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EXPERIENCE REPORT10-25-2022
Patients who experience systemic lupus erythematosus and leg ulcer: phenomenological approach
- Eline Lima Borges
, - Selisvane Ribeiro da Fonseca Domingos ,
- Larissa Pereira de Carvalho Campos ,
- Josimare Aparecida Otoni Spira
Abstract
EXPERIENCE REPORTPatients who experience systemic lupus erythematosus and leg ulcer: phenomenological approach
Revista Brasileira de Enfermagem. 2022;75(2):e20200081
DOI 10.1590/0034-7167-2020-0081
- Eline Lima Borges ,
- Selisvane Ribeiro da Fonseca Domingos ,
- Larissa Pereira de Carvalho Campos ,
- Josimare Aparecida Otoni Spira
Views0See moreABSTRACT
Objective:
To understand the experience of a woman with systemic lupus erythematosus and leg ulcers with cutaneous calcinosis.
Methods:
An experience report based on the social phenomenology of Alfred Schutz, conducted with a young woman undergoing treatment in an outpatient service.
Results:
The disease manifested itself in adolescence and brought emotional instability associated with body image concern and social isolation. The discontinuation of the studies triggered financial limitations with implications for treatment. The presence of ulcers aggravated by skin calcification makes the process of getting sick tiring and painful. Interpersonal relationships are resources for coping with situations experienced.
Final considerations:
Patients with lupus may have social, affective, and family life, even in the face of the limitations imposed by the disease. However, the emergence of leg ulcer with calcinosis changes this situation.
- Eline Lima Borges
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ORIGINAL ARTICLE10-25-2022
COVID-19 pandemic and nursing week: analysis from software Iramuteq
- Samira Silva Santos Soares ,
- Norma Valéria Dantas de Oliveira Souza ,
- Eloá Carneiro Carvalho ,
- Ana Beatriz Azevedo Queiroz ,
- Carolina Cabral Pereira da Costa , [ … ],
- Jaqueline da Silva Soares Souto
Abstract
ORIGINAL ARTICLECOVID-19 pandemic and nursing week: analysis from software Iramuteq
Revista Brasileira de Enfermagem. 2022;75:e20200690
DOI 10.1590/0034-7167-2020-0690
- Samira Silva Santos Soares ,
- Norma Valéria Dantas de Oliveira Souza ,
- Eloá Carneiro Carvalho ,
- Ana Beatriz Azevedo Queiroz ,
- Carolina Cabral Pereira da Costa ,
- Jaqueline da Silva Soares Souto
Views0See moreABSTRACT
Objective:
to analyze the themes of publications on the Federal Council of Nursing (Cofen) website during Nursing Week 2020.
Method:
documentary, qualitative research, whose data sources were publications on the Cofen website from May 12 to 20, 2020. Data were processed by software IRAMUTEQ®, through the Descending Hierarchical Classification and analyzed under the historical materialism framework.
Results:
thirty publications were analyzed, giving rise to five classes.
Final considerations:
the themes published in the period investigated pointed to the grief experienced by the category, due to the death of its members, and the fight for better working conditions. Overcoming the pandemic involves recognizing science and the Unified Health System, protecting nursing workers’ health and fighting misinformation and fake news.
- Samira Silva Santos Soares
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ORIGINAL ARTICLE10-25-2022
Online mental health care during the COVID-19 pandemic
- Ariane da Cruz Guedes ,
- Luciane Prado Kantorski ,
- Janaína Quinzen Willrich ,
- Valéria Cristina Christello Coimbra ,
- Carla Gabriela Wünsch , [ … ],
- César Brasil Sperb
Abstract
ORIGINAL ARTICLEOnline mental health care during the COVID-19 pandemic
Revista Brasileira de Enfermagem. 2022;75:e20210554
DOI 10.1590/0034-7167-2021-0554
- Ariane da Cruz Guedes ,
- Luciane Prado Kantorski ,
- Janaína Quinzen Willrich ,
- Valéria Cristina Christello Coimbra ,
- Carla Gabriela Wünsch ,
- Lilian Cruz Souto de Oliveira Sperb ,
- César Brasil Sperb
Views0See moreABSTRACT
Objective:
Identify users, services, and reasons for seeking online mental health care during the COVID-19 pandemic.
Methods:
A descriptive, retrospective study, with documentary analysis of medical records of users served between April and July 2020.
