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RESEARCH01-01-2018
Deontological aspects of the nursing profession: understanding the code of ethics
Revista Brasileira de Enfermagem. 2018;71(1):3-10
Abstract
RESEARCHDeontological aspects of the nursing profession: understanding the code of ethics
Revista Brasileira de Enfermagem. 2018;71(1):3-10
DOI 10.1590/0034-7167-2016-0565
Views0See moreABSTRACT
Objective:
to investigate nursing professionals’ understanding concerning the Code of Ethics; to assess the relevance of the Code of Ethics of the nursing profession and its use in practice; to identify how problem-solving is performed when facing ethical dilemmas in professional practice.
Method:
exploratory descriptive study, conducted with 34 (thirty-four) nursing professionals from a teaching hospital in João Pessoa, PB – Brazil.
Results:
four thematic categories emerged: conception of professional ethics in nursing practice; interpretations of ethics in the practice of care; use of the Code of Ethics in the professional practice; strategies for solving ethical issues in the professional practice.
Final considerations:
some of the nursing professionals comprehend the meaning coherently; others have a limited comprehension, based on jargon. Therefore, a deeper understanding of the text contained in this code is necessary so that it can be applied into practice, aiming to provide a quality care that is, above all, ethical and legal.
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01-01-2018
It is not a crisis itself, if does not promote changes
Revista Brasileira de Enfermagem. 2018;71(1):1-2
Abstract
It is not a crisis itself, if does not promote changes
Revista Brasileira de Enfermagem. 2018;71(1):1-2
DOI 10.1590/0034-7167.2018710101
Views1ECONOMIC CRISISBrazil has been going through crisis in the past three years, due to often and systemic cuts in funds in multiple fields of society, such as education, health, science and technology, affecting directly on Brazilian scientific production. The nursing scientific production – as being an integrative part – now experiences a phase of quantitative […]See more -
01-01-2018
Uma crise que não gera mudanças não é uma crise em sua essência
Revista Brasileira de Enfermagem. 2018;71(1):1-2
Abstract
Uma crise que não gera mudanças não é uma crise em sua essência
Revista Brasileira de Enfermagem. 2018;71(1):1-2
DOI 10.1590/0034-7167.2018710101
Views0A CRISE ECONÔMICAAs dificuldades político-econômicas que o Brasil atravessa nos últimos três anos, com cortes frequentes e sistemáticos de recursos nas mais diversas áreas, incluindo educação, saúde, ciência e tecnologia, repercutem diretamente na produção científica brasileira. Como parte integrante desse sistema, a produção científica da enfermagem passa a experimentar uma fase de declínio quantitativo na […]See more -
REFLECTION01-01-2018
Nursing and light technologies for a peace culture within the family
Revista Brasileira de Enfermagem. 2018;71:2854-2857
Abstract
REFLECTIONNursing and light technologies for a peace culture within the family
Revista Brasileira de Enfermagem. 2018;71:2854-2857
DOI 10.1590/0034-7167-2017-0756
Views0See moreABSTRACT
Objective:
To reflect on technologies for the peace culture that can be used in family nursing.
Method:
Theoretical essay, based on the premises of non-violence and peace culture.
Results:
Four light technologies are singled out for the peace culture within families: nonviolent communication, qualified listening, conflict mediation, and restorative circles.
Conclusion:
The technologies proposed can be used by nurses to promote care and policies aiming at a peace culture and non-violence in families, with the objective of assisting in the obtainment of the well-being for family systems and their correlations.
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REFLECTION01-01-2018
The face-to-face encounter in indigenous health care: a perspective in Lévinas
Revista Brasileira de Enfermagem. 2018;71:2848-2853
Abstract
REFLECTIONThe face-to-face encounter in indigenous health care: a perspective in Lévinas
Revista Brasileira de Enfermagem. 2018;71:2848-2853
DOI 10.1590/0034-7167-2017-0389
Views0See moreABSTRACT
Objective:
To reflect on the sensitive behaviors of indigenous healthcare professionals based on the philosophy of Emmanuel Lévinas, to ratify completeness, equity, and humanity.
Method:
reflective study.
