-
ORIGINAL ARTICLE12-16-2024
Editorial discourses in the history of Acta Paulista de Enfermagem (1988-2017)
Revista Brasileira de Enfermagem. 2024;77(6):e20230362
Abstract
ORIGINAL ARTICLEEditorial discourses in the history of Acta Paulista de Enfermagem (1988-2017)
Revista Brasileira de Enfermagem. 2024;77(6):e20230362
DOI 10.1590/0034-7167-2023-0362
Views0See moreABSTRACT
Objectives:
to analyze the editorial discourses of Acta Paulista de Enfermagem from 1988 to 2017.
Methods:
qualitative, historical, oral research, with interviews with the journal’s editors. Statements were categorized and presented in three decades, discussed from Foucault’s archaeological perspective.
Results:
seven statements presented three discourses. In the first decade, the discourse of knowledge registration and circulation presented statements of graduate studies and professional recognition. In the second decade, knowledge internationalization was added, with statements of business and editorial panopticism, selection criteria, indexing and digitalization. Finally, the discourse of shifting scientific assessment centrality was added with statements of preprint, open science, exclusive digitalization and mediatization of science.
Final Considerations:
the journal needed to adapt to form its official discourse, which made it possible, over the years, to change its initial peripheral position to a central one within scientific communication, supporting its panoptic role.
-
REVIEW12-16-2024
Strategies for expanding vaccination coverage in children in Brazil: systematic literature review
- Janaina Fonseca Almeida Souza
, - Thales Philipe Rodrigues da Silva ,
- Camila Kümmel Duarte ,
- Anna Luiza de Fatima Pinho Lins Gryschek ,
- Elysângela Dittz Duarte , [ … ],
- Fernanda Penido Matozinhos
Abstract
REVIEWStrategies for expanding vaccination coverage in children in Brazil: systematic literature review
Revista Brasileira de Enfermagem. 2024;77(6):e20230343
DOI 10.1590/0034-7167-2023-0343
- Janaina Fonseca Almeida Souza ,
- Thales Philipe Rodrigues da Silva ,
- Camila Kümmel Duarte ,
- Anna Luiza de Fatima Pinho Lins Gryschek ,
- Elysângela Dittz Duarte ,
- Fernanda Penido Matozinhos
Views1See moreABSTRACT
Objectives:
to identify the strategies found in the literature for increasing vaccination coverage among children in Brazil. It is justified mainly by the current scenario of falling vaccination coverage.
Methods:
systematic literature review. The search was carried out in the Pubmed (MEDLINE), Embase and Scopus databases, following the PRISMA guidelines.
Results:
initially, 4,824 results were returned. In the end, 6 studies were included for narrative synthesis using the SWiM methodology. Of these, 50% dealt with studies related to the Bolsa Família Program (PBF). The others explored strategies for approaching parents directly, Rapid Vaccination Monitoring (MRV) and the Community Health Agents Program (PACS). The PBF did not guarantee compliance with the conditionality of keeping vaccinations up to date. The MRV and PACS are effective strategies, especially because they allow active search for absentees.
Conclusions:
we conclude that more publications are needed on strategies to increase vaccination coverage among children in Brazil.
- Janaina Fonseca Almeida Souza
-
ORIGINAL ARTICLE12-16-2024
Educational technology to empower patients as participants in their care
- Rodrigo da Silva Ramos ,
- Mateus Ferreira de Aguiar ,
- Eurinete Catarina Guimarães da Silva ,
- Cleberson Morais Caetano ,
- Rizioléia Marina Pinheiro Pina , [ … ],
- Hadelândia Milon de Oliveira
Abstract
ORIGINAL ARTICLEEducational technology to empower patients as participants in their care
Revista Brasileira de Enfermagem. 2024;77(6):e20230359
DOI 10.1590/0034-7167-2023-0359
- Rodrigo da Silva Ramos ,
- Mateus Ferreira de Aguiar ,
- Eurinete Catarina Guimarães da Silva ,
- Cleberson Morais Caetano ,
- Rizioléia Marina Pinheiro Pina ,
- Joice Claret Neves ,
- Hadelândia Milon de Oliveira
Views0See moreABSTRACT
Objectives:
to build and validate an educational technology to empower patients as participants in their own care.
