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ORIGINAL ARTICLE03-11-2024
Ethnically distinct populations and coping with violence against children in the COVID-19 pandemic
Revista Brasileira de Enfermagem. 2024;77:e20230350
Abstract
ORIGINAL ARTICLEEthnically distinct populations and coping with violence against children in the COVID-19 pandemic
Revista Brasileira de Enfermagem. 2024;77:e20230350
DOI 10.1590/0034-7167-2023-0350
Views0See moreABSTRACT
Objective:
To identify policies and programs adopted by a Brazilian municipality to address violence against children during the COVID-19 pandemic.
Method:
A qualitative documentary study. The study setting was the municipality of Ananindeua, Pará, Brazil. Data was collected from official websites between November 2021 and February 2022. Thematic content analysis was used with the support of webQDA software.
Results:
Three empirical categories emerged: a) Impacts of the COVID-19 pandemic on violence against children; b) Action strategies for tackling violence against children in the COVID-19 pandemic; c) Evaluation indicators and targets for action strategies for tackling violence against children.
Final considerations:
The documents revealed few direct mentions of children, especially traditional populations; they presented superficial and ineffective evaluations of the policies and programs adopted, using exclusively quantitative indicators.
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ORIGINAL ARTICLE03-11-2024
Experiences of women with physical disabilities in labor and delivery assistance
Revista Brasileira de Enfermagem. 2024;77:e20230290
Abstract
ORIGINAL ARTICLEExperiences of women with physical disabilities in labor and delivery assistance
Revista Brasileira de Enfermagem. 2024;77:e20230290
DOI 10.1590/0034-7167-2023-0290
Views0See moreABSTRACT
Objective:
To understand the meaning attributed by women with physical disabilities to the health care received and expected during labor and delivery.
Methods:
Qualitative study, based on Social Network Theory, conducted through an online workshop in April 2022, with the participation of six women with physical disabilities. Data, collected through the focus group technique, underwent thematic content analysis with the assistance of the IRaMuTeQ tool.
Results:
Three thematic categories emerged: Challenges experienced during pregnancy; The experience within the maternity ward; and, The importance of social networks. The assistance provided by healthcare professionals sometimes differed between what was expected and what was received by women with physical disabilities during labor and delivery.
Final Considerations:
Experiences were predominantly negative, resulting from inappropriate professional conduct due to ableist attitudes. Support from members of social networks is crucial for preventing stressors.
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03-11-2024
O uso da ultrassonografia point-of-care na prática clínica do enfermeiro como alicerce para a segurança do paciente
Revista Brasileira de Enfermagem. 2024;77:e77suppl0201
Abstract
O uso da ultrassonografia point-of-care na prática clínica do enfermeiro como alicerce para a segurança do paciente
Revista Brasileira de Enfermagem. 2024;77:e77suppl0201
DOI 10.1590/0034-7167.202477suppl0201pt
Views0Recentemente, mais um caso de dano grave associado ao cuidado em saúde foi reportado pela mídia. Uma jovem grávida teve a mão e o punho amputados depois de dar à luz ao terceiro filho em um hospital do Rio de Janeiro(). Após o incidente ocasionado pelo acesso vascular, a mulher apresentou hemorragia e foi reinternada.Os […]See more -
REVIEW03-11-2024
Continuing nursing education actions in the face of homophobia: an integrative review
Revista Brasileira de Enfermagem. 2024;77:e20230094
Abstract
REVIEWContinuing nursing education actions in the face of homophobia: an integrative review
Revista Brasileira de Enfermagem. 2024;77:e20230094
DOI 10.1590/0034-7167-2023-0094
Views0See moreABSTRACT
Objectives:
to analyze continuing nursing education actions in the scientific literature in the face of homophobia.
Methods:
an integrative literature review with structured search in June 2022 in eight databases, using the descriptors Nursing Education, Homophobia, Sexual and Gender Minorities. Final sample consisted of six primary studies.
Results:
continuing nursing education actions are supported by strategies such as use of teaching materials, lectures, case studies and focus groups, addressing content such as gender identity issues and affective-sexual orientation, health disparities and their relationship with homophobia in healthcare settings.
Final considerations:
carried out in various healthcare settings, continuing education actions proved to be successful in raising nurses’ awareness in facing homophobia in health services, however, their expansion is necessary to create health spaces that meet the specific needs of these people.
