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01-01-2016
Discoveries of Biological Sciences and their implications for nursing practice
Revista Brasileira de Enfermagem. 2016;69(4):619-620
Abstract
Discoveries of Biological Sciences and their implications for nursing practice
Revista Brasileira de Enfermagem. 2016;69(4):619-620
DOI 10.1590/0034-7167.2016690401i
Views1For the longest time, the production of knowledge in the field of biological sciences was viewed as the exclusive responsibility and competence of medical professionals. This scenario has changed in light of the worldwide trend of improvements in other health professions, which includes the need to implement the use of evidence-based methodology in nursing practice. […]See more
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01-01-2016
Descobertas das Ciências Biológicas e as implicações para a prática da Enfermagem
Revista Brasileira de Enfermagem. 2016;69(4):619-620
Abstract
Descobertas das Ciências Biológicas e as implicações para a prática da Enfermagem
Revista Brasileira de Enfermagem. 2016;69(4):619-620
DOI 10.1590/0034-7167.2016690401i
Views1A produção de conhecimento na área das ciências biológicas, durante muito tempo, foi vista como de responsabilidade e competência exclusivamente de profissionais médicos. Esse cenário alterou-se frente à tendência mundial de aperfeiçoamento dos demais profissionais de saúde, incluindo-se a necessidade de se concretizar a utilização da metodologia da prática baseada em evidência na atuação do […]See more -
01-01-2016
The importance of civilian nursing organizations: integrative literature review
Revista Brasileira de Enfermagem. 2016;69(3):610-618
Abstract
The importance of civilian nursing organizations: integrative literature review
Revista Brasileira de Enfermagem. 2016;69(3):610-618
DOI 10.1590/0034-7167.2016690326i
Views0See moreABSTRACT
Objective:
to identify and analyze evidence from studies about the importance of civilian nursing organizations.
Method:
an integrative literature review, for which searches were conducted in the databases LILACS, PubMed/MEDLINE, SciELO, BDENF, and Scopus.
Results:
sixteen articles published between the years 2004-2013 were selected, 68.75% of which were sourced from Brazilian journals and 31.25% from American journals.
Conclusion:
civilian nursing organizations are important and necessary, because they have collaborated decisively in nursing struggles in favor of the working class and society in general, and these contributions influence different axes of professional performance.
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01-01-2016
Effects from acupuncture in treating anxiety: integrative review
Revista Brasileira de Enfermagem. 2016;69(3):602-609
Abstract
Effects from acupuncture in treating anxiety: integrative review
Revista Brasileira de Enfermagem. 2016;69(3):602-609
DOI 10.1590/0034-7167.2016690325i
Views0See moreABSTRACT
Objective:
to evaluate the scientific evidence that is available in the literature on the effects of acupuncture for treating anxiety and on the quality of such studies.
Method:
the study is an integrative review of CINAHL, LILACS, PUBMED-PICO, SciELO, and The Cochrane Library between 2001 and 2014. Keywords anxiety, acupuncture therapy, acupuncture, and anxiety disorders were combined among themselves to ensure a wide search of primary studies.
Results:
among 514 articles, 67 were selected to be fully read and 19 were included. Among these, 11 were found to have strong evidence levels. Among the six articles about randomized clinical studies, five were found to be of reasonable quality. Two studies used acupuncturist nurses to perform their interventions. Its results showed positive and statistically significant effects from using acupuncture for treating subjects with anxiety.
Conclusion:
acupuncture seems to be a promising treatment for anxiety; however, there is a need for improving the methodological quality of the research on this field.
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01-01-2016
Palliative care and spirituality: an integrative literature review
Revista Brasileira de Enfermagem. 2016;69(3):591-601
Abstract
Palliative care and spirituality: an integrative literature review
Revista Brasileira de Enfermagem. 2016;69(3):591-601
DOI 10.1590/0034-7167.2016690324i
Views0See moreABSTRACT
Objective:
to analyze scientifi c articles published in international online journals about palliative care and spirituality.
Methods:
an integrative literature review with data collected in September 2014 from the LILACS, SCIELO, MEDLINE/PubMed, and IBECS databases.
Results:
thirty-nine publications were identifi ed and their textual analysis facilitated through four thematic approaches: the meaning of spirituality in the context of palliative care; palliative care and spiritual support; spirituality and relief of pain and other symptoms in patients under palliative care; and instruments to evaluate the spiritual dimension of the scope of palliative care.
