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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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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
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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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
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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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
Bladder ultrasound: evidence of content validity of a checklist for training nurses
- Filipe Utuari de Andrade Coelho ,
- Sabrina Martins Reigota ,
- Flávia Manfredi Cavalcanti ,
- Dejanira Aparecida Regagnin ,
- Beatriz Murata Murakami , [ … ],
- Vinícius Batista Santos
Abstract
ORIGINAL ARTICLEBladder ultrasound: evidence of content validity of a checklist for training nurses
Revista Brasileira de Enfermagem. 2024;77(6):e20230183
DOI 10.1590/0034-7167-2023-0183
- Filipe Utuari de Andrade Coelho ,
- Sabrina Martins Reigota ,
- Flávia Manfredi Cavalcanti ,
- Dejanira Aparecida Regagnin ,
- Beatriz Murata Murakami ,
- Vinícius Batista Santos
Views0See moreABSTRACT
Objectives:
to develop and analyze evidence of content validity of a checklist for training nurses in measuring bladder volume through ultrasound.
Methods:
a methodological study, consisting of three stages: literature review; instrument item preparation; and analysis of evidence of content validity. The Content Validity Index (CVI) and Gwet’s AC2 were used for content validity analyses.
Results:
the checklist consisted of 23 items. The CVIs for clarity, relevance and dimensionality were 0.99, 0.99 and 0.98 respectively, and the CVIs for Gwet’s AC2 with coefficients for clarity, relevance and dimensionality were 0.89, 0.97 and 0.95, respectively, with p<0.001.
Conclusions:
the checklist developed for training nurses in measuring bladder volume through ultrasound achieved adequate evidence of content validity, and can be used to train nurses in clinical practice and future research.
- Filipe Utuari de Andrade Coelho
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12-16-2024
A relação entre gênero, formação educacional e ambiente de aprendizagem com a ansiedade do estudante de enfermagem
- Amelia Margaretha Simbolon ,
- Jesika Sari Munthe ,
- Mikar Syah Idaman Daeli ,
- Ineke Patrisia ,
- Chriska Roully Adeline Sinaga
Abstract
A relação entre gênero, formação educacional e ambiente de aprendizagem com a ansiedade do estudante de enfermagem
Revista Brasileira de Enfermagem. 2024;77(6):e20220615
DOI 10.1590/0034-7167-2022-0615
- Amelia Margaretha Simbolon ,
- Jesika Sari Munthe ,
- Mikar Syah Idaman Daeli ,
- Ineke Patrisia ,
- Chriska Roully Adeline Sinaga
Views1See moreRESUMEN
Objetivos:
identificar las variables asociadas a la práctica clínica relacionadas con la ansiedad de los estudiantes de enfermería.
Métodos:
se utilizó un diseño descriptivo, cuantitativo, correlacional con las recomendaciones STROBE, EQUATOR. La población fue de 233 estudiantes de enfermería con una muestra de 135 personas. Los datos se recopilaron de marzo a abril de 2022 utilizando instrumentos validados.
Resultados:
la prueba de chi-cuadrado y razón de verosimilitud significativa para género, formación académica y entorno de aprendizaje son superiores a 0.05, por lo que no existe una relación significativa entre las variables y la ansiedad de los estudiantes.
Conclusiones:
los estudiantes necesitan prepararse nuevamente antes de ingresar al campo de la práctica. Investigaciones cualitativas también son necesarias.
- Amelia Margaretha Simbolon
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ORIGINAL ARTICLE09-16-2019
Validation of educational booklet: an educational technology in dengue prevention
- Camila Fernandes Wild ,
- Elisabeta Albertina Nietsche ,
- Cléton Salbego ,
- Elizabeth Teixeira ,
- Natalia Barrionuevo Favero
Abstract
ORIGINAL ARTICLEValidation of educational booklet: an educational technology in dengue prevention
Revista Brasileira de Enfermagem. 2019;72(5):1318-1325
DOI 10.1590/0034-7167-2018-0771
- Camila Fernandes Wild ,
- Elisabeta Albertina Nietsche ,
- Cléton Salbego ,
- Elizabeth Teixeira ,
- Natalia Barrionuevo Favero
Views0See moreABSTRACT
Objective:
to validate a booklet on dengue prevention in order to make it an educational technology to be used with the population.
Method:
methodological study, carried out with two groups of judges specialized in health and other areas. For data analysis, the calculation of Content Validity Index was carried out.
Results:
the booklet, in general, was considered valid by the expert judges, since it obtained an overall CVI of 70%. However, it has undergone a textual and aesthetic re-elaboration. The changes were based on the substitution of expressions, phrases, information additions and language adequacy. The illustrations were redone, adding clarity, expressiveness, movement, interaction and contextualization.
Conclusion:
the booklet is valid to be used for the population, with the purpose of informing, in a playful way, the forms of prevention and combat to mosquito transmitting dengue.
