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10-09-2023
Standard Operating Procedure validity on intramuscular vaccine administration in adults: a methodological study
- Elaine Aparecida da Cunha Lima
, - Renata Oliveira Caetano ,
- Marisa Dibbern Lopes Correia ,
- Luana Vieira Toledo ,
- Thais Bitencourt Faria , [ … ],
- Luciene Muniz Braga Daskaleas
Abstract
Standard Operating Procedure validity on intramuscular vaccine administration in adults: a methodological study
Revista Brasileira de Enfermagem. 2023;76(4):e20220692
DOI 10.1590/0034-7167-2022-0692
- Elaine Aparecida da Cunha Lima ,
- Renata Oliveira Caetano ,
- Marisa Dibbern Lopes Correia ,
- Luana Vieira Toledo ,
- Thais Bitencourt Faria ,
- Daniela de Almeida Pereira ,
- Luciene Muniz Braga Daskaleas
Views0See moreABSTRACT
Objective:
to validate a Standard Operating Procedure on the intramuscular vaccine administration technique in adults using high frequency vibration associated with cryotherapy.
Methods:
a literature review on intramuscular vaccination practice using a vibration device associated with cryotherapy. Then, a form was created to validate the instrument, detailing the items that were assessed by judges following recommendations in the literature. Judges’ answers were assessed using the Content Validity Index, with items whose index was greater than or equal to 0.80 being validated.
Results:
twenty-five nurses participated in validity, identifying judges’ opinion regarding item relevance, clarity and accuracy. Judges validated the instrument, according to the values that remained between 0.88 and 1.0.
Conclusions:
the instrument developed and validated is a tool capable of guaranteeing safety and standardizing immunization practice in vaccine rooms.
- Elaine Aparecida da Cunha Lima
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ORIGINAL ARTICLE10-09-2023
Translation and validity of the Multidimensional Individual and Interpersonal Resilience Measure
- Jéssica Diniz Rodrigues Ferreira ,
- Mariana Figueiredo Miranda ,
- Millena Figueiredo Miranda ,
- Marco Aurélio Romano-Silva ,
- Maria Aparecida Camargos Bicalho , [ … ],
- Bernardo de Mattos Viana
Abstract
ORIGINAL ARTICLETranslation and validity of the Multidimensional Individual and Interpersonal Resilience Measure
Revista Brasileira de Enfermagem. 2023;76(4):e20220696
DOI 10.1590/0034-7167-2022-0696
- Jéssica Diniz Rodrigues Ferreira ,
- Mariana Figueiredo Miranda ,
- Millena Figueiredo Miranda ,
- Marco Aurélio Romano-Silva ,
- Maria Aparecida Camargos Bicalho ,
- Bernardo de Mattos Viana
Views0See moreABSTRACT
Objective:
to translate, culturally adapt and validate the Multidimensional Individual and Interpersonal Resilience Measure to Brazilian Portuguese.
Method:
after initial translation, the pre-final version underwent rigorous cultural adaptation procedures. As a result, the final adapted version was submitted to a validity study.
Results:
adaptation procedures provided equivalence between the pre-final and the original versions in semantic, idiomatic, experiential and conceptual terms. A total of 187 older adults were included in the validity study. Exploratory factorial analysis (EFA) generated a model of five factors ((RMSEA = 0.030; TLI = 0.959; X = 151.590 p> 0.05). Final version showed adequate consistency (Cronbach’s α = 0.705) and test-retest reliability (ICC=0.835). No statistically significant correlation was found between resilience and sociodemographic and epidemiological variables assessed in this study.
Conclusion:
EMRII-BR is a valid and reliable instrument for measuring resilience in Brazilian older adults.
- Jéssica Diniz Rodrigues Ferreira
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ORIGINAL ARTICLE10-09-2023
Health care for people with tuberculosis/HIV co-infection from the multidisciplinary team’s perspective
- Eduarda Aguiar da Silva ,
- Paula Hino ,
- Hugo Fernandes ,
- Maria Rita Bertolozi ,
- Aline Aparecida Monroe , [ … ],
- Lucimara Fabiana Fornari
Abstract
ORIGINAL ARTICLEHealth care for people with tuberculosis/HIV co-infection from the multidisciplinary team’s perspective
Revista Brasileira de Enfermagem. 2023;76(4):e20220733
DOI 10.1590/0034-7167-2022-0733
- Eduarda Aguiar da Silva ,
- Paula Hino ,
- Hugo Fernandes ,
- Maria Rita Bertolozi ,
- Aline Aparecida Monroe ,
- Lucimara Fabiana Fornari
Views0See moreABSTRACT
Objective:
to know the multidisciplinary team’s perspective about the health care of people with tuberculosis and human immunodeficiency virus co-infection in relation to treatment.
