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ORIGINAL ARTICLE11-22-2024
Temporal trends in neonatal mortality in Pernambuco
Revista Brasileira de Enfermagem. 2024;77(4):e20230451
Abstract
ORIGINAL ARTICLETemporal trends in neonatal mortality in Pernambuco
Revista Brasileira de Enfermagem. 2024;77(4):e20230451
DOI 10.1590/0034-7167-2023-0451
Views0See moreABSTRACT
Objective:
To verify the temporal trend of neonatal mortality in the health regions of Pernambuco between 2000 and 2020.
Method:
A time-series ecological study was conducted, analyzing the total neonatal mortality rate and its early and late components. For regression analysis, Joinpoint Regression was applied, trends were classified, and annual and average percentage changes were calculated for the period, with a significance level of 95%.
Results:
The average neonatal mortality rate in Pernambuco was 11.5 during the studied period. A decreasing trend in neonatal mortality rate was observed, especially in the early component. The region where the state capital is located showed the fastest decrease across all components.
Conclusion:
The temporal trend of neonatal mortality was decreasing; however, the rate of reduction was not uniform across the health regions of the state, and the implementation of the Mãe Coruja Pernambucana Program did not impact the trend in neonatal mortality.
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ORIGINAL ARTICLE11-22-2024
Evaluation of a video to promote HIV testing in sexual minorities
Revista Brasileira de Enfermagem. 2024;77(4):e20230320
Abstract
ORIGINAL ARTICLEEvaluation of a video to promote HIV testing in sexual minorities
Revista Brasileira de Enfermagem. 2024;77(4):e20230320
DOI 10.1590/0034-7167-2023-0320
Views0ABSTRACT
Objective:
To design and evaluate an educational video aimed at promoting HIV testing in gay men from the theoretical perspective of the Nola J. Pender Health Promotion Model.
Methods:
The design comprised five steps: 1.- Literature search; 2.- Formulation of the educational objective; 3.- Drafting of the script and location of the information in the theoretical components; 4.- Production; and 5.- Evaluation by experts and the target population.
Results:
The video “Living Without Fear” was produced, which presents the dilemma faced by gay men before taking a HIV test. The content validity index was 0.85, which indicated that the information was adequate and acceptable for promoting the rapid HIV test.
Final Considerations:
The results contribute to the scientific evidence aimed at promoting healthy behavior. In addition, the video was shown to be an acceptable educational tool.
Keywords:Audiovisual ResourcesHIV TestingInstructional Film and VideoSexual and Gender MinoritiesValidation StudySee more -
ORIGINAL ARTICLE11-22-2024
Development and validity of a mobile application prototype for hospital shift handover
Revista Brasileira de Enfermagem. 2024;77(4):e20230173
Abstract
ORIGINAL ARTICLEDevelopment and validity of a mobile application prototype for hospital shift handover
Revista Brasileira de Enfermagem. 2024;77(4):e20230173
DOI 10.1590/0034-7167-2023-0173
Views0ABSTRACT
Objective:
To develop and validate a mobile application prototype for nursing shift handover in a hospital inpatient unit.
Methods:
A methodological study of technological production, carried out from April 2020 to January 2022, for mobile application construction and validity through the Design Thinking methodology. The study involved the stages of prototype development and validity by experts.
Results:
The application for mobile nursing shift handover obtained a usability score of 79 points and a content validity coefficient of 0.7.
Conclusions:
The instrument obtained an excellent assessment according to usability and agreement among experts. However, future studies are needed to implement this technology in order to assess effectiveness, time optimization and failures during communication.
Keywords:Health Information ExchangeHealth TechnologyHospitalizationMobile ApplicationsSoftware ValidationSee more -
ORIGINAL ARTICLE10-25-2024
Analysis of the vaccination situation against Mpox in people living with HIV/AIDS: an ecological study
Revista Brasileira de Enfermagem. 2024;77(5):e20230234
Abstract
ORIGINAL ARTICLEAnalysis of the vaccination situation against Mpox in people living with HIV/AIDS: an ecological study
Revista Brasileira de Enfermagem. 2024;77(5):e20230234
DOI 10.1590/0034-7167-2023-0234
Views0See moreABSTRACT
Objectives:
to analyze the vaccination situation against Mpox in people living with HIV/AIDS in Brazil.
Methods:
an ecological study on the vaccination status against Mpox in people living with HIV/AIDS (PLWHA) in Brazil. The data were collected in April 2023 through information from the Ministry of Health, using the “Microsoft app Power BI,” which is publicly accessible.
Results:
the data analysis revealed that in Brazil, 2,978 doses of the MVA-BN Jynneos Mpox vaccine were administered in PLWHA, resulting in a vaccination coverage of 18.3%, with the southern and southeastern regions showing the lowest and highest vaccination coverage, respectively. Gender-based evaluation showed a higher proportion of vaccinated males.