Results:
Of the 258 accesses, 159 were complete, and 99 were offline messages. Although there were 61 (38.36%) consultations in May, in April, there were 49 (30.82%) in 18 days of reception. More than 89% of accesses were women between 40 and 59 years. Among the motivations in the search for care, anxiety, fear, depression, sadness, crying, stress, and suicidal ideation stand out.
Final considerations:
Chat is a quick, early and short-wait intervention opportunity for people in need of mental health care. Therefore, the study emphasizes the importance of investing in the training of nursing professionals to act in mental health.
- Ariane da Cruz Guedes
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ORIGINAL ARTICLE10-25-2022
Planned home birth assistance: challenges during the COVID-19 pandemic
- Natália Webler ,
- Lilian Conceição Guimarães de Almeida ,
- Jordana Brock Carneiro ,
- Luana Moura Campos ,
- Tanila Amorim Glaeser , [ … ],
- Telmara Menezes Couto
Abstract
ORIGINAL ARTICLEPlanned home birth assistance: challenges during the COVID-19 pandemic
Revista Brasileira de Enfermagem. 2022;75:e20210083
DOI 10.1590/0034-7167-2021-0083
- Natália Webler ,
- Lilian Conceição Guimarães de Almeida ,
- Jordana Brock Carneiro ,
- Luana Moura Campos ,
- Tanila Amorim Glaeser ,
- Margarete Costa Santos ,
- Telmara Menezes Couto
Views0See moreABSTRACT
Objective:
To understand the challenges faced by urban midwives in assisting planned home births during the COVID-19 pandemic.
Methods:
Qualitative study, based on the Collective Subject Discourse methodological framework, carried out with eight professionals, members of a birth care collective from the northeast region of Brazil. Data was collected between September and October of 2020 using the focus group technique.
Results:
The collective discourses revealed five central ideas: Changing assistance strategy; Dealing with frustration; Facing the fear of contamination; Avoiding exposure to the virus; and Keeping distance during the care process.
Final considerations:
The challenging condition the pandemic brings to the care of planned home births is made evident, being marked by the need for collective protection and the pressure of following health recommendations. The study also points out the need for official protocols and good quality information based on scientific evidence and humanizing principles to guide health care.
- Natália Webler
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ORIGINAL ARTICLE10-25-2022
Brazilian nursing in pandemic times and the bicentennial of Florence Nightingale
- Beatriz Maria dos Santos Santiago Ribeiro ,
- Fabio Scorsolini-Comin ,
- Sérgio Valverde Marques dos Santos ,
- Rita de Cassia de Marchi Barcellos Dalri
Abstract
ORIGINAL ARTICLEBrazilian nursing in pandemic times and the bicentennial of Florence Nightingale
Revista Brasileira de Enfermagem. 2022;75:e20210081
DOI 10.1590/0034-7167-2021-0081
- Beatriz Maria dos Santos Santiago Ribeiro ,
- Fabio Scorsolini-Comin ,
- Sérgio Valverde Marques dos Santos ,
- Rita de Cassia de Marchi Barcellos Dalri
Views0See moreABSTRACT
Objective:
To reflect on the role of Brazilian nursing during the COVID-19 pandemic, considering as a historical landmark the bicentenary of the birth of Florence Nightingale, a precursor of modern nursing, celebrated in 2020.
Method:
Theoretical-reflective study, based on Florence Nightingale’s environmental theory through a literature review, carried out in international and national virtual news from different sources and added to the authors’ experiences related to the pandemic.
Results:
It was possible to identify the weaknesses experienced by nurse practitioners as to contagion by COVID-19, the routine of exposure to risks, the lack of adequate protection in many scenarios, the high rates of illness, and also deaths that occurred in this profession.
Final considerations:
Florence Nightingale’s Environmental Theory describes the importance of the adequacy of the work environment. It also emphasizes the value of this professional for contemporary nursing and the redefinition of this professional category during the COVID-19 pandemic.
- Beatriz Maria dos Santos Santiago Ribeiro
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ORIGINAL ARTICLE10-24-2022
Avoidable deaths in the first 24 hours of life: health care reflexes
- Aline Beatriz dos Santos Silva ,
- Ana Catarina de Melo Araújo ,
- Paulo Germano de Frias ,
- Mirella Bezerra Rodrigues Vilela ,
- Cristine Vieira do Bonfim
Abstract
ORIGINAL ARTICLEAvoidable deaths in the first 24 hours of life: health care reflexes
Revista Brasileira de Enfermagem. 2022;75(1):e20220027
DOI 10.1590/0034-7167-2022-0027
- Aline Beatriz dos Santos Silva ,
- Ana Catarina de Melo Araújo ,
- Paulo Germano de Frias ,
- Mirella Bezerra Rodrigues Vilela ,
- Cristine Vieira do Bonfim
Views0See moreABSTRACT
Objectives:
to analyze the risks of deaths in the first 24 hours of life and their preventable causes.
