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ORIGINAL ARTICLE11-10-2023
Construction and validity of a storyboard about breast cancer for women deprived of liberty
Revista Brasileira de Enfermagem. 2023;76:e20220436
Abstract
ORIGINAL ARTICLEConstruction and validity of a storyboard about breast cancer for women deprived of liberty
Revista Brasileira de Enfermagem. 2023;76:e20220436
DOI 10.1590/0034-7167-2022-0436
Views0See moreABSTRACT
Objectives:
to build storyboards based on health literacy about breast cancer for women deprived of liberty for later production of videos and e-books.
Methods:
a methodological study, construction and validity of storyboards with 10 expert judges. The Educational Content Validation Instrument in Health and the Suitability Assessment of Materials were used. For validity, an agreement criterion greater than 80% was considered, verified from the Content Validation Index, with 40-100% for suitability.
Results:
the storyboards’ overall Content Validity Index was 0.99, combined with the measurement of suitability of 81% and readability percentage of 73.2, categorizing the material as superior and easy to read.
Conclusions:
the educational technology built proved to be valid and reliable, and can be transformed into an e-book and video to promote self-care for women deprived of liberty.
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ORIGINAL ARTICLE11-10-2023
Construction and validity of educational technology in audiovisual media on premature newborn care
Revista Brasileira de Enfermagem. 2023;76:e20220403
Abstract
ORIGINAL ARTICLEConstruction and validity of educational technology in audiovisual media on premature newborn care
Revista Brasileira de Enfermagem. 2023;76:e20220403
DOI 10.1590/0034-7167-2022-0403
Views0See moreABSTRACT
Objectives:
to construct and validate an educational video storyboard about care for premature newborns at home.
Methods:
a methodological study, with the construction of an educational video storyboard, validated with 14 judges. Content was selected from scoping review. For data collection, a validated instrument was used. The criterion for validity was agreement greater than 80%, analyzed using the Content Validity Index.
Results:
the storyboard construction was guided by the Cognitive Theory of Multimedia Learning theoretical framework. Construction and validity took place from May to December 2020. The storyboard’s final version lasted 10 minutes, and was validated in terms of objective, structure, presentation and relevance, with a Content Validity Index of 0.9.
Conclusions:
the storyboard of the educational video proved to be valid and adequate for health promotion in developing care for premature newborns at home.
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11-10-2023
ERRATA
Revista Brasileira de Enfermagem. 2023;76(5):e2023n5e04
Abstract
ERRATA
Revista Brasileira de Enfermagem. 2023;76(5):e2023n5e04
DOI 10.1590/0034-7167.20237605e04pt
Views0No artigo “Primeira graduada do Mestrado em Enfermagem em Prática Avançada em Oncologia no Chile”, com número DOI: , publicado no periódico Revista Brasileira de Enfermagem, 2023; 2023(Suppl 4):e76suppl401, no segundo parágrafo:Onde se lia:[…]See more -
ERRATUM11-10-2023
ERRATUM
Revista Brasileira de Enfermagem. 2023;76(5):e2023n5e04
Abstract
ERRATUMERRATUM
Revista Brasileira de Enfermagem. 2023;76(5):e2023n5e04
DOI 10.1590/0034-7167.20237605e04
Views0In the article “First graduate of the Master of Nursing in Advanced Practice in Oncology in Chile”, with DOI number: , published in Revista Brasileira de Enfermagem, 2023(Suppl 4):e76suppl401, in the second paragraph:Where it read:[…]See more -
11-10-2023
Time to act sustainably: Why can’t we wait any longer?
Revista Brasileira de Enfermagem. 2023;76(5):e20220813
Abstract
Time to act sustainably: Why can’t we wait any longer?
Revista Brasileira de Enfermagem. 2023;76(5):e20220813
DOI 10.1590/0034-7167-2022-0813
Views0See moreABSTRACT
Objectives:
to raise reflections on the need for health services and professionals to implement sustainable actions, aiming at their own survival and that of the planet.
Methods:
reflective essay based on international reports regarding the impact of climate change on people’s health and the role of institutions in this context.
Results:
the article focused on three fundamentals: climate change continues to be a threat to the health and well-being of all beings on Earth; the institutions that should contribute to health are great agents of contamination of the environment and emission of gases that aggravate the greenhouse effect; and there are several benefits for health institutions to act sustainably.
