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01-01-2015
Ineffective airway clearance: accuracy of clinical indicators in asthmatic children
Revista Brasileira de Enfermagem. 2015;68(5):862-868
Abstract
Ineffective airway clearance: accuracy of clinical indicators in asthmatic children
Revista Brasileira de Enfermagem. 2015;68(5):862-868
DOI 10.1590/0034-7167.2015680514i
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Objective:
to analyze the accuracy measurements of clinical indicators of the nursing diagnosis Ineffective airway clearance.
Method:
cross-sectional study with 205 asthmatic children treated in the emergency unit of a hospital in the city of Fortaleza, Ceará. An interview script and pulmonary evaluation were used for data collection.
Results:
the diagnosis of Ineffective airway clearance was present in 89.3% of the sample. The most prevalent clinical indicators were dyspnea, change in respiratory rate, change in respiratory rhythm, orthopnea, adventitious respiratory sounds and ineffective cough. The clinical indicators with highest sensitivity were dyspnea, change in respiratory rate, change in respiratory rhythm, orthopnea and adventitious respiratory sounds. Ineffective cough and adventitious respiratory sounds were the indicators with best specifi city.
Conclusion:
the clinical indicator adventitious respiratory sounds was the best predictor of Ineffective airway clearance in asthmatic children treated in emergency units.
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01-01-2015
Mortality from external causes in Pernambuco, 2001-2003 and 2011-2013
Revista Brasileira de Enfermagem. 2015;68(5):855-861
Abstract
Mortality from external causes in Pernambuco, 2001-2003 and 2011-2013
Revista Brasileira de Enfermagem. 2015;68(5):855-861
DOI 10.1590/0034-7167.2015680513i
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Objective:
to describe the mortality from external causes, by Health Regions in Pernambuco, during the periods of2001-2003 and 2011-2013.
Method:
descriptive study with data from the Mortality Information System. For data analysis we used percentage, percentage variation and proportion ratio.
Results:
mortality from external causes reduced in Pernambuco, however, mortality increased in some health regions of the countryside. Increased numbers of deaths from accidents and event of undetermined intent were registered. There was an increase of deaths classified as “other/unspecified” event of undetermined intent.
Conclusion:
there was a change in the spatial distribution of mortality from external causes moving to Pernambuco countryside regions. We found necessity for data classification regarding deaths from external causes and strengthening of the monitoring.
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01-01-2015
Evaluation of scientific production, patents and human resources training in the Brazilian nursing
Revista Brasileira de Enfermagem. 2015;68(5):846-854
Abstract
Evaluation of scientific production, patents and human resources training in the Brazilian nursing
Revista Brasileira de Enfermagem. 2015;68(5):846-854
DOI 10.1590/0034-7167.2015680512i
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Objective:
to evaluate scientifi c production, patents and human resources training of nursing researchers with scholarships of research productivity (PQ) in National Counsel for Technological and Scientific Development (CNPq) in the 2000-2012 historic series; to verify the association between this production and characteristics of the researchers regarding gender, education and origin.
Methods:
this analytic cross-sectional study whose inclusion criterion was to be a nursing PQ/CNPq researcher during the period in question. We analyzed curriculum lattes of 208 researchers with scholarships between 2000 and 2012. For statistical analyses we used the SPSS® software.
Results:
the study points to female predominance, concentration in the Southeast region and existence of an association between scientific production, patents and human resources training and education, gender and origin of the researcher.
Conclusion:
the study presents a significant participation of nursing PQ/CNPq researchers in scientific production and in human resources training, and a modest involvement in the production of patents.
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01-01-2015
Structure, process and outcomes of organ and tissue donation for transplantation
Revista Brasileira de Enfermagem. 2015;68(5):837-845
Abstract
Structure, process and outcomes of organ and tissue donation for transplantation
Revista Brasileira de Enfermagem. 2015;68(5):837-845
DOI 10.1590/0034-7167.2015680511i
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Objective:
to analyze the factors related to the structure, process and outcomes of organ and tissue donation for transplantation.
Method:
analytic, longitudinal and quantitative study, conducted in six hospitals in Natal/RN, between August 2010 and February 2011, with 65 potential donors (PD), by means of no participant observation structured script.