Conclusion:
this study examined the relevance of the spiritual dimension in the care of patients with palliative care and the need for developing new studies to disseminate knowledge about this topic.
Descriptors:
Palliative Care; Palliative Care at End of Live; Spirituality; Religion; Health.
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01-01-2016
Educational technologies to encourage (self) care in postpartum women
Revista Brasileira de Enfermagem. 2016;69(3):582-590
Abstract
Educational technologies to encourage (self) care in postpartum women
Revista Brasileira de Enfermagem. 2016;69(3):582-590
DOI 10.1590/0034-7167.2016690323i
Views0See moreABSTRACT
Objective:
to evaluate national and international literature regarding the use of educational technologies to encourage self care in postpartum women.
Method:
an integrative review of the literature. The articles were collected from the CINAHL, SCOPUS, PubMed, SciELO, LILACS and Cochrane databases; the time period for the articles referred to January/2004 to July/2014; the languages used in the articles were Portuguese, English, Spanish and French; the articles were selected from the following descriptors: postpartum care period, educational technology, nursing and self care. Twenty-seven articles were selected for analysis
Results:
based on the information found, the scales, counseling and home visits were among the most recommended educational technologies.
Conclusion:
the technologies promote communication, but are sometimes dependent on computer and internet access, which hinder their use by low-income women.
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01-01-2016
Patients with HIV/Aids and ulcer risk: nursing care demands
Revista Brasileira de Enfermagem. 2016;69(3):574-581
Abstract
Patients with HIV/Aids and ulcer risk: nursing care demands
Revista Brasileira de Enfermagem. 2016;69(3):574-581
DOI 10.1590/0034-7167.2016690322i
Views0See moreABSTRACT
Objective:
to analyze the demand for nursing care and the risk of pressure ulcers (PU) of patients with HIV/Aids.
Method:
quantitative survey, carried out from December 2012 to March 2013 in a public hospital of Teresina, state of Piauí, Brazil.
Results:
the sample of 31 patients was predominantly male, mean age 36.6 years, average care demand 49.4%, most showing some risk of developing PU. The variables correlated with PU risk were care demand and clinical outcome (death). Those associated with care demand were age and clinical outcome (death).
Conclusion:
the results showed that patients require moderate nursing care needs and most of them present risk of developing PU.
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01-01-2016
Lack of anticipated support for care for community-dwelling older adults
Revista Brasileira de Enfermagem. 2016;69(3):566-573
Abstract
Lack of anticipated support for care for community-dwelling older adults
Revista Brasileira de Enfermagem. 2016;69(3):566-573
DOI 10.1590/0034-7167.2016690321
Views0See moreABSTRACT
Objective:
to identify the factors associated with lack of anticipated support for care for community-dwelling older adults.
Method:
this study presents comparison and logistic regression analyses of data from 671 individuals who took part of the multicentric study entitled “Frailty in older Brazilians” – a quantitative, epidemiologic and transversal investigation carried out between 2008 and 2009.
Results:
the subjective evaluation of anticipated support for care for community-dwelling older adults was a good indicator of risk for lack of anticipated support for care in women, older adults who live alone and those with poor self-rated health.
Conclusion:
it is necessary to reflect upon the formal support system currently available for older people in Brazil, considering that those who most frequently presented lack of anticipated support for care are an increasing population. The study also highlights the importance of using subjective methods for the evaluation of the adequacy of older adults’ support network.
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RESEARCH01-01-2017
Violence against children and adolescents: the perspective of Primary Health Care
Revista Brasileira de Enfermagem. 2017;70(3):511-518
Abstract
RESEARCHViolence against children and adolescents: the perspective of Primary Health Care
Revista Brasileira de Enfermagem. 2017;70(3):511-518
DOI 10.1590/0034-7167-2016-0471
Views0See moreABSTRACT
Objective:
To analyze the care provided by Basic Health Units (BHU) to families involved in domestic intrafamily violence against children and adolescents.
Method:
Qualitative research, based on the Paradigm of Complexity. Data collection was performed with 41 professionals through focus groups and semi-structured interviews.
