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01-01-2016
Nurses’ performance on indigenous and African-Brazilian health care practices
Revista Brasileira de Enfermagem. 2016;69(5):840-846
Abstract
Nurses’ performance on indigenous and African-Brazilian health care practices
Revista Brasileira de Enfermagem. 2016;69(5):840-846
DOI 10.1590/0034-7167.2016690504
Views0See moreABSTRACT
Objective:
to analyze the performance of nurses from the Estratégia Saúde da Família (Family Health Strategy) on health care practices rooted in African and Indigenous cultures.
Methods:
Thematic Oral History was used and interviews were conducted with seven participants, who worked with Primary Health Care in Northeastern Brazil. The analysis was based on Leininger’s Theory of Cultural Care and the intercultural concept of human rights, among others.
Results:
nurses are unaware of the religious and historical context of the ethnic groups cared for and do not appreciate their self-care practices in areas with a predominance of African and indigenous cultures. These practices coexist with the hegemonic biomedical model.
Conclusion:
the debate on cultural competence in the context of professional qualification and exercise is required, aiming to promote the nursing work in the perspective of diversity and comprehensiveness of health care.
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01-01-2016
Accessibility assessment of assistive technology for the hearing impaired
Revista Brasileira de Enfermagem. 2016;69(5):833-839
Abstract
Accessibility assessment of assistive technology for the hearing impaired
Revista Brasileira de Enfermagem. 2016;69(5):833-839
DOI 10.1590/0034-7167.2016690503
Views0See moreABSTRACT
Objective:
to assess the automatic accessibility of assistive technology in online courses for the hearing impaired.
Method:
evaluation study guided by the Assessment and Maintenance step proposed in the Model of Development of Digital Educational Material. The software Assessor and Simulator for the Accessibility of Sites (ASES) was used to analyze the online course “Education on Sexual and Reproductive Health: the use of condoms” according to the accessibility standards of national and international websites.
Results:
an error report generated by the program identified, in each didactic module, one error and two warnings related to two international principles and six warnings involved with six national recommendations. The warnings relevant to hearing-impaired people were corrected, and the course was considered accessible by automatic assessment.
Conclusion:
we concluded that the pages of the course were considered, by the software used, appropriate to the standards of web accessibility.
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01-01-2016
Functional disability: health conditions and physical activity practice in older adults
Revista Brasileira de Enfermagem. 2016;69(5):825-832
Abstract
Functional disability: health conditions and physical activity practice in older adults
Revista Brasileira de Enfermagem. 2016;69(5):825-832
DOI 10.1590/0034-7167.2016690502
Views0See moreABSTRACT
Objective:
to verify the prevalence of functional disability among older adults and how it can affect their health conditions and the regular practice of physical activities.
Method:
this is a household and cross-sectional study conducted with older adults of both sexes. We verified the variables associated with functional disability by Poisson’s regression.
Results:
around 420 older adults participated in this study (68.1% of them being women). We observed a statistically significant association between functional disability, the number of chronic diseases, self-assessed health conditions, and the practice of physical activities; the latter only being found among men. Older adults who reported presenting four or more chronic diseases, self-assessed their health conditions as poor, and were not used to practice physical activities, showing high prevalence of functional disability.
Conclusion:
considering the changeable character of these variables, we recommend that prevention actions be taken, mainly at primary level, to delay the emergence of disability.
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01-01-2016
Organizational culture of a psychiatric hospital and resilience of nursing workers
Revista Brasileira de Enfermagem. 2016;69(5):817-824
Abstract
Organizational culture of a psychiatric hospital and resilience of nursing workers
Revista Brasileira de Enfermagem. 2016;69(5):817-824
DOI 10.1590/0034-7167.2016690501
Views0See moreABSTRACT
Objective:
to analyze the organizational culture of a psychiatric hospital and identify the capacity of resilience of nursing workers.
Method:
quantitative research. For data collection, were used the Brazilian Instrument for Evaluation of Organizational Culture (IBACO – Instrumento Brasileiro para Avaliação da Cultura Organizacional) and the Resilience Scale (RS).
Results:
participants reported the existence of centralization of power and devaluation of workers, despite recognizing the existence of collaboration at work and practices for improving interpersonal relations. In relation to the capacity of resilience, 50% of workers showed high level, and 42.9% a medium level of resilience. The correlation tests revealed negative values between the IBACO and RS domains, indicating that the lower the appreciation of individuals in the institution, the greater their capacity of resilience.
