cristina Arreguy-Sena ,
- Paulo Ferreira Pinto , [ … ],
- Elenir Pereira de Paiva
Abstract
Quality of life and falls in elderly people: a mixed methods study
Revista Brasileira de Enfermagem. 2021;74:e20200400
DOI 10.1590/0034-7167-2020-0400
- Thainara Lopes da Silva ,
- Vanessa Vieira da Motta ,
- Willian José Garcia ,
- Cristina Arreguy-Sena ,
- Paulo Ferreira Pinto ,
- Pedro Miguel Santos Dinis Parreira ,
- Elenir Pereira de Paiva
Views0See moreABSTRACT
Objective:
to assess elderly people’s quality of life, understanding the social representations of falls.
Methods:
a convergent mixed methods research carried out at homes, with a sample of 134 elderly people. A structured questionnaire was used, covering sociodemographic variables and factors that indicated frailty and risk of falling. For quality of life assessment, Medical Outcomes Study Short-Form 36 and Theory of Social Representations, Abric’s structural approach were used, with data treated by dictionary of equivalent terms, processed in Evoc 2000, converging analytically according to Neuman.
Results:
quality of life impairment was identified in terms of physical, emotional and functional capacity. The elements of the possible central nucleus were fall, fear, and bruised-broken-bone.
Final considerations:
quality of life impairment can contribute to increase the number of falls, which has been shown to be an event present in elderly people’s lives through evocations. Understanding elderly people’s individual demands allows planning actions.
- Thainara Lopes da Silva
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ORIGINAL ARTICLE06-08-2020
Understanding the dramatic therapeutic play session: a contribution to pediatric nursing
Revista Brasileira de Enfermagem. 2020;73(4):e20180812
Abstract
ORIGINAL ARTICLEUnderstanding the dramatic therapeutic play session: a contribution to pediatric nursing
Revista Brasileira de Enfermagem. 2020;73(4):e20180812
DOI 10.1590/0034-7167-2018-0812
Views0See moreABSTRACT
Objectives:
to understand how the dramatic therapeutic play session occurs within the care of hospitalized children.
Methods:
qualitative multiple case study, using theoretical references, such as symbolic interactionism and Vygotsky’s theory of symbolic play. Twenty play sessions performed with six children from 3 to 10 years old were analyzed, each corresponding to one case.
Results:
these sessions demonstrated that a dramatic therapeutic play session is a process of four interdependent and complementary steps: bonding, exploring, dramatizing, and play cessation. They also revealed the imaginary situations externalized by the child, the importance of the exploration step for which they manage the imaginary situation and catharsis, and how her higher psychological faculties are articulated during this process.
Final Considerations:
the results contribute to the understanding of the conduct and analysis of the dramatic therapeutic play session, reinforcing the importance of its use in pediatric nursing care practice.
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04-14-2021
Nurse-midwives reconfiguring care in the scope of labor and births in COVID-19 times
- Paolla Amorim Malheiros Dulfe ,
- Valdecyr Herdy Alves ,
- Audrey Vidal Pereira ,
- Bianca Dargam Gomes Vieira ,
- Diego Pereira Rodrigues , [ … ],
- Maria Bertilla Lutterbach Riker Branco
Abstract
Nurse-midwives reconfiguring care in the scope of labor and births in COVID-19 times
Revista Brasileira de Enfermagem. 2021;74:e20200863
DOI 10.1590/0034-7167-2020-0863
- Paolla Amorim Malheiros Dulfe ,
- Valdecyr Herdy Alves ,
- Audrey Vidal Pereira ,
- Bianca Dargam Gomes Vieira ,
- Diego Pereira Rodrigues ,
- Giovanna Rosário Soanno Marchiori ,
- Maria Bertilla Lutterbach Riker Branco
Views0See moreABSTRACT
Objectives:
to analyze how the nurse-midwives of maternity wards that were fields of practice for an improvement course in obstetrics have reorganized care in the context of labor and birth amidst the COVID-19 pandemic.
