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ORIGINAL ARTICLE10-07-2024
Consequences of the legislation issued for nursing education in times of COVID-19 (2020-2022)
Revista Brasileira de Enfermagem. 2024;77(5):e20230375
Abstract
ORIGINAL ARTICLEConsequences of the legislation issued for nursing education in times of COVID-19 (2020-2022)
Revista Brasileira de Enfermagem. 2024;77(5):e20230375
DOI 10.1590/0034-7167-2023-0375
Views0See moreABSTRACT
Objectives:
to analyze the legislation issued during the COVID-19 pandemic for nursing education and immediate consequences.
Methods:
documentary research, whose source was the legislation issued for nursing education during the COVID-19 pandemic. Thirty-two documents were analyzed and submitted to a collection instrument.
Results:
contradictions and consequences for nursing education following the guidelines and law of guidelines and bases were revealed. The consequences of the law affected the quality of teaching, equal access, exemption from minimum school days and course abbreviation. Regarding the guidelines, there was a lack of conditions for developing skills, in addition to the attempt to update them. Concerning internships, acting during the pandemic put students at risk, and their abbreviation prevented them from consolidating knowledge and skills.
Final Considerations:
remote teaching did not guarantee the quality and equality of teaching, weakened the development of skills, not taking into account nursing’s educational needs.
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ORIGINAL ARTICLE09-30-2024
Giving new meaning to the impact of touch in Shantala massage: mothers’ perceptions of maternal and child well-being
Revista Brasileira de Enfermagem. 2024;77:e20240012
Abstract
ORIGINAL ARTICLEGiving new meaning to the impact of touch in Shantala massage: mothers’ perceptions of maternal and child well-being
Revista Brasileira de Enfermagem. 2024;77:e20240012
DOI 10.1590/0034-7167-2024-0012
Views0See moreABSTRACT
Objectives:
to understand maternal perceptions of maternal and child well-being based on Shantala massage and discuss its association with the third Sustainable Development Goal.
Methods:
a descriptive-exploratory study in the light of Symbolic Interactionism. Eight women, mothers of infants, participated in five online meetings to teach Shantala massage, collected in focus groups, between November and December 2021. The data was subjected to thematic content analysis and lexical analysis with IRAMUTEQ®.
Results:
two categories emerged, 1) Maternal perceptions of Shantala massage and its promotion of child well-being and 2) Maternal perceptions of Shantala massage and its impact on their well-being, interconnected with subcategories.
Final Considerations:
Shantala massage promoted mutual impacts on maternal and child well-being, working together to achieve the third Sustainable Development Goal.
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ORIGINAL ARTICLE09-30-2024
Educational video for adherence to vaginal pessary in pelvic organ prolapse treatment
Revista Brasileira de Enfermagem. 2024;77:e20230515
Abstract
ORIGINAL ARTICLEEducational video for adherence to vaginal pessary in pelvic organ prolapse treatment
Revista Brasileira de Enfermagem. 2024;77:e20230515
DOI 10.1590/0034-7167-2023-0515
Views0ABSTRACT
Objectives:
to construct and assess an educational video to promote the adherence of women with pelvic organ prolapse to vaginal pessary use.
Methods:
this is a methodological study, with a longitudinal design and quantitative analysis. The pre-production (synopsis, argument, script, storyboard), production and post-production stages were covered. Content and technical assessments were carried out by judges from the health and communication areas, respectively, and appearance assessment by the target audience.
Results:
the video was the first to be developed on the topic on the national scene, considered assessed from the point of view of appearance and content, presenting an overall Content Validity Index of 0.99 and a level of agreement among judges of 91.1% to 100%. Assessment by the target audience reached a percentage of 96% to 100%.
Conclusions:
the educational video is an instrument capable of promoting adherence to pessary in women indicated for this therapeutic approach.
Keywords:Health CommunicationInstructional Film and VideoPelvic Organ ProlapsePessariesTreatment Adherence and ComplianceSee more -
EXPERIENCE REPORT09-30-2024
Health promotion of long-haul truck drivers and their families
Revista Brasileira de Enfermagem. 2024;77:e20230511
Abstract
EXPERIENCE REPORTHealth promotion of long-haul truck drivers and their families
Revista Brasileira de Enfermagem. 2024;77:e20230511
DOI 10.1590/0034-7167-2023-0511
Views0ABSTRACT
Objectives:
to describe the development of a Health Information and Communication Technology for the health care of long-haul truck drivers and their families.