Conclusion:
the organizational values reflect the work organization model in the institution that devalues the workers’ needs and requires greater capacity of resilience.
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01-01-2016
Making our nursing research matter
Revista Brasileira de Enfermagem. 2016;69(5):813-814
Abstract
Making our nursing research matter
Revista Brasileira de Enfermagem. 2016;69(5):813-814
DOI 10.1590/0034-7167-2015-0156
Views0Nurses worldwide are being increasingly exposed to new and interesting research methodologies. At the same time, they are feeling considerable pressure to ensure that the studies they propose are sufficiently methodologically rigorous to pass the scrutiny of review for funding or publication. In this context, it is increasingly important to remind ourselves that methodological rigor […]See more -
01-01-2016
Fazendo nossa pesquisa em enfermagem ser relevante
Revista Brasileira de Enfermagem. 2016;69(5):813-814
Abstract
Fazendo nossa pesquisa em enfermagem ser relevante
Revista Brasileira de Enfermagem. 2016;69(5):813-814
DOI 10.1590/0034-7167-2015-0156
Views0Enfermeiros em todo o mundo estão cada vez mais expostos a metodologias de pesquisa novas e interessantes. Ao mesmo tempo, sentem uma pressão considerável para assegurar que os estudos a que se propõem são suficientemente rigorosos metodologicamente para passar pelo crivo de avaliação para fomento ou publicação. Nesse contexto, é cada vez mais importante lembrarmos […]See more -
01-01-2016
O Espiritismo como terapia no cuidado em saúde na epilepsia
Revista Brasileira de Enfermagem. 2016;69(4):804-810
Abstract
O Espiritismo como terapia no cuidado em saúde na epilepsia
Revista Brasileira de Enfermagem. 2016;69(4):804-810
DOI 10.1590/0034-7167.2016690425i
Views0See moreRESUMEN
Objetivo:
presentar una breve historia del Espiritismo, la visión de la epilepsia por el Espiritismo, y el potencial de la espiritualidade y religiosidad como tratamientos complementarios y coadyuvantes de la epilepsia.
Método:
esta es una breve revisión del impacto de la fe, la espiritualidad y religiosidad, en particular la filosofía espiritual como tratamiento complementario de los trastornos neurológicos (centrada especialmente en la epilepsia) y la salud mental. Para esto, se realizó una revisión de la religiosidad/espiritualidad y la epilepsia en la base de datos PubMed y SciELO.
Conclusión:
el ejercicio de la espiritualidad y la religiosidad puede ser una estrategia de afrontamiento y tratamiento positivo para apoyar la terapia tradicional de los pacientes con epilepsia y otros trastornos neurológicos. Sin embargo, es necesario desmitificar muchas creencias sobre la epilepsia así como mejorar el conocimiento sobre este importante aspecto de la dimensión de salud entre profesionales, cuidadores y pacientes para explorar su potencial para el tratamiento y el apoyo.
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REVIEW01-01-2016
The Spiritism as therapy in the health care in the epilepsy
Revista Brasileira de Enfermagem. 2016;69(4):804-810
Abstract
REVIEWThe Spiritism as therapy in the health care in the epilepsy
Revista Brasileira de Enfermagem. 2016;69(4):804-810
DOI 10.1590/0034-7167.2016690425i
Views0See moreABSTRACT
Objective:
to present a brief history of Spiritism, the vision of epilepsy by Spiritism, and the potential of spirituality and religiosity care as complementary and coadjutants treatments in epilepsy.
Method:
this is a brief review about the impact of faith, spirituality, and religiosity, particularly the Spiritism philosophy as complementary treatment to neurological disorders (particularly focusing on epilepsy) and mental health. We conduct a review of published articles (about religion/spirituality and epilepsy) in the Pubmed and SciELO databases.
Conclusion:
the exercise of spirituality and religiosity can be a positive coping strategy to support the traditional therapy of patients with epilepsy and other neurological disorders. However, it is necessary to demystify myths and beliefs about the epilepsy and improve knowledge about this important health dimension among professionals, patients, and caregivers to explore their full treatment and supportive potential.
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01-01-2017
Enfermagem em cardiologia: estado da arte e fronteiras do conhecimento
Revista Brasileira de Enfermagem. 2017;70(3):451-452
Abstract
Enfermagem 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 -
01-01-2017
Nursing in cardiology: state of the art and frontiers of knowledge
Revista Brasileira de Enfermagem. 2017;70(3):451-452
Abstract
Nursing 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
Views0See moreABSTRACT
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.