- Camila Fernandes Wild
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REVIEW09-18-2020
Mental health of healthcare professionals in China during the new coronavirus pandemic: an integrative review
- Marcelle Paiano ,
- André Estevam Jaques ,
- Paula Antunes Bezerra Nacamura ,
- Maria Aparecida Salci ,
- Cremilde Aparecida Trindade Radovanovic , [ … ],
- Ligia Carreira
Abstract
REVIEWMental health of healthcare professionals in China during the new coronavirus pandemic: an integrative review
Revista Brasileira de Enfermagem. 2020;73:e20200338
DOI 10.1590/0034-7167-2020-0338
- Marcelle Paiano ,
- André Estevam Jaques ,
- Paula Antunes Bezerra Nacamura ,
- Maria Aparecida Salci ,
- Cremilde Aparecida Trindade Radovanovic ,
- Ligia Carreira
Views0See moreABSTRACT
Objective:
to identify publishing related to the mental health of health professionals working in the front line of the COVID-19 pandemic.
Methods:
an integrative review that included primary articles indexed in the Latin American and Caribbean Literature in Health Sciences, Medical Literature Analysis and Retrieval System Online, Cumulative Index to Nursing and Allied Health Literature, Scopus, Embase, Web of Science, Science Direct databases and US National Library of Medicine databases. The result analysis was performed descriptively, in four analytical categories.
Results:
The publishing involved aspects related to insufficient personal protective equipment, feelings of fear and stigma, the need for psychological and psychiatric support and the possibility of post-outbreak mental disorders.
Conclusion:
All mentioned aspects have a direct impact on the mental health of professionals, demanding the creation of strategies that minimize the emotional burnout of workers, considering that each country and culture reacts differently to the disease.
- Marcelle Paiano
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ORIGINAL ARTICLE06-27-2019
Religious/spiritual coping and level of hope in patients with cancer in chemotherapy
- Diogo Timóteo Costa ,
- Darine Marie Rodrigues da Silva ,
- Iago Dillion Lima Cavalcanti ,
- Eduardo Tavares Gomes ,
- Juliana Lúcia de Albuquerque Vasconcelos , [ … ],
- Maria Valéria Gorayeb de Carvalho
Abstract
ORIGINAL ARTICLEReligious/spiritual coping and level of hope in patients with cancer in chemotherapy
Revista Brasileira de Enfermagem. 2019;72(3):640-645
DOI 10.1590/0034-7167-2018-0358
- Diogo Timóteo Costa ,
- Darine Marie Rodrigues da Silva ,
- Iago Dillion Lima Cavalcanti ,
- Eduardo Tavares Gomes ,
- Juliana Lúcia de Albuquerque Vasconcelos ,
- Maria Valéria Gorayeb de Carvalho
Views0See moreABSTRACT
Aim:
To demonstrate the relationship between religious/spiritual coping and hope in cancer patients undergoing chemotherapy.
Method:
This is a cross-sectional, descriptive study with a quantitative approach performed in a reference outpatient clinic in Caruaru, PE, between August and October 2017. A total of 82 cancer patients undergoing chemotherapy were included in the study, using the brief religious/spiritual coping scale (RCOPE-Brief) and the Herth Hope Scale (HHS).
Results:
The sample presented mean positive RCOPE scores (3.03 ± 0.41) and the level of hope was considered high (42.7 points ± 3.67). Patients who had a high RCOPE score were found to have a higher mean of Herth’s level of hope (44.12 points).
Conclusion:
This study becomes relevant to nursing professionals by encouraging care that takes into account the patient’s spiritual dimension in order to stimulate positive mechanisms of religious coping and, consequently, raise the levels of hope.
- Diogo Timóteo Costa
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ORIGINAL ARTICLE04-22-2020
Construction and validation of an educational booklet on care for children with gastrostomy
- Lidiane do Nascimento Rodrigues ,
- Aliniana da Silva Santos ,
- Priscila Pereira de Souza Gomes ,
- Wandra Camila Penaforte da Silva ,
- Edna Maria Camelo Chaves
Abstract
ORIGINAL ARTICLEConstruction and validation of an educational booklet on care for children with gastrostomy
Revista Brasileira de Enfermagem. 2020;73(3):e20190108
DOI 10.1590/0034-7167-2019-0108
- Lidiane do Nascimento Rodrigues ,
- Aliniana da Silva Santos ,
- Priscila Pereira de Souza Gomes ,
- Wandra Camila Penaforte da Silva ,
- Edna Maria Camelo Chaves
Views0See moreABSTRACT
Objectives:
to describe the process of construction and validation of an educational booklet on care for children with gastrostomy, directed to caregivers.
Methods:
a methodological study developed in five stages: bibliographic survey; situational diagnosis; illustration, layout, design and text construction; expert validation and Flesch-Kincaid Readability calculation; validation with the target audience. Content Validity Index and Suitability Assessment of Materials were applied for expert analysis.
Results:
the Content Validity Index obtained overall score of 0.93. In the Suitability Assessment of Materials score, the booklet scored 85.2%. It presented a satisfactory readability percentage, with an overall score of 72%, and was consistent with caregivers’ assessment in the validation with the target audience, considering the explanatory technology, important and adequate.
Conclusions:
the developed educational booklet was considered valid for use by caregivers, thus contributing to the maintenance of best practices in care for children with gastrostomy.
