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01-01-2015
Low birth weight in a municipality in the southeast region of Brazil
Revista Brasileira de Enfermagem. 2015;68(6):1169-1175
Abstract
Low birth weight in a municipality in the southeast region of Brazil
Revista Brasileira de Enfermagem. 2015;68(6):1169-1175
DOI 10.1590/0034-7167.2015680624i
Views0See moreABSTRACT
Objective:
to identify the prevalence of low birth weight in the city of São Paulo.
Method:
epidemiological cross-sectional study with data collected by means of the Brazilian Live Birth Information System related to births occurred in the city of São Paulo between 2007 and 2013. Maternal, gestational, childbirth, and neonatal variables were analyzed descriptively and by association.
Results:
9.65% (1,342,655) of live births were underweight (mean of 3234.55 grams in the term group and 2312.17 in the pre-term group) with a mean maternal age of 27.53 years old. The risk factors identified include maternal age, not having a partner, low maternal level of education, other race rather than white, pre-term pregnancy, multiple births, low number of prenatal check-ups, and cesarean delivery.
Conclusion:
knowledge of this evidence favors planning the care provided by defining strategies to reduce it and consequently improve maternal and infant health care.
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01-01-2015
Gait speed and cognitive score in elderly users of the primary care service
Revista Brasileira de Enfermagem. 2015;68(6):1163-1168
Abstract
Gait speed and cognitive score in elderly users of the primary care service
Revista Brasileira de Enfermagem. 2015;68(6):1163-1168
DOI 10.1590/0034-7167.2015680623i
Views0See moreABSTRACT
Objective:
to investigate the association between gait speed and the cognitive score of elderly patients enrolled in a Basic Health Unit.
Method:
a quantitative cross-sectional study with 203 elderly, a sample calculated based on the estimated population proportion. Data were collected using a sociodemographic and clinical questionnaire, gait speed test (GS) and the Mini Mental State Examination (MMSE).
Results:
the illiterate patients had a mean MMSE=19.33(±3.7) and GS = 0.76m/s (±0.3); those with low/medium education had a MMSE = 25.43(±2.8) and GS = 0.92m/s (±0.2); and the elderly with higher education had a MMSE = 27.33(±2.9) and GS=1.12m/s (±0.3).There was a weak correlation (R2=00354) between gait speed and cognitive score, with statistical significance (Prob>F = 0.0072) and a positive linear trend.
Conclusion:
the better cognitive score the higher the gait speed; the illiterate elderly were those with lower gait speed, thereby indicating a poorer physical performance.
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01-01-2015
Fluid and dietary restriction’s efficacy on chronic kidney disease patients in hemodialysis
Revista Brasileira de Enfermagem. 2015;68(6):1154-1162
Abstract
Fluid and dietary restriction’s efficacy on chronic kidney disease patients in hemodialysis
Revista Brasileira de Enfermagem. 2015;68(6):1154-1162
DOI 10.1590/0034-7167.2015680622i
Views0See moreABSTRACT
Objective:
to identify self-care measures to manage fluid and dietary restrictions and assess their effectiveness.
Method:
descriptive-correlational study and cluster analysis with 254 chronic renal failure patients on regular hemodialysis program, handled by hemodiafiltration. We evaluated the effectiveness of self-care by interdialytic weight gain (IWG) and by potassium and phosphorus serum pre-dialysis serum levels.
Results:
several self-care measures were significantly correlated with a lower IWG and a lower level of pre-dialysis phosphorus. Patients most often use measures to reduce salt consumption than measures to restrict potassium and dietary phosphorus. The spouse provides important support dietary management. Subjects who use more often the self-care measure are mostly female, are older, less IWG and have a higher Kt/V.
Conclusion:
these results can contribute to the nursing educational support.
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01-01-2015
Validation of newborn positioning protocol in Intensive Care Unit
Revista Brasileira de Enfermagem. 2015;68(6):1147-1153
Abstract
Validation of newborn positioning protocol in Intensive Care Unit
Revista Brasileira de Enfermagem. 2015;68(6):1147-1153
DOI 10.1590/0034-7167.2015680621i
Views0See moreRESEARCH
Objective:
to verify the positioning indications of newborn sand build a standard operating procedure protocol for newborn positioning in Neonatal Intensive Care Unit (NICU).