Methods:
this is a descriptive-exploratory study, with a qualitative approach, carried out in a health care service in São Paulo, from May to June 2019. Semi-structured interviews were conducted with nine professionals from the multidisciplinary team. Data were processed through discourse analysis with the support of webQDA.
Results:
Two empirical categories emerged: Health care interfaces for people with tuberculosis and human immunodeficiency virus co-infection; Barriers and facilitators for health care for people with co-infection.
Final considerations:
the health-disease process in co-infection is mediated by conditions that positively or negatively interfere with treatment compliance. People’s health care goes beyond exclusively clinical assistance and requires the recognition of needs in a broad perspective.
- Eduarda Aguiar da Silva
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ORIGINAL ARTICLE10-09-2023
Independent and combined effects of lifestyle behaviors on adolescent health-related quality of life
Revista Brasileira de Enfermagem. 2023;76(4):e20220780
Abstract
ORIGINAL ARTICLEIndependent and combined effects of lifestyle behaviors on adolescent health-related quality of life
Revista Brasileira de Enfermagem. 2023;76(4):e20220780
DOI 10.1590/0034-7167-2022-0780
Views0See moreABSTRACT
Objective:
To investigate the independent and combined effects of lifestyle behaviors, including physical activity, sedentary behavior, sleep duration and food intake, in the health-related quality of life (HRQoL) of Brazilian adolescents.
Methods:
Cross-sectional school-based study, with the participation of 306 adolescents aged 14 to 18 years. A questionnaire was applied with structured questions to collect lifestyle behaviors data. Perception of the HRQoL was identified using the Kidscreen-27. The study used covariance analysis and linear regression models for statistical analysis.
Results:
Adolescents who reported ≤ 2 hours/day of screen-based sedentary behavior and sleep duration equivalent to 8-10 hours/night presented significantly higher HRQoL. Adolescents who reported joint adherence ≥ 3 healthy lifestyle behaviors demonstrated approximately two [OR=2.12] to three times [OR=3.04] more chance of presenting higher perceptions of HRQoL.
Conclusion:
Although healthy lifestyle behaviors had a positive independent effect on HRQoL, joint adherence to healthy behaviors enhances the cumulative effect.
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ORIGINAL ARTICLE10-09-2023
Spirituality in the uncertainty of illness: the perspective of oncology patients
- Roberto Firpo de Almeida Filho ,
- Maria Cristina Soares Figueiredo Trezza ,
- Isabel Comassetto ,
- Lucas Kayzan Barbosa da Silva ,
- Marcela Porangaba Lopes , [ … ],
- Francyane Adielle de Souza Praxedes
Abstract
ORIGINAL ARTICLESpirituality in the uncertainty of illness: the perspective of oncology patients
Revista Brasileira de Enfermagem. 2023;76(4):e20220712
DOI 10.1590/0034-7167-2022-0712
- Roberto Firpo de Almeida Filho ,
- Maria Cristina Soares Figueiredo Trezza ,
- Isabel Comassetto ,
- Lucas Kayzan Barbosa da Silva ,
- Marcela Porangaba Lopes ,
- Kleytonn Giann Silva de Santana ,
- Francyane Adielle de Souza Praxedes
Views0See moreABSTRACT
Objective:
To analyze spirituality in the process of illness uncertainty in cancer patients.
Methods:
This is a qualitative study, in which Merle Mishel’s Theory of Uncertainty of Disease was used as a theoretical framework; and as a methodological reference, the stages of Bardin’s Content Analysis. As a technique for obtaining information, a semi-structured interview was used.
Results:
Spirituality in the uncertainty of the disease varies from patient to patient and acts in a unique way. They presented readaptation attitudes in their reports. The presence of spirituality in their lives acted as the main force mechanism to deal with the uncertainty of the disease, and this moment was called by Mishel “probabilistic thinking”.
