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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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EDITORIAL01-01-2017
Enfermagem em cardiologia: estado da arte e fronteiras do conhecimento
Revista Brasileira de Enfermagem. 2017;70(3):451-452
Abstract
EDITORIALEnfermagem em cardiologia: estado da arte e fronteiras do conhecimento
Revista Brasileira de Enfermagem. 2017;70(3):451-452
DOI 10.1590/0034-7167.2017700301
Views0As doenças cardíacas lideram o grupo das desordens clínicas de maiores taxas de hospitalização e mortalidade, além de apresentarem um progressivo aumento da incidência na população devido ao envelhecimento concomitante ao desenvolvimento das terapias e tecnologias em saúde. Uma estimativa obtida pelo DATASUS() acusa um gasto onerado ao sistema de saúde do país, no ano […]See more -
EDITORIAL01-01-2017
Nursing in cardiology: state of the art and frontiers of knowledge
Revista Brasileira de Enfermagem. 2017;70(3):451-452
Abstract
EDITORIALNursing in cardiology: state of the art and frontiers of knowledge
Revista Brasileira de Enfermagem. 2017;70(3):451-452
DOI 10.1590/0034-7167.2017700301
Views0Heart diseases lead the group of clinical disorders with higher rates of hospitalization and mortality and present a progressive increase in incidence due to population ageing, simultaneously to the development of new health therapies and technology. DATASUS() estimated a cost of nearly 700 million Reais for the country’s health care system in 2015, only for […]See more -
REFLECTION01-01-2017
Nursing care in early childhood: contributions from intersubjective recognition
Revista Brasileira de Enfermagem. 2017;70(2):446-450
Abstract
REFLECTIONNursing care in early childhood: contributions from intersubjective recognition
Revista Brasileira de Enfermagem. 2017;70(2):446-450
DOI 10.1590/0034-7167-2016-0319
Views0See moreABSTRACT
Objective:
to understand the elements composing intersubjective recognition that are relevant for nursing care in early childhood in favor of comprehensive child development.
Method:
reflexive study based on the Honnethian concept of intersubjective recognition in the dimensions of affection, defense of rights, and social esteem.
Results:
nursing knowledge and practices, permeated by the intersubjective recognition in the mentioned dimensions, contribute to the dynamism of interpersonal relations, the production of co-responsibility, and shared construction of health care in early childhood, with benefits to comprehensive development.
Conclusion:
a successful coordination of the three intersubjective dimensions enables the expansion of the understanding on childhood and nursing care in child health in the field of human development promotion, covering affection, defense of rights, and social esteem in the established relationships with future positive individual and social possibilities.
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REFLECTION01-01-2017
Hand hygiene as a caring practice: a reflection on professional responsibility
Revista Brasileira de Enfermagem. 2017;70(2):442-445
Abstract
REFLECTIONHand hygiene as a caring practice: a reflection on professional responsibility
Revista Brasileira de Enfermagem. 2017;70(2):442-445
DOI 10.1590/0034-7167-2016-0189
Views0ABSTRACT
Hand hygiene represents a fundamental nursing care practice and is traditionally considered the most important and effective measure in the prevention and control of healthcare-related infections. However, studies indicate that adherence to the procedure is unsatisfactory throughout the world, and show low adherence rates. In a context in which patient safety stands out as a priority, this text submits refl ections about professional responsibility when not adhering to hand hygiene practices, and ethical aspects related to this conduct.
Keywords:Cross InfectionsHand hygieneKnowledge, Health Knowledge, Attitudes, PracticeNursing CarePatient SafetySee more -
REFLECTION01-01-2017
Brazilian method for the development terminological subsets of ICNP®: limits and potentialities
Revista Brasileira de Enfermagem. 2017;70(2):430-435
Abstract
REFLECTIONBrazilian method for the development terminological subsets of ICNP®: limits and potentialities
Revista Brasileira de Enfermagem. 2017;70(2):430-435
DOI 10.1590/0034-7167-2016-0308
Views1See moreABSTRACT
Reflection on the limits and potentialities of a Brazilian method for the development of terminological subsets of ICNP®,(International Classification for Nursing Practice) based on the correlation between this method and international methods. This issue has been debated by the International Council of Nurses (ICN). Although the council propose a guideline for elaboration, they encourage and reinforce the use of various perspectives and processes in the development of subsets. Brazilian Nursing needs to propose a method and deepen reflections on the use of terminological subsets of ICNP® in the reality of the country. The development of subsets in Brazil is considered incipient and the proposed method needs to be used and deepened in order to spread the use of terminology through the application of subsets.