Methods:
this is a description of the development of an Information and Communication Technology, developed from March to September 2023, following the systematization of the experience in five steps: 1) starting point, 2) initial questions, 3) recovery of the lived process, 4) background reflection, and 5) arrival points.
Results:
the technology called “Work-Family Balance,” electronically available, presents resources for the health care of long-haul truck drivers. It is anchored in studies on the health of long-haul truck drivers, notes from the International Labor Organization, the Strategic Action Plan for Confronting Chronic Diseases and Non-Communicable Diseases in Brazil, 2021-2030, and the Declaration by the International Association of Family Nursing.
Final Considerations:
the theoretical improvement of nursing can potentially improve the health care of long-haul truck drivers, prevent Chronic Non-Communicable Diseases, and promote work-life balance to achieve the goals of Agenda 2030.
Keywords:Family HealthInformation TechnologyNoncommunicable DiseasesSustainable DevelopmentWork-Life BalanceSee more -
Política Nacional de Cuidados Paliativos: reflexões a partir da Agenda 2030 para o Desenvolvimento Sustentável
Revista Brasileira de Enfermagem. 2024;77(6):e770601
Abstract
Política Nacional de Cuidados Paliativos: reflexões a partir da Agenda 2030 para o Desenvolvimento Sustentável
Revista Brasileira de Enfermagem. 2024;77(6):e770601
DOI 10.1590/0034-7167.2024770601pt
Views1A Agenda 2030 para o Desenvolvimento Sustentável, um plano de ação para as pessoas, para o planeta e para a prosperidade, é um plano de ação global adotado por representantes de todos os 193 Estados-Membros das Nações Unidas, reunidos na sede das Nações Unidas, em Nova York, de 25 a 27 de setembro de 2015. […]See more -
Brazilian National Palliative Care Policy: reflections based on the 2030 Agenda for Sustainable Development
Revista Brasileira de Enfermagem. 2024;77(6):e770601
Abstract
Brazilian National Palliative Care Policy: reflections based on the 2030 Agenda for Sustainable Development
Revista Brasileira de Enfermagem. 2024;77(6):e770601
DOI 10.1590/0034-7167.2024770601
Views0The 2030 Agenda for Sustainable Development, an action plan for people, planet and prosperity, is a global action plan adopted by representatives of all 193 United Nations Member States, meeting at United Nations Headquarters, in New York, from September 25 to 27, 2015. By achieving 17 sustainable objectives, the Agenda aims to promote sustainable development […]See more -
ORIGINAL ARTICLE09-20-2024
Middle-range theory for nursing for care in the context of cardiovascular risk
Revista Brasileira de Enfermagem. 2024;77(4):e20240190
Abstract
ORIGINAL ARTICLEMiddle-range theory for nursing for care in the context of cardiovascular risk
Revista Brasileira de Enfermagem. 2024;77(4):e20240190
DOI 10.1590/0034-7167-2024-0190
Views0ABSTRACT
Objectives:
to develop a middle-range nursing theory for care in the context of cardiovascular risk.
Methods:
a theoretical development study, through induction through research and ICNP® practice standards, carried out in six stages: concept analysis; ICNP® terminological subset structuring; theory contextualization and purpose; proposition construction; modeling; and assumption construction.
Results:
the Theory of Care in the Context of Cardiovascular Risk has a middle-range scope, describing care, prescribing actions to promote health and reduce cardiovascular risk. Thirteen propositions were constructed in three categories (nursing metaparadigm, central and factorial concepts), two models and 16 assumptions.
Final Considerations:
the theory contributes to the construction of knowledge arising from the nursing process for care in the context of cardiovascular risk, generating propositions, assumptions and modeling, which will enable theoretical testing.
Keywords:Concept FormationHeart Disease Risk FactorsNursing TheoriesStandardized Nursing TerminologyTheoretical ModelsSee more -
ORIGINAL ARTICLE09-20-2024
Content validity of guidance on self-care in the post-operative period for breast cancer
Revista Brasileira de Enfermagem. 2024;77(4):e20240188
Abstract
ORIGINAL ARTICLEContent validity of guidance on self-care in the post-operative period for breast cancer
Revista Brasileira de Enfermagem. 2024;77(4):e20240188
DOI 10.1590/0034-7167-2024-0188
Views0See moreABSTRACT
Objectives:
to validate the content of a guidance guide on self-care in the postoperative period of breast surgery for breast cancer.
