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01-01-2016
Nasal colonization with Staphylococcus aureus in nursing students: ground for monitoring
Revista Brasileira de Enfermagem. 2016;69(6):1046-1051
Abstract
Nasal colonization with Staphylococcus aureus in nursing students: ground for monitoring
Revista Brasileira de Enfermagem. 2016;69(6):1046-1051
DOI 10.1590/0034-7167-2016-0210
Views0See moreABSTRACT
Objective:
to monitor bacterial strains of Staphylococcus aureus that are resistant or not to oxacillin in nursing undergraduate students, with an emphasis on the process of colonization.
Method:
cross-sectional prevalence study carried out with 138 nursing students. The biological samples of the nasal cavity were collected in June 2015, by means of sterile swabs, which were subsequently submitted to confirmatory tests of catalase and coagulase. Isolated Staphylococcus aureus had their sensitivity profile determined by means of the Kirby Bauer method. Descriptive, univariate and bivariate analyses were performed.
Results:
the prevalence of Staphylococcus aureus was 21.7. Regarding the resistance profile, 24.1% of strains were resistant to oxacillin, with ampicillin being the antimicrobial with the greatest resistance (82.8%).
Conclusion:
the nasal cavity is an important bacterial flora of S. aureus in nursing students. The profile of isolated strains highlights the increase of Staphylococcus aureus resistance to antimicrobials such as oxacillin.
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01-01-2016
Factors associated with the occurrence of adverse events in critical elderly patients
Revista Brasileira de Enfermagem. 2016;69(6):1039-1045
Abstract
Factors associated with the occurrence of adverse events in critical elderly patients
Revista Brasileira de Enfermagem. 2016;69(6):1039-1045
DOI 10.1590/0034-7167-2016-0199
Views0See moreABSTRACT
Objective:
to identify the factors associated with the occurrence of adverse events in critical elderly patients admitted to intensive care unit according to demographic and clinical characteristics.
Method:
a retrospective cohort study was conducted in nine units of a teaching hospital. Data were collected from medical records and from monitoring of nursing shift change. We used the t-test/Mann-Whitney, chi-square and logistic regression to test associations. Significance level of 5% was used.
Results:
out of the 315 elderly, 94 experienced events. Those who experienced events were men (60.6%) with mean age of 70.7 years, length of hospital stay of 10.6 days and survivors (61.7%). Most of the 183 events were clinical processes and procedures (37.1%). There was an association between adverse event and length of hospital stay in the unit (p=0.000; OR=1.10, 95% CI [1.06, 1.14]).
Conclusion:
the identification of associated events and factors in the elderly subsidize the prevention of these occurrences before the vulnerability of this age group.
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01-01-2016
Challenges to implementation of advance directives of will in hospital practice
Revista Brasileira de Enfermagem. 2016;69(6):1031-1038
Abstract
Challenges to implementation of advance directives of will in hospital practice
Revista Brasileira de Enfermagem. 2016;69(6):1031-1038
DOI 10.1590/0034-7167-2016-0085
Views0See moreABSTRACT
Objective:
to understand the difficulties and limitations in the implementation of advance directives of will in the hospital context.
Method:
qualitative, exploratory and descriptive study conducted by means of semi-structured interviews with nurses, resident physicians and family caregivers. The data were analyzed by using discursive textual analysis based on the framework of bioethics principles.
Results:
the following categories emerged: Terminality as an expression of loss and cure as an option for care; concerns about legal implications; advance directives of will demand patient autonomy and proper communication.
Conclusion:
limitations and difficulties in practice of advance directives of will from the perspective of the participants show, apart from countless conflicts and dilemmas regarding end-of life matters, that impending death experiences obstruct patients’ wishes.
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01-01-2016
Experience and coping strategies in relatives of addicts
Revista Brasileira de Enfermagem. 2016;69(6):1024-1030
Abstract
Experience and coping strategies in relatives of addicts
Revista Brasileira de Enfermagem. 2016;69(6):1024-1030
DOI 10.1590/0034-7167-2015-0044
Views0See moreABSTRACT
Objective:
to understand the experience and coping strategies in relatives of drug addicts.
Method:
a study was developed with 87 relatives of addicts, registered in two Basic Health Units. The focus group was used as the study method, and content analysis was applied.
