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01-01-2016
Factors associated with inconsistent condom use among people living with HIV/Aids
Revista Brasileira de Enfermagem. 2016;69(1):47-53
Abstract
Factors associated with inconsistent condom use among people living with HIV/Aids
Revista Brasileira de Enfermagem. 2016;69(1):47-53
DOI 10.1590/0034-7167.2016690106i
Views0See moreABSTRACT
Objective:
to analyze the prevalence and factors associated with inconsistent use of condoms among people living with HIV/ Aids (PLWHA).
Method:
it is a cross-sectional study with 228, with individual interviews conducted in 2011. A multivariate analysis was performed with a logistic regression model.
Results:
143 participants met the inclusion criteria, and the prevalence of inconsistent condom use was 28.7%. However, there was greater adherence among men (79.3%). In the multivariate analysis, the independent variable daily use of alcohol (OR=11.02; 95% CI 1.84, 65.92; p = 0.021) was associated with inconsistent condom use. The chance of men making consistent condom use was higher than women (OR = 0.36, 95% CI 0.15, 0.81; p = 0.015).
Conclusion:
the prevalence of inconsistent condom male use among PLWHA was low, however, evidenced greater compliance among men over women with a statistically significant difference and the daily use of alcohol was associated with inconsistent condom use.
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01-01-2016
Influence of sociodemographic and clinical characteristics at the impact of valvular heart disease
Revista Brasileira de Enfermagem. 2016;69(1):40-46
Abstract
Influence of sociodemographic and clinical characteristics at the impact of valvular heart disease
Revista Brasileira de Enfermagem. 2016;69(1):40-46
DOI 10.1590/0034-7167.2016690105i
Views0See moreABSTRACT
Objective:
to analyze the sociodemographic and clinical characteristics of patients with valvular heart disease and to verify the influence of these variables on the impact of valve disease in daily life.
Method:
the study involved 86 outpatients. Data collection was performed in two stages – face-to-face interview for sociodemographic and clinical characterization and through telephone contact for the application of the Instrument to Measure the Impact of Valvular Heart Disease on Patient’s Everyday Life (IDCV). Data were analyzed through descriptive statistics and multiple regression analysis.
Results:
it was noticed that the total score of IDCV and its domains were influenced by age, schooling, presence or absence of symptoms, use or not of diuretic.
Conclusion:
The impact of the disease was influenced by sociodemographic and clinical variables. The results provide subsidies for the design of nursing interventions aimed at reducing the impact of the disease on the patient’s daily life with valve disease.
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01-01-2016
Health indicators of workers of the hospital area
Revista Brasileira de Enfermagem. 2016;69(1):30-39
Abstract
Health indicators of workers of the hospital area
Revista Brasileira de Enfermagem. 2016;69(1):30-39
DOI 10.1590/0034-7167.2016690104i
Views0See moreABSTRACT
Objective:
to analyze the health indicators of workers of hospital area for exposure to workloads, wear processes and its consequences.
Method:
a retrospective, descriptive and exploratory study performed in a hospital in southern Brazil. The population consisted of 1,050 workers notifications of registered in the Monitoring System of Nursing Workers Health, in 2011.
Results:
80.8% of the records were female workers, with 34.2% aged between 31 to 40 years old, corresponding to 2478 working lost days. The results subsidized the implementation of nine indicators that showed the prevalence of respiratory and osteoarticular problems.
Conclusion:
the results allow the reflection and redirection of actions for workers’ health, as the processes of becoming ill are compounded by exposure to psychic burdens. These indicators, when monitored, can contribute to the transformation of the profile of morbidity of these workers.
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01-01-2016
Evaluation of environmentally sustainable actions in the medication process
Revista Brasileira de Enfermagem. 2016;69(1):23-29
Abstract
Evaluation of environmentally sustainable actions in the medication process
Revista Brasileira de Enfermagem. 2016;69(1):23-29
DOI 10.1590/0034-7167.2016690103i
Views0See moreABSTRACT
Objective:
to analyze sustainable actions from an environmental point of view in the medication process, from the reception of the prescription of the pharmacy to waste discard by nursing.
Method:
study before and after performed through Lean Six Sigma methodology. The sample consisted of the amount and type of waste resulting from the pharmacy and nursing services of a medical-surgical clinical unit.