Reflection:
Studies have identified inadequacies in meeting the indigenous singularities. In the hospital and outpatient settings, they are diluted in the search for care. The difficulty of the professionals to admit them generates conflicts and non-adherence of indigenous individuals to treatments that disregard their care practices. In Lévinas, consciousness requires, “a priori,” sensitivity to access the Infinity on the Face of the Other, which in the face-to-face encounters is presented to the Self as radical Alterity, proposing an Ethical relationship through transcendence. The freedom of the Self as to the Other is finite, as the Self cannot possess the Other, and infinite for its responsibility for the Other.
Final considerations:
The Self builds essence and existence in responsibility. In the Ethics of Alterity, in Lévinas, reflections are proposed that influence sensitive behaviors.
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EXPERIENCE REPORT01-01-2018
Implementation of the Street Outreach Office in the perspective of health care
Revista Brasileira de Enfermagem. 2018;71:2843-2847
Abstract
EXPERIENCE REPORTImplementation of the Street Outreach Office in the perspective of health care
Revista Brasileira de Enfermagem. 2018;71:2843-2847
DOI 10.1590/0034-7167-2017-0616
Views0See moreABSTRACT
Objective:
To report the experience of implementation of a clinical equipment of health care production to homeless people, denominated Street Outreach Office.
Method:
Experience report in the city of Rio de Janeiro, Brazil.
Results:
The Street Outreach Office implementation resulted from a demand for health care practices for homeless people. This implementation had intersectoral articulations, causing health professionals to carry out street care practices, which led them to strive for public policies, to rethink their actions in order to increase the resolution of care to this population.
Conclusion:
We should emphasize the importance of health professionals to reinvent their practices, daily, seeking partnerships and acquisition of new knowledge in order to achieve results that can reduce the demands of these individuals throughout their life routes.
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EXPERIENCE REPORT01-01-2018
Developing a nursing healthcare protocol: a case report
Revista Brasileira de Enfermagem. 2018;71:2837-2842
Abstract
EXPERIENCE REPORTDeveloping a nursing healthcare protocol: a case report
Revista Brasileira de Enfermagem. 2018;71:2837-2842
DOI 10.1590/0034-7167-2017-0846
Views0See moreABSTRACT
Objective:
to report the use experience of convergent healthcare research for developing a nursing care protocol.
Method:
convergent care research developed in university hospital, from July to December 2016, with 27 participants.
Results:
the stages of the research and its results are described in the steps: conception, instrumentation, screening and analysis. The end result was the nursing care protocol in day zero of hematopoietic stem cell transplantation.
Conclusion:
convergent care research was an appropriate method for developing the care protocol, and an important contribution to the approximation between theory and practice. The nursing care protocol was the result of this study and confirmed both the purpose of the research as a professional Master’s in acquiring knowledge aimed at improving professional practice.
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EXPERIENCE REPORT01-01-2018
Safe Embrace: technological innovation for elderly safety in the use of toilets
Revista Brasileira de Enfermagem. 2018;71:2833-2836
Abstract
EXPERIENCE REPORTSafe Embrace: technological innovation for elderly safety in the use of toilets
Revista Brasileira de Enfermagem. 2018;71:2833-2836
DOI 10.1590/0034-7167-2017-0751
Views0See moreABSTRACT
Objective:
to describe the development of a device to prevent falling for seniors when using the toilet.
Method:
we sought in literature and in the hospital market for a device to prevent falling, without success. Geriatric nurses, in partnership with the hospital engineering team, elaborated a prototype and, after several analysis, looked for a partner for its production.
Results:
the device, named “Safe Embrace”, installed and tested in an apartment of the Geriatric ward, was positively evaluated by the health team, patients and caregivers.
Conclusion:
for the benefit obtained and considering the safety and privacy during use, Safe Embrace was patented so that other institutions could use it.
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EXPERIENCE REPORT01-01-2018
Clinical and epidemiological teaching of dengue through simulated practice
Revista Brasileira de Enfermagem. 2018;71(2):451-456
Abstract
EXPERIENCE REPORTClinical and epidemiological teaching of dengue through simulated practice
Revista Brasileira de Enfermagem. 2018;71(2):451-456
DOI 10.1590/0034-7167-2016-0503
Views2See moreABSTRACT
Objective:
to describe the experience of clinical teaching on dengue and the practice of epidemiological surveillance using problematization methodology.
Method:
report of experience on educational activity with undergraduate nursing students, held in March 2016, at a public university in the city of São Paulo, conceived in four stages: dialogic lecture, active search of Aedes aegypti, case study and simulation of nursing consultation to individuals with dengue.