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03-11-2024
The use of point-of-care ultrasound in nurses’ clinical practice as a foundation for patient safety
Revista Brasileira de Enfermagem. 2024;77:e77suppl0201
Abstract
The use of point-of-care ultrasound in nurses’ clinical practice as a foundation for patient safety
Revista Brasileira de Enfermagem. 2024;77:e77suppl0201
DOI 10.1590/0034-7167.202477suppl0201
Views0Recently, another case of serious harm associated with healthcare was reported by the media. A young pregnant woman had her hand and wrist amputated after giving birth to her third child in a hospital in Rio de Janeiro(). After the incident caused by vascular access, the woman suffered hemorrhage and was readmitted.The harm caused to […]See more -
03-08-2024
A enfermagem como protagonista no enfrentamento da hesitação e recusa vacinal
Revista Brasileira de Enfermagem. 2024;77:e77suppl101
Abstract
A enfermagem como protagonista no enfrentamento da hesitação e recusa vacinal
Revista Brasileira de Enfermagem. 2024;77:e77suppl101
DOI 10.1590/0034-7167.202477suppl101pt
Views0Desde a década de 1970, o Ministério da Saúde do Brasil instituiu o Programa Nacional de Imunização (PNI), que precedeu o Sistema Único de Saúde e que lhe foi incorporado e fortalecido, devido ao modelo descentralizado aos municípios, mas de comando único ao nível central. Seu objetivo era e ainda é coordenar as ações de […]See more -
03-08-2024
Nursing as a player in tackling vaccine hesitancy and refusal
Revista Brasileira de Enfermagem. 2024;77:e77suppl101
Abstract
Nursing as a player in tackling vaccine hesitancy and refusal
Revista Brasileira de Enfermagem. 2024;77:e77suppl101
DOI 10.1590/0034-7167.202477suppl101
Views1Since the 1970s, the Brazilian Ministry of Health established the Brazilian National Immunization Program (PNI – Programa Nacional de Imunização), which preceded the Brazilian Health System and which was incorporated and strengthened due to the decentralized model to municipalities, but under single command at central level. Its objective was and still is to coordinate vaccination […]See more -
02-26-2024
Nurse Navigator of Cancer Patients: contributions to the discussion on the national stage
Revista Brasileira de Enfermagem. 2024;77(2):e770201
Abstract
Nurse Navigator of Cancer Patients: contributions to the discussion on the national stage
Revista Brasileira de Enfermagem. 2024;77(2):e770201
DOI 10.1590/0034-7167.2024770201
Views0The professional practice of patient navigation is incipient in Brazil and, therefore, a broad discussion with various sectors of society is essential, which is the main purpose of this editorial. Shall we start with the story.Patient navigation was defined in 1989 as a community-based service delivery intervention aimed at appropriately promoting access to diagnosis and […]See more
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ORIGINAL ARTICLE12-04-2023
Burnout, ethical climate and work organization in covid-19 intensive care units: mixed method study
Revista Brasileira de Enfermagem. 2023;76:e20220684
Abstract
ORIGINAL ARTICLEBurnout, ethical climate and work organization in covid-19 intensive care units: mixed method study
Revista Brasileira de Enfermagem. 2023;76:e20220684
DOI 10.1590/0034-7167-2022-0684
Views0See moreABSTRACT
Objectives:
to analyze the association between burnout and the perception of the ethical climate in nursing professionals in the covid-19 Intensive Care Unit and the relationship with the organization of work from the perspective of managers of these units.
Methods:
mixed method study conducted in three university hospitals in southern Brazil from December 2021 to March 2022. A cross-sectional study was developed with 110 nursing professionals, followed by an exploratory-descriptive study through semi-structured interviews with six managers. Descriptive and analytical statistics and discursive textual analysis were used.
Results:
the prevalence of burnout was 10% and the perception of negative ethical climate was 24.5%. The association between burnout and ethical climate revealed overload and fatigue during working hours, related to tension, fear, and stress that emerged from the consequences of the organization and relations of work in the covid-19 Intensive Care Unit.
Conclusions:
there was an association between burnout and ethical climate and elements of the work organization.