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REFLECTION01-01-2017
Systematization of nursing care and the formation of professional identity
Revista Brasileira de Enfermagem. 2017;70(2):436-441
Abstract
REFLECTIONSystematization of nursing care and the formation of professional identity
Revista Brasileira de Enfermagem. 2017;70(2):436-441
DOI 10.1590/0034-7167-2016-0515
Views0See moreABSTRACT
The aim of this study is to explore arguments that broaden the understanding of possible links between the organization of nursing care and the structuring of professional identity. For that purpose, some aspects related to these themes are addressed, highlighting issues regarding differences in the concepts of the organization of nursing care and the nursing process, as well as the performance of this activity and its possible impact on the establishment of its relationship with the professional identity. Emphasis is given to the need to stimulate the debate on the subject by nursing professionals involved in the training of human resources and the provision of care, as well as in class entities, in order to deepen understanding of these concepts as significant elements for strengthening our professional identity.
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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 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
Analysis of omission of antimicrobial doses in Intensive Care Units
Revista Brasileira de Enfermagem. 2024;77(6):e20240102
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
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.
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REVIEW12-16-2024
Recommendations for guidelines for promoting mental health in the workplace: an umbrella review
Revista Brasileira de Enfermagem. 2024;77(6):e20240086
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
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.
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ORIGINAL ARTICLE12-16-2024
Psychometric analysis of ProQOL-BR in nursing: building hospital safety and protection
Revista Brasileira de Enfermagem. 2024;77(6):e20240085
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
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.
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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
Respectful care for postpartum women with sickle cell disease: a netnographic study
Revista Brasileira de Enfermagem. 2024;77(6):e20230545
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
Views0See 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.
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ORIGINAL ARTICLE12-16-2024
Construction and validation of an educational game on biosafety in the central sterile supply department
Revista Brasileira de Enfermagem. 2024;77(6):e20230478
Abstract
ORIGINAL ARTICLEConstruction and validation of an educational game on biosafety in the central sterile supply department
Revista Brasileira de Enfermagem. 2024;77(6):e20230478
DOI 10.1590/0034-7167-2023-0478
Views0See moreABSTRACT
Objectives:
to construct and validate an educational game on biosafety in the Central Sterile Supply Department of a hospital in Curitiba, PR.
Methods:
the study was conducted using a quantitative approach, employing applied and technological research with an exploratory design. The process was divided into six stages, from the definition of the theme to the validation and application of the game. The study was carried out from May to August 2022, involving 17 nursing professionals from a Central Sterile Supply Department during day and night shifts, as well as 9 judges.
Results:
the study resulted in the construction of a board game named by the authors as “My Health First.”
Conclusions:
the research achieved its objective of constructing and validating an educational game. By reflecting on professional practice and correlating the occupational risks present, the professionals were able to list safe actions, identify problems, and seek solutions.
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ORIGINAL ARTICLE12-16-2024
Training profile of intensive care nurses in Brazil: cross-sectional study
Revista Brasileira de Enfermagem. 2024;77(6):e20230460
Abstract
ORIGINAL ARTICLETraining profile of intensive care nurses in Brazil: cross-sectional study
Revista Brasileira de Enfermagem. 2024;77(6):e20230460
DOI 10.1590/0034-7167-2023-0460
Views0See moreABSTRACT
Objectives:
to describe the training profile of Brazilian intensive care nurses.
Methods:
a cross-sectional study carried out in two stages: a structured, self-administered questionnaire; mapping of the national supply of lato sensu postgraduate courses. Data was collected on the sociodemographic profile, training process and characterization of the courses.
Results:
in the first stage, 202 respondents were obtained. The majority were women (79.2%), aged between 26 and 45 (80.7%), graduated less than 5 years ago (44%), through lato sensu postgraduate courses (55.5%), which were marked by the absence of laboratory practice (57.5%) and guided tours (42.5%). In the second stage, 457 courses were identified, with face-to-face teaching (58.9%), a workload of 360 to 420 hours (51.2%), a duration of up to 6 months (41.8%) and variation in the sub-area of training.
Conclusions:
there was a predominance of professionals graduating from lato sensu post-graduate courses, with essentially theoretical teaching and heterogeneity in terms of modality, workload and sub-area of training.
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