Final Considerations:
we cannot wait any longer; we must develop policies and management models aimed at environmentally responsible, economically viable, and socially more collaborative healthcare.
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REVIEW11-10-2023
Applying Lean Healthcare in the hospitalization and patient discharge process: an integrative review
Revista Brasileira de Enfermagem. 2023;76(5):e20220751
Abstract
REVIEWApplying Lean Healthcare in the hospitalization and patient discharge process: an integrative review
Revista Brasileira de Enfermagem. 2023;76(5):e20220751
DOI 10.1590/0034-7167-2022-0751
Views0See moreABSTRACT
Objectives:
to identify scientific evidence regarding the use of Lean Healthcare approach in the hospitalization and patient discharge process.
Methods:
this is an Integrative Review conducted in the PubMed, LILACS, SCOPUS, CINAHL, Web of Science, and Embase databases.
Results:
out of 904 records identified, three were included in this review. The studies demonstrated that when applied to discharge planning, the Lean philosophy brings favorable results, promoting improvements in the communication process, as well as assisting in workflow organization, with a reduction in length of stay and improvement in the quality of care.
Final Considerations:
although the Lean methodology presents positive results, it is considered that the application of the philosophy in healthcare institutions is still not sustainable, as it is often restricted to specific departments or services. Thus, to maximize the success of implementation, the Lean philosophy needs to be incorporated into the organizational culture, representing the greatest challenge.
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11-10-2023
A eficácia do uso de livros interativos multimodalidade em enfermagem pediátrica na implementação do programa Merdeka Belajar
Revista Brasileira de Enfermagem. 2023;76(5):e20220599
Abstract
A eficácia do uso de livros interativos multimodalidade em enfermagem pediátrica na implementação do programa Merdeka Belajar
Revista Brasileira de Enfermagem. 2023;76(5):e20220599
DOI 10.1590/0034-7167-2022-0599
Views0See moreRESUMEN
Objetivos:
analizar la efectividad del uso de libros interactivos multimodales en enfermería pediátrica sobre los resultados de aprendizaje de los estudiantes en la implementación del Programa Merdeka Belajar.
Métodos:
investigación cuasi-experimental con un diseño de grupo de control posterior a la prueba. En este estudio, la muestra incluyó 52 estudiantes de enfermería del cuarto semestre del Instituto de Ciencias de la Salud Suaka Insan Banjarmasin que recibieron el curso de Enfermería Pediátrica. Fue utilizada la técnica de muestreo total y la prueba t dependiente en el análisis de datos.
Resultados:
el libro interactivo multimodal de enfermería pediátrica fue efectivo en la mejora del logro de aprendizaje de los estudiantes de cuarto semestre con un valor de significancia de 0,015 < 0,05. Hay una diferencia en el valor promedio de los cursos de enfermería pediátrica para la clase A y la clase B, que es de 3,173.
Conclusiones:
el uso de libros multimodales interactivos es muy bueno para que los profesores los apliquen en la enseñanza para ayudar a los estudiantes a comprender el material que están aprendiendo.
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ORIGINAL ARTICLE11-10-2023
The effectiveness of using interactive multimodality books in pediatric nursing in implementing Merdeka Belajar program
Revista Brasileira de Enfermagem. 2023;76(5):e20220599
Abstract
ORIGINAL ARTICLEThe effectiveness of using interactive multimodality books in pediatric nursing in implementing Merdeka Belajar program
Revista Brasileira de Enfermagem. 2023;76(5):e20220599
DOI 10.1590/0034-7167-2022-0599
Views0See moreABSTRACT
Objectives:
to analyzing the Effectiveness of Using Interactive Multimodality Books in Pediatric Nursing on Student Learning Outcomes in Implementing the Merdeka Belajar Program.
Methods:
the research design used a quasi-experimental approach with a posttest control group design. The sample in this study was the fourth-semester nursing students of Institute of Health Science Suaka Insan Banjarmasin who received the Pediatric Nursing course, a total of 52 students. The sampling technique used is total sampling. Data analysis used the dependent t-test.
Results:
the interactive multimodality pediatric nursing book was effective in improving the learning achievement of fourth-semester students with a significance value of 0.015 < 0.05. There is a difference in the average value of pediatric nursing courses for class A and class B, which is 3.173.
