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ORIGINAL ARTICLE10-09-2023
Independent and combined effects of lifestyle behaviors on adolescent health-related quality of life
Revista Brasileira de Enfermagem. 2023;76(4):e20220780
Abstract
ORIGINAL ARTICLEIndependent and combined effects of lifestyle behaviors on adolescent health-related quality of life
Revista Brasileira de Enfermagem. 2023;76(4):e20220780
DOI 10.1590/0034-7167-2022-0780
Views0See moreABSTRACT
Objective:
To investigate the independent and combined effects of lifestyle behaviors, including physical activity, sedentary behavior, sleep duration and food intake, in the health-related quality of life (HRQoL) of Brazilian adolescents.
Methods:
Cross-sectional school-based study, with the participation of 306 adolescents aged 14 to 18 years. A questionnaire was applied with structured questions to collect lifestyle behaviors data. Perception of the HRQoL was identified using the Kidscreen-27. The study used covariance analysis and linear regression models for statistical analysis.
Results:
Adolescents who reported ≤ 2 hours/day of screen-based sedentary behavior and sleep duration equivalent to 8-10 hours/night presented significantly higher HRQoL. Adolescents who reported joint adherence ≥ 3 healthy lifestyle behaviors demonstrated approximately two [OR=2.12] to three times [OR=3.04] more chance of presenting higher perceptions of HRQoL.
Conclusion:
Although healthy lifestyle behaviors had a positive independent effect on HRQoL, joint adherence to healthy behaviors enhances the cumulative effect.
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ORIGINAL ARTICLE10-09-2023
Health care for people with tuberculosis/HIV co-infection from the multidisciplinary team’s perspective
Revista Brasileira de Enfermagem. 2023;76(4):e20220733
Abstract
ORIGINAL ARTICLEHealth care for people with tuberculosis/HIV co-infection from the multidisciplinary team’s perspective
Revista Brasileira de Enfermagem. 2023;76(4):e20220733
DOI 10.1590/0034-7167-2022-0733
Views0See moreABSTRACT
Objective:
to know the multidisciplinary team’s perspective about the health care of people with tuberculosis and human immunodeficiency virus co-infection in relation to treatment.
Methods:
this is a descriptive-exploratory study, with a qualitative approach, carried out in a health care service in São Paulo, from May to June 2019. Semi-structured interviews were conducted with nine professionals from the multidisciplinary team. Data were processed through discourse analysis with the support of webQDA.
Results:
Two empirical categories emerged: Health care interfaces for people with tuberculosis and human immunodeficiency virus co-infection; Barriers and facilitators for health care for people with co-infection.
Final considerations:
the health-disease process in co-infection is mediated by conditions that positively or negatively interfere with treatment compliance. People’s health care goes beyond exclusively clinical assistance and requires the recognition of needs in a broad perspective.
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ORIGINAL ARTICLE10-09-2023
Spirituality in the uncertainty of illness: the perspective of oncology patients
Revista Brasileira de Enfermagem. 2023;76(4):e20220712
Abstract
ORIGINAL ARTICLESpirituality in the uncertainty of illness: the perspective of oncology patients
Revista Brasileira de Enfermagem. 2023;76(4):e20220712
DOI 10.1590/0034-7167-2022-0712
Views0See moreABSTRACT
Objective:
To analyze spirituality in the process of illness uncertainty in cancer patients.
Methods:
This is a qualitative study, in which Merle Mishel’s Theory of Uncertainty of Disease was used as a theoretical framework; and as a methodological reference, the stages of Bardin’s Content Analysis. As a technique for obtaining information, a semi-structured interview was used.
Results:
Spirituality in the uncertainty of the disease varies from patient to patient and acts in a unique way. They presented readaptation attitudes in their reports. The presence of spirituality in their lives acted as the main force mechanism to deal with the uncertainty of the disease, and this moment was called by Mishel “probabilistic thinking”.
Conclusion:
Patients demonstrated readaptation attitudes in their reports, and spirituality acted as the main mechanism of strength to deal with uncertainty in the disease
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ORIGINAL ARTICLE10-09-2023
Tradução e validação do Multidimensional Individual and Interpersonal Resilience Measure
Revista Brasileira de Enfermagem. 2023;76(4):e20220696
Abstract
ORIGINAL ARTICLETradução e validação do Multidimensional Individual and Interpersonal Resilience Measure
Revista Brasileira de Enfermagem. 2023;76(4):e20220696
DOI 10.1590/0034-7167-2022-0696
Views0See moreRESUMEN
Objetivo:
traducir, adaptar culturalmente y validar el Multidimensional Individual and Interpersonal Resilience Measure para el portugués brasileño.