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ERRATUM02-26-2024
ERRATUM
Revista Brasileira de Enfermagem. 2024;77(1):e20160061
Abstract
ERRATUMERRATUM
Revista Brasileira de Enfermagem. 2024;77(1):e20160061
DOI 10.1590/0034-7167.20247701e03
Views2In the article “Nurses in the labor market: professional insertion, competencies and skills”, with DOI number: , published in Revista Brasileira de Enfermagem, 2017;70(6):1220-6, on page 1225:Include before REFERENCES:[…]See more -
ERRATUM06-14-2024
ERRATUM
Revista Brasileira de Enfermagem. 2024;77(2):e2024n2e06
Abstract
ERRATUMERRATUM
Revista Brasileira de Enfermagem. 2024;77(2):e2024n2e06
DOI 10.1590/0034-7167.20247702e06
Views2In the article “Is there scientific relevance to the plot of films and documentaries about eating disorders?”, with DOI number: , published in Revista Brasileira de Enfermagem, 2024;77(1):e20220547, page 7:Where it read:[…]See more -
ORIGINAL ARTICLE07-29-2024
Educational technology for multidisciplinary training for managing waiting lists for elective patients
Revista Brasileira de Enfermagem. 2024;77(3):e20230299
Abstract
ORIGINAL ARTICLEEducational technology for multidisciplinary training for managing waiting lists for elective patients
Revista Brasileira de Enfermagem. 2024;77(3):e20230299
DOI 10.1590/0034-7167-2023-0299
Views1See moreABSTRACT
Objectives:
to construct and assess an educational technology for managing patient waiting lists for multidisciplinary training.
Methods:
study supported by Instructional Design – ADDIE model, whose stages of construction of educational technology were developed in the form of a multi-professional training course. Its respective content assessment was carried out by a committee of experts from 2021 to 2022. The analysis occurred based on the proportion of content adequacy with 95% Confidence Interval.
Results:
seventeen products were created as educational technology learning objects: five storyboards; four videos; three comic books; two pedagogical action plans; a mind map; and a YouTube® playlist. Nine experts assessed content adequacy, which reached 0.89.
Conclusions:
this educational technology contributes to the performance of professionals who manage waiting lists by reducing inequalities, alleviating differences, in addition to promoting equity in care and good health for patients in the Brazilian Health System.
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REVIEW11-22-2024
Spirituality and religiosity in children, adolescents and their families in a vulnerable context: a scoping review
Revista Brasileira de Enfermagem. 2024;77(5):e20230425
Abstract
REVIEWSpirituality and religiosity in children, adolescents and their families in a vulnerable context: a scoping review
Revista Brasileira de Enfermagem. 2024;77(5):e20230425
DOI 10.1590/0034-7167-2023-0425
Views1See moreABSTRACT
Objective:
to map evidence in the literature on the spirituality and religiosity of children, adolescents and their families in social vulnerability.
Methods:
this is a scoping review based on the JBI methodology, with the search without delimiting the time period, in English, Portuguese and Spanish, in the Virtual Health Library, PubMed, Embase, Cochrane Library, Scopus and Web of Science databases.
Results:
twenty-two studies were identified. The most studied population were adolescents, followed by children and their families. Regarding the setting, the context of vulnerability related to the low socioeconomic level experienced by these populations was highlighted. Furthermore, spirituality and religiosity were considered important for coping, social support, purpose and strength.
Conclusion:
there is an influence of spirituality and religiosity in the lives of children, adolescents and families, being a protective factor and a source of comfort, playing essential tools for living in context.
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ORIGINAL ARTICLE12-13-2024
Stress in nursing workers caring for people with COVID-19
Revista Brasileira de Enfermagem. 2024;77(5):e20230542
Abstract
ORIGINAL ARTICLEStress in nursing workers caring for people with COVID-19
Revista Brasileira de Enfermagem. 2024;77(5):e20230542
DOI 10.1590/0034-7167-2023-0542
Views1See moreABSTRACT
Objectives:
to analyze stress from the perspective of nursing workers caring for people with COVID-19 in a public hospital in the Recôncavo region of Bahia.
Methods:
this is an exploratory qualitative study, conducted through semi-structured interviews. The data were analyzed using word clouds, similarity trees, and content analysis.
Results:
nursing workers were exposed to stress while attending to patients with COVID-19. The reported stressors in the workplace included: work overload, lack of planning, speed in performing tasks, fatigue, lack of participation in decision-making, lack of support from management, technological changes, excessive responsibility without preparation, interpersonal conflicts, and professional undervaluation.