Conclusions:
the use of interactive multimodality books is very good for lecturers to apply in teaching to help students understand the material they are learning.
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01-01-2016
Health needs and nursing care
Revista Brasileira de Enfermagem. 2016;69(6):1236-1239
Abstract
Health needs and nursing care
Revista Brasileira de Enfermagem. 2016;69(6):1236-1239
DOI 10.1590/0034-7167-2016-0128
Views0See moreABSTRACT
Objective:
to present the concept of needs according to different approaches to discuss the possibility of health care that incorporates a broader view of human vulnerabilities in health services.
Methods:
the arguments are founded on nursing theorists who worked on the construction of frameworks relevant to care, based on needs and on philosophers who show the possibility of identifying the vulnerabilities of human beings, defending art as a therapeutic instrument that can promote health care.
Conclusion:
although care can acquire a new dimension with the introduction of art, according to certain perspectives, philosophical studies on ethics and aesthetics should be resumed to identify human vulnerabilities that can in fact be compensated by sensible understanding of the outer world. To incorporate art in nursing care requires studies from theorists to be recovered, deepening concepts and working on empirical investigations for their adequate use.
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01-01-2016
Case studies and role play: learning strategies in nursing
Revista Brasileira de Enfermagem. 2016;69(6):1231-1235
Abstract
Case studies and role play: learning strategies in nursing
Revista Brasileira de Enfermagem. 2016;69(6):1231-1235
DOI 10.1590/0034-7167-2016-0277
Views0See moreABSTRACT
Objective:
to report professors’ experience in a public university of Southern region of Brazil using case studies and role play as learning strategies for nursing care of hospitalized adults.
Method:
learning experience report from the Nursing Care of Adults I class of nursing undergraduate course.
Results
the development of case studies and role play considered health care needs from epidemiological profile of chronic noncommunicable diseases morbidity and mortality, nursing as an assisting method, and social aspects of hospitalized individuals. Role play planning was made by creating a stage in laboratory of practices and dialogues comprising students and professors interaction.
Conclusion
case studies and role play encouraged students to active search for learning and brought theory closer to real health care situations.
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01-01-2016
Politicy of care in the criticism towards gender stereotypes
Revista Brasileira de Enfermagem. 2016;69(6):1223-1230
Abstract
Politicy of care in the criticism towards gender stereotypes
Revista Brasileira de Enfermagem. 2016;69(6):1223-1230
DOI 10.1590/0034-7167-2016-0441
Views0See moreABSTRACT
Objectives:
analyze gender inequalities among Brazilian women in Portugal and in contemporary nursing based on care politicity in the light of gender; disclose oppression of the female produced by the stereotypes that look upon women as natural caregivers; point out politicity to deconstruct gender stereotypes.
Method:
theoretical reflection with narrative review of literature to analyze classic references in the feminist epistemology combined with the care politicity thesis.
Results:
the similarities between the stereotypes of the Brazilian Eves and the Portuguese Maries as either the sexualized or sanctified nurse are inserted in the Jewish-Christian moral genealogy that reaffirms the subservience of the female to the male.
Conclusion:
by attaching priority to care that needs non-care to expand the possibilities of care giving, the theoretical assumption of politicy of care can contribute to subvert the stereotypical images of Brazilian women in Portuguese lands and in contemporary nursing.
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01-01-2016
Strategies for thirst relief: integrative literature review
Revista Brasileira de Enfermagem. 2016;69(6):1215-1222
Abstract
Strategies for thirst relief: integrative literature review
Revista Brasileira de Enfermagem. 2016;69(6):1215-1222
DOI 10.1590/0034-7167-2016-0317
Views0See moreABSTRACT
Objective:
to analyze the strategies used to relieve the thirst of hospitalized patients.
Method:
an integrative review, for which the databases PubMed, LILACS, CINAHL and the group of references organized by the Group for Study and Research of Thirst were selected for the search of primary studies, with the keywords: thirst, ice, cold, intervention, nursing care, artificial saliva.
Results:
the review sample was composed of ten primary studies. The strategies found were: low temperature using frozen gauze, ice chips, and cold water, menthol associated with cold strategies, chewing gum, acupressure, and the use of a thin straw, substitute saliva, and early fluid ingestion.
Conclusion:
the temperature was presented as a predominant and effective strategy to relieve the thirst for surgical patients in intensive care and hemodialysis treatment.
