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RESEARCH01-01-2016
Modified early warning score: evaluation of trauma patients
Revista Brasileira de Enfermagem. 2016;69(5):906-911
Abstract
RESEARCHModified early warning score: evaluation of trauma patients
Revista Brasileira de Enfermagem. 2016;69(5):906-911
DOI 10.1590/0034-7167-2015-0145
Views0ABSTRACT
Objective:
to identify the severity of patients admitted to an emergency trauma.
Method:
A cross-sectional and retrospective study with 115 trauma patients classified as orange (Manchester System), from June 2013 to July 2014. The data were presented as mean and standard deviation, in addition to the Pearson Chi-square test, One-Way ANOVA and Tukey tests.
Results:
from the sample, 81.7% were male with mean age of 39.46±19.71 years. Higher incidence of major trauma (48.7%) and traumatic brain injury (37.4%). At the end of the outcome and MEWS, most cases that had score 1 to 3 were referred to the operating room and the ICU.
Conclusion:
the start point of MEWS was 2 to 3 points, with significant increase in the severity of the situation of patients seen after 6 hours, and approximately half of the individuals underwent surgery, indicating that the scale is a good predictor of severity.
Keywords:EmergenciesEmergency Medical ServicesExposureMeasures of AssociationRisk or OutcomeSeverity of Illness IndexSee more -
RESEARCH01-01-2016
Occupational health nurses: interdisciplinary experience in occupational health
Revista Brasileira de Enfermagem. 2016;69(5):897-905
Abstract
RESEARCHOccupational health nurses: interdisciplinary experience in occupational health
Revista Brasileira de Enfermagem. 2016;69(5):897-905
DOI 10.1590/0034-7167-2015-0113
Views0ABSTRACT
Objective:
to analyze the relationship of occupational health nurses with the other members of the Specialized Service in Safety Engineering and Occupational Medicine (SESMT) and characterize joint actions of these professionals in occupational health.
Method:
qualitative, exploratory, and descriptive study with 34 professionals of seven companies from the South Macroregion of the state of Rio Grande do Sul. Interviews and observations were conducted for content analysis of Bardin.
Results:
the SESMTs are multidisciplinary and intersectoral workers. Nurses have working relations of an interpersonal, technical/legal, and management of logistics/organizational nature, influenced by the technical division of work and by the division in the work environment of the staff, which distances areas, generates conflicts, and fragments the actions of the service.
Conclusion:
SESMT faces challenges to develop a work befitting their legal objectives, once staff and companies need to understand the importance of interdisciplinarity for the success of actions on the workers’ health and safety.
Keywords:InterrelationshipOccupational Health NursingOccupational Health ServicesWorkWorkers' HealthSee more -
RESEARCH01-01-2016
Translation and adaptation of a pediatric early warning score
Revista Brasileira de Enfermagem. 2016;69(5):888-896
Abstract
RESEARCHTranslation and adaptation of a pediatric early warning score
Revista Brasileira de Enfermagem. 2016;69(5):888-896
DOI 10.1590/0034-7167-2015-0096
Views0See moreABSTRACT
Objective:
to translate and adapt the BPEWS for the Portuguese language, with the purpose of verifying its applicability in the Brazilian context studied.
Method:
methodological study guided by international and nationally accepted recommendations for translation and adaptation of health measurement instruments. Stages of conceptual, item, semantic, operational and pre-test equivalence are described for obtaining the BPEWS Portuguese version to be used in Brazil.
Results:
the BPEWS version translated and adapted for Brazilian Portuguese (BPEWS-Br) identified, in the pilot study, that 26.6% of children were presenting warning signs for clinical deterioration.
Conclusion:
the BPEWS-Br seems to be applicable for the context studied, and its use might help nurses in the recognition and documentation of warning signs for clinical deterioration in hospitalized Brazilian children.
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RESEARCH01-01-2016
Validation of the Nursing Activities Score in Portuguese intensive care units
Revista Brasileira de Enfermagem. 2016;69(5):881-887
Abstract
RESEARCHValidation of the Nursing Activities Score in Portuguese intensive care units
Revista Brasileira de Enfermagem. 2016;69(5):881-887
DOI 10.1590/0034-7167-2016-0147
Views0See moreABSTRACT
Objective:
to describe the process of adaptation and validation of the Nursing Activities Score to the Portuguese context.