Conclusions:
exposure to these stressors leads to emotional exhaustion and demotivation, which were intensified during the COVID-19 pandemic.
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ORIGINAL ARTICLE01-13-2024
Knowledge, Attitudes, and Practices of nurses regarding blood culture collection
Revista Brasileira de Enfermagem. 2024;77(6):e20230424
Abstract
ORIGINAL ARTICLEKnowledge, Attitudes, and Practices of nurses regarding blood culture collection
Revista Brasileira de Enfermagem. 2024;77(6):e20230424
DOI 10.1590/0034-7167-2023-0424
Views2See moreABSTRACT
Objectives:
to investigate the knowledge, attitudes, and practices of nurses regarding blood culture collection.
Methods:
a cross-sectional study was conducted in five Brazilian public hospitals with 112 nurses. Data were collected using an adapted questionnaire and analyzed through descriptive and inferential statistics.
Results:
nurses who did not consider themselves capable of collecting blood cultures had a 72% lower chance of performing the collection at the recommended site and an 83% lower chance of using the same needle for blood inoculation into the vials. Nurses working in the emergency department had a 75% lower chance of knowing the international benchmark for blood culture contamination rates, and those with less than 5 years in the position decreased their chance of accuracy in this matter by 79%.
Conclusions:
there are gaps in the knowledge, attitudes, and practices of nurses regarding blood culture collection. Standardization of the technique, periodic education, supervision and guidance of the collection team, and process auditing are recommended coping strategies.
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ORIGINAL ARTICLE01-10-2024
Inventory of ethical problems in mobile pre-hospital care
Revista Brasileira de Enfermagem. 2024;77:e20230539
Abstract
ORIGINAL ARTICLEInventory of ethical problems in mobile pre-hospital care
Revista Brasileira de Enfermagem. 2024;77:e20230539
DOI 10.1590/0034-7167-2023-0539
Views1See moreABSTRACT
Objective:
to construct and validate the content of an inventory of ethical problems experienced by nurses in mobile pre-hospital care.
Method:
a psychometric approach study, developed with the following stages: (1) instrument construction through a theoretical matrix based on deliberative bioethics, scoping review and online qualitative research; (2) content validity by judges; (3) pre-testing with Mobile Emergency Care Service nurses in various Brazilian states. For content validity analysis, the Content Validity Ratio was calculated (CVR>0.45 for judges and CVR>0.35 for the target population).
Results:
the instrument had 44 items, distributed across four dimensions.
Final considerations:
the constructed instrument presented sources of evidence of content validity, providing good psychometric measurements and constituting a useful tool for nurses’ practice in the pre-hospital setting.
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ORIGINAL ARTICLE09-21-2020
The care provided by the family to the premature newborn: analysis under Leininger’s Transcultural Theory
Revista Brasileira de Enfermagem. 2020;73:e20190644
Abstract
ORIGINAL ARTICLEThe care provided by the family to the premature newborn: analysis under Leininger’s Transcultural Theory
Revista Brasileira de Enfermagem. 2020;73:e20190644
DOI 10.1590/0034-7167-2019-0644
Views0See moreABSTRACT
Objective:
To analyze the care practices of family members of premature infants admitted to a Neonatal Intensive Care Unit in the light of Leininger’s transcultural theory.
Methods:
Qualitative, descriptive and exploratory study. Participant observation and semi-structured interviews were conducted with 16 family members of newborns, admitted to the neonatal unit of a public maternity hospital, during the months of May and June 2019. The software called Interface de R pour analyses Multidimensionnelles de Textes et de Questionnaire® and the Bardin Content Analysis technique.
Results:
Two thematic categories emerged: Family care in the neonatal unit; (in)effective support for shared care.
Conclusion:
The participation of families in the care of babies is still unstable, but it must be an inseparable element of culturally congruent care, thus collaborating with the full recovery of the premature.
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ORIGINAL ARTICLE02-10-2020
Common mental disorders in nursing technicians of a university hospital
Revista Brasileira de Enfermagem. 2020;73(1):e20180513
Abstract
ORIGINAL ARTICLECommon mental disorders in nursing technicians of a university hospital
Revista Brasileira de Enfermagem. 2020;73(1):e20180513
DOI 10.1590/0034-7167-2018-0513
Views0See moreABSTRACT
Objective:
To verify the prevalence of common mental disorders and associated factors in nursing technicians.