Conclusion:
Patients demonstrated readaptation attitudes in their reports, and spirituality acted as the main mechanism of strength to deal with uncertainty in the disease
- Roberto Firpo de Almeida Filho
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ORIGINAL ARTICLE10-09-2023
Glycemic variability and mortality in oncologic intensive care units
Revista Brasileira de Enfermagem. 2023;76(4):e20220812
Abstract
ORIGINAL ARTICLEGlycemic variability and mortality in oncologic intensive care units
Revista Brasileira de Enfermagem. 2023;76(4):e20220812
DOI 10.1590/0034-7167-2022-0812
Views0See moreABSTRACT
Objective:
This study aimed to investigate the association between glycemic variability and mortality in patients admitted to oncologic intensive care units.
Methods:
A retrospective cohort study was conducted using a convenience sample of 30 medical records of patients over 18 years of age of both sexes. Glycemic variability was measured using the standard deviation and general amplitude. Statistical analysis was performed using the receiver operating characteristic (ROC) curve and the area under the curve (AUC). The significance level (α) was set at 5% with a confidence interval (CI) of 95%.
Results:
The study included 14 male patients (46.67%) with a mean age of 60±15 years. A total of 1503 blood glucose samples were collected. The AUC analysis for the standard deviation did not show a statistically significant result (p=.966; 95% CI=[0.283, 0.726]). In contrast, the general amplitude had a statistically significant association with mortality (p=.049; 95% CI=[0.514, 0.916]).
Conclusions:
This study found that glycemic variability measured by the general amplitude was significantly associated with patient mortality in oncologic intensive care units. These findings suggest that monitoring glycemic variability may be an important factor in the management of critically ill patients in oncologic intensive care units.
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ORIGINAL ARTICLE10-09-2023
Educational intervention in social skills for Primary Care nurses
- Aline Loiola Moura Bianconi ,
- Tatiana da Silva Melo Malaquias ,
- Adriana Valongo Zani ,
- Elen Ferraz Teston ,
- Maira Sayuri Sakai Bortoletto , [ … ],
- Maria do Carmo Fernandez Lourenço Haddad
Abstract
ORIGINAL ARTICLEEducational intervention in social skills for Primary Care nurses
Revista Brasileira de Enfermagem. 2023;76(4):e20220503
DOI 10.1590/0034-7167-2022-0503
- Aline Loiola Moura Bianconi ,
- Tatiana da Silva Melo Malaquias ,
- Adriana Valongo Zani ,
- Elen Ferraz Teston ,
- Maira Sayuri Sakai Bortoletto ,
- Maria do Carmo Fernandez Lourenço Haddad
Views0See moreABSTRACT
Objective:
to assess an educational intervention on social skills for nurses who work in Primary Health Care.
Method:
a qualitative research-intervention study, carried out in the municipalities covered by the 17th Health Regional of Paraná. It was developed in three interrelated stages: exploratory, where meetings were held with the managers to define the groups and logistics for running the course; intermediate, developed in meetings with different groups of nurses, addressing selected topics; assessment, in which the nurses developed a personal plan to improve their social skills.
Results:
participants were 57 nurses who acted as coordinators of Primary Care. They considered the educational intervention in social skills fundamental for positive changes in their professional performance.
Final considerations:
the educational intervention in social skills was assessed as an important strategy to strengthen the development of nurses’ managerial and care skills.
- Aline Loiola Moura Bianconi
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ORIGINAL ARTICLE10-09-2023
Intestinal parasitic infections: telephone health literacy with men in areas of poverty in the syndemic
- Julio Cesar Pegado Bordignon ,
- Antonia de Castro Ribeiro ,
- Érica Tex Paulino ,
- Maria de Fatima Leal Alencar ,
- Marcio Neves Boia , [ … ],
- Antonio Henrique Almeida de Moraes Neto
Abstract
ORIGINAL ARTICLEIntestinal parasitic infections: telephone health literacy with men in areas of poverty in the syndemic
Revista Brasileira de Enfermagem. 2023;76(4):e20220300
DOI 10.1590/0034-7167-2022-0300
- Julio Cesar Pegado Bordignon ,
- Antonia de Castro Ribeiro ,
- Érica Tex Paulino ,
- Maria de Fatima Leal Alencar ,
- Marcio Neves Boia ,
- Antonio Henrique Almeida de Moraes Neto
Views0See moreABSTRACT
Objectives:
to assess Popular Health Education practices on intestinal parasites, carried out by telephone contact with men living in urban communities in Rio de Janeiro, Brazil, during the COVID-19 syndemic.