Results:
after the intervention was obtained at the pharmacy a reduction of 74.8% of chemical, infectious and sharps waste, an increase of 33.3% of common recyclable and 20% of common non-recyclable. In nursing, there was a reduction of 22.5% of chemical, infectious and sharps waste, an increase of 22.9% of common recyclable and an increase of 20% of common non-recyclable.
Conclusion:
the practice of sustainable actions in the hospital is possible, contributing to the optimization of resources and waste production with benefits to the institution, environment, and health.
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01-01-2016
Nursing education: training evaluation by graduates, employers and teachers
Revista Brasileira de Enfermagem. 2016;69(1):16-22
Abstract
Nursing education: training evaluation by graduates, employers and teachers
Revista Brasileira de Enfermagem. 2016;69(1):16-22
DOI 10.1590/0034-7167.2016690102i
Views0See moreABSTRACT
Objective:
to support the assessment and the necessary changes in the curriculum of an undergraduate degree in Nursing.
Methods:
it is a descriptive study developed in two stages as an action research. In the first stage, the speeches of 19 graduates and 15 employers were interviewed and analyzed; in the second stage, five teachers participated in the focus group. For processing the data, the content analysis was adopted.
Results:
based on the assessment of the actors, an action plan was created with suggestions regarding the curriculum flexibility, content resizing, continuing education, practice enhancement, active methodologies and autonomy of the student.
Conclusion:
the participation of actors participants of the training process and performance of professional nurses in the evaluation of a curriculum pointed aspects to realignment and provided concrete benefits to improving the quality of undergraduate course curriculum, scenario of this study.
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01-01-2016
The challenge of the 67th Brazilian Conference of Nursing: In what direction is the Brazilian Nursing going?
Revista Brasileira de Enfermagem. 2016;69(1):7-9
Abstract
The challenge of the 67th Brazilian Conference of Nursing: In what direction is the Brazilian Nursing going?
Revista Brasileira de Enfermagem. 2016;69(1):7-9
DOI 10.1590/0034-7167.2016690101i
Views0Bringing together about 3,700 participants among conference participants, speakers, support staff, organizers and exhibitors, the 67th Brazilian Conference of Nursing extraordinary presented São Paulo with deep and meaningful reflections in an attempt to answer the question “In what direction is the Brazilian Nursing going?”.From the submission of the proposal to host the event until its […]See more -
01-01-2016
O desafio do 67º Congresso Brasileiro de Enfermagem: para onde caminha a Enfermagem brasileira?
Revista Brasileira de Enfermagem. 2016;69(1):7-9
Abstract
O desafio do 67º Congresso Brasileiro de Enfermagem: para onde caminha a Enfermagem brasileira?
Revista Brasileira de Enfermagem. 2016;69(1):7-9
DOI 10.1590/0034-7167.2016690101i
Views0Reunindo cerca de 3.700 participantes entre congressistas, palestrantes, equipe de apoio, organizadores e expositores, o 67º Congresso Brasileiro de Enfermagem agraciou São Paulo com reflexões profundas e significativas, na tentativa de dar sua resposta à questão “Para onde caminha a enfermagem brasileira?”.Desde a apresentação da proposta de sediar o evento até sua realização, o que […]See more -
06-01-2015
Anticipated directives and living will for terminal patients: an integrative review
Revista Brasileira de Enfermagem. 2015;68(3):524-534
Abstract
Anticipated directives and living will for terminal patients: an integrative review
Revista Brasileira de Enfermagem. 2015;68(3):524-534
DOI 10.1590/0034-7167.2015680321i
Views0See moreABSTRACT
Objective:
characterizing the national and international scientifi c literature about the advanced directives of living will as applied to the terminally ill patient.
Method:
integrative review considering the articles published in Portal Capes, SciELO, LILACS, MEDLINE, Journal of Bioethics and Bioethikos, with the descriptors: Advanced directives, Wills regarding life and Advance Directives, Living Will and Terminally Ill, totaling 44 articles submitted to content analysis.
Results:
three categories emerged: Students and professionals facing the advance directives of living will: Perceptions, opinions and practices; Patient’s receptivity to the Advance Directives of Living Will; The family facing the advance directives of living will.
Conclusion:
the relevance of the topic became evident as a guarantee of respect for the dignity and autonomy of the patient, as well as to reduce ethical confl icts faced by families and health professionals facing care at the end of life.