Methods:
a methodological study with content validity, carried out with 15 expert nurses and physiotherapists, between May and July 2022. Recruitment took place from the Lattes Platform, using snowball sampling. The level of relevance and representativeness for each item was verified using the Content Validity Index (CVI). It was considered valid when CVI was equal to or greater than 78% (0.78).
Results:
from the initial total of 37 items, two were excluded, as they had insufficient practical relevance and theoretical relevance, and another five items which, although presenting a CVI lower than the established cut-off, were suggested to be rewritten and grouped with other similar items.
Conclusions:
thirty items were considered valid and demonstrated important and significant characteristics, constituting suitable material for application in clinical practice.
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Adherence to standard precautions in a teaching hospital
Revista Brasileira de Enfermagem. 2017;70(1):96-103
Abstract
Adherence to standard precautions in a teaching hospital
Revista Brasileira de Enfermagem. 2017;70(1):96-103
DOI 10.1590/0034-7167-2016-0138
Views0ABSTRACT
Objective:
analyze related factors and the level of adherence to standard precautions of nursing professionals from the clinical medical division of a teaching hospital.
Method:
a quantitative, cross-sectional, analytical study was conducted with 54 nursing professionals using the Psychometric Scale of Adherence to Standard Precautions, translated and validated to Brazilian Portuguese.
Results:
the global score of adherence was intermediate (4.41); no statistically significant correlation was observed between adherence and professional category (p=0.404) and length of professional practice (p= 0.612). A correlation was observed between ‘Washes hands after removing disposable gloves’ (p=0.026) and professionals with nursing practice above 10 years.
Conclusion:
adherence to standard precautions by the nursing team was intermediate, with no statistically significant difference in relation to the professional category and length of professional practice.
Keywords:Exposure to Biological AgentsNursing, TeamOccupational RisksPersonal Protective EquipmentUniversal PrecautionsSee more -
Analysis of adverse events following immunization caused by immunization errors
Revista Brasileira de Enfermagem. 2017;70(1):87-95
Abstract
Analysis of adverse events following immunization caused by immunization errors
Revista Brasileira de Enfermagem. 2017;70(1):87-95
DOI 10.1590/0034-7167-2016-0034
Views0See moreABSTRACT
Objective:
to analyze adverse events following immunization (AEFI) caused by immunization error in the state of Paraná, Brazil, from 2003 to 2013.
Method:
this is a descriptive, documental, retrospective, and quantitative research using secondary data from the Adverse Event Following Immunization Information System and the Immunization Program Evaluation System. We included cases confirmed and/or associated with different types of vaccines. For the analysis, we collected frequencies and incidence rates, and used simple linear regression models with Student’s t-test.
Results:
it was observed an AEFI increase due to immunization errors, especially hot subcutaneous abscesses. BCG vaccine had the highest incidence of adverse events and children under one year old were the most affected individuals.
Conclusion:
the current scenario is worrisome because these are preventable AEFI – injuring patients due to bad vaccination practices – that may undermine the population’s confidence, reducing immunization coverage, and the progress in the control of vaccine-preventable diseases.
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Nursing practice environment and work satisfaction in critical units
Revista Brasileira de Enfermagem. 2017;70(1):79-86
Abstract
Nursing practice environment and work satisfaction in critical units
Revista Brasileira de Enfermagem. 2017;70(1):79-86
DOI 10.1590/0034-7167-2016-0211
Views0See moreABSTRACT
Objective:
to analyze the association between the environment of nursing practices and work satisfaction in Intensive Care Units (ICU).
Method:
a cross-sectional study was performed in eight adult ICUs of a public university hospital between 2012 and 2015. The Nursing Work Index-Revised (NWI-R), in their short forms, and the Index of Work Satisfaction (IWS) were applied to investigate the environment of nursing practices and work satisfaction, respectively.
Results:
a total of 100 (34.84%) nurses and 187 (65.15%) nursing assistants/technicians participated in this study. The environment was favorable for autonomy and relationships and it showed vulnerability for control of practices and organizational support. The IWS score indicated low work satisfaction. “Environment of practices”, “length of work in the ICU” and “willingness to work” were associated with work satisfaction.
