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EDITORIAL08-19-2024
Sexual abuse, abortion and public health in Brazil: when moral judgment accentuates inequities
Revista Brasileira de Enfermagem. 2024;77:e77suppl0401
Abstract
EDITORIALSexual abuse, abortion and public health in Brazil: when moral judgment accentuates inequities
Revista Brasileira de Enfermagem. 2024;77:e77suppl0401
DOI 10.1590/0034-7167.202477suppl0401
Views0Here is an academic-political editorial that aims to call on the scientific field to reflect on the dangers of decisions regarding the right to abortion under moral rules, since there is no evidence that such a perspective translates into practices of care, protection of childhood and gender equity – elements that are so urgent and […]See more -
ORIGINAL ARTICLE08-19-2024
The use of individual tracking programs in public health: a bioethics dilemma
Revista Brasileira de Enfermagem. 2024;77:e20230041
Abstract
ORIGINAL ARTICLEThe use of individual tracking programs in public health: a bioethics dilemma
Revista Brasileira de Enfermagem. 2024;77:e20230041
DOI 10.1590/0034-7167-2023-0041
Views0See moreABSTRACT
Objective:
to understand the bioethical perspectives on mobile tracking device use.
Methods:
theoretical study based on action research, carried out with eight graduate students from a public university. A focus group was used, with a thematic content analysis methodology with a codebook structure, approved by the Research Ethics Committee.
Results:
from the analysis, there was a concern about using devices after the pandemic ended. Using or not the device, rights inherent to humans, legislation and effectiveness of methods deepen interpretations, moving participants from a personalistic conception of the topic to a vision focused on professional implications about the methods.
Final considerations:
the debate on the impact of using technological devices on health, especially those that imply restriction of rights that refer to individuals’ private life, involves a discussion of a professional nature, in addition to requirement for clear rules on the topic.
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ORIGINAL ARTICLE08-19-2024
Bioethical issues in the family health strategy: Considerations for nursing care management
Revista Brasileira de Enfermagem. 2024;77:e20220818
Abstract
ORIGINAL ARTICLEBioethical issues in the family health strategy: Considerations for nursing care management
Revista Brasileira de Enfermagem. 2024;77:e20220818
DOI 10.1590/0034-7167-2022-0818
Views0See moreABSTRACT
Objective:
To understand the bioethical issues involved in the care management of nurses working in the Family Health Strategy.
Method:
A qualitative study was conducted through five focus groups with 36 nurses selected in the sample. Thematic content analysis was performed based on the bioethical framework, and the synthesis was presented in a conceptual map.
Results:
Bioethical issues were identified in the nursing care practice, related to both specific bioethical themes and the peculiarities of the work. Additionally, challenges and facilitators that interfere with addressing these issues were identified.
Final considerations:
Understanding the bioethical issues involved in the care management of nurses was possible with the theoretical support of different bioethical perspectives. The identified issues relate to persistent and current themes in the field of bioethics. However, some aspects intrinsic to daily practice are still imperceptible to professionals, contributing to the difficulty of discussing bioethics in this care model.
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REVIEW07-29-2024
Telenursing in the postoperative period: a scoping review
Revista Brasileira de Enfermagem. 2024;77(3):e20240066
Abstract
REVIEWTelenursing in the postoperative period: a scoping review
Revista Brasileira de Enfermagem. 2024;77(3):e20240066
DOI 10.1590/0034-7167-2024-0066
Views0See moreABSTRACT
Objectives:
to map available evidence on telenursing use in the postoperative period and its impact on patient outcomes.
Methods:
a scoping review, conducted according to the JBI model and the PRISMA-ScR checklist. The search was carried out in the CINAHL, Embase, LILACS, PubMed, Web of Science, SciELO, Scopus and Cochrane Library databases.
Results:
twelve studies were included, published between 2011 and 2023, 66.6% of which were in developed countries. Of the positive outcomes, we highlight improved levels of disability, autonomy and quality of life, lower rates of post-operative complications, pain and reduced costs. Telephone monitoring was the most widely used modality, but there were few studies in the pediatric context and in Brazil.
Conclusions:
of the studies, 11 (91.6%) identified at least one positive outcome in telenursing use and none showed negative aspects in the postoperative period. The role of nurses in digital health needs further study.