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01-01-2016
The experience of grandmothers of children with cancer
Revista Brasileira de Enfermagem. 2016;69(3):559-565
Abstract
The experience of grandmothers of children with cancer
Revista Brasileira de Enfermagem. 2016;69(3):559-565
DOI 10.1590/0034-7167.2016690320i
Views0See moreABSTRACT
Objective:
to understand, from grandmothers’ perspectives, the experience of having a grandchild with cancer.
Method:
qualitative study, guided by philosophical hermeneutics. Eight grandmothers of children who had finished an oncology treatment participated in this study. Data were collected through interviews, which were recorded, transcribed, and analyzed according to the principles of hermeneutics.
Results:
the grandmothers underwent an experience of multiplied, silent, transformative, and permanent suffering. They believe it is their role to be present, but they recognize their adult children’s independence and self-determination. Grandmothers highlighted that their experience has been very little accessed and considered by health care professionals.
Conclusion:
we recommend including grandparents in the context of care and in additional research.
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01-01-2016
Knowledge of healthcare professionals on the evaluation and treatment of neonatal pain
Revista Brasileira de Enfermagem. 2016;69(3):552-558
Abstract
Knowledge of healthcare professionals on the evaluation and treatment of neonatal pain
Revista Brasileira de Enfermagem. 2016;69(3):552-558
DOI 10.1590/0034-7167.2016690319i
Views0See moreABSTRACT
Objective:
to identify knowledge of healthcare professionals on the management, evaluation and treatment of pain in a neonatal unit in a municipality of Rio de Janeiro.
Method:
descriptive, exploratory study with quantitative analysis. Data were analyzed using the software R. Core Team
Results:
of the 96 healthcare professionals who participated in the study, 42 nursing aides/technicians responded, along with 22 nurses, 20 physicians and 2 physical therapists. The results showed that 40.5% of the nursing aides/technicians, 50% of the physicians and 50% of the physical therapists confirmed that they coordinate/perform/assist in the care of babies’ pain while performing procedures (lumbar puncture, chest tube insertion and central line). There was a significant difference of agreement in relation to the nursing aides/technicians and physicians. Most (69.8%) of the healthcare professionals knew of some non-pharmacological measure effective for relief of acute pain.
Conclusion:
there is a need for an educational intervention program, with participation of those involved, in the process to change professional practice.
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01-01-2016
Moments for hand hygiene in Material and Sterilization Center
Revista Brasileira de Enfermagem. 2016;69(3):546-551
Abstract
Moments for hand hygiene in Material and Sterilization Center
Revista Brasileira de Enfermagem. 2016;69(3):546-551
DOI 10.1590/0034-7167.2016690318i
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Objective:
to characterize the moments when there is a need for hand hygiene (HH) by employees who work in Material and Sterilization Center (MSC).
Method:
we conducted a descriptive cross-sectional study in the MSC of a large hospital, from July to November 2012, in Goiânia, state of Goiás, Brazil. Data obtained through observation of workers, following a previously evaluated and tested checklist.
Results:
to the dirty area, standardized moments of HH were enough. In the clean area, “Extra moments with indication” for HH, resulting from the work process, such as: after disinfecting benches, after verification and inventory of consigned products, before assembling boxes/trays, before loading and unloading the autoclave, before handling and distributing health care products, among others, were necessary.
Conclusion:
the moments of HH in the dirty area coincide with indications of the clinical practice; and, in the clean area, characteristic moments of the work process were captured.
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01-01-2016
The experience of family care in transitional support houses
Revista Brasileira de Enfermagem. 2016;69(3):538-545
Abstract
The experience of family care in transitional support houses
Revista Brasileira de Enfermagem. 2016;69(3):538-545
DOI 10.1590/0034-7167.2016690317i
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Objective:
to present the theoretical model that represents the experience of care in transitional homes of support to families of children in a period of post-transplantation of hematopoietic stem cells.
Method:
grounded theory, performed with 18 participants from three different samples. For analysis, we used the QSR Nvivo10 software.
Results:
we elaborated four categories: living in the transitional support home; experiencing care of children in post-transplantation of hematopoietic stem cells; taking care of the family caregiver; and returning to a new life at home, which interrelate according to the theoretical code of the interactive family.