Results:
regarding the donation structure, there was deficiencies of physical resources (temperature control), materials (mobile radiology) human resources (nurse technicians) and lack of adequate records and care protocols. In the process of donation, the biggest problems were related to the evaluation stages, brain death diagnosis, maintenance and documentation, with greater proportion of care for the non-donor.
Conclusion:
the structure and process possibly determined the result of 72.3% no donation implementation of potential donors, indices compatible with the national data, but contradictory to those of Spain, which manages to transplant organs of 86.7% of its donors.
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01-01-2015
The nurse in the area of collective health: conceptions and competencies
Revista Brasileira de Enfermagem. 2015;68(5):830-836
Abstract
The nurse in the area of collective health: conceptions and competencies
Revista Brasileira de Enfermagem. 2015;68(5):830-836
DOI 10.1590/0034-7167.2015680510i
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Objective:
to learn coordinators and professors’ conceptions from undergraduate Nursing courses of public universities in northern Brazil regarding collective health and to know the necessary competencies to work in the area.
Method:
data were collected through semi-structured interviews and subjected to thematic analysis.
Results:
the participants consider population health as an essential area for the training of nurses, where professionals have autonomy and confidence. It is an interdisciplinary, intersectoral and multidisciplinary field, with extensive scope, that studies the Unified Health System (SUS). The competencies to work in collective health identified were: to work at the SUS, to understand the health and disease process and its determinants and to develop actions towards integrality, to conduct health education, researches and systematization of the nursing care.
Conclusion:
the variety of conceptions about collective health among participants might reflect in training of nurses and their working area.
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01-01-2015
Level of dependence among patients in a surgical unit
Revista Brasileira de Enfermagem. 2015;68(5):824-829
Abstract
Level of dependence among patients in a surgical unit
Revista Brasileira de Enfermagem. 2015;68(5):824-829
DOI 10.1590/0034-7167.2015680509i
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Objective:
to identify the complexity of the nursing care of inpatient surgical unit patients, using the Perroca patients classification scale.
Method:
a descriptive, cross-sectional study with 546 reviews of 187 patients between October and December of 2012. Data were analyzed using SPSS 18.0 and the Kappa test, to measure interrater agreement.
Results:
a predominance of patients in the categories of semi-intensive (46.5%) and intermediate care (44.0%) was found, with a prevalence of unassisted bath (58.4%) in the total sample, and bed bath (69.3%) in the semi-intensive care patients. The level of agreement between two pairs of raters was considered good.
Conclusion:
the systematic application of the instrument was useful as a complementary measure of the level of patient dependence, and may contribute to the improvement of the working process, refl ecting on management decision-making with regard to nursing workload
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01-01-2015
Psychological violence in the nursing work
Revista Brasileira de Enfermagem. 2015;68(5):817-823
Abstract
Psychological violence in the nursing work
Revista Brasileira de Enfermagem. 2015;68(5):817-823
DOI 10.1590/0034-7167.2015680508i
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Objective:
to investigate and characterize psychological violence practices within teams in the relationship between patients, caregivers and other professionals with the nursing staff of the public hospital network of Caxias, in the State of Maranhão, Brazil.
Method:
descriptive, quantitative, cross-sectional study with data collected by form between November/2013-May/2014.
Results:
verbal aggression is the most common psychological violence subtype 95% (84), followed by bullying 27% (24). Emergency rooms 51% (45) are the most frequent place; patients 60% (53) are the main aggressors; nurses 76% (19) suffer more violence, being mostly female, young and inexperienced.
Conclusion:
the largest number of occurrences was of verbal aggression perpetrated by patients against nurses in the emergency room. Workers try to pretend that nothing happened or are inert in the face of violence. Employers do little about the case, referring to the need for strategies to control violence.
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01-01-2015
Dietary intake and stress in patients with acute coronary syndrome
Revista Brasileira de Enfermagem. 2015;68(5):810-816
Abstract
Dietary intake and stress in patients with acute coronary syndrome
Revista Brasileira de Enfermagem. 2015;68(5):810-816
DOI 10.1590/0034-7167.2015680507i
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Objective:
to assess whether dietary intake of patients with acute coronary syndrome (ACS) meets national and international recommendations and whether there is a relationship with the levels of stress.
Method:
a cross-sectional study with 150 patients with ACS, who were interviewed with the Food Frequency Questionnaire and the Perceived Stress Scale-10.
