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ORIGINAL ARTICLE05-29-2023
Risk of violence and frailty syndrome among older adults treated at a hospital service
Revista Brasileira de Enfermagem. 2023;76:e20220278
Abstract
ORIGINAL ARTICLERisk of violence and frailty syndrome among older adults treated at a hospital service
Revista Brasileira de Enfermagem. 2023;76:e20220278
DOI 10.1590/0034-7167-2022-0278
Views0See moreABSTRACT
Objectives:
to assess the association between risk of violence and frailty syndrome among hospitalized older adults.
Methods:
quantitative, analytical and cross-sectional research, carried out with older adults in two university hospitals. Data collection was performed using the Brazil Old Age Schedule, Hwalek-Sengstock Elder Abuse Screening Test and Edmonton Frail Scale instruments. It was analyzed using descriptive statistics and inferential statistics.
Results:
risk of violence was higher among women (68.9%), over 70 years old (64.7%), with more than 3 years of study (68.9%), without relationship (67.1%), who do not work (65.1%) and with income above 1 minimum wage (65.2%). There is a significant association between risk of violence and frailty (72.3%; p<0.001) and a positive correlation between the instrument scores (r=0.350; p-value<0.001).
Conclusions:
risk of violence was associated with being female and frailty. The study is expected to encourage further discussions related to the theme and nursing practice.
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ORIGINAL ARTICLE05-29-2023
Quality of life from women’s perspective in the exercise of sex work: a study of social representations
Revista Brasileira de Enfermagem. 2023;76:e20220169
Abstract
ORIGINAL ARTICLEQuality of life from women’s perspective in the exercise of sex work: a study of social representations
Revista Brasileira de Enfermagem. 2023;76:e20220169
DOI 10.1590/0034-7167-2022-0169
Views0See moreABSTRACT
Objectives:
to analyze the social representations elaborated by sex workers from Alto Sertão Produtivo Baiano about quality of life.
Methods:
a qualitative study, based on the Social Representation Theory, carried out in the region of Alto Sertão Produtivo Baiano, with 30 sex workers. Individual in-depth interview was carried out, with speeches organized in a corpus and treated in IRAMUTEQ, enabling lexical analysis for Descending Hierarchical Classification.
Results:
four thematic classes emerged, in which social representations of quality of life pervade: money earned to supply needs; association with healthy living and obtaining health (physical and mental); balance of emotions (although there are some negative sensations such as fear and anxiety); and faith in a deity.
Final Considerations:
the social representations elaborated by sex workers about quality of life are anchored in concepts, subjective and practical, punctuated by the World Health Organization.
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ORIGINAL ARTICLE05-12-2023
Preceptorship contributions to the development of clinical and managerial skills in nursing residency
Revista Brasileira de Enfermagem. 2023;76(2):e20220510
Abstract
ORIGINAL ARTICLEPreceptorship contributions to the development of clinical and managerial skills in nursing residency
Revista Brasileira de Enfermagem. 2023;76(2):e20220510
DOI 10.1590/0034-7167-2022-0510
Views0See moreABSTRACT
Objectives:
to analyze the experience of resident nurses with preceptorship contributions to the development of common clinical and managerial skills acquired in pedagogical projects.
Methods:
exploratory qualitative research developed in two stages: document analysis of pedagogical projects and semi-structured interviews with residents. Content analysis was carried out based on the framework of the nurse’s work process and skills.
Results:
the pedagogical projects of the three programs foresee the development of common skills, mostly clinical and only two managerial skills. The 22 residents reported the contributions of preceptorship in the development of competences centered on clinical practice, focusing on technical procedures disjointed from clinical reasoning and the managerial dimension of the nurse’s work.
Final Considerations:
it is necessary to train preceptors and involve all social actors linked to residency programs to expand preceptorship potential.
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ORIGINAL ARTICLE05-12-2023
Humanized care in the Intensive Care Unit: discourse of Angolan nursing professionals
Revista Brasileira de Enfermagem. 2023;76(2):e20220474
Abstract
ORIGINAL ARTICLEHumanized care in the Intensive Care Unit: discourse of Angolan nursing professionals
Revista Brasileira de Enfermagem. 2023;76(2):e20220474
DOI 10.1590/0034-7167-2022-0474
Views0See moreABSTRACT
Objectives:
to analyze the perception of nursing professionals in an intensive care unit in Angola about humanized care and identify resources necessary for its implementation.
Methods:
a qualitative, descriptive study conducted with 15 professionals in June-October/2020 in intensive care unit in Angola. The data were collected through semi-structured interviews; analysis based on the collective subject discourse technique.