Conclusion:
this research contributes to understanding the experience of care in transitional support homes of families with children in post-transplantation of hematopoietic stem cells and subsidizes nursing and health actions provided to this population; it also contributes to the development of a hospital discharge guidance and care directed to this clientele.
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01-01-2016
Social representations of nurses on tuberculosis
Revista Brasileira de Enfermagem. 2016;69(3):532-537
Abstract
Social representations of nurses on tuberculosis
Revista Brasileira de Enfermagem. 2016;69(3):532-537
DOI 10.1590/0034-7167.2016690316i
Views0See moreABSTRACT
Objective:
to describe the social representation of nurses on tuberculosis and identify the implications on nursing care.
Method:
qualitative research with the participation of 52 nurses from 23 Basic Health Units of Belém, Pará. A semi-structured interview was conducted with subsequent analysis of the thematic content according to the Theory of Social Representations.
Results:
the social representations of tuberculosis were organized into two categories: infection, evidencing the clinical-epidemiological aspects of the disease, and stigma and prejudice, representing the social aspect. Care is affected by fear – a fact that explains the distance adopted by some nurses when handling ill people.
Conclusion:
the social representations of nurses on tuberculosis remain grounded in fear, leading professionals to keep a certain distance from patients and generating stigma and prejudice, which may affect adherence to treatment.
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01-01-2016
Health care for children and adolescents with HIV: a comparison of services
Revista Brasileira de Enfermagem. 2016;69(3):522-531
Abstract
Health care for children and adolescents with HIV: a comparison of services
Revista Brasileira de Enfermagem. 2016;69(3):522-531
DOI 10.1590/0034-7167.2016690315i
Views0See moreABSTRACT
Objective:
compare the quality of different types of health care for children and adolescents with HIV, in the experience of family members and caregivers.
Method:
a cross-sectional study was conducted with 71 family members and caregivers, using the children’s version of the Primary Care Assessment Tool (PCATool-Brazil). The Mann-Whitney or Student’s t-test and Pearson’s chi-square or Fisher’s exact test were used for the analysis.
Results:
primary care services and, predominantly, specialized HIV services, were identified as the regular health care sources. There were no significant differences in quality, since their scores were close to the ideal level.
Conclusion:
the attributes of these services need to be improved, which would entail reformulating their structural and performance aspects. In addition, it is imperative to recognize primary health care as an integral place for promoting the health of children and adolescents with HIV.
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01-01-2016
Nursing care in Specialized HIV/Aids Outpatient Services
Revista Brasileira de Enfermagem. 2016;69(3):515-521
Abstract
Nursing care in Specialized HIV/Aids Outpatient Services
Revista Brasileira de Enfermagem. 2016;69(3):515-521
DOI 10.1590/0034-7167.2016690314i
Views0See moreABSTRACT
Objective:
to analyze the discourses about the care provided by nurses operating in Specialized HIV/Aids Outpatient Services in four public institutions of the city of Fortaleza, Ceará, Brazil.
Method:
descriptive and exploratory study with a qualitative approach, which used as a method the discourse analysis.
Results:
when titling the “care as negative”, such title came from the analogy proposed by Freud (1912) with the photographic negative, represented by what that care can configure from the unconscious movement, since nurses did not perceive themselves in the care actions developed by supporting the work of other occupational categories, contributing to maintain the ideology of biomedicine.
Conclusion:
it is necessary to justify and theorize a nursing clinical practice from epistemological issues of the profession, in such a way that nurses can understand their relevance within the care provided.
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01-01-2016
Notification of health problems among nursing workers in university hospitals
Revista Brasileira de Enfermagem. 2016;69(3):507-514
Abstract
Notification of health problems among nursing workers in university hospitals
Revista Brasileira de Enfermagem. 2016;69(3):507-514
DOI 10.1590/0034-7167.2016690313i
Views0See moreABSTRACT
Objective:
to identify the health problems of nursing workers and describe their consequences.
Method:
an epidemiological, descriptive study with a quantitative approach. The survey was conducted through the Health Monitoring System for Nursing Workers (SIMOSTE) in three university hospitals in São Paulo within a 12-month period.
Results:
a total of 970 records related to health problems were identified; most of these were related to sick leave, occupational accidents with leave, absences, and occupational accidents without leave, with a predominance of musculoskeletal and respiratory system diseases, infectious and parasitic diseases, and nervous system diseases, among others. A total of 4,161 days of work were lost because of the mentioned health problems.