Conclusions:
we identified low vaccination coverage in all regions of Brazil, highlighting the need for intensified vaccination activities, especially for PLWHA.
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ORIGINAL ARTICLE10-11-2024
Indigenous women’s experiences about the pregnancy-puerperal cycle
Revista Brasileira de Enfermagem. 2024;77:e20230410
Abstract
ORIGINAL ARTICLEIndigenous women’s experiences about the pregnancy-puerperal cycle
Revista Brasileira de Enfermagem. 2024;77:e20230410
DOI 10.1590/0034-7167-2023-0410
Views0See moreABSTRACT
Objectives:
to understand the experiences of indigenous women regarding the pregnancy-puerperal cycle.
Methods:
qualitative, exploratory and descriptive research, carried out between May and August 2023 with 27 pregnant women from Indigenous Villages in Mato Grosso, Brazil, through open individual interviews. The data was analyzed using Reflexive thematic analysis.
Results:
data analysis resulted in the following themes: Cultivation of labor and birth in its natural and sacred path; Unique practices and beliefs associated with breastfeeding; Evolved or reductive thinking? The participants suggest inviolable practices and beliefs, which must be welcomed, respected and enhanced by indigenous health teams.
Final Considerations:
the experiences of indigenous women regarding the pregnancy-puerperal cycle are unique and motivated by inviolable cultural and religious beliefs, which transcend scientific knowledge, certainties and the linearity of contemporary approaches, normally established as order.
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REVIEW10-07-2024
Risk factors associated with the occurrence of the adverse event phlebitis in hospitalized adult patients
Revista Brasileira de Enfermagem. 2024;77(5):e20240162
Abstract
REVIEWRisk factors associated with the occurrence of the adverse event phlebitis in hospitalized adult patients
Revista Brasileira de Enfermagem. 2024;77(5):e20240162
DOI 10.1590/0034-7167-2024-0162
Views0See moreABSTRACT
Objectives:
to synthesize knowledge regarding risk factors associated with occurrence of adverse event phlebitis in hospitalized adult patients.
Methods:
an integrative literature review, carried out in the CINAHL, PubMed, Virtual Health Library, Embase, Web of Science and Scopus databases. The stages were carried out independently by two reviewers, and the data were analyzed descriptively.
Results:
from the analysis of 31 quantitative primary studies, the following risk factors were summarized: length of stay; use of antibiotics; peripheral intravenous catheter dwell time; receive less nursing care; catheter inserted multiple times; patients with infection and comorbidities; presence of pain at catheter insertion site; Teflon® catheter use; reduced patient mobility; quality of patient’s vein; skin elasticity; unsuccessful insertion.
Conclusions:
it is necessary to standardize the format for measuring occurrence of this adverse event and develop new studies with a higher level of evidence.
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ORIGINAL ARTICLE10-07-2024
Indicators of emotional distress and mindfulness in undergraduate students: a cross-sectional study
Revista Brasileira de Enfermagem. 2024;77(5):e20230499
Abstract
ORIGINAL ARTICLEIndicators of emotional distress and mindfulness in undergraduate students: a cross-sectional study
Revista Brasileira de Enfermagem. 2024;77(5):e20230499
DOI 10.1590/0034-7167-2023-0499
Views0See moreABSTRACT
Objectives:
to assess the association between indicators of emotional distress and dispositional mindfulness in health students at a Brazilian federal public university.
Methods:
a cross-sectional study, developed with university students in the health area of a public institution from May to June 2022. In the analysis, multiple linear regression was used using SPSS software.
Results:
the sample was mostly female, ≤ 22 years old, non-white, studying the first semesters, with a higher prevalence for the medicine course. Students presented moderate dispositional mindfulness scores. It was observed that the variables of stress, depression and current suicide risk were associated with the capacity for mindfulness.
Conclusions:
knowing the indicators of emotional distress that are related to the potential of mindfulness can contribute as a situational diagnosis to better design strategies that promote the improvement of emotional indicators of health students.
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ORIGINAL ARTICLE10-07-2024
Development and validation of a mobile application prototype for postoperative cardiac surgery
Revista Brasileira de Enfermagem. 2024;77(5):e20230491
Abstract
ORIGINAL ARTICLEDevelopment and validation of a mobile application prototype for postoperative cardiac surgery
Revista Brasileira de Enfermagem. 2024;77(5):e20230491
DOI 10.1590/0034-7167-2023-0491
Views0See moreABSTRACT
Objectives:
to develop and validate the content, appearance, and semantics of a prototype application for monitoring patients in the postoperative period of cardiac surgery.