Método:
después de la traducción inicial, la versión pre-final pasó por rigurosos procedimientos de adaptación cultural. Como resultado, la versión final adaptada fue sometida a un estudio de validez.
Resultados:
los procedimientos de adaptación proporcionaron equivalencia entre las versiones pre-final y original en términos semánticos, idiomáticos, experienciales y conceptuales. Un total de 187 ancianos fueron incluidos en el estudio de validez. El análisis factorial exploratorio (AFE) generó un modelo de cinco factores ((RMSEA = 0,030; TLI = 0,959; X = 151,590 p> 0,05). La versión final mostró adecuada consistencia (α de Cronbach = 0,705) y confiabilidad prueba-reprueba (ICC=0,835). No se encontró correlación estadísticamente significativa entre la resiliencia y las variables sociodemográficas y epidemiológicas evaluadas en este estudio.
Conclusión:
EMRII-BR es un instrumento válido y confiable para medir la resiliencia en ancianos brasileños.
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ORIGINAL ARTICLE10-09-2023
Translation and validity of the Multidimensional Individual and Interpersonal Resilience Measure
Revista Brasileira de Enfermagem. 2023;76(4):e20220696
Abstract
ORIGINAL ARTICLETranslation and validity of the Multidimensional Individual and Interpersonal Resilience Measure
Revista Brasileira de Enfermagem. 2023;76(4):e20220696
DOI 10.1590/0034-7167-2022-0696
Views0See moreABSTRACT
Objective:
to translate, culturally adapt and validate the Multidimensional Individual and Interpersonal Resilience Measure to Brazilian Portuguese.
Method:
after initial translation, the pre-final version underwent rigorous cultural adaptation procedures. As a result, the final adapted version was submitted to a validity study.
Results:
adaptation procedures provided equivalence between the pre-final and the original versions in semantic, idiomatic, experiential and conceptual terms. A total of 187 older adults were included in the validity study. Exploratory factorial analysis (EFA) generated a model of five factors ((RMSEA = 0.030; TLI = 0.959; X = 151.590 p> 0.05). Final version showed adequate consistency (Cronbach’s α = 0.705) and test-retest reliability (ICC=0.835). No statistically significant correlation was found between resilience and sociodemographic and epidemiological variables assessed in this study.
Conclusion:
EMRII-BR is a valid and reliable instrument for measuring resilience in Brazilian older adults.
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Standard Operating Procedure validity on intramuscular vaccine administration in adults: a methodological study
Revista Brasileira de Enfermagem. 2023;76(4):e20220692
Abstract
Standard Operating Procedure validity on intramuscular vaccine administration in adults: a methodological study
Revista Brasileira de Enfermagem. 2023;76(4):e20220692
DOI 10.1590/0034-7167-2022-0692
Views0See moreABSTRACT
Objective:
to validate a Standard Operating Procedure on the intramuscular vaccine administration technique in adults using high frequency vibration associated with cryotherapy.
Methods:
a literature review on intramuscular vaccination practice using a vibration device associated with cryotherapy. Then, a form was created to validate the instrument, detailing the items that were assessed by judges following recommendations in the literature. Judges’ answers were assessed using the Content Validity Index, with items whose index was greater than or equal to 0.80 being validated.
Results:
twenty-five nurses participated in validity, identifying judges’ opinion regarding item relevance, clarity and accuracy. Judges validated the instrument, according to the values that remained between 0.88 and 1.0.
Conclusions:
the instrument developed and validated is a tool capable of guaranteeing safety and standardizing immunization practice in vaccine rooms.
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ORIGINAL ARTICLE10-09-2023
Clinical supervision strategies, learning, and critical thinking of nursing students
Revista Brasileira de Enfermagem. 2023;76(4):e20220691
Abstract
ORIGINAL ARTICLEClinical supervision strategies, learning, and critical thinking of nursing students
Revista Brasileira de Enfermagem. 2023;76(4):e20220691
DOI 10.1590/0034-7167-2022-0691
Views0See moreABSTRACT
Objective:
To identify the supervisory strategies that Nursing students consider facilitators of the development of critical thinking skills in clinical teaching.