Results:
four categories were chosen: perception of relatives about the drug addiction of their family members; feelings and attitudes related to being a relative of an addict; difficulties found in the process; and, coping strategies. The findings reflected the difficulty when mentioning the subject, and the need of being cared for. Relatives believed that the addict needs to have the will to get into treatment, and they faced challenges in dealing with sporadic disappearances. They pointed to feelings of pity, impotence, disgust, hate, shame, fear of aggressiveness, and humiliation.
Conclusion:
the biggest difficulties were dealing with relapses, and the lack of public resources. Religiosity and faith, isolation and advice were used as coping strategies; ambivalence in thoughts and attitudes was demonstrated.
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01-01-2016
Leadership and cooperation: 25 years of mission as a WHO collaborating center
Revista Brasileira de Enfermagem. 2016;69(6):1017-1023
Abstract
Leadership and cooperation: 25 years of mission as a WHO collaborating center
Revista Brasileira de Enfermagem. 2016;69(6):1017-1023
DOI 10.1590/0034-7167-2016-0058
Views0See moreABSTRACT
Objective:
analyse the evolution in the mission and vision of a World Health Organization Collaborating Centre in Nursing in Brazil in the context of the implementation of its terms of reference.
Method:
Historical-social documentary research with a qualitative approach.
Results:
During the 25 years of its activities as a Collaborating Centre, its mission to “promote and stimulate the development of nursing research in the region, with a focus on Latin America” triggered activities in the context of its terms of reference in four areas: Human Resource Formation for Research, Knowledge Production, Knowledge Dissemination, Encouragement of Exchange and Stimulus of Partnerships.
Conclusion:
The activities developed were consolidated through the strengthening of Brazilian and international partnerships, further stimulated by the five redesignations of the Collaborating Centre in the period analysed. Thus, its vision of becoming leader and driving agent of innovations in the academic, care and political context of nursing could be put in practice.
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01-01-2016
ABEn 90 years and the Brazilian Journal of Nursing
Revista Brasileira de Enfermagem. 2016;69(6):1011-1012
Abstract
ABEn 90 years and the Brazilian Journal of Nursing
Revista Brasileira de Enfermagem. 2016;69(6):1011-1012
Views0In this special edition, we celebrate 90 years of the Brazilian Nursing Association (ABEn), at the same time in which we celebrate the creation and maintenance of the first scientific nursing journal in Brazil. Emerging in 1932, it has shone a light on the production of knowledge and the constitution of nursing in Brazil today.As […]See more -
01-01-2016
ABEn 90 anos e a Revista Brasileira de Enfermagem
Revista Brasileira de Enfermagem. 2016;69(6):1011-1012
Abstract
ABEn 90 anos e a Revista Brasileira de Enfermagem
Revista Brasileira de Enfermagem. 2016;69(6):1011-1012
Views0Neste número temático, celebramos os 90 anos da Associação Brasileira de Enfermagem (ABEn), ao mesmo tempo em que comemoramos a criação e manutenção da primeira revista científica de enfermagem do Brasil, que, desde 1932, despontou trazendo luz para a produção do conhecimento e a constituição do que é a enfermagem no Brasil atual.A ABEn, como […]See more -
01-01-2016
ERRATUM
Revista Brasileira de Enfermagem. 2016;69(5):1003-1003
Abstract
ERRATUM
Revista Brasileira de Enfermagem. 2016;69(5):1003-1003
DOI 10.1590/0034-7167.20166905e02
Views1Article “Association between self-care and hospital readmissions of patients with heart failure”, with number of DOI: 10.1590/0034-7167.2016690312i, published in the journal Revista Brasileira de Enfermagem, v69(3):469-74, page 469 that read:“Amanda Chlalup LinnI, Karina AzollinII,III, Emiliane Nogueira de SouzaII,IV“.[…]See more
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01-01-2016
Avaliação do risco de úlceras por pressão em pacientes hospitalizados com HIV/Aids
Revista Brasileira de Enfermagem. 2016;69(1):96-101
Abstract
Avaliação do risco de úlceras por pressão em pacientes hospitalizados com HIV/Aids
Revista Brasileira de Enfermagem. 2016;69(1):96-101
DOI 10.1590/0034-7167.2016690113i
Views0See moreRESUMEN
Objetivo:
evaluar el riesgo de desarrollar úlceras por presión en pacientes hospitalizados con VIH/SIDA.