Method:
a quasi-experimental, quantitative and descriptive study, carried out with men aged 20 to 59 years. Pre-test was applied, and participants were divided into two groups: control and experimental. Popular Education in Health practices were carried out with an experimental group, and post-test was applied for both.
Results:
health education practices were significant in the experimental group, with a reduction in incorrect answers. There was an increase in incorrect answers in the control group’s post-test.
Conclusions:
the Brazilian National Policy for Popular Education in Health contributed to qualify men’s health literacy on intestinal parasites. Practice by telephone contact proved to be a powerful strategy for nursing and public policies to access this group and promote health in Primary Health Care.
- Julio Cesar Pegado Bordignon
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ORIGINAL ARTICLE07-13-2020
Mental health of nursing in coping with COVID-19 at a regional university hospital
- Eduardo Bassani Dal’Bosco ,
- Lara Simone Messias Floriano ,
- Suellen Vienscoski Skupien ,
- Guilherme Arcaro ,
- Alessandra Rodrigues Martins , [ … ],
- Aline Cristina Correa Anselmo
Abstract
ORIGINAL ARTICLEMental health of nursing in coping with COVID-19 at a regional university hospital
Revista Brasileira de Enfermagem. 2020;73:e20200434
DOI 10.1590/0034-7167-2020-0434
- Eduardo Bassani Dal’Bosco ,
- Lara Simone Messias Floriano ,
- Suellen Vienscoski Skupien ,
- Guilherme Arcaro ,
- Alessandra Rodrigues Martins ,
- Aline Cristina Correa Anselmo
Views0See moreABSTRACT
Objective:
to identify prevalence and factors associated with anxiety and depression in nursing professionals who work to cope with COVID-19 at a university hospital.
Methods:
a cross-sectional observational study using a sociodemographic questionnaire and Hospital Anxiety and Depression Scale, with 88 nursing professionals. Data were analyzed using absolute and relative frequency and Statistical Package for the Social Sciences.
Results:
there was prevalence of anxiety (48.9%) and depression (25%). The majority of the sample consisted of women over 40 years old, married or in a common-law marriage, white, with higher education or graduate degree, with an income above 3,000.00 reais, public servants, working 40 hours a week and working in the hospital from 1 to 5 years.
Conclusion:
we must consider the impact on mental health nursing caused by COVID-19 and intervene with coping strategies to minimize the suffering of professionals.
- Eduardo Bassani Dal’Bosco
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REFLECTION04-22-2020
Thematic content analysis using ATLAS.ti software: Potentialities for researchs in health
Revista Brasileira de Enfermagem. 2020;73(3):e20190250
Abstract
REFLECTIONThematic content analysis using ATLAS.ti software: Potentialities for researchs in health
Revista Brasileira de Enfermagem. 2020;73(3):e20190250
DOI 10.1590/0034-7167-2019-0250
Views0See moreABSTRACT
Objective:
to describe the most important tools of ATLAS.ti Software and to associate them with the procedures of Thematic Content Analysis.
Method:
It is a theoretical reflection of the Content Analysis phases of Laurence Bardin, associating them with software tools Atlas.ti and showing its usefulness for data analysis in qualitative research.
Results:
historical contextualization and the available resources of Atlas.ti software with presentation of health research involving the phases of thematic content analysis.
Final considerations:
The Atlas.ti software assists in the accomplishment of the thematic content analysis being this promising association in health research.
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REFLECTION10-26-2020
Nursing education: challenges and perspectives in times of the COVID-19 pandemic
- Ana Luisa Brandão de Carvalho Lira ,
- Edlamar Kátia Adamy ,
- Elizabeth Teixeira ,
- Francisca Valda da Silva
Abstract
REFLECTIONNursing education: challenges and perspectives in times of the COVID-19 pandemic
Revista Brasileira de Enfermagem. 2020;73:e20200683
DOI 10.1590/0034-7167-2020-0683
- Ana Luisa Brandão de Carvalho Lira ,
- Edlamar Kátia Adamy ,
- Elizabeth Teixeira ,
- Francisca Valda da Silva
Views0See moreABSTRACT
Objective:
To discuss the challenges and perspectives of nursing education in times of the COVID-19 pandemic.