- Lidiane do Nascimento Rodrigues
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REVIEW12-05-2019
Hospital transition care for the elderly: an integrative review
- Tânia Maria de Oliva Menezes ,
- Ana Luíza Barreto de Oliveira ,
- Lucivalda Barbosa Santos ,
- Raniele Araújo de Freitas ,
- Larissa Chaves Pedreira , [ … ],
- Sylvia Maria Cardoso Bastos Veras
Abstract
REVIEWHospital transition care for the elderly: an integrative review
Revista Brasileira de Enfermagem. 2019;72:294-301
DOI 10.1590/0034-7167-2018-0286
- Tânia Maria de Oliva Menezes ,
- Ana Luíza Barreto de Oliveira ,
- Lucivalda Barbosa Santos ,
- Raniele Araújo de Freitas ,
- Larissa Chaves Pedreira ,
- Sylvia Maria Cardoso Bastos Veras
Views0See moreABSTRACT
Objective:
to identify evidence of scientific production on hospital transition care provided to the elderly.
Method:
an integrative review, with publications search in the MEDLINE, PubMed, LILACS, BDENF, Index Psychology and SciELO databases, with keywords and Mesh terms: elderly, hospitalization, patient discharge, health of the elderly, and transitional care, between 2013 and 2017 in English, Portuguese and Spanish. The 14 selected articles analysis was carried out through exploratory and critical reading of titles, abstracts and results of the researches.
Results:
transitional care can prevent re-hospitalizations as they enable rehabilitation, promotion and cure of illnesses in the elderly.
Final considerations:
transitional care implies the improvement of the quality of life of the elderly person, requiring skilled health professionals who involve the family through accessible communication.
- Tânia Maria de Oliva Menezes
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REVIEW08-07-2020
Positive aspects of authentic leadership in nursing work: integrative review
- Vanessa Gomes Maziero ,
- Andrea Bernardes ,
- Eline Aparecida Vendas Righetti ,
- Wilza Carla Spiri ,
- Carmen Silvia Gabriel
Abstract
REVIEWPositive aspects of authentic leadership in nursing work: integrative review
Revista Brasileira de Enfermagem. 2020;73(6):e20190118
DOI 10.1590/0034-7167-2019-0118
- Vanessa Gomes Maziero ,
- Andrea Bernardes ,
- Eline Aparecida Vendas Righetti ,
- Wilza Carla Spiri ,
- Carmen Silvia Gabriel
Views0See moreABSTRACT
Objective:
To identify and analyze the existing scientific production on the positive aspects of authentic leadership in the nurse’s work process.
Method:
This is an integrative literature review. The databases used were Scientific Electronic Library Online; Latin American and Caribbean Literature on Health Sciences; and National Library of Medicine – National Institutes of Health.
Results:
In this study, 17 articles were selected for analysis; 1 study (6%) was published in a national journal, and 16 (94%) were international studies. Of the 17 (100%) articles studied, 11 (65%) were developed in Canada. The hospital environment was present in the 17 (100%) articles.
Final considerations:
Authentic leadership has several positive aspects that significantly influence the nurse’s work process, such as engagement and job satisfaction, retention of new nurses, organizational commitment, among others.
- Vanessa Gomes Maziero
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ORIGINAL ARTICLE12-21-2020
Development of an appearance validity instrument for educational technology in health
Revista Brasileira de Enfermagem. 2020;73:e20190559
Abstract
ORIGINAL ARTICLEDevelopment of an appearance validity instrument for educational technology in health
Revista Brasileira de Enfermagem. 2020;73:e20190559
DOI 10.1590/0034-7167-2019-0559
Views1See moreABSTRACT
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.
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ORIGINAL ARTICLE02-10-2020
Burnout among nursing students: predictors and association with empathy and self-efficacy
Revista Brasileira de Enfermagem. 2020;73(1):e20180280
Abstract
ORIGINAL ARTICLEBurnout among nursing students: predictors and association with empathy and self-efficacy
Revista Brasileira de Enfermagem. 2020;73(1):e20180280
DOI 10.1590/0034-7167-2018-0280
Views0See moreABSTRACT
Objective:
to analyze burnout, its predictors and association with empathy and self-efficacy among nursing students.
Method:
cross-sectional analytical study with 284 students from five state universities in the state of Parana, Brazil. The instruments applied were: social and academic questionnaire, Maslach Burnout Inventory, Interpersonal Reactivity Index and Occupational Self-Efficacy Scale (Short Form). Spearman’s correlation and univariate and multivariate logistic analysis were used.
Results:
6.0% of the students presented high burnout, 36.3% presented high emotional exhaustion, 37.7% presented high depersonalization and 28.2% presented low personal accomplishment. The burnout predictors were: absence of physical activity; weekly workload >24 hours; low empathic concern. There were negative correlations between empathy (empathic concern and perspective taking) and depersonalization; self-efficacy and emotional exhaustion; and positive correlations between personal accomplishment and empathy and self-efficacy.
Conclusion:
Personal factors and an academic variable were burnout predictors among nursing students. The correlations suggest that self-efficacy and empathy can prevent burnout.
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