Method:
Cross-sectional analytical study conducted at a university hospital. A questionnaire with sociodemographic, educational and work-related variables and the Self Reporting Questionnaire-20 were used to verify the presence of common mental disorders. Association analysis was performed using the chi-squared test, with a significance level of 5%.
Results:
280 nursing technicians participated in the study. The prevalence of common mental disorders was 46.9%. The variables family income (p=0.021) and working exclusively in health area (p<0.001) were associated with the outcome. There was a higher prevalence of CMD among individuals with a family income below four minimum wages (PR=1.41) and among professionals who worked exclusively in the health area (PR=1.95).
Conclusion:
Approximately half of the nursing technicians of the university hospital presented common mental disorders, which were associated with economic and work-related variables.
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REFLECTION10-19-2020
Contributions of Florence Nightingale as a social entrepreneur: from modern to contemporary nursing
Revista Brasileira de Enfermagem. 2020;73:e20200064
Abstract
REFLECTIONContributions of Florence Nightingale as a social entrepreneur: from modern to contemporary nursing
Revista Brasileira de Enfermagem. 2020;73:e20200064
DOI 10.1590/0034-7167-2020-0064
Views0See moreABSTRACT
Objective:
To reflect on the transformations of modern and contemporary nursing as well as on Florence Nightingale’s social entrepreneurship.
Method:
This is a logical-reflective exhibition, with an emphasis on the theoretical assumptions of social entrepreneurship and the legacy of Florence Nightingale, from modern to contemporary nursing, based on readings of texts extracted from electronic databases, especially periodicals, books and theses.
Results:
The logical-reflective exhibition focuses on two fundamental aspects: 1) Florence Nightingale’s legacy as a social entrepreneur; 2) The evolution of Brazilian nursing: from modernity to contemporaneity.
Final considerations:
Florence Nightingale’s legacy is undeniable with regard to the evolution of modern and contemporary nursing and transcends different areas of knowledge. In addition to being a precursor to modern nursing, it is distinguished by its visionary attitude, humanitarian social value and potential for transforming the paths and realities present in the Contemporary Era.
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ORIGINAL ARTICLE06-27-2019
Assessment of feedback for the teaching of nursing practice
Revista Brasileira de Enfermagem. 2019;72(3):663-670
Abstract
ORIGINAL ARTICLEAssessment of feedback for the teaching of nursing practice
Revista Brasileira de Enfermagem. 2019;72(3):663-670
DOI 10.1590/0034-7167-2018-0539
Views0See moreABSTRACT
Objective:
to analyze the self-reported knowledge of professors in the use of feedback in the teaching of nursing practice; train professors to use this process; and evaluate the results of this training.
Method:
a qualitative study of research-action type. The focus group technique was used with seven collaborators of a nursing technical school. For content analysis, the Bardin framework was used and, for intervention, the Problematization Methodology supported by Pendleton’s Rules.
Results:
most present in their curricula training to teach. It is pointed out that feedback is a simple and essential assessment tool, although universal discourse does not express the exact dimension of feedback potentialities. The intervention was effective to solidify feedback.
Final Consideration:
this study shows that feedback should be disseminated and consolidated among the teaching staff of nursing technical education.
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ORIGINAL ARTICLE05-03-2021
Nursing care for patient in postoperatory heart surgery in the Intensive Care Unit
Revista Brasileira de Enfermagem. 2021;74(2):e20200163
Abstract
ORIGINAL ARTICLENursing care for patient in postoperatory heart surgery in the Intensive Care Unit
Revista Brasileira de Enfermagem. 2021;74(2):e20200163
DOI 10.1590/0034-7167-2020-0163
Views0See moreABSTRACT
Objective:
To investigate the critical nodes related to nursing care for patients in the postoperative period of cardiac surgery.
Methods:
Exploratory study with a qualitative approach. Data collected through semi-structured interviews with 27 members of the nursing team working in the Intensive Care Unit. Material submitted to thematic analysis.
Results:
Three categories emerged: Flaws in the professional qualification for patient care in the postoperative period of cardiac surgery; Team challenges concerning specific patient care in the postoperative period of cardiac surgery; and (dis) organization of work in the Intensive Care Unit and its impact on nursing care for patients in the postoperative period of cardiac surgery.