Method:
this was a pilot study of adaptation and validation of the Nursing Activities Score with a sample consisting of 67 patients hospitalized in the intensive care units of three Portuguese hospitals. The construct validity was assessed through factor analysis procedures and the internal consistency of the items was measured through the Cronbach’s alpha coefficient.
Results:
a mean workload value of 63.04% (SD = 14.25; Median = 61.30) was obtained. Psychometric data revealed a Cronbach’s alpha of 0.71 in the total scale, indicating an acceptable accuracy. Confirmatory factor analysis suggested an appropriate adjustment between the model and the data (χ2(199) = 214.5, p = 0.214; CFI = 0.95; RMSA = 0.035).
Conclusion:
in the present study, the Portuguese version of the Nursing Activities Score was found to be a valid instrument, enabling a safe assessment of the workload of nurses.
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RESEARCH01-01-2016
Managing educational practices for qualified nursing care in cardiology
Revista Brasileira de Enfermagem. 2016;69(5):872-880
Abstract
RESEARCHManaging educational practices for qualified nursing care in cardiology
Revista Brasileira de Enfermagem. 2016;69(5):872-880
DOI 10.1590/0034-7167-2015-0032
Views0See moreABSTRACT
Objective:
to understand significances attributed by nurses who manage nursing care to the individual affected by cardiovascular disease to relations, interactions and associations of the educational practices in a cardiovascular reference hospital. To elaborate a theoretical explanatory model based on significances attributed in the light of the complex thinking.
Method:
qualitative study, which used Theory Based on Data (TBD) as methodological reference. Twenty-two professionals of nursing participated in the study.
Results:
the results indicate need of professional qualification to ensure the safety of patients, institutional support for the realization of educational practices, attitude of openness and availability of dialogue of the health professionals and other institutional conformations for the workers’ development.
Conclusion:
the study presents a new space for the nurse’s action that can be used to qualify and optimize the nursing practice, as it provides visibility to management and care in health institutions.
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RESEARCH01-01-2016
Clinical validation of nursing diagnosis “Willingness for improved infant development”
Revista Brasileira de Enfermagem. 2016;69(5):855-863
Abstract
RESEARCHClinical validation of nursing diagnosis “Willingness for improved infant development”
Revista Brasileira de Enfermagem. 2016;69(5):855-863
DOI 10.1590/0034-7167-2015-0131
Views0See moreABSTRACT
Objective:
to conduct the clinical validation of nursing diagnosis “Willingness for improved infant development”.
Method:
a cross-sectional study, conducted in a Centro de Saúde da Família (Family Health Care center), with 45 healthy breastfed infants. The instrument for collecting the data was prepared based on the literature and validated by nurses. It contained the following variables: sociodemographic, gestational, and obstetrical variables; breastfed infant’s nutritional profile; evaluation of the defining characteristics of the proposed nursing diagnosis.
Results:
all the defining characteristics were found to have high sensitivity values (>90%), positive predictive values (>65%), negative predictive values (>66%); however, low specificity values (<32%). In this study, the defining characteristics we found to have estimates (>0.50) within the ROC curve, which provides good sensitivity and specificity.
Conclusion:
this study verified the structural elements of the proposed nursing diagnosis to be relevant in the clinical context, which justifies the need for its being employed with children, taking into account its contribution to improving nursing care.
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RESEARCH01-01-2016
Oral drugs at a hospital unit: adequacy for use via enteral feeding tubes
Revista Brasileira de Enfermagem. 2016;69(5):847-854
Abstract
RESEARCHOral drugs at a hospital unit: adequacy for use via enteral feeding tubes
Revista Brasileira de Enfermagem. 2016;69(5):847-854
DOI 10.1590/0034-7167-2015-0081
Views0See moreABSTRACT
Objective:
to describe the profile of standardized oral drugs at a hospital unit and assess their adequacy for use via enteral feeding tubes, according to recommendations from the literature.
Method:
descriptive study, with data on drugs collected from the Pharmacy Service Dispensing System. Specific recommendations for the use of these drugs via enteral feeding tubes were found after searches in literary databases, books, manuals, guidelines and package insert collections.
Results:
among the 236 dispensed oral drugs, 86% were in solid form; of those, 32 were “non-crushable”, with the liquid form available at the institution. Twenty-eight drugs with potential interactions with enteral nutrition were identified. Sixty percent of those presented specific recommendations on their administration via enteral feeding tube.