Results:
The activity allowed to retrieve previous knowledge about the disease, respond to exercises that addressed different clinical situations and epidemiological surveillance, including in situ evaluation of possible mosquito outbreaks, and discuss the need to expand prevention and health of the individual and the community, the impact of the media in the dissemination of cases and the coping difficulties experienced in the different levels of attention.
Conclusion:
the methodology adopted enabled qualified training of students to cope with dengue.
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ORIGINAL ARTICLE07-18-2022
Beliefs, knowledge, actions of nursing techniques in breastfeeding in pain management in immunization
Revista Brasileira de Enfermagem. 2022;75(6):e20210546
Abstract
ORIGINAL ARTICLEBeliefs, knowledge, actions of nursing techniques in breastfeeding in pain management in immunization
Revista Brasileira de Enfermagem. 2022;75(6):e20210546
DOI 10.1590/0034-7167-2021-0546
Views1See moreABSTRACT
Objective:
Understand the beliefs, knowledge, and actions of nursing technicians on breastfeeding as a form of non-pharmacological intervention to relieve pain in newborns and infants during immunization.
Methods:
Qualitative study carried out through semi-structured interviews with nine nursing technicians from three Basic Health Units in a city in the state of São Paulo. The theoretical approach of the Belief Model and the methodological framework of Thematic Analysis supported this study.
Results:
Three themes originated: Beliefs, Knowledge, and Actions of nursing technicians.
Final considerations:
Despite knowledge about the benefits of breastfeeding as the most effective method for relieving pain in newborns and infants during vaccination, their restrictive beliefs overrode the evidence, leading them to act in ways that discourage or prevent the mother from breastfeed during vaccination. Formal training is recommended to align with current evidence-based practices.
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REVIEW12-08-2023
Educational technologies for accident prevention due to falls in childhood: a scoping review
Revista Brasileira de Enfermagem. 2023;76:e20220807
Abstract
REVIEWEducational technologies for accident prevention due to falls in childhood: a scoping review
Revista Brasileira de Enfermagem. 2023;76:e20220807
DOI 10.1590/0034-7167-2022-0807
Views2See moreABSTRACT
Objectives:
to map evidence on educational technology use for accident prevention due to falls in childhood.
Methods:
a scoping review, carried out in October and November 2022, in the MEDLINE, Web of Science, BDENF and CINAHL databases and LILACS bibliographic index. There was no delimitation of language or time. Data were extracted and analyzed descriptively by two independent researchers. The research protocol was registered in the Open Science Framework.
Results:
twenty-six studies were selected. Booklets, pamphlets and leaflets were the most used technologies, presenting health services as the most frequent environment to develop research on fall prevention. The technologies developed were important outcomes: increased knowledge of children, family members, caregivers, health and education professionals.
Conclusions:
educational technology use makes it possible to increase knowledge, adopt safe practices and reduce falls.
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REVIEW03-15-2024
Resources for health literacy among caregivers of prematurely born children: a scoping review
Revista Brasileira de Enfermagem. 2024;77(1):e20230062
Abstract
REVIEWResources for health literacy among caregivers of prematurely born children: a scoping review
Revista Brasileira de Enfermagem. 2024;77(1):e20230062
DOI 10.1590/0034-7167-2023-0062
Views1See moreABSTRACT
Objectives:
to map the available evidence on resources used to promote health literacy among caregivers of prematurely born children during outpatient follow-up.
Methods:
the Joanna Briggs Institute’s scope review protocol was utilized. The search encompassed six databases, incorporating studies from 2012 to 2022.
Results:
the three included publications revealed that the resources employed are: mobile applications, phone calls, individual counseling, videos, educational pamphlets, and group discussions. Implementing an education protocol during the transition home enhances scientifically grounded health promotion rates.
Conclusions:
there is limited literature addressing the health literacy of these caregivers. The nursing team plays a crucial role in health education and in developing resources applicable to these families.
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ORIGINAL ARTICLE01-13-2024
Social representations of oncologic surgery for patients with cancer
Revista Brasileira de Enfermagem. 2024;77(6):e20230273
Abstract
ORIGINAL ARTICLESocial representations of oncologic surgery for patients with cancer
Revista Brasileira de Enfermagem. 2024;77(6):e20230273
DOI 10.1590/0034-7167-2023-0273
Views2See moreABSTRACT
Objectives:
to analyze the social representations of patients with cancer regarding oncologic surgery.