Methods:
This is a qualitative study, within the interpretative paradigm, using the focus group methodology. Eight undergraduate nursing students participated in the study.
Results:
Participants recognized the indispensability of critical thinking for professional responsibility and quality of care and highlighted the importance of using supervisory strategies adapted to their needs, learning objectives, and the context of clinical practice.
Final considerations:
This study highlights the urgent need to establish, within the Nursing curricula, clinical supervision strategies that promote critical thinking and favor the development of skills for good clinical judgment, problem solving, and safe, effective, and ethical decision-making.
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EXPERIENCE REPORT10-09-2023
Focus group in the development of concepts for a Nursing model: experience report
Revista Brasileira de Enfermagem. 2023;76(4):e20220689
Abstract
EXPERIENCE REPORTFocus group in the development of concepts for a Nursing model: experience report
Revista Brasileira de Enfermagem. 2023;76(4):e20220689
DOI 10.1590/0034-7167-2022-0689
Views0See moreABSTRACT
Objective:
To communicate the experience of developing concepts for the construction of a care model through focus groups.
Methods:
An experience report on the development of concepts through remote focus groups with members of a research group from a public university in southern Brazil.
Results:
Focus groups were developed in which homogeneity and heterogeneity criteria were observed among participants. In addition to the concepts of the nursing metaparadigm, the concepts of care and family-centered care were developed, relevant to the nursing care model in question.
Final considerations:
Despite the challenges of conducting remote focus groups, they were suitable for the collective construction of concepts for a nursing care model, allowing the interaction of participants from different locations.
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EDITORIAL03-08-2024
A enfermagem como protagonista no enfrentamento da hesitação e recusa vacinal
Revista Brasileira de Enfermagem. 2024;77:e77suppl101
Abstract
EDITORIALA enfermagem como protagonista no enfrentamento da hesitação e recusa vacinal
Revista Brasileira de Enfermagem. 2024;77:e77suppl101
DOI 10.1590/0034-7167.202477suppl101pt
Views0Desde a década de 1970, o Ministério da Saúde do Brasil instituiu o Programa Nacional de Imunização (PNI), que precedeu o Sistema Único de Saúde e que lhe foi incorporado e fortalecido, devido ao modelo descentralizado aos municípios, mas de comando único ao nível central. Seu objetivo era e ainda é coordenar as ações de […]See more -
EDITORIAL03-08-2024
Nursing as a player in tackling vaccine hesitancy and refusal
Revista Brasileira de Enfermagem. 2024;77:e77suppl101
Abstract
EDITORIALNursing as a player in tackling vaccine hesitancy and refusal
Revista Brasileira de Enfermagem. 2024;77:e77suppl101
DOI 10.1590/0034-7167.202477suppl101
Views1Since the 1970s, the Brazilian Ministry of Health established the Brazilian National Immunization Program (PNI – Programa Nacional de Imunização), which preceded the Brazilian Health System and which was incorporated and strengthened due to the decentralized model to municipalities, but under single command at central level. Its objective was and still is to coordinate vaccination […]See more -
EDITORIAL02-26-2024
Enfermeiro Navegador de Pacientes com Câncer: contribuições para a discussão no cenário nacional
Revista Brasileira de Enfermagem. 2024;77(2):e770201
Abstract
EDITORIALEnfermeiro Navegador de Pacientes com Câncer: contribuições para a discussão no cenário nacional
Revista Brasileira de Enfermagem. 2024;77(2):e770201
DOI 10.1590/0034-7167.2024770201pt
Views0A prática profissional da navegação de pacientes é algo incipiente no Brasil e, sendo assim, é indispensável uma ampla discussão com vários setores da sociedade, sendo essa a principal propositura deste editorial. Comecemos pela história.A navegação de pacientes foi definida em 1989 como uma intervenção de prestação de serviços baseada na comunidade, com o objetivo […]See more -
EDITORIAL02-26-2024
Nurse Navigator of Cancer Patients: contributions to the discussion on the national stage
Revista Brasileira de Enfermagem. 2024;77(2):e770201
Abstract
EDITORIALNurse Navigator of Cancer Patients: contributions to the discussion on the national stage
Revista Brasileira de Enfermagem. 2024;77(2):e770201
DOI 10.1590/0034-7167.2024770201