Methods:
methodological study to develop an educational technology based on the elaboration, validation, and evaluation that were carried out in five stages at a teaching hospital in Amazonas. The study was carried out from 2019 to 2022, with the participation of 19 judges specialized in patient safety and 72 patients admitted to the hospital’s medical and surgical clinics, the study setting.
Results:
the agreement between the judges obtained an overall index of 0.85, being considered validated. The overall analysis of the booklet obtained an assessment of the level of agreement above 85%.
Final Considerations:
the educational technology presented here was validated and suitable for promoting patient/professional rapprochement and consolidating health care in a way that increases the patient’s ability to contribute to their treatment and prevent the occurrence of adverse events.
- Rodrigo da Silva Ramos
-
ORIGINAL ARTICLE12-13-2024
Educational booklet on labor and delivery: validity study
- Michelle Tatiane Carvalho Gonçalves ,
- Ana Roberta Vilarouca da Silva ,
- Mara Cristina Ribeiro Furlan ,
- Bruna Moretti Luchesi ,
- Tatiana Carvalho Reis Martins
Abstract
ORIGINAL ARTICLEEducational booklet on labor and delivery: validity study
Revista Brasileira de Enfermagem. 2024;77(5):e20240138
DOI 10.1590/0034-7167-2024-0138
- Michelle Tatiane Carvalho Gonçalves ,
- Ana Roberta Vilarouca da Silva ,
- Mara Cristina Ribeiro Furlan ,
- Bruna Moretti Luchesi ,
- Tatiana Carvalho Reis Martins
Views2See moreABSTRACT
Objectives:
to develop and validate an educational booklet on labor and delivery for pregnant women.
Methods:
this methodological study involved constructing and validating a booklet based on Echer’s framework. We used the Content Validity Index and Cronbach’s alpha for content and face validation, selecting judges according to Fering’s criteria. We then conducted a clinical validation with the target population.
Results:
the booklet, developed based on evidence from an integrative review and validated by judges and the target audience, achieved global Content Validity Index of 0.919 and 0.913, respectively. After clinical validation with 22 pregnant women, it included 28 topics and 48 pages, with illustrations by a graphic designer.
Conclusions:
expert judges and the target audience considered this educational technology valid, deeming it a relevant tool for promoting the health of pregnant women.
- Michelle Tatiane Carvalho Gonçalves
-
ORIGINAL ARTICLE12-13-2024
Interobserver agreement in Reception and Risk Stratification in Obstetrics implementation
- Manuela Beatriz Velho ,
- Luciana Santos Pimentel ,
- Fernanda Amâncio Soares da Silva ,
- Alberto Trapani Junior ,
- Thayná Ventura , [ … ],
- Roxana Knobel
Abstract
ORIGINAL ARTICLEInterobserver agreement in Reception and Risk Stratification in Obstetrics implementation
Revista Brasileira de Enfermagem. 2024;77(5):e20230361
DOI 10.1590/0034-7167-2023-0361
- Manuela Beatriz Velho ,
- Luciana Santos Pimentel ,
- Fernanda Amâncio Soares da Silva ,
- Alberto Trapani Junior ,
- Thayná Ventura ,
- Adaiana Fátima Almeida ,
- Roberta Costa ,
- Roxana Knobel
Views0See moreABSTRACT
Objectives:
to analyze interobserver agreement in the Reception and Risk Stratification in Obstetrics protocol implementation.
Methods:
a cross-sectional study carried out during Reception and Risk Stratification in Obstetrics implementation, conducted in a tertiary hospital in southern Brazil with 891 participants in January 2020. Descriptive and interobserver agreement analysis was carried out using the Kappa coefficient in the risk stratification assigned by the triage nurse and reviewed by the researcher.
Results:
around half of the calls (55.6%) were stratified as not very urgent (green), followed by urgent (yellow) (31.8%), very urgent (orange) (9.3%), not urgent (blue) (3.4%) and no emerging stratification (red). Agreement analysis of revised stratification found Kappa values of 0.20 (blue), 0.54 (green), 0.77 (yellow) and 0.80 (orange).