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ORIGINAL ARTICLE07-29-2024
Men’s perception of paternal parenthood and the promotion of child development
Revista Brasileira de Enfermagem. 2024;77(3):e20230514
Abstract
ORIGINAL ARTICLEMen’s perception of paternal parenthood and the promotion of child development
Revista Brasileira de Enfermagem. 2024;77(3):e20230514
DOI 10.1590/0034-7167-2023-0514
Views0See moreABSTRACT
Objectives:
to comprehend men’s perception of paternal parenthood while caring for infants to promote child development.
Methods:
this qualitative study adopts an exploratory approach and was conducted with undergraduate and graduate students, faculty, and staff who are fathers of infants up to 6 months old from a higher education institution, excluding fathers from mononuclear families. Data collection occurred through semi-structured interviews and was analyzed using thematic categorical analysis.
Results:
fifteen men participated in the study. From the analysis, two empirical categories emerged: “Perception of being a father: challenges and novelties” and “Promotion of child development: actions carried out by fathers”. Fathers revealed feeling unprepared, the need for emotional support, and recognized activities aimed at their children’s development.
Final Considerations:
the relevance of the paternal figure for child development is highlighted, as well as the need for public policies to encourage paternal parenthood.
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ORIGINAL ARTICLE07-29-2024
Contribution of informal caregivers to self-care in individuals with heart failure
Revista Brasileira de Enfermagem. 2024;77(3):e20230492
Abstract
ORIGINAL ARTICLEContribution of informal caregivers to self-care in individuals with heart failure
Revista Brasileira de Enfermagem. 2024;77(3):e20230492
DOI 10.1590/0034-7167-2023-0492
Views0See moreABSTRACT
Objectives:
to evaluate the contribution of informal caregivers to the self-care of individuals with heart failure.
Methods:
a cross-sectional study was conducted with 87 caregivers from March to October 2022 in the city of João Pessoa/PB. The caregivers’ contribution was assessed using the Caregiver Contribution to Self-Care of Heart Failure Index instrument. Scores ≥ 70 points indicate adequate contribution. Data were analyzed using descriptive statistics and Spearman’s correlation.
Results:
the sample consisted of 81.6% female caregivers. Median scores obtained for the self-care contribution scales were: 63.3 for maintenance; 55.5 for management; and 66.6 for confidence. Caregivers never or rarely recommended monitoring body weight, regular physical exercise, extra use of diuretics, and fluid restriction.
Conclusions:
informal caregivers showed inadequate contribution in the areas of maintenance, management, and confidence in self-care of individuals with heart failure.
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Reflections on theoretical framework use in nursing research
Revista Brasileira de Enfermagem. 2024;77(3):e20230486
Abstract
Reflections on theoretical framework use in nursing research
Revista Brasileira de Enfermagem. 2024;77(3):e20230486
DOI 10.1590/0034-7167-2024-0486
Views0See moreABSTRACT
Objectives:
to reflect on theoretical framework use in nursing research.
Methods:
a theoretical-reflexive study, based on concepts and constructs pertinent to using nursing theories and other sciences, considering issues of epistemology or philosophy of science.
Results:
we presented what it is and why to do nursing research and what a theoretical framework is and why to use it, in addition to some considerations regarding theoretical framework use in nursing research, essential for constructing disciplinary knowledge, which enables the materialization of researchers’ work and the presentation of propositions resulting from investigations in and for nursing as a discipline and science.
Final Considerations:
based on a reflection based on epistemological conceptions, it is possible to affirm that a theoretical framework is the core of researchers’ thinking, delimiting a problem to be investigated and, based on it, outlining methodological strategies to be followed, supporting nursing action and thinking as discipline and science.
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REVIEW07-29-2024
Nursing diagnoses for people hospitalized with heart failure: an integrative review
Revista Brasileira de Enfermagem. 2024;77(3):e20230471
Abstract
REVIEWNursing diagnoses for people hospitalized with heart failure: an integrative review
Revista Brasileira de Enfermagem. 2024;77(3):e20230471
DOI 10.1590/0034-7167-2023-0471
Views0See moreABSTRACT
Objectives:
to identify in the literature the main nursing diagnoses according to the NANDA-I diagnostic classification for people hospitalized with heart failure.