Method:
for protocol validation, the Delphi technique was used ,in which expert nurses in the field reviewed the proposed procedure.
Results:
we present the results of this validation in a protocol form, to contribute to the discussion about newborn positioning in NICU and standardization of nursing care related to positioning. We evaluated ten indicators, in which there was agreementof100.0% in seven, and of80% in three, above the 60% recommended by the validation technique.
Conclusion:
given the importance of newborn positioning in NICU for its neuromuscular development, this study contributes to the adoption of an evidence-based practice for nursing.
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01-01-2015
Patient safety culture in a bone marrow transplantation unit
Revista Brasileira de Enfermagem. 2015;68(6):1139-1146
Abstract
Patient safety culture in a bone marrow transplantation unit
Revista Brasileira de Enfermagem. 2015;68(6):1139-1146
DOI 10.1590/0034-7167.2015680620i
Views0See moreABSTRACT
Objective:
evaluate the patient safety culture in the perspective of health professionals from a bone marrow transplantation unit of an oncology research center, at a reference hospital for cancer treatment in Santa Catarina, Brazil.
Method:
a quantitative cross-sectional study that used the Safety Attitudes Questionnaire was conducted between August and September 2013. The study analyzed 33 professional surveys. Statistical data analysis used descriptive and inferential statistics.
Results:
among the dimensions analyzed, only “job satisfaction” reached a mean score above 75, considered positive in terms of patient safety culture.
Conclusion:
the dimensions of safety culture present in the survey have to be valued by professionals and managers to allow safe patient care.
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01-01-2015
Job satisfaction of nursing staff in a university hospital
Revista Brasileira de Enfermagem. 2015;68(6):1130-1138
Abstract
Job satisfaction of nursing staff in a university hospital
Revista Brasileira de Enfermagem. 2015;68(6):1130-1138
DOI 10.1590/0034-7167.2015680619i
Views0See moreABSTRACT
Objective:
identify the determinants of job satisfaction of the nursing staff of a public university hospital.
Method:
secondary study with mixed data approach and simple and multiple linear regression. A total of 115 subjects participated in the study, 41 nurses and 74 nursing assistants and technicians. The data collection occurred in 2013 using the QST-Caism questionnaire.
Results:
education, hierarchical level and workplace constitute job satisfaction determinants. However, age, gender, job and work period did not show this relationship. More educated workers held low job satisfaction if exercised not graduated nursing functions.
Conclusion:
graduated workers who perform high school functions are more unsatisfied than those who have high school function and qualification.
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01-01-2015
Medical waste in mobile prehospital care
Revista Brasileira de Enfermagem. 2015;68(6):1122-1129
Abstract
Medical waste in mobile prehospital care
Revista Brasileira de Enfermagem. 2015;68(6):1122-1129
DOI 10.1590/0034-7167.2015680618i
Views0See moreABSTRACT
Objective:
the objective of this study is to identify how Medical Waste (MW) is managed in Mobile Prehospital Care (MPC) services in the state of São Paulo as well as characterize and quantify this waste.
Method:
exploratory and descriptive field study with data collection based on the methodology proposed by the Pan American Health Organization (PAHO), which was conducted over eight consecutive days to identify the production and characteristics of generated waste.
Results:
it was found that the MW management of the MPC is not yet in line with the requirements of RDC 306/04, which could affect the occupational safety of workers, patients, the community, and the environment.
Conclusion:
it is recommended for the health managers to focus on this issue. The lack of studies with regard to MPC also indicates the need for further studies on the waste management.
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01-01-2015
Severe lactational mastitis: particularities from admission
Revista Brasileira de Enfermagem. 2015;68(6):1116-1121
Abstract
Severe lactational mastitis: particularities from admission
Revista Brasileira de Enfermagem. 2015;68(6):1116-1121
DOI 10.1590/0034-7167.2015680617i
Views0See moreABSTRACT
Objective:
to identify characteristics of women who have suffered severe lactational mastitis.
Method:
a descriptive, retrospective, documentary, quantitative study was performed. Data were collected from patient records of 114 hospitalized women from January of 2009 to December of 2013. Data were analyzed by using descriptive statistics.
Results:
a higher percentage of severe lactational mastitis was found in young, primiparous women who had completed high school, who had no partner, and did not have a job; 96.5% of women had breast complications before admission and remained hospitalized an average of 4.4 days; at discharge, 23.7% of women had weaned their infants.