Conclusions:
most appointments were non-urgent. The agreement analysis between the revised and assigned risk stratification revealed greater interobserver agreement as the priority level increased.
- Manuela Beatriz Velho
-
12-13-2024
Training of Brazilian indigenous nurses: between human rights, valuing diversity and inclusion
- Nádile Juliane Costa de Castro ,
- Ezequiel Sakew Wai Wai ,
- Fernanda Teixeira Paes ,
- Nyvia Cristina dos Santos Lima
Abstract
Training of Brazilian indigenous nurses: between human rights, valuing diversity and inclusion
Revista Brasileira de Enfermagem. 2024;77(5):e20230430
DOI 10.1590/0034-7167-2023-0430
- Nádile Juliane Costa de Castro ,
- Ezequiel Sakew Wai Wai ,
- Fernanda Teixeira Paes ,
- Nyvia Cristina dos Santos Lima
Views0See moreABSTRACT
Objectives:
to analyze the possibilities and potential of training indigenous nurses, given the Brazilian Health System (SUS), understanding the relationships between education and health.
Methods:
theoretical-reflective study, based on scientific literature, aligned with the experience, critical thinking of its authors and the Sustainable Development Goals in Brazil.
Results:
this text articulates three axes: Potential for including indigenous students in nursing training; Paths to achieving equity through inclusion and retention policies for indigenous students at different levels; and Implications of this for the SUS and global health.
Final Considerations:
indigenous students, beneficiaries of affirmative actions, face challenges of inclusion and retention in public universities that directly impact their academic training. Added to this are the difficulties identified in basic education, professor training and implementation of permanence policies, with consequences for services and training at other levels.
- Nádile Juliane Costa de Castro
-
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.
-
ORIGINAL ARTICLE12-13-2024
Adaptation and implementation of a Nursing care protocol for children in the Amazon Region
- Aline Lara de Carvalho ,
- Ezequiel Kleber Carpes Menezes ,
- Deisi Cristine Forlin Benedet ,
- Juliane Dias Aldrighi ,
- Hérica de Lara Cardoso , [ … ],
- Marilene Loewen Wall
Abstract
ORIGINAL ARTICLEAdaptation and implementation of a Nursing care protocol for children in the Amazon Region
Revista Brasileira de Enfermagem. 2024;77(5):e20230245
DOI 10.1590/0034-7167-2023-0245
- Aline Lara de Carvalho ,
- Ezequiel Kleber Carpes Menezes ,
- Deisi Cristine Forlin Benedet ,
- Juliane Dias Aldrighi ,
- Hérica de Lara Cardoso ,
- Marcus Vinicius da Rocha Santos da Silva ,
- Tatiane Herreira Trigueiro ,
- Marilene Loewen Wall
Views0See moreABSTRACT
Objectives:
to describe the process of implementing an adapted protocol for pediatric nursing care in a health unit located in a municipality in the Amazon Region.
Methods:
methodological research conducted in a basic health unit with four family health teams in the state of Rondônia, involving seven nursing professionals. Data collection occurred between October 2020 and April 2022, following the research phases: situational diagnosis, exploratory phase, protocol definition, implementation, and evaluation.
Results:
the outcome was the adaptation and implementation of a nursing care protocol for children.
Final Considerations:
the adaptation and implementation process can be an effective approach to improving care, strengthening nursing as a profession with a solid foundation in scientific and clinical evidence. This facilitates early problem identification and appropriate guidance, leading to better health outcomes for children.