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EXPERIENCE REPORT01-01-2017
Focus group on qualitative research: experience report
Revista Brasileira de Enfermagem. 2017;70(2):424-429
Abstract
EXPERIENCE REPORTFocus group on qualitative research: experience report
Revista Brasileira de Enfermagem. 2017;70(2):424-429
DOI 10.1590/0034-7167-2016-0091
Views0See moreABSTRACT
Objective:
to report the experience of applying the focus group technique for production of data in qualitative research.
Method:
four group sessions were held from May to June 2015, with the participation of professionals from the public sector of PHC and from specialized service.
Results:
the way focus group was developed is described in steps: planning, recruitment, ambience, group sessions, and evaluation.
Conclusion:
we highlight that the focus group, as a technique to produce data in collective space, can contribute not only to the construction of knowledge in Nursing, but also to the research approach with the assistance practice.
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REVIEW01-01-2017
Patient with stroke: hospital discharge planning, functionality and quality of life
Revista Brasileira de Enfermagem. 2017;70(2):415-423
Abstract
REVIEWPatient with stroke: hospital discharge planning, functionality and quality of life
Revista Brasileira de Enfermagem. 2017;70(2):415-423
DOI 10.1590/0034-7167-2016-0166
Views0See moreABSTRACT
Objective:
analyze the strategies of hospital discharge planning for these patients, increasing the knowledge related to hospitalhome transition, discharge planning processes and the main impact on the quality of life and functionality.
Method:
integrative literature review using the PICOD criteria, with database research.
Results:
19 articles were obtained, using several approaches and contexts. For quality of life, the factors related to the patient satisfaction with care and the psychoemotional aspects linked with functionality are the most significant.
Conclusion:
during the hospitalization period, a careful hospital discharge planning and comprehensive care to patients and caregivers – in particular the functional and psychoemotional aspects – tend to have an impact on the quality of life of patients.
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ORIGINAL ARTICLE09-20-2024
Predictor variables effect on the development of Burnout Syndrome in higher education professor
Revista Brasileira de Enfermagem. 2024;77(4):e20240132
Abstract
ORIGINAL ARTICLEPredictor variables effect on the development of Burnout Syndrome in higher education professor
Revista Brasileira de Enfermagem. 2024;77(4):e20240132
DOI 10.1590/0034-7167-2024-0132
Views0See moreABSTRACT
Objectives:
to correlate the development of Burnout Syndrome in higher education professors with the following variables: sociodemographic, economic, work, sleep pattern, level of anxiety and quality of life.
Methods:
observational, analytical, cross-sectional study with a quantitative approach. Data collection took place from August to November 2022, with 140 professors from a private higher education institution in the Western Brazilian Amazon.
Results:
professors who carried out activities outside institutional hours and who had sleep duration < 5 hours, presented lower scores in the personal fulfillment dimension of burnout, with (p=0.002) and (p=0.001), respectively. The higher the scores for the physical (p=0.001), psychological (p=0.000) and social relationships (p=0.002) domains of quality of life, the lower the personal fulfillment scores for the syndrome.
Conclusions:
through linear regression, it was evidenced that several variables explain the development of burnout. Institutional and governmental actions can minimize the negative influence of these variables.
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ORIGINAL ARTICLE09-20-2024
Construction and enhancement of a prototype for a medical-hospital equipment for hypodermoclysis: a qualitative study
Revista Brasileira de Enfermagem. 2024;77(4):e20240059
Abstract
ORIGINAL ARTICLEConstruction and enhancement of a prototype for a medical-hospital equipment for hypodermoclysis: a qualitative study
Revista Brasileira de Enfermagem. 2024;77(4):e20240059
DOI 10.1590/0034-7167-2024-0059
Views0See moreABSTRACT
Objectives:
to construct a Subcutaneous Hydration Device semi-functional prototype and gather initial information to improve this prototype design and realize its acceptance potential.