Conclusion:
this study showed that severe lactational mastitis can cause great harm to the woman and the baby.
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ORIGINAL ARTICLE12-04-2023
Work-related stress among nurses in the COVID-19 pandemic: What are the contributing factors?
Revista Brasileira de Enfermagem. 2023;76:e20220586
Abstract
ORIGINAL ARTICLEWork-related stress among nurses in the COVID-19 pandemic: What are the contributing factors?
Revista Brasileira de Enfermagem. 2023;76:e20220586
DOI 10.1590/0034-7167-2022-0586
Views0See moreABSTRACT
Objective:
To analyze the contributing factors of work-related stress among nurses in the COVID-19 pandemic.
Methods:
A cross-sectional study was conducted with 101 nurse practitioners from two hospitals in West Java, Indonesia. We distributed an online questionnaire to evaluate work-related stress and the data were analyzed using ordinal logistic regression.
Results:
More than half of the nurses experienced moderate work-related stress. The study revealed that nurses aged over 35 years old had a lower likelihood of experiencing work-related stress (AOR: 0.173; 95%CI: 0.038-0.782). Married nurses had a higher likelihood (AOR: 7.156; 95% CI: 1.456-35.163). Additionally, nurses with low and moderate workloads had a lower likelihood (AOR: 0.003; 95%CI: 0.000-0.051) and (AOR: 0.025; 95%CI: 0.005-0.116), respectively.
Conclusion:
The consideration of age, marital status, and workload is essential in effectively addressing work-related stress among nurse practitioners.
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ORIGINAL ARTICLE12-04-2023
Incidence and risk factors of pressure injuries in critically ill patients with COVID-19
Revista Brasileira de Enfermagem. 2023;76:e20220553
Abstract
ORIGINAL ARTICLEIncidence and risk factors of pressure injuries in critically ill patients with COVID-19
Revista Brasileira de Enfermagem. 2023;76:e20220553
DOI 10.1590/0034-7167-2022-0553
Views0See moreABSTRACT
Objective:
to analyze pressure injury (PI) incidence and risk factors in patients with COVID-19 admitted to an Intensive Care Unit and characterize the identified PIs.
Method:
a retrospective cohort study, consisting of 668 patients, carried out between March 2020 and February 2021. Clinical/demographic and PI variables were collected from medical records and electronic database. Data were analyzed using descriptive and inferential statistics. Logistic regression was performed to analyze risk factors for PI.
Results:
PI incidence was 30.2% (n=202), with the majority located in the sacral region (52.9%) and in stage 1 (39%). Risk factors were age (p<0.001), Diabetes Mellitus (p=0.005), length of stay (p<0.001), immunosuppression (p=0.034), nutritional risk (p=0.015) and mechanical ventilation (p<0.001).
Conclusion:
PI incidence in critically ill patients with COVID-19 was high.
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12-04-2023
Enfermagem e os Objetivos de Desenvolvimento Sustentável (ODS): Um Compromisso Essencial
Revista Brasileira de Enfermagem. 2023;76(6):e760601
Abstract
Enfermagem e os Objetivos de Desenvolvimento Sustentável (ODS): Um Compromisso Essencial
Revista Brasileira de Enfermagem. 2023;76(6):e760601
DOI 10.1590/0034-7167.2023760601pt
Views0Os Objetivos de Desenvolvimento Sustentável (ODS) são uma iniciativa global lançada pela Organização das Nações Unidas (ONU) em setembro de 2015 como parte da Agenda 2030 para o Desenvolvimento Sustentável, cujos objetivos sumarizam um apelo universal à ação para acabar com a pobreza, proteger o meio ambiente e garantir que todas as pessoas tenham acesso […]See more -
12-04-2023
Nursing and the Sustainable Development Goals (SDGs): An Essential Commitment
Revista Brasileira de Enfermagem. 2023;76(6):e760601
Abstract
Nursing and the Sustainable Development Goals (SDGs): An Essential Commitment
Revista Brasileira de Enfermagem. 2023;76(6):e760601
DOI 10.1590/0034-7167.2023760601
Views0The Sustainable Development Goals (SDGs) are a global initiative launched by the United Nations (UN) in September 2015 as part of the 2030 Agenda for Sustainable Development, whose objectives summarize a universal call to action to end poverty, protect the environment and ensure that all people have access to opportunities and well-being, all in an […]See more -
ERRATUM12-04-2023
ERRATUM
Revista Brasileira de Enfermagem. 2023;76(6):e2023n6e06
Abstract
ERRATUMERRATUM
Revista Brasileira de Enfermagem. 2023;76(6):e2023n6e06
DOI 10.1590/0034-7167.20237606e06
Views0In the article “Undergraduate nursing students’ knowledge and experience in infusion therapy and peripheral vascular acces”, with DOI number: , published in Revista Brasileira de Enfermagem, 2023;76(3): e20220219, authored:Where it read:[…]See more -
12-04-2023
Elder abuse: a conceptual analysis
Revista Brasileira de Enfermagem. 2023;76(6):e20230150
Abstract
Elder abuse: a conceptual analysis
Revista Brasileira de Enfermagem. 2023;76(6):e20230150
DOI 10.1590/0034-7167-2023-0150
Views0See moreABSTRACT
Objective:
to analyze the concept of elder abuse and identify its respective antecedents, attributes and consequents.