Methods:
this is a descriptive, exploratory and qualitative study carried out with nine nurse-midwives who are preceptors and collaborators in maternity wards that were fields of practice for an improvement course, between February and April 2020, through a semi-structured interview through WhatsApp®. Content analysis was used to treat the information.
Results:
the pandemic brought the need to reorganize work, with a focus on service training and maintenance of good practices in labor and birth, whose movement was intensely experienced, interfering in nurse-midwives’ mental health.
Conclusion:
nurse-midwives have faced the pandemic with concerns about maintaining safe care, focused on practices based on updated scientific evidence.
- Paolla Amorim Malheiros Dulfe
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ORIGINAL ARTICLE12-16-2023
School Nursing Guide for student health promotion: construction and validity
- Emanoel Avelar Muniz ,
- Maria Veraci Oliveira Queiroz ,
- Patrícia Neyva da Costa Pinheiro ,
- Maria Rocineide Ferreira da Silva ,
- Thereza Maria Magalhães Moreira , [ … ],
- Valter Cordeiro Barbosa Filho
Abstract
ORIGINAL ARTICLESchool Nursing Guide for student health promotion: construction and validity
Revista Brasileira de Enfermagem. 2023;76(1):e20220260
DOI 10.1590/0034-7167-2022-0260
- Emanoel Avelar Muniz ,
- Maria Veraci Oliveira Queiroz ,
- Patrícia Neyva da Costa Pinheiro ,
- Maria Rocineide Ferreira da Silva ,
- Thereza Maria Magalhães Moreira ,
- Eliany Nazaré Oliveira ,
- Isabelline Freitas Dantas Paiva de Almeida ,
- Valter Cordeiro Barbosa Filho
Views0See moreABSTRACT
Objectives:
to describe the process of construction and validity of a School Nursing Guide for student health promotion.
Methods:
a methodological study, carried out from February to December 2021, composed of Convergent Care Research based on Pender’s Health Promotion Model. Based on the literature and dialogue with 11 nurses in the seven online focus groups, actions were constructed. Subsequently, 24 judges assessed content and appearance.
Results:
the guide proposes strategies for developing school nursing practices focusing on health promotion. The Appearance Validity Index ranged from 0.63 to 1.0, and the total was 0.84. The Content Validity Index ranged from 0.95 to 1.0, and the total was 0.997.
Conclusions:
the guide incorporated the needs of young people recognized by professionals, and the assessment phase confirms its validity, and can be used in the context of practice with young people.
- Emanoel Avelar Muniz
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REFLECTION09-07-2020
Training and work process in Multiprofessional Residency in Health as innovative strategy
- Mariana da Silva Bernardo ,
- Greici Capellari Fabrizzio ,
- Marina Leite Souza ,
- Thiago Oliveira dos Santos ,
- Selma Regina de Andrade
Abstract
REFLECTIONTraining and work process in Multiprofessional Residency in Health as innovative strategy
Revista Brasileira de Enfermagem. 2020;73(6):e20190635
DOI 10.1590/0034-7167-2019-0635
- Mariana da Silva Bernardo ,
- Greici Capellari Fabrizzio ,
- Marina Leite Souza ,
- Thiago Oliveira dos Santos ,
- Selma Regina de Andrade
Views0See moreABSTRACT
Objectives: To
reflect about education in health and work process on three programs of multiprofessional residency in Florianópolis/SC.
Method:
Reflexive study about Multiprofessional Residency Health Programs of Florianópolis.
Results:
Multiprofessional Residency characterizes training health professionals through service education. Developing these professionals’ specialization with assignments that promote professional exercise and magnifies multiprofessional work at the same time, for excellency in unabridged healthcare.
Final Considerations:
Multiprofessional Residency Programs make interdisciplinary education, sharing knowledge between residents and other professionals stimulating development of innovation skills.
- Mariana da Silva Bernardo
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