Methods:
a qualitative study based on Social Representation Theory was conducted with 126 participants between October 2021 and May 2022 in a public hospital in Rio de Janeiro. A characterization questionnaire, free evocations of the inducing term “surgery”, and semi-structured interviews with 60 participants were applied. Data were analyzed using Microsoft Excel® and IRaMuTeQ.
Results:
the central core of the representation is composed of fear, cure, hope, and removing the disease. The analysis of interviews resulted in six classes that highlight the social changes caused by treatment as well as the need for a support network to cope with the surgical process.
Final Considerations:
the representations reflect fear and hope towards the procedure and the desire to remove the disease, thus translating the cure through surgery.
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ORIGINAL ARTICLE01-13-2024
Nurses’ perspectives on the use of telemonitoring in the management of people with diabetes and hypertension
Revista Brasileira de Enfermagem. 2024;77(6):e20230481
Abstract
ORIGINAL ARTICLENurses’ perspectives on the use of telemonitoring in the management of people with diabetes and hypertension
Revista Brasileira de Enfermagem. 2024;77(6):e20230481
DOI 10.1590/0034-7167-2023-0481
Views3See moreABSTRACT
Objectives:
to understand the perspective of nurses on the use of telemonitoring in the management of people with type 2 diabetes mellitus and arterial hypertension in primary care.
Methods:
this qualitative research involved sixteen nurses from eight municipalities in Paraná. Data were collected between November 2022 and January 2023 through inperson or remote interviews, which were audio-recorded and subjected to content analysis.
Results:
according to the nurses, telemonitoring enhances users’ knowledge about these conditions, communication and connection with the team, and productivity. However, the lack of electronic resources and equipment, high staff turnover, low user adherence, and the limited availability of professional time present significant challenges.
Final Considerations:
the effective implementation and operation of telemonitoring in the management of people with diabetes and hypertension involve both potential benefits and barriers. It is essential to have the availability of human and technological resources, managerial support, and the commitment of professionals and users.
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ERRATUM01-13-2024
ERRATUM
Revista Brasileira de Enfermagem. 2024;77(6):e2024n6e08
Abstract
ERRATUMERRATUM
Revista Brasileira de Enfermagem. 2024;77(6):e2024n6e08
DOI 10.1590/0034-7167.20247706e08
Views2In the article “Brazilian nursing specific situation, middle and micro-range theories: a bibliometric study”, with DOI number: , published in Revista Brasileira de Enfermagem, 2024;77(4):e20230520, Chart 1:Where it read:[…]See more -
ORIGINAL ARTICLE09-29-2022
Palliative care production for health professionals in the context of home care
Revista Brasileira de Enfermagem. 2022;75(1):e20210030
Abstract
ORIGINAL ARTICLEPalliative care production for health professionals in the context of home care
Revista Brasileira de Enfermagem. 2022;75(1):e20210030
DOI 10.1590/0034-7167-2021-0030
Views1See moreABSTRACT
Objectives:
to analyze palliative care production developed by health professionals to home care patients.
Methods:
this is an exploratory study, with a qualitative approach, using the transpersonal care theoretical framework. Thirteen interviews were conducted with health professionals and 18 observations were conducted on different cases. Content analysis was performed using MAXQDA©.
Results:
actions performed: maintenance and follow-up measures to people eligible for palliative care, in acts of dialogue and “listening” to caregivers and users, conducting guidelines for the care and self-care process, performing technical procedures, delivery of materials, referrals and medical prescriptions to users.
Final Considerations:
it is perceived the need for advances in the implementation of government policies in Brazil that insert palliative care into the Health Care Network through educational, managerial and care actions that ensure human dignity, thus allowing the development of these and other palliative care interventions.
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ORIGINAL ARTICLE06-16-2021
Patient participation in care safety: Primary Health Care professionals’ perception
Revista Brasileira de Enfermagem. 2021;74(2):e20200773
Abstract
ORIGINAL ARTICLEPatient participation in care safety: Primary Health Care professionals’ perception
Revista Brasileira de Enfermagem. 2021;74(2):e20200773
DOI 10.1590/0034-7167-2020-0773
Views0See moreABSTRACT
Objectives:
to analyze health professionals’ perception about the meaning and practice of patient involvement in care safety in Primary Health Care.