Results:
five central ideas emerged: three related to the perception of humanized care (“From integral vision and empathy to a set of actions in all phases of care”, “Humanizing is extending care to family members and companions”, “Humanized care requires the establishment of a bond of trust and guarantee of individualized care”); and two on the resources necessary for this care (“Need for infrastructure – human and material resources”, “Professional training and humanized care are interconnected”).
Final Considerations:
humanized care involves objectivity and subjectivity; it includes family members. An adequate infrastructure can provide it.
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ORIGINAL ARTICLE05-12-2023
The history of obstetric nurses’ professional training of in Minas Gerais (1957-1999): a genealogical analysis
Revista Brasileira de Enfermagem. 2023;76(2):e20220459
Abstract
ORIGINAL ARTICLEThe history of obstetric nurses’ professional training of in Minas Gerais (1957-1999): a genealogical analysis
Revista Brasileira de Enfermagem. 2023;76(2):e20220459
DOI 10.1590/0034-7167-2022-0459
Views0See moreABSTRACT
Objectives:
to analyze obstetric nurses’ professional training in Minas Gerais between 1957 and 1999, according to genealogical principles.
Methods:
a qualitative interpretative study based on historical research with genealogical analysis. Data were obtained through documentary research and oral history, with six participants, and submitted to discourse analysis.
Results:
they recompose the genealogical path of obstetric nurses’ professional training from Minas. The speeches reveal field of practice deprivation in professional training and the importance of the articulation between the Universidade Federal de Minas Gerais Nursing School and Hospital Sofia Feldman for teaching and work in obstetric nursing. It was identified that training, in the national scenario, evolved from a Escola de Enfermagem Carlos Chagas’ peripheral initiative to centrality and capillarity.
Final Considerations:
the unique historical trajectory of obstetric nurses’ professional training in Minas Gerais, marked by ruptures, institutional articulations, conflicting games and interest, was unveiled.
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ORIGINAL ARTICLE05-08-2023
Efectividad del Programa educativo de autorregulación en incrementar conocimientos sobre COVID-19 en militares peruanos
Revista Brasileira de Enfermagem. 2023;76:e20220498
Abstract
ORIGINAL ARTICLEEfectividad del Programa educativo de autorregulación en incrementar conocimientos sobre COVID-19 en militares peruanos
Revista Brasileira de Enfermagem. 2023;76:e20220498
DOI 10.1590/0034-7167-2022-0498es
Views0RESUMEN
Objetivo:
Determinar la efectividad del Programa educativo basado en autorregulación del aprendizaje en el nivel de conocimiento sobre COVID-19 en militares.
Métodos:
Estudio preexperimental de diseño pretest y postest con un solo grupo, realizado en 2020. Participaron 179 militares de Puno, Perú. Se desarrollaron dos sesiones expositivo-participativas y un taller demostrativo. Se empleó un cuestionario válido (V de Aiken = 0,69) y confiable (Omega de McDonald = 0,81). Se utilizó el test de Friedman para comparar los resultados en pre y postest.
Resultados:
El nivel de conocimientos sobre COVID-19 y en dos de sus dimensiones cambió de deficiente (pretest) a regular (postest). Sin embargo, en la dimensión medidas preventivas, cambió de deficiente (pretest) a excelente (postest).
Conclusión:
La intervención educativa propuesta fue efectiva al incrementar los conocimientos sobre COVID-19 en militares, principalmente en cuanto a medidas preventivas.
Keywords:ConocimientoEfectividadInfecciones por CoronavirusPersonal MilitarPrevención de EnfermedadesSee more -
ORIGINAL ARTICLE05-08-2023
Effectiveness of the self-regulation educational program in increasing knowledge about COVID-19 in Peruvian soldiers
Revista Brasileira de Enfermagem. 2023;76:e20220498
Abstract
ORIGINAL ARTICLEEffectiveness of the self-regulation educational program in increasing knowledge about COVID-19 in Peruvian soldiers
Revista Brasileira de Enfermagem. 2023;76:e20220498
DOI 10.1590/0034-7167-2022-0498
Views0See moreABSTRACT
Objective:
To determine the effectiveness of the educational program based on self-regulation of learning in the level of knowledge about COVID-19 in the soldiers.
Methods:
Pre-experimental study with a pre-test and post-test design with a single group, carried out in 2020. 179 soldiers from Puno, Peru participated. Two expository-participatory sessions and a demonstrative workshop were developed. A valid (Aiken’s V = 0.69) and reliable (McDonald’s Omega = 0.81) questionnaire was used. The Friedman’s test was used to compare the results pre and post-test.