Final considerations:
Given the identification of the critical nodes, the professionals presented suggestions to overcome daily difficulties: investments in strategies for Permanent Education in Health; creation of tools to guide patient assistance in the postoperative of cardiac surgery; and provision of adequate human resources.
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ORIGINAL ARTICLE12-13-2019
Factors associated with low Apgar in newborns in birth center
Revista Brasileira de Enfermagem. 2019;72:297-304
Abstract
ORIGINAL ARTICLEFactors associated with low Apgar in newborns in birth center
Revista Brasileira de Enfermagem. 2019;72:297-304
DOI 10.1590/0034-7167-2018-0924
Views1See moreABSTRACT
Objective:
to analyze factors associated with Apgar of 5 minutes less than 7 of newborns of women selected for care at the Center for Normal Birth (ANC).
Method:
a descriptive cross-sectional study with data from 9,135 newborns collected between July 2001 and December 2012. The analysis used absolute and relative frequency frequencies and bivariate analysis using Pearson’s chi-square test or the exact Fisher.
Results:
fifty-three newborns (0.6%) had Apgar less than 7 in the 5th minute. The multivariate analysis found a positive association between low Apgar and gestational age less than 37 weeks, gestational pathologies and intercurrences in labor. The presence of the companion was a protective factor.
Conclusion:
the Normal Birth Center is a viable option for newborns of low risk women as long as the protocol for screening low-risk women is followed.
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REVIEW09-06-2022
Biosafety measures to prevent COVID-19 in healthcare professionals: an integrative review
Revista Brasileira de Enfermagem. 2022;75(1):e20201191
Abstract
REVIEWBiosafety measures to prevent COVID-19 in healthcare professionals: an integrative review
Revista Brasileira de Enfermagem. 2022;75(1):e20201191
DOI 10.1590/0034-7167-2020-1191
Views0See moreABSTRACT
Objective:
to identify the main biosafety measures for preventing COVID-19 in healthcare professionals.
Methods:
this is an integrative literature review, with studies published between January and July 2020, on the MEDLINE/PubMed, Scopus, Embase, Web of Science, LILACS, SciELo, Wiley Online Library, Cochrane CINAHL databases. The selection of studies followed the PRISMA recommendations.
Results:
among the 2,208 publications identified, 12 studies comprised the sample, which enabled the analysis in four thematic categories: The importance of using recommendations about the use of personal protective equipment; The restructuring of new operational and clinical routines and flows in the practice of services; Monitoring professionals, especially testing; Conducting training.
Conclusions:
the phenomena involved are innumerable, covering operational management and the training of teams to deal with highly infectious pathogens and disease outbreaks.
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ORIGINAL ARTICLE09-21-2020
Adolescents in situations of poverty: resilience and vulnerabilities to sexually transmitted infections
Revista Brasileira de Enfermagem. 2020;73:e20190242
Abstract
ORIGINAL ARTICLEAdolescents in situations of poverty: resilience and vulnerabilities to sexually transmitted infections
Revista Brasileira de Enfermagem. 2020;73:e20190242
DOI 10.1590/0034-7167-2019-0242
Views0See moreABSTRACT
Objective:
To analyze the association between vulnerabilities to Sexually Transmitted Infections (STIs/HIV/AIDS) of adolescents in poverty and their level of resilience.
Method:
Cross-sectional study with 287 students between 11 and 17 years old in a school in the outskirts of Fortaleza-Ce. The study was conducted from August to October 2016. Three instruments related to characterization, vulnerability to STIs/HIV/AIDS and resilience were used. The association between the instruments was calculated using the Mann-Whitney and Kruskal-Wallis tests. Association between vulnerability to STIs/HIV/AIDS and resilience was assessed through the Spearman’s correlation coefficient. Statistical significance was set at p<0.05.
Results:
There was a significant association between the factors “housing” (p=0.022), “family income” (p=0.037) and vulnerability to STIs/HIV/AIDS. Adolescents whose father has completed high school (p=0.043) have moderately high resilience.
Conclusion:
Adolescents with low socioeconomic status and who live on less than a minimum wage tends to be more susceptible to vulnerabilities to STIs/HIV/AIDS and to have low resilience.
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