Methods:
an integrative literature review, carried out in February 2019 and updated in July 2023, in the MEDLINE via PubMed, LILACS, SciELO and CINAHL databases. Given the use of acronym PEO, studies without a time cut in Portuguese, English and Spanish were included. Descriptive analysis was carried out to present the identified information.
Results:
analysis of 27 articles identified 24 nursing diagnoses, with emphasis on Decreased Cardiac Output, Excessive Fluid Volume, Decreased Activity Tolerance and Fatigue.
Final Considerations:
evidence can contribute to better diagnostic decisions centered on people with heart failure in search of more assertive health results and have the potential to support future studies on a possible syndromic pattern in this population.
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RESEARCH01-01-2016
Determining impacts and factors in ventilator-associated pneumonia bundle
Revista Brasileira de Enfermagem. 2016;69(6):1108-1114
Abstract
RESEARCHDetermining impacts and factors in ventilator-associated pneumonia bundle
Revista Brasileira de Enfermagem. 2016;69(6):1108-1114
DOI 10.1590/0034-7167-2016-0253
Views0See moreABSTRACT
Objective:
Assessing the determining impacts and factors in ventilator-associated pneumonia (VAP) bundle.
Method:
descriptive retrospective longitudinal study, with quantitative approach, held at a public teaching hospital. Collection held between May 2014 and April 2015. Patients of the ICU with VAP participated in the research. For organizing data, the Microsoft Excel 2010 program was used. A critical analysis between the data collected and infection rates was performed. The survey was approved under no. 566,136.
Results:
an increase in the incidence of VAP after implementing the bundle was observed; the prevalent pathogens were gram-negative bacteria. Deaths were equal to or greater than 50%. Changes of professionals and lack of supplies were determining factors.
Conclusion:
in this context, the need for permanent qualification of the team is emphasized, with the purpose of promoting the adherence to the protocol and preventing VAP.
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RESEARCH01-01-2016
Multidisciplinary team of intensive therapy: humanization and fragmentation of the work process
Revista Brasileira de Enfermagem. 2016;69(6):1099-1107
Abstract
RESEARCHMultidisciplinary team of intensive therapy: humanization and fragmentation of the work process
Revista Brasileira de Enfermagem. 2016;69(6):1099-1107
DOI 10.1590/0034-7167-2016-0221
Views0See moreABSTRACT
Objective:
to understand the meaning of humanized care in intensive care units considering the experience of the multidisciplinary team.
Method:
descriptive and exploratory qualitative research. For this purpose, we conducted semi-structured interviews with 24 professionals of the heath-care team, and, after transcription, we organized the qualitative data according to content analysis.
Results:
from two main categories, we were able to understand that humanized care is characterized in the actions of health-care: effective communication, team work, empathy, singularity, and integrality; and mischaracterized in the management processes, specifically in the fragmentation of the work process and health-care, in the precarious work conditions, and in differing conceptual aspects of the political proposal of humanization.
Conclusion:
care activities in intensive therapy are guided by the humanization of care and corroborate the hospital management as a challenge to be overcome to boost advances in the operationalization of this Brazilian policy.
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RESEARCH01-01-2016
Humanized Care: insertion of obstetric nurses in a teaching hospital
Revista Brasileira de Enfermagem. 2016;69(6):1091-1098
Abstract
RESEARCHHumanized Care: insertion of obstetric nurses in a teaching hospital
Revista Brasileira de Enfermagem. 2016;69(6):1091-1098
DOI 10.1590/0034-7167-2016-0295
Views0ABSTRACT
Objective:
to evaluate the care provided at an Antepartum, Intrapartum, Postpartum (AIP) unit at a teaching hospital following the inclusion of obstetric nurses.
Method:
transversal study, performed at a AIP unit at a teaching hospital in the capital of the Brazilian state of Mato Grosso. The sample comprised data regarding the 701 childbirths that took place between 2014 and 2016. The data were organized using Excel and analyzed using version 7 of Epi Info software.
Results:
the results suggest that including obstetric nurses contributed towards qualifying the care provided during labor and childbirth, followed by a reduction in the number of interventions, such as episiotomy caesareans sections, and resulting in encouragement to employ practices that do not interfere in the physiology of the parturition process, which in turn generate good perinatal results.
Conclusion:
inserting these nurses collaborated towards humanizing obstetric and neonatal care.