Methods:
Reflection study, with theoretical approach based on national and international publications, allied to the experience of researchers in the area of nursing education.
Results:
Four sections are identified: Nursing education: current affairs and perspectives; Education and technologies in time of pandemic: acceleration, alteration and paralysis; Difference between emergency, intentional and remote teaching; the return to the “new normality”: new structuring axes and legal norms.
Final considerations:
The conclusion is that longstanding challenges have emerged with the pandemic, and the processes of acceleration, change and paralysis have marked education in these times. Moreover, epidemiological, technological and psychological aspects should be more valued in the return to activities.
- Ana Luisa Brandão de Carvalho Lira
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ORIGINAL ARTICLE11-13-2020
Social determinants of health and COVID-19 infection in Brazil: an analysis of the pandemic
- Alexandre Medeiros de Figueiredo ,
- Daniela Cristina Moreira Marculino de Figueiredo ,
- Luciano Bezerra Gomes ,
- Adriano Massuda ,
- Eugenia Gil-García , [ … ],
- Antonio Daponte
Abstract
ORIGINAL ARTICLESocial determinants of health and COVID-19 infection in Brazil: an analysis of the pandemic
Revista Brasileira de Enfermagem. 2020;73:e20200673
DOI 10.1590/0034-7167-2020-0673
- Alexandre Medeiros de Figueiredo ,
- Daniela Cristina Moreira Marculino de Figueiredo ,
- Luciano Bezerra Gomes ,
- Adriano Massuda ,
- Eugenia Gil-García ,
- Rodrigo Pinheiro de Toledo Vianna ,
- Antonio Daponte
Views0See moreABSTRACT
Objective:
To analyze the influence of socioeconomic, demographic, epidemiological factors, and the health system structure in the evolution of the COVID-19 pandemic in Brazil.
Methods:
Ecological study with variables extracted from databases, having the incidence and mortality by COVID-19 until August 23, 2020, in Brazilian states, as response variables. The magnitude of the associations was estimated using Spearman’s correlation coefficient and multiple regression analysis.
Results:
In the Brazilian states, 59.8% of variation in the incidence of COVID-19 was justified by income inequality, significant home densification, and higher mortality. In the case of mortality, those same variables explained 57.9% of the country’s variations in federal units.
Conclusion:
Our results indicate that socioeconomic factors influenced the evolution and impact of COVID-19 in Brazil. Thus, we suggest comprehensive actions to ensure economic conditions and strengthening of health networks for populations with socioeconomic vulnerability.
- Alexandre Medeiros de Figueiredo
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ORIGINAL ARTICLE06-27-2019
Validation of a booklet on self-care with the diabetic foot
- Yara Lanne Santiago Galdino ,
- Thereza Maria Magalhães Moreira ,
- Antonio Dean Barbosa Marques ,
- Francisca Alexandra Araújo da Silva
Abstract
ORIGINAL ARTICLEValidation of a booklet on self-care with the diabetic foot
Revista Brasileira de Enfermagem. 2019;72(3):780-787
DOI 10.1590/0034-7167-2017-0900
- Yara Lanne Santiago Galdino ,
- Thereza Maria Magalhães Moreira ,
- Antonio Dean Barbosa Marques ,
- Francisca Alexandra Araújo da Silva
Views0See moreABSTRACT
Objective:
to describe the validation of the booklet on self-care with the feet of people with diabetes.
Method:
methodological study, focusing on the validation of a printed booklet. The content and appearance of the booklet was validated by 23 judges divided into three groups: 11 content and appearance, seven technicians and five of the area of design and marketing. The appearance was validated by 30 people with type 2 Diabetes Mellitus.
Results:
the judges in the nursing area allowed the validation of material with a Content Validity Index (CVI) of 0.99, judges in the area of design and marketing with Suitability Assessment of Materials (SAM) of 99.2% and the target audience with concordance index of 99.4%.
Conclusion:
the educational booklet proved to be valid and reliable educational material to be used in order to promote compliance with self-care with the feet of people with Diabetes Mellitus.