Results:
daily intake above the recommendations: cholesterol (92%), fiber (42.7%) and protein (68%); intake below the recommendations: potassium (88%) and carbohydrates (68.7%); intake according to the recommendations: sodium (53.3%) and lipids (53.3%). Most patients with inadequate dietary intake (54%) were stressed or highly stressed. There was a signifi cant association between a lower stress level and a higher fi ber intake.
Conclusion:
in patients with ACS, dietary intake did not meet the guideline recommendations, and a lower fi ber intake occurs concomitantly with higher stress levels. Educational efforts can support patients in dietary intake adequacy and stress control.
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01-01-2016
Prevalence and factors associated with traffic accidents involving motorcycle taxis
Revista Brasileira de Enfermagem. 2016;69(2):382-388
Abstract
Prevalence and factors associated with traffic accidents involving motorcycle taxis
Revista Brasileira de Enfermagem. 2016;69(2):382-388
DOI 10.1590/0034-7167.2016690223i
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Objective:
to determine the prevalence of motorcycle accidents involving motorcycle taxi drivers and associated factors.
Method:
this is a cross-sectional and exploratory study, with application of questionnaires to motorcycle taxi drivers of 32 regions of Caicó, Rio Grande do Norte, Brazil (N=420).
Results:
motorcycle taxi drivers have a high level of daily working hours (12 hours on average), and it was found that 63.6% were involved in at least one motorcycling accident. The occurence of motorcycling accidents was significantly associated only to level of education (p<0.001), with no significant association with the other variables, such as age (p=0.132), time of service (p=0.744) and working hours (p=0.830).
Conclusion:
it is necessary to implement preventive and educational actions with motorcycle taxi drivers and users of this service concerning accidents and emergency measures, due to constant exposure to accidents during work routine.
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01-01-2016
Characterization of undergraduate nursing courses according to the National Student Performance Exam
Revista Brasileira de Enfermagem. 2016;69(2):375-381
Abstract
Characterization of undergraduate nursing courses according to the National Student Performance Exam
Revista Brasileira de Enfermagem. 2016;69(2):375-381
DOI 10.1590/0034-7167.2016690222i
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Objective:
to characterize undergraduate nursing courses according to Enade (National Student Performance Exam) in 2010 and 2013.
Method:
a quantitative documental study was performed and descriptive statistics was used for data organization and analysis.
Results:
Enade report analysis enabled the identification of a reduction in the total number of institutions providing undergraduate nursing courses that passed the evaluation process. The Southeastern, Northeastern and Southern regions of Brazil included the highest numbers of courses assessed and showed the best results in the two evaluation cycles. Additionally, the courses characterized as “without a ranking” were mainly held at private institutions.
Conclusion:
the results of these evaluation cycles are important to support investigative and intervention processes about and with undergraduate nursing courses.
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01-01-2016
Teaching airway management with laryngeal mask: randomized controlled trial
Revista Brasileira de Enfermagem. 2016;69(2):368-374
Abstract
Teaching airway management with laryngeal mask: randomized controlled trial
Revista Brasileira de Enfermagem. 2016;69(2):368-374
DOI 10.1590/0034-7167.2016690221i
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Objective:
to teach airway management with laryngeal mask to nursing students through dialogic lectures along with laboratory activities or exclusively through simulation class.
Method:
randomized controlled trial. Population: eighth semester bachelor’s degree students. Sample: 17 students randomized in the intervention group (IG: simulation class) or control group (CG: dialogic lecture along with laboratory activities). Elaborated and validated instruments: written test, simulation scenario, objective structured clinical examination (checklist). Data collected from workshop. Structured clinical examination in simulation scenario filmed and evaluated by 3 experts, and written tests were applied.
Results:
24.4±4.2 years old. Right answers percentage: CG: pre-test 66±10%; post-test 84±8%. IG: pre-test 65±5%; post-test 86±11%. Scenario: CG 78±5.2%; IG 84±8.9%.
Conclusion:
strategies allowed the development of knowledge, skills and decision-making, which are essential to achieve the scenario objectives. Knowledge was incorporated in airway management with laryngeal mask, shown by the increase in the scenario and written tests scores.