Conclusion:
to invest in the environment of practices, in factors that promote willingness to work and length of experience in the ICU increases nursing work satisfaction.
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Emergency interventions for air medical services trauma victims
Revista Brasileira de Enfermagem. 2017;70(1):54-60
Abstract
Emergency interventions for air medical services trauma victims
Revista Brasileira de Enfermagem. 2017;70(1):54-60
DOI 10.1590/0034-7167-2016-0311
Views0See moreABSTRACT
Objective:
to analyze emergency interventions for air medical services trauma victims, considering the time at the scene of trauma and the severity of the victims.
Method:
This was a descriptive, correlational and quantitative study, conducted from October of 2014 to December of 2015. Six nurses participated, completing an instrument containing emergency interventions performed in the care of victims after the occurrence of trauma. The sample consisted of 97 treatments.
Results:
Among the 97 for whom care was provided, peripheral venipuncture was performed in 97.94% of the cases; immobilization, including a backboard, was used in 89.70% of cases. The most commonly used medications were dipyrone in 44.33%, and ondansetron in 76.29%. The time on the scene showed significance with the severity of the victims. The Glasgow Coma scores were inversely related to time on the scene.
Conclusion:
Further studies are necessary, focused on care protocols for trauma victims
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Evaluation of the hospital accreditation program: face and content validation
Revista Brasileira de Enfermagem. 2017;70(1):47-53
Abstract
Evaluation of the hospital accreditation program: face and content validation
Revista Brasileira de Enfermagem. 2017;70(1):47-53
DOI 10.1590/0034-7167-2016-0184
Views0ABSTRACT
Objective:
to describe the results of face and content validation of the questionnaire entitled Quality Improvement Implementation Survey, and of two complementary scales as part of the adaptation process to the Brazilian language and culture.
Method:
included the following stages: (1) translation and synthesis of translations; (2) consideration by the expert committee; (3) back translation; (4) evaluation of verbal understanding by the target population.
Results:
the questionnaire was translated into Portuguese and its final version included 90 items. In the pre-test, the target population evaluated all items as easy to understand, with the global average of 4.58 (maximum value = 5).
Conclusion:
the questionnaire is currently translated into Portuguese and adapted to the Brazilian context. The adapted version maintained the semantic, idiomatic, conceptual and cultural equivalence, according to the assessment of the expert committee and the information provided by the target population, which confirmed the face and content validity.
Keywords:AccreditationAssurance of Health Care QualityHospital AdministrationOutcome Assessment (Health Care)Validation StudiesSee more -
Adecuación de escalas para medir cargas de trabajo mediante metodología de calidad
Revista Brasileira de Enfermagem. 2017;70(1):39-46
Abstract
Adecuación de escalas para medir cargas de trabajo mediante metodología de calidad
Revista Brasileira de Enfermagem. 2017;70(1):39-46
DOI 10.1590/0034-7167-2016-0246
Views0RESUMEN
Objetivo:
Determinar cuál de las escalas evaluadas (NEMS y NAS), es más adecuada para Unidades de Cuidados Intensivos aplicando metodología de calidad.
Método:
Tras identificar como oportunidad de mejora la no adecuación de la escala NEMS para determinar cargas de trabajo de enfermería en UCI, se aplica metodología de los ciclos de mejora a dicha escala y a la NAS, como propuesta de mejora, evaluando los criterios: medición de cargas de trabajo al día y por turno, inclusión de todas las actividades enfermeras, y análisis por paciente y unidad.
Resultados:
Escala NEMS no muestra diferencias significativas en el cumplimiento (67%). Comparación NEMS-NAS, todos los criterios excepto el 1º, obtienen mejora significativa. NEMS sólo valora el criterio 1 (64,22%), y NAS todos con un cumplimiento para el 1º, 2º y 4º del 64,74%, y el 3º del 100%.
Conclusión:
La escala NAS es más adecuada para medir cargas de trabajo de enfermería en UCI.