Methods:
this is a technological development study based on Contextualized Instructional Design. The content and appearance evaluation was conducted by a committee of specialists, and semantic validation was carried out by patients from a cardiac surgery outpatient clinic.
Results:
the application prototype consisted of 43 screens, validated by 17 health specialists, with content validity ratio and appearance validity index results of 0.86 and 0.99, respectively. For semantic validation, 10 patients participated in data collection, with a total content validity index of 0.978.
Conclusions:
the prototype of the “VivaCor PósOp” application demonstrated evidence of content, appearance, and semantic validity, with the potential to stimulate self-care in patients in the postoperative period of cardiac surgery.
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ERRATUM
Revista Brasileira de Enfermagem. 2016;69(5):1002-1002
Abstract
ERRATUM
Revista Brasileira de Enfermagem. 2016;69(5):1002-1002
DOI 10.1590/0034-7167.20166905e01
Views0Article “Alcohol and alcoholism: attitudes of nursing students”, with number of DOI: http://dx.doi.org/10.1590/S0034-71672013000100013, published in the journal Revista Brasileira de Enfermagem, v66(1):84-9, page 89 that read:“18. Miranda SP, Vargas D. Satisfação de pacientes de um centro de atenção Psicossocial álcool e drogas com o atendimento do enfermeiro. SMAD, Rev Eletrônica Saúde Mental Alcool Drog 2019;5(2):1-15”.[…]See more -
REVIEW01-01-2016
Research methodology for nursing and health: a book review
Revista Brasileira de Enfermagem. 2016;69(5):1000-1001
Abstract
REVIEWResearch methodology for nursing and health: a book review
Revista Brasileira de Enfermagem. 2016;69(5):1000-1001
DOI 10.1590/0034-7167-2015-0135
Views1For those interested in nursing and health, the book entitled “Research methodology for nursing and health: from theory to practice”() was released in October 2015, at the 67th Brazilian Congress of Nursing, sponsored by National ABEn. The interest emerged from two organizers: Dr. Maria Ribeiro Lacerda (UFPR) and Dr. Regina Gema Santini Costerano (UNIFRA). Forty-seven […]See more -
Violence in the workplace in Nursing: consequences overview
Revista Brasileira de Enfermagem. 2016;69(5):996-999
Abstract
Violence in the workplace in Nursing: consequences overview
Revista Brasileira de Enfermagem. 2016;69(5):996-999
DOI 10.1590/0034-7167-2015-0133
Views0See moreABSTRACT
Objective:
to reflect on the consequences of workplace violence experienced by nursing professionals.
Methods:
this is a reflection paper based on recent publications related to the subject, particularly researches carried out in Brazil and in other countries.
Results:
exposure to workplace violence has been associated with health problems in nursing professionals, which may be physical damage, emotional manifestations, and psychic disorders. It also affects the employee performance, his or her family and social interactions.
Conclusion:
this phenomenon is potentially noxious and costly, for it leads to suffering, illness, absence from work, and even death. This reflection calls attention moreover to the importance of a safe and adequate health care work environment.
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REFLECTION01-01-2016
Construcción de la enfermera de práctica avanzada en Catalunya (España)
Revista Brasileira de Enfermagem. 2016;69(5):991-995
Abstract
REFLECTIONConstrucción de la enfermera de práctica avanzada en Catalunya (España)
Revista Brasileira de Enfermagem. 2016;69(5):991-995
DOI 10.1590/0034-7167.2016690507
Views0RESUMEN
El desarrollo de la enfermera de práctica avanzada (EPA) ha supuesto un reto para las enfermeras en países como EE.UU., Canadá, Gran Bretaña y Australia, entre otros, y desde hace escasos años está siendo considerada en Catalunya y España como un sistema para desarrollar nuevos roles que aporten eficacia y eficiencia al sistema sanitario. El presente artículo pretende conceptualizar la EPA y los modelos de referencia así como contextualizar y reflexionar sobre la EPA en Catalunya, desde el punto de vista de formación y de la implantación de los denominados nuevos roles de enfermería, asimilándolos a la práctica avanzada.
Keywords:Competencia ClínicaEnfermeríaEnfermería de Práctica AvanzadaPráctica ProfesionalRol de la EnfermeraSee more -
Developing the Advanced Practice Nurse in Catalonia
Revista Brasileira de Enfermagem. 2016;69(5):991-995
Abstract
Developing the Advanced Practice Nurse in Catalonia
Revista Brasileira de Enfermagem. 2016;69(5):991-995
DOI 10.1590/0034-7167.2016690507
Views0See moreABSTRACT
The development of advanced practice nurses (APN) has proved a challenge for nurses in countries such as the USA, Canada, Great Britain, and Australia among others. It is only in recent years that the system has been considered in Catalonia and Spain as a way to develop new roles to bring effectiveness and efficiency to the health system. From the standpoint of training and implementation of the above-mentioned new nursing roles, the following article aims to conceptualise APN and its reference models, as well as to contextualise and reflect on APN in Catalonia in order to assimilate them into advanced practice.