Methods:
this is a conceptual analysis according to Walker and Avant’s proposition. The search for the concept was mediated by an integrative review in the LILACS, PubMed, CINAHL, Web of Science and BDENF databases.
Results:
as antecedents, female, family member, low social support and low income or socioeconomic conditions stand out. Attributes were threats and/or intimidation, intentional use of physical force, using resources without authorization, unwanted sexual activity, offering low insufficient amount of nutrients for older adults and not meeting older adults’ affective/emotional needs. Consequents were psychological disorders, dependence on aggressors, environment of insecurity and damage/loss of human rights or human dignity.
Final considerations:
the phenomenon under discussion is broad and multifaceted, suggesting expansion of studies related to the theme in order to explore it in detail.
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ORIGINAL ARTICLE12-04-2023
Meanings of nurses’ role in Child and Adolescent Psychosocial Care Centers
Revista Brasileira de Enfermagem. 2023;76(6):e20230124
Abstract
ORIGINAL ARTICLEMeanings of nurses’ role in Child and Adolescent Psychosocial Care Centers
Revista Brasileira de Enfermagem. 2023;76(6):e20230124
DOI 10.1590/0034-7167-2023-0124
Views0See moreABSTRACT
Objective:
to analyze the meaning attributed to nurses’ role in mental health care in Child and Adolescent Psychosocial Care Centers.
Methods:
qualitative research, anchored in the paradigm of complexity. Data collection was carried out through online semi-structured interviews with ten nurses from São Paulo, between March and September 2022, being analyzed thematically.
Results:
the diversity and specificity of a child and adolescent mental health clinic, with the need for expanded, territorial and intersectoral care, were unveiled in addition to a fragmented training in the area. There was a need for a deconstruction of being a nurse to make it possible to produce more inclusive and salutogenic practices.
Final considerations:
the need for training nurses with adequate knowledge and skills to care for the mental health of children, adolescents and their families is reinforced as well as permanent education of working teams.
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12-04-2023
Quantification of blood loss for the diagnosis of postpartum hemorrhage: a systematic review and meta-analysis
Revista Brasileira de Enfermagem. 2023;76(6):e20230070
Abstract
Quantification of blood loss for the diagnosis of postpartum hemorrhage: a systematic review and meta-analysis
Revista Brasileira de Enfermagem. 2023;76(6):e20230070
DOI 10.1590/0034-7167-2023-0070
Views0See moreABSTRACT
Objective:
to compare the effectiveness of different diagnostic methods to estimate postpartum blood volume loss.
Methods:
a systematic review of effectiveness according to PRISMA and JBI Protocol. Searches in PubMed/MEDLINE, LILACS, Scopus, Embase, Web of Science and CINAHL, with descriptor “Postpartum Hemorrhage” associated with keyword “Quantification of Blood Loss”. Tabulated extracted data, presented in metasynthesis and meta-analysis was applied to quantitative data. To assess risk of bias, JBI Appraisal Tools were applied.
Results:
fourteen studies were included, published between 2006 and 2021. Quantification of loss by any method was superior to visual estimation and is highly recommended, however the studies’ high heterogeneity did not allow estimating this association.