Keywords:Hospitals, TeachingHumanization of CareHumanized ChildbirthNatural ChildbirthObstetric NursesSee more -
RESEARCH01-01-2016
Normative grounds of health care practice in Brazilian nursing
Revista Brasileira de Enfermagem. 2016;69(6):1082-1090
Abstract
RESEARCHNormative grounds of health care practice in Brazilian nursing
Revista Brasileira de Enfermagem. 2016;69(6):1082-1090
DOI 10.1590/0034-7167-2016-0228
Views0See moreABSTRACT
Objective:
to understand the normative grounds of health care practice in Brazilian nursing.
Method:
qualitative study with the use of document research, carried out based on resolutions of the Federal Nursing Council. From a total of 263 resolutions, in the period from 1975 to 2015, 38 which were in accordance with the objective of the study were selected.
Results:
three analytical categories were systematized: Normative grounds of health care practice by the nursing team, under coordination/supervision of the nurse; Normative grounds of the care performed privately by the nurse; and Management and administrative aspects which affect and permeate the practice of health care in nursing.
Conclusion:
the set of normative grounds of health care practice by the nursing team leads to the reflection on the possible overlapping of attributions between professional levels and requires expansion to the other fields of nursing which are coherent with the health care network model.
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RESEARCH01-01-2016
Multi-professional intervention in adults with arterial hypertension: a randomized clinical trial
Revista Brasileira de Enfermagem. 2016;69(6):1067-1073
Abstract
RESEARCHMulti-professional intervention in adults with arterial hypertension: a randomized clinical trial
Revista Brasileira de Enfermagem. 2016;69(6):1067-1073
DOI 10.1590/0034-7167-2016-0320
Views0See moreABSTRACT
Objective:
assess the influence of an intervention, comprised of counseling related to health and aerobic physical training for lowering pressure values, in anthropometric indicators and in the adjustment of biochemical parameters in individuals with hypertension.
Method:
intervention study of the randomized clinical trial variety, with 42 individuals. The intervention-group followed the protocol of health counseling, nutrition and physical activity.
Results:
two intervention groups were considered: intervention-group (a) and intervention-group (b). Intervention-group (a) showed significant decrease in measurements of systolic and diastolic arterial pressure, of high-density lipoprotein parameters, hip circumference values and waist-hip ratio. Intervention-group (b) presented significant decrease in systolic arterial pressure values.
Conclusion:
it was found that the health intervention in conjunction with physical activities were effective in decreasing and/or controlling values for pressure, biochemical and anthropometric indicators.
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RESEARCH01-01-2016
Clinical Caritas Processes in workshops for caregivers of institutionalized elderly people
Revista Brasileira de Enfermagem. 2016;69(6):1059-1066
Abstract
RESEARCHClinical Caritas Processes in workshops for caregivers of institutionalized elderly people
Revista Brasileira de Enfermagem. 2016;69(6):1059-1066
DOI 10.1590/0034-7167-2016-0359
Views0See moreABSTRACT
Objective:
to describe the use of the Clinical Caritas Processes in workshops for caregivers of institutionalized elderly people, aimed at analyzing these professionals’ perception on humane care towards the institutionalized elderly.
Method:
a convergent care research was conducted with 18 caregivers of a long-term care institution for elderly people in the state of Paraíba, Brazil. Data were collected from June to November 2013, consisting of two months of interaction with the care service and ten meetings conducted in workshops for caregivers. Data were based on the theoretical framework of the Clinical Caritas Processes. Data analysis was based on content analysis and produced ten thematic categories based on the Caritas factors of caring.
Conclusion:
it was found that the use of the ten Caritas factors of caring were useful for humanistic formations when introducing the group to the conceptions of caring that value the self of the people providing the care and of the ones-being cared for.
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RESEARCH01-01-2016
Technological innovation for peripheral venipuncture: ultrasound training
Revista Brasileira de Enfermagem. 2016;69(6):1052-1058
Abstract
RESEARCHTechnological innovation for peripheral venipuncture: ultrasound training
Revista Brasileira de Enfermagem. 2016;69(6):1052-1058
DOI 10.1590/0034-7167-2016-0125
Views0See moreABSTRACT
Objective:
to evaluate the training of nurses in the use of ultrasound in peripheral venipuncture.
Method:
descriptive research of quantitative approach performed with nurses as part of an analytical cross-sectional study in two patient care centers: an intensive care unit and an adult emergency center.