Método:
estudio cuantitativo descriptivo con 35 pacientes. Caracterización epidemiológica y clínica de los pacientes en un instrumento mediante la Escala de Braden. Las variables se realizaron en forma descriptiva simple, por números absolutos.
Resultados:
la incidencia de la PU observada en 2 pacientes, y las comorbilidades fueron neumocistosis pneumocisti carinii y tuberculosis pulmonar. Se reveló que la subescala de fricción y fuerza de deslizamiento obtuvo una puntuación más baja, seguido por actividad y la nutrición, la movilidad y la humedad. La percepción sensorial obtuvo la puntuación más alta. Dos pacientes fueron clasificados como de “alto riesgo” a 6 de “alto riesgo”, 3 para “bajo riesgo” y el otro “ningún riesgo”.
Conclusión:
la calificación de riesgo, mediante el uso de escalas proporciona información objetiva para la toma de decisione de enfermería a un modo específico.
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01-01-2016
Assessment of the risk of pressure ulcer development among hospitalized HIV/Aids patients
Revista Brasileira de Enfermagem. 2016;69(1):96-101
Abstract
Assessment of the risk of pressure ulcer development among hospitalized HIV/Aids patients
Revista Brasileira de Enfermagem. 2016;69(1):96-101
DOI 10.1590/0034-7167.2016690113i
Views0See moreABSTRACT
Objective:
to assess the risk of pressure ulcer development among hospitalized HIV/Aids.
Metod:
study quantitative descriptive with 35 patients admitted to an infectious diseases hospital in Curitiba-PR-BR. Characterized clinical and epidemiological of patients using a data collection instrument and the Braden Scale. Data was compiled using Excel® and a simple descriptive analysis.
Results:
two patients were found to have pressure ulcers and the most common comorbidities associated with HIV/Aids were pneumocystis pneumonia, caused by pneumocisti cariini (16), and pulmonary tuberculosis (13). The lowest scores were obtained in the friction and shear subscale, followed by the activity, nutrition, mobility and moisture subscales. The highest score was obtained in the sensory perception subscale. Two patients were classified as ‘very high risk’, six as ‘high risk’, three as ‘low risk’, and the rest as ‘no risk’.
Conclusion:
risk assessment using scales provides objective information to assist with systemized and targeted nursing decision-making.
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01-01-2016
Children with special health needs and family: implications for Nursing
Revista Brasileira de Enfermagem. 2016;69(1):88-95
Abstract
Children with special health needs and family: implications for Nursing
Revista Brasileira de Enfermagem. 2016;69(1):88-95
DOI 10.1590/0034-7167.2016690112i
Views0See moreABSTRACT
Objective:
to understand the family experience of children and adolescents with myelomeningocele by the discovery of chronic illness and their daily life in the realization of needed care to these people.
Method:
qualitative study, developed from October 2013 to February 2014, with family, in a pediatric hospital in Fortaleza. Data were collected through interviews and checked by analysis thematic category.
Results:
it was found that the diagnosis after the birth of the child caused fear and anguish to the families in front of the unknown and the unexpected and that over the years they started to deal with many challenges conducting the daily care due to the disease sequelae.
Conclusion:
nursing plays an important role in the lives of families, children and adolescents, through emotional support, guidelines and care inserted in the health care network.
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01-01-2016
Evaluation of the care program implementation to people with high blood pressure
Revista Brasileira de Enfermagem. 2016;69(1):79-87
Abstract
Evaluation of the care program implementation to people with high blood pressure
Revista Brasileira de Enfermagem. 2016;69(1):79-87
DOI 10.1590/0034-7167.2016690111i
Views0See moreABSTRACT
Objective:
to evaluate the implementation of the care program for people with hypertension in Maringá-PR.
Method:
it is an evaluative research of cross-sectional design. Data were collected through structured interviews with 63 nurses between April and June 2013.
Results:
as missing or insufficient, there were: transportation for outside activities; work equipment; educational materials; training resources; inclusion of the family in the care plan; risk classification of individuals; determination of therapy from the risk classification and referral of the patient to medical and/or specialized tests.
Conclusion:
in addition to qualifying structure, there are: the need to identify people with hypertension as risk factors, perform risk stratification and systematic care planning, establishing an advanced clinical practice, such as support for self-care and management cases, accomplish with existing protocols and develop collective actions based on information systems.