Keywords:Carga de TrabajoControl de CalidadEnfermeríaGestión de la CalidadUnidades de Cuidados IntensivosSee more
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Factors associated with inconsistent condom use among people living with HIV/Aids
Revista Brasileira de Enfermagem. 2016;69(1):47-53
Abstract
Factors associated with inconsistent condom use among people living with HIV/Aids
Revista Brasileira de Enfermagem. 2016;69(1):47-53
DOI 10.1590/0034-7167.2016690106i
Views0See moreABSTRACT
Objective:
to analyze the prevalence and factors associated with inconsistent use of condoms among people living with HIV/ Aids (PLWHA).
Method:
it is a cross-sectional study with 228, with individual interviews conducted in 2011. A multivariate analysis was performed with a logistic regression model.
Results:
143 participants met the inclusion criteria, and the prevalence of inconsistent condom use was 28.7%. However, there was greater adherence among men (79.3%). In the multivariate analysis, the independent variable daily use of alcohol (OR=11.02; 95% CI 1.84, 65.92; p = 0.021) was associated with inconsistent condom use. The chance of men making consistent condom use was higher than women (OR = 0.36, 95% CI 0.15, 0.81; p = 0.015).
Conclusion:
the prevalence of inconsistent condom male use among PLWHA was low, however, evidenced greater compliance among men over women with a statistically significant difference and the daily use of alcohol was associated with inconsistent condom use.
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Influence of sociodemographic and clinical characteristics at the impact of valvular heart disease
Revista Brasileira de Enfermagem. 2016;69(1):40-46
Abstract
Influence of sociodemographic and clinical characteristics at the impact of valvular heart disease
Revista Brasileira de Enfermagem. 2016;69(1):40-46
DOI 10.1590/0034-7167.2016690105i
Views0See moreABSTRACT
Objective:
to analyze the sociodemographic and clinical characteristics of patients with valvular heart disease and to verify the influence of these variables on the impact of valve disease in daily life.
Method:
the study involved 86 outpatients. Data collection was performed in two stages – face-to-face interview for sociodemographic and clinical characterization and through telephone contact for the application of the Instrument to Measure the Impact of Valvular Heart Disease on Patient’s Everyday Life (IDCV). Data were analyzed through descriptive statistics and multiple regression analysis.
Results:
it was noticed that the total score of IDCV and its domains were influenced by age, schooling, presence or absence of symptoms, use or not of diuretic.
Conclusion:
The impact of the disease was influenced by sociodemographic and clinical variables. The results provide subsidies for the design of nursing interventions aimed at reducing the impact of the disease on the patient’s daily life with valve disease.
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Health indicators of workers of the hospital area
Revista Brasileira de Enfermagem. 2016;69(1):30-39
Abstract
Health indicators of workers of the hospital area
Revista Brasileira de Enfermagem. 2016;69(1):30-39
DOI 10.1590/0034-7167.2016690104i
Views0ABSTRACT
Objective:
to analyze the health indicators of workers of hospital area for exposure to workloads, wear processes and its consequences.
Method:
a retrospective, descriptive and exploratory study performed in a hospital in southern Brazil. The population consisted of 1,050 workers notifications of registered in the Monitoring System of Nursing Workers Health, in 2011.
Results:
80.8% of the records were female workers, with 34.2% aged between 31 to 40 years old, corresponding to 2478 working lost days. The results subsidized the implementation of nine indicators that showed the prevalence of respiratory and osteoarticular problems.
Conclusion:
the results allow the reflection and redirection of actions for workers’ health, as the processes of becoming ill are compounded by exposure to psychic burdens. These indicators, when monitored, can contribute to the transformation of the profile of morbidity of these workers.
Keywords:Epidemiological SurveillanceHealth Basics IndicatorsHospital Human ResourcesNursingOccupational HealthSee more -
Evaluation of environmentally sustainable actions in the medication process
Revista Brasileira de Enfermagem. 2016;69(1):23-29
Abstract
Evaluation of environmentally sustainable actions in the medication process
Revista Brasileira de Enfermagem. 2016;69(1):23-29
DOI 10.1590/0034-7167.2016690103i
Views0See moreABSTRACT
Objective:
to analyze sustainable actions from an environmental point of view in the medication process, from the reception of the prescription of the pharmacy to waste discard by nursing.
Method:
study before and after performed through Lean Six Sigma methodology. The sample consisted of the amount and type of waste resulting from the pharmacy and nursing services of a medical-surgical clinical unit.