Conclusion:
the results evidence the need to propose preventive strategies to mitigate and reduce health problems in nursing workers.
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01-01-2015
Analysis of the decision-making process of nurse managers: a collective refl ection
Revista Brasileira de Enfermagem. 2015;68(4):668-675
Abstract
Analysis of the decision-making process of nurse managers: a collective refl ection
Revista Brasileira de Enfermagem. 2015;68(4):668-675
DOI 10.1590/0034-7167.2015680414i
Views0See moreABSTRACT
Objective:
to analyze the decision-making model adopted by nurses from the perspective of some decision-making process theories.
Method:
qualitative approach, based on action research. Semi-structured questionnaires and seminars were conducted from April to June 2012 in order to understand the nature of decisions and the decision-making process of nine nurses in position of managers at a public hospital in Southern Brazil. Data were subjected to content analysis.
Results:
data were classified in two categories: the current situation of decision-making, which showed a lack of systematization; the construction and collective decision-making, which emphasizes the need to develop a decision-making model.
Conclusion:
the decision-making model used by nurses is limited because it does not consider two important factors: the limits of human rationality, and the external and internal organizational environments that infl uence and determine right decisions.
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01-01-2015
Social representations of sexuality for the elderly
Revista Brasileira de Enfermagem. 2015;68(4):662-667
Abstract
Social representations of sexuality for the elderly
Revista Brasileira de Enfermagem. 2015;68(4):662-667
DOI 10.1590/0034-7167.2015680413i
Views0See moreABSTRACT
Objective:
to know the social representations of sexuality for the elderly, based on the Social Representation Theory.
Method:
study performed in a Basic Family Health Unit in Maracanau-CE, Brazil, with 30 elderly adults. Data were collected from March through April of 2013, using the free word evocation technique. Data were organized and processed using the EVOC 2000.software
Results:
the subjects evoked 150 words associated with the evocator word “sexuality”. Out of these, 43 were different. At the possible core of the representation of sexuality for the elderly, the following words were found: love, affection and respect. Sex, companionship, understanding and coexistence composed the intermediate elements of representation.
Conclusion:
the performed analyses pointed to love, respect and affection as central elements that structured and organized the social representation of sexuality in the elder years for the group studied.
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01-01-2015
Post-accident work behavior in caring for people with HIV/Aids
Revista Brasileira de Enfermagem. 2015;68(4):656-661
Abstract
Post-accident work behavior in caring for people with HIV/Aids
Revista Brasileira de Enfermagem. 2015;68(4):656-661
DOI 10.1590/0034-7167.2015680412i
Views0See moreABSTRACT
Objective:
To identify post-accident conduct in the workplace by health professionals in caring for people with HIV/Aids.
Method:
A qualitative and descriptive research study with a socio-historical perspective (1986-2006), performed in a reference hospital for infectious diseases in the State of Santa Catarina. To collect data, interviews were conducted with oral history among 23 health workers and, for the treatment of data, Bardin’s content analysis was used.
Results:
Post-accident behaviors emerged that included assessment, accident records, chemoprophylaxis when necessary, support, monitoring of the injured worker, and mainly psychological support.
Conclusion:
In situations in which the accident could not be avoided, post-exposure behaviors were important biosecurity strategies mentioned by health workers caring for patients with HIV/Aids, in the sense of minimizing the possible transmission of the HIV virus.
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01-01-2015
Social support towards the necessity of caring after myocardial infarction
Revista Brasileira de Enfermagem. 2015;68(4):649-655
Abstract
Social support towards the necessity of caring after myocardial infarction
Revista Brasileira de Enfermagem. 2015;68(4):649-655
DOI 10.1590/0034-7167.2015680411i
Views0See moreABSTRACT
Objective:
to know the received or assisted social support by the family towards the necessity of care after acute myocardial infarction.
Method:
qualitative and exploratory research. Data collection was carried out through observation and interviews with six families, from February to May, 2012. Data were also analyzed based on the thematic analysis.
Results:
three categories emerged: Immediate social support; Mediate social support; Late social support.
Conclusion:
social support follows the infarction trajectory, which attains the family members and favors the support according to the needs of care in each lived moments by the patient.