Results:
The level of knowledge about COVID-19 and in two of its dimensions changed from poor (pre-test) to regular (post-test). However, in the preventive measures dimension, it changed from poor (pre-test) to excellent (post-test).
Conclusion:
The proposed educational intervention was effective in increasing knowledge about COVID-19 in the soldiers, mainly in terms of preventive measures.
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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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ORIGINAL ARTICLE11-22-2024
Safe practices for prevention and management of antineoplastic agent extravasation: development of an educational video
Revista Brasileira de Enfermagem. 2024;77(5):e20240172
Abstract
ORIGINAL ARTICLESafe practices for prevention and management of antineoplastic agent extravasation: development of an educational video
Revista Brasileira de Enfermagem. 2024;77(5):e20240172
DOI 10.1590/0034-7167-2024-0172
Views0ABSTRACT
Objectives:
to develop, validate, and evaluate an educational video on the prevention and management of antineoplastic agent extravasation, aimed at nursing professionals.
Methods:
this methodological study was developed according to Falkembach’s theoretical framework, which outlines five phases in the production of educational video materials: analysis and planning, modeling, implementation, evaluation, and distribution.
Results:
content validation demonstrated agreement above the minimum threshold stipulated. The overall Content Validity Index was 90.8%, and it was 94.2% among the content and technical evaluation judges, respectively. The target audience evaluated the video positively, highlighting the importance of the content, the clarity of the language used, and the understanding of the information pertinent to the topic.
Conclusions:
the video proved to be an appropriate strategy for instructing interventions on the prevention and management of extravasation, with the potential to improve educational practices among nursing professionals.
Keywords:Antineoplastic AgentsEducational TechnologyExtravasation of Diagnostic and Therapeutic MaterialsInstructional Film and VideoNursingSee more -
REVIEW11-22-2024
Telenursing contributions in Primary Health Care in the COVID-19 pandemic context: an integrative review
Revista Brasileira de Enfermagem. 2024;77(5):e20240093
Abstract
REVIEWTelenursing contributions in Primary Health Care in the COVID-19 pandemic context: an integrative review
Revista Brasileira de Enfermagem. 2024;77(5):e20240093
DOI 10.1590/0034-7167-2024-0093
Views1See moreABSTRACT
Objective:
to identify telenursing contributions in Primary Health Care during the COVID-19 pandemic.
Methods:
an integrative literature review, conducted between January and August 2022 in the PubMed, CINAHL, LILACS, BDENF, Scopus, WoS, EMBASE and SciELO databases. A total of 493 studies was found, 62 were read in full, and of these, 16 were selected. For analysis, a dynamic reading of the studies and synthesis of the main results were carried out.
Results:
the main results highlighted telenursing practice as a challenge for professionals and the population. Among the contributions and positive points and aspects that require improvement, practice showed promise when considered in a post-pandemic scenario.
Final considerations:
through telenursing, the population’s access to Primary Health Care was guaranteed in the face of the COVID-19 pandemic. However, a critical look at current technological advances in healthcare is necessary.
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ORIGINAL ARTICLE11-22-2024
Percepções de pessoas com deficiência física sobre acessibilidade e condições sociais: intervenções para enfermagem de reabilitação
Revista Brasileira de Enfermagem. 2024;77(5):e20240005
Abstract
ORIGINAL ARTICLEPercepções de pessoas com deficiência física sobre acessibilidade e condições sociais: intervenções para enfermagem de reabilitação
Revista Brasileira de Enfermagem. 2024;77(5):e20240005
DOI 10.1590/0034-7167-2024-0005
Views0RESUMEN
Objetivos:
analizar las experiencias de personas con discapacidad física adquirida en cuanto a accesibilidad y condiciones sociales; identificar intervenciones de rehabilitación dirigidas por enfermeras para la accesibilidad y condiciones sociales; determinar indicadores sensibles a la enfermería para mejorar la accesibilidad y condiciones sociales.
Métodos:
estudio cualitativo descriptivo-exploratorio utilizó entrevistas semiestructuradas con personas con discapacidad física adquirida mediante muestreo intencionado en bola de nieve para cumplir con todos los objetivos. El análisis de datos siguió los principios del análisis de contenido de Bardin. Los objetivos 2 y 3 se lograron mediante un enfoque teórico reflexivo.
Resultados:
los 27 participantes informaron desafíos de accesibilidad, que impactan las actividades de la vida diaria y las condiciones sociales. Esto influye en la enfermería de rehabilitación, dando lugar a tres campos de intervención: Evaluar la capacidad para realizar actividades diarias y los factores que influyen; Desarrollar e implementar capacitación para la realización de actividades diarias; Promover la movilidad, la accesibilidad y la participación social.