Views0The professional practice of patient navigation is incipient in Brazil and, therefore, a broad discussion with various sectors of society is essential, which is the main purpose of this editorial. Shall we start with the story.Patient navigation was defined in 1989 as a community-based service delivery intervention aimed at appropriately promoting access to diagnosis and […]See more -
ERRATUM02-26-2024
ERRATUM
Revista Brasileira de Enfermagem. 2024;77(1):e2024n1e02
Abstract
ERRATUMERRATUM
Revista Brasileira de Enfermagem. 2024;77(1):e2024n1e02
DOI 10.1590/0034-7167.20247701e02
Views0In the article “Active teaching model to promote critical thinking”, with DOI number: , published in Revista Brasileira de Enfermagem, 2019;72(1):293-8, on page 297:Include before REFERENCES:[…]See more -
REVIEW02-26-2024
Practice of immersion in hot water to relieve pain in neonatology: an integrative review
Revista Brasileira de Enfermagem. 2024;77(1):e20230260
Abstract
REVIEWPractice of immersion in hot water to relieve pain in neonatology: an integrative review
Revista Brasileira de Enfermagem. 2024;77(1):e20230260
DOI 10.1590/0034-7167-2023-0260
Views0See moreABSTRACT
Objectives:
to identify immersion use in hot water to relieve pain in newborns.
Methods:
an integrative literature review, carried out in the PubMed, VHL, EMBASE, Scopus, CINAHL, Cochrane and SciELO databases, with investigations in English, Spanish, French or Portuguese, published between 2002 and 2022. The Health Sciences Descriptors (DeCS) and Medical Subject Headings (MeSH) were used to answer the following question: what are the uses of hot water immersion in relieving pain in newborns?
Results:
nine studies were included, mainly Brazilian, experimental, with a predominance of strong and moderate levels of evidence. Hydrotherapy and bath use (immersion and bandaging) was observed, promising interventions in reducing pain scores, assessed using scales, physiological and endocrine parameters.
Conclusions:
hot water proved to be a promising non-pharmacological intervention in relieving pain in infants in different contexts.
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ORIGINAL ARTICLE02-26-2024
Artificial intelligence to predict bed bath time in Intensive Care Units
Revista Brasileira de Enfermagem. 2024;77(1):e20230201
Abstract
ORIGINAL ARTICLEArtificial intelligence to predict bed bath time in Intensive Care Units
Revista Brasileira de Enfermagem. 2024;77(1):e20230201
DOI 10.1590/0034-7167-2023-0201
Views0See moreABSTRACT
Objectives:
to assess the predictive performance of different artificial intelligence algorithms to estimate bed bath execution time in critically ill patients.
Methods:
a methodological study, which used artificial intelligence algorithms to predict bed bath time in critically ill patients. The results of multiple regression models, multilayer perceptron neural networks and radial basis function, decision tree and random forest were analyzed.
Results:
among the models assessed, the neural network model with a radial basis function, containing 13 neurons in the hidden layer, presented the best predictive performance to estimate the bed bath execution time. In data validation, the squared correlation between the predicted values and the original values was 62.3%.
Conclusions:
the neural network model with radial basis function showed better predictive performance to estimate bed bath execution time in critically ill patients.
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REVIEW02-26-2024
Evidence of intrauterine device insertion by nurses in Primary Health Care: an integrative review
Revista Brasileira de Enfermagem. 2024;77(1):e20230134
Abstract
REVIEWEvidence of intrauterine device insertion by nurses in Primary Health Care: an integrative review
Revista Brasileira de Enfermagem. 2024;77(1):e20230134
DOI 10.1590/0034-7167-2023-0134
Views0ABSTRACT
Objectives:
to synthesize and analyze evidence on intrauterine device insertion by nurses in Primary Health Care.
Methods:
an integrative review, carried out in the BDENF, CINAHL, LILACS, SciELO, Scopus, PubMed and Web of Science databases in June 2022, delimiting the period from 1960 to 2022.
Results:
141 articles were identified in the initial search, and 10 studies made up the final sample. Four (40%) were developed in the United States and one (10%) in Brazil, with publications from 1979 to 2021. The findings were grouped into three categories: Nurse training to insert an intrauterine device; Nurses’ competency to insert an intrauterine device; and Women’s access to intrauterine devices.