- Aline Lara de Carvalho
-
ORIGINAL ARTICLE07-08-2020
No to distance education! Production of meaning of discourses of nursing representative entities
- Marina da Silva Sanes ,
- Franciele Budziareck das Neves ,
- Lenna Eloisa Madureira Pereira ,
- Flávia Regina Souza Ramos ,
- Laura Cavalcanti de Farias Brehmer , [ … ],
- Jussara Gue Martini
Abstract
ORIGINAL ARTICLENo to distance education! Production of meaning of discourses of nursing representative entities
Revista Brasileira de Enfermagem. 2020;73(5):e20190465
DOI 10.1590/0034-7167-2019-0465
- Marina da Silva Sanes ,
- Franciele Budziareck das Neves ,
- Lenna Eloisa Madureira Pereira ,
- Flávia Regina Souza Ramos ,
- Laura Cavalcanti de Farias Brehmer ,
- Mara Ambrosina de Oliveira Vargas ,
- Jussara Gue Martini
Views0See moreABSTRACT
Objectives:
to analyze the processes of production of meanings, based on the positions of Brazilian nursing representative entities, on distance education, considering the implications for nursing as a discipline, profession and work.
Methods:
this documentary research was carried out in sources from the Federal Nursing Council and Associação Brasileira de Enfermagem, from 2015 to 2018. Data were examined from discourse analysis, using paraphrase and polysemy as analytical devices.
Results:
they were organized based on the effects of meanings produced and affiliated to two analytical categories: “Forms of mobilization and operating entities” and “Basis and justifications for the positions”.
Final Considerations:
the discourses signal concern about the future training of new professionals. Resistance, participation, visibility, broad and emphatic debate on the topic are shown as strategies for coping and defending a training process less captured by neoliberal logic, and more relational and committed to the quality of health care.
- Marina da Silva Sanes
-
ORIGINAL ARTICLE07-13-2020
Culture of patient safety in hospital units of gynecology and obstetrics: a cross-sectional study
- Juliana Maria Almeida do Carmo ,
- Isabel Yovana Quispe Mendoza ,
- Vania Regina Goveia ,
- Kleyde Ventura de Souza ,
- Bruna Figueiredo Manzo , [ … ],
- Gilberto de Lima Guimarães
Abstract
ORIGINAL ARTICLECulture of patient safety in hospital units of gynecology and obstetrics: a cross-sectional study
Revista Brasileira de Enfermagem. 2020;73(5):e20190576
DOI 10.1590/0034-7167-2019-0576
- Juliana Maria Almeida do Carmo ,
- Isabel Yovana Quispe Mendoza ,
- Vania Regina Goveia ,
- Kleyde Ventura de Souza ,
- Bruna Figueiredo Manzo ,
- Gilberto de Lima Guimarães
Views0See moreABSTRACT
Objectives:
to assess the patient safety culture of the health team working in three maternity hospitals.
Methods:
observational, cross-sectional, comparative study. 301 professionals participated in the study. The Hospital Survey on Patient Safety Culture questionnaire validated in Brazil was used. For data analysis, it was considered a strong area in the patient safety culture when positive responses reached over 75%; and areas that need improvement when positive responses have reached less than 50%. To compare the results, standard deviation and thumb rule were used.
Results:
of the 12 dimensions of patient safety culture, none obtained a score above 75%, with nine dimensions scoring between 19% and 43% and three dimensions between 55% and 57%.
Conclusions:
no strong dimensions for safety culture were identified in the three maternity hospitals. It is believed that these results may contribute to the development of policies that promote a culture of safety in institutions.
- Juliana Maria Almeida do Carmo
-
REVIEW07-13-2020
The quality of life of family health professionals: a systematic review and meta-synthesis
- Pedro Rogério Camargos Pennisi ,
- Natalia Caroline Alves ,
- Pietra Sanitá Michelin ,
- Lívia Medeiros-Souza ,
- Álex Moreira Herval , [ … ],
- Luiz Renato Paranhos
Abstract
REVIEWThe quality of life of family health professionals: a systematic review and meta-synthesis
Revista Brasileira de Enfermagem. 2020;73(5):e20190645
DOI 10.1590/0034-7167-2019-0645
- Pedro Rogério Camargos Pennisi ,
- Natalia Caroline Alves ,
- Pietra Sanitá Michelin ,
- Lívia Medeiros-Souza ,
- Álex Moreira Herval ,
- Luiz Renato Paranhos
Views1See moreABSTRACT
Objectives:
to perform a systematic review and meta-synthesis of qualitative studies about the work-related quality of life of Family Health Strategy professionals.