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01-01-2016
Influence of the São Paulo State innovative models on Brazil’s mental health policy
Revista Brasileira de Enfermagem. 2016;69(2):360-367
Abstract
Influence of the São Paulo State innovative models on Brazil’s mental health policy
Revista Brasileira de Enfermagem. 2016;69(2):360-367
DOI 10.1590/0034-7167.2016690220i
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Objective:
to analyze the influence of two São Paulo State experiences in the choice of psychosocial care centers as guiding service providers for the national mental health policy.
Method:
qualitative, exploratory, and descriptive study using oral history as a methodology and theoretical reference.
Results:
eight professionals involved in the deployment of the mental health policy in the cities of Santos and São Paulo between the years 1989 and 1992 were interviewed. Data were analyzed after treating the narratives and grouping the most significant content. Two central themes emerged: development of the local-regional model, and the model’s influence on the choice of the psychosocial care center.
Conclusion:
due to greater insertion of the Santos experience group in the spheres of the federal government, its influence on the choice of the substitute model was higher in ideological terms, whereas the São Paulo model had its influence restricted for political reasons.
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01-01-2016
Stress and cardiovascular risk: multi-professional intervention in health education
Revista Brasileira de Enfermagem. 2016;69(2):351-359
Abstract
Stress and cardiovascular risk: multi-professional intervention in health education
Revista Brasileira de Enfermagem. 2016;69(2):351-359
DOI 10.1590/0034-7167.2016690219i
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Objective:
to identify cardiovascular risk in educators (administrators and teachers) from the South region of Brazil, evaluated before and after intervention with stress management activities and health education.
Method:
longitudinal study of the before and after type. The sample consisted of 49 participants. Variables studied were socio-demographic, morbidity antecedents and lifestyle habits. Measured risk factors for cardiovascular disease were arterial blood pressure, body mass index, ratio of waist to hip size, lipid profile and capillary blood glucose. Stress levels were evaluated using the Lipp Stress Symptoms Inventory (LSSI). The study ran for four months, with weekly meetings of a multidisciplinary team.
Results:
after intervention, the study observed a statistically significant reduction of the investigated variables, except for blood glucose levels in the administrators group.
Conclusion:
stress management activities are potential tools in the identification and control of the risk factors studied, particularly in those involving multi- and trans-disciplinary focus.
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01-01-2016
Social representations of nursing students about hospital assistance and primary health care
Revista Brasileira de Enfermagem. 2016;69(2):343-350
Abstract
Social representations of nursing students about hospital assistance and primary health care
Revista Brasileira de Enfermagem. 2016;69(2):343-350
DOI 10.1590/0034-7167.2016690218i
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Objective:
To analyze how social representations of hospital and community care are structured in two groups of nursing students – 1st and 4th years.
Method:
Qualitative research oriented by the Theory of Social Representations. We used a questionnaire with Free Association of Words. Data were analyzed in the Software IRaMuTeQ 0.6 alpha 3.
Results:
We applied the method of Descending Hierarchical Classification and obtained four classes. Class 4 has the largest social representation (30.41%) within the corpus. The two organizational axes are nurse and disease/patient in the central core. On the periphery are the care and help related to the nurse and the treatment and prevention associated with the disease.
Conclusion:
Social representations focus on disease/patient and on the role of nurses in the treatment, prevention, and care. Health promotion and the social determinants of health are absent from the social representations of students.
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01-01-2016
Prevalence of medication therapy adherence in the elderly and related factors
Revista Brasileira de Enfermagem. 2016;69(2):335-342
Abstract
Prevalence of medication therapy adherence in the elderly and related factors
Revista Brasileira de Enfermagem. 2016;69(2):335-342
DOI 10.1590/0034-7167.2016690217i
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Objective:
to determine the prevalence of adherence to medication therapy in elderly outpatients; to verify whether there is an association between medication therapy adherence and demographic and socioeconomic factors, health conditions.
Method:
a quantitative, exploratory, descriptive, cross-sectional study, performed in outpatient clinics of a university hospital in Rio Grande do Sul, Brazil. Three data collection instruments were answered by a convenience sample of 107 elders. A descriptive and inferential statistical analysis was conducted.
Results:
the prevalence of adherence was 86.9%. A statistically significant association was identified between the adherence variable and receiving medical guidelines on how to take medications, and having adverse reactions. Conclusion: Nurses must know the prevalence of medication adherence and related factors in order to plan interventions that promote therapeutic success.
Conclusion:
Nurses must know the prevalence of medication adherence and related factors in order to plan interventions that promote therapeutic success.