Conclusion:
the studies’ high heterogeneity, with a probable margin of error given the uncontrolled factors, indicates the need for further studies, however quantification proved to be effective in relation to visual estimate. PROSPERO registration CRD 42021234486.
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01-01-2015
Health technologies for spatial analysis and situational diagnosis of the territories: contributions to nursing
Revista Brasileira de Enfermagem. 2015;68(6):999-1000
Abstract
Health technologies for spatial analysis and situational diagnosis of the territories: contributions to nursing
Revista Brasileira de Enfermagem. 2015;68(6):999-1000
DOI 10.1590/0034-7167.2015680601i
Views0In order to establish an organizational basis for work processes in primary health care geared towards a new social practice, it is important to recognize territories and their contexts, as these materialize human interactions, conflicts, health problems and human needs.In the process of recognition and situational diagnosis of territories, technologies for spatial analysis can facilitate […]See more -
01-01-2015
Tecnologias em saúde para análise espacial e diagnóstico situacional dos territórios: contribuições para a enfermagem
Revista Brasileira de Enfermagem. 2015;68(6):999-1000
Abstract
Tecnologias em saúde para análise espacial e diagnóstico situacional dos territórios: contribuições para a enfermagem
Revista Brasileira de Enfermagem. 2015;68(6):999-1000
DOI 10.1590/0034-7167.2015680601i
Views0Para a constituição de uma base organizativa dos processos de trabalho na Atenção Primária à Saúde em direção a uma nova prática social é importante o reconhecimento dos territórios e seus contextos, pois estes materializam as interações humanas, os conflitos, os problemas de saúde e necessidades humanas.Nesse processo de reconhecimento e diagnóstico situacional dos territórios, […]See more -
01-01-2015
CARTA DE FORTALEZA PARA A ENFERMAGEM BRASILEIRA
Revista Brasileira de Enfermagem. 2015;68(5):961-962
Abstract
CARTA DE FORTALEZA PARA A ENFERMAGEM BRASILEIRA
Revista Brasileira de Enfermagem. 2015;68(5):961-962
DOI 10.1590/0034-7167.2015680527
Views0APRESENTAÇÃOOs participantes do 18º Seminário Nacional de Pesquisa em Enfermagem (SENPE), promovido pela Associação Brasileira de Enfermagem (ABEn) e realizado pela ABEn Seção Ceará, aprovaram, em Sessão Plenária de Encerramento, no dia 03 de junho de 2015, a “Carta de Fortaleza para a Enfermagem Brasileira”. A ABEn vem a público divulgá-la, ao mesmo tempo em […]See more -
01-01-2015
Delayed surgical recovery: a concept analysis
Revista Brasileira de Enfermagem. 2015;68(5):953-960
Abstract
Delayed surgical recovery: a concept analysis
Revista Brasileira de Enfermagem. 2015;68(5):953-960
DOI 10.1590/0034-7167.2015680526i
Views0See moreABSTRACT
Objective:
analyze the concept of delayed surgical recovery.
Method:
the Rodgers’ concept analysis provided the procedural mechanisms to guide the study, and an integrative review was performed to achieve the second activity of the model adopted. The PubMed, CINAHL, EMBASE and LILACS databases were selected to search for primary studies.
Results:
sixty-six primary studies were included and served as basis to construct the use and meaning of delayed surgical recovery concept. In the analysis, six attributes were outlined, which are interrelated and underpin the research concept definition. Preliminary experience was identified as the antecedent. The consequences of the concept are expressed through clinical manifestations, re-interventions, dependence on care and reduced quality of life.
Conclusion:
the definition of the concept was constructed, and the antecedents and consequents were identified. The use and meaning of the delayed surgical recovery concept point to the use of the qualifier ‘impaired’ instead of ‘delayed’.
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01-01-2015
Total Quality Management and hospital nursing: an integrative literature review
Revista Brasileira de Enfermagem. 2015;68(5):945-952
Abstract
Total Quality Management and hospital nursing: an integrative literature review
Revista Brasileira de Enfermagem. 2015;68(5):945-952
DOI 10.1590/0034-7167.2015680525i
Views0See moreABSTRACT
Objective:
to identify the available evidence in the literature on Total Quality Management in nursing administration.
Method:
integrative literature review of full text articles in Portuguese, English and Spanish, published between 2000 and 2011 in the LILACS, MEDLINE, SciELO and PubMed databases.