Conclusion:
the joint participation of multidisciplinary nutritional therapy and care teams and the implementation of programs for continuous training are suggested strategies for the prevention of potential problems in the administration of drugs in the hospital setting.
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EDITORIAL12-08-2024
Ibero-American nursing context: constructing and sharing knowledge
Revista Brasileira de Enfermagem. 2024;77(1):e770101
Abstract
EDITORIALIbero-American nursing context: constructing and sharing knowledge
Revista Brasileira de Enfermagem. 2024;77(1):e770101
DOI 10.1590/0034-7167.2024770101
Views0Next week, two major scientific events will take place in Madrid and Granada (Spain). These will be international, specific activities in a very special way, although not exclusive to the Ibero-American field, organized and developed by two very important scientific nursing societies, such as Community Nursing Association (AEC) and Latin American Association of Schools and […]See more -
REVIEW12-08-2024
Interventions for Strengthening General Self-Efficacy Beliefs in College Students: An Integrative Review
Revista Brasileira de Enfermagem. 2024;77(1):e20230192
Abstract
REVIEWInterventions for Strengthening General Self-Efficacy Beliefs in College Students: An Integrative Review
Revista Brasileira de Enfermagem. 2024;77(1):e20230192
DOI 10.1590/0034-7167-2023-0192
Views0See moreABSTRACT
Objective:
To assess the evidence regarding the effectiveness of interventions aimed at strengthening self-efficacy beliefs in college students.
Methods:
Integrative Review conducted on the Lilacs, PubMed, CinahL, Cochrane Collaboration Databases, Scopus, and PsycInfo databases. The methodological quality of the studies was assessed using tools proposed by the Joanna Briggs Institute, and the results were analyzed descriptively.
Results:
Out of the 10 selected studies, six demonstrated that interventions aimed at strengthening self-efficacy were effective (Levels of Evidence II and III), and four revealed contrary results (Levels of Evidence I and II). Programs aimed at enhancing self-efficacy should include content on positive mental health, psychoeducation strategies, cover a period of eight to twelve weeks, and consider the completion of homework assignments.
Conclusion:
The synthesis of evidence pointed to pathways for building an effective self-efficacy strengthening program to be implemented in universities.
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ORIGINAL ARTICLE12-08-2024
Safe practices for bed bathing in the intensive care unit: validation of a checklist
Revista Brasileira de Enfermagem. 2024;77(1):e20230135
Abstract
ORIGINAL ARTICLESafe practices for bed bathing in the intensive care unit: validation of a checklist
Revista Brasileira de Enfermagem. 2024;77(1):e20230135
DOI 10.1590/0034-7167-2023-0135
Views0See moreABSTRACT
Objective:
To validate a checklist for safe bathing in critically ill patients.
Methods:
This is a methodological and quantitative study. Researchers developed a checklist for safe bathing in critically ill patients consisting of 41 items, which were submitted to the apparent and content validation process, evaluated by eleven judges, and interobserver reliability. For reliability analysis, the instrument was applied in 54 bed bath procedures in the ICU; Kappa and CHF tests were used.
Results:
In the apparent and content validation, adjustments were made according to the judges’ suggestions. Kappa values ranged from moderate to almost perfect (0.462 to 0.962), and, in some items, there was 100% agreement; the reliability of the instrument was excellent (ICC = 0.962).
Conclusion:
The instrument proved to be dependable and easy to apply. Its use will contribute to safe bed bathing and subsidize interventions aimed at increasing the quality of care.
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ORIGINAL ARTICLE12-08-2024
Initial nipple damages in breastfeeding women: analysis of photographic images and clinical associations
Revista Brasileira de Enfermagem. 2024;77(1):e20220773
Abstract
ORIGINAL ARTICLEInitial nipple damages in breastfeeding women: analysis of photographic images and clinical associations
Revista Brasileira de Enfermagem. 2024;77(1):e20220773
DOI 10.1590/0034-7167-2022-0773
Views0See moreABSTRACT
Objective:
to analyze the initial nipple damage degree by breastfeeding practice and to associate findings with clinical manifestations of breastfeeding women.