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01-01-2016
Evaluation of quality of life of visually impaired
Revista Brasileira de Enfermagem. 2016;69(1):72-78
Abstract
Evaluation of quality of life of visually impaired
Revista Brasileira de Enfermagem. 2016;69(1):72-78
DOI 10.1590/0034-7167.2016690110i
Views0See moreABSTRACT
Objective:
to evaluate the quality of life of visually impaired using WHOQOL-100.
Method:
exploratory, descriptive, and quantitative study, performed between April and May 2013 with 20 visually impaired of the Blind Association of Ceará, through interviews.
Results:
the analysis showed that males predominated (80%), 41-55 years (40%), students (50%) and personal income than the minimum wage (70%). Participants were self-rated with good quality of life (68.75%). The facets with the highest rates were personal relationships (74.06%), sexual activity (66.88%) and spirituality/religion/personal beliefs (65%). With lower rates were financial (43.44%), physical environment: pollution/noise/traffic/climate (46.88%), physical security and protection (37.19%), transport (35.63%) and medication or treatment dependency (8.25%).
Conclusion:
these results reflect the importance of the nurse to perform health education actions promoting the empowerment, autonomy and guaranteed of access in society for this clientele.
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01-01-2016
Coping strategies for oncology nurses in high complexity
Revista Brasileira de Enfermagem. 2016;69(1):67-71
Abstract
Coping strategies for oncology nurses in high complexity
Revista Brasileira de Enfermagem. 2016;69(1):67-71
DOI 10.1590/0034-7167.2016690109i
Views0See moreABSTRACT
Objective:
to identify the coping strategies of oncology services of nurses in highly complex hospital care before the person with cancer.
Method:
it is a qualitative research, with 18 nurses in inpatient oncology units and/or outpatient chemotherapy in two cities in southern Brazil, sampled by a snowball and carrying out semi-structured interviews. Data were submitted to thematic analysis.
Results:
three categories emerged that show strategies such as denial and resignation in care, for support in the health team and the plurality and multiplicity of perspectives on the care, including the patient and his family and the search for personal and professional improvement.
Conclusion:
coping strategies are expressed in the cultural understanding of what it means to have cancer or not and management of health institutions for nurses to work with satisfaction. The service in education is a major factor in the development of ethical competence.
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01-01-2016
Implementation of fast tests for syphilis and HIV in prenatal care in Fortaleza – Ceará
Revista Brasileira de Enfermagem. 2016;69(1):62-66
Abstract
Implementation of fast tests for syphilis and HIV in prenatal care in Fortaleza – Ceará
Revista Brasileira de Enfermagem. 2016;69(1):62-66
DOI 10.1590/0034-7167.2016690108i
Views0See moreABSTRACT
Objective:
to describe the implementation of the Fast Test (FT) of syphilis and HIV in prenatal care in primary healthcare units in Fortaleza, Ceará.
Method:
a descriptive study with a quantitative approach. There were training supervisions carried out in 24 units between May and August 2014, and the inclusion criterion was to have at least one trained professional.
Results:
the physical space, the availability, validity and the performance of FT in prenatal were analyzed. The data were presented in simple frequency tables. It was identified adequate space in 79.2% of the units, availability of FT in 62.5%, performing the tests in 37.5%, and of these, 55.6% doing these procedures in routine prenatal care.
Conclusion:
the primary units have difficulties in implementing FT in syphilis and HIV in the prenatal routine. This activity is seen as an effective strategy to reduce vertical transmission of these infections.
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01-01-2016
Evaluating child care in the Family Health Strategy
Revista Brasileira de Enfermagem. 2016;69(1):54-61
Abstract
Evaluating child care in the Family Health Strategy
Revista Brasileira de Enfermagem. 2016;69(1):54-61
DOI 10.1590/0034-7167.2016690107i
Views0See moreABSTRACT
Objective:
to evaluate the healthcare provided to children under two years old by the Family Health Strategy.
Method:
evaluative, quantitative, cross-sectional study that used the Primary Care Assessment Tool – Child Version for measuring the access, longitudinality, coordination, integrality, family orientation and community orientation.
Results:
a total of 586 adults responsible for children under two years old and linked to 33 health units in eleven municipalities of the state of Minas Gerais, Brazil, were interviewed. The evaluation was positive for the attributes longitudinality and coordination, and negative for access, integrality, Family orientation and community orientation.