Results:
the results showed contributions of training for professional skill and visibility of nurses, requiring, however, more time for complete assimilation of this technological innovation as a safer clinical practice.
Conclusion:
as the use of this technology represents an innovation aimed to facilitate difficult venipuncture and to provide subsidies to the most appropriate clinical decision-making, it is urgent to qualify nurses for its use.
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ERRATUM01-01-2016
ERRATUM
Revista Brasileira de Enfermagem. 2016;69(1):206-206
Abstract
ERRATUMERRATUM
Revista Brasileira de Enfermagem. 2016;69(1):206-206
DOI 10.1590/0034-7167.20166901e02
Views0In the article “Conceptions of mid-level nursing professionals facing those with a chemical dependency”, with the number of DOI: 10.1590/0034-7167.2015680610i, published in the journal Revista Brasileira de Enfermagem, v68(6):755-60, page 760 that read:“8. Vargas D, Soares J. Knowledge and attitudes of nurses towards alcohol and related problems: the impact of an educational intervention. Rev Esc […]See more -
ERRATUM01-01-2016
ERRATUM
Revista Brasileira de Enfermagem. 2016;69(1):205-205
Abstract
ERRATUMERRATUM
Revista Brasileira de Enfermagem. 2016;69(1):205-205
DOI 10.1590/0034-7167.20166901e01
Views0In the article “Using the theory of meaningful learning in nursing education”, with the number of DOI: 10.1590/0034-7167.2015680420i, published in the journal Revista Brasileira de Enfermagem, v68(4):626-35, page 627 that read:“Ausubel was descended from Jewish, born in New York in 1918 and died in 1994 at the age of 75. He thought and wrote until […]See more -
EXPERIENCE REPORT01-01-2016
Nursing process documentation: rationale and methods of analytical study
Revista Brasileira de Enfermagem. 2016;69(1):197-204
Abstract
EXPERIENCE REPORTNursing process documentation: rationale and methods of analytical study
Revista Brasileira de Enfermagem. 2016;69(1):197-204
DOI 10.1590/0034-7167.2016690126i
Views0See moreABSTRACT
Objective:
to describe the methods used to analyze the associations between variables of service, nursing and the nursing process documentation in institutions of the Department of Health of the State of São Paulo.
Method:
multilevel analytical study with data obtained in the domains of institution, units of the institution and nursing professionals who work there, using standardized instruments. The analyses had as axis the degree of completeness of the nursing process documentation in units or institutions and their association with variables of nursing personnel, of units and of institutions.
Conclusion:
This study will provide important empirical evidence on the factors involved in the nursing process documentation.
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EXPERIENCE REPORT01-01-2016
Qualitative methodologies in health research: interpretive referential of Patricia Benner
Revista Brasileira de Enfermagem. 2016;69(1):192-196
Abstract
EXPERIENCE REPORTQualitative methodologies in health research: interpretive referential of Patricia Benner
Revista Brasileira de Enfermagem. 2016;69(1):192-196
DOI 10.1590/0034-7167.2016690125i
Views0See moreABSTRACT
Objective:
this article reports on the experience of using the interpretive phenomenological framework of Patricia Benner in a Brazilian context. Benner’s interpretive phenomenology, based on existential and interpretative philosophy, aims to understand human experiences in the particular worlds of research participants. Data were collected through interviews with nine nurses in November and December 2014.
Results:
data analysis process according to Benner’s framework consisted of: transcription, coding, thematic analysis, and search for paradigmatic cases and examples. Therefore, the prior knowledge of the researcher is an important part of the study, consisting in manners of the research conduction.
Conclusion:
The use of this methodological framework entailed a great challenge for the researcher, however, it also enabled a unique opportunity to illuminate important existential phenomena related to the daily lives of research participants.
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REVIEW01-01-2016
Nurses’ performance on primary care in the National Health Service in England
Revista Brasileira de Enfermagem. 2016;69(1):182-191
Abstract
REVIEWNurses’ performance on primary care in the National Health Service in England
Revista Brasileira de Enfermagem. 2016;69(1):182-191
DOI 10.1590/0034-7167.2016690124i
Views0See moreABSTRACT
Objective:
To analyze the expansion of nursing roles in primary care in the English National Health Service and the implications for professional practice.