Consideraciones Finales:
a partir de las experiencias de los participantes, identificamos intervenciones de rehabilitación dirigidas por enfermeras para promover la accesibilidad y condiciones sociales.
Keywords:Acessibilidade ArquitetónicaCondições SociaisEnfermagem em ReabilitaçãoObjetivos de Desenvolvimento SustentávelPessoas com DeficiênciaSee more -
ORIGINAL ARTICLE11-22-2024
Rondas a beira leito no ambiente hospitalar na perspectiva de equipes multiprofissionais de saúde
Revista Brasileira de Enfermagem. 2024;77(5):e20230493
Abstract
ORIGINAL ARTICLERondas a beira leito no ambiente hospitalar na perspectiva de equipes multiprofissionais de saúde
Revista Brasileira de Enfermagem. 2024;77(5):e20230493
DOI 10.1590/0034-7167-2023-0493
Views0RESUMEN
Objetivo:
Analizar la configuración de las relaciones de poder entre el equipo multiprofesional en el proceso de rondas de cabecera en el hospital.
Método:
Investigación cualitativa con datos analizados a través del análisis del discurso, basado en el marco teórico de Michel Foucault. De septiembre a diciembre de 2022, realizamos entrevistas y observaciones de campo con el equipo multiprofesional de un hospital de Belo Horizonte, Minas Gerais, Brasil, así como entrevistas cualitativas semiestructuradas con 37 profesionales.
Resultados:
Los participantes señalaron que las experiencias de los profesionales involucrados en las rondas de cabecera dependen de cómo el médico conduce el proceso, y el proceso centrado en el médico dificulta la participación de otros profesionales del equipo.
Consideraciones finales:
La forma en que los hospitales organizan las rondas de cabecera no promueve la articulación del conocimiento de sus profesionales. Además, dificulta la circulación del poder y perjudica el trabajo interdisciplinario en un proceso que mantiene al médico como actor principal de las decisiones clínicas.
Keywords:Conhecimentos, Atitudes e Prática em SaúdeEquipe de Assistência MultidisciplinarHospitaisPrática ProfissionalRelações InterprofissionaisSee more -
ORIGINAL ARTICLE11-22-2024
Bedside rounds in the hospital environment from the perspective of multiprofessional health teams
Revista Brasileira de Enfermagem. 2024;77(5):e20230493
Abstract
ORIGINAL ARTICLEBedside rounds in the hospital environment from the perspective of multiprofessional health teams
Revista Brasileira de Enfermagem. 2024;77(5):e20230493
DOI 10.1590/0034-7167-2023-0493
Views0ABSTRACT
Objective:
To analyze the configuration of power relations among the multiprofessional team in the bedside round process in the hospital.
Methods:
Qualitative research with data analyzed through discourse analysis, based on Michel Foucault’s theoretical framework. From September to December 2022, we conducted interviews and field observations with the multiprofessional team at a hospital in Belo Horizonte, Minas Gerais, Brazil, as well as qualitative, semi-structured interviews with 37 professionals.
Results:
The participants pointed out that the experiences of the professionals involved in bedside rounds depend on how the physician conducts the process, and the physician-centered process makes it difficult for other professionals in the team to participate.
Final considerations:
The way hospitals organize bedside rounds does not promote knowledge articulation for their professionals. It hinders the circulation of power and harms interdisciplinary work in a process that maintains the physician as the main actor in clinical decisions.
Keywords:Health Knowledge, Attitudes, PracticeHospitalsInterprofessional RelationsPatient Care TeamProfessional PracticeSee more -
REVIEW11-22-2024
Transition to family parenting in the face of the first child: a scoping review
Revista Brasileira de Enfermagem. 2024;77(5):e20230487
Abstract
REVIEWTransition to family parenting in the face of the first child: a scoping review
Revista Brasileira de Enfermagem. 2024;77(5):e20230487
DOI 10.1590/0034-7167-2023-0487
Views1See moreABSTRACT
Objectives:
to identify and summarize the elements that characterize the family transition process in relation to the first child.
Methods:
a scoping review was carried out based on JBI methodology, in six databases, following the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews checklist.
Results:
ten articles were included with factors characterizing the transition, such as hindering/facilitating conditions that influence the process, important support structures in adaptation and strategies/responses used in the transition process.
Final Considerations:
elements characterizing the transition process in relation to the first child were identified. However, no theoretical explanation for this was identified. Further research should be carried out to obtain a deeper understanding of this process.
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