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01-01-2016
Care of the self and power relations: female nurses taking care of other women
Revista Brasileira de Enfermagem. 2016;69(6):1204-1214
Abstract
Care of the self and power relations: female nurses taking care of other women
Revista Brasileira de Enfermagem. 2016;69(6):1204-1214
DOI 10.1590/0034-7167-2016-0021
Views0See moreABSTRACT
Objective:
to analyze the care of self of female nurses and the power relations established by them in the care of other women.
Method:
integrative review of literature published between 2005 and 2015. There were 25 publications in the sample.
Results:
qualitative state of the art with reference domain of a liberating perspective, based on humanization, autonomy and empowerment as a risk reduction strategy in the practice of care to women. The findings suggest solidified power relations among female nurses and women, focused on professional domain concentrated on nurse education under the patriarchal and society’s normalization discourse. Some studies consider the importance of understanding power in a capillary way, operating on the bodies of individuals.
Conclusion:
there is little discussion about the care of self of nurses and the effects on their professional practice, indicating gaps in knowledge in this field.
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01-01-2016
Nursing competencies in promoting the health of individuals with chronic diseases
Revista Brasileira de Enfermagem. 2016;69(6):1195-1203
Abstract
Nursing competencies in promoting the health of individuals with chronic diseases
Revista Brasileira de Enfermagem. 2016;69(6):1195-1203
DOI 10.1590/0034-7167-2016-0312
Views0See moreABSTRACT
Objective:
to identify nurse’s competencies related to health promotion of individuals with chronic cardiac disease, in the light of the Galway consensus.
Method:
integrative literature review was conducted to search for studies published between 2010 and 2014 in the databases LILACS, BDENF, IBECS; and PubMed in February 2015. The 21 included studies were analyzed according to the eight domains of competence: Catalyzing change, Leadership, Evaluation, Planning, Implementation, Assessment, Advocacy and Partnerships.
Results:
all domains of competence were included in the nursing interventions in health promotion of chronic cardiac patients, and the Planning and Evaluation were the most evident competences.
Conclusion:
the results of this research highlighted the nurse as an agent capable of operating care management, in order to improve coordination of the latter with work and education and, thus, the health care of the population.
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01-01-2016
Assisted therapy with dogs in pediatric oncology: relatives’ and nurses’ perceptions
Revista Brasileira de Enfermagem. 2016;69(6):1188-1194
Abstract
Assisted therapy with dogs in pediatric oncology: relatives’ and nurses’ perceptions
Revista Brasileira de Enfermagem. 2016;69(6):1188-1194
DOI 10.1590/0034-7167-2016-0243
Views0See moreABSTRACT
Objective:
to understand the perception of nursing staff professionals and legal guardians of children and adolescents with cancer regarding Assisted Therapy with dogs.
Method:
qualitative study based on participant observation conducted with 16 participants in a reference hospital of child cancer. We applied an in-depth interview and interpreted the data according to a content analysis technique.
Results:
the practice is admittedly beneficial to participants despite the fact they do not understand its true objectives and therapeutic applications. Participants only associate it with something distracting and entertaining without realizing the occurrence of a more complex process behind it, which comprises changes besides the emotional ones (more easily perceived).
Conclusion:
the perceptions of participants reinforce recommendations that can be applied in the hospital environment, also showing that the therapy in question can become an effective technology to promote the health of children and adolescents with cancer.
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01-01-2016
Socio-environmental approach in nursing: focusing on rural labor and the use of pesticides
Revista Brasileira de Enfermagem. 2016;69(6):1179-1187
Abstract
Socio-environmental approach in nursing: focusing on rural labor and the use of pesticides
Revista Brasileira de Enfermagem. 2016;69(6):1179-1187
DOI 10.1590/0034-7167-2016-0364
Views0See moreABSTRACT
Objective:
to apply a socio-environmental approach to the relationship between human health and rural labor through a link verification/association between health disorders and the use of pesticides.
Method:
this is a quantitative, cross-sectional, observational and exploratory study with 331 inhabitants of two cities in the state of Rio Grande do Sul, Brazil. Data analysis was conducted by Poisson regression.