Method:
qualitative research in case study format, held in London, England, in six primary care units. Data were obtained through interviews with nine nurses. After the thematic data analysis, two units emerged: the nurses’ performance characteristics and effects of the expansion of nursing roles.
Results:
expansion of nurses’ roles: consultation, diagnosis and drug therapy, case management and monitoring of chronic conditions. Repercussions: for the user, there was improved access, communication and comprehensive care, increased duration of consultations, resulting in greater adherence; for nurses, there was the expansion of professional skills, knowledge and professional recognition; to the health care system, it resulted in cost savings.
Conclusion:
benefits in expanding nursing roles, were visible, contributing to primary care quality.
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REVIEW01-01-2016
Meleis’ Nursing Theories Evaluation: integrative review
Revista Brasileira de Enfermagem. 2016;69(1):174-181
Abstract
REVIEWMeleis’ Nursing Theories Evaluation: integrative review
Revista Brasileira de Enfermagem. 2016;69(1):174-181
DOI 10.1590/0034-7167.2016690123i
Views0See moreABSTRACT
Objective:
to analyze the application of the theory evaluation model proposed by Meleis in Brazilian studies.
Method:
integrative review of online articles published from 2002 to 2012 in the databases LILACS and BDENF.
Results:
the 16 selected studies confirmed the use of only three of the five stages proposed for Meleis’ theories analysis: Description of the Theory, Criticism of the Theory and Analysis of the Theory, with a predominance of a single unit of analysis in each.
Conclusion:
the analysis of nursing theories provides support to nurses in the practice, research, education and administration of the different dimensions of care. Meleis’ model figures as very important by contributing to the development of knowledge of nursing discipline, considering that its use as a method allows several reflections on theories in order that they be revalidated to support a more theoretical and practical applicability.
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REVIEW01-01-2016
Clinical indicators of sexual dysfunction in pregnant women: integrative literature review
Revista Brasileira de Enfermagem. 2016;69(1):165-173
Abstract
REVIEWClinical indicators of sexual dysfunction in pregnant women: integrative literature review
Revista Brasileira de Enfermagem. 2016;69(1):165-173
DOI 10.1590/0034-7167.2016690122i
Views0ABSTRACT
Objective:
to identify the nursing diagnosis clinical indicators of sexual dysfunction in pregnant women.
Method:
it is an integrative literature review, with research in databases using the keywords “sexual*”, “pregnan*” and “function*”. Studies included had an abstract available for analysis, referring to pregnant women over 18 years old, written in Portuguese, French, Spanish and English, with publication date between 2010 and 2014. Studies that reporting pregnant women with an associated pathology were excluded.
Results:
sexual dysfunction in pregnant women is consistent in the literature. Nine defining characteristics were identified and 16 related factors, some not classified in NANDA International.
Conclusion:
clinical indicators can be added to the nursing diagnosis to favor an accurate diagnosis and effective interventions in the surveillance of pregnancy as a period of healthy sexual experience.
Keywords:Physiological Sexual Dysfunction, Psychogenic Sexual DysfunctionPregnant WomenReviewSexual BehaviorSee more -
RESEARCH01-01-2016
Conditions of functional health literacy of an elderly diabetics group
Revista Brasileira de Enfermagem. 2016;69(1):156-164
Abstract
RESEARCHConditions of functional health literacy of an elderly diabetics group
Revista Brasileira de Enfermagem. 2016;69(1):156-164
DOI 10.1590/0034-7167.2016690121i
Views0See moreABSTRACT
Objective:
to evaluate the conditions of functional health literacy of an elderly diabetics group.
Method:
cross-sectional and descriptive study, with diabetic’s elderly assisted in the SUS (N = 114). The social and health conditions were evaluated as well as functional health literacy by S-TOFHLA test (short version); the simple proportions, average, standard deviation and Pearson’s Chi-square were described by SPSS software (20.0) with α = 5% value.
Results:
the mean age was 67.4 years, 74.0% of the elderly were women, had up to four years of schooling; 29.8% had a long-standing illness, 64.0% reported having high blood pressure, 47.4% smoke or were smokers, 73.7% had low functional health literacy, which was associated with schooling p = 0.001.
Conclusions:
the low functional health literacy could be a self-care conditioning and can be influenced by low schooling because it implies to have skills to understand and make decisions aimed at self-management of health.
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