Methods:
this systematic review was developed to answer the following PVO question: “Which factors (variables) are associated with the work-related quality of life (outcome) of Family Health Strategy professionals (population)?” The PubMed, Scopus, Embase, SciELO, Web of Science, LILACS, Science Direct, OpenThesis, OpenGrey, and OATD databases were selected. The meta-synthesis analyzed the main codes and secondary codes of all included studies.
Results:
the database search resulted in 1,744 reports; six were considered eligible for the meta-synthesis. Four factors were considered for the quality of work life: working conditions; work processes; interpersonal relationships; and personal aspects.
Conclusions:
although this study confirms the adequacy of aspects commonly related to the quality of work life, other factors are important in the case of FHS professionals, especially work context.
- Pedro Rogério Camargos Pennisi
-
LETTER TO THE EDITOR07-01-2020
Letter to the Editor: doubts and considerations about Coronary Syndrome
Revista Brasileira de Enfermagem. 2020;73(5):e2020730502c
Abstract
LETTER TO THE EDITORLetter to the Editor: doubts and considerations about Coronary Syndrome
Revista Brasileira de Enfermagem. 2020;73(5):e2020730502c
DOI 10.1590/0034-7167.2020730502c
Views0Dear Editor,We wrote this letter referring to the article “Impact of anxiety and depression on morbidity and mortality of patients with coronary syndrome”() to make some comments, in order to clarify doubts that we were missing from answering. We have already made it clear that our intention is not to question the work of the […]See more -
ORIGINAL ARTICLE08-10-2020
Workers’ Health in Brazil: Accidents recorded by Social Security from 2008 to 2014
- Josierton Cruz Bezerra ,
- Luciano José Arantes ,
- Helena Eri Shimizu ,
- Edgar Merchán-Hamann ,
- Walter Massa Ramalho
Abstract
ORIGINAL ARTICLEWorkers’ Health in Brazil: Accidents recorded by Social Security from 2008 to 2014
Revista Brasileira de Enfermagem. 2020;73(6):e20180892
DOI 10.1590/0034-7167-2018-0892
- Josierton Cruz Bezerra ,
- Luciano José Arantes ,
- Helena Eri Shimizu ,
- Edgar Merchán-Hamann ,
- Walter Massa Ramalho
Views0See moreABSTRACT
Objectives:
to analyze the incidence of occupational accidents in Brazil, recorded by Social Security according to the geographic regions, age group, gender and their prevalence according to the causes and branch of economic activity.
Methods:
ecological descriptive study with time series analysis from 2008 to 2014. Data on the beginning and end of the historical series were compared in each ecological unit studied.
Results:
the South and Southeast regions, male, between 20 and 49 years of age presented the highest falls in incidence. 70.87% of the causes occurred in group XIX of ICD-10. The economic activity with the highest prevalence of accidents was the manufacturing industry.
Conclusions:
accidents at work have decreased in Brazil, however, the incidence is still high. Advances need to be made in the recording of accidents and in the prevention and surveillance of workers’ health.
- Josierton Cruz Bezerra
-
ORIGINAL ARTICLE08-10-2020
Neonatal near miss in the intensive care unit
- Maria Rita Guimarães Maia ,
- Rosângela Aparecida Pimenta Ferrari ,
- Alexandrina Aparecida Maciel Cardelli ,
- Ieda Harumi Higarashi ,
- Maria Dalva de Barros Carvalho , [ … ],
- Sandra Marisa Pelloso
Abstract
ORIGINAL ARTICLENeonatal near miss in the intensive care unit
Revista Brasileira de Enfermagem. 2020;73(6):e20180931
DOI 10.1590/0034-7167-2018-0931
- Maria Rita Guimarães Maia ,
- Rosângela Aparecida Pimenta Ferrari ,
- Alexandrina Aparecida Maciel Cardelli ,
- Ieda Harumi Higarashi ,
- Maria Dalva de Barros Carvalho ,
- Sandra Marisa Pelloso
Views0See moreABSTRACT
Objective:
To analyze near miss cases among newborns hospitalized in the Intensive Care Unit.