Results:
The following categories emerged from data analysis: ‘Everything comes here’, which reflects the legitimate place of BHUs for the population and the actions taken to build care for families; and ‘We only do what is really necessary’, which brings the look to violence still based on the positivist and biomedical paradigm.
Final considerations:
The model of understanding and construction of work processes in the BHU is structured in the aforementioned paradigm. Nurses have the possibility to become agents of change, both in professionals’ training and in the care thought and provided to communities.
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RESEARCH01-01-2017
Integrality of care: challenges for the nurse practice
Revista Brasileira de Enfermagem. 2017;70(3):504-510
Abstract
RESEARCHIntegrality of care: challenges for the nurse practice
Revista Brasileira de Enfermagem. 2017;70(3):504-510
DOI 10.1590/0034-7167-2016-0380
Views0See moreABSTRACT
Objective:
to understand the role of the nurse in the collegiate management model of a teaching hospital, in the integrality of care perspective.
Method:
a single case study with multiple units of analysis, with the theoretical proposition “integrality of care is a result of the care offered to the user by multiple professionals, including the nurse”. Data were obtained in a functional unit of a teaching hospital through interviews with 13 nurses in a non-participant observation and document analysis.
Results:
from the analytical categories emerged subcategories that allowed understanding that the nurse promotes integrality of care through nursing management, team work and integration of services.
Final considerations:
the theoretical proposition was confirmed and it was verified that the nursing management focus on attending to health care needs and is a strategy to provide integrality of care.
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RESEARCH01-01-2017
Low completion rate of hepatitis B vaccination in female sex workers
Revista Brasileira de Enfermagem. 2017;70(3):489-494
Abstract
RESEARCHLow completion rate of hepatitis B vaccination in female sex workers
Revista Brasileira de Enfermagem. 2017;70(3):489-494
DOI 10.1590/0034-7167-2016-0567
Views0See moreABSTRACT
Objective:
to assess predictive factors for noncompletion of the hepatitis B vaccination schedule in female sex workers in the city of Teresina, Northeastern Brazil.
Method:
402 women were interviewed and, for those who did not wish to visit specialized sites, or did not know their hepatitis B vaccination status, the vaccine was offered at their workplaces. Bi- and multivariate analyses were performed to identify potential predictors for noncompletion of the vaccination schedule.
Results:
of the 284 women eligible for vaccination, 258 (90.8%) received the second dose, 157/258 (60.8%) and 68/258 (26.3%) received the second and third doses, respectively. Working at clubs and consuming illicit drugs were predictors for noncompletion of the vaccination schedule.
Conclusion:
the high acceptability of the vaccine’s first dose, associated with low completion rates of the vaccination schedule in sex workers, shows the need for more persuasive strategies that go beyond offering the vaccine at their workplaces.
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RESEARCH01-01-2017
Cost of nursing most frequent procedures performed on severely burned patients
Revista Brasileira de Enfermagem. 2017;70(3):481-488
Abstract
RESEARCHCost of nursing most frequent procedures performed on severely burned patients
Revista Brasileira de Enfermagem. 2017;70(3):481-488
DOI 10.1590/0034-7167-2015-0034
Views0See moreABSTRACT
Objective:
to identify the mean direct cost (MDC) of the most frequent procedures performed by nursing professionals on severely burned patients in an Intensive Care Unit.
Method:
exploratory-descriptive quantitative single-case study. The MDC was calculated by multiplying time (timed) spent by nursing professionals in the performance of the procedures by the unit cost of direct labor, and adding the costs of material and medicine/solutions.
Results:
a MDC of US$ 0.65 (SD=0.36) was obtained for “vital signs monitoring”; US$ 10.00 (SD=24.23) for “intravenous drug administration”; US$ 5.90 (SD=2.75) for “measurement of diuresis”; US$ 0.93 (SD=0.42) for “capillary blood glucose monitoring”; and US$ 99.75 (SD=129.55) for “bandaging”.
Conclusion:
the knowledge developed can support managerial decision-making, contribute to the efficiency distribution of the resources involved and, when possible, provide cost-containment or cost-minimization strategies without impairing the quality of nursing care.
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RESEARCH01-01-2017
Nursing Activities Score and Acute Kidney Injury
Revista Brasileira de Enfermagem. 2017;70(3):475-480
Abstract
RESEARCHNursing Activities Score and Acute Kidney Injury
Revista Brasileira de Enfermagem. 2017;70(3):475-480
DOI 10.1590/0034-7167-2016-0266
Views0See moreABSTRACT
Objective:
to evaluate the nursing workload in intensive care patients with acute kidney injury (AKI).