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01-01-2016
Family farming and human and environmental health conservation
Revista Brasileira de Enfermagem. 2016;69(2):326-334
Abstract
Family farming and human and environmental health conservation
Revista Brasileira de Enfermagem. 2016;69(2):326-334
DOI 10.1590/0034-7167.2016690216i
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Objective:
understand how farmers identify positive and negative impacts of family farming work on the environment and conserve the environmental health.
Method:
a qualitative study with 129 farmers from Ilha dos Marinheiros, Rio Grande, Brazil. Secondary data and recorded interviews were used in this study, with subsequent analysis performed by Bardin and NVivo10, both based on Enrique Leff’s cultural rationality.
Results:
the positive impacts included food production with responsibility, work appreciation, and the correct, minimum or inexistent insertion of agrochemicals. The negative aspects included excessive and incorrect use of agrochemicals and absent farming knowledge.
Conclusion:
environmental conservation consisted in reducing impacts that could have a negative effect on health, while performing work activities.
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01-01-2016
ERRATUM
Revista Brasileira de Enfermagem. 2016;69(1):206-206
Abstract
ERRATUM
Revista Brasileira de Enfermagem. 2016;69(1):206-206
DOI 10.1590/0034-7167.20166901e02
Views0In the article “Conceptions of mid-level nursing professionals facing those with a chemical dependency”, with the number of DOI: 10.1590/0034-7167.2015680610i, published in the journal Revista Brasileira de Enfermagem, v68(6):755-60, page 760 that read:“8. Vargas D, Soares J. Knowledge and attitudes of nurses towards alcohol and related problems: the impact of an educational intervention. Rev Esc […]See more -
01-01-2016
ERRATUM
Revista Brasileira de Enfermagem. 2016;69(1):205-205
Abstract
ERRATUM
Revista Brasileira de Enfermagem. 2016;69(1):205-205
DOI 10.1590/0034-7167.20166901e01
Views0In the article “Using the theory of meaningful learning in nursing education”, with the number of DOI: 10.1590/0034-7167.2015680420i, published in the journal Revista Brasileira de Enfermagem, v68(4):626-35, page 627 that read:“Ausubel was descended from Jewish, born in New York in 1918 and died in 1994 at the age of 75. He thought and wrote until […]See more -
01-01-2016
Nursing process documentation: rationale and methods of analytical study
Revista Brasileira de Enfermagem. 2016;69(1):197-204
Abstract
Nursing process documentation: rationale and methods of analytical study
Revista Brasileira de Enfermagem. 2016;69(1):197-204
DOI 10.1590/0034-7167.2016690126i
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Objective:
to describe the methods used to analyze the associations between variables of service, nursing and the nursing process documentation in institutions of the Department of Health of the State of São Paulo.
Method:
multilevel analytical study with data obtained in the domains of institution, units of the institution and nursing professionals who work there, using standardized instruments. The analyses had as axis the degree of completeness of the nursing process documentation in units or institutions and their association with variables of nursing personnel, of units and of institutions.
Conclusion:
This study will provide important empirical evidence on the factors involved in the nursing process documentation.
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01-01-2016
Qualitative methodologies in health research: interpretive referential of Patricia Benner
Revista Brasileira de Enfermagem. 2016;69(1):192-196
Abstract
Qualitative methodologies in health research: interpretive referential of Patricia Benner
Revista Brasileira de Enfermagem. 2016;69(1):192-196
DOI 10.1590/0034-7167.2016690125i
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Objective:
this article reports on the experience of using the interpretive phenomenological framework of Patricia Benner in a Brazilian context. Benner’s interpretive phenomenology, based on existential and interpretative philosophy, aims to understand human experiences in the particular worlds of research participants. Data were collected through interviews with nine nurses in November and December 2014.
Results:
data analysis process according to Benner’s framework consisted of: transcription, coding, thematic analysis, and search for paradigmatic cases and examples. Therefore, the prior knowledge of the researcher is an important part of the study, consisting in manners of the research conduction.
Conclusion:
The use of this methodological framework entailed a great challenge for the researcher, however, it also enabled a unique opportunity to illuminate important existential phenomena related to the daily lives of research participants.