Methods:
cross-sectional study carried out in Pernambuco, Northeast of Brazil, between 2000-2019, with mortality and live birth data. The avoidability was analyzed through the Brazilian List of Avoidable Causes of Deaths due to Interventions of the Unified Health System. For the statistical analyses, Pearson’s chi-squared test and relative and attributable risks were used.
Results:
13,601 deaths were registered, of which 10,497 (77.19%) were from preventable causes. Of the total, 5,513 (40.53%) were reducible through adequate care for women during pregnancy. The lower the gestational age, birth weight and education level, the higher the relative and attributable risk of death in the first 24 hours of life.
Conclusions:
most of the deaths were considered avoidable and with high relative and attributable risks. These early deaths suggest care failures and the need to reinforce prevention and treatment measures.
- Aline Beatriz dos Santos Silva
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ORIGINAL ARTICLE10-24-2022
Factors associated with symptoms of physical and emotional burden in informal caregivers of the elderly
- Leandro Corrêa Figueiredo ,
- Gustavo Carrijo Barbosa ,
- Diana Quirino Monteiro ,
- Gabriela Martins ,
- Adrielli Fernanda de Oliveira e Silva , [ … ],
- Aline Cristina Martins Gratão
Abstract
ORIGINAL ARTICLEFactors associated with symptoms of physical and emotional burden in informal caregivers of the elderly
Revista Brasileira de Enfermagem. 2022;75:e20210927
DOI 10.1590/0034-7167-2021-0927
- Leandro Corrêa Figueiredo ,
- Gustavo Carrijo Barbosa ,
- Diana Quirino Monteiro ,
- Gabriela Martins ,
- Adrielli Fernanda de Oliveira e Silva ,
- Luana Flávia Talmelli Ruy ,
- Tatiana de Oliveira Sato ,
- Aline Cristina Martins Gratão
Views1See moreABSTRACT
Objectives:
to analyze the personal and work-related burden factors associated with physical and emotional symptoms of informal caregivers of the elderly.
Methods:
cross-sectional study conducted with 121 informal caregivers and 121 seniors who received care, assessed individually for the risk of: physical overload, musculoskeletal symptoms, Self-Reporting Questionnaire, effort perception, and Katz index.
Results:
a greater perception of effort raises up to 3.3 times the chances of presenting symptoms of pain in the spine region (p=0.01), and lower functional capacity of the elderly increases up to 1.3 times the chances of presenting pain symptoms in the spine region (p=0.02). The symptoms of emotional overload were associated with the caregiver’s low income (p=0.02).
Conclusions:
the perception of effort, dependence of the elderly, caregiver’s age, and symptoms of emotional overload are involved with caregivers’ symptoms of physical overload, and low income, with emotional overload.
- Leandro Corrêa Figueiredo
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ORIGINAL ARTICLE10-24-2022
Development and testing of the Prev’Quedas game for older adults in the community: a descriptive study
- Jamylle Lucas Diniz ,
- Janaína Fonseca Victor Coutinho ,
- Marília Braga Marques ,
- Ismayle de Sousa Santos ,
- Rachel Gabriel Bastos Barbosa , [ … ],
- Maria Júlia Barbosa Muniz
Abstract
ORIGINAL ARTICLEDevelopment and testing of the Prev’Quedas game for older adults in the community: a descriptive study
Revista Brasileira de Enfermagem. 2022;75:e20220098
DOI 10.1590/0034-7167-2022-0098
- Jamylle Lucas Diniz ,
- Janaína Fonseca Victor Coutinho ,
- Marília Braga Marques ,
- Ismayle de Sousa Santos ,
- Rachel Gabriel Bastos Barbosa ,
- Rávida da Rocha Lima Silva ,
- Débora dos Reis Soares Ferreira ,
- Maria Júlia Barbosa Muniz
Views0See moreABSTRACT
Objectives:
to develop and test a board game for fall prevention in older adults in the community.
Methods:
a descriptive study, carried out through the use of game design elements (narrative, mechanics, aesthetics and technology), the Health Promotion Model, assessment by experts and testing with older adults. For assessment, the Concordance Index was used, considering it greater than 80%.