- Yara Lanne Santiago Galdino
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ORIGINAL ARTICLE08-10-2020
Braden Scale in pressure ulcer risk assessment
Revista Brasileira de Enfermagem. 2020;73(6):e20190413
Abstract
ORIGINAL ARTICLEBraden Scale in pressure ulcer risk assessment
Revista Brasileira de Enfermagem. 2020;73(6):e20190413
DOI 10.1590/0034-7167-2019-0413
Views0See moreABSTRACT
Objective:
To analyze the applicability of the Braden Scale to individuals admitted to an Intensive Care Unit (ICU) with the nursing diagnosis Impaired Physical Mobility, in its prediction potential to develop pressure ulcer (PU).
Methods:
A cross-sectional, quantitative study that evaluated all patients hospitalized in an ICU between November 2016 and February 2017, with the Braden Scale.
Results:
The prevalence of PU was 35.8% (24/67), in male individuals 58.3% (14/24), diagnosed with ischemic CVA 51.9% (12/27), and with hemorrhagic CVA 7.4% (2/27). Among patients classified at severe risk of developing pressure ulcer, 83.3% (20/53) developed it, and 76.7% (33/53) did not develop it.
Conclusion:
The performance of the Braden Scale showed a balance between sensitivity and specificity, confirming it as a better predictive risk assessment instrument in this group of patients.
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ORIGINAL ARTICLE02-27-2020
Prevalence of symptoms and quality of life of cancer patients
- Marina de Góes Salvetti ,
- Caroline Silva Pereira Machado ,
- Suzana Cristina Teixeira Donato ,
- Adriana Marques da Silva
Abstract
ORIGINAL ARTICLEPrevalence of symptoms and quality of life of cancer patients
Revista Brasileira de Enfermagem. 2020;73(2):e20180287
DOI 10.1590/0034-7167-2018-0287
- Marina de Góes Salvetti ,
- Caroline Silva Pereira Machado ,
- Suzana Cristina Teixeira Donato ,
- Adriana Marques da Silva
Views0See moreABSTRACT
Objectives:
to analyze the prevalence of symptoms and their relationship with the quality of life of cancer patients.
Methods:
this is a cross-sectional study with 107 patients evaluated using a sociodemographic instrument, the hospital anxiety and depression scale (HADS) and the quality of life scale (EORTC-QLQ-C30). Pearson’s correlation test was used to evaluate the relationship between symptoms and quality of life.
Results:
prevalence of female patients (56.1%), 55 years as the mean age and 10 years of schooling. Fatigue (76.6%), insomnia (47.7%), pain (42.1%), loss of appetite (37.4%), anxiety (31.8%) and depression (21.5%) were identified. Anxiety and depression symptoms presented a negative correlation with quality of life and positive correlation with physical symptoms.
Conclusions:
fatigue, insomnia, pain and loss of appetite were the most common and most intense symptoms. Anxiety and depression symptoms presented a negative correlation with quality of life and positive correlation with physical symptoms.
- Marina de Góes Salvetti
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REVIEW03-24-2021
Strategies of active learning methodologies in nursing education: an integrative literature review
- Joyce Fernanda Soares Albino Ghezzi ,
- Elza de Fátima Ribeiro Higa ,
- Monike Alves Lemes ,
- Maria José Sanches Marin
Abstract
REVIEWStrategies of active learning methodologies in nursing education: an integrative literature review
Revista Brasileira de Enfermagem. 2021;74(1):e20200130
DOI 10.1590/0034-7167-2020-0130
- Joyce Fernanda Soares Albino Ghezzi ,
- Elza de Fátima Ribeiro Higa ,
- Monike Alves Lemes ,
- Maria José Sanches Marin
Views0See moreABSTRACT
Objectives:
to analyze the scientific evidence on the strategies of active learning methodologies used in the training of nurses, as well as their contributions and obstacles in training.
Methods:
integrative literature review conducted with 33 selected articles in the Medical Literature Analysis and Retrieval System Online, Latin American and Caribbean Literature in Health Sciences, Nursing Database, Scopus, Web of Science and Education Resources Information Center databases.
Results:
among the strategies, simulation, problem-based learning and flipped classroom were highlighted. The active search, the integration of theory and practice and group work were examples of contributions to the training of nurses. However, the lack of preparation of the actors and the lack of structural support contribute to the dissatisfaction of the students.
Final Considerations:
the active learning methodology places the student at the heart of the learning process, favors critical thinking and the ability to make decisions.
- Joyce Fernanda Soares Albino Ghezzi
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