Methods:
a retrospective, cross-sectional study with primary data and photographic images database from two randomized clinical trials. Photographic images were analyzed by two independent evaluators using the Nipple Trauma Score. For analysis, the chi-square, Mann-Whitney tests and Kappa coefficient were applied.
Results:
115 breastfeeding women and their respective 186 photographic images were analyzed. The degree of agreement of evaluators using the Nipple Trauma Score was 93.6%. The nipple pain score during breastfeeding was moderate and compromised more than 25% of the nipple surface area.
Conclusions:
assistance to breastfeeding women should prioritize nipple pain intensity instead of the nipple damage size.
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REVIEW12-08-2024
Common mental disorders in hematopoietic stem cell transplant patients: a scoping review
Revista Brasileira de Enfermagem. 2024;77(1):e20220581
Abstract
REVIEWCommon mental disorders in hematopoietic stem cell transplant patients: a scoping review
Revista Brasileira de Enfermagem. 2024;77(1):e20220581
DOI 10.1590/0034-7167-2022-0581
Views0ABSTRACT
Objective:
to map common recurrent mental disorders in patients undergoing hematopoietic stem cell transplantation.
Methods:
this is a scoping review carried out in January 2022 in electronic databases and repositories of dissertations and thesis. Studies that answered the research question, met the objective of the study and were available in full electronically, in any language, were included.
Results:
the sample consisted of 28 studies, 14 of which were published in the United States of America. The common mental disorders found were depressive, anxiety, post-traumatic stress and mood disorders. Twenty symptoms were mentioned, among the most prevalent are fatigue and sleep disorders/insomnia.
Conclusions:
the difficulty and importance of carrying out the differential diagnosis of these disorders were highlighted, since their symptoms can be confused with other health problems and have a strong potential to interfere with patients’ evolution.
Keywords:Bone Marrow TransplantationHematopoietic Stem Cells TransplantationMental DisordersMental HealthReviewSee more -
ORIGINAL ARTICLE12-08-2023
Factors associated with surgical site infection in myocardial revascularization: a retrospective longitudinal study
Revista Brasileira de Enfermagem. 2023;76:e20230108
Abstract
ORIGINAL ARTICLEFactors associated with surgical site infection in myocardial revascularization: a retrospective longitudinal study
Revista Brasileira de Enfermagem. 2023;76:e20230108
DOI 10.1590/0034-7167-2023-0108
Views0See moreABSTRACT
Objectives:
to analyze the influence of sociodemographic and clinical variables, as well as the surgical checklist adherence score, on the occurrence of surgical site infection among patients undergoing myocardial revascularization.
Methods:
an observational, longitudinal, retrospective study was conducted at a university hospital, involving 266 medical records of patients who underwent myocardial revascularization surgery. Instruments containing sociodemographic, clinical, and infection-related variables were used, along with the Perioperative Surgical Safety Checklist. Descriptive, bivariate, and logistic regression analyses were employed.
Results:
surgical site infection occurred in 89 (33.5%) patients. There was a statistically significant association between body temperature outside the range of 36 degrees Celsius to 36.5 degrees Celsius (p=0.01), the presence of invasive devices (p=0.05), surgical procedures with the anticipation of critical events (p<0.001), and the occurrence of infection.
Conclusions:
body temperature, the presence of invasive devices, and surgical procedures with the anticipation of critical events were significant factors contributing to an increased risk of infection.
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REVIEW12-08-2023
Educational technologies used to promote self-care for people with diabetes mellitus: integrative review
Revista Brasileira de Enfermagem. 2023;76:e20230049
Abstract
REVIEWEducational technologies used to promote self-care for people with diabetes mellitus: integrative review
Revista Brasileira de Enfermagem. 2023;76:e20230049
DOI 10.1590/0034-7167-2023-0049
Views0See moreABSTRACT
Objective:
To summarize the scientific productions that used educational technologies to promote self-care for people with diabetes.
Method:
Integrative review carried out from October 2022 to January 2023, in the databases: LILACS; Scopus; Embase; PubMed/MEDLINE and CINAHL. The search was paired, and the sample consisted of ten articles. The levels of evidence were analyzed by the Hierarchy of Evidence for Intervention Studies, and the results were synthesized for interpretation of the findings.
Results:
The educational technologies identified to promote self-care were: mobile applications, interactive platforms, print, telemonitoring, video and simulation. The focus of the contents was on the promotion of foot care, prevention of neuropathy, self-management, knowledge, and expectation of people with diabetes and prevention of acute complications.