Methods:
a qualitative, descriptive and exploratory study, which used focus group, following the Technology Acceptance Model. The group was held at the Escola Superior de Enfermagem de Coimbra, Portugal, in December 2022, composed of nine participants from six different disciplinary areas, and followed thematic analysis.
Results:
four topics emerged associated with the device components: elastomeric infusion pump; needle/access device; clamp; administration set. From these topics, topics were triggered that highlighted: characteristics about the target population; ease of use and accessories; patient comfort and safety; and device application context.
Final Considerations:
the Subcutaneous Hydration Device semi-functional prototype is viable and interesting for the clinic. The results support its improvement and direct future investments for experimental studies.
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REVIEW09-20-2024
Brazilian nursing specific situation, middle and micro-range theories: a bibliometric study
Revista Brasileira de Enfermagem. 2024;77(4):e20230520
Abstract
REVIEWBrazilian nursing specific situation, middle and micro-range theories: a bibliometric study
Revista Brasileira de Enfermagem. 2024;77(4):e20230520
DOI 10.1590/0034-7167-2023-0520
Views0See moreABSTRACT
Objectives:
to map the nursing theories developed in stricto sensu graduate programs in nursing in Brazil.
Methods:
a bibliometric study, carried out on the Coordination for the Improvement of Higher Education Personnel Theses and Dissertations Portal in October 2023. The controlled descriptors “Nursing Theory” and “Nursing Models” and the uncontrolled descriptors “Theories” and “Middle-Range Theory” were used. Selected studies were cataloged for analysis, which was conducted by the study authors, who have a doctoral degree and expertise in research on nursing theories.
Results:
thirty-nine nursing theories were mapped, with a predominance of middle-range theories (79.5%), focusing on nursing diagnostic concepts and use of the theoretical-methodology strategy of theoretical-causal validity.
Conclusions:
the study identified nursing theories developed in Brazil, recognizing trends, development strategies, theorized objects of disciplinary interest and investments necessary for practical application in Brazilian contexts.
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ORIGINAL ARTICLE09-20-2024
Cross-cultural adaptation and validation of the Healthy Work Environment Assessment Tool in Brazilian culture
Revista Brasileira de Enfermagem. 2024;77(4):e20230505
Abstract
ORIGINAL ARTICLECross-cultural adaptation and validation of the Healthy Work Environment Assessment Tool in Brazilian culture
Revista Brasileira de Enfermagem. 2024;77(4):e20230505
DOI 10.1590/0034-7167-2023-0505
Views0ABSTRACT
Objectives:
to adapt and validate the content of the Healthy Work Environment Assessment Tool for Brazilian culture, and evaluate the practical aspects of its application.
Methods:
methodological study that followed six stages: translation; synthesis; back translation; content validation by a group of experts, pre-testing and approval of the process by the author of the original instrument.
Results:
the first three stages were carried out by contracted companies. In the committee, two items and the title of a subscale were evaluated in a second round, when consensus was reached among experts. In the pre-test, more than 93% of professionals agreed that the tool was easy to understand. The average completion time was 8.53 minutes. The American Association of Critical-Care Nurses authorized publication of the results.
Conclusions:
the adaptation of the tool to Brazilian culture was completed following the adopted framework. In addition to the evidence of content validity, the tool appears promising for managerial use.
Keywords:Cross-Cultural ComparisonHealth Facility EnvironmentTranslatingValidation StudyWorking ConditionsSee more -
ORIGINAL ARTICLE09-20-2024
Construction and validation of a checklist for the management of totally implanted catheters in children
Revista Brasileira de Enfermagem. 2024;77(4):e20230447
Abstract
ORIGINAL ARTICLEConstruction and validation of a checklist for the management of totally implanted catheters in children
Revista Brasileira de Enfermagem. 2024;77(4):e20230447
DOI 10.1590/0034-7167-2023-0447
Views0See moreABSTRACT
Objectives:
to construct and validate the content of a checklist for the management of totally implanted catheters in hospitalized children and adolescents.
Methods:
methodological research conducted from October 2021 to December 2022 in two stages: development of the instrument with care guidelines and content validation of the checklist. The instrument, containing 23 items presented in Likert format, was evaluated online by specialists in two rounds. The Content Validity Index was applied, considering indices above 0.8 as valid.