Method:
A quantitative study, conducted in an intensive care unit, from April to August of 2015. The Nursing Activities Score (NAS) and Kidney Disease Improving Global Outcomes (KDIGO) were used to measure nursing workload and to classify the stage of AKI, respectively.
Results:
A total of 190 patients were included. Patients who developed AKI (44.2%) had higher NAS when compared to those without AKI (43.7% vs 40.7%), p <0.001. Patients with stage 1, 2 and 3 AKI showed higher NAS than those without AKI. A relationship was identified between stage 2 and 3 with those without AKI (p = 0.002 and p <0.001).
Conclusion:
The NAS was associated with the presence of AKI, the score increased with the progression of the stages, and it was associated with AKI, stage 2 and 3.
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RESEARCH01-01-2017
Nursing appointment and cardiometabolic control of diabetics: a randomized clinical trial
Revista Brasileira de Enfermagem. 2017;70(3):468-474
Abstract
RESEARCHNursing appointment and cardiometabolic control of diabetics: a randomized clinical trial
Revista Brasileira de Enfermagem. 2017;70(3):468-474
DOI 10.1590/0034-7167-2016-0352
Views0See moreABSTRACT
Objective:
to verify the effect of nursing appointment on cardiometabolic profile of people with Diabetes Mellitus type 2.
Method:
randomized controlled trial, developed with 134 individuals chosen for two groups: intervention and control. The intervention consisted of three nursing appointments alternated bimonthly, with two phone calls, over five months. The control group received usual care offered by the Health Unit. Data were collected through semi-structured interviews before and after the intervention, in addition to conducting laboratory tests.
Results:
after the intervention, a significant difference was shown in the amount of glycated hemoglobin (p = 0.006) and in the systolic blood pressure (p = 0.031), which were higher in the control group.
Conclusion:
besides being low-cost and easy to develop on the monitoring routine of people with diabetes, the intervention performed influenced positively the biochemical profile.
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RESEARCH01-01-2017
Terms of the specialized nursing language for the care of ostomates
Revista Brasileira de Enfermagem. 2017;70(3):461-467
Abstract
RESEARCHTerms of the specialized nursing language for the care of ostomates
Revista Brasileira de Enfermagem. 2017;70(3):461-467
DOI 10.1590/0034-7167-2015-0058
Views0See moreABSTRACT
Objectives:
to identify terms of the specialized nursing language for the care of ostomates from the literature of the area, and to map the identified terms with terms of the International Classification for Nursing Practice (ICNP®).
Method:
descriptive study of quantitative approach guided by the guidelines for the elaboration of terminology subsets of the ICNP®. The terms were collected in 49 scientific articles, extracted using a computational tool, selected according to the relevance for the theme, and normalized and mapped with the ICNP®.
Results:
20,668 terms were extracted. The standardization process resulted in 425 relevant terms (151 were constant in ICNP® and 274 were not contained in ICNP®), of which 154 were similar, 19 were more comprehensive, 50 were more restricted, and 51 were not in concordance.
Conclusion:
the use of standardized language can minimize the ambiguities and redundancies identified in the mapping. The existence of terms not in concordance with the ICNP® reinforces the need for constant updating of this classification.
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RESEARCH01-01-2017
Validation of an instrument regarding nursing intervention in patients in vasoactive therapy
Revista Brasileira de Enfermagem. 2017;70(3):453-460
Abstract
RESEARCHValidation of an instrument regarding nursing intervention in patients in vasoactive therapy
Revista Brasileira de Enfermagem. 2017;70(3):453-460
DOI 10.1590/0034-7167-2016-0254
Views0See moreABSTRACT
Objective:
to validate the content of a Standard Operational Procedure, regarding nursing interventions in emergency patients treated with vasoactive drugs.
Method:
methodological study, carried out from December 2015 to January 2016. Content validity was determined by 16 experts (13 nurses, 2 pharmacists and one biomedical scientist), who judged it through a four-point Likert scale. The items were evaluated in terms of: feasibility, objectivity, simplicity, clearness, pertinence and accuracy. The Content Validity Index was applied, accepting the value ≥ 0.90.