Conclusion:
there are discrepancies between health needs of children and what is offered by the service; organizational barriers to access; absence of counter-reference; predominance of curative and long-standing and individual preventive practices; verticalization in organization of actions; and lack of good communication between professionals and users.
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01-01-2015
Critical incidents in nursing academics: discovering a new identity
Revista Brasileira de Enfermagem. 2015;68(2):219-227
Abstract
Critical incidents in nursing academics: discovering a new identity
Revista Brasileira de Enfermagem. 2015;68(2):219-227
DOI 10.1590/0034-7167.2015680206i
Views0See moreABSTRACT
Objective:
a qualitative study that followed the principles of the grounded theory in order to analyze the professional identity of nursing academics through the analysis of the most disturbing critical incidents.
Method:
semi-structured interviews were conducted with seven nurses who worked as professors and researchers in a private university in Barcelona.
Results:
the resulting empirical material was organized into two categories: characterization of critical incidents and responsiveness to the incident.
Conclusion:
the professional identity of nurses regarding the academic area is still under construction and inexperience is the major obstacle in the management of critical incidents in the teaching career.
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01-01-2015
Body mass index, waist circumference, and arterial hypertension in students
Revista Brasileira de Enfermagem. 2015;68(2):214-218
Abstract
Body mass index, waist circumference, and arterial hypertension in students
Revista Brasileira de Enfermagem. 2015;68(2):214-218
DOI 10.1590/0034-7167.2015680205i
Views0See moreABSTRACT
Objective:
to investigate what is the best anthropometric predictor of arterial hypertension among private school students.
Method:
this was a cross-sectional study with 286 students between the ages of 10 and 14 from two private schools in the city of Paranavaí, Paraná, Brazil. The following variables were analyzed: body mass index, waist circumference and blood pressure. Statistical analysis was conducted with Pearson’s partial correlation test and multivariate logistic regression, with p<0.05.
Results:
both anthropometric indicators displayed weak correlation with systolic and diastolic levels, with coeffi cients (r) ranging from 0.27 to 0.36 (p < 0.001). Multivariate analysis showed that the only anthropometric indicator associated with arterial hypertension was waist circumference (OR= 2.3; 95% CI: 1.1-4.5), regardless of age or gender.
Conclusion:
this age group, waist circumference appeared to be a better predictor for arterial hypertension than body mass index.
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01-01-2015
Perception of primary healthcare management nurses on the nursing process
Revista Brasileira de Enfermagem. 2015;68(2):206-213
Abstract
Perception of primary healthcare management nurses on the nursing process
Revista Brasileira de Enfermagem. 2015;68(2):206-213
DOI 10.1590/0034-7167.2015680204i
Views0See moreABSTRACT
Objective:
this qualitative study aimed to analyze the perceptions of primary health care management nurses on the nursing process.
Method:
data were collected through interviews and analyzed by the Content Analysis proposed by Bardin’s theoretical framework.
Results:
managers recognize the importance of the nursing process, although its implementation was not a priority at the time of the interviews. A conceptual diffi culty and a lack of understanding that the implementation of the care methodology should be a cross-departmental action in the local healthcare management were clearly observed.
Conclusion:
managers should have their perspectives broadened concerning the relevance of the nursing process and the professional training. The active participation of legislative nursing bodies, local healthcare management and the federal government may open the way for the effective implementation of the nursing process.
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01-01-2015
Cross-cultural cultural adaptation of the “Nursing Students’ Attitudes Toward Mental Health Nursing and Consumers” in Brazil
Revista Brasileira de Enfermagem. 2015;68(2):198-205
Abstract
Cross-cultural cultural adaptation of the “Nursing Students’ Attitudes Toward Mental Health Nursing and Consumers” in Brazil
Revista Brasileira de Enfermagem. 2015;68(2):198-205
DOI 10.1590/0034-7167.2015680203i
Views0See moreABSTRACT
Objective:
to make across-cultural adaptation of the “Nursing Students’ Attitudes Toward Mental Health Nursing and Consumers” scale in Brazil.
Method:
the scale was tested regarding conceptual, item, semantic, and operational equivalence.