Results:
the final checklist included four domains and 22 checklist items, validated with a Content Validity Index of 0.98. The overall evaluation of the instrument presented a global score of 9.9.
Conclusions:
the validation and application of instruments that standardize procedures, in addition to supporting professionals, promote autonomy and quality of care for children and adolescents using this device.
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ORIGINAL ARTICLE09-20-2024
Transgender people’s knowledge about the adverse effects of cross-hormonization: challenges for nursing
Revista Brasileira de Enfermagem. 2024;77(4):e20230346
Abstract
ORIGINAL ARTICLETransgender people’s knowledge about the adverse effects of cross-hormonization: challenges for nursing
Revista Brasileira de Enfermagem. 2024;77(4):e20230346
DOI 10.1590/0034-7167-2023-0346
Views0See moreABSTRACT
Objectives:
to identify trans women’s and men’s knowledge about the adverse effects of cross-hormonization and understand the repercussions of hormonization practices on trans women’s and men’s health.
Methods:
exploratory, descriptive, qualitative research, developed with 41 participants, from July 2019 to February 2020, in a trans health outpatient clinic. Thematic-categorical content analysis was used.
Results:
from the analysis, the categories emerged: Knowledge about the adverse effects of cross-hormonization; and Cross-hormonization practices and their meaning.
Final Considerations:
nursing practices, based on the identification of knowledge about adverse effects and the understanding of cross-hormonization practices in trans women’s and men’s health, can result in more inclusive care.
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ORIGINAL ARTICLE09-20-2024
Sociocognitive factors determining compliance with standard precautions by nursing professionals during the COVID-19 pandemic
Revista Brasileira de Enfermagem. 2024;77(4):e20230301
Abstract
ORIGINAL ARTICLESociocognitive factors determining compliance with standard precautions by nursing professionals during the COVID-19 pandemic
Revista Brasileira de Enfermagem. 2024;77(4):e20230301
DOI 10.1590/0034-7167-2023-0301
Views0See moreABSTRACT
Objectives:
to assess the socio-cognitive factors determining adherence to standard precautions by nursing professionals in care practice during the COVID-19 pandemic in Brazil.
Methods:
an analytical cross-sectional study, carried out with 9,039 nursing professionals in Brazil, using an electronic form containing participant sociodemographic, training and work variables, and the Brazilian version of the Standard Precautions Questionnaire. Descriptive and inferential statistics were used using the statistical software R.
Results:
participants recognize standard precautions as effective measures to reduce infections and report intention to perform them. Training regarding standard precautions was evidenced as a facilitator of adherence (4.72; SD: 0.73), and problems related to materials (3.78; SD: 1.45) were a hindrance.
Conclusions:
among the determining factors, facilitating organization presented the highest score, followed by intention to perform. Facilitating and hindering factor identification makes it possible to develop intervention strategies to strengthen patient safety and reduce occupational risks among professionals.
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ORIGINAL ARTICLE09-20-2024
Middle-range theory of the existential dimension of being-in-the-world of chronic kidney disease: Grounded Theory
Revista Brasileira de Enfermagem. 2024;77(4):e20230152
Abstract
ORIGINAL ARTICLEMiddle-range theory of the existential dimension of being-in-the-world of chronic kidney disease: Grounded Theory
Revista Brasileira de Enfermagem. 2024;77(4):e20230152
DOI 10.1590/0034-7167-2023-0152
Views0See moreABSTRACT
Objectives:
to develop a middle-range theory of the existential dimension of being-in-the-world of chronic kidney disease in the light of humanistic nursing theory.
Methods:
exploratory-descriptive, qualitative, Grounded Theory study, whose guiding question was: what theoretical relationships can be established between clinical practice carried out in the context of renal replacement therapies and the concepts of humanistic nursing theory? Data were collected through semi-structured interviews with nursing staff and chronic kidney disease patients.
Results:
a theory was developed that describes and explains the existential dimension of being-in-the-world of chronic kidney disease, identifying the qualitative evidence present in this context.
Final Considerations:
the theory contributes to clinical nursing practice qualification in nephrology, consolidating nursing as an art and science, because it arises from care practice and research, in addition to rescuing what differentiates it within the health disciplines, which is care par excellence.
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