Results:
two rounds of evaluation were required to achieve the minimum index. The items were reviewed regarding writing, dilution, indication and replacement interval. The instrument was validated with 33 items and with total Content Validity Index of 0.99.
Conclusion:
the instrument was considered appropriate, fractionally and globally, for nursing care for the patient treated with vasoactive drugs in emergency, in a safe and reliable way.
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01-01-2015
Critical incidents in nursing academics: discovering a new identity
Revista Brasileira de Enfermagem. 2015;68(2):219-227
Abstract
Critical incidents in nursing academics: discovering a new identity
Revista Brasileira de Enfermagem. 2015;68(2):219-227
DOI 10.1590/0034-7167.2015680206i
Views0See moreABSTRACT
Objective:
a qualitative study that followed the principles of the grounded theory in order to analyze the professional identity of nursing academics through the analysis of the most disturbing critical incidents.
Method:
semi-structured interviews were conducted with seven nurses who worked as professors and researchers in a private university in Barcelona.
Results:
the resulting empirical material was organized into two categories: characterization of critical incidents and responsiveness to the incident.
Conclusion:
the professional identity of nurses regarding the academic area is still under construction and inexperience is the major obstacle in the management of critical incidents in the teaching career.
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01-01-2015
Body mass index, waist circumference, and arterial hypertension in students
Revista Brasileira de Enfermagem. 2015;68(2):214-218
Abstract
Body mass index, waist circumference, and arterial hypertension in students
Revista Brasileira de Enfermagem. 2015;68(2):214-218
DOI 10.1590/0034-7167.2015680205i
Views0See moreABSTRACT
Objective:
to investigate what is the best anthropometric predictor of arterial hypertension among private school students.
Method:
this was a cross-sectional study with 286 students between the ages of 10 and 14 from two private schools in the city of Paranavaí, Paraná, Brazil. The following variables were analyzed: body mass index, waist circumference and blood pressure. Statistical analysis was conducted with Pearson’s partial correlation test and multivariate logistic regression, with p<0.05.
Results:
both anthropometric indicators displayed weak correlation with systolic and diastolic levels, with coeffi cients (r) ranging from 0.27 to 0.36 (p < 0.001). Multivariate analysis showed that the only anthropometric indicator associated with arterial hypertension was waist circumference (OR= 2.3; 95% CI: 1.1-4.5), regardless of age or gender.
Conclusion:
this age group, waist circumference appeared to be a better predictor for arterial hypertension than body mass index.
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01-01-2015
Perception of primary healthcare management nurses on the nursing process
Revista Brasileira de Enfermagem. 2015;68(2):206-213
Abstract
Perception of primary healthcare management nurses on the nursing process
Revista Brasileira de Enfermagem. 2015;68(2):206-213
DOI 10.1590/0034-7167.2015680204i
Views0See moreABSTRACT
Objective:
this qualitative study aimed to analyze the perceptions of primary health care management nurses on the nursing process.
Method:
data were collected through interviews and analyzed by the Content Analysis proposed by Bardin’s theoretical framework.
Results:
managers recognize the importance of the nursing process, although its implementation was not a priority at the time of the interviews. A conceptual diffi culty and a lack of understanding that the implementation of the care methodology should be a cross-departmental action in the local healthcare management were clearly observed.
Conclusion:
managers should have their perspectives broadened concerning the relevance of the nursing process and the professional training. The active participation of legislative nursing bodies, local healthcare management and the federal government may open the way for the effective implementation of the nursing process.
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01-01-2015
Cross-cultural cultural adaptation of the “Nursing Students’ Attitudes Toward Mental Health Nursing and Consumers” in Brazil
Revista Brasileira de Enfermagem. 2015;68(2):198-205
Abstract
Cross-cultural cultural adaptation of the “Nursing Students’ Attitudes Toward Mental Health Nursing and Consumers” in Brazil
Revista Brasileira de Enfermagem. 2015;68(2):198-205
DOI 10.1590/0034-7167.2015680203i
Views0See moreABSTRACT
Objective:
to make across-cultural adaptation of the “Nursing Students’ Attitudes Toward Mental Health Nursing and Consumers” scale in Brazil.
Method:
the scale was tested regarding conceptual, item, semantic, and operational equivalence.