Methods:
this is an exploratory, qualitative study, developed with 22 professionals in the Federal District, Brazil. A semi-structured interview was conducted between October and November/2018. Content analysis was carried out according to Bardin.
Results:
nurses, physicians, dentists, among others, participated. The following categories emerged: Meaning of patient involvement in care safety; Factors intervening in patient involvement in care safety; Strategies for patient involvement in care safety; Qualification for patient involvement in care safety.
Final Considerations:
the meaning of patient involvement for care safety was associated with co-responsibility and patient-centered care. Professionals’ practice revealed intervening factors and the use of involvement strategies. A gap was identified in training on patient involvement in care safety.
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REVIEW03-30-2020
Internet influence on the biopsychosocial health of adolescents: an integratitive review
Revista Brasileira de Enfermagem. 2020;73(2):e20180766
Abstract
REVIEWInternet influence on the biopsychosocial health of adolescents: an integratitive review
Revista Brasileira de Enfermagem. 2020;73(2):e20180766
DOI 10.1590/0034-7167-2018-0766
Views0See moreABSTRACT
Objectives:
To identify scientific evidence on the influence of internet use on adolescents’ biopsychosocial health.
Methods:
Integrative review, with database search, using the descriptors “internet”, “adolescent health” and “adolescent behavior”. After applying the inclusion and exclusion criteria, 16 articles were selected.
Results:
Knowledge convergence produced for three main themes was demonstrated: “Internet exposure time and possible damages to adolescent health”; “Internet, adolescent and cyberbullying”; and “Internet as a source of information for adolescent health”.
Final considerations:
The network involves an intricate network of interactions, providing varied behaviors and attitudes that reflect on adolescent health. Therefore, it is important to articulate nursing actions with the school community and the family, in order to carry out health education.
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REFLECTION07-10-2020
Psychosocial risks and the health of health workers: reflections on Brazilian labor reform
Revista Brasileira de Enfermagem. 2020;73:e20190092
Abstract
REFLECTIONPsychosocial risks and the health of health workers: reflections on Brazilian labor reform
Revista Brasileira de Enfermagem. 2020;73:e20190092
DOI 10.1590/0034-7167-2019-0092
Views0See moreABSTRACT
Objective:
to reflect on the psychosocial risks and their impacts on the health of health workers in light of the Brazilian economic context and Labor Reform.
Method:
reflective study on the Brazilian Labor Reform and its impacts on health of health workers.
Results:
although the changes observed in the labor sphere have contributed to improvements in health and safety policies for, these changes have also contributed to the emergence of new risks arising from work activities, including psychosocial risks, which affect all occupational categories.
Final considerations:
we understand that the Brazilian Labor Reform carried out in 2017 leads to the weakening of labor relations, increases workers’ exposure to risks in the workplace, increases the risk of illness, and opposes the global movement of international organizations aimed at the prevention of aggravation in workers’ health and also at preserving their health.
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REVIEW06-17-2020
The role of the nurse in caring for the critical patient with sepsis
Revista Brasileira de Enfermagem. 2020;73(4):e20190031
Abstract
REVIEWThe role of the nurse in caring for the critical patient with sepsis
Revista Brasileira de Enfermagem. 2020;73(4):e20190031
DOI 10.1590/0034-7167-2019-0031
Views0See moreABSTRACT
Objectives:
to know the nursing interventions in the identification, prevention and control of sepsis in critical patients.
Methods:
integrative review of the literature, with two parallel researches using different MesH terms, using the EBSCO database and Google Scholar. Nine studies were included in the sample.
Results:
nursing interventions are centered on the creation/implementation of protocols for the early recognition of sepsis, the training of teams to ensure a safe and effective approach and the adoption of measures for infection prevention and control as a way to prevent sepsis.
Final Considerations:
the evidence shows that nurses are fundamental in the early identification, control and prevention of sepsis, preventing disease progression and contributing to decreased morbidity and mortality.
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ORIGINAL ARTICLE05-15-2020
Configuration of power relations in physicians and nurses’ professional practices
Revista Brasileira de Enfermagem. 2020;73:e20180629
Abstract
ORIGINAL ARTICLEConfiguration of power relations in physicians and nurses’ professional practices
Revista Brasileira de Enfermagem. 2020;73:e20180629
DOI 10.1590/0034-7167-2018-0629
Views0See moreABSTRACT
Objective:
to analyze the configuration of power relations constituted in and by the knowledge and daily practices of physicians and nurses in an Intensive Care Unit (ICU).