Conclusion:
The synthesis of knowledge about educational technologies to promote self-care for people with diabetes pointed to the need for robust evidence.
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ORIGINAL ARTICLE12-08-2023
Construction and validity of educational technology about the human papillomavirus vaccine for adolescents
Revista Brasileira de Enfermagem. 2023;76:e20230048
Abstract
ORIGINAL ARTICLEConstruction and validity of educational technology about the human papillomavirus vaccine for adolescents
Revista Brasileira de Enfermagem. 2023;76:e20230048
DOI 10.1590/0034-7167-2023-0048
Views0See moreABSTRACT
Objectives:
to construct and validate an educational technology in comic book format about the human papillomavirus vaccine aimed at adolescents.
Methods:
a methodological study, with a quantitative approach, through the agreement method. It was carried out in two phases: educational technology construction and content validity. Participants are expert judges in the health field. Data collection took place in a virtual environment, through a questionnaire. Data analysis was performed by calculating the Content Validity Index. A Content Validity Index of at least 80% was accepted.
Results:
the comic book’s overall Content Validity Index was 82%, reaching the minimum limit established to be validated.
Conclusions:
comics are fundamental in the teaching-learning process, aiming to catch adolescents’ attention. Therefore, it is characterized as a valid tool to inform, in a playful manner, about the human papillomavirus vaccine.
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ORIGINAL ARTICLE06-17-2024
Quality of life associated with nursing professionals’ individual resources and work
Revista Brasileira de Enfermagem. 2024;77(3):e20230476
Abstract
ORIGINAL ARTICLEQuality of life associated with nursing professionals’ individual resources and work
Revista Brasileira de Enfermagem. 2024;77(3):e20230476
DOI 10.1590/0034-7167-2023-0476
Views0See moreABSTRACT
Objectives:
to assess the physical and mental components of nursing professionals’ quality of life and associate them with individual, health and work characteristics.
Methods:
cross-sectional research, with nursing professionals from a university hospital in São Paulo. Own questionnaire and validated instruments were applied.
Results:
the overall quality of life was compromised. The physical component was lower in relation to low family income and among those who perceived greater control/pressure at work, and better for those who practiced physical activity and had support of leader and organization. The mental component was lower in professionals who reported dissatisfaction with work, worse self-rated physical health and were older. Scores for both components reduced due to work-related illnesses, worse work ability and increased daytime sleepiness.
Conclusions:
quality of life was statistically associated with controllable institutional factors and individual resources that, except age, can be promoted.
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ORIGINAL ARTICLE06-17-2024
Giving meaning to internalized violence throughout life by older adults living in rural areas
Revista Brasileira de Enfermagem. 2024;77(3):e20230163
Abstract
ORIGINAL ARTICLEGiving meaning to internalized violence throughout life by older adults living in rural areas
Revista Brasileira de Enfermagem. 2024;77(3):e20230163
DOI 10.1590/0034-7167-2023-0163
Views0See moreABSTRACT
Objectives:
to understand the meanings of violence internalized throughout life by older adults living in rural areas.
Methods:
a qualitative study, anchored in the Symbolic Interactionism theoretical framework and the Grounded Theory methodological framework in the constructivist aspect. Data collection occurred through individual interviews. Data were coded using the Atlas.ti software.
Results:
it was possible to identify that the context of rural areas strengthens patriarchy culture as well as contributing to violence silence and naturalization. It was also found that violence is a product of social inequality and gender inequality.
Final Considerations:
older adults living in rural areas internalized the violence suffered in a unique way, and this scenario’s specific aspects can increase intra-family abuse, as there is a patriarchal culture that promotes social and gender inequality.