Results:
after the intervention was obtained at the pharmacy a reduction of 74.8% of chemical, infectious and sharps waste, an increase of 33.3% of common recyclable and 20% of common non-recyclable. In nursing, there was a reduction of 22.5% of chemical, infectious and sharps waste, an increase of 22.9% of common recyclable and an increase of 20% of common non-recyclable.
Conclusion:
the practice of sustainable actions in the hospital is possible, contributing to the optimization of resources and waste production with benefits to the institution, environment, and health.
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Nursing education: training evaluation by graduates, employers and teachers
Revista Brasileira de Enfermagem. 2016;69(1):16-22
Abstract
Nursing education: training evaluation by graduates, employers and teachers
Revista Brasileira de Enfermagem. 2016;69(1):16-22
DOI 10.1590/0034-7167.2016690102i
Views0ABSTRACT
Objective:
to support the assessment and the necessary changes in the curriculum of an undergraduate degree in Nursing.
Methods:
it is a descriptive study developed in two stages as an action research. In the first stage, the speeches of 19 graduates and 15 employers were interviewed and analyzed; in the second stage, five teachers participated in the focus group. For processing the data, the content analysis was adopted.
Results:
based on the assessment of the actors, an action plan was created with suggestions regarding the curriculum flexibility, content resizing, continuing education, practice enhancement, active methodologies and autonomy of the student.
Conclusion:
the participation of actors participants of the training process and performance of professional nurses in the evaluation of a curriculum pointed aspects to realignment and provided concrete benefits to improving the quality of undergraduate course curriculum, scenario of this study.
Keywords:CurriculumGraduate Programs in NursingNursing EducationNursing StudentsResearch in Nursing EducationSee more -
The challenge of the 67th Brazilian Conference of Nursing: In what direction is the Brazilian Nursing going?
Revista Brasileira de Enfermagem. 2016;69(1):7-9
Abstract
The challenge of the 67th Brazilian Conference of Nursing: In what direction is the Brazilian Nursing going?
Revista Brasileira de Enfermagem. 2016;69(1):7-9
DOI 10.1590/0034-7167.2016690101i
Views0Bringing together about 3,700 participants among conference participants, speakers, support staff, organizers and exhibitors, the 67th Brazilian Conference of Nursing extraordinary presented São Paulo with deep and meaningful reflections in an attempt to answer the question “In what direction is the Brazilian Nursing going?”.From the submission of the proposal to host the event until its […]See more -
O desafio do 67º Congresso Brasileiro de Enfermagem: para onde caminha a Enfermagem brasileira?
Revista Brasileira de Enfermagem. 2016;69(1):7-9
Abstract
O desafio do 67º Congresso Brasileiro de Enfermagem: para onde caminha a Enfermagem brasileira?
Revista Brasileira de Enfermagem. 2016;69(1):7-9
DOI 10.1590/0034-7167.2016690101i
Views0Reunindo cerca de 3.700 participantes entre congressistas, palestrantes, equipe de apoio, organizadores e expositores, o 67º Congresso Brasileiro de Enfermagem agraciou São Paulo com reflexões profundas e significativas, na tentativa de dar sua resposta à questão “Para onde caminha a enfermagem brasileira?”.Desde a apresentação da proposta de sediar o evento até sua realização, o que […]See more -
Anticipated directives and living will for terminal patients: an integrative review
Revista Brasileira de Enfermagem. 2015;68(3):524-534
Abstract
Anticipated directives and living will for terminal patients: an integrative review
Revista Brasileira de Enfermagem. 2015;68(3):524-534
DOI 10.1590/0034-7167.2015680321i
Views0See moreABSTRACT
Objective:
characterizing the national and international scientifi c literature about the advanced directives of living will as applied to the terminally ill patient.
Method:
integrative review considering the articles published in Portal Capes, SciELO, LILACS, MEDLINE, Journal of Bioethics and Bioethikos, with the descriptors: Advanced directives, Wills regarding life and Advance Directives, Living Will and Terminally Ill, totaling 44 articles submitted to content analysis.
Results:
three categories emerged: Students and professionals facing the advance directives of living will: Perceptions, opinions and practices; Patient’s receptivity to the Advance Directives of Living Will; The family facing the advance directives of living will.
Conclusion:
the relevance of the topic became evident as a guarantee of respect for the dignity and autonomy of the patient, as well as to reduce ethical confl icts faced by families and health professionals facing care at the end of life.
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