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01-01-2015
Nursing care management for children hospitalized with chronic conditions
Revista Brasileira de Enfermagem. 2015;68(4):641-648
Abstract
Nursing care management for children hospitalized with chronic conditions
Revista Brasileira de Enfermagem. 2015;68(4):641-648
DOI 10.1590/0034-7167.2015680410i
Views0See moreABSTRACT
Objective:
to understand the interactions of nurses managing nursing care for the hospitalized child with a chronic condition.
Method:
Theoretical and methodological references were used, Complex Thought and grounded theory, respectively. In the study 18 subjects have participated arranged in three groups: nurses, nursing technicians and family members. A semi-structured interview was used as technique for data collection. The data analysis followed three stages of coding: open, axial and selective.
Results:
the category “Needing to manage nursing care to the hospitalized child with chronic condition in Pediatric Inpatient Unit” and their subcategories show the complex inter subjective bindings established by nurses that support the practice of nursing care management.
Conclusion:
There are difficulties for nursing professionals to interact with the child’s family and the dialogical order/disorder/interaction/organization in the implementation of the management process of care is.
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01-01-2015
Functional disability and socioeconomic and demographic factors in elderly
Revista Brasileira de Enfermagem. 2015;68(4):633-640
Abstract
Functional disability and socioeconomic and demographic factors in elderly
Revista Brasileira de Enfermagem. 2015;68(4):633-640
DOI 10.1590/0034-7167.2015680409i
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Objective:
to verify the prevalence of functional disability and associated socioeconomic and demographic factors in elderly patients of Campina Grande/PB.
Method:
cross-sectional study with elderly patients of both genders. The variables associated with functional disability were assessed using Poisson regression.
Results:
A total of 420 elderly patients were included (68.1% women). The highest prevalence of functional disability were found among females aged 80 or older, white, widowed, of economic classes D/E , who lived alone, with frequency of contacts of up to 224 people and diversity of contacts of up to 14 people. After multivariate analysis, statistically significant association was observed between functional disability, gender and age group.
Conclusion:
the association between functional disability gender and age group is shown to be an important guidance for health interventions since it will allow health services to plan actions aiming to improve, maintain or restore the functional capacity of the elderly population.
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01-01-2015
Hypertension and Diabetes Mellitus Program evaluation on user’s view
Revista Brasileira de Enfermagem. 2015;68(4):626-632
Abstract
Hypertension and Diabetes Mellitus Program evaluation on user’s view
Revista Brasileira de Enfermagem. 2015;68(4):626-632
DOI 10.1590/0034-7167.2015680408i
Views0See moreABSTRACT
Objectives:
to evaluate the program proposed by the Reorganization Care Plan for Hypertension and Diabetes Mellitus on user’s view, and describe aspects of the trajectory of the participants correlating with the program’s evaluation.
Method:
evaluative study with a qualitative approach conducted in health units with the Family Health Strategy, in a city of the metropolitan region of Curitiba, in the period from September to March, 2012. A total of 30 adults with hypertension and/or Diabetes mellitus were interviewed. Data were analyzed through content analysis.
Results:
Four categories were identified: Disease diagnosis; Reasons for the program need; Knowledge of the program, and program evaluation.
Conclusion:
there was the recognition of the orientations, and the monitoring of activities developed, with emphasis in cost reduction for users.
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01-01-2015
Violence in the eye of adolescents: education intervention with Culture Circles
Revista Brasileira de Enfermagem. 2015;68(4):617-625
Abstract
Violence in the eye of adolescents: education intervention with Culture Circles
Revista Brasileira de Enfermagem. 2015;68(4):617-625
DOI 10.1590/0034-7167.2015680407i
Views0See moreABSTRACT
Objective:
to apply the methodology of Culture Circles on adolescents as a strategy for health education of nurses in the construction of the collective knowledge of the thematic violence.
Method:
action research type and qualitative study. Participants were 11 adolescents from a public school in Recife, PE, Brazil. Data production in Culture Circles included the participant observation with field diary, photographic recording and filming, as well as the photovoice technique. The analysis was performed by triangulating data in dialogue with the literature.
Results:
it was shown that the problematizing action provided by the Culture Circle made possible to create situations in which adolescents felt invited to critically refl ect on the phenomenon of violence in all its complexity.
Conclusion:
the health education intervention, performed by Culture Circles, added learning and mutual growth subsidizing nursing care actions that excel at leadership and autonomy of adolescents.
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