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ERRATUM06-14-2024
ERRATUM
Revista Brasileira de Enfermagem. 2024;77(2):e2024n2e06
Abstract
ERRATUMERRATUM
Revista Brasileira de Enfermagem. 2024;77(2):e2024n2e06
DOI 10.1590/0034-7167.20247702e06
Views0In the article “Is there scientific relevance to the plot of films and documentaries about eating disorders?”, with DOI number: , published in Revista Brasileira de Enfermagem, 2024;77(1):e20220547, page 7:Where it read:[…]See more -
ERRATUM06-14-2024
ERRATUM
Revista Brasileira de Enfermagem. 2024;77(2):e2024n2e05
Abstract
ERRATUMERRATUM
Revista Brasileira de Enfermagem. 2024;77(2):e2024n2e05
DOI 10.1590/0034-7167.20247702e05
Views0In the article “Educational technologies used to promote self-care for people with diabetes mellitus: integrative review”, with DOI number: , published in Revista Brasileira de Enfermagem, 2023;76(Suppl 4):e20230049, in the title:Where it read:[…]See more -
REVIEW06-14-2024
Lean and/or Six Sigma for process optimization in the perioperative period: an integrative review
Revista Brasileira de Enfermagem. 2024;77(2):e20230431
Abstract
REVIEWLean and/or Six Sigma for process optimization in the perioperative period: an integrative review
Revista Brasileira de Enfermagem. 2024;77(2):e20230431
DOI 10.1590/0034-7167-2023-0431
Views0See moreABSTRACT
Objective:
To analyze the evidence on the influence of Lean and/or Six Sigma for process optimization in the perioperative period.
Methods:
Integrative review carried out in the MEDLINE (PubMed), Web of Science, EMBASE, CINAHL, Scopus and LILACS databases on the use of Lean and/or Six Sigma to optimize perioperative processes. The studies included were analyzed in three thematic categories: flow of surgical patients, work process and length of stay.
Results:
The final sample consisted of ten studies, which covered all operative periods. Lean and/or Six Sigma make a significant contribution to optimizing perioperative processes.
Final considerations:
Lean and/or Six Sigma optimize perioperative processes to maximize the achievement of system stability indicators, making it possible to identify potential problems in order to recognize them and propose solutions that can enable the institution of patient-centered care.
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ORIGINAL ARTICLE06-14-2024
Strategies used by nurses regarding underreporting of rural work accidents due to pesticide use
Revista Brasileira de Enfermagem. 2024;77(2):e20230384
Abstract
ORIGINAL ARTICLEStrategies used by nurses regarding underreporting of rural work accidents due to pesticide use
Revista Brasileira de Enfermagem. 2024;77(2):e20230384
DOI 10.1590/0034-7167-2023-0384
Views0See moreABSTRACT
Objective:
To learn the strategies used regarding underreporting of pesticide use in rural areas.
Methods:
A qualitative study was carried out in eight primary healthcare units in rural areas and two emergency care units in a municipality in southern Brazil. Data collection took place in 2023 through interviews. Twenty professional nurses participated. The data was submitted to content analysis.
Results:
The strategies identified were lifelong and continuing education for the professionals who carry out the notification, active search and training of workers who deal directly with this type of substance, computerizing the notification by filling in the forms online, and carrying out research on the subject.
Final considerations:
Nurses play an important role in reporting occupational accidents caused by the use of pesticides, improving occupational safety in rural areas.
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ORIGINAL ARTICLE06-14-2024
Teoria de médio alcance do diagnóstico de enfermagem sobrepeso
Revista Brasileira de Enfermagem. 2024;77(2):e20230372
Abstract
ORIGINAL ARTICLETeoria de médio alcance do diagnóstico de enfermagem sobrepeso
Revista Brasileira de Enfermagem. 2024;77(2):e20230372
DOI 10.1590/0034-7167-2023-0372
Views0See moreRESUMEN
Objetivo:
Construir una teoría de rango medio para el diagnóstico de enfermería Sobrepeso en adolescentes y adultos jóvenes.
Métodos:
Estudio metodológico a la luz de los marcos teóricos de Roy y de Lopes, Silva y Herdman. Un total de 3.925 artículos fueron recuperados y evaluados utilizando el software State of the Art Through Systematic Review. La muestra final fue de 28 artículos.
Resultados:
Los resultados convergieron en 3 atributos esenciales, 13 antecedentes y 7 consecuencias. Se construyó una teoría de rango medio compuesta por un diagrama ilustrado, 11 proposiciones y 12 relaciones causales.
Consideraciones finales:
A partir de la creación de la teoría, fue posible comprender mejor el diagnóstico de enfermería Sobrepeso en el contexto de adolescentes y adultos jóvenes. La comprensión de los fenómenos de enfermería contribuye para el avance y fortalecimiento de la ciencia de enfermería.
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