Results:
the sample comprises 24 periodical articles grouped by the following thematic categories: Theoretical assumptions; Practical application and Quality indicators. Despite the criticism of models derived from classic administration theories, experiences of success with the deployment of TQM have already marked the health and nursing setting in Brazil.
Conclusion:
Total Quality Management in managing of nursing care has being fully used in some health institutions, while others have adopted several of its principles. Two of the twenty four articles are intervention studies, which characterizes the necessity for clinical research in this area.
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01-01-2015
Association between fatigue and functional capacity in patients with intermittent claudication
Revista Brasileira de Enfermagem. 2015;68(5):937-944
Abstract
Association between fatigue and functional capacity in patients with intermittent claudication
Revista Brasileira de Enfermagem. 2015;68(5):937-944
DOI 10.1590/0034-7167.2015680524i
Views0See moreABSTRACT
Objective:
to characterize fatigue and exertion fatigue in patients with intermittent claudication (IC), and to test their association with sociodemographic and clinical variables, walking capacity and level of physical activity.
Method:
forty-nine participants (66.6 years; 70% male) were studied. Validated questionnaires were used to assess fatigue (DUFS), exertion fatigue (DEFS), level of physical activity (BASIC) and walking capacity (WIQ).
Results:
participants had substantial fatigue (DUFS = 20.4+8.8) and substantial exertion fatigue (DEFS = 20.4+10.8). There was an association between the DUFS and marital status (p = 0,008). There was a statically significant association between DEFS with scores of the BASIC (r = .331; p = .02) and among DEFS with WIQ domains – walking distance (r=.359; p = .011) and climbing stairs (r=.331; p = .02).
Conclusion:
patients with IC have fatigue and exertion fatigue. Exertion fatigue might compromise the engagement of these patients in physical activity, one of the main components of IC treatment.
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01-01-2015
Body mobilization for prevention of pressure ulcers: direct labor costs
Revista Brasileira de Enfermagem. 2015;68(5):930-936
Abstract
Body mobilization for prevention of pressure ulcers: direct labor costs
Revista Brasileira de Enfermagem. 2015;68(5):930-936
DOI 10.1590/0034-7167.2015680523i
Views0See moreABSTRACT
Objective:
to calculate the average total cost (ATC) on the direct labor costs (DLC) of nursing professionals in body mobilization of patients for the prevention of pressure ulcers.
Method:
this is a quantitative, exploratory and, descriptive research. We observed 656 preventive mobilizations and we calculated the cost by multiplying the time spent by professionals at a unitary DLC.
Results:
ATC with DLC for each Unit corresponded to: Medical Clinic R$ 5.38 for bed turning, R$ 5.26 for seating positions, R$ 5.55 for walking aid; Surgical Clinic R$ 2.42 for bed turning, R$ 2.30 for seating positions, R$ 2.96 for walking aid and Intensive Care Unit R$ 8.15 for bed turning, R$ 7.57 for seating positions, R$ 15.32 for walking aid.
Conclusion:
the knowledge generated can support management related to costs of human resources needed to efficiently and effectively nursing care.
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01-01-2015
The mobilization of nurses for the non-interruption of nursing residence
Revista Brasileira de Enfermagem. 2015;68(5):923-929
Abstract
The mobilization of nurses for the non-interruption of nursing residence
Revista Brasileira de Enfermagem. 2015;68(5):923-929
DOI 10.1590/0034-7167.2015680522i
Views0See moreABSTRACT
Objective:
To analyze the strategies employed by nurses to maintain the nursing residence program at the Ophir Loyola Hospital and discuss the potential effects of this interruption on the state of Pará.
Method:
Social-historic research. Data were collected through primary sources, written documents, and oral testimonial; the secondary sources used were manuals and articles that approached the topic in question. The theoretical reference was based on the French sociologist Pierre Bourdieu’s ideas about the concepts of cultural, social, and symbolic capital, in addition to the habitus and field concepts.
Results:
During the nurses’ mobilization there was a strong political influence on the development of the crisis and the interruption of the nursing residence Program at the Ophir Loyola Hospital, with implications for the nurses’ qualifications and the health care delivered to the societyof Pará.
Conclusion:
The analysis showed the prevalence of partisan political interests at the expense of social interests, culminating in the interruption of the nursing residency.
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