Results:
reported health disorders included: mental (62.2%); circulatory (49.8%); dermatologic (45%); respiratory (41%); and gastric (36.2%). Workers who apply pesticides showed a 90% higher prevalence of dermatological alterations when compared to those who did not.
Conclusion:
the socio-environmental approach, comprising elements of the rural environment, of workers, and of the use of pesticides in the work process in connection/association with potential health disorders has shown that rural workers who apply pesticides present a higher prevalence of dermatological alterations.
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01-01-2015
Critical incidents in nursing academics: discovering a new identity
Revista Brasileira de Enfermagem. 2015;68(2):219-227
Abstract
Critical incidents in nursing academics: discovering a new identity
Revista Brasileira de Enfermagem. 2015;68(2):219-227
DOI 10.1590/0034-7167.2015680206i
Views0See moreABSTRACT
Objective:
a qualitative study that followed the principles of the grounded theory in order to analyze the professional identity of nursing academics through the analysis of the most disturbing critical incidents.
Method:
semi-structured interviews were conducted with seven nurses who worked as professors and researchers in a private university in Barcelona.
Results:
the resulting empirical material was organized into two categories: characterization of critical incidents and responsiveness to the incident.
Conclusion:
the professional identity of nurses regarding the academic area is still under construction and inexperience is the major obstacle in the management of critical incidents in the teaching career.
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01-01-2015
Body mass index, waist circumference, and arterial hypertension in students
Revista Brasileira de Enfermagem. 2015;68(2):214-218
Abstract
Body mass index, waist circumference, and arterial hypertension in students
Revista Brasileira de Enfermagem. 2015;68(2):214-218
DOI 10.1590/0034-7167.2015680205i
Views0See moreABSTRACT
Objective:
to investigate what is the best anthropometric predictor of arterial hypertension among private school students.
Method:
this was a cross-sectional study with 286 students between the ages of 10 and 14 from two private schools in the city of Paranavaí, Paraná, Brazil. The following variables were analyzed: body mass index, waist circumference and blood pressure. Statistical analysis was conducted with Pearson’s partial correlation test and multivariate logistic regression, with p<0.05.
Results:
both anthropometric indicators displayed weak correlation with systolic and diastolic levels, with coeffi cients (r) ranging from 0.27 to 0.36 (p < 0.001). Multivariate analysis showed that the only anthropometric indicator associated with arterial hypertension was waist circumference (OR= 2.3; 95% CI: 1.1-4.5), regardless of age or gender.
Conclusion:
this age group, waist circumference appeared to be a better predictor for arterial hypertension than body mass index.
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01-01-2015
Perception of primary healthcare management nurses on the nursing process
Revista Brasileira de Enfermagem. 2015;68(2):206-213
Abstract
Perception of primary healthcare management nurses on the nursing process
Revista Brasileira de Enfermagem. 2015;68(2):206-213
DOI 10.1590/0034-7167.2015680204i
Views0See moreABSTRACT
Objective:
this qualitative study aimed to analyze the perceptions of primary health care management nurses on the nursing process.
Method:
data were collected through interviews and analyzed by the Content Analysis proposed by Bardin’s theoretical framework.
Results:
managers recognize the importance of the nursing process, although its implementation was not a priority at the time of the interviews. A conceptual diffi culty and a lack of understanding that the implementation of the care methodology should be a cross-departmental action in the local healthcare management were clearly observed.
Conclusion:
managers should have their perspectives broadened concerning the relevance of the nursing process and the professional training. The active participation of legislative nursing bodies, local healthcare management and the federal government may open the way for the effective implementation of the nursing process.
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01-01-2015
Cross-cultural cultural adaptation of the “Nursing Students’ Attitudes Toward Mental Health Nursing and Consumers” in Brazil
Revista Brasileira de Enfermagem. 2015;68(2):198-205
Abstract
Cross-cultural cultural adaptation of the “Nursing Students’ Attitudes Toward Mental Health Nursing and Consumers” in Brazil
Revista Brasileira de Enfermagem. 2015;68(2):198-205
DOI 10.1590/0034-7167.2015680203i
Views0See moreABSTRACT
Objective:
to make across-cultural adaptation of the “Nursing Students’ Attitudes Toward Mental Health Nursing and Consumers” scale in Brazil.
Method:
the scale was tested regarding conceptual, item, semantic, and operational equivalence.