Conclusions:
nurse theoretical and practical training is a prominent element, consolidated in the favorable outcomes of insertions performed by nurses and satisfaction among women, a practice that has expanded access to the contraceptive method in Primary Health Care.
Keywords:Advanced Practice NursingIntrauterine DevicesLong-Acting Reversible ContraceptionNursesPrimary Health CareSee more
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RESEARCH01-01-2015
Analysis of the decision-making process of nurse managers: a collective refl ection
Revista Brasileira de Enfermagem. 2015;68(4):668-675
Abstract
RESEARCHAnalysis of the decision-making process of nurse managers: a collective refl ection
Revista Brasileira de Enfermagem. 2015;68(4):668-675
DOI 10.1590/0034-7167.2015680414i
Views0ABSTRACT
Objective:
to analyze the decision-making model adopted by nurses from the perspective of some decision-making process theories.
Method:
qualitative approach, based on action research. Semi-structured questionnaires and seminars were conducted from April to June 2012 in order to understand the nature of decisions and the decision-making process of nine nurses in position of managers at a public hospital in Southern Brazil. Data were subjected to content analysis.
Results:
data were classified in two categories: the current situation of decision-making, which showed a lack of systematization; the construction and collective decision-making, which emphasizes the need to develop a decision-making model.
Conclusion:
the decision-making model used by nurses is limited because it does not consider two important factors: the limits of human rationality, and the external and internal organizational environments that infl uence and determine right decisions.
Keywords:Decision Support PracticesNursingNursing Administration ResearchPractice ManagementProfessional CompetenceSee more -
RESEARCH01-01-2015
Social representations of sexuality for the elderly
Revista Brasileira de Enfermagem. 2015;68(4):662-667
Abstract
RESEARCHSocial representations of sexuality for the elderly
Revista Brasileira de Enfermagem. 2015;68(4):662-667
DOI 10.1590/0034-7167.2015680413i
Views0See moreABSTRACT
Objective:
to know the social representations of sexuality for the elderly, based on the Social Representation Theory.
Method:
study performed in a Basic Family Health Unit in Maracanau-CE, Brazil, with 30 elderly adults. Data were collected from March through April of 2013, using the free word evocation technique. Data were organized and processed using the EVOC 2000.software
Results:
the subjects evoked 150 words associated with the evocator word “sexuality”. Out of these, 43 were different. At the possible core of the representation of sexuality for the elderly, the following words were found: love, affection and respect. Sex, companionship, understanding and coexistence composed the intermediate elements of representation.
Conclusion:
the performed analyses pointed to love, respect and affection as central elements that structured and organized the social representation of sexuality in the elder years for the group studied.
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RESEARCH01-01-2015
Post-accident work behavior in caring for people with HIV/Aids
Revista Brasileira de Enfermagem. 2015;68(4):656-661
Abstract
RESEARCHPost-accident work behavior in caring for people with HIV/Aids
Revista Brasileira de Enfermagem. 2015;68(4):656-661
DOI 10.1590/0034-7167.2015680412i
Views0ABSTRACT
Objective:
To identify post-accident conduct in the workplace by health professionals in caring for people with HIV/Aids.
Method:
A qualitative and descriptive research study with a socio-historical perspective (1986-2006), performed in a reference hospital for infectious diseases in the State of Santa Catarina. To collect data, interviews were conducted with oral history among 23 health workers and, for the treatment of data, Bardin’s content analysis was used.
Results:
Post-accident behaviors emerged that included assessment, accident records, chemoprophylaxis when necessary, support, monitoring of the injured worker, and mainly psychological support.
Conclusion:
In situations in which the accident could not be avoided, post-exposure behaviors were important biosecurity strategies mentioned by health workers caring for patients with HIV/Aids, in the sense of minimizing the possible transmission of the HIV virus.
Keywords:Acquired Immunodeficiency SyndromeHealth ProfessionalsOccupational AccidentsOccupational HealthOccupational RisksSee more -
RESEARCH01-01-2015
Nursing care management for children hospitalized with chronic conditions
Revista Brasileira de Enfermagem. 2015;68(4):641-648
Abstract
RESEARCHNursing care management for children hospitalized with chronic conditions
Revista Brasileira de Enfermagem. 2015;68(4):641-648
DOI 10.1590/0034-7167.2015680410i
Views0See moreABSTRACT
Objective:
to understand the interactions of nurses managing nursing care for the hospitalized child with a chronic condition.