Methods:
An observational, cross-sectional, retrospective study using the STROBE guideline. Data were collected from 1,101 records of live births (newborns). Statistical analysis used the Epi-Info program 3.3.2 and Chi-square and Fisher’s exact tests.
Results:
A total of 162 newborns were hospitalized, of which 63 had at least one criterion of near miss. The variables that remained associated with neonatal near miss were weight <1.750 g, gestational age <33 weeks and Apgar at 5 minutes <7, pragmatic criteria to identify cases of neonatal near miss morbidity.
Conclusion:
Prematurity and low birth weight were the factors that contributed most to the near miss outcome among newborns hospitalized in intensive care, a rate two and a half times higher than the number of deaths, according to scientific evidence.
- Maria Rita Guimarães Maia
-
08-10-2020
Care for the critical patient undergoing point-of-care testing: integrative review
- Débora Thais Siqueira Soares ,
- Ana Paula Hermann ,
- Maria Ribeiro Lacerda ,
- Marineli Joaquim Méier ,
- Nayla Tamara de Godoi Caceres , [ … ],
- Juliana Zimmermann Lima
Abstract
Care for the critical patient undergoing point-of-care testing: integrative review
Revista Brasileira de Enfermagem. 2020;73(6):e20180948
DOI 10.1590/0034-7167-2018-0948
- Débora Thais Siqueira Soares ,
- Ana Paula Hermann ,
- Maria Ribeiro Lacerda ,
- Marineli Joaquim Méier ,
- Nayla Tamara de Godoi Caceres ,
- Juliana Zimmermann Lima
Views0See moreABSTRACT
Objective:
to identify, based on the evidence, point-of-care testing in bedbound in critically ill patients.
Method:
integrative review, carried out through search in Pubmed, Virtual Health Library, Joanna Briggs Institute, The British Institute of Radiology, Brazilian Radiology, and Google Scholar databases. We used the PICO research strategy and selected articles published from 2013 onwards, which presented information about point-of-care testing.
Results:
the different interventions found in the analysis of the 23 selected articles allowed the thematic grouping of care related to safety in communication, patient identification, care with devices, and the prevention and control of infection, which can be used in point-of-care testing.
Final considerations:
The care described in the evidence provided support for validating a safe care protocol for critically ill patients undergoing imaging studies in bed.
- Débora Thais Siqueira Soares
-
ORIGINAL ARTICLE08-10-2020
Risk management in the scope of nursing professionals in the hospital setting
Revista Brasileira de Enfermagem. 2020;73(6):e20190303
Abstract
ORIGINAL ARTICLERisk management in the scope of nursing professionals in the hospital setting
Revista Brasileira de Enfermagem. 2020;73(6):e20190303
DOI 10.1590/0034-7167-2019-0303
Views1See moreABSTRACT
Objective:
To evaluate occupational hazards affecting nursing professionals’ health in the environment of the hospital.
Method:
Descriptive-exploratory research with a qualitative approach.
Results:
The main hazards affecting nursing professionals were work overload due to the large number of patients or the small number of professionals, inadequate infrastructure, and insufficient organizational management. It became evident the work interferences in the nursing professional’s life are enormous. Despite the existence of health occupational risk management, there is still a shortage of bigger endeavors to be employed in the hospital routine. As a main result of the study, a Standard Operational Protocol (SOP) for biological risk was created to be applied in a hospital setting.
Conclusion:
Based on the identification of occupational hazards, it was suggested the Standard Operational Protocol which should be standardized to manage biological occupational hazards, to ensure the adequate flow of procedures after the exposure, as well as the occupational safety of nursing professionals.
Search
Search in:
Nuvem de Tags
Adolescente (85) Atenção Primária à Saúde (239) COVID-19 (91) Criança (91) Cuidados de Enfermagem (269) Educação em Enfermagem (151) Educação em Saúde (139) Enfermagem (930) Enfermagem Pediátrica (86) Estudantes de Enfermagem (77) Estudos de Validação (131) Família (87) Idoso (208) Promoção da Saúde (99) Qualidade de Vida (104) Saúde do Trabalhador (86) Saúde Mental (145) Saúde Pública (82) Segurança do Paciente (150) Tecnologia Educacional (100)