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01-01-2016
Nurses’ performance on primary care in the National Health Service in England
Revista Brasileira de Enfermagem. 2016;69(1):182-191
Abstract
Nurses’ performance on primary care in the National Health Service in England
Revista Brasileira de Enfermagem. 2016;69(1):182-191
DOI 10.1590/0034-7167.2016690124i
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Objective:
To analyze the expansion of nursing roles in primary care in the English National Health Service and the implications for professional practice.
Method:
qualitative research in case study format, held in London, England, in six primary care units. Data were obtained through interviews with nine nurses. After the thematic data analysis, two units emerged: the nurses’ performance characteristics and effects of the expansion of nursing roles.
Results:
expansion of nurses’ roles: consultation, diagnosis and drug therapy, case management and monitoring of chronic conditions. Repercussions: for the user, there was improved access, communication and comprehensive care, increased duration of consultations, resulting in greater adherence; for nurses, there was the expansion of professional skills, knowledge and professional recognition; to the health care system, it resulted in cost savings.
Conclusion:
benefits in expanding nursing roles, were visible, contributing to primary care quality.
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01-01-2016
Meleis’ Nursing Theories Evaluation: integrative review
Revista Brasileira de Enfermagem. 2016;69(1):174-181
Abstract
Meleis’ Nursing Theories Evaluation: integrative review
Revista Brasileira de Enfermagem. 2016;69(1):174-181
DOI 10.1590/0034-7167.2016690123i
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Objective:
to analyze the application of the theory evaluation model proposed by Meleis in Brazilian studies.
Method:
integrative review of online articles published from 2002 to 2012 in the databases LILACS and BDENF.
Results:
the 16 selected studies confirmed the use of only three of the five stages proposed for Meleis’ theories analysis: Description of the Theory, Criticism of the Theory and Analysis of the Theory, with a predominance of a single unit of analysis in each.
Conclusion:
the analysis of nursing theories provides support to nurses in the practice, research, education and administration of the different dimensions of care. Meleis’ model figures as very important by contributing to the development of knowledge of nursing discipline, considering that its use as a method allows several reflections on theories in order that they be revalidated to support a more theoretical and practical applicability.
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01-01-2016
Clinical indicators of sexual dysfunction in pregnant women: integrative literature review
Revista Brasileira de Enfermagem. 2016;69(1):165-173
Abstract
Clinical indicators of sexual dysfunction in pregnant women: integrative literature review
Revista Brasileira de Enfermagem. 2016;69(1):165-173
DOI 10.1590/0034-7167.2016690122i
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Objective:
to identify the nursing diagnosis clinical indicators of sexual dysfunction in pregnant women.
Method:
it is an integrative literature review, with research in databases using the keywords “sexual*”, “pregnan*” and “function*”. Studies included had an abstract available for analysis, referring to pregnant women over 18 years old, written in Portuguese, French, Spanish and English, with publication date between 2010 and 2014. Studies that reporting pregnant women with an associated pathology were excluded.
Results:
sexual dysfunction in pregnant women is consistent in the literature. Nine defining characteristics were identified and 16 related factors, some not classified in NANDA International.
Conclusion:
clinical indicators can be added to the nursing diagnosis to favor an accurate diagnosis and effective interventions in the surveillance of pregnancy as a period of healthy sexual experience.
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01-01-2016
Conditions of functional health literacy of an elderly diabetics group
Revista Brasileira de Enfermagem. 2016;69(1):156-164
Abstract
Conditions of functional health literacy of an elderly diabetics group
Revista Brasileira de Enfermagem. 2016;69(1):156-164
DOI 10.1590/0034-7167.2016690121i
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Objective:
to evaluate the conditions of functional health literacy of an elderly diabetics group.
Method:
cross-sectional and descriptive study, with diabetic’s elderly assisted in the SUS (N = 114). The social and health conditions were evaluated as well as functional health literacy by S-TOFHLA test (short version); the simple proportions, average, standard deviation and Pearson’s Chi-square were described by SPSS software (20.0) with α = 5% value.
Results:
the mean age was 67.4 years, 74.0% of the elderly were women, had up to four years of schooling; 29.8% had a long-standing illness, 64.0% reported having high blood pressure, 47.4% smoke or were smokers, 73.7% had low functional health literacy, which was associated with schooling p = 0.001.
Conclusions:
the low functional health literacy could be a self-care conditioning and can be influenced by low schooling because it implies to have skills to understand and make decisions aimed at self-management of health.
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