Results:
content validation was conducted by an expert committee with a minimum consensus level of 80%. This process resulted in a 35-item scale divided into 6 factors. The experts reached 100% consensus on the scale’s clarity of language, practical pertinence and theoretical relevance, as well as on the need for excluding one factor. Data were collected in 2013 in the city of Londrina, Paraná, Brazil.
Conclusion:
the instrument was cross-culturally adapted to Brazilian Portuguese and presented satisfactory content validity. We propose further studies on the scale’s psychometric properties, such as construct validity, internal consistency and reliability.
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01-01-2015
Relational skills and preserving patient privacy in the caring process
Revista Brasileira de Enfermagem. 2015;68(2):191-197
Abstract
Relational skills and preserving patient privacy in the caring process
Revista Brasileira de Enfermagem. 2015;68(2):191-197
DOI 10.1590/0034-7167.2015680202i
Views0See moreABSTRACT
Objective:
to analyze the development and mobilization of relational skills central to the caring process among nursing students throughout their professional training.
Method:
this was a quantitative study, descriptive and cross-sectional in design. The sample consisted of nursing undergraduate students from the Higher School of Health Sciences, in the city of Évora, Portugal. Data were collected using the previously validated Helping Relational Skills Inventory.
Results:
the students gradually acquired “generic skills”, “communication skills” and “contact skills”, presenting the highest mean score in the last year of the program. However, the highest mean score for the “empathetic skills” subscale was presented by second-year students.
Conclusion:
age and year in program were found to be decisive variables regarding the acquisition of specifi c skills (empathetic and communication) by nursing students.
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01-01-2015
The Brazilian Association of Nursing in the uncompromising defense of the Brazilian Unified Health System
Revista Brasileira de Enfermagem. 2015;68(2):185-186
Abstract
The Brazilian Association of Nursing in the uncompromising defense of the Brazilian Unified Health System
Revista Brasileira de Enfermagem. 2015;68(2):185-186
DOI 10.1590/0034-7167.2015680201i
Views0The title of the 2015 Editor’s Comments could very well be from a journal published in decades past, a time when, in Brazil, all professional entities and civil society fought for the right to health, as was later established in the Brazilian Constitution of 1988. Twenty-five years later, despite its financial limitations and restricted operational […]See more -
01-01-2015
A ABEn na defesa intransigente do SUS
Revista Brasileira de Enfermagem. 2015;68(2):185-186
Abstract
A ABEn na defesa intransigente do SUS
Revista Brasileira de Enfermagem. 2015;68(2):185-186
DOI 10.1590/0034-7167.2015680201i
Views0Este título do Editorial de 2015 bem poderia ser de uma revista publicada em décadas passadas, período em que todas as entidades profissionais e a sociedade civil lutaram pela saúde como direito, como conquistado na Constituição de 1988. Vinte e cinco anos depois, com o Sistema Único de Saúde capilarizado por todo o país, mesmo […]See more -
EXPERIENCE REPORT01-01-2015
Nursing diagnoses and interventions for a child after cardiac surgery in an intensive care unit
Revista Brasileira de Enfermagem. 2015;68(1):155-160
Abstract
EXPERIENCE REPORTNursing diagnoses and interventions for a child after cardiac surgery in an intensive care unit
Revista Brasileira de Enfermagem. 2015;68(1):155-160
DOI 10.1590/0034-7167.2015680121i
Views0See moreObjetivo:
descrever o julgamento clínico de enfermagem para identificar diagnósticos NANDA e desenvolver um plano de tratamento NIC para uma criança em pós-operatório de cirurgia cardíaca em terapia intensiva.
Método:
estudo de caso com coleta de dados retrospectiva no prontuário.
Resultados:
três enfermeiras identificaram diagnósticos NANDA e intervenções NIC. Criança de 6 meses, submetida a cirurgia cardíaca, necessitou oxigenação extracorpórea por membrana no pós-operatório. Foram identificados quatro principais diagnósticos, aos quais foram direcionadas dez intervenções. A proposta de intervenções para responder às necessidades humanas prioritárias da criança foi otimizada pelo uso das terminologias padronizadas. Todos os diagnósticos foram sustentados por indicadores diagnósticos; todas as intervenções foram cientificamente sustentadas.
Conclusão:
espera-se que os enfermeiros abordem não somente as respostas fisiológicas, mas também aquelas dos domínios psicossociais.
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