Results:
three prototypes and the final version were developed. The game’s narrative was based on promotion model, comprising individual aspects, benefits and barriers in behavior to prevent falls. The mechanics outlined goals and rules. Aesthetics encompassed layout and illustrations. The technology involved board, cards, pin, roulette and instruction manual. The game was assessed by 36 experts and 31 older women from the community, with a Concordance Index of 93.22% and 99%, respectively.
Conclusions:
the game developed and tested was considered an adequate educational strategy for fall prevention.
- Jamylle Lucas Diniz
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ORIGINAL ARTICLE06-16-2021
Patient participation in care safety: Primary Health Care professionals’ perception
- Pedro Rodrigues Carvalho ,
- Emannuela Sofia Dantas Ferraz ,
- Cristiane Chagas Teixeira ,
- Valéria Bertonha Machado ,
- Ana Lúcia Queiroz Bezerra , [ … ],
- Thatianny Tanferri de Brito Paranaguá
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
- Pedro Rodrigues Carvalho ,
- Emannuela Sofia Dantas Ferraz ,
- Cristiane Chagas Teixeira ,
- Valéria Bertonha Machado ,
- Ana Lúcia Queiroz Bezerra ,
- Thatianny Tanferri de Brito Paranaguá
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.
- Pedro Rodrigues Carvalho
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REVIEW03-30-2020
Internet influence on the biopsychosocial health of adolescents: an integratitive review
- Elisabete Zimmer Ferreira ,
- Adriane Maria Netto de Oliveira ,
- Silvana Possani Medeiros ,
- Giovana Calcagno Gomes ,
- Marta Regina Cezar-Vaz , [ … ],
- Janaína Amorim de Ávila
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
- Elisabete Zimmer Ferreira ,
- Adriane Maria Netto de Oliveira ,
- Silvana Possani Medeiros ,
- Giovana Calcagno Gomes ,
- Marta Regina Cezar-Vaz ,
- Janaína Amorim de Ávila
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.
- Elisabete Zimmer Ferreira
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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
- Maria João Chambel Branco ,
- Ana Paula Mirco Lucas ,
- Rita Margarida Dourado Marques ,
- Patrícia Pontífice Sousa
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
- Maria João Chambel Branco ,
- Ana Paula Mirco Lucas ,
- Rita Margarida Dourado Marques ,
- Patrícia Pontífice Sousa
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.
- Maria João Chambel Branco
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ORIGINAL ARTICLE05-15-2020
Configuration of power relations in physicians and nurses’ professional practices
- Tauana Wazir Mattar e Silva ,
- Isabela Silva Câncio Velloso ,
- Meiriele Tavares Araújo ,
- Aline da Rocha Kallás Fernandes
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
- Tauana Wazir Mattar e Silva ,
- Isabela Silva Câncio Velloso ,
- Meiriele Tavares Araújo ,
- Aline da Rocha Kallás Fernandes
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.
- Tauana Wazir Mattar e Silva
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ORIGINAL ARTICLE02-10-2020
Theater of the Oppressed and bullying: nursing performance in school adolescent health
- Lidiane Cristina da Silva Alencastro ,
- Jorge Luiz da Silva ,
- André Vilela Komatsu ,
- Fabiane Blanco Silva Bernardino ,
- Flávia Carvalho Malta de Mello , [ … ],
- Marta Angélica Iossi Silva
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
- Lidiane Cristina da Silva Alencastro ,
- Jorge Luiz da Silva ,
- André Vilela Komatsu ,
- Fabiane Blanco Silva Bernardino ,
- Flávia Carvalho Malta de Mello ,
- Marta Angélica Iossi Silva
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.
- Lidiane Cristina da Silva Alencastro
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ORIGINAL ARTICLE02-10-2020
Common Mental Disorders and Contemporary Factors: 1982 Birth Cohort
- Lenice de Castro Muniz de Quadros ,
- Luciana de Avila Quevedo ,
- Helen Denise Gonçalves ,
- Bernardo Lessa Horta ,
- Janaína Vieira dos Santos Motta , [ … ],
- Denise Petrucci Gigante
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
- Lenice de Castro Muniz de Quadros ,
- Luciana de Avila Quevedo ,
- Helen Denise Gonçalves ,
- Bernardo Lessa Horta ,
- Janaína Vieira dos Santos Motta ,
- Denise Petrucci Gigante
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.
- Lenice de Castro Muniz de Quadros
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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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