Results:
content validation was conducted by an expert committee with a minimum consensus level of 80%. This process resulted in a 35-item scale divided into 6 factors. The experts reached 100% consensus on the scale’s clarity of language, practical pertinence and theoretical relevance, as well as on the need for excluding one factor. Data were collected in 2013 in the city of Londrina, Paraná, Brazil.
Conclusion:
the instrument was cross-culturally adapted to Brazilian Portuguese and presented satisfactory content validity. We propose further studies on the scale’s psychometric properties, such as construct validity, internal consistency and reliability.
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01-01-2015
Relational skills and preserving patient privacy in the caring process
Revista Brasileira de Enfermagem. 2015;68(2):191-197
Abstract
Relational skills and preserving patient privacy in the caring process
Revista Brasileira de Enfermagem. 2015;68(2):191-197
DOI 10.1590/0034-7167.2015680202i
Views0See moreABSTRACT
Objective:
to analyze the development and mobilization of relational skills central to the caring process among nursing students throughout their professional training.
Method:
this was a quantitative study, descriptive and cross-sectional in design. The sample consisted of nursing undergraduate students from the Higher School of Health Sciences, in the city of Évora, Portugal. Data were collected using the previously validated Helping Relational Skills Inventory.
Results:
the students gradually acquired “generic skills”, “communication skills” and “contact skills”, presenting the highest mean score in the last year of the program. However, the highest mean score for the “empathetic skills” subscale was presented by second-year students.
Conclusion:
age and year in program were found to be decisive variables regarding the acquisition of specifi c skills (empathetic and communication) by nursing students.
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01-01-2015
The Brazilian Association of Nursing in the uncompromising defense of the Brazilian Unified Health System
Revista Brasileira de Enfermagem. 2015;68(2):185-186
Abstract
The Brazilian Association of Nursing in the uncompromising defense of the Brazilian Unified Health System
Revista Brasileira de Enfermagem. 2015;68(2):185-186
DOI 10.1590/0034-7167.2015680201i
Views0The title of the 2015 Editor’s Comments could very well be from a journal published in decades past, a time when, in Brazil, all professional entities and civil society fought for the right to health, as was later established in the Brazilian Constitution of 1988. Twenty-five years later, despite its financial limitations and restricted operational […]See more -
01-01-2015
A ABEn na defesa intransigente do SUS
Revista Brasileira de Enfermagem. 2015;68(2):185-186
Abstract
A ABEn na defesa intransigente do SUS
Revista Brasileira de Enfermagem. 2015;68(2):185-186
DOI 10.1590/0034-7167.2015680201i
Views0Este título do Editorial de 2015 bem poderia ser de uma revista publicada em décadas passadas, período em que todas as entidades profissionais e a sociedade civil lutaram pela saúde como direito, como conquistado na Constituição de 1988. Vinte e cinco anos depois, com o Sistema Único de Saúde capilarizado por todo o país, mesmo […]See more -
EXPERIENCE REPORT01-01-2015
Nursing diagnoses and interventions for a child after cardiac surgery in an intensive care unit
Revista Brasileira de Enfermagem. 2015;68(1):155-160
Abstract
EXPERIENCE REPORTNursing diagnoses and interventions for a child after cardiac surgery in an intensive care unit
Revista Brasileira de Enfermagem. 2015;68(1):155-160
DOI 10.1590/0034-7167.2015680121i
Views0See moreObjetivo:
descrever o julgamento clínico de enfermagem para identificar diagnósticos NANDA e desenvolver um plano de tratamento NIC para uma criança em pós-operatório de cirurgia cardíaca em terapia intensiva.
Método:
estudo de caso com coleta de dados retrospectiva no prontuário.
Resultados:
três enfermeiras identificaram diagnósticos NANDA e intervenções NIC. Criança de 6 meses, submetida a cirurgia cardíaca, necessitou oxigenação extracorpórea por membrana no pós-operatório. Foram identificados quatro principais diagnósticos, aos quais foram direcionadas dez intervenções. A proposta de intervenções para responder às necessidades humanas prioritárias da criança foi otimizada pelo uso das terminologias padronizadas. Todos os diagnósticos foram sustentados por indicadores diagnósticos; todas as intervenções foram cientificamente sustentadas.
Conclusão:
espera-se que os enfermeiros abordem não somente as respostas fisiológicas, mas também aquelas dos domínios psicossociais.
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