Method:
Theoretical and methodological references were used, Complex Thought and grounded theory, respectively. In the study 18 subjects have participated arranged in three groups: nurses, nursing technicians and family members. A semi-structured interview was used as technique for data collection. The data analysis followed three stages of coding: open, axial and selective.
Results:
the category “Needing to manage nursing care to the hospitalized child with chronic condition in Pediatric Inpatient Unit” and their subcategories show the complex inter subjective bindings established by nurses that support the practice of nursing care management.
Conclusion:
There are difficulties for nursing professionals to interact with the child’s family and the dialogical order/disorder/interaction/organization in the implementation of the management process of care is.
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RESEARCH01-01-2015
Functional disability and socioeconomic and demographic factors in elderly
Revista Brasileira de Enfermagem. 2015;68(4):633-640
Abstract
RESEARCHFunctional disability and socioeconomic and demographic factors in elderly
Revista Brasileira de Enfermagem. 2015;68(4):633-640
DOI 10.1590/0034-7167.2015680409i
Views0See moreABSTRACT
Objective:
to verify the prevalence of functional disability and associated socioeconomic and demographic factors in elderly patients of Campina Grande/PB.
Method:
cross-sectional study with elderly patients of both genders. The variables associated with functional disability were assessed using Poisson regression.
Results:
A total of 420 elderly patients were included (68.1% women). The highest prevalence of functional disability were found among females aged 80 or older, white, widowed, of economic classes D/E , who lived alone, with frequency of contacts of up to 224 people and diversity of contacts of up to 14 people. After multivariate analysis, statistically significant association was observed between functional disability, gender and age group.
Conclusion:
the association between functional disability gender and age group is shown to be an important guidance for health interventions since it will allow health services to plan actions aiming to improve, maintain or restore the functional capacity of the elderly population.
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RESEARCH01-01-2015
Hypertension and Diabetes Mellitus Program evaluation on user’s view
Revista Brasileira de Enfermagem. 2015;68(4):626-632
Abstract
RESEARCHHypertension and Diabetes Mellitus Program evaluation on user’s view
Revista Brasileira de Enfermagem. 2015;68(4):626-632
DOI 10.1590/0034-7167.2015680408i
Views0See moreABSTRACT
Objectives:
to evaluate the program proposed by the Reorganization Care Plan for Hypertension and Diabetes Mellitus on user’s view, and describe aspects of the trajectory of the participants correlating with the program’s evaluation.
Method:
evaluative study with a qualitative approach conducted in health units with the Family Health Strategy, in a city of the metropolitan region of Curitiba, in the period from September to March, 2012. A total of 30 adults with hypertension and/or Diabetes mellitus were interviewed. Data were analyzed through content analysis.
Results:
Four categories were identified: Disease diagnosis; Reasons for the program need; Knowledge of the program, and program evaluation.
Conclusion:
there was the recognition of the orientations, and the monitoring of activities developed, with emphasis in cost reduction for users.
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RESEARCH01-01-2015
Violence in the eye of adolescents: education intervention with Culture Circles
Revista Brasileira de Enfermagem. 2015;68(4):617-625
Abstract
RESEARCHViolence in the eye of adolescents: education intervention with Culture Circles
Revista Brasileira de Enfermagem. 2015;68(4):617-625
DOI 10.1590/0034-7167.2015680407i
Views0See moreABSTRACT
Objective:
to apply the methodology of Culture Circles on adolescents as a strategy for health education of nurses in the construction of the collective knowledge of the thematic violence.
Method:
action research type and qualitative study. Participants were 11 adolescents from a public school in Recife, PE, Brazil. Data production in Culture Circles included the participant observation with field diary, photographic recording and filming, as well as the photovoice technique. The analysis was performed by triangulating data in dialogue with the literature.
Results:
it was shown that the problematizing action provided by the Culture Circle made possible to create situations in which adolescents felt invited to critically refl ect on the phenomenon of violence in all its complexity.
Conclusion:
the health education intervention, performed by Culture Circles, added learning and mutual growth subsidizing nursing care actions that excel at leadership and autonomy of adolescents.
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