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International academic mobility in nursing education: an experience report
Revista Brasileira de Enfermagem. 2016;69(5):986-990
Abstract
International academic mobility in nursing education: an experience report
Revista Brasileira de Enfermagem. 2016;69(5):986-990
DOI 10.1590/0034-7167-2015-0128
Views0See moreABSTRACT
Objective:
report the experience of international academic mobility in Ireland through the program Science Without Borders during undergraduate education in nursing.
Method:
a report of experience presented in chronological order, with a descriptive nature.
Results:
the opportunity to know and be able to discuss questions regarding health and nursing in Ireland allowed the review of concepts and a more reflective perspective regarding nursing practices. Additionally, the exchange promoted personal strengthening regarding the confrontation and solution of problems, development of technical and scientific abilities, improvement of linguistic competences and construction of personality, independence and maturity.
Conclusion:
regarding such constructive and enriching experience that this mobility provides to students, to the governing authorities, to the population and to Brazilian nursing, sharing this experience is expected to serve as encouragement for those who search for new horizons, with the objective of adding knowledge for their personal and professional life.
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Online training for health professionals in three regions of Brazil
Revista Brasileira de Enfermagem. 2016;69(5):981-985
Abstract
Online training for health professionals in three regions of Brazil
Revista Brasileira de Enfermagem. 2016;69(5):981-985
DOI 10.1590/0034-7167.2016690506
Views0See moreABSTRACT
Objective:
to describe online training experience aimed at professionals working in the public health service in 27 Neonatal and Pediatric Intensive Care Units, and to reflect concerning the training process and possible improvements in this process.
Method:
this is an experience report study about the online training with multidisciplinary content, planned from the situational diagnosis of 27 institutions. The training target set was 10 participants per institution and per module, including the following topics: Indicators of Quality as a Management Tool, Hand Hygiene, Patient Safety, Intravenous Therapy and Patients’ Chart Record.
Results:
a total of 2,071 active students in the modules, with 1,046 approved. The mean of 76 students per module exceeded the target set.
Conclusion:
experience has shown that online training is comprehensive as a potential tool for the professional technical development and digital inclusion. The online learning system becomes weakened if participants are unaware of the technological resources.
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Technologies in intensive care: causes of adverse events and implications to nursing
Revista Brasileira de Enfermagem. 2016;69(5):972-980
Abstract
Technologies in intensive care: causes of adverse events and implications to nursing
Revista Brasileira de Enfermagem. 2016;69(5):972-980
DOI 10.1590/0034-7167.2016690505
Views0See moreABSTRACT
Objective:
to identify the causes of adverse events affecting clients resulting from the use of equipment in intensive care services; to point out the main recommendations for clinical practice to minimize these events and, then, discuss the implications to nursing care.
Method:
integrative and descriptive review on the SciELO, Medline, LILACS, and PubMed databases. Articles were selected based on the inclusion criteria and the structured instrument was applied.
Results:
altogether, 11 articles were selected where three evidence units were outstanding: Equipment failure; inadequate use of equipment; and team failure. Permanent education of professionals; evaluation of production and availability of equipment; and use of checklists are recommended.
Conclusion:
preventing adverse events related to equipment is one of the nursing responsibilities and requires the establishment of defensive barriers to prevent these.
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Determining impacts and factors in ventilator-associated pneumonia bundle
Revista Brasileira de Enfermagem. 2016;69(6):1108-1114
Abstract
Determining 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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Multidisciplinary team of intensive therapy: humanization and fragmentation of the work process
Revista Brasileira de Enfermagem. 2016;69(6):1099-1107
Abstract
Multidisciplinary 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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Humanized Care: insertion of obstetric nurses in a teaching hospital
Revista Brasileira de Enfermagem. 2016;69(6):1091-1098
Abstract
Humanized 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 -
Normative grounds of health care practice in Brazilian nursing
Revista Brasileira de Enfermagem. 2016;69(6):1082-1090
Abstract
Normative 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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Multi-professional intervention in adults with arterial hypertension: a randomized clinical trial
Revista Brasileira de Enfermagem. 2016;69(6):1067-1073
Abstract
Multi-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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Clinical Caritas Processes in workshops for caregivers of institutionalized elderly people
Revista Brasileira de Enfermagem. 2016;69(6):1059-1066
Abstract
Clinical 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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Technological innovation for peripheral venipuncture: ultrasound training
Revista Brasileira de Enfermagem. 2016;69(6):1052-1058
Abstract
Technological 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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