Results:
content validation was conducted by an expert committee with a minimum consensus level of 80%. This process resulted in a 35-item scale divided into 6 factors. The experts reached 100% consensus on the scale’s clarity of language, practical pertinence and theoretical relevance, as well as on the need for excluding one factor. Data were collected in 2013 in the city of Londrina, Paraná, Brazil.
Conclusion:
the instrument was cross-culturally adapted to Brazilian Portuguese and presented satisfactory content validity. We propose further studies on the scale’s psychometric properties, such as construct validity, internal consistency and reliability.
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01-01-2015
Relational skills and preserving patient privacy in the caring process
Revista Brasileira de Enfermagem. 2015;68(2):191-197
Abstract
Relational skills and preserving patient privacy in the caring process
Revista Brasileira de Enfermagem. 2015;68(2):191-197
DOI 10.1590/0034-7167.2015680202i
Views0See moreABSTRACT
Objective:
to analyze the development and mobilization of relational skills central to the caring process among nursing students throughout their professional training.
Method:
this was a quantitative study, descriptive and cross-sectional in design. The sample consisted of nursing undergraduate students from the Higher School of Health Sciences, in the city of Évora, Portugal. Data were collected using the previously validated Helping Relational Skills Inventory.
Results:
the students gradually acquired “generic skills”, “communication skills” and “contact skills”, presenting the highest mean score in the last year of the program. However, the highest mean score for the “empathetic skills” subscale was presented by second-year students.
Conclusion:
age and year in program were found to be decisive variables regarding the acquisition of specifi c skills (empathetic and communication) by nursing students.
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01-01-2015
The Brazilian Association of Nursing in the uncompromising defense of the Brazilian Unified Health System
Revista Brasileira de Enfermagem. 2015;68(2):185-186
Abstract
The Brazilian Association of Nursing in the uncompromising defense of the Brazilian Unified Health System
Revista Brasileira de Enfermagem. 2015;68(2):185-186
DOI 10.1590/0034-7167.2015680201i
Views0The title of the 2015 Editor’s Comments could very well be from a journal published in decades past, a time when, in Brazil, all professional entities and civil society fought for the right to health, as was later established in the Brazilian Constitution of 1988. Twenty-five years later, despite its financial limitations and restricted operational […]See more -
01-01-2015
A ABEn na defesa intransigente do SUS
Revista Brasileira de Enfermagem. 2015;68(2):185-186
Abstract
A ABEn na defesa intransigente do SUS
Revista Brasileira de Enfermagem. 2015;68(2):185-186
DOI 10.1590/0034-7167.2015680201i
Views0Este título do Editorial de 2015 bem poderia ser de uma revista publicada em décadas passadas, período em que todas as entidades profissionais e a sociedade civil lutaram pela saúde como direito, como conquistado na Constituição de 1988. Vinte e cinco anos depois, com o Sistema Único de Saúde capilarizado por todo o país, mesmo […]See more -
EXPERIENCE REPORT01-01-2015
Nursing diagnoses and interventions for a child after cardiac surgery in an intensive care unit
Revista Brasileira de Enfermagem. 2015;68(1):155-160
Abstract
EXPERIENCE REPORTNursing diagnoses and interventions for a child after cardiac surgery in an intensive care unit
Revista Brasileira de Enfermagem. 2015;68(1):155-160
DOI 10.1590/0034-7167.2015680121i
Views0See moreObjetivo:
descrever o julgamento clínico de enfermagem para identificar diagnósticos NANDA e desenvolver um plano de tratamento NIC para uma criança em pós-operatório de cirurgia cardíaca em terapia intensiva.
Método:
estudo de caso com coleta de dados retrospectiva no prontuário.
Resultados:
três enfermeiras identificaram diagnósticos NANDA e intervenções NIC. Criança de 6 meses, submetida a cirurgia cardíaca, necessitou oxigenação extracorpórea por membrana no pós-operatório. Foram identificados quatro principais diagnósticos, aos quais foram direcionadas dez intervenções. A proposta de intervenções para responder às necessidades humanas prioritárias da criança foi otimizada pelo uso das terminologias padronizadas. Todos os diagnósticos foram sustentados por indicadores diagnósticos; todas as intervenções foram cientificamente sustentadas.
Conclusão:
espera-se que os enfermeiros abordem não somente as respostas fisiológicas, mas também aquelas dos domínios psicossociais.
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