Method:
qualitative study in which data were collected through interviews with physicians and nurses from an ICU of a hospital in Belo Horizonte, Minas Gerais. A semi-structured script was used. Data were analyzed through discourse analysis in a Foucaultian perspective.
Results:
three categories were developed – Professional Identity: self-recognition in the profession; Discipline: individualizing attitudes or collective need?; and Circularity of knowledge and power in the constitution of daily practices.
Final considerations:
the identity, discipline and circulation of power are connected in a continuous movement of subjectivation of the subject, which, in turn, uses discourse as a persuasion strategy to modify the position taken over in different situations thereby causing the circulation of power.
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ORIGINAL ARTICLE02-10-2020
Theater of the Oppressed and bullying: nursing performance in school adolescent health
Revista Brasileira de Enfermagem. 2020;73(1):e20170910
Abstract
ORIGINAL ARTICLETheater of the Oppressed and bullying: nursing performance in school adolescent health
Revista Brasileira de Enfermagem. 2020;73(1):e20170910
DOI 10.1590/0034-7167-2017-0910
Views0See moreABSTRACT
Objective:
to assess the effects of an intervention based on the Theater of the Oppressed in reducing school bullying.
Method:
a quasi-experimental study with 232 first-year high school students from two public schools in the city of Cuiabá, Mato Grosso State, Brazil. An intervention was performed with the Theater of the Oppressed, a theatrical methodology created by Augusto Boal and inspired by Paulo Freire’s “Pedagogy of the Oppressed”, in which one school composed the intervention group, and another school, the comparison group. Both groups were assessed for involvement in bullying situations before and after intervention. For data analysis, Poisson Regression models with random effect were used.
Results:
intervention group presented a significant decrease in direct victimization (physical and verbal aggression).
Conclusion:
the Theater of the Oppressed represents an important strategy in reducing bullying victimization among school adolescents.
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ORIGINAL ARTICLE02-10-2020
Common Mental Disorders and Contemporary Factors: 1982 Birth Cohort
Revista Brasileira de Enfermagem. 2020;73(1):e20180162
Abstract
ORIGINAL ARTICLECommon Mental Disorders and Contemporary Factors: 1982 Birth Cohort
Revista Brasileira de Enfermagem. 2020;73(1):e20180162
DOI 10.1590/0034-7167-2018-0162
Views0See moreABSTRACT
Objective:
To describe the association between common mental disorders and socio-demographic variables, smoking habits and stressful events among the 30-year-old members of a 1982 cohort.
Method:
Mental disorder was analyzed by the Self-Reporting Questionnaire (SRQ-20). Poisson regression was used to analyze the unadjusted and adjusted associations.
Results:
Low level of education and stressful events increased the prevalence of mental disorders for both genders. Lower income for women and unemployment for men also remained associated with CMD.
Conclusion:
It was possible to describe the association between contemporary factors and mental disorders in a young population, to which prevention and control measures, through public policies proposed to the areas of Primary Care, Mental Health and Education, can represent a better quality of life and health.
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REVIEW12-21-2020
Lean Six Sigma methodology application in health care settings: an integrative review
Revista Brasileira de Enfermagem. 2020;73:e20190861
Abstract
REVIEWLean Six Sigma methodology application in health care settings: an integrative review
Revista Brasileira de Enfermagem. 2020;73:e20190861
DOI 10.1590/0034-7167-2019-0861
Views0See moreABSTRACT
Objective:
to analyze the scientific production on the results of Lean Six Sigma methodology in health care institutions.
Methods:
an integrative literature review, with the following question: what are the results in health institutions using Lean Six Sigma and Six Sigma methodology? The search was carried out at MEDLINE, LILACS, BDENF, CINAHL, Web of Science, and Scopus, with no time frame.
Results:
thirty-four articles were included, published between 2005 and 2019, of which 52.9% came from the United States of America. The most commonly found improvements were in hospital institutions and from the perspective of customers and internal processes.
Conclusion:
using Lean Six Sigma methodology proved to be effective in the different health care settings, evidencing a gap in its application regarding people engagement and training.
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